Training activity information
Details
Select appropriate diagnostic testing for a patient about to undergo significant immunosuppression
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 specifically constitutes a successful selection of appropriate diagnostic testing for a patient about to undergo significant immunosuppression?
- This could involve identifying the most relevant pathogens based on the patient’s specific type of immunosuppression (e.g., related to malignancies or transplants) and selecting diagnostic methods that are both sensitive and appropriate for this patient group.
- Have you discussed the expected outcomes and criteria for success with your training officer to gain clarity?
- How would a successful outcome reflect your ability to advise on test selection and interpretation in this complex patient group?
- What do you already know about selecting diagnostic testing for patients undergoing significant immunosuppression?
- Specifically for patients with immunosuppression due to malignancies or transplants, what have you learned about the unique microbiological risks and diagnostic challenges?
- Have you previously interpreted serology for transplant donors or recipients?
- What prior knowledge do you have that will inform your test selection? What are the potential challenges you might face during this activity when dealing with this specific specialist patient group (e.g., navigating atypical presentations of infection, managing rapid disease progression, or considering complex drug interactions related to immunosuppression)? How might you handle these?
- What is the scope of your own practice for this activity? When will you need to seek advice or help, and from whom (e.g., your training officer, senior colleagues, or the clinical teams involved in the patient’s care, such as those attending multidisciplinary team meetings where infections in patients with malignancies or transplants are discussed?
- Drawing upon previous experiences or your current understanding, what specific skills related to selecting diagnostic tests in this context do you want to develop?
- What specific insights do you hope to gain from engaging with this activity?
- Are you hoping to deepen your understanding of specific pathogens (e.g., opportunistic infections), diagnostic methods (e.g., molecular diagnostics relevant to immunosuppressed patients), or the clinical considerations for immunosuppressed patients?
- Have you consulted any actions for improvement or points for future consideration you identified following previous similar experiences?
- What important information do you need to consider before embarking on this activity? This might include reviewing relevant national or local clinical guidelines for infection prophylaxis or management in specific immunosuppressed patient populations (e.g., transplant recipients, chemotherapy patients).
- Do you need to consider the pharmacodynamics of antimicrobials in these special groups and how that might impact test interpretation or further management advice?
- Have you considered how specific patient-specific factors, such as the type of immunosuppression (e.g., post-solid organ transplant, haematological malignancy, HIV), duration of immunosuppression, or recent travel history, might influence the appropriate diagnostic tests?
In action
- As you select diagnostic tests, do you encounter any patient information, clinical context (e.g., the specific type or severity of immunosuppression, an unexpected underlying condition, or new co-morbidities), or unforeseen laboratory constraints (e.g., a specific sample type or volume is unavailable, or a test has a longer turnaround time than expected) that differ from your initial anticipation?
- How does this immediate experience, including any unexpected elements, compare with previous instances where you have considered testing for immunosuppressed patients, or with other complex cases you encounter during your training?
- Do you adapt or change your initial approach to selecting tests based on the unexpected information or constraints? How does this impact your ability to proceed effectively with selecting the most appropriate tests?
- How do you feel in that moment – does adapting your approach feel challenging, or do you feel positive and confident in your ability to adjust your test selection strategy as needed?
- Does the unexpected development require you to check a relevant clinical guideline (e.g., national or local guidelines for immunosuppressed patients), consult with a colleague (e.g., a clinical scientist, consultant microbiologist/virologist, or the requesting clinician), or seek clarification on your scope of practice in that moment to ensure you are making appropriate test selections?
- Do you successfully adapt and continue with the activity, ensuring you work within your scope of practice by making appropriate decisions in the moment about which tests to select, when to seek advice, and how to handle any constraints?
- What, if anything, do you learn as a result of having to adapt your test selection process in the moment due to the unexpected development? This could be about the clinical context, specific pathogens, diagnostic methods, or your own decision-making process.
On action
- Begin by summarising the key points of the experience. Describe the specific scenario of the patient undergoing significant immunosuppression and the process you follow to select appropriate diagnostic testing.
- What are the patient’s specific clinical details and the planned immunosuppressive regimen?
- Consider specific events, actions, or interactions which feel important, including your own feelings during the experience.
- Do you feel confident in your test selection? Are there any points of uncertainty?
- Include any reflect-in-action moments, where you adapt to the situation as it unfolds. Do you change your initial approach to test selection based on new information or constraints encountered during the process (e.g., unexpected patient information, clinical context, or laboratory constraints)?
- What strengths did you demonstrate in selecting appropriate diagnostic tests for this immunosuppressed patient? What skills and/or knowledge gaps were evident in your understanding of relevant pathogens, diagnostic methods, or the clinical context of immunosuppression?
- Compare this experience against previous engagement with similar activities, if applicable. Are any previous identified actions for development related to managing or investigating infections in immunosuppressed patients achieved during this activity? Has your practice in selecting tests in this context improved?
- Identify any challenges you experience and how you react to these. Does this affect your ability to deal with the situation effectively? Are you able to overcome the challenges in selecting the most appropriate tests?
- Identify anything significant about the activity. Do you need to seek advice or clarification from your training officer, a consultant, or another colleague regarding test selection or interpretation in this specific case? Or do you need to escalate to ensure that you are working within your scope of practice?
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
- Based on this experience, what will you do differently next time you need to select diagnostic testing for a patient about to undergo significant immunosuppression?
- Has anything changed in terms of what you would do if you are faced with a similar situation again?
- Do you need to practise any aspect of the activity further, such as reviewing relevant guidelines for immunosuppressed patients, understanding specific test methodologies for opportunistic infections, or interpreting results in this patient group?
- Consider how this experience contributes to your overall development as a Healthcare Scientist in Microbiology and your ability to be entrusted with this ETA with indirect supervision.
Beyond action
- Have you reviewed your previous reflections from earlier instances of undertaking this training activity?
- What specific actions did you previously identify you would need to take to improve your practice in selecting diagnostic testing for immunosuppressed patients?
- Have you completed these identified actions in subsequent instances of undertaking this training activity? Are you now ready to demonstrate this new learning in practice?
- Have you discussed specific cases where you had to select diagnostic testing for immunosuppressed patients with your Training Officer, consultant colleagues, or peers?
- Consider if your view of the situation, your approach to test selection, or your understanding of the clinical context of immunosuppression has changed because of analysing this with others. Remember that a mutual exchange of experiences can lead to transformation.
- How has your approach to selecting appropriate diagnostic testing for patients about to undergo significant immunosuppression become more efficient, accurate, or confident as a result of your cumulative experiences with this training activity?
- Have your experiences helped you better integrate knowledge of specific pathogens and relevant diagnostic methods with the clinical context of different types of immunosuppression (e.g., malignancies, transplants)?
- ow has your ability to identify situations where you need to seek advice or clarification regarding test selection or interpretation for immunosuppressed patients improved over time?
- What skills, such as clinical reasoning, integrating knowledge from different sources, understanding the impact of immunosuppression on infection risk, and selecting appropriate laboratory investigations, have been strengthened through your repeated engagement with this training activity?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Select appropriate diagnostic testing for a patient about to undergo significant immunosuppression |