Training activity information
Details
Use local molecular based techniques in accordance with quality standards for HLA typing
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
- Clinical indications
- The local repertoire, source of requests and turnaround times for investigations performed
- Selection of appropriate molecular based technique(s) to achieve required HLA typing resolution
- Internal quality controls and external quality assessment measures
- Troubleshooting
- Principles of PCR
- Principles of HLA typing assays
- Infection control
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 successfully using molecular based techniques for HLA typing while adhering to strict quality standards.
- Consider how the learning outcomes apply, specifically in relation to applying the appropriate testing strategy, performing the relevant laboratory investigations, and practicing in accordance with quality and accreditation standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to performing critical quality control checks, setting up reaction parameters correctly (e.g., thermocycler profiles), and achieving required data quality for analysis.
What is your prior experience of this activity?
- Think about what you already know about molecular techniques (e.g., PCR, sequencing), preparing reaction mixes, and operating specialized equipment (e.g., thermocyclers or sequencers).
- Consider possible challenges you might face during the activity, such as reaction failure due to inhibition, unexpected control results, or technical errors during thermal cycling or data acquisition.
- 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 internal quality control standards are violated (e.g., a positive control fails to amplify) and the root cause is not immediately apparent.
- Acknowledge how you feel about undertaking complex, multi-step molecular assays where precision is paramount.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as meticulous pipette handling for master mix preparation or systematic troubleshooting of molecular assay failures.
- Identify the specific insights you hope to gain into the relationship between technique fidelity and quality standards in diagnostic HLA typing.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of running similar molecular assays or troubleshooting technical equipment issues.
- Identify important information you need to consider before embarking on the activity, such as reviewing the specific molecular protocol steps, confirming equipment calibration status, and checking the performance history of critical reagents (e.g., enzyme activity).
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the molecular HLA typing technique?
- Are you encountering situations such as:
- Reaction failure (e.g., no amplification) or unexpected results with the control DNA/reagents?
- Technical issues arising with specialised equipment (e.g., thermocycler temperature accuracy, sequencer performance)?
- The initial raw data files or sequence traces being of poor quality, challenging interpretation?
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 troubleshooting equipment or repeating the reaction?
- Consider the steps you are taking in the moment, such as:
- Immediately checking the equipment calibration status and reviewing reagent preparation documentation when controls fail
- Pausing the run to seek technical assistance if a persistent error message is encountered on the sequencer
- How are you feeling in that moment? For instance, are you finding it difficult to troubleshoot the cause of a complex reaction failure? Is it affecting your confidence in completing the assay independently and meeting quality standards?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully obtaining valid results after performing standard troubleshooting checks? Or are you needing support because a major equipment malfunction compromises the integrity of the run and requires senior escalation?
- What are you learning as a result of the unexpected development? For example, are you mastering a more systematic method for troubleshooting thermocycler performance? Or gaining insight into the influence of pipette calibration on reaction success?
On action
What happened?
- Begin by summarising the key steps you took when using the specific molecular HLA typing technique.
- Consider specific events, actions, or interactions which felt important, such as how you prepared the master mix, set the thermocycler profile, or checked the sequence run quality.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately halting the run and escalating when the positive control failed to amplify or adjusting the reaction volume based on real-time observation.
- How did you feel during this experience, e.g., did you feel responsible for quality control or challenged by assay complexity?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing molecular HLA typing techniques and applying quality standards. What strengths did you demonstrate, e.g., meticulous adherence to quality control checks?
- What skills and/or knowledge gaps were evident, e.g., troubleshooting specific enzyme inhibition issues or managing signal-to-noise ratio in raw data?
- 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 reaction failure, unexpected control results, or needing advice on dealing with poor signal-to-noise ratio, 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 improving your proficiency with the techniques and adherence to quality standards.
- What will you do differently next time you approach molecular HLA typing, for instance, by proactively verifying equipment maintenance records before starting the run?
- Do you need to practise any aspect of the activity further, such as calculating reagent concentrations or key learning outcomes related to performing the relevant laboratory investigations?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of using local molecular based techniques for HLA typing since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent run failure due to reagent mix errors forced you to re-evaluate the rigour of your initial master mix preparation and pipetting accuracy during your first attempt at this training activity.
- Considering what you understand about assay quality control, equipment functionality, and potential causes of technical failure 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 technical technique or troubleshooting protocols based on further learning and experiences? For example, how you proactively reviewed and implemented a standardized checklist for thermocycler programming based on further learning.
- Has discussing the principles behind different molecular methods or best practices for achieving reliable results 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 time when a batch of results was invalidated due to QC failure refined your understanding of the critical nature of adherence to specific quality standards during molecular assays.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of performing HLA typing, contributed to your overall confidence and competence in executing molecular HLA typing assays reliably, particularly in preparing for observed assessments (DOPS or OCEs) such as ‘Perform HLA typing using local molecular methods’? For example, how your accumulated ability in precise laboratory technique and troubleshooting now enables you to manage technical challenges confidently during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to molecular HLA typing?
- How does this evolved understanding help you identify when a molecular run has failed or yielded questionable results and when this requires expert support? For example, how your evolved approach means you now routinely seek expert support immediately when technical issues require investigation beyond routine troubleshooting, recognising this falls outside routine technical scope.
- Looking holistically at your training journey, how has this initial molecular typing 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 precise technique and working within a quality framework 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. |
| # 3 |
Outcome
Perform the relevant laboratory investigations for a range of patients referred to an H&I laboratory. |
| # 6 |
Outcome
Practice in accordance with quality and accreditation standards. |