Training activity information
Details
Analyse, interpret and draft a clinical report for risk stratification and treatment for CLL, to include:
- IGH somatic hypermutation
- TP53/17p
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 accurately reporting on IGH somatic hypermutation status and TP53/17p deletion for CLL risk stratification and treatment implications.
- Consider how the learning outcomes apply, specifically in relation to report preparation, interpreting somatic variants/hypermutation, and ensuring clear communication to relevant specialties.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for using precise prognostic language and reporting on therapeutic implications (e.g., chemo-immunotherapy vs. targeted agents).
What is your prior experience of this activity?
- Think about your knowledge of the prognostic significance of IGH somatic hypermutation status and TP53/17p deletion in CLL.
- Consider possible challenges you might face during the activity, such as borderline IGH mutational status results complicating the prognostic classification or interpreting the clinical significance of low-level TP53 mutations.
- 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 IGH mutational status calculation is borderline or if the NGS results for TP53 suggest a sub clonal mutation requiring specific verification.
- Acknowledge how you feel about the responsibility of reporting critical prognostic markers that guide treatment.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as mastering the interpretation of IGH somatic hypermutation and integrating it with TP53 status for comprehensive risk stratification.
- Identify the specific insights you hope to gain into how these key genetic features directly guide clinical management decisions (e.g., choice of first-line therapy) in CLL.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting prognostic haematological markers (e.g., in CML or AML).
- Identify important information you need to consider before embarking on the activity, such as the methodology used for IGH somatic hypermutation status determination and established local prognostic cut-offs.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst analysing and interpreting the IGH somatic hypermutation and TP53/17p results for CLL patients?
- Are you encountering situations such as:
- Borderline results for IGH mutational status complicating prognostic classification?
- Conflicting results between TP53 sequencing and FISH results for 17p deletion?
- An unexpected pattern enhancing your understanding of the interplay between these markers?
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 interpretation by considering alternative interpretations or consulting the latest CLL guidelines?
- Consider the steps you are taking in the moment, such as immediately consulting the prognostic cut-off criteria for IGH mutational status or deciding how to integrate the markers into the overall risk profile.
- How are you feeling in that moment? For instance, are you finding it difficult to assess borderline results accurately or ensure the report conveys the full impact on treatment (e.g., eligibility for targeted agents)? Is it affecting your confidence in accurate risk stratification?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully conveying the impact of the findings on targeted therapy eligibility? Or are you needing support because the complexity of integrating conflicting risk markers requires consultation before drafting the final report?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the clinical significance of the interrelation between IGH somatic hypermutation and TP53/17p status in CLL?
On action
What happened?
- Begin by summarising the key steps you took when analysing, interpreting, and drafting the clinical report focusing on IGH somatic hypermutation and TP53/17p status for the CLL case(s).
- Consider specific events, actions, or interactions which felt important, such as how you assessed the key findings for these markers, or how these findings directly influenced the risk stratification and treatment considerations for the patient.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification when faced with borderline IGH mutational status or conflicting TP53/17p results, requiring guidance before assigning the final prognostic risk.
- How did you feel during this experience, e.g., did you feel acutely aware of the prognostic implications or challenged by the ambiguity of results when attempting to define the risk stratification?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding CLL risk stratification. What strengths did you demonstrate, e.g., improved understanding of risk stratification in CLL and the prognostic significance of these findings?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the precise prognostic language related to certain targeted agents when integrating the molecular markers into the report?
- 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 prepare interpretive reports for common haematological malignancies, specifically focusing on risk stratification?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the specific therapeutic recommendations permissible in the report based on the TP53/17p status, 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 CLL risk stratification or interpreting IGH/TP53 findings.
- What will you do differently next time you approach CLL analysis, for instance, by proactively reviewing the latest treatment guidelines (e.g., guidelines distinguishing between chemo-immunotherapy vs. targeted agents) before interpreting the findings?
- Do you need to practise any aspect of the activity further, such as reviewing the prognostic significance of these molecular markers or key learning outcomes related to interpreting and reporting borderline IGH/TP53 results?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of analysing and reporting CLL prognostic markers (IGH somatic hypermutation, TP53/17p) 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 CLL case had borderline IGH mutation status forced you to re-evaluate the precision and justification required for assigning prognostic risk you applied during your first attempt at this training activity?
- Considering what you understand about CLL risk stratification and the correlation between molecular markers and targeted therapy 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 report drafting methodology based on further learning and experiences? For example, how you proactively reviewed and integrated the current ERIC recommendations for TP53 mutation analysis to ensure accurate risk stratification?
- Has discussing reports with conflicting molecular findings (e.g., TP53 deletion by FISH but no mutation by NGS) or the impact of inaccurate risk stratification on treatment decisions with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a medical consultant about a patient who was deemed ineligible for targeted therapy due to ambiguous reporting refined your understanding of the critical nature of unambiguous prognostic classification?
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 and reporting complex CLL prognostic markers, particularly in preparing for assessments? For example, how your accumulated ability in accurately preparing reports now enables you to confidently discuss the therapeutic implications of a high-risk CLL profile during an assessment?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to CLL reporting? 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 encountering a CLL case that requires risk assessment for clinical trial entry based on non-standard molecular criteria?
- Looking holistically at your training journey, how has this initial CLL reporting experience, revisited with your current perspective, contributed to your development in analysing and interpreting clinically relevant findings and ensuring reports directly inform treatment decisions?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Analyse, interpret and prepare interpretive reports for common haematological malignancies, including results for somatic variants, clonality, and somatic hypermutation. |
| # 5 |
Outcome
Interpret the associated IQC and EQA of the laboratory tests for investigation of haematological malignancies. |
| # 6 |
Outcome
Practice with the relevant specialties for the diagnosis, monitoring and management of haematological malignancies. |