Pathological Basis of Disease —
Training activity: 3

Details

Prepare representative patient samples from a range of tissue types and identify the following processes:

• Tissue and cell injury
• Healing and repair
• Thrombosis
• Embolism
• Atherosclerosis
• Oedema
• Ischaemia
• Infarction

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

• Differences between the types of physiological and pathological processes
• Normal and disease states associated with these processes
• Macroscopic vs microscopic identification
• The microscopical differences between normal tissue morphology and tissue undergoing these processes
• Local SOPs
• 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 these processes.
• Consider how the learning outcomes apply, specifically in relation to using histological techniques to demonstrate the different types of injury, repair and vascular damage.
• Discuss with your training officer to gain clarity of what is expected of you when preparing patient samples from a range of tissue types and identifying the processes identified.

What is your prior experience of this activity?

• Think about your previous experience with sample preparation or microscopic identification of injury, repair, or vascular pathology.
• Consider possible challenges you might face, such as identifying subtle signs of injury (e.g., early ischaemia) or complex vascular events e.g., distinguishing between different types of thrombosis, 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 Pathologist specialising in vascular pathology when required, for example:
  • If you encounter a sample where healing and repair phases are overlapping, making classification of the primary injury difficult
  • If the histological features of thrombosis/embolism are complex and require specific ancillary stains (e.g., elastic stains) for complete demonstration
• Acknowledge how you feel about preparing samples in the context of this training activity.

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 histological features of injury, repair, and vascular pathology.
• Identify the specific insights you hope to gain into the microscopic manifestation of tissue injury, healing, and vascular events.

What additional considerations do you need to make?

• Consult actions identified following previous experience with sample preparation or examining slides for similar conditions.
• Identify important information you need to consider before embarking on the activity, such as characteristic histological patterns or relevant clinical context linked to these conditions.

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 appearance doesn’t immediately fit a specific category e.g., an area of injury is present, but clear evidence of repair is absent or vice versa
  • Morphological changes are subtle (e.g., early ischaemia or oedema) and difficult to confirm without clinical context

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 address the uncertainty?
• Consider the steps you are taking in the moment, such as:
  • Approaching the uncertainty by focusing attention on the most striking features to establish a context e.g., noting the presence of haemorrhage or fibrin
  • Immediately connecting the morphological changes to specific physiological processes e.g., linking amorphous eosinophilic material to thrombosis
• How are you feeling in that moment? For instance, are you finding it difficult to focus your attention due to the complexity? Is it affecting your confidence in achieving a successful identification?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully applying knowledge to identify a complex vascular event? Or are you needing support because the histological features are complex e.g., requiring ancillary stains and demand specialist advice such as a pathologist specialising in vascular pathology?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for correlating morphological features with specific injury mechanisms? Or gaining insight into patterns of tissue repair?

On action

What happened?

• Begin by summarising your approach to identifying the various injury, repair, and vascular processes in the sample.
• Consider specific events, actions, or interactions which felt important, such as whether specific features e.g., fibrin, inflammatory cells, or vascular changes were particularly informative or confusing.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, if you encountered an appearance that didn’t immediately fit a category e.g., distinguishing early healing from chronic injury and how you approached this uncertainty in the moment. How did you feel during this experience, e.g., did you feel focused on systematically ruling out possibilities?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding injury and vascular pathology. What strengths did you demonstrate, e.g., ability to correlate macroscopic or clinical information with microscopic findings related to vascular events? What skills and/or knowledge gaps were evident, e.g., difficulty identifying the microscopic features of early ischaemia?
• Compare this experience against previous engagement with similar activities – Has your practice improved in your ability to identify different stages of injury, healing, or vascular events?
• Identify any challenges you experienced, such as needing to consult with a supervisor to confirm interpretations of complex vascular lesions like embolism or atherosclerosis, and what the learning outcome was.

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 patterns or features will you look for specifically the next time you encounter potential injury, repair, or vascular changes, for instance, actively searching for the cellular evidence of infarction in a solid organ?
• Do you need to practise any aspect of the activity further, such as reviewing the systematic approach to evaluating slides for these complex changes?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences identifying injury, repair, and vascular damage processes in various tissue types or clinical scenarios since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
• Considering what you understand about the microscopic appearances of different types of injury, repair, and vascular damage, their relevance to the pathological basis of disease, 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 injury, repair, and vascular damage based on further learning and experiences?
• Has discussing cases illustrating these processes, perhaps in the context of morbidities or mortalities, 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 injury, repair, and vascular damage, contributed to your overall confidence and competence in identifying tissue injury and repair and vascular damage 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 these processes? 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 injury, repair, and vascular damage, 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
# 3	Outcome Use histological techniques to demonstrate the different types of injury, repair and vascular damage.
# 9	Outcome Practice safely in accordance with quality management and accreditation standards.