Fertility, Assisted Reproduction and HFEA Regulation —
Training activity: 2

Details

Plan and optimally time a thaw/warming of zygotes, eggs or embryos within a natural and a stimulated cycle

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

• Natural and stimulated cycles
• In-house consents
• Number of embryos to thaw
• Consideration of embryo stage
• Use of luteal support
• Communication with the multidisciplinary team

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 planning and timing the thaw procedure, for example, determining the criteria for ‘optimal timing’ in both natural and stimulated cycles.
• Consider how the learning outcomes apply, specifically how correctly timing the thaw contributes to the overall patient pathway and what effective communication with the multidisciplinary team looks like when coordinating thaw timing.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to the criteria for optimal timing in both natural and stimulated cycles.

What is your prior experience of this activity?

• Think about what you already know about the biological timing requirements for different stages (eggs, zygotes, embryos) post-thaw. Are you familiar with the different phases of natural and stimulated cycles?
• Consider possible challenges you might face during the activity, such as unpredictable cycle lengths, sudden changes in patient status, or logistical conflicts in the lab, and how you might handle them.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example, if a patient’s cycle monitoring results suddenly complicate the planned transfer date.
• Acknowledge how you feel about embarking on this training activity, especially concerning the criticality of correct timing for patient outcome.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as interpreting clinical cycle monitoring data, coordinating effectively with clinicians and embryologists, or logistical planning.
• Identify the specific insights you hope to gain from engaging with the activity, such as a deeper understanding of the interplay between clinical treatment protocols and laboratory procedures, and how timing decisions impact the patient’s chance of success.

What additional considerations do you need to make?

• Consult actions identified following previous experience of coordinating lab procedures or dealing with timing-sensitive tasks.
• Identify important information you need to consider before embarking on the activity, such as the patient’s specific cycle type, the stage of the cryopreserved material, and the clinical team’s requirements or preferences.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst planning the thaw/warming procedure?
• Are you encountering situations such as:
  • Communication with the patient or multidisciplinary team revealing unexpected information affecting timing?
  • Cycle tracking data or other parameters that were surprising or different from what you anticipated for optimal timing?

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 immediately adjusting your approach to planning or timing based on the new information?
• Consider the steps you are taking in the moment, such as seeking immediate clarification from a team member regarding the parameters.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your plan? Is it affecting your confidence in determining the optimal timing in that moment?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully adapting your proposed timing based on the unexpected information? Or are you needing support because the unexpected factor requires senior input before the optimal timing can be confidently determined?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the critical factors influencing optimal timing or the importance of effective multidisciplinary team communication?

On action

What happened?

• Begin by summarising the key steps you took when producing the plan, including the steps you took to plan and time the thaw/warming for both a natural and a stimulated cycle.
• Consider specific events, actions, or interactions which felt important, such as the key factors or information you considered for optimal timing in each cycle type.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the proposed thaw time when new cycle tracking data indicated a slightly advanced transfer window.
• How did you feel during this experience, e.g., did you feel confident in coordinating the timing or challenged by the need to apply different criteria to natural versus stimulated cycles?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding planning and timing thawing procedures and effectively communicating these plans. What strengths did you demonstrate, e.g., meticulous adherence to cycle parameters?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with a specific communication tool used to coordinate with the clinical team?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating clinical communication requirements into your timing plan?
• Identify any challenges you experienced, such as coordinating with the multidisciplinary team or interpreting specific cycle data. Identify how you reacted to this, e.g., needing to seek advice or clarification on scope of practice regarding the level of clinical input needed to finalise the timing plan.

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, including from any feedback you have received, with regards to improving the communication aspects of the planning process.
• What will you do differently next time you approach planning and timing a thaw/warming, for instance, by proactively verifying the preferred clinical communication method with the transfer team before starting the planning process.
• Do you need to practise any aspect of the activity further, such as reviewing cycle monitoring protocols or key learning outcomes related to applying and adapting communication skills?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of planning and timing thaw/warming procedures since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent patient’s cycle monitoring data unexpectedly accelerated the planned transfer date forced you to re-evaluate the rigidity of your communication and contingency planning during your first attempt at this training activity.
• Considering what you understand about optimal timing for thaw/warming, clinical cycle coordination and effective multidisciplinary communication now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your thaw/warming planning process based on further learning and experiences? For example, how you proactively developed a standardised checklist for communicating critical timing windows with the clinical team based on further learning.
• Has discussing timing challenges or the impact of miscommunication on procedure scheduling with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with the multidisciplinary team about a time when poor coordination led to sub-optimal embryo transfer timing refined your understanding of the critical nature of communication regarding optimal timing criteria.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent thaw/warming planning experiences, contributed to your overall confidence and ability in coordinating critical laboratory procedures and communicating effectively with the multidisciplinary team (MDT), particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated understanding of clinical cycle monitoring and logistical requirements now enables you to confidently plan and discuss timing logistics during an Observed Communication Event (OCE) assessment focusing on coordination with the MDT.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to thaw timing planning? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved understanding helps you identify when unpredictable cycle dynamics or logistical conflicts require immediate escalation to the Training Officer or Clinical Coordinator to adjust the treatment pathway, ensuring compliance with the required procedure.
• Looking holistically at your training journey, how has this initial thaw/warming planning experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying and adapting communication skills? For example, how this foundational experience has supported your development in applying effective communication skills when coordinating time-sensitive procedures with the MDT.

Relevant learning outcomes

#	Outcome
# 1	Outcome Determine a patient’s pathway, including assisted reproduction options and stimulation regimens based on clinical presentation.
# 3	Outcome Apply and adapt skills to communicate effectively with patients and the multidisciplinary team.