Cancer —
Training activity: 3

Details

Select, analyse, interpret and report the appropriate genomic testing for acquired Colorectal Cancer (CRC).

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?

• Do you have a clear understanding of how to select the appropriate laboratory testing strategy for acquired CRC (e.g., NGS panels for RAS/BRAF, MMR/MSI testing) and the requirements for analysing, interpreting, and reporting these results for acquired cancer patients?
• How will you apply your integrative knowledge of different laboratory techniques (such as immunohistochemistry, PCR-based assays, or large-scale sequencing) to investigate these cases?
• What steps will you take to ensure you can demonstrate appropriate communication skills to present CRC investigation results clearly and effectively to your healthcare professional colleagues?
• What foundational knowledge regarding CRC molecular pathways 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 clinical significance of variants found in CRC?
• Thinking about what you already know, which aspects of CRC genomic analysis or the integration of multi-modal data do you find most challenging or interesting to explore further?

What actions will you take in preparation for the experience?

• How will you gain clarity on the local CRC testing pathway and the expectations for your case presentations?
• What challenges do you anticipate (e.g., interpreting variants of uncertain significance, managing poor-quality tissue samples, or explaining discordant results), and how have you planned to handle them?
• How do you feel about embarking on this activity, considering the direct impact that rapid and accurate genomic profiling has on the personalised treatment journey for CRC patients?

In action

What are you doing?

• How are you currently approaching the selection and analysis of genomic tests for CRC (e.g., NGS panels for RAS/BRAF, MMR/MSI testing), and what real-time decisions are you making to ensure the testing strategy matches the clinical referral?
• Which aspects of the CRC genomic analysis feel intuitive, and where are you consciously relying on specific guidelines or protocols (such as those for anti-EGFR therapy eligibility or Lynch syndrome screening) right now?

How are you progressing with the activity?

• How effective are your actions in achieving the genomic profiling of the case, and what technical challenges—such as poor-quality tissue samples or variants of uncertain significance (VUS)—are you encountering?
• How are you applying integrative knowledge of different laboratory techniques (e.g., IHC, PCR, and sequencing) as the data unfolds to ensure a comprehensive investigation of the acquired CRC?

How are you adapting to the situation?

• What immediate support or alternative methodologies do you need to resolve ambiguous genomic results or discordant data as they arise?
• How are you ensuring your communication of these findings to healthcare colleagues is clear, accurate, and remains within your professional scope of practice?

On action

What did you notice?

• Summarise the key points of the CRC referral and the specific laboratory testing strategy (e.g., NGS panels, MMR immunohistochemistry, or MSI by PCR) you selected to investigate the case.
• What were the primary genomic findings (such as RAS/BRAF mutations or mismatch repair status), and were there any clinical details or sample quality issues that significantly influenced your final analysis?

What did you learn from the activity?

• How did you improve your ability to integrate knowledge across different techniques (e.g., molecular sequencing and pathology results) to provide a comprehensive interpretation for the diagnosis or treatment of acquired quired cancer?
• What insights did you gain from managing technical challenges—such as low neoplastic cell content or interpreting variants of uncertain significance—and how did your reflection-in-action influence the final reporting of the case?

What will you take from the experience moving forward?

• How will you apply the learning from this activity to your routine practice to ensure CRC results are communicated clearly and accurately to healthcare colleagues?
• What specific next steps or resources (e.g., updated therapeutic guidelines or senior consultation) have you identified to further develop your skills in presenting complex genomic investigations within a multidisciplinary context?

Beyond action

Have you revisited the experiences?

• How has your perspective on selecting CRC testing strategies (e.g., NGS panels vs. MSI by PCR) evolved as you have gained more experience with other acquired cancer referrals?
• Have discussions with peers changed how you view your earlier interpretations of complex CRC cases, such as those involving low neoplastic content or discordant MMR/MSI results?
• Compare this experience with your Observed Training Activities—what specific laboratory behaviours or analytical practices have you now assimilated into your routine CRC workflow?

How have these experiences impacted upon your current practice?

• How has your integrative knowledge of CRC biomarkers (e.g., RAS, BRAF, and mismatch repair status) informed your current problem-solving when investigating other solid tumour types?
• In what ways are you now applying the communication and presentation skills developed during this activity to your wider interactions with clinical colleagues and the multidisciplinary team (MDT)?
• How is the learning from these CRC cases helping you prepare for upcoming Case-based Discussions or other in-person assessments for this module?

How might these experiences contribute towards your future practice?

• What transferable skills—such as translating complex genomic data into clear clinical reports or identifying actionable targets—will be most valuable as you progress toward becoming a Clinical Scientist?
• How will the principles learned here help you adapt to future advancements in CRC diagnostics, such as the increasing use of liquid biopsies or expanded gene panels?
• What clear actions have you identified to continue developing your expertise in precision oncology and the molecular investigation of acquired cancers?

Relevant learning outcomes

#	Outcome
# 1	Outcome Select the laboratory testing strategy, analyse, interpret and report tests for patients referred with acquired cancer.
# 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.