Haematological Malignancies 1 —
Training activity: 4

Details

Analyse, interpret and draft a clinical report for appropriate assays for suspected myeloproliferative neoplasms, including:

• PV
• ET
• MF

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 clinical report for myeloproliferative neoplasms (PV, ET, MF).
• Consider how the learning outcomes apply, specifically in relation to analysing, interpreting, and reporting molecular findings (Learning Outcome 4) and ensuring clear communication of key mutations (e.g., JAK2, CALR, MPL).
• Discuss with your training officer to gain clarity of what is expected of you in relation to the specific format and content required for a diagnostic report on MPN molecular findings.

What is your prior experience of this activity?

• Think about what you already know about analysing laboratory data, interpreting molecular findings, and drafting clinical reports, including characteristic molecular features used for the diagnosis of MPNs.
• Consider possible challenges you might face during the activity, such as interpreting complex findings from NGS data or drafting a clear, clinically relevant report that integrates molecular findings concisely.
• 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 encountering equivocal molecular findings or difficulty applying standard nomenclature to report complex variants.
• Acknowledge how you feel about the responsibility of drafting reports that contribute to the diagnosis of chronic haematological malignancies.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as systematically applying bioinformatics tools for MPN analysis and ensuring accurate correlation with diagnostic criteria.
• Identify the specific insights you hope to gain into the analysis, interpretation, and reporting requirements for MPN assays, specifically PV, ET, and MF.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of data analysis or reporting in oncology.
• Identify important information you need to consider before embarking on the activity, such as reviewing example reports for MPNs and ensuring familiarity with the structure and content required for a diagnostic report in your laboratory.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst analysing and interpreting the assay results for suspected Polycythaemia Vera (PV), Essential Thrombocythaemia (ET), or Myelofibrosis (MF)?
• Are you encountering situations such as:
  • Discordant results between different assays or complex mutational profiles (e.g., unexpected co-mutations) that challenge the primary diagnosis?
  • Difficulty interpreting Variant Allele Frequencies (VAFs) for JAK2, CALR, or MPL mutations, requiring conscious effort to assess significance?
  • The interpretation requires extensive annotation due to ambiguous findings, complicating the report drafting?

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 correlating findings (e.g., JAK2 status) with established diagnostic criteria for PV, ET, or MF?
• Consider the steps you are taking in the moment, such as:
  • Immediately consulting guidelines on VAF interpretation to determine the significance of a borderline mutation
  • Considering alternative interpretations if the molecular findings conflict with the initial clinical suspicion
• How are you feeling in that moment? For instance, are you finding it difficult to interpret less common mutations or determine the phrasing for a discordant result? Is it affecting your confidence in contributing to a correct MPN diagnosis?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully analysing MPN assays by applying diagnostic criteria to complex mutational profiles? Or are you needing support because interpreting complex or unusual MPN molecular findings requires consultation before drafting the report?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the complexities of assessing clonality or VAF thresholds for key MPN driver mutations (JAK2, CALR, MPL)?

On action

What happened?

• Begin by summarising the key steps you took when analysing, interpreting, and drafting a clinical report for assays for suspected PV, ET, or MF cases. What specific assays did you analyse and interpret, and what were the key genetic findings (e.g., JAK2, CALR, MPL mutations, cytogenetics)?
• Consider specific events, actions, or interactions which felt important, such as how you integrated the results of different assays to reach an overall interpretation, and what challenges or straightforward aspects you faced when drafting the clinical report, including integrating relevant IQC/EQA information.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately addressing unexpected results or complexities encountered during analysis or interpretation by seeking consultation.
• How did you feel during this experience, e.g., did you feel focused on integrating all available data (e.g., different assay results) to reach an overall interpretation or challenged by integrating relevant IQC/EQA information into the clinical report?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding MPN analysis and reporting. What strengths did you demonstrate, e.g., improved ability to analyse and interpret molecular and potentially cytogenetic results for MPNs (PV, ET, MF)?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the significance of specific genetic variants in the prognosis of MPNs?
• 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 and EQA data to support your confidence in the patient results?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding unexpected results or complexities encountered during analysis or interpretation, and how you reacted to this. How does drafting accurate and informative reports for MPNs relate to supporting clinical colleagues and patient care?

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 genetic variants or aspects of MPN analysis/interpretation that require further study or experience.
• What will you do differently next time you approach MPN reporting, for instance, by proactively taking actions to improve your report writing skills and your understanding of the clinical implications of MPN findings?
• Do you need to practise any aspect of the activity further, such as reviewing reporting guidelines, databases, or discussing with senior scientists or clinicians for continued development in MPN analysis and reporting?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of analysing, interpreting, and drafting clinical reports for MPN assays since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent complex case requiring integration of multiple non-driver mutations forced you to re-evaluate the detail included in the interpretation section of your initial report you applied during your first attempt at this training activity?
• Considering what you understand about reporting MPN findings and integrating quality control data 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, interpretation, or reporting style based on further learning and experiences? For example, how you proactively reviewed and integrated standardised criteria for documenting VAF thresholds for JAK2 mutations based on further learning?
• Has discussing challenging MPN reports or the impact of accurate reporting on collaborating with relevant specialities with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a supervising physician about an ambiguous report that failed to clearly categorise the malignancy refined your understanding of the critical nature of concise and actionable reporting for MPN patient management?

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 analysing and reporting MPN assays, particularly in preparing for assessments like Case-Based Discussions?
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to MPN report drafting? 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 encountering complex findings that require specialist prognostic language?
• Looking holistically at your training journey, how has this initial MPN reporting experience, revisited with your current perspective, contributed to your development in effective reporting and collaborating with relevant specialities?

Relevant learning outcomes

#	Outcome
# 4	Outcome Analyse, interpret and prepare interpretive reports for common haematological malignancies, including results for somatic variants, kinase domain mutations, minimal 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.