Training activity information
Details
Warm vitrified oocyte and embryos, and assess and record suitability for treatment
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
- Methods for cryopreservation
- Implications of cryopreservation on viability
- In-house standard operating procedures
- Aseptic technique
- Use of media
- Troubleshooting
- Witnessing requirements
- Patient consent for training and storage
- Viral screening requirements
- HFEA regulations
- Record keeping and traceability
- Health and safety
- Infection control
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 the warming procedure for vitrified oocytes and embryos, assessing their condition, and recording their suitability for subsequent treatment.
- Consider how the learning outcomes apply, specifically in relation to appraising the impact of cryopreservation on viability and performing cryopreservation, thawing and warming of gametes and embryos.
- Discuss with your Training Officer to gain clarity of what is expected of you in relation to the specific criteria used to assess and record the suitability of the warmed oocytes or embryos.
What is your prior experience of this activity?
- Think about what you already know about the warming protocols for vitrified oocytes and embryos.
- Consider possible challenges you might face during the activity, such as potential difficulties during the warming process or the post-warming assessment (e.g., differentiating between viable and non-viable cells).
- 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 the post-warming assessment is ambiguous regarding viability.
- Acknowledge how you feel about the responsibility of assessing the suitability of precious patient material for treatment.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as improving specific skills in performing the warming procedure and assessing viability.
- Identify the specific insights you hope to gain into the factors that influence the post-warming survival and quality of oocytes and embryos.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of warming procedures or handling delicate materials.
- Identify important information you need to consider before embarking on the activity, such as reviewing the specific SOPs for warming vitrified oocytes and embryos, patient details, and the specific vitrification method used.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst warming the cryopreserved cells or assessing survival?
- Are you encountering situations such as:
- Unexpectedly low survival rate for the warmed embryos/oocytes
- The morphological assessment is ambiguous regarding suitability for transfer
- Technical issues arise
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 adapting or changing your approach to morphological assessment or viability recording?
- Consider the steps you are taking in the moment, such as immediately re-observing the cell structure under higher magnification to confirm viability.
- How are you feeling in that moment? For instance, are you finding it difficult to make a final judgment on suitability for transfer when viability is borderline? Is it affecting your confidence in the recorded assessment?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully re-evaluating viability criteria based on observed recovery characteristics? Or are you needing support because the low survival rate necessitates immediate consultation with the senior embryologist and clinical team regarding the patient’s treatment plan?
- What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous technique for differentiating recoverable damage from non-viability?
On action
What happened?
- Begin by summarising the key steps you took when performing the warming process.
- Consider specific events, actions, or interactions which felt important, such as your process for assessing the survival and suitability of the warmed oocytes or embryos.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, re-observing the cell structure under higher magnification to confirm viability when post-warming assessment was ambiguous.
- How did you feel during this experience, e.g., aware of the responsibility of assessing suitability for treatment?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding accurately executing the warming protocol or assessing viability. What strengths did you demonstrate, e.g., accurate documentation of observations?
- What skills and/or knowledge gaps were evident, e.g., inconsistency in assessing viability when survival was borderline?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in assessing viability and suitability for treatment?
- Identify any challenges you experienced, such as an unexpectedly low survival rate and how you reacted to this. This might include needing to seek advice or clarification on scope of practice regarding validating your viability assessment when recovery characteristics were ambiguous and how you reacted to this.
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 your assessment of viability, especially in challenging cases.
- What will you do differently next time you approach warming and assessing vitrified samples, for instance, by proactively reviewing the expected recovery characteristics of oocytes versus embryos before the warming procedure?
- Do you need to practise any aspect of the activity further, such as assessing specific morphological criteria or key learning outcomes related to appraising the impact of cryopreservation on viability?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of warming vitrified oocytes and embryos and assessing suitability for treatment since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, subsequent knowledge gained about post-warm survival predictors forced you to re-evaluate the thoroughness of your initial viability assessment and suitability recording during your first attempt at this training activity.
- Considering what you understand about post-warm survival predictors, clinical outcomes, and assessment criteria 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 assessment of post-warm viability and suitability for treatment based on further learning and experiences? For example, how you proactively integrated observable behaviours and practices related to careful technique during warming and thorough assessment of post-warm survival and morphology based on further learning.
- Has discussing warming and assessing post-warm viability or the clinical implications of warming outcomes 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 pregnancy from an embryo with borderline survival refined your understanding of the assessment of cell viability.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent warming and assessment experiences, contributed to your overall confidence and ability in assessing cell viability and accurately recording clinical data, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated awareness of the importance of careful technique during warming and thorough assessment of post-warm survival and morphology now enables you to confidently and accurately perform and justify viability checks and suitability decisions during observed assessments.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to assessing post-warm viability and suitability for treatment? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when the assessment of suitability for treatment is borderline or involves complex morphological ambiguity, recognising that the clinical implications of warming outcomes sometimes require senior input to influence the patient treatment pathway.
- Looking holistically at your training journey, how has this initial warming and assessment experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing cryopreservation, thawing and warming of gametes and appraising the impact of cryopreservation on viability? For example, how this foundational experience has supported your development in meticulous laboratory technique, critical assessment of cell viability, and accurate data recording, and has enhanced your understanding of the clinical implications of warming outcomes.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform cryopreservation, thawing and warming of gametes and embryos. |
| # 3 |
Outcome
Practice safely in accordance with the statutory and regulatory requirements of micromanipulation and cryopreservation. |
| # 4 |
Outcome
Appraise the impact of cryopreservation on viability of gametes and embryos. |