Training activity information
Details
Select the correct genetic tests for patients referred with germline cancer susceptibility, to include:
- Breast/ovarian
- Lynch syndrome
- FAP
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 learning outcomes related to this activity. What specific knowledge or skills are you expected to demonstrate by selecting the correct genetic tests for conditions like breast/ovarian, Lynch syndrome, and FAP?
- What constitutes ‘correct’ test selection in the context of germline cancer susceptibility? What are the key considerations e.g., specific genes, testing methodologies, clinical criteria that define a successful choice?
- How does selecting the correct tests contribute to the diagnosis and management pathway for patients with inherited cancer risk, as per the module aim?
- Discuss with your training officer to clarify what is specifically expected of you for this activity.
What is your prior experience of this activity?
- Think about what you already know about selecting genetic tests for germline cancer susceptibility conditions. Have you encountered referrals for breast/ovarian, Lynch, or FAP testing before?
- Consider possible challenges you might face when selecting tests for these types of referrals e.g., complex family histories, identifying the most appropriate panel, understanding turnaround times, and think about how you might handle them.
- Recognise the scope of your own practice for this activity. Do you know when and from whom you will need to seek advice or help e.g., from a clinical scientist, genetic counsellor, or consultant clinical geneticist, particularly for complex cases or where guidelines are ambiguous?
- Acknowledge how you feel about embarking on this training activity. Are you feeling confident, nervous, or curious?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop or refine during this activity, drawing upon previous experiences. This might include skills related to test selection for germline cancer susceptibility.
- Identify specific insights you hope to gain into the factors influencing test choice for conditions like breast/ovarian, Lynch syndrome, and FAP.
- How do you think this activity will help you better understand the application of genetic testing for germline susceptibility as highlighted in the module aim?
What additional considerations do you need to make?
- Consult actions you identified following previous experiences that are relevant to test selection for germline conditions. What did you plan to do differently next time?
- Identify important information you need to consider before selecting the test. This might include detailed clinical information, family history, previous genetic testing results in the family, or specific referral questions.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while selecting the genetic tests for these germline cancer susceptibility referrals (Breast/ovarian, Lynch syndrome, FAP)?
- Are you encountering situations such as:
- Incomplete clinical information or complex family history that makes it difficult to narrow down the most appropriate specific genes, panels, or methodologies for the suspected germline syndrome?
- An unexpected presentation requiring you to differentiate between syndromes with overlapping features (e.g., Lynch vs. FAP) in the moment?
- The test you intended to select proving to be unavailable within current laboratory resources, necessitating immediate substitution?
- How is this selection process comparing with previous experiences of similar activities, such as test selection in other modules?
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to the selection process in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately consulting testing algorithms or local policies to resolve ambiguity regarding specific germline cancer syndromes (Breast/ovarian, Lynch syndrome, FAP).
- Modifying your plan to consider alternative testing strategies, like broader panel testing or sequential testing, if the initial clinical picture is unclear.
- Seeking immediate support or guidance from a senior colleague or clinical geneticist regarding the most appropriate test selection for a specific complex family history.
- How are you feeling in that moment? For instance, is the challenge affecting your confidence in justifying the chosen test type? Are you finding it difficult to adapt your knowledge of clinical criteria to the information at hand? 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 when selecting the test e.g., successfully prioritising clinical urgency while escalating uncertainty regarding diagnosis to a clinical geneticist.
- What are you learning as a result of the unexpected development? For example, are you learning a more effective technique for quickly cross-referencing clinical presentations with specific guidelines for Breast/ovarian, Lynch, or FAP, or gaining crucial insight into resource constraints?
On action
What happened?
- Begin by summarising the key points of the experience, detailing the key referral reasons for the germline cancer susceptibility cases you considered e.g., personal history or specific family history.
- Consider specific events, actions or interactions which felt important, such as the range of genetic tests you considered for Breast/ovarian, Lynch syndrome, and FAP, and any specific clinical details or family history aspects that significantly influenced your test selection.
- Include any ‘reflect-in-action’ moments, where you adapted to the situation as it unfolded, such as when your initial thoughts on test selection changed based on further information or analysis. 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 improve your understanding of the appropriate genetic tests for inherited cancer susceptibility syndromes like Breast/ovarian, Lynch syndrome, and FAP?
- What strengths did you demonstrate e.g., adherence to protocols, efficient retrieval of guideline information? What skills and/or knowledge gaps were evident e.g., understanding the specific indications for different genetic tests or testing panels in these conditions?
- Compare this experience against previous engagement with similar activities. Was your previous identified action for development achieved? Has your practice in test selection for germline conditions improved?
- Identify any challenges you experienced e.g., managing complex family histories and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Acknowledge anything significant about the activity, such as how selecting appropriate tests for germline cancer susceptibility relates to the requirements for post-programme practice as a Clinical Scientist.
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 ability in selecting the correct genetic tests in the context of this training activity.
- What resources or guidelines e.g., national/international guidance will you consult in the future when selecting genetic tests for germline cancer susceptibility? What will you do differently next time?
- Are there any specific areas of genetic testing for Breast/ovarian, Lynch syndrome, FAP, or other germline cancer syndromes that you need to explore further?
- How will you ensure you stay up to date with the evolving landscape of genetic testing in this area?
Beyond action
Have you revisited the experiences?
- Revisit your previous reflections for this specific training activity. Have you looked back at your past test selections for Breast/ovarian, Lynch syndrome, or FAP cases and evaluated how your approach now compares to your initial decisions?
- Have discussions with colleagues or clinical teams about challenging cases influenced your understanding of appropriate test selection?
- Compare this experience to other related training activities within the S-G-S4 module or other modules. What overlapping skills or considerations are there? For example, how does selecting tests for germline susceptibility compare to selecting tests for acquired malignancies?
- 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 have your multiple experiences selecting tests for these specific germline syndromes improved your efficiency and accuracy in your current work?
- How has your improved understanding of the clinical implications of selecting the correct test improved your ability to identify appropriate referrals in your current practice?
- Consider how the accumulated learning from this training activity supports you in preparing for observed assessments for the module, such as a DOPS titled ‘Identify if a referral is appropriate for the testing required’.
- How does your cumulative experience here help you to scope tests for less common germline syndromes?
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. |