Training activity information
Details
Select appropriate sera for highly sensitised patient crossmatching in accordance with local and national guidelines for a complex potential solid organ recipient case
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
- 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 correctly selecting the serum samples for crossmatching a highly sensitised patient according to local and national guidelines.
- Consider how the learning outcomes apply, specifically in relation to interpreting and reporting tests, assessing suitability, and practicing according to standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to what criteria are used to determine the appropriate sera, considering the patient’s sensitisation profile and the donor.
What is your prior experience of this activity?
- Think about what you already know about selecting samples for crossmatching before, particularly for complex cases, or if you are familiar with the concept of high sensitisation.
- Consider possible challenges you might face during the activity, such as complex patient antibody history, availability of suitable historical samples, or interpretation of national guidelines.
- 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 ‘peak’ historical sample is of insufficient volume or integrity for the required assay.
- Acknowledge how you feel about the critical importance of selecting the correct samples for these challenging cases.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as reviewing historical antibody data and applying complex guidelines to select appropriate sera.
- Identify the specific insights you hope to gain into the strategies and challenges associated with crossmatching for highly sensitised patients.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of reviewing historical patient data or adhering to complex protocols.
- Identify important information you need to consider before embarking on the activity, such as what the requirements are for sample age and storage for crossmatching.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst selecting appropriate sera for highly sensitised patient crossmatching?
- Are you encountering situations such as:
- The required ‘peak’ serum sample, which captured the patient’s highest sensitisation event, is unavailable or has compromised integrity, necessitating a deviation from standard sample selection policy?
- The patient’s history includes recent desensitisation therapy, complicating the decision on which sample (current vs. historical) is the most clinically representative for the crossmatch?
- Conflicting information exists in the patient file regarding the date or source of a critical historical sample, requiring immediate verification?
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 sample justification and documentation methodology?
- Consider the steps you are taking in the moment, such as:
- Immediately consulting the national or local guidance specifically addressing serum selection deviation for highly sensitised patients
- Documenting the rationale for using a non-peak or alternative serum sample and seeking supervisory approval for the deviation
- How are you feeling in that moment? For instance, are you finding it difficult to reconcile policy adherence with the urgency of the transplant? Is it affecting your confidence in selecting the most immunologically representative sample?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully justifying the use of an alternative sample based on comprehensive review and policy adherence? Or are you needing support because the immunological risk associated with the only available serum sample requires senior pathological sign-off before proceeding to crossmatch?
- What are you learning as a result of the unexpected development? For example, are you mastering the critical application of complex guidelines and risk justification in pre-transplant sample management?
On action
What happened?
- Begin by summarising the key steps you took when selecting appropriate sera for crossmatching for the highly sensitised patient case.
- Consider specific events, actions, or interactions which felt important, such as the specific patient’s sensitisation history and the criteria you applied from local and national guidelines to select the sera, or the process of reviewing available samples.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, re-consulting guidelines or adjusting your selection strategy based on sample constraints.
- How did you feel during this experience, e.g., did you feel confident in applying complex guidelines or stressed if limited sample availability presented a challenge?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding sera selection for highly sensitised patients and the application of guidelines. What strengths did you demonstrate, e.g., systematic application of guidelines?
- What skills and/or knowledge gaps were evident, e.g., gaps in your understanding of sensitisation or relevant guidelines?
- 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 select sera for complex cases?
- Identify any challenges you experienced, such as balancing multiple guidelines or dealing with limited sample options, and how you reacted to these. Were you able to overcome them?
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 selection of sera for highly sensitised patient crossmatching.
- What will you do differently next time you approach selecting sera for a highly sensitised patient crossmatch, for instance, by proactively deepening your understanding of complex sensitisation profiles or navigating specific guidelines?
- Do you need to practise any aspect of the activity further, such as deepening your understanding of complex sensitisation profiles or navigating specific guidelines or key learning outcomes related to assessing the suitability of patients?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of selecting appropriate sera for highly sensitised patient crossmatching since completing this specific training activity led you to revisit your initial approach or decisions during that activity? The subsequent crossmatch results, clinical outcomes, or expert review may lead you to evaluate whether the selected sera were indeed appropriate and representative.
- Considering what you understand about the rationale for selecting specific historical samples or applying guidelines for different sensitisation levels 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 the rationale for selecting specific historical samples or applying guidelines for different sensitisation levels based on further learning and experiences? For example, improving your understanding of the rationale for selecting specific historical samples or applying guidelines for different sensitisation levels forced you to re-evaluate the necessity of selecting the ‘peak’ or most relevant serum sample during your first attempt at this training activity.
- Has discussing serum selection for complex sensitised patients or how guidelines are applied in challenging cases or the impact of managing samples from patients on desensitisation therapies with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? Engaging in professional storytelling with peers, near peers or colleagues can lead to transformation.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent complex crossmatching experiences, contributed to your overall confidence and ability in applying complex guidelines and clinical judgement to select critical samples for crossmatching highly sensitised patients, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in understanding the historical context of sensitisation and the importance of selecting samples that capture the patient’s antibody profile now enables you to confidently participate in case discussions involving highly sensitised patients 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 selecting appropriate sera for highly sensitised patient crossmatching?
- How does this evolved understanding help you identify when a highly sensitised patient’s history or antibody profile makes serum selection exceptionally complex, requires consultation with senior staff or the transplant team, and when this is beyond your scope of practice?
- 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 complex guidelines, critical evaluation of patient history and laboratory data, decision-making in challenging scenarios, and understanding the clinical impact of sample selection? For example, how this foundational experience has supported your development in transferable skills such as applying complex guidelines, critical evaluation of patient history and laboratory data, decision-making in challenging scenarios, and understanding the clinical impact of sample selection.
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. |