Training activity information
Details
Dissect gynaecological specimens, received for a range of non-malignant pathologies, to include:
- Polyp
- Ovary
- Fallopian tube
- Uterus
- Fibroids
- Cervix
- Products of conception
- Vulva
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
- Cervical 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 gynaecological 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, uterus, fibroids, cervix, products of conception, vulva.
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with uterine or ovarian tissue.
- Consider possible challenges you might face e.g., handling large uteri with fibroids, orientation of cervical specimens, sampling products of conception 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 Gynae when required, for example:
- When dealing with a large, complex uterine specimen e.g., multiple fibroids, adenomyosis requiring extensive, detailed mapping and sampling.
- If products of conception require specialised triage or handling due to specific legal or genetic testing requirements.
- When encountering unusual ovarian pathology e.g., unexpected solid component in a cyst that might require deviation from the routine non-malignant protocol.
- Acknowledge how you feel about dissecting gynaecological specimens 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 gynaecological specimens, such as sectioning uteri, sampling ovaries, and appropriate block selection.
- Identify the specific insights you hope to gain into the macroscopic appearance and dissection rationale for non-malignant gynaecological pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with gynae specimens.
- Identify important information you need to consider, such as specific protocols for products of conception or requirements for inking cervical specimens.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst sectioning the specimen?
- Are you encountering situations such as:
- Extensive cystic degeneration or haemorrhage within a uterine fibroid, making the demarcation of the lesion difficult?
- Difficulty in finding or orienting a small specimen like a fallopian tube or cervical biopsy, compromising accurate description and sampling?
- The macroscopic features of a polyp or ovarian cyst are highly ambiguous or complex, potentially requiring sampling that deviates significantly from routine non-malignant protocol?
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 large specimens (e.g., uterus) or identifying margins in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately adapting the sectioning plan to map out and document all representative surfaces of a large, complex specimen like a fibroid uterus?
- Seeking immediate clarification from a senior colleague on the appropriate sampling required for ‘products of conception’ due to specific legal or protocol requirements?
- How are you feeling in that moment? For instance, are you finding it difficult to maintain clarity while managing a large, complex specimen? Is it affecting your confidence in performing representative block sampling?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully ensuring that all relevant anatomical structures are identified and sampled? Or are you needing support because the ambiguity of a finding (e.g., ovarian cyst) requires senior input to determine the block rationale?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for dissecting uterine specimens with significant benign pathology? Or gaining insight into specialised handling protocols for certain gynae specimens?
On action
What happened?
- Begin by summarising your approach to dissecting this gynae specimen (e.g., polyp, uterus, fibroid).
- Consider specific events, actions, or interactions which felt important, such as how you managed the weight and size of a uterus with large fibroids or the delicate handling of a cervical polyp.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, modifying the sectioning pattern of a large specimen to ensure that the relationship between multiple lesions was documented. How did you feel during this experience, e.g., was your decision-making clear despite the complexity of the specimen?
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 documentation of lesion sizes and location? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the specific sampling protocols for products of conception due to non-standard requirements?
- Compare this experience against previous engagement with similar activities – Has your practice improved in identifying key anatomical structures in excised specimens (e.g., ovaries, fallopian tubes)?
- Identify any challenges you experienced, such as needing to seek advice about the complexity of the specimen (e.g., extensive adhesions), and what you learned about procedural escalation.
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 gynaecological specimens from the multiple identified structures.
- What will you focus on improving in future dissections of gynae specimens, for instance, proactively reviewing images of specific benign ovarian pathology before starting the grossing process to recognise subtle features?
- Do you need to practise any aspect of the activity further, such as reviewing guidelines for sectioning and inking cervical specimens or methods for assessing margin adequacy on vulval excisions?
Beyond action
Have you revisited the experiences?
- How has your subsequent experience dissecting different gynaecological specimens or attending related clinical experiences, since completing this specific TA led you to revisit your initial approach to specimen preparation, orientation, or block sampling during that activity? For example, how has handling a large, complex uterus with diffuse adenomyosis in a later task demonstrated the inadequacy of the simple sectioning plane you used for a smaller fibroid uterus in your first training activity?
- Considering what you understand about the importance of accurate specimen preparation, orientation, block sampling, and the link between macroscopic description and microscopic assessment for gynaecological specimens now, were the actions or considerations you identified after your initial reflection on this TA sufficient? How have you since implemented or adapted improvements in your technique for these specimens based on further learning and experiences? For example, how have you implemented a visual checklist for ensuring the accurate sampling and description of products of conception due to non-standard requirements and high clinical/legal sensitivity?
- Has discussing challenging gynaecological dissections or their clinical impact with colleagues, peers, or in multidisciplinary team meetings changed how you now view your initial experience in this training activity? For example, how has discussing a cervical excision at an MDT where the pathologist highlighted margin ambiguity reinforced the need for precise orientation and inking, improved your initial technique?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent gynaecological dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from the gynaecological system and employing appropriate techniques, particularly in preparing for assessments? For example, how your foundational knowledge in dissecting uteri and ovaries directly supported your ability to accurately dictate the description of these specimens 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 dissecting gynaecological specimens? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, your current approach of immediately escalating any ovarian cyst with a solid component or papillary projections to a senior pathologist, recognising the heightened risk of 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 the systematic approach to specimen preparation and block sampling developed here contributed to your overall commitment to practicing safely by minimising diagnostic risk.
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. |