Malignant Dissection —
Training activity: 1

Details

Triage malignant requests 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 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 for dissection.
• Discuss with your training officer to gain clarity of what is expected of you in this specific triaging activity for malignant cases.

What is your prior experience of this activity?

• Think about what you already know about triaging requests, handling clinical history information, or specific protocols for malignant specimens.
• Consider possible challenges you might face during the activity, such as urgent malignant cases, complex clinical histories, or specific local policies for cancer referrals, 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 dealing with urgent malignant cases requiring clarification on priority.
  • If a request form involves complex legal or consent issues specific to cancer pathway protocols.
  • If local laboratory policies do not clearly address a specific type of malignant referral.
• Acknowledge how you feel about triaging malignant requests.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently reviewing clinical histories for malignant requests and applying relevant local policies and urgency criteria.
• Identify the specific insights you hope to gain into the process of triaging malignant specimens and its importance in the cancer patient pathway.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reviewing request forms or triaging, particularly for urgent or complex cases.
• Identify important information you need to consider before embarking on the activity, such as reviewing local laboratory policies for triaging malignant specimens or understanding common clinical presentations for the types of malignant cases processed.

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:
  • The urgency is different to expected for a malignant case e.g., a known, aggressive malignancy arrives marked as routine
  • The clinical history is unusually sparse or complex for a malignant case, complicating the assessment of critical information
  • There is a conflict with local policy regarding the handling of a specific malignant referral e.g., specific molecular testing requirements clash with initial triage protocols

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 usual approach to triaging this request?
• Consider the steps you are taking in the moment, such as:
  • Immediately documenting the conflict and seeking advice from the Training Officer or senior pathologist regarding the correct urgency protocol
  • Halting the triaging process until verification of the clinical urgency or necessary ancillary test requirements is confirmed
• How are you feeling in that moment? For instance, did you find it difficult to adapt your triaging strategy? Did it affect your confidence in making an accurate decision about urgency?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully determining the correct malignant pathway yourself? Or are you needing support because the decision on handling an urgent malignant case 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 specific information e.g., previous treatment details in malignant clinical histories? Or gaining insight into which specific local policies govern urgent cancer referrals?

On action

What happened?

• Begin by summarising the key steps you took when triaging this specific malignant request.
• Consider specific events, actions, or interactions which felt important, such as how you weighed clinical urgency against local laboratory policy requirements for a cancer pathway.
• 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 a conflicting clinical history e.g., an aggressive cancer marked as routine, which 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 for cancer referrals? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the correct protocol for urgent cancer referrals?
• Compare this experience against previous engagement with similar activities – Has your practice improved in interpreting complex clinical request forms for malignant disease?
• 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.
• Acknowledge any changes in your own feelings now you are looking back on the experience.

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 about your ability to triage requests effectively.
• What will you do differently next time you approach triaging a similar malignant request, for instance, by proactively checking local policy appendices for specific definitions of urgency before commencing triage on complex malignant requests?
• Do you need to practise any aspect of the activity further, such as reviewing specific clinical scenarios related to urgency assessment for common malignancies or key learning outcomes related to assessing suitability?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences triaging different malignant requests, encountering more complex clinical histories, or dealing with urgent/challenging cases since your initial reflection on this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent urgent malignant case (e.g., suspected acute leukaemia) was handled, forced you to re-evaluate the depth of clinical history review and immediate prioritisation you applied during your first attempt at this training activity.
• Considering what you now understand about the nuances of interpreting clinical history for malignant cases, applying complex local laboratory policies, identifying safety considerations, or knowing when to seek advice, 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, additional experiences, or discussions? For example, how you proactively reviewed and integrated new sections of local policy concerning specimen retention and specific referral pathways for rare malignancies, demonstrating you have adapted improvements based on further learning.
• Has discussing challenging malignant triaging scenarios, the impact of incorrect triaging on patient care, or your scope of practice 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 delaying the triage of a critical prognostic sample refined your understanding of the critical nature of timely data verification during triage for cancer pathways.

How have these experiences impacted upon current practice?

• How has the learning from your initial engagement with this training activity, in combination with subsequent triaging experiences contributed to your overall confidence and skill in interpreting clinical request forms and assessing suitability for dissection, particularly in preparing for assessments like Case-Based Discussions or Observed Communication Events? For example, how your accumulated ability in interpreting complex clinical request forms for pre-treatment tumour status 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 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 Haematopathology Consultant immediately when a request involves a specialised tissue banking requirement or non-standard protocol, recognising this falls outside routine triaging scope.
• Looking holistically at your training journey, how has this initial triaging experience with malignant requests, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to triaging specimens and practicing safely in accordance with quality management? 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 malignant specimen preparation and 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.