Training activity information
Details
Dissect head and neck specimens, received for a range of non-malignant pathologies, to include:
- Polyp, cyst and nodule
- Tonsil
- Thyroid
- Parathyroid
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 head and neck 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, cyst and nodule, tonsil, thyroid, parathyroid.
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with endocrine or lymphoid tissue.
- Consider possible challenges you might face e.g., handling small parathyroids, sectioning thyroids 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 specialist Head and Neck Pathologist when required, for example:
- When identifying small, critical endocrine tissue (e.g., parathyroid glands) that must be meticulously preserved and sampled
- If a specimen is from a delicate anatomical site e.g., tonsil with uncertain margins and requires precise orientation and inking beyond routine technique
- When facing a large neck dissection mass that involves multiple structures (polyp/cyst/nodule) where the non-malignant nature is questioned
- Acknowledge how you feel about dissecting head and neck 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 head and neck specimens, such as identifying specific structures e.g., parathyroid vs lymph node and appropriate sampling.
- Identify the specific insights you hope to gain into the macroscopic appearance and dissection rationale for non-malignant head and neck pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with head and neck specimens.
- Identify important information you need to consider, such as the need for fine needles for thyroid palpation or specific protocols for tonsils.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst dissecting small head and neck structures?
- Are you encountering situations such as:
- Extreme difficulty in locating or distinguishing tiny endocrine structures (e.g., parathyroid gland) from surrounding fat or lymph nodes?
- The tissue consistency of a tonsil or nodule is unexpectedly firm or calcified, making sectioning difficult or requiring immediate equipment adjustment?
- An unexpected lesion or cyst lining appears complex or unusually proliferative, challenging the routine non-malignant approach?
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 specimen palpation or sectioning thickness in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately employing fine probing or magnification to attempt to locate the critical, small structures?
- Seeking immediate guidance regarding the optimal sampling density required for an ambiguous head and neck nodule?
- How are you feeling in that moment? For instance, are you finding it difficult to focus on meticulous, small-scale dissection? Is it affecting your confidence in locating and sampling all diagnostic areas?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully securing the tiny parathyroid gland? Or are you needing support because the uncertainty regarding the type of nodule requires specialist head and neck input?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective, systematic technique for dissecting small thyroid or lymphoid specimens? Or gaining insight into the need for ancillary equipment during specific dissections?
On action
What happened?
- Begin by summarising your dissection of this head and neck specimen (e.g., tonsil, thyroid, nodule).
- Consider specific events, actions, or interactions which felt important, such as how you managed the meticulous handling of small, delicate structures like the parathyroid gland.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately verifying anatomical landmarks when the expected tissue consistency was challenging or unexpected. How did you feel during this experience, e.g., did you find the requirement for fine attention to detail demanding?
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., proficiency in grossing small biopsies? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the macroscopic distinction between a benign cyst and a specific type of nodule?
- Compare this experience against previous engagement with similar activities – Has your practice improved in ensuring representative sampling from small or friable specimens?
- Identify any challenges you experienced, such as needing to verify the dissection protocol for a thyroid specimen with unexpected features, and how this contributed to your understanding of scope of practice.
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 head and neck specimens from the identified multiple structures.
- What specific techniques or considerations will you apply to future head and neck dissections, for instance, systematically using magnification and fine instruments to ensure accurate sampling of endocrine tissue, such as the parathyroid?
- Do you need to practise any aspect of the activity further, such as reviewing common non-malignant head and neck pathologies or departmental protocols for specific lymphoid tissue?
Beyond action
Have you revisited the experiences?
- How has your increased knowledge of head and neck anatomy, pathology, or related clinical practice, gained from subsequent experiences since completing this specific training activity led you to revisit your initial dissection technique or rationale during that activity?
- Considering what you understand about the principles of non-malignant dissection, inking, block selection, and the link to microscopic assessment for head and neck 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 the use of fine dissection tools and magnification (loupes) to ensure accurate identification and sampling of minute head and neck structures.
- Has discussing challenging head and neck dissections or their clinical impact in multidisciplinary team meetings changed how you now view your initial experience in this training activity? For example, how participating in an MDT where an unusual thyroid nodule was discussed reinforced the need for extensive sectioning and inking, even in presumed benign cases, altering your initial conservative sampling strategy.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent head and neck dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from the head and neck system and employing appropriate techniques, particularly in preparing for assessments? For example, how your confidence in dissecting head and neck specimens now allows you to apply appropriate dissection rationale immediately upon reviewing the clinical history of a referred tonsil or cyst.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to dissecting head and neck specimens? How does this evolved understanding help you identify when something is beyond your scope of practice? For example, your current approach of always involving a senior colleague before finalising the blocks for any nodule in the neck where the clinical history is vague or there is conflicting imaging evidence.
- 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 detailed anatomical knowledge gained from this training activity is a transferable skill that assists in macroscopic description and dissection across all 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. |