Training activity information
Details
Select and interpret diagnostic techniques for the investigation of antenatal Haemoglobinopathy and thalassaemia testing in line with the national screening programme
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 identifying appropriate investigations for hereditary red cell disorders and performing essential quality assurance tasks?
- In what ways will exploring the indicative content—such as the scientific basis of analytical procedures and inheritance patterns of thalassaemia—help guide your preparation?
- What specific knowledge do you need before embarking on the activity, such as the national screening programme guidelines and the criteria for identifying significant haemoglobin variants?
- How will this activity help you define success in providing a diagnostic interpretation that supports the management of these disorders in a clinical context?
What do you anticipate you will learn from the experience?
- What specific insights do you hope to gain regarding the selection of follow-up tests, such as molecular testing, for complex carrier combinations?
- Based on what you already know, how do you anticipate this activity will deepen your understanding of techniques like high-performance liquid chromatography (HPLC) and haemoglobin electrophoresis?
- In what ways will this activity prepare you for the high-level analytical responsibilities required to ensure reliable results through the performance of IQC and EQA?
- How do you expect this experience to improve your ability to outline the clinical implications and potential need for prenatal diagnosis?
What actions will you take in preparation for the experience?
- How will you discuss the diagnostic protocols and laboratory workflow for antenatal screening with your Training Officer or assessor to ensure a clear understanding of expectations?
- What possible challenges have you identified—such as interpreting results in patients with concurrent iron deficiency or identifying rare variants—and how do you plan to handle them?
- Which national guidelines (e.g. from the NHS Sickle Cell and Thalassaemia Screening Programme) will you review beforehand to ensure your interpretations are evidence-based?
- How do you feel about embarking on this training activity, especially acknowledging the significant implications your findings will have for prospective parents?
In action
What are you doing?
- Following the national screening programme guidelines, which specific diagnostic techniques—such as high-performance liquid chromatography (HPLC) or capillary electrophoresis—are you selecting at each stage of the investigation?
- Why is the specific sequence of these tests important for an accurate antenatal investigation?
- How are you ensuring that your selection of investigations effectively identifies the correct hereditary red cell disorder?
- What aspects of your practice feel intuitive, such as recognising common haemoglobin variants, and what requires more conscious effort, such as interpreting complex or rare electrophoretic patterns?
How are you progressing with the activity?
- As you obtain results, are you identifying any abnormal patterns or variants, and how are you immediately confirming these findings?
- How are you performing quality assurance and control tasks while the activity is underway, such as verifying that IQC and EQA for the HPLC or electrophoresis platforms are within acceptable limits before you proceed with interpretation?
- What challenges are you facing during this activity—such as resolving results in a patient with a concurrent iron deficiency—and what can you learn from this as it unfolds?
- How does this investigation connect to your existing knowledge of the scientific basis of analytical procedures and inheritance patterns?
How are you adapting to the situation?
- Are there alternative approaches or further tests (e.g., molecular studies) you should consider if you encounter difficulties in differentiating between various haemoglobin variants?
- What resources or national guidelines are you referring to in real-time to resolve complex diagnostic questions?
- 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 clinical team?
- How are you adapting your approach to ensure the final report provides the necessary information to outline the management of the disorder and support the clinical team’s communication with the patient?
On action
What did you notice?
- What were the key steps in the antenatal screening pathway relevant to the cases you investigated, and how did they align with the national programme?
- Which specific diagnostic techniques did you select and perform, such as a full blood count (FBC), haemoglobin analysis by HPLC or electrophoresis, or DNA analysis?
- What were the results obtained from these investigations, and how did you interpret them specifically within the context of the national screening programme guidelines?
- In terms of Quality Assurance, did you verify that the internal quality control (IQC) and external quality assurance (EQA) for the HPLC or electrophoresis platforms were within acceptable limits before the data was used for clinical interpretation?
- Did you identify any further actions or investigations that were indicated based on the initial results?
What did you learn from the activity?
- What is the primary purpose and process of the national antenatal haemoglobinopathy and thalassaemia screening programme?
- How do the different laboratory techniques you used differ in their roles for screening versus definitive diagnosis?
- What skills did you develop in interpreting results to accurately identify carriers, affected individuals, and at-risk couples?
- How has this activity improved your ability to outline the management of these hereditary red cell disorders and understand the implications for genetic counselling and pregnancy management?
- In what ways did your reflection-in-action (decisions made during the activity) influence how the investigation unfolded?
- How does this experience relate to the high-level requirements for post-programme practice, particularly regarding the sensitive nature of antenatal data?
What will you take from the experience moving forward?
- How has this experience enhanced your understanding of the complexities involved in antenatal testing and the broader national screening programme?
- Which key guidelines and protocols have you identified as essential for ensuring your practice remains evidence-based and compliant with national standards?
- What specific ‘next steps’ will you take to support your development, such as attending an obstetric/haematological antenatal clinic to appreciate the patient experience and management pathway?
- How will you ensure that results are interpreted and reported accurately and in a timely manner in your routine practice, given the sensitivity of these tests?
- How will you apply your learning regarding quality assurance to ensure the long-term reliability of the screening service?
Beyond action
Have you revisited the experiences?
- Since completing this training activity, have you been involved in other cases of antenatal haemoglobinopathy and thalassaemia screening, and were the findings consistent with your previous experience and the national screening programme?
- How has your understanding of the screening process, confirmatory testing, and reporting of results deepened as you reviewed your initial reflect-on-action notes?
- Can you recall instances where you discussed the implications of positive antenatal results with the antenatal team or family, and how did your laboratory findings inform those discussions?
- Have you reviewed national guidelines and protocols for antenatal haemoglobinopathy and thalassaemia screening recently to ensure your practice remains up to date?
- Have you engaged in professional storytelling with colleagues or peers regarding complex carrier patterns, and has this mutual exchange changed your view of these diagnostic pathways?
How have these experiences impacted upon your current practice?
- How has this activity enhanced your knowledge of specific laboratory techniques used in screening, such as haemoglobin electrophoresis and HPLC?
- In what ways do you now have a better appreciation for the importance of adhering to national screening programme guidelines to ensure accurate and timely reporting?
- How has this experience influenced your current ability to interpret the clinical implications of different haemoglobin variants and their inheritance patterns?
- How has your performance of quality assurance and control tasks matured, ensuring that the precision required for antenatal testing is consistently maintained in your routine work?
- How is this cumulative learning supporting your preparation for observed ‘in-person’ assessments, such as a DOPS for ‘investigating a positive haemoglobinopathy screen’ or an OCE for ‘communicating results to the antenatal team’?
How might these experiences contribute towards your future practice?
- How will your experience in antenatal screening prepare you for ongoing advancements and potential changes to national screening protocols in the future?
- Will your ability to accurately perform and interpret these tests contribute to effective genetic counselling and informed reproductive choices for families?
- What clear actions for continued development have you identified, such as seeking further training in specialised molecular diagnostics or transfusion science?
- How might this experience support your development toward a specialist role, where you may be responsible for the implementation of new screening technologies or managing complex diagnostic datasets?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 6 |
Outcome
Identify appropriate clinical and laboratory investigations and outline the management of acquired and hereditary red cell disorders. |
| # 7 |
Outcome
Perform quality assurance and control tasks across the range of investigations. |