Advanced H&I – Stem Cells —
Training activity: 5

Details

Produce an interpretive report on the suitability of potential alternative HSCT donor for clinical colleagues

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 reporting in-line with current accreditation standards
• Non-HLA factors
• Integration of patient history and investigative results

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 an interpretive report for an alternative HSCT donor that clearly communicates their suitability, unique aspects, and associated considerations to clinical colleagues.
• Consider how the learning outcomes apply, specifically in relation to evaluating alternative donor suitability, accurately interpreting complex data, and detailing specific follow-up or risk considerations in the report.
• Discuss with your training officer to gain clarity of what is expected of you in relation to highlighting the unique aspects and potential challenges related to the specific alternative donor type e.g., cord blood unit characteristics or relatedness for haploidentical.

What is your prior experience of this activity?

• Think about what you already know about interpreting alternative donor evaluations and if you are familiar with the specific information required in a report for an alternative donor compared to a matched donor.
• Consider possible challenges you might face during the activity, such as explaining the rationale for using an alternative donor, detailing specific immunological considerations, or accurately describing the characteristics of a cord blood unit.
• 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 immunological considerations (e.g., haploidentical risk) are ambiguous or complex, or if the report terminology needs specialist verification for the chosen alternative donor type.
• Acknowledge how you feel about presenting the complexities and potential risks associated with alternative donor options to the clinical team.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as interpreting and reporting on alternative donor evaluations, including the immunological and logistical considerations.
• Identify the specific insights you hope to gain into how clinicians utilise information about alternative donors to make complex treatment decisions.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of evaluating or reporting on complex, high-risk donor types.
• Identify important information you need to consider before embarking on the activity, such as the specific criteria and policies for reporting on alternative donors, essential details regarding the donor source (e.g., cord blood unit characteristics), and how the potential risks or limitations are communicated in the report.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst producing an interpretive report on the suitability of a potential alternative HSCT donor for clinical colleagues?
• Are you encountering situations such as the unique characteristics or data associated with the specific alternative donor type (e.g., cord blood metrics, haploidentical mismatch details) requiring unexpected interpretation while you are writing the report?
• Are you finding it unexpectedly challenging to explain the rationale for using an alternative donor or to detail the associated considerations in the report? Or are you experiencing unexpected non-HLA factors or logistical details specific to the alternative donor that need careful inclusion?

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 interpreting alternative donor data or ensuring clarity for clinical colleagues?
• Consider the steps you are taking in the moment, such as consulting references or specialists during the drafting process because interpreting alternative donor data was complex? or adapting your language or structure to ensure clarity for clinical colleagues if explaining complexities was difficult?
• How are you feeling in that moment? For instance, did dealing with the complexities of reporting on an alternative donor affect your ability to complete the report confidently and independently? Is it affecting your confidence in presenting the information accurately?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to produce a comprehensive and clear interpretive report for the alternative donor? Or are you needing support because you needed to seek senior review before finalising the report?
• What are you learning as a result of the unexpected development? For example, what did you learn in the moment about reporting on the specific considerations and potential challenges of alternative HSCT donors?

On action

What happened?

• Begin by summarising the key steps you took when producing the interpretive report on the suitability of a potential alternative HSCT donor.
• Describe the specific data associated with the alternative donor type you interpreted and how you explained the suitability and associated considerations to clinical colleagues.
• Consider specific events, actions, or interactions which felt important, such as how you interpreted the specific limitations of the alternative donor (e.g., low cell dose for cord blood or high immunological disparity for haploidentical) and detailed the associated risks.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revising the interpretation to clearly state the rationale for using an alternative donor or consulting specialised protocols on reporting immunological risk factors unique to that donor type.
• How did you feel during this experience, e.g., did you feel challenged by the complexity of reporting on a less common donor type or focused on ensuring the reported risks were accurately balanced against clinical need?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding interpreting and reporting on the suitability of alternative HSCT donors. What strengths did you demonstrate, e.g., ability to clearly explain complex immunological risks associated with alternative donor types?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with reporting criteria unique to cord blood units or translating specific immunological risks into understandable language?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating specialised data from alternative donor options into a clinical report compared to reporting on standard matched donors?
• Identify any challenges you experienced, such as interpreting data unique to the alternative donor type or needing to seek review or clarification on scope of practice regarding clearly stating the limitations and risks of the alternative donor option, 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 the reporting structure for complex alternative donor suitability cases.
• What will you do differently next time you approach producing an interpretive report on an alternative donor, for instance, by proactively obtaining examples of reports covering various alternative donor types (e.g., haploidentical, cord blood) to ensure comprehensive risk reporting?
• Do you need to practise any aspect of the activity further, such as understanding specific alternative donor criteria or key learning outcomes related to refining your reporting on associated risks/benefits?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of producing interpretive reports on the suitability of alternative HSCT donors since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
• Considering what you understand about alternative donor reporting criteria, clinical risk communication, and regulatory requirements 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 explanation of the specific considerations for alternative donors and communication of associated risks/benefits based on further learning and experiences? For example, how you proactively implemented a structured framework for reporting haploidentical risk factors based on further learning.
• Has discussing the rationale for using alternative donors or the specific challenges in reporting complex alternative donor data or the impact of feedback from clinical colleagues changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a report where a key cord blood unit characteristic was ambiguously reported refined your understanding of the critical nature of detailed communication for less common donor types.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent alternative donor reporting experiences, contributed to your overall confidence and ability in interpreting and reporting on the suitability of alternative HSCT donors, effectively communicating the unique considerations for these options, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in explaining the rationale for considering alternative donors and the associated clinical factors now enables you to confidently prepare for observed assessments (DOPS or OCEs) such as ‘Present laboratory results for an HSCT case at a multidisciplinary meeting’ during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to alternative donor interpretive reporting?
• How does this evolved understanding help you identify when an alternative donor case involves complex or conflicting data, requires careful explanation of limitations or uncertainties, or necessitates expert input on clinical feasibility, and when this is beyond your scope of practice requiring expert review or clinical liaison?
• Looking holistically at your training journey, how has this initial alternative donor reporting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to interpreting complex information and evaluating alternative donor suitability?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply the appropriate strategy for the investigation of patients being considered for haematopoietic stem cell transplantation (HSCT), interpret and report results of the investigation in the correct clinical context.
# 2	Outcome Assess the suitability of potential related and unrelated matched and mismatched donors for HSCT.
# 3	Outcome Perform clinical and laboratory monitoring of patients who have received HSCT.