Techniques in Microbiology —
Training activity: 14

Details

Select, perform and interpret tests for the detection of Mycobacterium tuberculosis and non-tuberculous Mycobacteria to include:

• Sample prep
• Microscopy
• Molecular
• Culture

And suggest management of infections caused by Mycobacteria including the interpretation of drug resistance.

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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

• Why is the diagnosis of mycobacterial infections a specialist area?
  • What is your knowledge of Mycobacterium tuberculosisand non-tuberculous mycobacteria (NTM), their unique characteristics, and the implications of drug resistance?
  • What is your understanding of sample preparation, microscopy (e.g., Ziehl-Neelsen staining), molecular methods (e.g., PCR), and culture for mycobacteria?
• What specific skills in performing and interpreting microscopy for acid-fast bacilli do you hope to develop?
  • How will you learn about the specialised culture techniques and the longer incubation periods required for mycobacteria?
  • What insights do you expect to gain regarding the interpretation of molecular tests for  tuberculosisand drug resistance markers?
• How will you prepare for this DTA? Will you review the laboratory safety procedures for handling mycobacterial cultures?
  • Will you discuss with your training officer the national guidelines for tuberculosis diagnosis and management?
  • What challenges might arise due to the slow growth rate of mycobacteria in culture?
  • How will you approach the interpretation of complex drug susceptibility testing results for  tuberculosisand NTM?
  • How do you feel about learning about these important pathogens with significant public health implications and complex diagnostic pathways?

In action

• What specific Mycobacteriadetection tests are you currently performing or interpreting (e.g., Ziehl-Neelsen staining, auramine staining, PCR for  tuberculosis complex, culture on Lowenstein-Jensen media, phenotypic drug susceptibility testing)?
  • How are you approaching the execution or interpretation of these assays?
  • Why are you doing it this way (e.g., understanding the acid-fast nature of mycobacteria, the slow growth of M. tuberculosis, the principles of different drug susceptibility testing methods)?
  • What decisions are you making regarding the interpretation of smear results, culture growth, and drug susceptibility patterns?
  • What aspects of performing or interpreting these tests feel intuitive to you, and what requires more conscious effort (e.g., reading auramine-stained smears, interpreting complex drug resistance profiles)?
• How effective are your current actions in obtaining or interpreting accurate results for Mycobacteriadetection and drug resistance?
  • What challenges are you facing during the process (e.g., low sensitivity of smear microscopy, contamination of cultures, discordant drug susceptibility results)?
  • What can you learn about diagnosing Mycobacteria infections and the importance of timely and accurate drug susceptibility testing as the activity unfolds?
  • How does this activity connect to your understanding of tuberculosis, non-tuberculous mycobacterial infections, and public health implications?
• Are there alternative approaches you could be considering if initial tests are negative but clinical suspicion remains high (e.g., requesting induced sputum, using liquid culture systems, considering genotypic drug resistance testing)?
  • What support or guidance might you need in this moment from a senior colleague or the training officer regarding the interpretation of complex drug resistance patterns or the identification of rare mycobacterial species?
  • Are you working within your scope of practice when selecting, performing, and interpreting these tests and considering management options?

On action

• Begin by summarising the key points of the experience working with Mycobacteria diagnostics.
  • What were the most significant observations regarding the specific sample preparation requirements, techniques (Microscopy, Molecular, Culture), the prolonged culture times, or the process of interpreting drug resistance?
• What skills or knowledge did you develop or improve through this DTA, specifically in performing sample decontamination, microscopy (e.g., ZN stain), molecular assays, culture for Mycobacteria, interpreting results from multiple techniques, or interpreting drug resistance profiles?
  • Were there any unexpected challenges (e.g., dealing with paucibacillary samples, interpreting molecular results in culture-negative cases, understanding complex resistance patterns) or successes?
  • What did you learn from these? In what ways did your ‘reflection-in-action’ influence your approach during the activity, such as ensuring appropriate safety precautions or validating microscopy findings with molecular results?
• What areas for continued development have been identified, particularly concerning interpreting drug resistance profiles or understanding the nuances of different diagnostic techniques for Mycobacteria?
  • How can you apply the learning from this activity to your routine practice, especially when handling samples potentially containing Mycobacteria or interpreting complex results?
  • Identify the specific actions or ‘next steps’ you will take to deepen your knowledge of Mycobacterial diagnostics and resistance interpretation. What support or resources might you need to further develop in these areas?

Beyond action

• Revisit your initial reflect-on-action notes for this DTA. What additional insights have you gained since the initial reflection?
  • Has discussing TB cases at clinical meetings or reviewing national/international guidelines altered your perspective on management and public health implications?
  • How did this specific Mycobacteria testing experience compare to testing for other slow-growing or hazardous pathogens?
  • What unique challenges (e.g., sample processing, biosafety, long culture times, interpreting resistance patterns) have you identified across Mycobacteria samples?
  • Have you discussed Mycobacteria diagnostics, management, or public health control during professional discussions or visits to reference laboratories? What new perspectives did this bring?
• How have the skills (e.g., specialised sample processing and microscopy, performing and interpreting molecular tests for detection and resistance, managing long-term cultures, interpreting complex drug resistance profiles, adhering to high biosafety standards) you developed during this DTA influenced your approach to other hazardous or slow-growing pathogens?
  • Have you applied the learning from this DTA, such as understanding the significant public health implications of specific pathogens or the complexity of resistance interpretation, to other aspects of your microbiology practice?
  • How does the learning from this DTA contribute to your preparedness for interpreting resistance data or liaising with public health?
• What transferable skills in handling hazardous materials safely, applying specialised techniques for challenging pathogens, interpreting complex molecular and resistance data, and understanding the significant public health implications of infections, developed through this DTA, will be invaluable throughout your training and beyond?
  • Identify clear actions for continued development related to Mycobacteria diagnostics, drug resistance interpretation, or public health microbiology based on your cumulative experiences and reflections.

Relevant learning outcomes

#	Outcome
# 1	Outcome Select and perform tests to investigate common infections from a range of sample types following guidance and fulfilling health and safety requirements
# 2	Outcome Interpret the results of tests used to investigate common infections from a range of sample types with consideration of laboratory quality assurance and quality control
# 3	Outcome Identify options for management of common infections based on test results and clinical context, considering infection control, guidelines and public health requirements
# 4	Outcome Perform and interpret molecular techniques for the investigation of common infections following guidance and fulfilling health and safety requirements
# 5	Outcome Select and interpret tests for the investigation and management of drug resistant pathogens