Non-Malignant Dissection Copy —
Training activity: 2

Details

Review suitability and appropriateness of the non-malignant patient sample type for requests, considering the clinical history

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
• Criteria for sample analysis
• Interpretation of the clinical question
• Specimen types and categorisation
• Diagnostic pathways
• Clinical history

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 reviewing sample suitability based on clinical history, specifically learning outcomes related to triaging specimens and interpreting clinical request forms to assess clinical urgency and suitability for dissection.
• Discuss with your training officer to gain clarity of what is expected when reviewing the suitability and appropriateness of patient samples in the context of this training activity.

What is your prior experience of this activity?

• Think about your previous exposure to different sample types and their requirements.
• Consider possible challenges you might face, such as unusual sample types or discrepancies between the sample and the request, and think about how you might handle them.
• Recognise the scope of your own practice i.e. know when and from whom you will need to seek advice or help. You will need to seek advice from your Training Officer or a Laboratory Quality Manager when required, for example:
  • When the fixation status is compromised e.g., sample appears dry or inadequately fixed and may jeopardise diagnostic suitability
  • If there is a significant discrepancy between the sample type received and the clinical history or requested diagnosis
  • When the sample needs special handling or ancillary studies e.g., fresh tissue for microbiology/genetics that are outside standard operating procedures
• Acknowledge how you feel about reviewing the suitability of the patient sample type in the context of this training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in assessing sample suitability and appropriateness.
• Identify the specific insights you hope to gain regarding the relationship between sample type, clinical history, and diagnostic requirements.

What additional considerations do you need to make?

• Consult actions identified following previous experiences with handling different sample types or requests.
• Identify important information you need to consider before embarking on the activity, such as specific sample handling protocols or common issues with certain sample types.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing the sample container or assessing its integrity?
• Are you encountering situations such as:
  • The sample appears inadequately fixed or partially dried out, compromising diagnostic suitability despite the clinical history being routine?
  • A significant size discrepancy between the received sample e.g., a tiny fragment and what is expected for the requested non-malignant pathology e.g., a large cyst?
  • The sample type conflicts critically with the clinical history, leading you to question the entire request e.g., an ovarian biopsy is received, but the history suggests a uterine polyp?

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 immediate documentation of the sample condition?
• Consider the steps you are taking in the moment, such as:
  • Immediately documenting the fixation issue and seeking advice from a senior colleague regarding the suitability for processing?
  • Consulting the tissue handling protocol to determine if ancillary testing (e.g., fresh tissue banking) is still possible, despite the sample’s poor condition?
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your assessment strategy? Is it affecting your confidence in determining the sample’s appropriateness?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully classifying the sample as non-suitable and escalating the documentation? Or are you needing support because the decision to proceed or reject the specimen requires specialist input?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for rapidly assessing tissue integrity? Or gaining insight into the critical consequences of poor pre-analytical handling?

On action

What happened?

• Begin by summarising the key considerations when reviewing suitability for this sample.
• Consider specific events, actions, or interactions which felt important, such as how you assessed the integrity or fixation status of the sample in relation to the clinical needs.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking advice regarding significant sample degradation or a critical discrepancy between sample type and clinical history. How did you feel during this experience, e.g., did you find it difficult to maintain objectivity when assessing suitability?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding sample suitability. What strengths did you demonstrate, e.g., meticulous review of sample integrity? What skills and/or knowledge gaps were evident, e.g., understanding the appropriateness of a sample type for a rare non-malignant diagnosis?
• Compare this experience against previous engagement with similar activities – Has your practice improved in identifying and handling pre-analytical issues?
• Identify any challenges you experienced, such as needing to seek advice about the impact of poor fixation on subsequent diagnostic testing, and what you learned from that interaction.

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 your ability to effectively review the suitability of patient samples, utilising the information available to you.
• What criteria will you pay closer attention to when reviewing sample suitability in the future, for instance, proactively checking the volume of fixation fluid for large specimens to ensure adequate fixation based on tissue size?
• Do you need to practise any aspect of the activity further, such as reviewing guidelines on sample requirement for specific non-malignant requests particularly those requiring microbiological or genetic ancillary studies?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences reviewing different sample types or encountering unsuitable/inappropriate samples since completing this specific training activity led you to revisit your initial assessment and decisions during that activity? For example, how encountering a subsequent sample with severe fixation artifact led you to re-evaluate the leniency you might have shown during the initial training activity when faced with a minor pre-analytical issue.
• Considering what you understand about the link between sample type, clinical history, and diagnostic accuracy 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 sample review process based on further learning and experiences? For example, how you implemented an immediate double-check protocol for confirming the required volume of fixative based on subsequent learning about sample degradation.
• Has discussing the implications of unsuitable samples or challenging review cases with colleagues, peers, or in multidisciplinary team meetings changed how you now view your initial experience in this training activity? For example, how discussions in an MDT meeting regarding the cancellation of ancillary tests due to inadequate fixation reinforced the high standard required during the initial review of sample suitability.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent sample review experiences, contributed to your overall confidence and ability in reviewing sample suitability and ensuring you are practicing safely, particularly in preparing for assessments? For example, how your increased confidence in reviewing sample suitability allows you to pre-emptively identify and resolve pre-analytical issues during a DOPS assessment focused on triage.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to reviewing sample types for non-malignant dissection? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, how your evolved approach means you now automatically consult a biomedical scientist specialist regarding complex requirements for samples intended for genetic testing, knowing technical verification is beyond your initial scope.
• Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to interpreting clinical request forms and practicing safely? For example, how mastering the assessment of sample suitability directly supports your ability to successfully employ appropriate specimen preparation later in the module.

Relevant learning outcomes

#	Outcome
# 1	Outcome Triage specimens and interpret clinical request forms to assess clinical urgency and suitability for dissection.
# 5	Outcome Practice safely in accordance with quality management and accreditation standards.