Paediatric Genomics —
Training activity: 10

Details

Participate in service delivery for paediatric services

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 participating in service delivery in paediatric genomics.
• Consider how the learning outcomes apply, considering those which cover applying testing strategies, performing analysis, interpreting variants and results, reporting, and employing specialist knowledge to deliver a safe and high-quality service.
• What does active participation in the paediatric genomics service look like, contributing to your understanding of applying genomic testing and interpreting results for paediatric patients?
• Discuss with your training officer to gain clarity on the expectations for your involvement in service delivery.

What is your prior experience of this activity?

• Think about what you already know about participating in routine laboratory service delivery, especially in a clinical genomics setting.
• Consider possible challenges you might face during the activity, such as managing workload, adhering to turnaround times, troubleshooting issues, or communicating with colleagues, and think about how you might plan to handle them.
• Recognise the scope of your own practice within the service and know when you need to seek advice or escalate issues.
• Acknowledge how you feel about having the responsibility for routine laboratory service delivery

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to contributing effectively to a clinical laboratory service, such as workflow management, attention to detail, and adherence to quality procedures.
• Identify specific insights you hope to gain into the practical aspects of delivering a timely, safe, and high-quality paediatric genomics service and the importance of integrated working between the laboratory and clinical teams.

What additional considerations do you need to make?

• Consult actions identified following previous experience of similar activities.
• Identify important information you need to consider before embarking on the activity, such as the key components and workflows of the paediatric genomics service including sample reception, processing, testing pipelines, and reporting.
• You should also review relevant quality management procedures e.g., internal quality control and external quality assurance, turnaround time targets, procedures for handling urgent results, and considerations for consent and safeguarding children / young people.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate while participating in paediatric genomics service delivery?
• Are you encountering situations such as:
  • An unexpected sample issue or a bottleneck arising in the workflow e.g., a delay in processing, equipment malfunction that immediately impacts the required turnaround time?
  • An urgent clinical request from a paediatrician or clinical geneticist requiring immediate prioritisation and adaptation of the standard workflow?
  • A communication barrier or complex query from a clinical colleague regarding the specifics of a test or a result that necessitates immediate problem-solving?

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 task prioritisation or problem-solving?
• Consider the steps you are taking in the moment, such as:
  • Immediately addressing or escalating the service delivery issue (e.g., sample problem or reporting delay) to a senior member of staff?
  • Seeking immediate advice or support regarding a complex query or an urgent request from a clinician?
  • Are you ensuring that your immediate actions are aligned with the standard operating procedures and the quality management system of the service?
• How are you feeling in that moment? For instance, are you finding it difficult to prioritise tasks under pressure? Is it affecting your ability to contribute to the smooth operation of the paediatric genetic testing pathway?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the operational issue, or needing support because the issue requires senior management or engineering intervention, meaning it is beyond your current scope?
• What are you learning as a result of the unexpected development? For example, are you learning an improved workflow for managing urgent paediatric sample requests, or gaining insight into the essential importance of cross-specialty communication in maintaining service quality?

On action

What happened?

• Begin by summarising the key points of the experience of participating in paediatric genomics service delivery.
• Consider specific events, actions, or interactions which felt important, such as managing sample workflows, adhering to quality control procedures, or communicating with clinicians regarding turnaround times.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately addressing or escalating a bottleneck in the workflow or rapidly prioritising an urgent clinical request. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the overall process of paediatric genomic testing, integrated working, and service delivery.
• What strengths did you demonstrate e.g., systematic approach to tasks, attention to quality? What skills and/or knowledge gaps were evident e.g., unfamiliarity with specific roles within the team or challenges in managing unexpected workload?
• Compare this experience against previous service delivery activities – were any previous identified actions for development achieved? Has your practice in contributing to the service improved?
• Identify any challenges you experienced e.g., technical troubleshooting during high volume periods or communication barriers with clinical staff and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
• Identify anything significant about the activity, such as needing to seek advice or clarification on standard operating procedures, or needing to escalate a quality issue to ensure that you were working within your scope of practice.
• Acknowledge any changes in your own feelings in relation to your ability to participate in service delivery specifically for paediatric services.

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 regarding your ability to participate in service delivery for paediatric services.
• What will you do differently next time you participate in service delivery to enhance efficiency or quality? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as exploring specific areas of the service or contributing to continuous improvement initiatives?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific actions did you previously identify you would need to take to improve your practice related to contributing to a high-quality service?
• Have you completed these previously identified actions? For example, if you planned to review relevant quality management procedures e.g., internal quality control and external quality assurance, how did completing this action impact your contribution to the operational flow of the service?
• Engage in professional storytelling with peers, near peers, or colleagues about service delivery challenges e.g., urgent clinical requests, managing bottlenecks. How do your initial observations during service delivery compare to your current understanding of the flow and complexities of the service, including turnaround time?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on service delivery will support you in preparing for observed ‘in-person’ assessments for the module, such as the Observed Communication Event (OCE) titled ‘Provide advice to another healthcare professional on the requirements for a sample for paediatric investigation’.
• How has your practice related to professional conduct and service management developed and evolved over time? For example, how has this experience contributed to your understanding of delivering a safe and high-quality paediatric genomic service, including concepts like consent and safeguarding children and young people?
• What transferable skills related to teamwork, communication, or operational awareness did you develop through participating in-service delivery, and how will this help you contribute to service improvement and innovation in the future?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply appropriate testing strategies to patients referred for paediatric disorders.
# 2	Outcome Perform targeted analysis for patients referred with paediatric conditions.
# 3	Outcome Perform whole genome analysis for patients referred for paediatric disorders.
# 4	Outcome Interpret genomic variants, including copy number changes, and investigate the clinical significance of variants using bioinformatic tools using best practice guidelines.
# 5	Outcome Interpret and report genomic testing relevant to paediatric conditions, including appropriate recommendations for patient management.
# 6	Outcome Employ specialist knowledge of paediatric genomics to deliver a safe and high quality paediatric genomic service.