Training activity information
Details
Prepare representative patient samples from a range of tissue types, identify the presence and pathological manifestation of infections caused by the following:
- Bacteria
- Viruses
- Fungi
- Parasites
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
- Role of the patient history in developing the clinical picture and selection of adjunct histochemical, immunohistochemical, molecular and other techniques
- Appropriateness of investigation
- Microscopical differences between normal tissue morphology and infected tissue
- Local SOPs
- RCPath tissue pathways and cancer datasets
- Infection control and notifiable diseases
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 infectious organisms and their effects.
- Consider how the learning outcomes apply, specifically in relation to using histological techniques to demonstrate the different types of infection.
- 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 the identifying types of infection.
What is your prior experience of this activity?
- Think about your previous experience with sample preparation or microscopic identification of infectious agents or host response to infection.
- Consider possible challenges you might face, such as identifying subtle organisms e.g., small viral inclusions or recognising the specific type of infection e.g., distinguishing fungal species, 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 Clinical Scientist specialising in microbiology/infectious disease when required, for example:
- If the routine haematoxylin and eosin stain is ambiguous regarding the presence of infectious organisms and ancillary stains (e.g., GMS, PAS) are required for confirmation
- When dealing with a rare or complex parasitic infection where morphology is not immediately clear from standard training resources
- Acknowledge how you feel about preparing the samples and identifying the range of infections.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in preparing samples and microscopically identifying different infectious organisms and the associated tissue reactions.
- Identify the specific insights you hope to gain into the histological appearance of various types of infection.
What additional considerations do you need to make?
- Consult actions identified following previous experience with sample preparation or examining slides for infections.
- Identify important information you need to consider before embarking on the activity, such as specific stains for different organisms or typical morphological features.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst preparing the sample or identifying the infection microscopically?
- Are you encountering situations such as:
- You did not expect to see evidence of infection in this sample, but organisms or suggestive inflammatory patterns (e.g., small viral inclusions) are present
- There is difficulty differentiating between two types of organisms e.g., small fungi vs. large bacterial clumps based solely on haematoxylin and eosin morphology
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 search strategy?
- Consider the steps you are taking in the moment, such as:
- Immediately considering special stains (e.g., GMS, PAS) or additional information that might be required to confirm the organism identity
- Adapting the search strategy based on the inflammatory response observed e.g., looking for fungal elements in an abscess with heavy neutrophil infiltration
- How are you feeling in that moment? For instance, are you finding it difficult to maintain objectivity during the search for organisms? Is it affecting your confidence in ensuring an accurate classification?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully narrowing the organism type based on morphology? Or are you needing support because the organism is subtle or ambiguous and requires specific ancillary testing protocols from a Clinical Scientist specialising in microbiology/infectious disease?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for differentiating between host response and organism morphology? Or gaining insight into the need for ancillary diagnostic tools?
On action
What happened?
- Begin by summarising your process for searching for and identifying infectious organisms and their effects in this sample.
- Consider specific events, actions, or interactions which felt important, such as whether specific morphological characteristics helped you distinguish between different types of organisms (e.g., fungal hyphae vs. bacterial colonies).
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, if you found evidence of an organism you didn’t anticipate (e.g., small viral inclusions) and how this affected your immediate examination strategy. How did you feel during this experience, e.g., did you find the need for a targeted search challenging?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding infection identification. What strengths did you demonstrate, e.g., ability to recognise the histological features of infections caused by different organism types? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the typical tissue response to a parasitic infection?
- Compare this experience against previous engagement with similar activities – Has your practice improved in your decision to consider special stains or alternative techniques when haematoxylin and eosin morphology is ambiguous?
- Identify any challenges you experienced, such as needing to consult specific microbiology resources to confirm the identity of a rare organism, and how this reinforced working within your 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 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 various types of infections?
- What morphological clues will you specifically look for when assessing for different types of infections in the future, for instance, checking for GMS positivity if fungal elements are suspected?
- Do you need to practise any aspect of the activity further, such as studying the pathological manifestation of viruses or other specific organisms?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences identifying infectious organisms or the host response to infection in different tissue types or with different pathogens 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 infectious processes, the different types of infections, 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 infections based on further learning and experiences?
- Has discussing cases involving infectious pathology, or the role of pathology in diagnosing infections, 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 infections, contributed to your overall confidence and skill in identifying the presence of infectious organisms 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 infections? 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 infections, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to using histological techniques to demonstrate infection and practicing safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Use histological techniques to demonstrate the different types of infection. |
| # 9 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |