Specialist Haematology —
Training activity: 14

Details

Select and interpret testing for the diagnostic techniques used for the investigation of myeloproliferative neoplasms (MPN) and chronic myelogenous leukaemia (CML)

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 techniques, complying with national/international guidelines, and performing quality assurance specifically for MPN and CML?
• What specific knowledge do you need regarding the role of molecular markers (e.g. BCR::ABL1, JAK2, CALR, MPL) and cytogenetics before you begin the investigation?
• How will this activity help you define success in providing a diagnostic report that supports both the initial classification and the long-term 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, molecular data, and cytogenetics contribute to distinguishing between different phases of CML or types of MPN?
• Based on what you already know, how do you anticipate this activity will deepen your understanding of molecular monitoring (e.g. quantifying BCR::ABL1 transcripts) as a tool for assessing treatment response?
• How do you expect this experience to improve your ability to comply with BSH, WHO, and NICE guidelines when navigating the diagnostic algorithms for chronic myeloid neoplasms?
• In what ways will this activity prepare you for the high-level analytical and interpretive responsibilities required to ensure reliable results through IQC and EQA performance?

What actions will you take in preparation for the experience?

• How will you discuss the diagnostic protocols and workflow for MPN/CML with your Training Officer to ensure you have a clear understanding of departmental expectations?
• What possible challenges have you identified—such as interpreting triple-negative MPN cases or reconciling borderline morphological features with molecular findings—and how do you plan to handle them?
• Which specific guidelines (e.g. BSH guidelines for the investigation of erythrocytosis or CML monitoring) will you gather beforehand to ensure your interpretations are evidence-based?
• How do you feel about embarking on this investigation? Does acknowledging feelings of curiosity or the weight of responsibility regarding long-term patient monitoring help you focus on the technical precision required?

In action

What are you doing?

• Given a clinical suspicion of MPN or CML, which diagnostic tests (e.g. peripheral blood morphology, molecular markers like BCR::ABL1 or JAK2) are you currently prioritising and why?
• How are you ensuring your choice of investigations and initial interpretations comply with national and international guidelines (such as WHO classification, BSH, or NICE) for chronic myeloid cancers?
• What decisions are you making regarding determining if the testing is for initial diagnosis or the long-term monitoring of treatment?
• Which aspects of your practice feel intuitive—such as recognising the characteristic blood film of CML—and which require more conscious effort, such as the precise interpretation of complex molecular datasets?

How are you progressing with the activity?

• As you obtain results (e.g. blood counts, bone marrow morphology, and molecular assays), are they aligning with the expected findings for these specific conditions, or are you seeing unexpected flags or messages?
• How are you performing quality assurance and control tasks while the activity unfolds, such as verifying that IQC and EQA parameters for molecular quantitative assays are within acceptable limits before you proceed?
• How are you integrating clinical and laboratory findings in real-time to build a comprehensive diagnostic picture that distinguishes between different MPN subtypes?
• What are you learning from the case as it unfolds regarding the aetiology and pathogenesis of these malignancies?

How are you adapting to the situation?

• If you encounter difficulties in interpreting complex results—such as a ‘triple-negative’ MPN or a borderline BCR::ABL1 transcript level—what alternative approaches or further investigations are you considering in the moment?
• Are you working within your defined scope of practice, and at what point do you recognise the need for support or guidance from a senior colleague or the multidisciplinary team (MDT)?
• How are you troubleshooting technical issues with the testing platforms (e.g. molecular assay failure) as they occur to ensure the investigation remains on track?
• How are you adapting your strategy to ensure the final report provides the necessary information for the clinical team to monitor treatment effectively?

On action

What did you notice?

