Training activity information
Details
Select laboratory molecular assays for patients referred for haematological malignancies investigation, to include:
- CML
- AML
- MPN
- MDS
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 selecting the appropriate molecular assays for patients referred for haematological malignancies (CML, AML, MPN, and MDS).
- Consider how the learning outcomes apply, specifically in relation to selecting relevant testing strategies and evaluating urgency based on clinical and initial laboratory findings.
- Discuss with your training officer to gain clarity of what is expected of you in relation to identifying the specific molecular assays indicated for diagnosis, classification, monitoring, or management of these conditions.
What is your prior experience of this activity?
- Think about what you already know about selecting laboratory tests, including the application of molecular techniques such as PCR, FISH, and NGS.
- Consider possible challenges you might face during the activity, such as limited sample material, a complex clinical picture, or the availability of specialised tests.
- 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 clinical picture or sample viability requires deviation from standard molecular testing protocols.
- Acknowledge how you feel about making critical decisions regarding molecular assay selection for cancer diagnosis.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as matching molecular techniques (e.g., NGS) to the requirements for diagnosing, classifying, or monitoring specific haematological malignancies.
- Identify the specific insights you hope to gain into the criteria and considerations for selecting the most appropriate molecular test(s) for CML, AML, MPN, and MDS referrals.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of evaluating different testing technologies (e.g., sensitivity, specificity).
- Identify important information you need to consider before embarking on the activity, such as consulting local guidelines related to the molecular investigation of CML, AML, MPN, or MDS, and reviewing specific clinical details from the referral.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing patient information and selecting appropriate molecular assays?
- Are you encountering situations such as:
- Limited sample availability requiring immediate compromise on the size or scope of the assay panel?
- A complex referral information where the clinical question (diagnosis, monitoring, risk stratification) is ambiguous, challenging the selection of assays?
- Unexpected urgency criteria requiring immediate selection of a rapid, targeted assay over a comprehensive panel?
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 assays when faced with limited sample material or conflicting clinical questions?
- Consider the steps you are taking in the moment, such as:
- Immediately reviewing the urgency criteria and focusing on rapid, targeted assays (if appropriate) to meet time constraints
- Considering alternative or additional assays if the standard panel seems insufficient for the specific AML or MPN case
- How are you feeling in that moment? For instance, are you finding it difficult to weigh resource constraints against diagnostic completeness? Is it affecting your confidence in ensuring the patient receives the most relevant tests?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying criteria like urgency or specific gene panels to make the selection? Or are you needing support because the case requires assays outside of the routine panel or deviation from the standard selection protocol?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into how sample viability critically restricts molecular testing choices for specific haematological malignancies like MDS?
On action
What happened?
- Begin by summarising the key steps you took when selecting molecular assays for the specific haematological malignancies (CML, AML, MPN, MDS).
- Consider specific events, actions, or interactions which felt important, such as how you used information (e.g., clinical details, previous assay results) to inform your selection, and the specific molecular assays you selected and the reasons for choosing them over others.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, considering factors in the moment during the selection process when facing limited sample availability or conflicting information.
- How did you feel during this experience, e.g., did you feel focused on correlating clinical and haematological findings with the required molecular genetic analysis or challenged by instances where selecting the appropriate assays was difficult?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the appropriate molecular assays for investigating CML, AML, MPN, and MDS. What strengths did you demonstrate, e.g., improved understanding of correlating clinical and haematological findings with the required molecular genetic analysis?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with selecting the correct tests for specific molecular assays or types of haematological malignancies?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying your learning about assay selection and urgency evaluation in future cases?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding challenging instances of selecting appropriate assays, and how you reacted to this. How does selecting the correct molecular assays contribute to efficient and accurate diagnosis and management in your future practice?
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 molecular assays or types of haematological malignancies that require further study.
- What will you do differently next time you approach assay selection, for instance, by proactively taking actions to stay updated on current molecular testing strategies for haematological malignancies?
- Do you need to practise any aspect of the activity further, such as reviewing internal protocols, guidelines, or consultations to refine your assay selection skills?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of selecting laboratory molecular assays since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case requiring rapid, targeted NGS over standard FISH analysis due to extreme urgency forced you to re-evaluate the efficiency of your evaluation of testing urgency you applied during your first attempt at this training activity?
- Considering what you understand about selecting relevant testing strategies and urgency 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 assay selection process based on further learning and experiences? For example, how you proactively reviewed and integrated the current evidence base linking specific molecular markers to therapeutic pathways to justify your assay choice?
- Has discussing challenging cases of molecular assay selection or the impact of assay choice on turnaround time with a senior colleague changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a selection delay caused by insufficient sample volume for the chosen assay refined your understanding of the critical nature of integrating sample constraints into the initial selection process?
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 competence in selecting molecular assays for haematological malignancies, particularly in preparing for discussions where you might need to justify your assay selections?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to molecular assay selection? 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 from your Training Officer immediately when a patient referral requires testing outside established departmental panels?
- Looking holistically at your training journey, how has this initial assay selection experience, revisited with your current perspective, contributed to your development in selecting the most relevant assays and ensuring efficiency in the broader genomic testing pathway?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Select the relevant testing strategy for commonly referred haematological malignancies, including CML, AML, MPN and MDS. |
| # 3 |
Outcome
Evaluate the urgency of testing for particular haematological malignancies to inform management decisions. |