Training activity information
Details
Identify pregnancies requiring obstetrician or FMU referral according to guidelines
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
- Current guidelines
- Impact of laboratory results on clinical practice
- Impact of laboratory results on different treatment options (Doppler, intrauterine transfusion (IUT), early delivery, etc.)
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 identifying pregnancies requiring obstetrician or FMU referral.
- Review learning outcomes which relate to guidelines, risk prediction, advice to healthcare professionals, and management plan development.
- What specific criteria, based on guidelines and HDFN investigations indicate the need for referral?
- What are the expected outcomes of timely and appropriate referral for pregnancies at high risk of HDFN?
- Discuss with your training officer to clarify the specific types of cases that necessitate referral and the expected format of your recommendations.
What is your prior experience of this activity?
- Think about what you already know about the clinical management pathways for pregnancies affected by clinically significant antibodies or HDFN.
- What specific laboratory findings e.g., antibody specificity, high titre/quantification results, rising titres trigger a referral?
- Consider possible challenges you might face in interpreting results according to complex guidelines or communicating the urgency of a referral to clinicians. Think about how you might handle these.
- Recognise the scope of your own practice for this activity, meaning knowing when you would need to seek advice regarding borderline results, complex cases, or difficulties in communicating recommendations.
- Acknowledge how you feel about the responsibility of identifying cases that require specialist obstetric or Foetal Medicine Unit (FMU) input.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in applying guidelines to laboratory results and formulating clear recommendations for clinical teams.
- Identify the specific insights you hope to gain into how laboratory findings directly influence clinical decisions and patient management in high-risk pregnancies.
What additional considerations do you need to make?
- Consult actions identified following previous experience with interpreting antibody results or communicating with clinicians.
- Identify important information you need to consider before embarking on the activity, such as the specific referral guidelines used in your region, the contact details for the obstetric and FMU teams, and the required information to include in a referral recommendation.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst identifying pregnancies requiring obstetrician or FMU referral?
- Are you encountering situations such as:
- Conflicting information, multiple antibodies, or rapidly changing results that complicate the assessment of risk and urgency
- Borderline results (e.g., antibody titre/quantification) that fall close to the guideline threshold for referral, requiring immediate judgment
- An unexpected clinical scenario where the antibody specificity is not typically associated with HDFN but the titre is high, challenging the decision
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your assessment and communication approach in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately reviewing the specific guidelines to confirm the criteria for escalation based on the observed results
- Making a real-time decision about the urgency of escalating the case, even if the results are borderline
- Seeking immediate expert advice from a senior colleague or clinical team to confirm whether a referral is warranted, particularly for ambiguous or complex cases
- How are you feeling in that moment? For instance, are you finding it difficult to apply complex clinical thresholds to laboratory data? Is it affecting your confidence in formulating clear recommendations?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying the required guidelines to identify high-risk cases, or needing support when communicating the urgency of the referral to the clinical team?
- What are you learning as a result of the unexpected development? For example, are you gaining critical insight into the thresholds and criteria for clinical referral in antenatal serology, or mastering how laboratory findings directly influence high-risk clinical decisions?
On action
What happened?
- Begin by summarising the key points of the experience of identifying a pregnancy requiring referral to an obstetrician or Foetal Medicine Unit (FMU). What specific guidelines or criteria did you apply? What were the key laboratory or clinical findings that indicated the need for referral?
- Consider specific events, actions, or interactions which felt important, such as discussing the case with a senior colleague or informing clinical staff. Acknowledge how you felt when deciding on the urgency or necessity of referral.
- Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For instance, describe when new or updated information e.g., a critical antibody level, a specific scan finding immediately led you to escalate the case for referral.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the specific laboratory and clinical indicators for obstetric or FMU referral in antenatal cases. What skills in applying guidelines and communicating critical information did you develop? Were there knowledge gaps about specific referral pathways or the clinical implications of certain results?
- Compare this experience against previous engagement with similar activities. Has your ability to recognise high-risk pregnancies requiring specialist referral improved?
- Identify any challenges you experienced e.g., incomplete clinical information, ambiguous guidelines and how you reacted to these. Were you able to overcome the challenges?
- Did you need to seek advice or clarify whether a specific case met the referral criteria? Did you ensure your recommendation for referral was within your scope of practice and appropriately communicated?
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in identifying pregnancies requiring obstetric or FMU referral.
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 guidelines or criteria related to obstetric/FMU referral that you need to study further. Do you need to learn more about specific clinical findings e.g., MCA doppler scan results that influence referral decisions?
- How will this experience change your approach to reviewing antenatal cases for potential referral needs?
- Do you need to practise any aspect of the activity further, such as applying complex referral criteria or communicating with clinicians about high-risk cases?
Beyond action
Have you revisited the experiences?
- Considering your various experiences identifying pregnancies requiring referral to an obstetrician or foetal Medicine Unit (FMU), have you looked back at your previous reflections on these cases?
- What specific actions did you identify to enhance your skills in this area e.g., applying specific referral guidelines, recognising clinical indicators, communication? Have you implemented these actions, and can you now demonstrate improvement in identifying such cases?
- Have you engaged in professional storytelling or discussed cases where referral criteria were ambiguous or complex with colleagues or presented findings in a team meeting? Did the collective knowledge or feedback provided change your understanding of specific indicators for referral or the process of communicating the need for referral?
How have these experiences impacted upon current practice?
- How does the cumulative learning from identifying pregnancies requiring referral, coupled with your ongoing reflection, contribute to your preparation for observed ‘in-person’ assessments such as an OCE discussing clinically significant results with an obstetrician/midwife, or for attending a foetal medicine unit clinic as a clinical experience?
- How has your expertise in applying guidelines to identify pregnancies requiring obstetrician or FMU referral developed over time? Are you more skilled at assessing laboratory results and clinical context to determine the urgency or appropriateness of referral?
- How effectively can you now recognise when a case is particularly complex and requires input from senior colleagues, indicating you are working within your scope?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Practice in accordance with antenatal serology standards and guidelines. |
| # 3 |
Outcome
Perform and interpret clinical and laboratory investigations to identify cases of haemolytic disease of the fetus or newborn (HDFN). |
| # 4 |
Outcome
Identify sequential testing algorithms appropriate to the samples under investigation for HDFN. |
| # 5 |
Outcome
Predict current and future pregnancies at highest risk of HDFN. |
| # 6 |
Outcome
Identify and advise healthcare professionals on appropriate actions to manage HDFN. |
| # 7 |
Outcome
Develop management plans including selection of blood components for mother, fetus and neonates during pregnancy. |