Solid Cancers 2 —
Training activity: 2

Details

Select laboratory molecular assay for patients referred for solid tumour investigation for:

• 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 selecting laboratory molecular assays for ovarian, breast, CNS, and sarcoma patients.
• 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 assay selection criteria.

What is your prior experience of this activity?

• Think about what you already know about available molecular assays (e.g., NGS, non-NGS) and their application to these specific cancer types.
• Consider possible challenges you might face during the activity, such as limited sample quantity or ambiguity in the clinical question impacting assay choice 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 if assay requirements conflict with patient sample quality or clinical urgency.
• Acknowledge how you feel about undertaking this assay selection task.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as matching molecular assays to referral information and clinical context for these cancer types.
• Identify the specific insights you hope to gain into the rationale behind selecting particular molecular assays for different solid tumours.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of assay selection.
• Identify important information you need to consider before embarking on the activity, such as turn-around time requirements, cost implications, or specific gene panels used for different tumour types.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst selecting the molecular assay? How did this situation compare with previous assay selection experiences?
• Are you encountering situations such as:
  • Conflicting information between the clinical request and the available sample type/quality, complicating the assay choice?
  • Limited sample availability requiring a compromise on the scope of the NGS panel chosen?
  • Unusual patient history (e.g., history of multiple primary tumours) that complicates the standard decision pathway?

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 the standard assay selection protocol?
• Consider the steps you are taking in the moment, such as needing to pause and reconsider your initial assay choice or immediately consulting cost implications and turnaround times for alternative assays.
• How are you feeling in that moment? For instance, are you finding it difficult to reconsider your pre-flection strategy? Is it affecting your confidence in making the selection independently?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully justifying a smaller, targeted panel based on resource limitations? Or are you needing support because the complex clinical picture requires senior sign-off on the deviation from the standard testing strategy?
• What are you learning as a result of the unexpected development? For example, are you identifying anything new about selecting assays, such as the direct trade-off between panel size and clinical urgency?

On action

What happened?

• Begin by summarising the key steps you took when selecting the laboratory molecular assay(s) for the specific patient case(s) (ovarian, breast, CNS, sarcoma).
• Consider specific events, actions, or interactions which felt important, such as how you weighed the clinical urgency against the size and scope of the NGS panel, or how you justified the choice when facing conflicting clinical information.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately modifying your selection from a comprehensive panel to a rapid targeted assay when sample limitations were confirmed mid-process.
• How did you feel during this experience, e.g., did you feel focused on optimising the assay strategy or challenged by the ambiguity in the clinical question?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding testing strategy selection. What strengths did you demonstrate, e.g., strong ability to correlate sample quality limitations with assay input requirements?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific applications of certain non-NGS assays for CNS tumours?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in accurately selecting the most relevant testing strategy based on patient prognosis or sample constraints?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the necessity to choose an expensive, specialised assay when routine options were unsuitable, 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 the process of assay selection for solid cancers.
• What will you do differently next time you approach assay selection, for instance, by proactively checking the current departmental stock of specialised reagents before committing to an assay?
• Do you need to practise any aspect of the activity further, such as reviewing the sensitivity and specificity data for different assays or key knowledge areas related to molecular testing strategies for breast cancer?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of selecting 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 urgent CNS tumour referral required immediate targeted testing over a planned comprehensive NGS panel forced you to re-evaluate the rigidity of your initial approach to assay selection you applied during your first attempt at this training activity?
• Considering what you understand about assay utility, resource constraints, and testing strategy 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 justification for assay choice based on further learning and experiences? For example, how you proactively reviewed and integrated the comparative performance data (e.g., sensitivity/specificity) of both NGS and non-NGS assays into your decision-making template?
• Has discussing complex assay selection scenarios involving limited tissue from breast biopsies or the trade-offs between NGS panel size and clinical turnaround time 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 missed variant due to inappropriate assay panel selection refined your understanding of the critical nature of integrating clinical question and sample constraints into the selection decision?

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 the relevant testing strategy for solid tumours, particularly in preparing for Case-based Discussions (CBDs)? For example, how your accumulated expertise in evaluating NGS vs. non-NGS options now enables you to confidently justify your assay choice for a complex ovarian cancer case during a CBD assessment?
• 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 immediately when required testing falls outside routine departmental protocols or requires highly specialised or resource-intensive options?
• Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in applying integrative knowledge of aetiology and appropriate technologies for these solid cancers?

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.