Training activity information
Details
Analyse, interpret and draft a clinical report for testing to inform urgent treatment decisions in lymphomas, to include:
- Burkitt lymphoma
- Hairy cell leukaemia
- High grade lymphomas
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 analysing, interpreting, and drafting urgent clinical reports for aggressive lymphomas (Burkitt, hairy cell, high grade).
- Consider how the learning outcomes apply, specifically in relation to evaluating testing urgency and preparing a concise and actionable report.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for reporting turnaround time and immediate escalation procedures for urgent findings.
What is your prior experience of this activity?
- Think about your knowledge of the critical genetic features (e.g., MYC, BCL2, BCL6 rearrangements) and relevant rapid assays for urgent lymphomas.
- Consider possible challenges you might face during the activity, such as maintaining accuracy under extreme time pressure or interpreting ambiguous findings from a small or suboptimal sample.
- 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 a suspected critical translocation requires immediate confirmation or if the data quality is compromised due to limited sample integrity.
- Acknowledge how you feel about working effectively and accurately with urgent, high-stakes cases.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as mastering rapid analysis, interpretation, and reporting techniques for urgent treatment decisions.
- Identify the specific insights you hope to gain into the specific genetic drivers of these lymphomas and how positive findings directly impact immediate patient management.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of urgent reporting for acute conditions (e.g., rapid testing for AML in S-CG-S2).
- Identify important information you need to consider before embarking on the activity, such as the clinical context necessitating urgent results and the specific communication channels/protocols required for immediate escalation.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst analysing and interpreting test results for urgent lymphomas?
- Are you encountering situations such as:
- Technical issues or incomplete information compounding the pressure of tight deadlines?
- An ambiguous result for a critical prognostic marker (e.g., MYC rearrangement)?
- A finding that is particularly striking given the clinical urgency?
- A finding that indicates an alternative diagnosis
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 prioritise critical findings or ensure timely communication?
- Consider the steps you are taking in the moment, such as immediately contacting the laboratory team to troubleshoot a technical issue or consulting the departmental protocol for immediate escalation of findings suggestive of Burkitt lymphoma.
- How are you feeling in that moment? For instance, are you finding it difficult to manage complex data efficiently under time pressure? Is it affecting your confidence in reporting quickly and accurately?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully prioritising analysis and ensuring timely communication under extreme pressure? Or are you needing support because the interpretative challenge or time constraint requires senior guidance to finalize the report?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the specific diagnostic features and interpretative priorities necessary for informing urgent treatment decisions for high grade lymphomas?
On action
What happened?
- Begin by summarising the key steps you took when rapidly analysing, interpreting, and drafting the clinical report for the urgent lymphoma case(s) (Burkitt, hairy cell leukaemia, high grade lymphomas).
- Consider specific events, actions, or interactions which felt important, such as how the testing results directly informed the urgent treatment decisions, or the challenges encountered due to the required speed of analysis and reporting.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately modifying the reporting priority to maximise speed while maintaining accuracy when faced with findings highly suggestive of Burkitt lymphoma.
- How did you feel during this experience, e.g., did you feel stressed by the urgency but highly focused on identifying critical prognostic markers?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding urgent reporting. What strengths did you demonstrate, e.g., ability to prioritise findings relevant to urgent treatment decisions?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the characteristic cytogenetic/molecular abnormalities for a specific rare high-grade 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 understanding of the testing and reporting requirements for urgent lymphoma cases and ability to evaluate the urgency of testing?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the immediate verbal communication of results prior to the final signed-off report, 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 enhancing your skills in handling and reporting urgent cases.
- What will you do differently next time you approach urgent reporting, for instance, by proactively establishing a streamlined communication checklist to ensure timely verbal communication with the clinical team?
- Do you need to practise any aspect of the activity further, such as reviewing specific characteristic cytogenetic/molecular abnormalities for high-grade lymphomas or key learning outcomes related to evaluating testing urgency?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of rapidly analysing and reporting urgent lymphoma 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 Burkitt lymphoma case required immediate verbal communication of critical findings forced you to re-evaluate the efficiency and priority of your analysis and communication workflow you applied during your first attempt at this training activity?
- Considering what you understand about evaluating urgency, rapid reporting, and critical markers (e.g., MYC rearrangement) 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 drafting concise and actionable urgent reports based on further learning and experiences? For example, how you proactively implemented a standardized template emphasising critical findings and time-to-result for all high-grade lymphoma reports?
- Has discussing cases involving near misses due to delayed urgent reporting or the impact of imprecise report conclusions on immediate clinical intervention 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 delay in identifying a critical translocation in a high-grade lymphoma refined your understanding of the critical nature of rapid diagnostic action and clear escalation protocols?
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 handling urgent reporting for aggressive lymphomas, particularly in preparing for assessments? For example, how your accumulated ability in evaluating urgency now enables you to confidently justify the immediate escalation required for a highly acute lymphoma finding during an assessment?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to urgent lymphoma 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 an urgent result is obtained but conflicts with prior pathology findings, requiring senior sign-off on the interpretative conclusion?
- Looking holistically at your training journey, how has this initial urgent reporting experience, revisited with your current perspective, contributed to your development in assessing clinical urgency and ensuring effective communication of critical findings?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Evaluate the urgency of testing for particular haematological malignancies to inform management decisions. |
| # 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. |