Training activity information
Details
With supervision from a reporting consultant, request and interpret appropriate immunohistochemical and molecular tests, used in the diagnosis of:
- Malignant melanoma
- Colorectal cancer
- Gynaecological cancer
- Breast cancer
- Urological cancer
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.
Considerations
- RCPath cancer datasets
- Local SOPs and/or proforma
- NICE guidance
- Molecular testing strategies and national guidance
- Biomarkers
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 principles behind these tests and their role in cancer diagnosis and prognostication?
- What are your objectives in terms of understanding when and why specific tests are requested and how their results are interpreted?
- Discuss the common immunohistochemical and molecular tests used in the diagnosis of each of the specified cancer types with the reporting consultant.
- Review the clinical scenarios and histopathological findings of the cases for which you will be considering these tests.
- What are the key biomarkers and their significance in the diagnosis, staging/grading, and prognostication of these malignancies?
- Consider the specific insights you hope to gain regarding the practical application of these ancillary tests in real-world diagnostic cases.
- Think about your current understanding of the relationship between morphology and the results of immunohistochemical and molecular tests.
- What specific skills in selecting appropriate tests based on clinical and histological context, and in interpreting their results in conjunction with morphology, do you aim to develop?
- Discuss the specific cases with the consultant beforehand and ask about the differential diagnoses and the potential utility of specific tests.
- Review relevant national guidance (e.g., NICE, RCPath) on the use of these tests for the specified cancer types.
- Reflect on your current knowledge of immunohistochemistry and molecular pathology and identify any areas where you need to refresh your understanding before this activity.
In action
- What factors are you considering when deciding which IHC or molecular tests to request for this specific case? Why are these particular tests indicated based on the clinical history, morphology, and differential diagnoses?
- What decisions are you making about the specific markers or analyses to include in your request? What are you hoping to gain from these tests in terms of diagnosis, prognosis, or prediction of treatment response?
- How intuitive is the process of linking the clinical and pathological features with the appropriate ancillary tests? What aspects of understanding the utility and limitations of different tests are requiring more conscious thought?
- As you receive initial information or discuss potential interpretations of the test results with the consultant, how are you evaluating their significance in the context of the case? Are there any unexpected findings or discrepancies?
- What immediate learning points are emerging as you consider the role of these tests in the diagnostic workup of this malignancy? How is this enhancing your understanding of their application in different cancer types?
- Are there alternative testing strategies that could be considered? Would it be beneficial to discuss the rationale for the chosen tests with the consultant at this point?
- Are you ensuring that the requested tests are clinically relevant and that you are considering how the results will impact the final diagnosis and patient management?
On action
- For the specific malignant case you worked on, what immunohistochemical and/or molecular tests were requested?
- What was the rationale provided by the consultant for ordering these specific tests?
- What were the key findings of the test results that you interpreted under supervision?
- How effectively did the results of the immunohistochemical or molecular tests fulfil their intended role in confirming the diagnosis or providing prognostic and predictive insights for this specific cancer type?
- How did you approach the interpretation of these test results in conjunction with the routine histology, and were there any discrepancies that challenged your final conclusion?
- What learning can you take from this experience regarding the diagnostic utility of the specific markers or assays you selected for this case?
- What will you take from the experience moving forward?
- How will you improve your understanding of the utility and interpretation of different immunohistochemical and molecular tests in various malignancies?
- Will you seek further learning resources or discussions on the application of these tests in diagnostic pathology?
- How will you ensure you are requesting the most relevant ancillary tests in your future practice?
Beyond action
- How does the process of requesting and interpreting these tests relate to your understanding of the pathogenesis and molecular pathology of these cancers (as covered in the academic content)?
- Review your reflections on these activities. What did you learn about the specific tests used for each cancer type and their clinical significance?
- Have you discussed challenging cases involving IHC and molecular testing with colleagues? Did this enhance your understanding of the interpretation of results?
- How has this experience influenced your understanding of the role of cellular pathology reports in guiding diagnosis, management, and clinical outcomes in cancer? How has it affected how you view macroscopic and microscopic findings?
- Consider how your learning from this DTA will support your participation in MDT meetings where these results are discussed.
- What transferable skills, such as critical thinking and the integration of different data types, did you develop?
- What clear actions will you take to further develop your knowledge and skills in requesting and interpreting IHC and molecular tests?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Summarise the macroscopic features and block sampling for accurate microscopic assessment malignant specimens. |
| # 5 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |