Specialist Haematology —
Training activity: 11

Details

Select and interpret testing for the investigation of a haematological malignancy to include investigation by:

• Morphology
• Immunophenotyping
• Molecular
• Karyotyping/cytogenetics

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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 are the intended outcomes of the training activity?

• How will you focus your attention on selecting and interpreting laboratory techniques, complying with national/international guidelines, and performing quality assurance?
• In what ways will exploring the curriculum considerations—such as the WHO classification of myeloid and lymphoid malignancies and the principles of IQC and EQA—help guide your preparation?
• What specific knowledge do you need regarding the workflow of different techniques (morphology, immunophenotyping, molecular, and karyotyping) before you begin the investigation?
• How will this activity help you define success in providing an integrated diagnostic report that supports both the diagnosis and monitoring of treatment in the correct clinical context?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding how morphology, flow cytometry, molecular data, and cytogenetics contribute to the overall classification of cancers?
• Based on what you already know about haematological malignancies, what new understanding do you expect to gain regarding the selection of testing modalities for different disease states?
• How do you anticipate this experience will improve your ability to comply with BSH, WHO, and NICE guidelines when interpreting complex results?
• In what ways will this activity prepare you for the high-level analytical and interpretive responsibilities required for post-programme practice as a Clinical Scientist?

What actions will you take in preparation for the experience?

• How will you discuss the diagnostic algorithms and integrated reporting protocols with your Training Officer to ensure you have a clear understanding of departmental expectations?
• What possible challenges have you identified—such as interpreting complex karyotypes or reconciling conflicting data between morphology and immunophenotyping—and how do you plan to handle them?
• Which specific guidelines (e.g., WHO classification of tumours of haematopoietic and lymphoid tissues) will you gather beforehand to ensure your interpretations are robust and evidence-based?
• How do you feel about embarking on this complex investigation, and how will acknowledging feelings like confidence or anxiety help you focus on the technical and clinical precision required?

In action

What are you doing?

• Based on your initial findings from the morphology (e.g., the presence of blasts or abnormal lymphoid cells), what further investigations (immunophenotyping, molecular, or cytogenetics) are you immediately deciding to perform?
• What is the rationale for your choices in this moment, and how are you ensuring your approach complies with national and international guidelines (such as WHO, BSH, or NICE) for the diagnosis of haematological cancer?
• What decisions are you making regarding the selection of specific antibody panels for flow cytometry or specific gene targets for molecular analysis as the case develops?
• Which aspects of your practice feel intuitive—such as recognising diagnostic patterns—and which require more conscious effort, such as ensuring the technical precision of karyotyping or molecular assays?

How are you progressing with the activity?

• As results from different platforms (e.g., flow cytometry alongside morphology) become available, how are you integrating this information in real-time to refine your interpretation and classification of the malignancy?
• How effective are your actions in building a comprehensive diagnostic picture that distinguishes between different disease states, such as myeloid versus lymphoid neoplasms?
• Are you performing the necessary quality assurance and control tasks across these diverse investigations to ensure the data is reliable before it is integrated into a final report?
• What can you learn from the case as it unfolds regarding the prognostic implications of certain genetic or phenotypic markers?

How are you adapting to the situation?

• How are you troubleshooting technical difficulties with any of the testing platforms (e.g., a failing molecular assay or poor-quality karyotype preparation) as they occur?
• If you encounter conflicting results—such as a morphology that suggests one condition while immunophenotyping suggests another—how are you adapting your strategy to resolve the discrepancy in real-time?
• Are you considering the need for multidisciplinary input (MDT) at any point during the investigation to ensure the results are interpreted in the correct clinical context?
• Are you ensuring that all real-time decisions, particularly regarding urgent reporting of new diagnoses to clinical teams, remain within your defined scope of practice?

On action

What did you notice?

• What were the key clinical features (e.g., lymphadenopathy, unexplained weight loss) and initial laboratory findings (e.g., cytopenias or circulating blasts) that indicated a potential haematological malignancy?
• How did you select the specific laboratory and molecular testing techniques (morphology, immunophenotyping, molecular, and karyotyping/cytogenetics) required for this case?
• What was the rationale for choosing these specific modalities, and how did they align with the goal of both diagnosing and monitoring treatment?
• What were the key findings from each investigation, and how did you integrate these results to form an overall interpretation? Were there any concordant or discordant findings between the different platforms?
• What were the quality assurance and control results for these diverse investigations, and were they verified as acceptable before the final results were reported?

