Solid Cancers 2 —
Training activity: 1

Details

Receive samples and referral information for a range of solid cancers, to include:

• Ovarian
• Breast
• CNS
• Sarcoma

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 effectively receiving samples and referral information for , ovarian, breast, CNS, and sarcoma cases.
• Consider how the learning outcomes apply, specifically in relation to selecting the relevant testing strategy.
• Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for sample handling protocols and referral documentation.

What is your prior experience of this activity?

• Think about what you already know about handling different sample types and processing referral forms for various cancer cases.
• Consider possible challenges you might face during the activity, such as incomplete referral information or incorrectly labelled samples, and think about how you might handle them.
• 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 regarding specific sample requirements for complex cases like CNS or Sarcoma samples.
• Acknowledge how you feel about receiving the samples and referrals on the range of samples stipulated.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as improving handling and referral skills for these specific cancer types.
• Identify the specific insights you hope to gain into the required information and specific sample types for diagnostic genomic testing in solid cancers.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of sample and referral handling.
• Identify important information you need to consider before embarking on the activity, such as specific sample requirements for different assay types or urgent case pathways.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst receiving samples and referral information for solid cancers?
• Are you encountering situations such as:
  • Missing information from the referral form, such as incomplete clinical history or specific tumour details?
  • An unusual sample type (e.g., CNS biopsy or specific sarcoma tissue) that challenges standard acceptance criteria?
  • Unclear referral details regarding the specific molecular investigation requested or clinical urgency?

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 standard procedure for sample receipt to account for missing information?
• Consider the steps you are taking in the moment, such as immediately seeking clarification from the submitting clinician regarding the unclear referral details.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your standard procedure? Is it affecting your confidence in accepting the sample or information?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully addressing the unexpected issue by applying procedural guidelines? Or are you needing support because the unusual sample type requires senior review before acceptance?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the criticality of specific documentation requirements for CNS referrals?

On action

What happened?

• Begin by summarising the key steps you took when receiving the samples and reviewing the referral information for the specific range of solid cancer referrals (, ovarian, breast, CNS, sarcoma).
• Consider specific events, actions, or interactions which felt important, such as how you assessed complex sample types (e.g., CNS biopsy or sarcoma tissue) against acceptance criteria, or how you managed ambiguous details in the clinical referral documentation.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting a senior colleague when a CNS referral lacked critical clinical history, requiring rapid deviation from the standard acceptance protocol.
• How did you feel during this experience, e.g., did you feel stressed by the complexity of the sample type or confident in applying the departmental SOPs for missing documentation?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding sample and referral handling. What strengths did you demonstrate, e.g., meticulous adherence to cross-checking documentation against physical sample details?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific pathological reporting requirements for sarcoma samples?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in managing high-risk samples or escalating concerns efficiently?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a sample with borderline cellularity could be accepted for a cancer NGS panel, and how you reacted to this.

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 refining sample acceptance criteria for these complex solid tumours.
• What will you do differently next time you approach receiving samples, for instance, by proactively reviewing the mandatory referral information checklist specific to CNS and sarcoma referrals before approaching sample acceptance?
• Do you need to practise any aspect of the activity further, such as reviewing specific handling protocols for rare solid tumour samples or key procedures related to handling documentation discrepancies?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of receiving complex samples (e.g., fragmented CNS or sarcoma biopsies) since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent complex CNS biopsy sample required stringent temperature control for acceptance forced you to re-evaluate the meticulousness of your initial documentation and environmental checklist you applied during your first attempt at this training activity?
• Considering what you understand about sample acceptance criteria and pre-analytical risk management 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 process for sample reception and escalation of compromised documentation based on further learning and experiences? For example, how you proactively reviewed and integrated local SOPs regarding tumour burden estimation criteria to standardise your sample acceptance decisions based on further learning?
• Has discussing challenging sample receipts involving ambiguous urgency criteria or the impact of receiving low-quality ovarian samples on downstream NGS success with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a time when critical pathology details were missed during sample acceptance refined your understanding of the critical nature of meticulous pre-analytical documentation checks?

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 applying appropriate sample acceptance criteria for solid cancers, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in consistently applying acceptance criteria now enables you to confidently advise another healthcare professional on sample quality requirements during an OCE assessment?
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to receiving complex solid cancer samples? 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 faced with a sample requiring non-standard handling due to unexpected high infection risk or unusual fixation method?
• Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in selecting the relevant testing strategy by ensuring high quality input material?

Relevant learning outcomes

#	Outcome
# 1	Outcome Select the relevant testing strategy for patients referred for diagnostic genomic testing for ovarian, breast, central nervous system (CNS) and sarcoma tumours.