• What were the key clinical features and peripheral blood findings (e.g. persistent leucocytosis, thrombocytosis, or erythrocytosis) that initially raised suspicion for an MPN or CML?
• How did you select the specific laboratory and molecular testing techniques (such as morphology, cytogenetics for the Philadelphia chromosome, or molecular assays for JAK2, CALR, MPL, and BCR::ABL1) for this case?
• What were the key morphological features observed in the bone marrow and peripheral blood (e.g. megakaryocyte clusters or a full spectrum of myeloid maturation)?
• What were the significant cytogenetic or molecular findings, and how did these specific results contribute to the definitive diagnosis?
• Regarding Quality Assurance, what were the IQC and EQA results for the molecular quantitative assays or cytogenetic investigations, and were they verified as acceptable before the data was integrated?

What did you learn from the activity?

• What are the specific diagnostic criteria for the different types of MPN (e.g. essential thrombocythaemia, polycythaemia vera, primary myelofibrosis) and CML according to current WHO classifications?
• In what ways did you comply with national and international guidelines (e.g. BSH, WHO, or NICE) when interpreting results and determining the patient’s disease phase or risk category?
• How did the laboratory findings inform the prognosis and monitoring of treatment (e.g. molecular response in CML) in the correct clinical context?
• What challenges did you identify in differentiating between different types of MPN or distinguishing them from reactive states or other myeloid disorders?
• How did your reflection-in-action (the decisions you made as results became available) influence the accuracy and efficiency of the 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 and interpret the complex investigations required for suspected chronic myeloid malignancies?
• Which key resources and guidelines (e.g. BSH guidelines for MPN investigation) have you identified as essential for your future practice?
• How will you improve your skills in the integrated interpretation of results, ensuring that morphological, molecular, and cytogenetic data are synthesised into a clear report?
• What specific ‘next steps’ will you take to support the assimilation of this learning, such as attending a multidisciplinary team (MDT) meeting to see how these results impact clinical management?
• How will you apply your learning regarding quality assurance and control to ensure that future monitoring of treatment (e.g. minimal residual disease) remains robust and reliable?

Beyond action

Have you revisited the experiences?

• Since completing this activity, have you investigated other cases of MPN or CML, perhaps encountering different driver mutations (e.g. CALR or MPL) or different disease phases (e.g. CML blast crisis)?
• How has your understanding of the diagnostic criteria and the specific role of molecular markers like BCR::ABL1 and JAK2 evolved since you first recorded your reflect-on-action notes?
• Can you recall Multidisciplinary Team (MDT) discussions where the laboratory’s role in monitoring treatment response was a focus? Has your view of these cases changed after engaging in professional storytelling with senior colleagues?
• As part of a holistic module review for Specialist Haematology (S-HT-S2), how does this investigation of chronic myeloid malignancies compare to your experiences with acute leukaemia?
• Have you reviewed updated national and international guidelines (e.g. WHO classification or BSH guidelines) to see how they have informed your recent diagnostic pathways?

How have these experiences impacted upon your current practice?

• How has this training activity enhanced your ability to select and interpret the correct combination of morphological and molecular tests to diagnose and monitor treatment in the correct clinical context?
• In what ways has your practice become more intuitive when integrating clinical, morphological, and molecular findings to comply with WHO and BSH guidelines?
• How consistently are you now performing and verifying quality assurance and control tasks (e.g. verifying IQC and EQA for quantitative PCR) across these complex investigations?
• How has this experience supported your preparation for observed ‘in-person’ assessments, such as the DOPS for ‘performing the initial morphological investigation for a chronic leukaemia and determining confirmatory testing’?
• Are the analytical and interpretative skills you applied here—such as synthesising multi-parameter data—now being transferred to other areas of your diagnostic work?

How might these experiences contribute towards your future practice?

• How will your experience in the long-term monitoring of chronic malignancies prepare you for managing complex patient pathways and staying abreast of therapeutic advancements?
• Will your ability to accurately interpret molecular and cytogenetic data contribute to more precise response assessments, ultimately improving patient outcomes?
• What clear actions have you identified for continued development, such as mastering the implementation of new molecular diagnostic techniques or emerging genetic markers?
• How might this fundamental experience support your progression towards a specialist role in haematological oncology, where you may lead on method validation or quality improvement initiatives?

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.