Training activity information
Details
Review and select potential HLA matched donors for HSCT, for:
- Related donors
- Unrelated adult donors
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 and national procedures
- Factors affecting HSCT donor selection including non-HLA factors
- National and international standards and legislation
- Local protocols
- Patient centred care and support, including clinical urgency, implications for recipient/donor of not finding a match and alternative treatment options
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 reviewing and selecting the most suitable potential HLA matched donors for Haematopoietic Stem Cell Transplantation (HSCT) from both related and unrelated donor pools.
- Consider how the learning outcomes apply, specifically in relation to interpreting test results and practicing in accordance with quality standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to applying specific matching algorithms (e.g., 10/10 vs 8/8 matches), prioritising donors, and incorporating non-HLA factors.
What is your prior experience of this activity?
- Think about what you already know about HLA matching principles, accessing national or international donor registries, and the clinical context of HSCT.
- Consider possible challenges you might face during the activity, such as dealing with a limited donor pool, conflicting data resolution levels between patient and donor, or integrating complex non-HLA factors (e.g., CMV, age, sex, ABO) into the final selection decision.
- 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 there is conflicting information regarding a donor’s non-HLA status or if the search criteria must be expanded beyond routine protocols.
- Acknowledge how you feel about selecting potential donors for a complex, life-saving procedure.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as advanced donor registry querying techniques or systematic integration of multiple clinical and laboratory criteria.
- Identify the specific insights you hope to gain into the critical impact of non-HLA factors on HSCT outcome and the nuances of matching resolution.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of complex data review or database searching.
- Identify important information you need to consider before embarking on the activity, such as reviewing the current clinical guidelines for HSCT donor selection and confirming the priority sequence for matching grades.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing and selecting potential HLA matched donors for HSCT?
- Are you encountering situations such as:
- A highly limited donor pool due to a rare or complex HLA type, making initial matching expectations difficult to meet?
- Donor data presenting unexpected complexities (e.g., conflicting typing resolution levels, unusual non-HLA markers) that complicate selection?
- Non-HLA factors (e.g., CMV status, age, sex) unexpectedly restricting the suitability of otherwise well-matched donors?
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 search or prioritisation strategy?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting the search criteria to include lower resolution matches or consulting local protocols on prioritising non-HLA factors
- Pausing the selection to seek expert advice on handling ambiguities in donor typing or complex clinical prioritisation
- How are you feeling in that moment? For instance, are you finding it difficult to prioritise donors when multiple factors conflict? Is it affecting your confidence in selecting the most appropriate potential donors independently?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying local guidelines to select the best 10/10 match based on standard criteria? Or are you needing support because the extremely limited donor pool necessitates developing non-standard selection protocols for discussion with the clinical team?
- What are you learning as a result of the unexpected development? For example, are you mastering advanced search techniques on donor registries? Or gaining insight into the critical balance between HLA matching and non-HLA factors in HSCT success?
On action
What happened?
- Begin by summarising the key steps you took when reviewing and selecting potential HLA matched donors for HSCT.
- Consider specific events, actions, or interactions which felt important, such as how you applied the matching algorithm (e.g., 10/10 vs 8/8) and integrated non-HLA factors (e.g., CMV, age) into the final decision.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the search filter parameters when faced with a limited pool or seeking immediate senior input when a highly matched donor presented complex non-HLA issues.
- How did you feel during this experience, e.g., did you feel responsible for the clinical outcome or challenged by complex prioritisation?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the process and criteria for selecting HSCT donors. What strengths did you demonstrate, e.g., systematic application of matching criteria?
- What skills and/or knowledge gaps were evident, e.g., knowledge of advanced registry search functionality or prioritisation when clinical factors conflict?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in reviewing registry data?
- Identify any challenges you experienced, such as limited donor pool, conflicting non-HLA data, or needing advice on scope of practice regarding donor prioritisation, 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 HSCT donor selection criteria and resources.
- What will you do differently next time you approach donor selection, for instance, by proactively documenting the rationale for selecting a suboptimal match over other options?
- Do you need to practise any aspect of the activity further, such as using donor registry software or key learning outcomes related to interpreting test results?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of reviewing and selecting potential HLA matched donors for HSCT since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case with a limited donor pool requiring complex prioritization of non-HLA factors forced you to re-evaluate the diligence of your search strategies and application of mismatch acceptability rules during your first attempt at this training activity.
- Considering what you understand about matching algorithms, acceptable mismatches, and the impact of non-HLA factors (e.g., CMV, age) 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 donor selection criteria or refinement of search strategies based on further learning and experiences? For example, how you proactively reviewed and integrated the local policy for prioritisation of donors with a 9/10 match based on further learning.
- Has discussing the complexities of donor matching algorithms or the role of non-HLA factors 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 donor was rejected late in the process due to an unaddressed non-HLA factor refined your understanding of the critical nature of complex data analysis and guideline adherence during selection.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of donor selection, contributed to your overall confidence and competence in applying complex matching criteria to identify suitable donors, particularly in preparing for observed assessments (DOPS or OCEs) such as ‘Select HLA matched donors for HSCT’? For example, how your accumulated ability in complex data analysis and application of guidelines now enables you to manage registry searches and prioritization 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 HSCT donor review and selection?
- How does this evolved understanding help you identify when a matching scenario requires deviation from standard protocols or needs expert clinical input and when this is beyond your scope of practice? For example, how your evolved approach means you now routinely seek expert clinical input immediately when complex immunological risk justifies selecting a non-standard match, recognising this falls outside routine technical scope.
- Looking holistically at your training journey, how has this initial donor selection experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to interpreting test results and practicing in accordance with quality standards? For example, how this foundational experience has supported your development in transferable skills such as decision-making and understanding of clinical context that will be valuable in future roles or responsibilities.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Interpret test results for the range of techniques performed. |
| # 6 |
Outcome
Practice in accordance with quality and accreditation standards. |