Gametes and Fertilisation —
Training activity: 6

Details

Perform insemination by IUI using donor or partner sperm

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

• Witnessing requirements
• Chain of custody
• In-house standard operating procedures
• Aseptic technique
• Infection control
• Record keeping and traceability
• Legal parenthood

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 performing witness checks, for example, ensuring mandatory verification of patient identity and material at critical laboratory stages.
• Consider how the learning outcomes apply, specifically how performing accurate witness checks ensures you are practicing in accordance with the statutory and regulatory framework and HFEA requirements.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to the critical points at which witnessing is mandatory and the level of detail required for documentation.

What is your prior experience of this activity?

• Think about what you already know about witnessing procedures in a laboratory or clinical setting. Have you observed or assisted with witnessing in fertility procedures before?
• Consider possible challenges you might face during the activity, such as interruptions, visual ambiguity of samples, or ensuring both parties are correctly identifying the material, 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 there is a discrepancy in patient identifiers between the lab sample and the electronic witnessing system.
• Acknowledge how you feel about embarking on this training activity, particularly concerning the critical importance of accurate witnessing for patient safety and regulatory compliance.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as meticulous attention to detail, accurate verbal verification and documentation during a procedure, and adhering strictly to Standard Operating Procedures (SOPs).
• Identify the specific insights you hope to gain from engaging with the activity, such as a deeper understanding of how HFEA regulations translate into practical laboratory procedures and the quality control role of witnessing in preventing errors.

What additional considerations do you need to make?

• Consult actions identified following previous experience with quality control checks or verification processes.
• Identify important information you need to consider before embarking on the activity, such as the specific laboratory procedure you will be witnessing, the clinic’s SOP for witnessing, and the patient identifiers you will need to confirm.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing the witness check?
• Are you encountering situations such as:
• Noticing any discrepancy between the patient details or sample information you were witnessing and what you expected?
• The procedure deviating from the Standard Operating Procedure (SOP) in a way that surprised you?

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 stopping the procedure or challenging the deviation to ensure HFEA compliance?
• Consider the steps you are taking in the moment, such as verbally challenging the sample label discrepancy or immediately consulting the SOP.
• How are you feeling in that moment? For instance, are you finding it difficult to address the unexpected finding appropriately? Is it affecting your confidence in ensuring regulatory requirements are met?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, did your immediate reaction correctly identify a potential error or non-compliance? Or are you needing support because the discrepancy cannot be immediately resolved and requires senior technical review before the procedure can continue?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the importance of vigilance or specific critical check points in preventing errors?

On action

What happened?

• Begin by summarising the key steps you took when performing the witness checks, including the procedures you witnessed (e.g., gamete/embryo identification) and the steps you took to perform the witness checks.
• Consider specific events, actions, or interactions which felt important, such as verifying the patient identifiers against the sample labels at a critical point.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the procedure when a discrepancy arose between the verbal patient identity confirmation and the label on the culture dish.
• How did you feel during this experience, e.g., did you feel acute focus on the meticulous detail or stressed by the potential risk of error during the procedure?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing accurate and compliant witness checks. What strengths did you demonstrate, e.g., meticulous vigilance and adherence to the SOP?
• What skills and/or knowledge gaps were evident, e.g., difficulty quickly accessing the electronic witnessing system during the procedure?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in maintaining regulatory compliance regarding traceability and identification?
• Identify any challenges you experienced, such as discrepancies in labelling or difficulties coordinating the check with the person performing the procedure. Identify how you reacted to this, e.g., needing to seek advice or clarification on scope of practice regarding whether a minor discrepancy required a formal incident report.

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 speed and efficiency of verification steps during witnessing.
• What will you do differently next time you approach performing witness checks, for instance, by proactively checking the legibility and accuracy of all patient labels before the start of the procedure.
• Do you need to practise any aspect of the activity further, such as reviewing departmental witnessing protocols or key learning outcomes related to practicing in accordance with the statutory framework?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing witness checks 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 near miss involving a mislabelled sample during witnessing forced you to re-evaluate the thoroughness of your real-time verification during your first attempt at this training activity.
• Considering what you understand about HFEA regulatory requirements for witnessing and maintaining the integrity of gamete/embryo traceability 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 witness check performance based on further learning and experiences? For example, how you proactively implemented a mandatory verbal confirmation protocol with the operating embryologist at every critical step based on further learning.
• Has discussing potential witnessing failures or the importance of traceability for patient safety with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a formal incident report due to a breakdown in the witnessing chain refined your understanding of the critical nature of meticulous adherence to regulatory requirements.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent witness check experiences, contributed to your overall confidence and ability in maintaining regulatory traceability and preventing errors, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated meticulousness in performing checks and adhering to SOPs enables confident and accurate demonstration during a DOPS assessment (e.g., performing witnessing checks in accordance with regulatory requirements).
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to witness checks? 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 a discrepancy in patient identifiers cannot be immediately resolved and requires escalation to the senior embryologist to prevent a critical regulatory error.
• Looking holistically at your training journey, how has this initial witness check experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to practicing in accordance with the statutory and regulatory framework? For example, how this foundational experience has supported your development in upholding the statutory and regulatory framework by ensuring critical patient safety and sample integrity throughout laboratory procedures.

Relevant learning outcomes

#	Outcome
# 5	Outcome Perform IVF insemination.
# 7	Outcome Practice in accordance with HFEA regulations.