Non-Malignant Dissection Copy —
Training activity: 1

Details

Triage requests for non-malignant disease considering the clinical history and local laboratory policies

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.

Considerations

• Local SOPs
• Prioritisation of requests
• Specimen types and categorisation
• Diagnostic pathways and targets
• Criteria for sample analysis

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?

• Identify what is expected of you in relation to triaging non-malignant requests.
• Consider how the learning outcomes apply, specifically in relation to triaging specimens and interpreting clinical request forms to assess clinical urgency and suitability.
• Discuss with your training officer to gain clarity of what is expected of you in this specific triaging activity.

What is your prior experience of this activity?

• Think about what you already know about triaging requests or handling clinical history information.
• Consider possible challenges you might face during the activity, such as incomplete clinical histories or complex request forms, and think about how you might handle them.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer or a Senior Pathologist when required, for example:
  • When the clinical history is ambiguous and complicates the assessment of urgency, requiring clarification on priority
  • If a request form presents complex legal or consent issues that fall outside standard triaging protocols
  • If local laboratory policies do not clearly address a specific type of non-malignant request e.g., unusual research or audit requests
• Acknowledge how you feel about triaging requests in line with laboratory policies and procedures.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently reviewing clinical histories and applying local policies.
• Identify the specific insights you hope to gain into the process of triaging and its importance in patient care pathways.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reviewing request forms or triaging.
• Identify important information you need to consider before embarking on the activity, such as reviewing local laboratory policies for triaging.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing the clinical history or checking laboratory policies?
• Are you encountering situations such as:
  • Conflicting clinical history details that complicate the assessment of clinical urgency e.g., a simple skin biopsy request arrives with a note mentioning an unexpected history of a rapidly growing mass?
  • Incomplete or ambiguous request forms that require immediate verification of sample origin or patient identity, challenging the standard triaging workflow?
  • Specific local laboratory policies are difficult to apply to an unusual non-malignant specimen type, requiring interpretation outside of routine examples?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to prioritising specific clinical history details or policy application?
• Consider the steps you are taking in the moment, such as:
  • Immediately documenting the ambiguity and seeking advice from the Training Officer to verify the correct urgency assessment protocol?
  • Halting the triaging process until clarification on the request form is obtained from the submitting clinical area?
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your triaging strategy? Is it affecting your confidence in making an accurate decision about suitability?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the documentation issue yourself? Or are you needing support because the ambiguity requires senior clinical review?
• What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for prioritising critical patient safety information during triage? Or gaining insight into the nuances of policy application for non-standard requests?

On action

What happened?

• Begin by summarising the key steps you took when triaging this specific request.
• Consider specific events, actions, or interactions which felt important, such as how you weighed clinical urgency against local laboratory policy requirements.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately documenting and escalating when faced with conflicting clinical history details that complicated the urgency assessment. How did you feel during this experience, e.g., did you feel stressed or confident in your initial assessment?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding triaging. What strengths did you demonstrate, e.g., technical skills in policy application? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the correct protocol for non-standard or unusual requests?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in interpreting complex clinical request forms?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a questionable clinical urgency, and how you reacted to this.

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 learnt, including from any feedback you have received, with regards to your ability to effectively triage requests in line with local protocols.
• What will you do differently next time you approach triaging a similar request, for instance, by proactively checking local policy appendices for specific definitions of urgency before commencing triage on complex non-malignant requests?
• Do you need to practise any aspect of the activity further, such as reviewing specific clinical scenarios related to urgency assessment or key learning outcomes related to assessing suitability?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences triaging different specimens or encountering more complex clinical histories since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent complex non-malignant request (e.g., highly specific inflammatory disorder) was initially misclassified as routine, forced you to re-evaluate the depth of clinical history review you applied during your first attempt at this training activity.
• Considering what you understand about local laboratory policies, quality management, and clinical urgency now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your triaging process based on further learning and experiences? For example, how you proactively reviewed and integrated new sections of the local laboratory policy concerning handling unusual request forms or specific referral pathways, demonstrating you have adapted improvements based on further learning.
• Has discussing challenging triaging scenarios or the impact of incorrect triaging with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a ‘near miss’, where a rush request had incomplete clinical data, refined your understanding of the critical nature of data verification during triage.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent triaging experiences, contributed to your overall confidence and competence in interpreting clinical request forms and assessing suitability for dissection, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in interpreting clinical request forms now enables you to summarise complex clinical context efficiently and accurately during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to triaging non-malignant requests? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the quality manager or senior pathologist immediately when a request involves a legal consent issue or non-standard protocol, recognising this falls outside routine triaging scope.
• Looking holistically at your training journey, how has this initial triaging experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to triaging specimens and practicing safely? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on dissection technique.

Relevant learning outcomes

#	Outcome
# 1	Outcome Triage specimens and interpret clinical request forms to assess clinical urgency and suitability for dissection.
# 5	Outcome Practice safely in accordance with quality management and accreditation standards.