Training activity information
Details
Select appropriate sera for crossmatching in accordance with local and national guidelines
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 procedures and national guidelines
- Importance of relevant factors for serum selection
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 selecting the most appropriate serum/sera sample for crossmatching, based on patient history, antibody status, and relevant guidelines.
- Consider how the learning outcomes apply, specifically in relation to applying the appropriate testing strategy and practicing in accordance with quality standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to identifying the ‘peak’ serum (highest historic reactivity) versus the ‘most recent’ serum and understanding the rationale for selecting specific time points.
What is your prior experience of this activity?
- Think about what you already know about antibody dynamics post-sensitisation and the importance of peak reactivity in historical risk assessment.
- Consider possible challenges you might face during the activity, such as non-availability of required sera, conflicting historical data on peak reactivity, or ambiguous guidelines regarding which specific sera to prioritise.
- 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 when required, for example if the ideal serum sample (e.g., peak historical) is exhausted, requiring guidance on the next best alternative selection that maintains acceptable risk management.
- Acknowledge how you feel about this critical step that determines the immunological risk tested in the crossmatch.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as systematic archival review of historical antibody reports or efficient application of local/national serum selection flowcharts.
- Identify the specific insights you hope to gain into how different transplantation types (e.g., kidney vs heart) might influence serum selection priority.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of sample retrieval or complex archival data review.
- Identify important information you need to consider before embarking on the activity, such as reviewing the patient’s complete transfusion and pregnancy history, the most recent and historical antibody reports, and the specific national guidance for crossmatch serum selection.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst selecting appropriate sera for crossmatching?
- Are you encountering situations such as:
- The required peak or most recent serum sample not being readily available or being of insufficient volume/quality?
- Conflicting local or national guidelines regarding serum selection for the specific clinical scenario e.g., highly sensitised patient, urgent case?
- Unexpected or critical information in the patient’s history suddenly influencing the selection decision?
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 by selecting an alternative serum sample?
- Consider the steps you are taking in the moment, such as:
- Immediately documenting the reason for selecting an alternative serum and consulting the Training Officer for guidance and rationale approval
- Reviewing historical antibody data to select the next best time point that captures highest reactivity
- How are you feeling in that moment? For instance, are you finding it difficult to reconcile conflicting guidance or limited availability? Is it affecting your confidence in confidently selecting sera independently?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying policy to select the ideal serum from the archive? Or are you needing support because the critical nature of the transplant requires senior input to deviate from standard serum selection protocols?
- What are you learning as a result of the unexpected development? For example, are you mastering the rationale for peak versus recent serum selection? Or gaining insight into the importance of meticulous documentation of serum selection rationale?
On action
What happened?
- Begin by summarising the key steps you took when selecting sera for the specific crossmatching scenario.
- Consider specific events, actions, or interactions which felt important, such as how you prioritised ‘peak’ historical serum over ‘most recent’ serum based on antibody reports or managed selection when the preferred sample was exhausted.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately reviewing national guidance when local criteria seemed ambiguous or checking the integrity of the frozen serum aliquot before confirming selection.
- How did you feel during this experience, e.g., did you feel diligent in adhering to rules or stressed by limited sample availability?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding selecting appropriate sera for crossmatching and adhering to guidelines. What strengths did you demonstrate, e.g., meticulous review of antibody history?
- What skills and/or knowledge gaps were evident, e.g., knowledge of criteria for non-standard serum selection (e.g., post-desensitisation)?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying the appropriate testing strategy?
- Identify any challenges you experienced, such as conflicting guidance, sample limitation, or needing advice on scope of practice regarding deviating from policy when the preferred serum is unavailable, and how you reacted to this.
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 deepening your understanding of sera selection criteria and relevant guidelines.
- What will you do differently next time you approach selecting sera for crossmatching, for instance, by proactively ensuring clear documentation of the rationale for selecting the specific serum?
- Do you need to practise any aspect of the activity further, such as reviewing specific guidelines for highly sensitised patients or key learning outcomes related to practicing in accordance with quality standards?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of selecting appropriate sera for crossmatching since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent urgent crossmatch required justification for selecting a non-peak serum sample due to volume constraints forced you to re-evaluate the rigour of your historical sample review and adherence to guideline prioritisation during your first attempt at this training activity.
- Considering what you understand about national guidance, the rationale for selecting ‘peak’ serum, and the impact of non-representative samples on crossmatch validity now, 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 consistency in serum selection or data review based on further learning and experiences? For example, how you proactively reviewed and integrated national guidance regarding the use of historical vs. current serum samples based on further learning.
- Has discussing the rationale behind selecting specific serum samples (e.g., peak serum) or how guidelines differ for various transplant types with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a crossmatch failure due to using a non-representative sample refined your understanding of the critical nature of applying guidelines and data review during the pre-analytical phase.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of sera selection, contributed to your overall confidence and competence in applying guidelines to ensure the correct patient sera are used, particularly in preparing for general observed assessments (DOPS or OCEs) related to pre-transplant workup? For example, how your accumulated ability in critical thinking and guideline application now enables you to justify complex sample selection confidently during an assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to crossmatch serum selection?
- How does this evolved understanding help you identify when a patient’s history makes serum selection complex and when this is beyond your scope of practice? For example, how your evolved approach means you now routinely seek expert input immediately when a deviation from standard serum selection protocols is required due to sample limitation, recognising this requires senior approval.
- Looking holistically at your training journey, how has this initial serum selection experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying the appropriate testing strategy and practicing in accordance with quality standards? For example, how this foundational experience has supported your development in transferable skills such as applying complex guidelines and critical thinking that will be valuable in future roles or responsibilities.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Apply the appropriate testing strategy for patients referred for solid organ transplantation, haematopoietic stem cell transplantation, HLA associated diseases and pharmacogenetic reactions. |
| # 6 |
Outcome
Practice in accordance with quality and accreditation standards. |