Training activity information
Details
Review antibody screening results for sensitised patients and define unacceptable antigens
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 policy for registration of unacceptable antigens and national requirements
- Sensitisation history
- Patient antibody testing history
- Relevance of cRF
- ODT tools
- Impact of unacceptable antigens on patient’ chances or receiving a transplant offer
- Patient sensitisation history
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 effectively reviewing antibody screening results for a sensitised patient according to laboratory policy and relevant guidelines.
- Consider how the learning outcomes apply, specifically in relation to interpreting and reporting tests, assessing patient suitability, and practicing in accordance with quality standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to accurately defining the unacceptable antigens for this patient based on the screening results and patient history.
What is your prior experience of this activity?
- Think about what you already know about reviewing antibody screening results, particularly for complex or highly sensitised patients, or if you are familiar with methods like Luminex or ELISA.
- Consider possible challenges you might face during the activity, such as interpreting results that show multiple antibodies, weak reactions, or potential non-HLA antibodies.
- 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 a non-HLA antibody pattern is suspected or if the antibody profile is particularly complex or the interpretation is unclear.
- Acknowledge how you feel about the responsibility of defining unacceptable antigens that will impact transplant or transfusion options.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as interpreting complex antibody profiles and applying stringent criteria for defining unacceptable antigens.
- Identify the specific insights you hope to gain into the impact of sensitisation on patient management in transplantation and transfusion.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of similar antibody analysis activities.
- Identify important information you need to consider before embarking on the activity, such as which patient history information is crucial to consider alongside the antibody results (e.g., previous transfusions, pregnancies, transplants).
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing antibody screening results and defining unacceptable antigens?
- Are you encountering situations such as:
- The antibody screening panel shows ambiguous weak signals or highly complex multi-specificity that challenges routine classification?
- Patient history information unexpectedly contradicts the observed PRA (Panel Reactive Antibody) level, complicating the initial assessment of sensitisation?
- You detect potential non-HLA reactivity that requires immediate differentiation from true HLA specificities?
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 systematic interpretation or policy application?
- Consider the steps you are taking in the moment, such as:
- Halting the definition process immediately to re-review historical data and MFI (Mean Fluorescence Intensity) threshold criteria to resolve the ambiguity
- Consulting a standardised flowchart for troubleshooting complex or non-HLA related reactivity
- How are you feeling in that moment? For instance, are you finding it difficult to maintain objectivity while faced with ambiguous data? Is it affecting your confidence in defining the definitive list of unacceptable antigens?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving the ambiguity by applying departmental criteria for weak positivity? Or are you needing support because the complexity of the antibody profile requires senior pathological verification before the unacceptable antigens can be finalised?
- What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous strategy for correlating antibody findings with patient clinical history?
On action
What happened?
- Begin by summarising the key steps you took when reviewing the antibody screening results and defining unacceptable antigens for the specific sensitised patient(s).
- Consider specific events, actions, or interactions which felt important, such as the specific types of antibodies identified and the criteria used to define them as unacceptable antigens, or consulting with colleagues or using software.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, revisiting guidelines or re-evaluating a result when the antibody profile was complex or challenging to interpret.
- How did you feel during this experience, e.g., did you feel confident in your use of software or stressed by the challenging nature of the interpretation?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the interpretation of antibody screening results and the definition of unacceptable antigens. What strengths did you demonstrate, e.g., meticulous adherence to quality standards?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with interpreting specific antibody patterns?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in your ability to handle complex antibody cases?
- Identify any challenges you experienced, such as ambiguous results or applying complex rules, and how you reacted to this. Were you able to overcome the challenges?
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 assimilation of new knowledge related to interpretation and reporting tests.
- What will you do differently next time you approach reviewing antibody screening results and defining unacceptable antigens, for instance, by proactively checking specific policy guidelines or interpreting specific antibody patterns?
- Do you need to practise any aspect of the activity further, such as interpreting specific antibody patterns or key learning outcomes related to interpreting and reporting tests?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of reviewing antibody screening results for sensitised patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about specific antibody patterns or refining your method for defining unacceptable antigens now, were the actions or considerations you identified after your initial reflection on this training activity sufficient?
- You should review any actions for improvement you identified in previous reflections for this activity.
- How have you since implemented or adapted improvements in your understanding of specific antibody patterns or refining your method for defining unacceptable antigens based on further learning and experiences? For example, improving your understanding of specific antibody patterns or refining your method for defining unacceptable antigens forced you to re-evaluate the meticulousness of your interpretation during your first attempt at this training activity.
- Has discussing reviewing antibody screening results for sensitised patients and defining unacceptable antigens or the impact of the patient history on antibody profiles with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent antibody screening results review experiences, contributed to your overall confidence and ability in accurately interpreting antibody screening results for sensitised patients, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in understanding the nuances of different assay technologies or the impact of patient history on antibody profiles now enables you to confidently interpret complex antibody profiles during observed assessments (DOPS or OCEs) related to antibody analysis or case discussions 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 interpreting antibody screening results for sensitised patients?
- How does this evolved understanding help you identify when a patient’s sensitisation profile is particularly complex, requires advanced interpretation or correlation with other clinical factors, and when this is beyond your scope of practice requiring expert review?
- Looking holistically at your training journey, how has this initial antibody screening review experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to complex data analysis, clinical interpretation, risk assessment (based on antibody profiles), and adherence to guidelines? For example, how this foundational experience has supported your development in transferable skills such as complex data analysis, clinical interpretation, risk assessment (based on antibody profiles), and adherence to guidelines.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Interpret and report tests across the range of techniques applied and provide appropriate clinical advice for solid organ transplant. |
| # 3 |
Outcome
Assess the suitability of patients for crossmatch and transplantation in deceased and live donor settings. |
| # 7 |
Outcome
Practice in accordance with quality management and accreditation standards. |