Training activity information
Details
Dissect lymphoreticular specimens, received for a range of non-malignant pathologies, to include:
- Lymph node
- Spleen
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 lymphoreticular 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: lymph node, spleen.
What is your prior experience of this activity?
- Think about your previous dissection experience, particularly with lymphoid tissue or spleens.
- Consider possible challenges you might face e.g., identifying small lymph nodes, handling splenic tissue 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. For example, you will need to seek advice from your Training Officer, Senior Haematopathology Scientist, or Laboratory Manager when required:
- To triage lymph nodes for specific flow cytometry or microbiological studies requiring fresh, unfixed tissue.
- If the spleen specimen is heavily fragmented or requires highly specialised tissue banking protocols.
- When the lymph node is tiny or difficult to palpate and sampling must be performed under specialised guidance that is outside routine scope.
- Acknowledge how you feel about dissecting lymphoreticular specimens across 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 lymph nodes and spleens, such as appropriate sectioning and sampling for microscopic examination.
- Identify the specific insights you hope to gain into the macroscopic appearance and dissection rationale for non-malignant lymphoreticular pathologies.
What additional considerations do you need to make?
- Consult actions identified following previous dissection experiences, especially with lymphoid tissue.
- Identify important information you need to consider, such as the need for fresh tissue or specific protocols for fixation or further studies if required.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst handling the lymph node or spleen?
- Are you encountering situations such as:
- A presumed reactive lymph node appears abnormally large, rubbery, or necrotic suggesting potential lymphoma or infection, requiring immediate special handling?
- A spleen specimen is heavily congested or fragmented, making the assessment of non-malignant features and sampling difficult?
- The clinical history suggests specialised testing e.g., microbiology or flow cytometry is needed, but the sample was inadvertently placed in fixative, requiring intervention?
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 sampling method or fixation status management in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately checking the standard operating procedure for handling specimens requiring ancillary studies e.g., obtaining fresh tissue if possible?
- Seeking immediate guidance from a haematopathology scientist or pathologist to verify if the macroscopic appearance requires deviation from routine non-malignant sampling protocol?
- How are you feeling in that moment? For instance, are you finding it difficult to prioritise the different sampling requirements? Is it affecting your confidence in ensuring all diagnostic tests can be performed?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully coordinating the retrieval of fresh tissue samples (if within scope)? Or are you needing support because the complex interpretation of macroscopic findings requires specialist input?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for assessing lymph node consistency in real-time? Or gaining insight into the criticality of early communication regarding ancillary study needs?
On action
What happened?
- Begin by summarising your approach to dissecting this lymphoreticular specimen (e.g., lymph node, spleen).
- Consider specific events, actions, or interactions which felt important, such as how you assessed the size and texture of the lymph node or the challenges of sectioning splenic tissue.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification on ancillary study requirements when the lymph node was found to be unexpectedly necrotic or unusually textured. How did you feel during this experience, e.g., did you find the need for rapid assessment of tissue suitability stressful?
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 macroscopic assessment of lymph node texture? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the optimal sampling strategy for a fragmented spleen?
- Compare this experience against previous engagement with similar activities – Has your practice improved in obtaining the most informative sections from soft or small lymph nodes?
- Identify any challenges you experienced, such as needing to consult a supervisor regarding the macroscopic findings due to suspicion of infection or a non-reactive process, and how this improved your understanding of 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, specific to the specimens identified in the training activity.
- What specific considerations will guide your dissection of lymphoreticular specimens in the future, for instance, proactively ensuring that all necessary information for ancillary studies is available before starting the dissection to maximise the utility of fresh tissue?
- Do you need to practise any aspect of the activity further, such as reviewing guidelines for splenic dissection or common non-malignant lymph node pathologies to refine macroscopic assessment skills?
Beyond action
Have you revisited the experiences?
- How has your continued practice in dissecting lymphoreticular specimens, perhaps across different modules or disease types, since completing this specific training activity led you to revisit your initial dissection technique or rationale during that activity? For example, how performing dissection for lymphoma workup in a later module demonstrated the necessity of rigorous, specific sampling protocols (e.g., fresh tissue banking), making your initial non-malignant lymph node dissection seem overly simplistic in comparison.
- Considering what you understand about the importance of employing appropriate dissection rationale, inking, and block sampling for lymphoreticular tissue, and the anatomical/pathological considerations 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 have implemented a visual protocol to ensure small lymph nodes are consistently bread-loafed and entirely submitted, correcting an initial tendency to submit fewer sections.
- Has discussing challenging lymphoreticular dissections or the impact of sampling on microscopic diagnosis with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a Haematopathology Scientist about splenic processing emphasised the need for immediate weighing and description, which was a step you overlooked during your first training activity.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent lymphoreticular dissection experiences, contributed to your overall confidence and competence in dissecting non-malignant specimens from the lymphoreticular system and employing appropriate techniques, particularly in preparing for assessments like DOPS? For example, how your foundational skills in lymph node assessment now allow you to confidently review the clinical history and determine the appropriate dissection rationale for a lymph node during an assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to dissecting lymphoreticular 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 to a senior scientist if a lymph node received for reactive assessment appears rubbery or matted, recognising the potential for non-benign disease requiring urgent fresh tissue submission.
- 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 development of systematic image assessment required in this training activity is a transferable skill that helps you analyse and report findings from other diagnostic modalities, such as those related to genomic testing.
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. |