Training activity information
Details
Perform immunohistochemical staining to demonstrate various antigens in relation to the assessment of:
- Non-malignant disease
- Pre-malignant disease
- Malignant disease
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
- Internal quality control of antibody staining, including IHC positive control material and staining patterns of antibodies in tissues and tumours
- Impact of specialist pre and post analytical factors
- Antigen retrieval
- Clinical appropriateness and implications of testing
- Local SOPs
- National and local policies and guidelines
- RCPath tissue pathways
- RCPath cancer datasets
- Screening programme guidance
- NICE guidance
- Troubleshooting
- Tumour panels
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 performing immunohistochemical (IHC) staining for different disease types.
- Review the learning outcomes related to employing IHC to identify various antigens and practicing safely.
- Consider the specific quality standards required for IHC in assessing non-malignant, pre-malignant, or malignant disease.
- Discuss with your training officer to gain clarity of what is expected, focusing on the appropriate antibody selection and technical execution for specific diagnostic queries.
What is your prior experience of this activity?
- Think about your previous exposure to or experience with IHC techniques from previous modules or experiences. Have you used IHC in the context of pre-malignant or malignant disease investigation before?
- Consider possible challenges you might face during IHC staining e.g., protocol optimisation, troubleshooting unexpected or weak staining, selecting appropriate control tissues. Think about how you might handle these challenges.
- Recognise the scope of your own practice for performing and interpreting IHC; know when and from whom you will need to seek advice or help.
- Acknowledge how you feel about embarking on this training activity, particularly if it involves complex antibody panels or novel techniques.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as mastering the technical steps for manual or automated IHC, learning to troubleshoot common IHC issues, or understanding the diagnostic utility of different antibodies in assessing various pathologies.
- Identify the specific insights you hope to gain regarding how IHC contributes to the assessment of non-malignant, pre-malignant, and malignant tissue features.
What additional considerations do you need to make?
- Consult actions identified following previous experiences with IHC, especially those where troubleshooting or achieving optimal results was challenging.
- Identify important information you need to consider before embarking on the activity, such as reviewing specific antibody protocols, understanding the rationale for antibody selection based on the clinical history and differential diagnosis, or safety protocols for handling reagents.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the IHC staining?
- Are you encountering situations such as:
- The instrument flags an error or you suspect an issue with reagent flow or incubation during the automated run
- There is a discrepancy in the expected result of the control slides during the run
- The performance of this specific IHC stain for an antigen feels significantly different from others you have performed
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 technical checks?
- Consider the steps you are taking in the moment, such as:
- Immediately checking the antibody preparation or instrument setup to verify parameters
- Reacting in the moment if the instrument flags an error by initiating predefined troubleshooting steps
- Making real-time checks or decisions regarding controls to ensure their integrity before committing to the full run
- How are you feeling in that moment? For instance, are you finding it difficult to maintain vigilance during the automated process? Is it affecting your confidence in resolving a potential technical failure?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully initiating the instrument restart after a minor error? Or are you needing support because the suspected reagent issue requires intervention from a specialist technician?
- Identify what you learnt as a result of the unexpected development. For example, are you mastering the technical steps for automating complex IHC runs? Or gaining insight into the importance of control placement and verification?
On action
What happened?
- Begin by summarising the process of performing the IHC stain for the specific antigen(s).
- Describe the outcome, including the staining pattern and intensity, and whether the antigen(s) were successfully demonstrated.
- Consider specific events or observations that felt important during the setup or the run.
- Include any ‘reflect-in-action’ moments where you responded to instrument alerts, unexpected control results, or potential issues during the run.
How has this experience contributed to your developing practice?
- Identify what learning you can take from the experience. What did you learn about the principles and application of IHC for demonstrating antigens?
- How did this experience enhance your ability to select appropriate antibodies or interpret IHC controls?
- What strengths did you demonstrate e.g., technical execution or troubleshooting? What skills or knowledge gaps were evident?
- Identify any challenges you faced (e.g., technical issues, unexpected staining) and how you reacted. Did you need to seek advice? What was the outcome?
What will you take from the experience moving forward?
- Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received on your staining technique for all assessments listed.
- What specific checks or steps will you focus on more closely next time when setting up or monitoring an IHC run for antigens?
- Do you need to practise any aspect of the activity further, such as reviewing specific antibodies, protocols, or troubleshooting strategies for antigen IHC?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences performing immunohistochemical (IHC) stains for a wider range of antigens, or troubleshooting issues, since completing this specific training activity led you to revisit your initial technique, reagent selection, or considerations during that activity?
- Considering your current understanding of quality management and accreditation standards related to IHC, 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 IHC technique or troubleshooting approach based on further learning and experiences? For example, how subsequent experience with complex antibody panels led you to realise the need to implement improvements in reagent selection for specific low-expression antigens, which was not initially considered.
- Has discussing challenging IHC results, appropriate antibody selection, or the interpretation of stains with colleagues, peers, or in multidisciplinary team meetings changed how you now view your initial experience in this training activity?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent IHC staining experiences, contributed to your overall confidence and ability in employing IHC to identify various antigens and practicing safely, particularly in preparing for assessments like DOPS or Observed Communication Events (OCEs)? For example, how your accumulated IHC experience now enables you to perform internal quality control for a case prior to reporting and confidently advise another member of the multidisciplinary team on appropriate antibody/antibody panel selection.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about IHC applications and troubleshooting, shaped your current approach to performing IHC staining? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation?
- Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to employing IHC and practicing safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Employ IHC to identify various antigens and molecular markers. |
| # 4 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |