Cancer —
Training activity: 20

Details

Participate in service delivery for the germline cancer service

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?

• Review the learning outcomes in the context of participating in germline cancer service delivery. What specific aspects of the service are you expected to engage with and learn about e.g., sample pathways, testing processes, reporting routes, interactions with clinical teams or MDTs?
• What constitutes successful participation in service delivery? Is it about observing, understanding workflows, identifying potential improvements, or actively contributing to tasks within your scope?
• How does gaining an understanding of service delivery contribute to your overall knowledge of the role and application of genetic testing for germline susceptibility, as highlighted in the module aim?
• Discuss with your training officer to clarify what your specific role and responsibilities will be during this participation and what you are expected to achieve.

What is your prior experience of this activity?

• Think about what you already know about the workflows and processes within your germline cancer genetic testing service. Have you had any previous exposure to or participation in laboratory or clinical service delivery processes?
• Consider possible challenges you might anticipate e.g., understanding complex workflows, managing workload, interacting with different teams, and think about how you might plan to navigate these.
• Recognise the scope of your own practice within the service. Do you know which tasks you are permitted to undertake independently and when and from whom you will need to seek advice or help regarding service processes or patient-specific queries?
• Acknowledge how you feel about embarking on this training activity. Are you looking forward to gaining a broader perspective, or do you feel apprehensive about stepping outside your usual tasks?

What do you anticipate you will learn from the experience?

• Drawing upon previous experiences, what specific skills related to understanding and contributing to service delivery do you want to develop or refine?
• What specific insights do you hope to gain into the practicalities, challenges, and interdependencies involved in providing a high-quality germline cancer genetic service? This might include understanding turnaround time targets, sample logistics, or communication with clinical teams.
• How do you think this activity will enhance your understanding of the partnership between genetics services and other clinical specialisms in the cancer patient’s care pathways?

What additional considerations do you need to make?

• Consult actions you identified following previous experiences related to service delivery or working in multidisciplinary teams. What aspects of service function or inter-team communication did you previously identify as areas for learning?
• Identify important information you need to know or access before participating in service delivery. This might include relevant Standard Operating Procedures (SOPs), key contacts in different sections of the lab or clinical service, and information on quality metrics or service audits.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate while involved in the germline cancer service delivery (e.g., workflow management, logistics, patient interactions)?
• Are you encountering situations such as:
  • An urgent request for processing or information that significantly conflicts with the planned workflow or staffing levels?
  • Unexpected sample issues (e.g., contamination) requiring immediate intervention and troubleshooting outside of routine procedure?
  • A breakdown in communication or an IT system problem that causes a bottleneck in the testing pathway.
• How is this participation in service delivery comparing with previous experiences of similar activities, such as service participation in other modules?

How are you reacting to the unexpected development?

• How is this impacting your actions? Are you adjusting or adapting your prioritisation or communication strategy in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately escalating a bottleneck or equipment malfunction to the relevant senior member of staff or engineering department.
  • Changing your prioritisation of tasks based on the urgency of an unexpected clinical request, ensuring adherence to quality management and confidentiality requirements.
  • Consulting relevant Standard Operating Procedures (SOPs) to ensure actions regarding sample rejection or handling are compliant.
• How are you feeling in that moment? Is the unexpected urgency affecting your confidence in ensuring actions are aligned with protocols and maintaining the required turnaround time? Are you finding it difficult to adapt your established task list? Do you feel positive you could reach a successful conclusion?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice e.g., successfully handling minor issues but knowing when to escalate a major equipment fault or complex sample issue.
• What are you learning as a result of the unexpected development? For example, are you gaining crucial insight into the importance of clear coordination among scientists, administrators, and clinical teams, or mastering an effective workflow for handling and escalating urgent requests within the germline cancer service?

On action

What happened?

• Begin by summarising the key points of the experience, detailing the key activities involved in the germline cancer service delivery that you participated in e.g., sample reception, testing workflow, reporting, multidisciplinary team meetings.
• Consider specific events, actions or interactions which felt important, such as how different members of the team e.g., scientists, genetic counsellors, clinicians, admin staff contributed to the service.
• Include any ‘reflect-in-action’ moments, where you adapted to the situation as it unfolded, such as key challenges and workflows within the germline cancer service e.g., turnaround times, managing referrals, liaising with other specialties. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from the experience. Did you gain a better understanding of the overall process of germline cancer genetic testing, from referral to reporting and follow-up?
• What strengths did you demonstrate e.g., adherence to SOPs, clear communication with colleagues? What skills and/or knowledge gaps were evident e.g., understanding the roles and responsibilities of different healthcare professionals involved in the service delivery and patient care pathway?
• Compare this experience against previous engagement with similar activities. How did participating in service delivery contribute to your developing practice and understanding of your specialty’s impact on patient care?
• Identify any challenges you experienced e.g., managing turnaround times and how you reacted to these. Were you able to overcome the challenges?
• Acknowledge anything significant about the activity, such as how laboratory practice integrates with the broader clinical care pathway for germline cancer patients, including consent and follow-up management.

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 learned, including incorporating any feedback received about your participation in service delivery for the germline cancer service.
• How will you apply your understanding of the germline cancer service and its workflows to your daily work and future practice? What will you do differently next time?
• What areas of the service delivery e.g., specific laboratory sections, clinical interactions, patient pathway stages would you like to learn more about?
• How can you contribute to the continuous improvement of the germline cancer service within your role?

Beyond action

Have you revisited the experiences?

• Revisit your previous reflections for this specific training activity. Reflecting on your past participation in different aspects of the germline cancer service (e.g., sample handling, data flow, MDT interactions), how has your understanding of the overall workflow and the roles of different team members deepened?
• Have specific challenges or successes you witnessed influenced your perspective on service efficiency or patient care pathways?
• Compare this experience to other related training activities. For example, how does your experience here compare to participating in the somatic cancer service? What are the differences in workflow or patient pathway considerations e.g., consent for germline testing?
• Have you reviewed the actions for improvement you identified previously? Have you completed these actions, and are you ready to demonstrate this new learning in practice?

How have these experiences impacted upon current practice?

• How has your understanding of the end-to-end service delivery for germline cancer patients informed your approach to your specific tasks within the laboratory?
• Has this holistic view helped you appreciate the importance of accuracy, turnaround time, and communication in impacting patient care?
• How does your participation contribute to your broader understanding of your specialty’s impact on patient care?
• Consider how the accumulated learning from this training activity supports you in preparing for observed assessments for the module, such as an Observed Communication Event (OCE) related to communication or service interaction.

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply appropriate sample selection criteria for the commonly referred cancer samples, taking into account the implications of the referral with respect to sample type, sampling mixed cell populations, limits of detection, sensitivity of assay and patient management.
# 2	Outcome Select the laboratory testing strategy for the commonly referred cancer samples at all stages of the patient pathway.
# 5	Outcome Analyse, interpret and report tests for patients referred with germline cancer.
# 6	Outcome Analyse, interpret and report pharmacogenetic testing in oncology patients.