Training activity information
Details
Dissect gastrointestinal specimens received for a range of non-malignant pathologies, to include:
- Polyp
- Appendix
- Gallbladder
- Small bowel
- Large bowel
- Anus
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
- Bowel cancer screening programme guidance
- 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 non-malignant GI specimens, specifically learning outcomes related to dissecting specimens and employing appropriate technique based on history.
- Discuss with your training officer to gain clarity, potentially reviewing the listed specimen types: polyp, appendix, gallbladder, small bowel, large bowel, anus.
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with hollow organs or GI tissue.
- Consider possible challenges you might face e.g., opening and fixing bowel specimens, handling delicate polyps and how you might handle them.
- Recognise the scope of your own practice; 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 Pathologist specialising in GI when required, for example:
- When an inflammatory bowel resection has complex pathology (e.g., stricture, fistula) requiring advanced sampling logic.
- Escalation is necessary if there is difficulty identifying critical anatomical landmarks or resection margins in hollow organs like the bowel or gallbladder.
- Consultation is required when encountering potential incidental malignant findings in a non-malignant specimen (e.g., a small focus of dysplasia in a polyp) requiring a deviation from the established non-malignant protocol.
- Acknowledge how you feel about dissecting gastrointestinal specimens, particularly across the range of non-malignant pathologies identified.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in dissecting these GI specimens, such as handling techniques, sampling strategies for different lesions, and inking.
- Identify the specific insights you hope to gain into the macroscopic appearance and dissection rationale for non-malignant GI pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with GI specimens.
- Identify important information you need to consider, such as fixation requirements for bowel, specific orientation needs for appendices, or departmental protocols for polyps.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst opening and sectioning the GI specimen?
- Are you encountering situations such as:
- Difficulty identifying a crucial anatomical landmark or resection margin in a specimen like a small bowel segment or gallbladder?
- The presence of extensive, unanticipated pathology e.g., multiple ulcers, deep fistulous tracts in a routine appendicectomy specimen, requiring complex sampling?
- The tissue is unusually friable or congested, making clean sectioning and orientation difficult, impacting block quality?
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 sectioning technique or block thickness in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your technique to ensure the specimen is opened correctly and fixed flat to preserve morphology (e.g., bowel segment)?
- Seeking immediate guidance regarding the optimal sampling strategy for extensive inflammatory changes not initially anticipated?
- How are you feeling in that moment? For instance, are you finding it difficult to maintain orientation while sectioning? Is it affecting your confidence in selecting representative blocks?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully maintaining block sampling consistency despite the friability? Or are you needing support because the sampling of a complex inflammatory process requires senior pathologist approval?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for identifying margins on tubular structures? Or gaining insight into the variations of macroscopic appearances of common non-malignant GI pathologies?
On action
What happened?
- Begin by summarising the key steps in dissecting this GI specimen (e.g., polyp, appendix, gallbladder).
- Consider specific events, actions, or interactions which felt important, such as how you ensured correct orientation of a tubular specimen (e.g., appendix) or fixation of a bowel segment.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting your sampling plan when encountering extensive, unanticipated inflammatory changes that required more blocks than initially planned. How did you feel during this experience, e.g., were you confident in your rapid decision to increase sampling density?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience. What strengths did you demonstrate, e.g., accurate assessment of mucosal features? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the optimal sampling plane for complex polyps?
- Compare this experience against previous engagement with similar activities – Has your practice improved in identifying relevant features in hollow organs?
- Identify any challenges you experienced, such as dealing with friable or poorly fixed tissue in a bowel specimen, and how you ensured representative sampling despite this challenge.
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 gastrointestinal specimens from the multiple identified structures.
- What specific considerations will be important for you the next time you dissect this type of GI specimen, for instance, proactively reviewing the clinical indication for chronic appendicitis before starting the gross description to anticipate specific required sampling areas?
- Do you need to practise any aspect of the activity further, such as reviewing standard sampling criteria for gallbladder specimens or different fixation requirements for GI tissue to optimise block selection?
Beyond action
Have you revisited the experiences?
- How has your continued practice dissecting a wider range of gastrointestinal specimens or attending clinical experiences related to GI cases, since completing this specific training activity led you to revisit your initial dissection technique or rationale during that activity? For example, how witnessing a subsequent case involving a complex inflammatory bowel resection in clinic led you to re-evaluate the thoroughness of the sampling rationale you applied to a routine appendicectomy in your initial reflection.
- Considering what you understand about the principles of non-malignant dissection, inking, block selection, and the link to microscopic assessment for GI specimens 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 a standardised measurement protocol for opening and fixing large bowel segments (e.g., diverticular disease resections) to ensure consistent orientation, based on previous feedback received.
- Has discussing challenging GI dissections or the impact of dissection on diagnosis in multidisciplinary team meetings changed how you now view your initial experience in this training activity? For example, how participation in an MDT meeting where a clinician queried the adequacy of polyp sampling confirmed the importance of meticulous margin assessment that you initially underestimated in your first dissection experience.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent GI dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from the gastrointestinal system and employing appropriate techniques, particularly in preparing for assessments? For example, highlight how proficiency in dissection developed in this training activity aids in accurately dictating block taking for GI specimens.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to dissecting gastrointestinal specimens? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, your current practice of immediately consulting a senior colleague when a gallbladder specimen, presumed benign, displays features suggestive of early mucosal carcinoma during sectioning.
- 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 the technical skills learned in this training activity are directly transferable to, and foundational for, the dissection of malignant GI specimens later in your 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. |