Training activity information
Details
Dissect skin, bone and soft tissue specimens received for a range of non-malignant pathologies, to include:
- Shave and curettage
- Cyst and polyp
- Punch and incisional
- Non-orientated
- Orientated
- Femoral head
- Synovium
- Lipoma
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
- Specimen orientation, inking, block sampling and macroscopic description
- Quality of blocks
- RCPath tissue pathways
- Macroscopic pathological features specific to the disease entity
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 dissecting these specific non-malignant specimens, specifically learning outcomes related to dissecting specimens and employing appropriate technique based on history.
- Discuss with your training officer to gain clarity of what is expected, potentially reviewing the listed specimen types
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with skin, bone, or soft tissue specimens.
- Consider possible challenges you might face with these specific specimen types e.g., orientation of skin excisions, handling bone, fatty nature of lipomas and think about how you might handle them.
- Recognise the scope of your own practice for these specimens; know when and from whom you will need to seek advice or help. You will need to seek advice from your Training Officer or Senior Dissection Scientist when required, for example:
- When encountering unexpected macroscopic findings e.g., a subtle suspicious nodule in a presumed lipoma that challenge the benign dissection rationale
- If orientation of an excised skin specimen is technically difficult or impossible due to fragmentation, impacting margin assessment
- When the specimen size or complexity demands specialised equipment or procedural steps beyond routine use e.g., need for extensive decalcification of a large bone sample
- Acknowledge how you feel about dissecting skin, bone and soft tissue specimens across all the listed specimen types.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in dissecting these particular specimen types, such as appropriate sampling techniques, inking, and orientation.
- Identify the specific insights you hope to gain into the macroscopic features and dissection rationale for non-malignant skin, bone, and soft tissue pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with similar specimen types.
- Identify important information you need to consider, such as specific departmental protocols for these specimens or necessary equipment for bone dissection.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst orienting or sectioning the specimen?
- Are you encountering situations such as:
- Unexpected macroscopic findings e.g., firm, irregular nodularity or unusual colour within a specimen presumed benign e.g., a lipoma or simple curettage?
- Significant difficulty with specimen orientation for a skin excision due to fragmentation or poor surgical marking, impacting margin assessment?
- The required equipment for bone dissection is malfunctioning e.g., saw, decalcification fluid check, compromising the ability to proceed accurately?
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 block sampling or inking strategy in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the grossing and consulting a senior pathologist or dissection scientist to verify the nature of an unexpected finding?
- Adapting the inking procedure to prioritise difficult margins on a poorly oriented skin specimen?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your dissection technique to the unexpected tissue consistency? Is it affecting your confidence in ensuring representative sampling?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying your knowledge of dissection planes for bone? Or are you needing support because the potential for malignancy requires the rationale to be reviewed by senior input?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective verification checklist when preparing for bone dissection equipment? Or gaining insight into how specific macroscopic changes dictate an immediate shift in block sampling rationale?
On action
What happened?
- Begin by summarising the dissection process for this specific specimen (e.g., shave, punch, femoral head).
- Consider specific events, actions, or interactions which felt important, such as how you addressed challenges with specimen orientation or inking.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting a supervisor when encountering an unexpected, firm nodule within a presumed benign soft tissue specimen. How did you feel during this experience, e.g., did you feel focused on maintaining the dissection rationale despite the unexpected finding?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding dissection. What strengths did you demonstrate, e.g., technical precision in sampling bone/decalcification management? What skills and/or knowledge gaps were evident, e.g., difficulty in identifying subtle macroscopic features typical of specific non-malignant skin pathologies?
- Compare this experience against previous engagement with similar activities – Has your practice improved in managing complex specimen orientation for excisions?
- Identify any challenges you experienced, such as difficulty dissecting around dense or calcified tissue, and how you successfully overcame these challenges.
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 dissection technique for skin, bone and soft tissue specimens from the multiple identified structures.
- What aspects of dissecting this type of specimen will you approach differently next time, for instance, performing a more methodical palpation of soft tissue excisions before sectioning to identify subtle unexpected macroscopic features?
- Do you need to practise any aspect of the activity further, such as reviewing block sampling protocols for different biopsy types (e.g., punch vs. shave) to ensure consistent margin representation?
Beyond action
Have you revisited the experiences?
- How has your continued practice dissecting a wider range of skin, bone, and soft tissue specimens, perhaps encountering more complex or unusual cases, since completing this specific training activity led you to revisit your initial dissection technique or rationale during that activity? For example, how encountering a large, complex soft tissue lipoma in a subsequent activity led you to refine the systematic search pattern (rationale) you use for small foci of malignancy, which you did not apply rigorously during your first dissection.
- Considering what you understand about employing appropriate dissection rationale, block sampling, and inking based on clinical history and the link to microscopic assessment 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 dissection technique for these specimens based on further learning and experiences? For example, how you implemented the use of specialised bone saws/decalcification protocols more systematically, which you had initially identified as a gap in your first reflection.
- Has discussing challenging dissections or the impact of dissection quality on microscopic assessment with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how a discussion about margin adequacy for skin excisions with a supervisor led you to realise the inking technique used in your first training activity could have been improved by using multiple colours for distinct surfaces.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from these organ systems and practicing safely, particularly in preparing for assessments like DOPS?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to dissecting skin, bone, and soft tissue specimens? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, how your current approach involves routinely consulting the senior team when a specimen designated as a simple cyst shows a solid, firm component, recognising this requires a higher level of pathological input due to potential malignancy.
- Looking holistically at your training journey, how has this initial dissection experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to dissecting non-malignant specimens, employing appropriate techniques, and practicing safely? For example, how mastering the technical skills of dissection in this training activity informs your ability to summarise macroscopic features required for reporting later in the training.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Dissect non-malignant specimens from a range of organ systems. |
| # 3 |
Outcome
Employ the appropriate specimen preparation, orientation, inking, block sampling and dissection rationale based on the clinical history for non-malignant specimens. |
| # 5 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |