Training activity information
Details
Decalcify a benign specimen and perform an ‘end of decalcification’ test
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
- Methods of decalcification, including decalcification agent selection, sensitivity and specificity
- Risk to patient sample and implications of using inappropriate decalcification agents
- Impact of decalcification on downstream processes
- Quality control
- Health and safety
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 decalcifying a specimen and performing the test.
- Consider how the learning outcomes apply, specifically in relation to applying decalcification techniques to minimise the impact on downstream testing.
- Discuss with your training officer to gain clarity of what is expected of you when decalcifying benign specimens and performing the end of decalcification test.
What is your prior experience of this activity?
- Think about your previous experience with handling bone or calcified specimens, or performing decalcification procedures.
- Consider possible challenges you might face, such as ensuring complete decalcification without damaging the tissue e.g., causing nuclear detail loss or performing the end test accurately, 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 Technical Manager when required, for example:
- If the end-point test (e.g., chemical test) provides an ambiguous result, and you need confirmation on whether to extend the decalcification period further
- If you are unsure about the impact of a specific decalcification agent on ancillary studies (e.g., IHC or future molecular testing) that may be required for the specimen
- Acknowledge how you feel about embarking on the decalcifying process and the end of decalcification test.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in applying decalcification techniques and performing the ‘end of decalcification’ test.
- Identify the specific insights you hope to gain regarding the process of decalcification and its importance for subsequent histological processing and testing.
What additional considerations do you need to make?
- Consult actions identified following previous experience with decalcification or handling calcified specimens.
- Identify important information you need to consider before embarking on the activity, such as different decalcification agents, safety precautions, and specific testing methods used in your department.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst managing the decalcification process or performing the end test?
- Are you encountering situations such as:
- The specimen still feels firm or rigid despite the expected decalcification time having passed, suggesting the process is insufficient.
- The result of the ‘end of decalcification’ test is ambiguous e.g., the chemical test is borderline, making a clear decision on the next step difficult
- There are challenges with the specimen size or type that are visibly causing damage to the tissue surface (e.g., causing nuclear detail loss) during decalcification
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 decision regarding the next step?
- Consider the steps you are taking in the moment, such as:
- Immediately interpreting the test result and, if ambiguous, reviewing the departmental SOP before deciding to extend the decalcification time
- Consulting the Technical Manager to confirm the impact of the specific decalcification agent on potential ancillary studies (e.g., IHC or molecular testing) before proceeding
- How are you feeling in that moment? For instance, are you finding it difficult to maintain focus on potential downstream impacts? Is it affecting your confidence in ensuring optimal tissue quality?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully determining the need for extended decalcification? Or are you needing support because the ambiguity of the end-point test requires confirmation from a senior colleague?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for performing the end of decalcification test accurately? Or gaining insight into the critical considerations regarding the impact on downstream testing?
On action
What happened?
- Begin by summarising the decalcification process and the performance of the ‘end of decalcification’ test.
- Consider specific events, actions, or interactions which felt important, such as your immediate interpretation of the test result e.g., clear negative result or ambiguous reading.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, if the specimen still felt hard or the chemical test result was ambiguous, and how you responded in the moment to ensure optimal tissue processing. How did you feel during this experience, e.g., did you feel pressure to complete the process quickly or focused on quality control?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding decalcification. What strengths did you demonstrate, e.g., accurate performance of the end-point test? What skills and/or knowledge gaps were evident, e.g., uncertainty about how specimen size or type might affect decalcification time?
- Compare this experience against previous engagement with similar activities – Has your practice improved in your understanding of the principles behind the decalcification process and its impact on morphology?
- Identify any challenges you experienced, such as needing to troubleshoot an unusual test result or confirm the appropriate extension time with the Technical Manager, and what you learned from that interaction.
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 about your ability to perform decalcification and an end of decalcification test.
- What considerations will be crucial for you the next time you decalcify a specimen, for instance, ensuring the decalcification process is optimised to minimise impact on downstream ancillary testing?
- Do you need to practise any aspect of the activity further, such as reviewing the protocol for handling large or challenging calcified specimens?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences decalcifying different types of specimens, encountering specimens with varying degrees of calcification, or dealing with troubleshooting decalcification issues since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about applying decalcification techniques to minimise the impact on downstream testing, the methods and relevance of decalcification techniques, 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 decalcification technique or your execution of the ‘end of decalcification’ test based on further learning and experiences?
- Has discussing challenging decalcification cases, or the impact of incomplete or inappropriate decalcification on diagnosis or onward molecular testing, 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 decalcifying specimens, contributed to your overall confidence and skill in applying decalcification techniques correctly and performing quality control checks, and practicing safely?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about tissue processing, shaped your current approach to decalcification? 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 decalcification experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying decalcification techniques and practicing safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 7 |
Outcome
Apply decalcification techniques to minimise the impact on downstream testing. |
| # 9 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |