Cancer —
Training activity: 9

Details

Prepare a CML case study for investigations that require the integration of laboratory results from different technologies such as morphology, flow cytometry, karyotyping and FISH for full interpretation.

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 integrative knowledge to synthesise findings from Morphology, IHC, Flow Cytometry, and Karyotyping/FISH into a single, cohesive interpretation of a CML case?
• What specific communication strategies will you employ to ensure the complex laboratory data is presented clearly and accurately to your healthcare professional colleagues?
• What do you need to know before embarking on this activity, such as the specific diagnostic criteria for CML phases (Chronic, Accelerated, Blast) or the technical strengths and limitations of Karyotyping versus FISH?
• How have ensured your case preparation focuses on the most clinically relevant aspects of a cancer investigation?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding how these different laboratory modalities complement each other (e.g., how Karyotyping identifies the Philadelphia chromosome while Flow Cytometry or Morphology determines the disease phase)?
• Think about what you already know about CML diagnostics and identifying the BCR::ABL1 translocation; which parts of the integration process do you anticipate will be the most complex to explain?

What actions will you take in preparation for the experience?

• What challenges do you anticipate when trying to present discordant or complex data (e.g., a case with variant translocations or additional cytogenetic abnormalities) and how have you planned to handle them?
• Identify how you feel about presenting this case to your colleagues—do you feel confident in your ability to translate technical cytogenetic or flow data into clear clinical messages?

In action

What are you doing?

• How are you currently approaching the integration of Morphology, IHC, Flow Cytometry, and Karyotyping/FISH results for this case, and why have you chosen this specific logical sequence for your analysis?
• What real-time decisions are you making as the case study progresses regarding which data points (e.g., blast percentage or specific BCR::ABL1 signal patterns) are most critical for a full interpretation?
• Which parts of the multi-modal synthesis feel intuitive, and where are you finding you need to apply more conscious effort to ensure the findings from different techniques correlate accurately?

How are you progressing with the activity?

• How effective is your current method of synthesising these four laboratory modalities into a single, cohesive narrative for this CML patient?
• What challenges are you encountering in the moment—such as managing discordant data between morphology and flow cytometry—and how are you learning from these complexities as they unfold?
• How does this specific task of cross-technique integration connect to your existing knowledge of acquired cancer and cytogenetic abnormalities?

How are you adapting to the situation?

• Are there alternative ways to present this complex data —such as comparative tables or annotated images—that you should consider making the integrated results clearer for your healthcare professional colleagues?
• What technical or clinical guidance do you need right now to resolve ambiguities in the Karyotyping or FISH data before you complete the interpretation?
• How are you ensuring that your communication of these findings and their clinical implications remains strictly within your professional scope of practice?

On action

What did you notice?

• Summarise the key points of the CML case study you prepared, specifically detailing how you integrated findings from Morphology, IHC, Flow Cytometry, and Karyotyping/FISH to reach a comprehensive interpretation of the disease.
• What were the essential clinical and laboratory findings you identified as necessary to include in the case study to ensure a full investigation of the patient’s condition?

What did you learn from the activity?

• How has this experience improved your ability to apply integrative knowledge across multiple laboratory modalities to build a cohesive narrative for a CML diagnosis?
• What did you learn from any unexpected challenges or successes encountered while correlating disparate data sets, such as aligning blast percentages from morphology with flow cytometry or cytogenetic markers?
• In what ways did your reflection-in-action—the real-time decisions you made while synthesising the data—influence the final clarity and technical accuracy of the case study?
• How does the process of constructing this multi-modal case study relate to the requirements for your post-programme practice as a Clinical Scientist?

What will you take from the experience moving forward?

• What specific areas for continued development in the integration of haematological laboratory techniques have you identified as a result of this activity?
• How will you apply the communication and presentation skills developed here to ensure that complex, integrated CML results are presented clearly to your routine clinical colleagues?
• What next steps or actions—such as seeking specialist feedback or reviewing updated diagnostic guidelines—will you now take to support the assimilation of these integrative skills?
• What support or resources have you identified as necessary to further develop your expertise in the multi-modal investigation of acquired cancer?

Beyond action

Have you revisited the experiences?

• How has your perspective on integrating Morphology, IHC, Flow, and Karyotyping/FISH evolved as you have encountered a broader range of haematological malignancies beyond the initial CML case?
• Through discussions with peers or colleagues, have you gained new insights into how you communicated complex cytogenetic results (like variant translocations) and whether your view of the case has transformed after hearing their experiences?
• Comparing this experience with your Observed Training Activities (OTAs), what specific observable behaviours in case synthesis and multidisciplinary communication have you now fully assimilated into your routine practice?
• As part of a module review, how does revisiting this CML reflection help you identify patterns in how you approach cases that require the reconciliation of discordant technical data?

How have these experiences impacted upon your current practice?

• How has the integrative knowledge gained from this CML activity supported your ability to handle other training activities, such as writing formal reports or presenting at MDT meetings?
• In what ways have you developed your communication and presentation skills since the original experience, particularly when explaining the clinical significance of a BCR::ABL1 finding to non-genomic specialists?
• How has your wider practice been influenced by the lessons learned from this case regarding the limitations and strengths of different laboratory modalities?
• How is the learning from this integrated case study helping you prepare for your 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 synthesise disparate data types into a clear diagnostic narrative—are you continuing to develop as you move toward becoming a Clinical Scientist?
• What clear actions have you identified for the continued development of your expertise in myeloid diagnostics and the application of new laboratory techniques as they emerge?
• How will the principles of multi-modal integration learned here help you adapt to future advancements in genomic medicine and the evolving landscape of personalised cancer treatment?

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.