Training activity information
Details
Review suitability and appropriateness of the malignant patient sample type for requests, considering the clinical history
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
- Criteria for sample analysis
- Interpretation of the clinical question
- Specimen types and categorisation
- Diagnostic pathways
- Clinical history
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 reviewing malignant sample suitability based on clinical history, specifically learning outcomes related 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 for malignant samples.
What is your prior experience of this activity?
- Think about your previous exposure to different malignant sample types and their requirements.
- Consider possible challenges you might face, such as unusual sample types for a given request, discrepancies between the sample label and the request form, or issues related to fixation or handling of malignant tissue, and think about how you might handle them.
- Recognise the scope of your own practice; know when and from whom you will need to seek advice or help regarding the suitability of malignant specimens. You will need to seek advice from your Training Officer or a Laboratory Quality Manager when required, for example:
- When the fixation or handling of malignant tissue is compromised and may jeopardise diagnostic suitability
- If there is a significant discrepancy between the sample label and the request form
- When the sample needs special handling for diagnosis and additional testing e.g., fresh tissue for molecular or immunohistochemical testing
- Acknowledge how you feel about undertaking such a review.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in assessing malignant sample suitability and appropriateness, ensuring they meet the requirements for diagnosis and additional testing.
- Identify the specific insights you hope to gain regarding the relationship between malignant sample type, clinical history, and the diagnostic requirements, potentially including requirements for molecular or immunohistochemical testing.
What additional considerations do you need to make?
- Consult actions identified following previous experiences with handling different sample types or requests, particularly those related to malignant disease.
- Identify important information you need to consider before embarking on the activity, such as specific sample handling protocols for malignant specimens e.g., fresh tissue requirements, common issues with certain malignant sample types (e.g., core biopsies), or specific departmental procedures for unsuitable samples.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing the malignant sample container or assessing its integrity?
- Are you encountering situations such as:
- The sample size or type is unusual for the suspected malignancy e.g., a very small biopsy where a large core was expected
- A critical discrepancy exists between the sample label and the request form, or the clinical history suggests potential contamination
- The sample fixation or handling is clearly inappropriate in the moment e.g., tissue intended for molecular testing was placed entirely in formalin
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 assessing suitability?
- Consider the steps you are taking in the moment, such as:
- Immediately documenting the fixation issue and seeking advice from a senior colleague regarding the suitability for onward molecular testing
- Consulting the tissue handling protocol to determine if a potentially compromised malignant sample can still yield diagnostic information
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your assessment strategy? Is it affecting your confidence in determining the sample’s appropriateness?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully classifying the sample as inappropriate for the requested testing? Or are you needing support because the decision to proceed or reject the malignant specimen requires specialist consultant input?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for rapidly assessing tissue integrity in core biopsies? Or gaining insight into the critical requirements for molecular sample handling?
On action
What happened?
- Begin by summarising the key considerations when reviewing suitability for this malignant sample.
- Consider specific events, actions, or interactions which felt important, such as how you assessed the fixation status for ancillary testing e.g., molecular testing in relation to the clinical needs.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking advice regarding a critical discrepancy between sample type and clinical history or when fixation appeared inappropriate e.g., tissue intended for molecular testing was placed entirely in formalin. How did you feel during this experience, e.g., did you find it difficult to maintain objectivity when assessing suitability?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding malignant sample suitability. What strengths did you demonstrate, e.g., meticulous review of sample integrity? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the appropriateness of a small core biopsy for a specific molecular test?
- Compare this experience against previous engagement with similar activities – Has your practice improved in identifying and handling pre-analytical issues specific to malignant tissue?
- Identify any challenges you experienced, such as needing to seek advice about the impact of poor fixation on subsequent malignant diagnostic testing, and what you learned from that interaction.
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 undertake such reviews.
- What criteria will you pay closer attention to when reviewing malignant sample suitability in the future, for instance, proactively checking the volume of fixation fluid for large specimens intended for malignant dissection to ensure adequate fixation based on tissue size?
- Do you need to practise any aspect of the activity further, such as reviewing guidelines on sample requirements for specific malignant requests e.g., those requiring molecular or IHC ancillary studies?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences reviewing different malignant sample types, encountering unusual or problematic samples, or seeing the downstream impact of sample suitability on microscopic diagnosis since your initial reflection on this specific training activity led you to revisit your initial assessment and decisions during that activity? For example, how encountering a subsequent malignant core biopsy with insufficient tissue for molecular testing led you to re-evaluate the tolerance you might have shown during the initial training activity when faced with a minor pre-analytical fixation issue.
- Considering what you now understand about the critical link between malignant sample type, clinical history, appropriate handling, and diagnostic accuracy, 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 sample review process based on further learning, additional experiences, or discussions? For example, how you implemented an immediate double-check protocol for confirming the preservation medium used for samples intended for highly specialised tests e.g., flow cytometry or molecular assays based on subsequent learning about sample degradation.
- Has discussing the implications of unsuitable malignant samples or challenging review cases with colleagues, peers, or in multidisciplinary team meetings changed how you now view your initial experience in this training activity? For example, how discussions in an MDT meeting regarding the impact of poor fixation on HER2 testing results reinforced the high standard required during the initial review of malignant sample suitability.
How have these experiences impacted upon current practice?
- How has the learning from your initial engagement with this training activity, in combination with subsequent sample review experiences and clinical experiences, contributed to your overall confidence and ability in reviewing malignant sample suitability and appropriateness and ensuring you are practicing safely in accordance with quality standards, particularly in preparing for assessments?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to reviewing malignant sample types for dissection? How does this evolved understanding help you identify when something is beyond your scope of practice or requires seeking advice? For example, how your evolved approach means you now automatically consult a biomedical scientist specialist regarding complex requirements for malignant samples intended for outsourced genomic profiling, knowing technical verification is beyond your initial scope.
- Looking holistically at your training journey, how has this initial experience of reviewing malignant samples, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to interpreting clinical request forms and practicing safely? For example, how mastering the assessment of malignant sample suitability directly supports your ability to successfully employ appropriate specimen preparation later in the module by ensuring quality input for downstream processes.
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. |