Training activity information
Details
Analyse, interpret and draft a clinical report for rapid testing for urgent treatment decisions for AML to include:
- FLT3
- IDH1/2
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to analysing, interpreting, and drafting a rapid clinical report for urgent treatment decisions in AML, specifically for targets like FLT3 and IDH1/2.
- Consider how the learning outcomes apply, specifically in relation to evaluating the urgency of findings and ensuring the report is rapidly generated.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the clinical significance of FLT3 and IDH1/2 mutations in influencing initial urgent treatment decisions.
What is your prior experience of this activity?
- Think about what you already know about urgent testing pathways and rapid reporting. Think about why rapid testing of your chosen targets are required in AML. is this based on specific practice/clinical guidelines?
- Consider possible challenges you might face during the activity, such as working accurately under urgent timelines, the pressure of quickly assessing data quality, or interpreting FLT3 Internal Tandem Duplications (ITDs) accurately.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example, if the analytical data quality is compromised under urgent timelines or if the FLT3 ITD allele burden is critical and requires immediate verification.
- Acknowledge how you feel about the high-stakes environment of rapid molecular reporting for acute cancer treatment.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as rapidly assessing molecular data quality and ensuring the report terminology is concise and clinically actionable.
- Identify the specific insights you hope to gain into the practicalities, analytical interpretation, and reporting requirements for rapid, clinically critical tests like FLT3 and IDH1/2.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of working under time constraints or reporting critical clinical data.
- Identify important information you need to consider before embarking on the activity, such as the specific turnaround time expectations for urgent testing and reviewing how findings like FLT3 ITD allele burden or IDH1/2 mutations impact initial treatment decisions.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst analysing the rapid test results for FLT3 and/or IDH1/2 under urgent time pressure?
- Are you encountering situations such as:
- Borderline or equivocal results that complicate assessment of relevance for urgent treatment?
- Procedural issues or delays unexpectedly arising during the rapid testing workflow?
- Pressure to report quickly leading to a risk of overlooking subtle but critical findings?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to prioritising steps by focusing solely on critical findings when time constraints are severe?
- Consider the steps you are taking in the moment, such as:
- Immediately prioritising a review of critical findings to maintain accuracy under time pressure
- Considering alternative ways to communicate preliminary findings if an unexpected delay prevents timely final report release
- How are you feeling in that moment? For instance, are you finding it difficult to double-check critical findings under immense time pressure? Is it affecting your confidence in providing timely and clinically relevant information for urgent treatment decisions?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully prioritising speed and accuracy when assessing IDH1/2 variants and their urgent relevance? Or are you needing support because urgent, critical results or technical issues under time constraints require senior technical or clinical review?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the necessary workflow adaptations required to maintain accuracy when reporting urgent molecular markers (e.g., FLT3)?
On action
What happened?
- Begin by summarising the key steps you took when analysing, interpreting, and drafting a clinical report for rapid testing. Which urgent assays (FLT3, IDH1/2) did you analyse and interpret?
- Consider specific events, actions, or interactions which felt important, such as how the need for rapid results influenced the analysis and reporting process, and what challenges you faced when interpreting these specific mutations and drafting the clinical report quickly, including IQC/EQA.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately addressing unexpected findings or pressures encountered due to the urgency.
- How did you feel during this experience, e.g., did you feel focused on providing rapid, accurate results or challenged by the urgency and pressure to report critical information quickly?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding urgent AML testing. What strengths did you demonstrate, e.g., improved ability to analyse and interpret results for urgent AML mutations like FLT3 and IDH1/2?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific clinical significance of these mutations and their direct impact on immediate treatment decisions?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in interpreting the associated IQC data within a rapid timeframe to ensure confidence in the reported result?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding managing unexpected findings or pressures encountered due to the urgency, and how you reacted to this. How does providing rapid, accurate results for these specific mutations contribute critically to patient care in acute leukaemia?
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to specific aspects of FLT3 or IDH1/2 testing, interpretation, or rapid reporting that require further study or practice.
- What will you do differently next time you approach urgent testing pathways, for instance, by proactively taking actions to enhance your efficiency and accuracy in analysing and reporting urgent results?
- Do you need to practise any aspect of the activity further, such as reviewing rapid assay protocols, clinical guidelines on mutation significance, or engaging in discussions with clinicians for continued development in urgent leukaemia testing?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of rapid testing for urgent treatment decisions (FLT3, IDH1/2) since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent urgent case requiring immediate calculation of FLT3 ITD allele burden under extreme time pressure forced you to re-evaluate the efficiency of your quality checks you applied during your first attempt at this training activity?
- Considering what you understand about urgent reporting and analysis now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your analysis and reporting workflow for urgent cases based on further learning and experiences? For example, how you proactively implemented a standardised template for urgent reporting to ensure all critical findings (e.g., VAF) are communicated clearly and immediately?
- Has discussing urgent cases where rapid results impacted treatment decisions or the pressure associated with time-sensitive reporting with a clinician changed how you now view your initial experience in this training activity? For example, how professional storytelling with a clinician about a rapid result being delivered but failing to include critical prognostic information refined your understanding of the critical nature of combining speed with comprehensive clinical relevance in urgent reports?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences, contributed to your overall confidence and ability in performing rapid testing and reporting under pressure, particularly in preparing for assessments where you might need to notify other healthcare professionals of authorised results?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to urgent testing and reporting? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately if technical data quality is compromised during a rapid run, recognising this could invalidate the urgent treatment decision?
- Looking holistically at your training journey, how has this initial urgent testing experience, revisited with your current perspective, contributed to your development in effective analysis and timely communication for acute patient management?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Analyse, interpret and prepare interpretive reports for common haematological malignancies, including results for somatic variants, kinase domain mutations, measurable residual disease and post-transplant monitoring. |
| # 5 |
Outcome
Interpret the associated IQC and EQA of the laboratory tests for investigation of haematological malignancies. |
| # 6 |
Outcome
Practice with the relevant specialities for the diagnosis, monitoring and management of haematological malignancies. |