Specialist Immunohistochemistry and Molecular Pathology —
Training activity: 8

Details

Prepare patient samples for molecular testing at another site and/or organisation

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

• Sample acceptance criteria
• Sample identification
• Data capture
• Transport requirements
• Impact of cold ischaemic time, including fixation, decalcification etc (pre-analytical factors) on samples
• Internal quality control
• Consent, use and storage of human tissue marked for genomic studies
• External quality assurance (GenQA)
• Reliability of results
• Patient safety

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 preparing and sending patient samples for molecular testing at an external site. This links to the learning outcome of preparing samples for testing.
• Discuss with your training officer to gain clarity of what is expected of you in this specific activity, including any specific protocols or requirements from the receiving organisation.

What is your prior experience of this activity?

• Think about what you already know about handling patient samples, preparing samples for analysis, or sending samples to external laboratories.
• Consider possible challenges you might face during the activity, such as ensuring correct sample type and quantity, proper packaging, completing necessary documentation, or meeting transport requirements, 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, Referral Laboratory Contact, or Technical Manager when required, for example:
  • If you are unsure about the correct preservation medium or temperature requirements for specialised molecular transport
  • When the required documentation or paperwork for the referral site is incomplete or ambiguous
  • If the sample quantity is borderline and needs confirmation before shipment to avoid test failure
• Acknowledge how you feel about preparing patient samples in the context of this training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as mastering sample preparation techniques for different molecular tests, accurate documentation, appropriate packaging, and understanding transport logistics.
• Identify the specific insights you hope to gain from engaging with the activity, such as understanding the workflows of referral molecular laboratories, the critical importance of pre-analytical steps for molecular testing, or the communication needed between laboratories.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of handling samples, particularly for send-away tests or complex analyses.
• Identify important information you need to consider before embarking on the activity, such as reviewing specific requirements from the external laboratory, necessary forms, and transport conditions (e.g., temperature).

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the sample, documentation, or packaging?
• Are you encountering situations such as:
  • The sample quantity is borderline (e.g., low tumour content) or the tissue block appears cracked, jeopardising the success of the test at the referral site
  • The required documentation for the external laboratory is complex or requires specific clinical staging details that are not immediately available, challenging the standard dispatch workflow
  • The transport container required for maintaining specific temperature or handling protocols for the molecular sample is unavailable or damaged

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 preparation, documentation, or packaging in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately contacting the referral laboratory to confirm the minimum required sample quantity for the molecular test before dispatching a borderline sample.
  • Halting the preparation and seeking guidance from the Training Officer or senior scientist regarding how to retrieve missing critical clinical information required for the complex referral form.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your approach to the logistics? Is it affecting your confidence in ensuring the sample arrives intact and compliant?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the documentation issue yourself? Or are you needing support because the uncertainty regarding sample viability or transport requirements requires clarification from the referral site or a senior colleague?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for verifying packaging requirements against specific transport regulations? Or gaining insight into the criticality of early communication with external sites regarding molecular sample discrepancies?

On action

What happened?

• Begin by summarising the key steps you took when preparing and sending this specific patient sample for molecular testing. What were the main stages, from ensuring pre-analytical steps were met to final dispatch and documentation?
• Consider specific events, actions, or interactions which felt important, such as how you ensured the correct sample type (e.g., tissue curls vs. FFPE block) and documentation for the specific molecular test (e.g., NGS) were complete.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded. For instance, immediately seeking advice regarding sample quantity or integrity when faced with a borderline sample, or when realising the required referral form was incomplete. How did you feel during this experience, e.g., did you feel pressured to meet the strict dispatch deadline or confident in managing the logistical steps?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding preparing samples for external molecular testing. What strengths did you demonstrate, e.g., meticulous verification of the referral site’s stringent pre-analytical requirements? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the specific temperature requirements for transport or unfamiliarity with a new courier’s documentation?
• Compare this experience against previous engagement with similar activities – Has your practice improved in handling complex documentation or preparing samples that meet external quality requirements?
• Identify any challenges you experienced, such as needing to seek advice or clarification regarding sample viability from the Molecular Scientist or technical manager before dispatch, and how this interaction refined your understanding of scope of practice.
• 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 on preparing patient samples.
• What will you do differently next time you prepare a patient sample for molecular testing at another site/organisation, for instance, proactively implementing a standardised checklist to ensure all referral paperwork, including clinical and consent details, is verified before packaging?
• Do you need to practise any aspect of the activity further, such as reviewing the specific SOP for molecular transport logistics or seeking out training on assessing minimum tumour cellularity requirements in different sample types to avoid unnecessary referrals?

Beyond action

Have you revisited the experiences?

• Have you reviewed your previous reflections on preparing samples for molecular testing?
  • What specific actions did you identify previously that you needed to take to improve your practice for this activity e.g., confirming minimum required sample quantity, accurate documentation, or specific transport logistics?
  • Have you completed these actions since your last reflection, and are you ready to demonstrate this new learning in your practice?
• How have your subsequent experiences preparing different types of samples, for different molecular tests, or for different external sites since your initial reflections on this specific training activity led you to revisit your initial approach or decisions made during those activities? For instance, has learning about new test requirements (e.g., genomic profiling) or encountering issues with transport conditions for later samples changed how you view your preparation process for earlier ones, particularly regarding the critical importance of pre-analytical steps?
• Has engaging in professional storytelling with colleagues, peers, or supervisors about preparing and sending samples for molecular testing, discussing challenging cases or logistics, changed your perspective on your past experiences with this activity? For example, has peer experience or feedback provided new insights into how you previously handled complex documentation or managed sample viability assessments?

How have these experiences impacted upon current practice?

• Considering the learning from all your experiences preparing samples for external molecular testing (including revisiting past reflections), how has this contributed to your overall confidence and skill in performing this task? How does this accumulated learning support you in preparing for observed assessments like Direct Observations of Practical Skills (DOPS) or Observed Communication Events (OCEs) related to sample handling or discussion of cases requiring molecular testing?
• How has reflecting back on your journey with this specific training activity, combined with everything you’ve learned since, shaped your current approach to preparing patient samples for external molecular testing? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, does your evolved approach help you identify when assessing sample suitability for a complex molecular test or dealing with ambiguous referral request forms requires senior technical or clinical escalation?
• Looking holistically at your training journey, how has your development in preparing samples for external molecular testing contributed to your broader understanding of the molecular pathology pathway and your role as a custodian of the sample, particularly in meeting the learning outcomes related to preparing samples for testing?

Relevant learning outcomes

#	Outcome
# 3	Outcome Identify molecular tests request for the investigation of malignant pathologies and prepare samples for testing.