Prenatal Genomics —
Training activity: 10

Details

Participate in service delivery for prenatal 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.

Considerations

• Service delivery pathways
• Best practice guidelines
• Local and national guidance
• Test directory
• Service management
• Duty scientist role
• Service costing
• Troubleshooting
• Communication with other healthcare professionals
• Quality management

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: to actively participate in aspects of service delivery for prenatal genomics, demonstrating an understanding of the service workflow and contributing effectively.
• Consider how the learning outcomes apply, specifically related to employing specialist knowledge to deliver a safe and high quality prenatal genomic service.
• What does active participation look like, e.g., demonstrating adherence to turnaround times and contributing effectively to quality management procedures (like EQA schemes) and laboratory workflows?
• Discuss with your training officer the specific areas of service delivery you will be involved in and what level of participation is expected.

What is your prior experience of this activity?

• Think about what you already know about the typical workflow of a prenatal genomic testing laboratory, including sample processing, testing pipelines, and reporting processes.
• Consider possible challenges you might face, and think about how you might handle them, e.g., managing urgent samples, understanding the roles and responsibilities of different staff, or appreciating the critical importance of turnaround times.
• 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, e.g., regarding urgent samples, complex service queries, or when to escalate issues.
• Acknowledge how you feel about embarking on this training activity, about participating directly in the day-to-day delivery of a clinical service.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop – drawing upon previous experiences of similar activities, e.g., practical skills related to service workflow (sample handling, data entry, quality checks) and communication skills with clinical teams involved in the prenatal pathway.
• Identify specific insights you hope to gain from engaging with the activity, e.g., a comprehensive understanding of the prenatal patient pathway from referral to report, and the logistical challenges of delivering a timely and reliable service.

What additional considerations do you need to make?

• Consult actions identified following previous experience participating in service delivery in other laboratory or clinical areas.
• Identify important information you need to consider before embarking on the activity, e.g., reviewing Standard Operating Procedures (SOPs) for relevant service processes, understanding Key Performance Indicators (KPIs) for the service, and familiarising yourself with the structure of relevant clinical meetings (e.g., MDT).

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst participating in prenatal genomics service delivery?
• Are you encountering situations such as:
  • An unexpected sample issue (e.g., poor quality, labelling error, or contamination) that immediately impacts the required turnaround time.
  • An urgent clinical request (e.g., for rapid aneuploidy testing) arriving that requires immediate and significant prioritization, disrupting the planned workflow.
  • A communication barrier or complex query from a midwife or clinician regarding turnaround times, sample requirements, or testing limitations 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., a sample problem or reporting delay) to a senior member of staff or supervisor.
  • Seeking immediate advice or support regarding a complex query or an urgent request to ensure timely action and adherence to protocols.
  • Are you adapting task prioritisation to ensure adherence to critical turnaround time targets for prenatal cases?
• 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 effectively to the smooth operation of the prenatal 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 while ensuring adherence to standard operating procedures (SOPs)? Or are you needing support because the issue requires senior management intervention or specialist troubleshooting (e.g., escalating a complex query regarding consent or safeguarding)?
• What are you learning as a result of the unexpected development? For example, are you learning an improved workflow for managing urgent prenatal sample requests, or gaining insight into the critical importance of quality management procedures (e.g., External Quality Assurance) in maintaining a safe service?

 

On action

What happened?

• Begin by summarising the key points of the experience of participating in prenatal service delivery, e.g., participation in sample processing, quality management procedures, or observing clinical MDT discussions.
• Consider specific events, actions, or interactions which felt important during the service delivery, such as the roles of different team members in the overall service pathway or key challenges that became apparent in the workflow.
• Include any ‘reflect-in-action’ moments, where you adapted to the situation as it unfolded, for instance, rapidly prioritising an urgent prenatal sample or troubleshooting a workflow bottleneck. 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 service delivery, e.g., gaining a comprehensive understanding of the prenatal patient pathway from referral to follow-up.
• What strengths did you demonstrate e.g., effective teamwork, adherence to quality control procedures? What skills and/or knowledge gaps were evident e.g., unfamiliarity with specific operational procedures or challenges in managing urgency?
• Compare this experience against previous service delivery activities – were any previously identified actions for development achieved? Has your practice in contributing to the service improved?
• Identify any challenges you experienced, e.g., managing urgency and adhering to strict turnaround times for prenatal cases, and how you reacted to these. Were you able to overcome the challenges?
• Identify anything significant about the activity, such as escalating a critical quality issue or seeking advice on procedures for handling urgent results, to ensure you were working within your scope of practice.
• Acknowledge any changes in your own feelings now you are looking back on the experience.

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, e.g., applying understanding of service workflow to daily tasks or learning more about specific areas like External Quality Assurance (EQA) schemes.
• What will you do differently next time you participate in service delivery, e.g., proactively reviewing SOPs for urgent sample handling prior to starting work? 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, e.g., contributing to continuous improvement initiatives or reviewing procedures for consent and safeguarding?

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 the Key Performance Indicators (KPIs) for the service, 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., managing urgent clinical requests or dealing with bottlenecks. How do your current observations of the service workflow e.g., from observing sample processing compared to your initial understanding of the service flow and complexities?
• Compare this experience with participating in service delivery in other specialties. What observable professional practices (e.g., rapid communication or escalation protocols) have you assimilated into your approach to prenatal service delivery?

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 prenatal investigation’.
• How has your understanding of the broader operational aspects of the prenatal service pathway evolved from your initial participation? How does this holistic view of the service influence your current daily tasks and interactions with colleagues from different parts of the pathway (e.g., clinical, administrative, lab)?
• How has this experience contributed to your ability to employ specialist knowledge to deliver a safe and high quality prenatal genomic service? For example, can you identify specific instances where your understanding of service urgency supported you in prioritising testing for a screen-positive case?
• What transferable skills e.g., understanding workflows, teamwork, problem-solving within a service context are you developing that will be valuable for your future practice in service improvement or leadership? For example, how will your foundational understanding help you contribute to the implementation of new tests not yet formally adopted in the UK?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply appropriate testing strategies to patients referred for increased screening risk.
# 2	Outcome Apply appropriate testing strategies to patients referred following abnormal ultrasound scan findings.
# 3	Outcome Apply appropriate testing strategies to patients with a family history of a genetic disorder.
# 6	Outcome Interpret and report prenatal genomic findings, including appropriate recommendations for patient management.
# 7	Outcome Employ specialist knowledge of prenatal genomics to deliver a safe and high quality prenatal genomic service.