Training activity information
Details
Dissect urological specimens received for a range of non-malignant pathologies, to include:
- Adrenal
- Testis and epididymis
- Foreskin and penis
- Kidney
- Ureter and urethra
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 urological 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: adrenal, testis and epididymis, foreskin and penis, kidney, ureter and urethra.
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with solid or genitourinary organs.
- Consider possible challenges you might face e.g., orienting foreskins, handling small ureters 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 Senior Colleague with urology experience when required, for example:
- When orienting small, non-fixed specimens e.g., ureters or small biopsies where crucial margins must be clearly inked.
- If the specimen is an adrenal gland with complex haemorrhage or mass that requires specialised dissection/sampling for endocrine studies.
- When there is uncertainty about whether a partial nephrectomy specimen is truly for non-malignant disease (due to potential miscoding).
- Acknowledge how you feel about dissecting urological specimens received for a range of non-malignant pathologies.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in dissecting these urological specimens, such as appropriate sectioning of kidneys, handling testis/epididymis, and sampling strategies.
- Identify the specific insights you hope to gain into the macroscopic appearance and dissection rationale for non-malignant urological pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with urological specimens.
- Identify important information you need to consider, such as necessary inking for excisions, or specific protocols for small biopsies.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst sectioning or orienting a urological specimen?
- Are you encountering situations such as:
- An unanticipated small mass or nodule within an organ e.g., testis, kidney designated for non-malignant resection, raising concern for incidental malignancy?
- Extreme technical difficulty in orienting and inking a small, irregular specimen like a foreskin or ureter, jeopardising margin assessment?
- A significant discrepancy in size or appearance from the expected non-malignant condition e.g., a kidney received for hydronephrosis appears severely distorted?
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 inking or sectioning approach to manage the unexpected finding or challenging orientation?
- Consider the steps you are taking in the moment, such as:
- Immediately seeking guidance from a senior colleague to confirm the appropriate dissection plane for an organ with distortion (e.g., kidney)?
- Rapidly ensuring the entire unexpected nodule is sampled and documented before proceeding with routine non-malignant sampling?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge of anatomy to the distorted specimen? Is it affecting your confidence in ensuring all critical areas are sampled?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving the orientation challenge through precise technique? Or are you needing support because the suspicion of malignancy requires a pathologist’s immediate review?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for sectioning solid urological organs (e.g., adrenal) to identify subtle pathology? Or gaining insight into the necessity of meticulous inking for small excisions?
On action
What happened?
- Begin by summarising your dissection process for this urological specimen (e.g., adrenal, testis, kidney).
- Consider specific events, actions, or interactions which felt important, such as how you managed the longitudinal sectioning of a kidney or the meticulous handling of a small ureter.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking input on how to ink an irregular foreskin specimen to define the necessary margin accurately. How did you feel during this experience, e.g., was the complexity of the internal anatomy affecting your speed?
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., systematic approach to sectioning a solid organ? What skills and/or knowledge gaps were evident, e.g., uncertainty about the sampling requirements for non-malignant testis pathologies (e.g., inflammation)?
- Compare this experience against previous engagement with similar activities – Has your practice improved in orienting small, non-fixed urological excisions?
- Identify any challenges you experienced, such as difficulty identifying a specific anatomical landmark in a distorted specimen, and what resources or colleagues you consulted to resolve 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 your dissection technique for urological specimens from the multiple identified structures.
- What specific steps will you take in future urological dissections, for instance, ensuring you have reviewed the standard block protocol for adrenal specimens before commencing dissection, particularly focusing on sectioning planes?
- Do you need to practise any aspect of the activity further, such as refining your skills in sectioning and description of kidney specimens or reviewing non-malignant diseases of the urinary tract?
Beyond action
Have you revisited the experiences?
- How has your experience dissecting further urological specimens, particularly those with complex pathologies or unusual features, since completing this specific training activity led you to revisit your initial dissection technique or rationale during that activity? For example, how performing longitudinal sectioning on a subsequent kidney specimen (e.g., for hydronephrosis) was significantly improved by incorporating better orientation techniques, which you realised were weak in your first reflection.
- Considering what you understand about the principles of non-malignant dissection, inking, block selection, and the link to microscopic assessment for urological specimens, especially linking to relevant clinical history, 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 reviewed and utilised standardised templates for sampling testis and epididymis specimens, ensuring comprehensive block selection, which you had previously done ad hoc.
- Has discussing challenging urological dissections or their clinical context with colleagues, peers, or in clinics changed how you now view your initial experience in this training activity? For example, how attending a urology clinic and observing discussions about foreskin excisions reinforced the importance of meticulous inking and margin assessment, changing your view on the relative simplicity of that initial dissection.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent urological dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from the urological system and employing appropriate techniques, particularly in preparing for assessments? For example, show how your ability in dissecting urological specimens now allows you to clearly articulate the rationale for block sampling when reviewing a clinical history for an assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to dissecting urological specimens? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, how your evolved understanding means you automatically seek advice before dissecting a partial nephrectomy received as non-malignant, to confirm the absence of a hidden tumour that would require a complex, specialist-guided approach.
- 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 has the required attention to detail for endocrine structures (e.g., adrenal) in this training activity served as foundational training for handling other small, crucial specimens across different organ systems?
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. |