Training activity information
Details
Interpret haematological assays to inform testing strategies, to include:
- CLL
- Plasma cell dyscrasias
- Lymphoma
- ALL
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 interpreting haematological assays to inform appropriate molecular testing strategies for conditions like CLL, plasma cell dyscrasias, lymphoma, and ALL.
- Consider how the learning outcomes apply, specifically in relation to selecting relevant testing strategies and analysing/interpreting reports.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for linking initial assay findings to subsequent molecular testing pathways.
What is your prior experience of this activity?
- Think about what you already know about interpreting haematological assays and how they inform testing strategies for conditions like CLL, plasma cell dyscrasias, lymphoma, and ALL.
- Consider possible challenges you might face during the activity, such as ambiguous flow cytometry or morphology results complicating the choice of downstream molecular assay.
- 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 initial immunophenotype data is ambiguous or suggests a pathology requiring specialised molecular tests outside routine protocol.
- Acknowledge how you feel about undertaking this assay interpretation task.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as efficiently translating complex haematological results into an actionable molecular testing strategy.
- Identify the specific insights you hope to gain into the relevance of different initial assay types (e.g., flow cytometry) for subsequent genomic decisions in these specific malignancies.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting initial laboratory data to guide subsequent testing.
- Identify important information you need to consider before embarking on the activity, such as reviewing patient history, morphology, or immunophenotype data to provide necessary clinical context.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst interpreting the results of the haematological assays and linking them to further molecular testing strategies?
- Are you encountering situations such as:
- Ambiguous flow cytometry or morphology results complicating the choice of downstream molecular assay?
- Areas requiring conscious effort or guidance, rather than feeling intuitive, such as navigating an unusual plasma cell dyscrasia profile?
- Unexpected results emerging that are informing your understanding of the disease-testing relationship?
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 interpretation by considering alternative interpretations or seeking clarification on specific points?
- Consider the steps you are taking in the moment, such as immediately consulting guidelines/previous experiences to verify the relevance of the finding in guiding the testing strategy.
- How are you feeling in that moment? For instance, are you finding it difficult to interpret complex haematological data or link it to the appropriate molecular pathway for a specific lymphoma? Is it affecting your confidence in guiding the overall testing strategy?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying prior knowledge to guide the selection of the appropriate testing strategy? Or are you needing support because the complexity of the patient profile requires input from a senior colleague to ensure the most appropriate testing strategy is selected?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the critical relationships between initial flow cytometry and subsequent sequencing panels for CLL or ALL?
On action
What happened?
- Begin by summarising the key steps you took when interpreting the haematological assays (e.g., flow cytometry, immunophenotype, morphology) and linking these key findings or results to subsequent testing strategies for conditions like CLL, plasma cell dyscrasias, lymphoma, or ALL.
- Consider specific events, actions, or interactions which felt important, such as which assays were the primary focus, the information from the assay results that was most influential in informing subsequent testing strategies, or any aspects that felt particularly challenging.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting external guidelines or senior colleagues when assay interpretation felt surprising or different from what you anticipated, requiring verification before selecting the downstream molecular test.
- How did you feel during this experience, e.g., did you feel focused on linking the initial findings to the molecular testing pathway or stressed by the necessity of navigating an unusual plasma cell dyscrasia profile?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding interpretation and testing strategy selection. What strengths did you demonstrate, e.g., improved understanding of the relationship between initial haematological findings and subsequent genomic/molecular testing requirements?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific molecular testing requirements for a rare lymphoma subtype?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in your ability to select relevant testing strategies for commonly referred haematological malignancies?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether an ambiguous flow cytometry result justified a specific high-cost molecular assay, 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 specific areas of assay interpretation or linking results to testing strategies.
- What will you do differently next time you approach interpretation and strategy selection, for instance, by proactively reviewing the relevant clinical guidelines (e.g., WHO criteria) for linking assays to pathways before committing to the molecular assay choice?
- Do you need to practise any aspect of the activity further, such as reviewing guidelines for interpreting complex plasma cell dyscrasia results or key learning outcomes related to applying genomic testing in the diagnosis and management of these conditions?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of interpreting flow cytometry or morphology data to inform molecular testing 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 ALL case required precise molecular testing after ambiguous flow results forced you to re-evaluate the weight you placed on morphology vs. immunophenotype during your first attempt at this training activity?
- Considering what you understand about assay relevance and molecular testing pathways 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 correlating initial assay data with subsequent NGS panel selection based on further learning and experiences? For example, how you proactively reviewed and integrated the diagnostic cascade guidelines for specific lymphoma subtypes to improve your strategy selection?
- Has discussing cases where initial haematological data was misleading or the impact of non-specific flow results on downstream testing efficiency 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 conflicting initial data led to a delayed molecular diagnosis refined your understanding of the critical nature of holistic data correlation during the initial interpretation phase?
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 interpreting initial haematological assays and selecting relevant testing strategies, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in systematically linking flow data to molecular targets now enables you to confidently justify your proposed testing strategy 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 interpreting initial laboratory data? 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 initial results suggest a complex pathology (e.g., mixed phenotype acute leukaemia requiring non-standard molecular confirmation?
- Looking holistically at your training journey, how has this initial assay interpretation experience, revisited with your current perspective, contributed to your development in selecting the relevant testing strategy by providing a strong foundation in pre-molecular diagnostics?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify the main clinical, morphological and phenotypical features of CLL, plasma cell dyscrasias, B cell lymphomas (low and high grade) and ALL. |
| # 2 |
Outcome
Select the relevant testing strategy for commonly referred haematological. |