What did you learn from the activity?

• What is the specific role of each investigative technique—morphology, immunophenotyping, molecular, and karyotyping—in the current classification of haematological malignancies?
• How did the results from these different approaches complement each other to provide a comprehensive picture of the disease state?
• In what ways did you comply with national and international guidelines (e.g., WHO classification, BSH, or NICE guidelines) during the interpretation of these integrated results (Learning Outcome 4)?
• Were there any unexpected challenges (e.g., poor sample viability for flow cytometry or complex cytogenetic results), and what did you learn about troubleshooting these issues?
• How did your reflection-in-action (decisions made during the testing process) influence the efficiency and accuracy of the final diagnostic pathway?
• How does this experience relate to the high-level analytical and interpretive requirements for post-programme practice as a Clinical Scientist?

What will you take from the experience moving forward?

• How has this activity enhanced your ability to select the most appropriate investigations for suspected malignancies based on initial clinical and morphological findings?
• How will you improve your skills in integrating complex data from multiple laboratory disciplines to produce a clear, clinically useful report?
• What specific actions will you take to stay updated on evolving diagnostic criteria and national guidelines for haematological cancers?
• How will you apply the learning regarding quality assurance to ensure that future complex investigations remain robust and reliable?
• What support or resources (e.g., attending a multidisciplinary team meeting or reviewing specialist textbooks/atlases) will you seek to further develop your expertise in this area?

Beyond action

Have you revisited the experiences?

• Since completing this activity, have you been involved in the investigation of other haematological malignancies using a range of diagnostic techniques, and how did those cases compare to this one?
• Have you reviewed your reflect-on-action notes to see if your understanding of the integrated approach—combining morphology, immunophenotyping, molecular, and cytogenetics—has deepened with further experience?
• Can you recall specific Multidisciplinary Team (MDT) meetings where the integration of these four modalities was crucial for determining a patient’s diagnosis or treatment plan?
• Have you engaged in professional storytelling with senior colleagues or pathologists to discuss how they interpret complex or conflicting datasets in different types of malignancies?
• When reviewing this training activity as part of a broader module review for Specialist Haematology (S-HT-S2), what cumulative learning have you identified regarding the diagnostic pathway for cancers?

How have these experiences impacted upon your current practice?

• How has this training activity enhanced your appreciation for the complementary roles of different laboratory techniques in the classification of haematological malignancies?
• In what ways has your ability to identify appropriate follow-up tests improved based on initial morphological or flow cytometric findings?
• How has this experience influenced your ability to comply with national and international guidelines (e.g., WHO or BSH) when synthesising results for a final report?
• How have the skills in critical evaluation of multi-parameter data and diagnostic algorithms been transferable to other areas of your clinical work?
• How has this activity supported your preparation for observed ‘in-person’ assessments, such as the DOPS for ‘performing the initial morphological investigation for an acute leukaemia and determining confirmatory testing’?
• Are you now more consistently performing quality assurance and control tasks across all platforms—from morphology to molecular—to ensure the integrity of integrated reports?

How might these experiences contribute towards your future practice?

• How will your experience with the integrated investigation of malignancies prepare you for managing more complex cases, research opportunities, or clinical trials in your future career?
• Will your ability to interpret diverse datasets contribute to more accurate and timely diagnoses, directly impacting patient care and treatment monitoring?
• How might this experience support your professional progression toward a specialist role focused on haematological oncology diagnostics?
• What clear actions have you identified for continued development, such as staying updated on advancements in molecular markers or emerging WHO classification updates?

Relevant learning outcomes

#	Outcome
# 3	Outcome Select and interpret a range of laboratory and molecular testing techniques to diagnose and monitor treatment of haematological malignancy in the correct clinical context.
# 4	Outcome Interpret and comply with national and international guidelines on the diagnosis and management of haematological cancer.
# 7	Outcome Perform quality assurance and control tasks across the range of investigations.