Cancer —
Training activity: 10

Details

Prepare a case study for an investigation that requires the integration of both somatic and germline molecular laboratory results from different technologies for full interpretation such as immunohistochemistry (IHC), microsatellite instability (MSI), methylation, sequence analysis).

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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 are the intended outcomes of the training activity?

• How do you plan to apply your integrative knowledge of diverse laboratory techniques (such as IHC, MSI, methylation, and sequence analysis) to build a comprehensive clinical picture for this case study?
• What specific methods will you use to demonstrate appropriate communication skills, ensuring that the complex relationship between somatic (acquired) and germline findings is presented clearly to your healthcare professional colleagues?
• What foundational knowledge regarding the biological mechanisms of cancer (e.g., mismatch repair pathways or the “two-hit” hypothesis) and current testing guidelines do you need to acquire before embarking on this activity?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the correlation of different test results—for instance, how a loss of IHC expression might be explained by either a germline mutation or somatic promoter methylation?
• Thinking about what you already know, which aspects of integrating these distinct techniques do you find most challenging or interesting to explore (e.g., navigating discordant results or determining the next logical testing step)?

What actions will you take in preparation for the experience?

• What challenges do you anticipate (e.g., missing clinical history, managing cases where no clear cause is found, or explaining the clinical implications for family members), and how have you planned to handle them?
• How do you feel about embarking on this training activity, considering the technical complexity and the critical role these integrated findings play in accurate diagnosis and patient management?

In action

What are you doing?

• How are you currently approaching the integration of diverse data types (e.g., IHC, MSI, methylation, and sequencing) for this case study, and why have you chosen this specific logical flow?
• What decisions are you making as the case preparation progresses regarding which specific results are most critical to highlight for a comprehensive cancer investigation?
• Which parts of the correlation between acquired and germline findings feel intuitive, and where are you finding you need more conscious effort to ensure technical accuracy?

How are you progressing with the activity?

• How effective is your current method of synthesising these multiple techniques into a single, cohesive case narrative?
• What challenges are you facing right now—such as interpreting discordant results between IHC and sequence analysis—and how are you learning from them as the case unfolds?
• How does this specific task of cross-technique integration connect to your existing knowledge of molecular biology and cancer genetics?

How are you adapting to the situation?

• Are there alternative ways to present this complex data —such as diagrams or tables—that you should consider to make the results clearer for your colleagues?
• What technical or clinical guidance do you need in this moment to resolve ambiguities in the methylation or MSI data before finalizing the case study?
• How are you ensuring that your interpretation of the results and their clinical implications remains strictly within your professional scope of practice?

On action

What are you doing?

• How are you currently approaching the integration of diverse data types (e.g., IHC, MSI, methylation, and sequencing) for this case study, and why have you chosen this specific logical flow?
• What decisions are you making as the case preparation progresses regarding which specific results are most critical to highlight for a comprehensive cancer investigation?
• Which parts of the correlation between acquired and germline findings feel intuitive, and where are you finding you need more conscious effort to ensure technical accuracy?

How are you progressing with the activity?

• How effective is your current method of synthesising these multiple techniques into a single, cohesive case narrative?
• What challenges are you facing right now—such as interpreting discordant results between IHC and sequence analysis—and how are you learning from them as the case unfolds?
• How does this specific task of cross-technique integration connect to your existing knowledge of molecular biology and cancer genetics?

How are you adapting to the situation?

• Are there alternative ways to present this complex data —such as diagrams or tables—that you should consider to make the results clearer for your colleagues?
• What technical or clinical guidance do you need in this moment to resolve ambiguities in the methylation or MSI data before finalizing the case study?
• How are you ensuring that your interpretation of the results and their clinical implications remains strictly within your professional scope of practice?

Beyond action

How have these experiences impacted upon your current practice?

• How has the integrative knowledge gained from this case study supported your ability to solve problems in other training activities, such as interpreting complex gene panels or large rearrangement data?
• In what ways are you now applying the communication and presentation skills developed during this activity to your daily interactions within the multidisciplinary team (MDT)?
• How has the experience of synthesising somatic and germline findings since the original activity influenced your wider practice in precision oncology?
• How is the learning from this integrated case study helping you prepare for upcoming in-person assessments, such as Case-based Discussions (CBDs) or Observed Communication Events (OCEs)?

How might these experiences contribute towards your future practice?

• What transferable skills—such as the ability to reconcile disparate technical data into a single clinical narrative—will be most valuable as you progress toward becoming a Clinical Scientist?
• How will the principles of cross-modality integration learned here help you adapt to future advancements, such as the implementation of whole-genome sequencing or new functional assays?
• What clear actions have you identified to continue developing your expertise in the molecular investigation of cancer, ensuring you remain at the forefront of genomic medicine?

Relevant learning outcomes

#	Outcome
# 4	Outcome Apply integrative knowledge of laboratory techniques applied to the investigation of cases referred for cancer.
# 5	Outcome Demonstrate appropriate communication skills to present the results of investigations into acquired and germline cancer cases clearly to healthcare professional colleagues.