Training activity information
Details
Perform immunohistochemical staining to demonstrate various molecular markers
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
- Impact of specialist pre and post analytic factors
- 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
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 IHC staining for molecular markers.
- Review the learning outcomes related to employing IHC to identify various antigens and molecular markers and practicing safely.
- Success means accurately demonstrating the presence or absence of specific molecular markers that are diagnostically or prognostically significant.
- Discuss with your training officer to gain clarity of what is expected, focusing on the specific requirements for molecular marker detection using IHC and ensuring the technical quality meets the standards for clinical reporting.
What is your prior experience of this activity?
- Think about your previous experience with IHC and any exposure to molecular pathology concepts. Have you performed IHC for specific molecular markers previously?
- Consider possible challenges you might face, such as assay sensitivity/specificity issues, interpreting control slides for molecular markers, or understanding the clinical context necessitating the marker test. Think about how you might handle these challenges.
- Recognise the scope of your own practice for performing IHC for molecular markers; know when and from whom you will need to seek advice or help, especially regarding interpretation or clinical significance.
- Acknowledge how you feel about embarking on this activity, particularly if molecular markers are a new area for you.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in performing IHC for molecular markers, including specific technical steps and troubleshooting related to these assays.
- Identify the specific insights you hope to gain into the role of molecular markers in diagnosis, prognosis, and therapeutic decision-making, and how IHC contributes to this.
What additional considerations do you need to make?
- Consult actions identified following previous IHC experiences or any learning points related to molecular pathology concepts.
- Identify important information you need to consider before embarking on the activity, such as understanding the specific molecular marker being tested, reviewing the protocol for that specific assay, and ensuring appropriate positive and negative controls are used.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the molecular marker IHC staining?
- Are you encountering situations such as:
- Unexpected results are observed on the control slides, potentially indicating an assay failure or non-specificity
- You realise that extra attention or different handling is required compared to a standard antigen stain, leading to uncertainty
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 quality checks?
- Consider the steps you are taking in the moment, such as:
- Immediately ensuring the correct specific protocol is followed or loaded for this sensitive molecular marker
- Considering immediate troubleshooting steps if the run does not appear to be working as expected e.g., checking incubation times or reagent stability
- Focusing efforts on checking the integrity and specificity of the control materials
- How are you feeling in that moment? For instance, are you feeling challenged due to the specific requirements of the molecular marker assay? Is it affecting your confidence in ensuring the technical quality meets the diagnostic standard?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully managing the run and documenting all quality metrics? Or are you needing support because a control failure requires intervention and data interpretation from a molecular scientist?
- Identify what you learnt as a result of the unexpected development. For example, are you mastering the specific technical steps and troubleshooting related to IHC for molecular markers? Or gaining insight into the higher sensitivity requirements for these critical prognostic assays?
On action
What happened?
- Begin by summarising the process of performing the IHC stain for the specific molecular marker(s).
- Describe the outcome, including the staining pattern and interpretation of the result for the molecular marker.
- Consider specific events or observations that felt important during the setup or the run for this molecular marker.
- Include any ‘reflect-in-action’ moments where you responded to issues or adjusted your approach based on observations 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 specific requirements or interpretation challenges associated with this molecular marker compared to typical antigens?
- How did this experience enhance your understanding of the clinical significance or technical nuances of staining for molecular markers?
- What strengths did you demonstrate? What skills or knowledge gaps were evident, particularly regarding molecular pathology or specific assays?
- Identify any challenges you faced (e.g., technical issues, ambiguity) and how you reacted. Did you need to seek advice regarding the assay or interpretation? 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 specific molecular markers.
- What specific considerations or checks will be crucial for you next time you perform IHC for molecular markers (e.g., careful review of controls)?
- Do you need to practise any aspect of the activity further, such as reviewing specific molecular markers, protocols, or interpretation guidelines?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences performing IHC stains for different molecular markers, understanding their clinical significance, or troubleshooting related 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 for molecular markers, 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 technique or approach based on further learning and experiences? For example, how attending a tumour board meeting where a molecular marker result was critical, prompted you to realise the need to implement improvements in verifying assay sensitivity, which was only vaguely addressed in your first reflection.
- Has discussing challenging IHC results for molecular markers, their interpretation, or their impact on patient management 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 for molecular markers, contributed to your overall confidence and ability in employing IHC to identify various molecular markers and practicing safely, particularly in preparing for assessments like DOPS or OCEs?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about molecular markers and their detection by IHC, shaped your current approach to performing IHC for these markers? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, your current proficiency allows you to perform microscopical interpretation of stained slides with increased confidence, but your evolved understanding means you routinely seek advice from the molecular team before releasing results for complex markers, recognising the potential for 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. |