Training activity information
Details
Prepare representative patient samples from a range of tissue types and identify three of the following processes:
- Hypoplasia
- Hyperplasia
- Hypertrophy
- Necrosis
- Apoptosis
- Atrophy
- Degenerative disease
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
- Types of physiological and pathological processes
- Associated normal and disease states
- Macroscopic vs microscopic identification
- Microscopical differences between normal tissue morphology and tissue undergoing apoptosis, necrosis, atrophy and degenerative disease
- Local SOPs
- Appropriate specimen block sampling and macroscopic description
- Quality of blocks
- RCPath tissue pathways and cancer datasets
- Selection of histological techniques to demonstrate different cell types involved in benign proliferative and degenerative processes
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 preparing samples and identifying three of these processes.
- Consider how the learning outcomes apply, specifically in relation to using histological techniques to demonstrate the different types of benign proliferation and degeneration.
- Discuss with your training officer to gain clarity of what is expected of you in relation to preparation of the samples across the range of tissue types. How can they support you in identifying the specified processes?
What is your prior experience of this activity?
- Think about your previous experience with sample preparation or microscopic identification of cell/tissue changes like those listed.
- Consider possible challenges you might face, such as distinguishing subtle changes (e.g., atrophy vs. hypoplasia) or identifying these processes in different tissue types, and think about 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 Consultant when required, for example:
- If you are tasked with quantifying the degree of necrosis in a tissue sample and are uncertain of the accepted assessment method.
- If you are unsure whether the cellular changes observed are pathological (e.g., hyperplasia) or simply artefactual due to fixation or preparation issues.
- Acknowledge how you feel about preparing samples which are representative consistently across the range of tissue types. How confident are you feeling about having to identify three of the stated processes?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in preparing samples and microscopically identifying the cellular and tissue changes listed.
- Identify the specific insights you hope to gain into the morphological characteristics of benign proliferation and degeneration.
What additional considerations do you need to make?
- Consult actions identified following previous experience with sample preparation or examining slides for similar changes.
- Identify important information you need to consider before embarking on the activity, such as characteristic microscopic features or relevant staining methods for these processes.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst preparing the sample or identifying the processes microscopically?
- Are you encountering situations such as:
- The cellular or tissue changes observed are ambiguous, making it difficult to determine immediately if the process represents pathological change e.g., hyperplasia versus an artefact e.g., due to fixation or preparation issues
- An unexpected degree of necrosis is present, or the distinction between apoptosis and necrosis is unclear due to poor cellular preservation
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 focusing on specific cellular details?
- Consider the steps you are taking in the moment, such as:
- Pausing and deliberately thinking through the criteria for each process (e.g., cellular swelling vs. nuclear shrinkage) before committing to an identification
- Seeking immediate guidance if quantifying a feature like necrosis is required and the appropriate method is unclear
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your assessment strategy? Is it affecting your confidence in ensuring you are working within your scope?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully clarifying the distinction between two similar processes? Or are you needing support because quantification of the abnormality requires consultation with a senior colleague?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for differentiating between artefactual changes and true pathology? Or gaining insight into the level of confidence required for interpretation?
On action
What happened?
- Begin by summarising your steps in preparing and identifying the three processes you focused on in this sample.
- Consider specific events, actions, or interactions which felt important, such as whether specific cellular or tissue changes were ambiguous or hard to classify e.g., distinguishing atrophy vs. hypoplasia.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, if you encountered an unexpected appearance on the slide related to these processes, requiring immediate verification. How did you feel during this experience, e.g., did you feel confident in your decision-making despite subtle changes?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding benign tissue changes. What strengths did you demonstrate, e.g., ability to distinguish between similar benign tissue changes (like atrophy vs. necrosis)? What skills and/or knowledge gaps were evident, e.g., difficulty relating the microscopic appearance of apoptosis to its mechanism?
- Compare this experience against previous engagement with similar activities – Has your practice improved in your ability to distinguish between benign tissue changes or identify artefacts?
- Identify any challenges you experienced, such as needing to seek advice from a consultant to confirm the quantification of a feature like necrosis, and what you learned about ensuring the identification was robust.
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 following any feedback you have received with regards to your ability to prepare patient samples across different tissue types. What actions are needed to further develop your ability to identify the range of processes identified?
- What criteria will you use to more effectively differentiate between these processes in the future, for instance, focusing on nuclear morphology to confirm apoptosis versus necrosis?
- Do you need to practise any aspect of the activity further, such as studying or looking for further examples of specific processes like apoptosis or degenerative disease?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences identifying these processes (proliferation/degeneration) in different tissue types or clinical contexts since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about the mechanisms and microscopic appearances of benign tissue pathologies, including regenerative and degenerative processes, and quality management standards 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 approach to preparing or identifying proliferation and degeneration based on further learning and experiences?
- Has discussing cases illustrating these processes, or their significance in patient investigations, with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences identifying proliferation/degeneration, contributed to your overall confidence and skill in identifying tissues undergoing proliferation or degeneration when performing microscopical assessment of stained slides and practicing safely, particularly in preparing for assessments like DOPS?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about pathology, shaped your current approach to identifying proliferation and degeneration? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation?
- Looking holistically at your training journey, how has this initial experience identifying proliferation/degeneration, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to using histological techniques to demonstrate these processes and practicing safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Use histological techniques to demonstrate the different types of benign proliferation and degeneration. |
| # 9 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |