Training activity information
Details
Perform embryo transfers to maintain embryo viability
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
- Local SOPs/protocols
- Aseptic technique and implications and risks of incorrect use
- Effect of environmental variables on sample viability
- Difficult embryo transfers
- Choice of embryo transfer catheter
- Communication with the multidisciplinary team
- HFEA witnessing requirements and implications of incorrect witnessing
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 embryo transfers.
- Consider how the learning outcomes apply, specifically in relation to performing embryo transfer, communicating effectively, and practicing safely.
- Discuss with your Training Officer to gain clarity of what is expected of you in relation to the technical steps required to minimize disruption and maintain viability during transfer and the role of communication with the clinical team.
What is your prior experience of this activity?
- Think about what you already know about the technical steps involved in handling embryos for transfer and the importance of aseptic technique and temperature control.
- Consider possible challenges you might face during the activity, such as managing critical timing during loading/transfer or coordinating the procedure efficiently with the physician.
- 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 may need to seek advice from your Training Officer when required, for example, if the embryo is returned when flushing the catheter.
- Acknowledge how you feel about the critical technical responsibility of handling the final step of the treatment cycle.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as refining precise micro-handling techniques, coordinating communication with the clinical team during transfer.
- Identify the specific insights you hope to gain into the relationship between laboratory handling and maintained embryo viability during transfer.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of observed transfers or technical procedures requiring high precision.
- Identify important information you need to consider before embarking on the activity, such as the specific SOP for embryo loading and coordinating with theatre staff.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the embryo transfer?
- Are you encountering situations such as:
- Technical difficulty during embryo loading.
- Equipment issue with the microscope.
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 micro-handling technique or environmental management?
- Consider the steps you are taking in the moment, such as immediately pausing the transfer procedure to verify the embryo position within the catheter.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain fine motor control under time pressure? Is it affecting your confidence in successful maintenance of viability?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully re-loading the catheter without compromising the embryo? Or are you needing support?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for handling the embryo during critical loading and transfer steps?
On action
What happened?
- Begin by summarising the key steps you took when performing embryo transfers to maintain embryo viability.
- Consider specific events, actions, or interactions which felt important, such as how you handled the embryo during loading into the catheter or how you communicated and coordinated with the physician during the transfer procedure.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the loading technique when the embryo did not enter the catheter on the first attempt.
- How did you feel during this experience, e.g., focused on technical precision or stressed by the rapidity required for successful transfer?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding technical execution and coordination during embryo transfer. What strengths did you demonstrate, e.g., aseptic technique and efficient handling/loading of the embryo?
- What skills and/or knowledge gaps were evident, e.g., difficulty maintaining consistent speed and control when reloading the catheter?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in performing embryo transfer and practicing safely?
- Identify any challenges you experienced, such as difficulty maintaining communication clarity with the physician, 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 micro-handling skills and procedural coordination.
- What will you do differently next time you approach performing embryo transfers, for instance, by proactively rehearsing the loading process using non-viable cells to build muscle memory and speed?
- Do you need to practise any aspect of the activity further, such as catheter loading technique or key learning outcomes related to describing and evaluating the techniques for the process of embryo transfer?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of performing embryo transfer procedures on patients with anatomical difficulties or severe anxiety since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, a subsequent transfer where uterine access was unexpectedly difficult and time-consuming forced you to re-evaluate communication efficiency during your first attempt at this training activity.
- Considering what you understand about aseptic technique, and patient-specific challenges 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 technical proficiency and coordination with the physician based on further learning and experiences? For example, how you proactively refined protocols for catheter handling outside the incubator to improve your speed and accuracy when loading the catheter.
- Has discussing challenges in loading fragile embryos or the impact of technical errors on implantation rates 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 transfer where rapid technical adaptation was necessary refined your understanding of the importance of anticipatory problem-solving.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent technical handling and procedural coordination experiences, contributed to your overall confidence and ability in maintaining embryo viability during the transfer procedure, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated technical precision in catheter loading and efficient coordination with the physician now enables you to successfully perform an embryo transfer during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to technical execution and safety protocols during embryo handling? 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 from the Training Officer immediately when technical difficulty compromises embryo viability (e.g. heated stage failure).
- Looking holistically at your training journey, how has this initial embryo transfer experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing embryo transfer? For example, how this foundational experience has supported your development in describing and evaluating the techniques for the process of embryo transfer.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform embryo transfer. |
| # 4 |
Outcome
Communicate embryo grade and clinical decisions effectively with patients and the multidisciplinary team to enhance the overall patient experience. |
| # 5 |
Outcome
Practice in accordance with regulatory and safety standards, including keeping accurate records of the fates of embryos. |