Training activity information
Details
Devise and perform a protocol to investigate a prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT)
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
- The sample type required and the preanalytical variables affecting results
- Clinical presentations and other investigations
- National guidelines
- Local SOPs
- Quality assurance
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 devising and performing a protocol to investigate prolonged PT and APTT.
- Review the learning outcomes which specifically relate to identifying appropriate investigations, interpreting and reporting results, and performing quality assurance and control.
- Consider how the learning outcomes apply, specifically concerning the essential elements of a protocol for investigating prolonged PT and APTT.
- Discuss with your training officer to gain clarity of what is expected for the protocol design and execution.
What is your prior experience of this activity?
- Think about what you already know about the coagulation cascade and how PT and APTT assess it.
- Consider possible challenges you might face in designing or performing this investigation, such as:
- Sample issues
- Analyser limitations
- Identifying appropriate tests to cover common causes of prolonged PT and/or APTT
- Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice from senior staff or clinical scientists regarding complex cases or protocol design.
- Acknowledge how you feel about undertaking this activity, especially if it involves independent protocol design.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to protocol design, test selection, and interpretation in haemostasis.
- Identify specific insights you hope to gain into the diagnostic approach for bleeding disorders or other conditions causing prolonged PT/APTT.
What additional considerations do you need to make?
- Consult actions identified following previous experience with coagulation testing that could inform your protocol design.
- Identify important information you need to consider before embarking on the activity, such as:
- Local analyser capabilities
- Available reagents
- Specific clinical guidelines
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst devising and performing the protocol to investigate prolonged PT and APTT?
- Are you encountering situations such as:
- A prolonged PT but normal APTT result, conflicting with the initial broad hypothesis, requiring immediate investigation into the extrinsic pathway factors (e.g., Factor VII)
- An analyser flag suggesting sample clotting, inadequate fill volume, or haemolysis, immediately impacting the integrity of the data
- Unexpected difficulty with a specific test within the devised protocol e.g., a reagent issue for a specific factor assay
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 troubleshooting or protocol execution?
- Consider the steps you are taking in the moment, such as:
- Immediately running mixing studies due to an unexpected result profile to differentiate factor deficiency from inhibitor presence
- Pausing the protocol to review the sample quality control metrics before proceeding with complex factor assays to rule out pre-analytical error
- Seeking immediate advice from a senior colleague or training officer to ensure the next step in the investigation (e.g., inhibitor screen) is appropriate given the complexity of the initial findings
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge of the coagulation cascade to the real-time constraints of the protocol? Is it affecting your confidence in justifying the next steps?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice (e.g., are you successfully troubleshooting the sample issue, or needing support because the interpretation of the results suggests a rare or complex inhibitor that is beyond your current scope)?
- What are you learning as a result of the unexpected development? For example, are you learning a more effective technique for troubleshooting analyser flags in coagulation testing, or gaining critical insight into the hierarchical use of mixing studies in PT/APTT investigation?
On action
What happened?
- Begin by summarising the key points of the experience of devising and/or performing the protocol to investigate the prolonged PT/APTT.
- Consider specific events, actions, or interactions which felt important during the protocol execution. For instance, describe the initial findings and any subsequent tests performed.
- Include any ‘reflect-in-action’ moments where you adapted your approach based on unexpected analyser flags or complex results. Describe the specific moments that triggered these adjustments.
- Acknowledge your own feelings during the experience, such as when encountering an unexpected analyser flag.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the logical sequence of investigating prolonged PT and APTT.
- What strengths did you demonstrate e.g., in protocol design or execution? What skills and/or knowledge gaps were evident e.g., unfamiliarity with specific technical issues?
- Compare this experience against previous engagement with similar activities. Did you successfully apply any lessons from previous attempts? Has your ability to troubleshoot improved?
- Identify any challenges you experienced e.g., interpreting complex results or technical issues and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as whether you needed to seek advice or clarification, or if you needed to escalate to ensure you were working within your scope of practice when interpreting or reporting results for a complex case.
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your ability to investigate prolonged PT/APTT.
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. For example, determining specific steps to improve your ability to investigate coagulation disorders.
- What will you do differently next time you encounter a patient with prolonged PT/APTT?
- Do you need to practise any aspect of the activity further, such as devising protocols, performing specific tests, or interpreting result patterns?
- Do you need to review specific guidelines or laboratory procedures?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions for improvement identified in your previous reflections for this specific activity?
- What specific steps for improvement did you previously identify regarding protocol design, performance, or troubleshooting?
- Have you actively worked on these areas, and are you now able to demonstrate improved proficiency in this area?
- Have you discussed challenging or notable PT/APTT investigation cases or protocol issues with peers or senior colleagues? Has hearing their perspectives or approaches changed your own understanding or method for devising and performing such protocols?
How have these experiences impacted upon current practice?
- Consider how the cumulative learning from these experiences and your reflections will support you in preparing for relevant observed ‘in-person’ assessments for the module, such as a DOPS on determining the cause of a prolonged APTT or an OCE presenting a case of unexplained bleeding.
- How has your ability to devise and perform robust protocols for PT/APTT investigations evolved over time?
- Have you become more adept at anticipating challenges or selecting appropriate follow-up steps?
- How confident are you now in knowing when you need to seek advice or escalate a complex investigation that might be beyond your current scope?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify appropriate clinical and laboratory investigations for the investigation of haemostasis. |
| # 2 |
Outcome
Interpret and report results of investigations of haemostasis in the correct clinical context. |
| # 7 |
Outcome
Perform quality assurance and control tasks across the range of investigations. |