Training activity information
Details
Select the appropriate testing pathway for patients with a suspected diagnosis of the following conditions:
- ALL
- CLL
- Plasma cell dyscrasias
- Lymphoma
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 diagnostic and monitoring testing pathway for patients with suspected ALL, CLL, plasma cell dyscrasias, and lymphoma.
- Consider how the learning outcomes apply, specifically in relation to selecting the relevant testing strategy and evaluating the urgency of testing.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for applying current guidelines (e.g., WHO/ELN) to pathway selection.
What is your prior experience of this activity?
- Think about what you already know about diagnostic pathways and guidelines (e.g., BSH, ELN, WHO) for ALL, CLL, plasma cell dyscrasias, and lymphoma.
- Consider possible challenges you might face during the activity, such as a complex presentation or conflicting initial laboratory results complicating pathway selection.
- 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 initial findings contradict standard diagnostic pathways, requiring deviation from established protocols for specific molecular/cytogenetics testing.
- Acknowledge how you feel about making critical decisions regarding patient diagnostic pathways.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as efficiently applying guidelines and clinical context to determine optimal testing strategies.
- Identify the specific insights you hope to gain into the factors influencing pathway decisions, including the assessment of clinical urgency.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of selecting testing strategies for haematological malignancies (e.g., CML, AML in S-CG-S2).
- Identify important information you need to consider before embarking on the activity, such as the initial clinical findings and the specific suspected diagnosis which determines the required molecular targets.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst evaluating the patient information and selecting the testing pathway?
- Are you encountering situations such as:
- Sample type related variations in disease burden complicating decisions on testing? (e.g. peripheral blood or bone marrow or lymph node)
- Conflicting initial results (e.g., morphology vs. immunophenotype) complicating the pathway decision?
- Unexpected clinical information (e.g., aggressive symptoms for a seemingly low-risk condition) challenging the urgency evaluation?
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 systematic review to account for conflicting initial results, or considering alternative pathways?
- Consider the steps you are taking in the moment, such as immediately seeking input on deviation from standard guidelines or proactively checking the current version of the clinical guidelines.
- How are you feeling in that moment? For instance, are you finding it difficult to navigate complex presentations or resolve conflicting information? 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 pathway deviation based on the patient’s specific clinical context? Or are you needing support because the clinical urgency is high and requires the input of a more experienced colleague to finalise the sequence of tests?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the specific factors (e.g., risk stratification criteria) that prove particularly significant in pathway selection for these haematological malignancies?
On action
What happened?
- Begin by summarising the key steps you took when evaluating the patient information and selecting the appropriate testing pathway for the suspected diagnosis (ALL, CLL, plasma cell dyscrasias, or lymphoma).
- Consider specific events, actions, or interactions which felt important, such as the key pieces of information (e.g., initial pathology, clinical presentation) used to select the pathway, or the critical decision points in the process, especially regarding the urgency of testing.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking input on a deviation from the standard guidelines when faced with conflicting initial laboratory results, requiring a modified testing sequence.
- How did you feel during this experience, e.g., did you feel confident in applying the diagnostic guidelines or challenged by having to choose between multiple potential pathways for a complex myelo/lymphoid overlap case?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding testing pathway selection. What strengths did you demonstrate, e.g., skill in evaluating the urgency of testing?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with applying specific WHO classification criteria for rare lymphoma subtypes?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in your understanding of appropriate testing pathways and ability to apply current laboratory pathways and international guidelines for diagnosis?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a deviation from the established testing protocol was permissible based on the patient’s unusual clinical presentation, 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 aspects of selecting testing pathways.
- What will you do differently next time you approach pathway selection, for instance, by proactively reviewing subtype-specific international guidelines (e.g., ELN criteria) before finalising the testing sequence?
- Do you need to practise any aspect of the activity further, such as reviewing the module content related to evaluating testing urgency or key knowledge areas related to diagnostic guidelines for plasma cell dyscrasias?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of selecting appropriate testing pathways for these specific malignancies 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 patient required urgent molecular testing due to rapidly progressing CLL or lymphoma forced you to re-evaluate the rigidity of your initial approach to clinical urgency assessment you applied during your first attempt at this training activity?
- Considering what you understand about diagnostic criteria, pathway guidelines, and urgency evaluation 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 applying international guidelines (e.g., WHO, ELN, or ERIC) to pathway selection based on further learning and experiences? For example, how you proactively reviewed and integrated the latest criteria for minimal workup in suspected CLL cases to streamline your pathway selection?
- Has discussing cases involving deviation from standard pathways or the impact of inappropriate pathway selection on patient 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 potential misclassification due to testing pathway omission in an ALL case refined your understanding of the critical nature of comprehensive guideline adherence during pathway selection?
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 and justifying complex haematological testing pathways, particularly in preparing for assessments? For example, how your accumulated ability in selecting testing strategy and evaluating urgency now enables you to confidently present a rationale for a high-risk lymphoma pathway during an assessment?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to testing pathway 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 the Haematopathologist immediately when findings suggest a rare or unclassified lymphoma subtype requiring highly specialised or experimental testing?
- Looking holistically at your training journey, how has this initial pathway selection experience, revisited with your current perspective, contributed to your development in applying guidelines and managing risk in a clinical setting?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Select the relevant testing strategy for commonly referred haematological. |
| # 3 |
Outcome
Evaluate the urgency of testing for particular haematological malignancies to inform management decisions. |