Training activity information
Details
Perform microtomy of a specimen for onward molecular testing
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
- National guidelines
- Sample preparation requirements for onward molecular testing
- 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 performing microtomy for a specimen intended for molecular testing.
- Consider how the learning outcomes apply, specifically in relation to practicing safely in accordance with quality management and accreditation standards.
- Discuss with your training officer to gain clarity of what is expected of you, especially regarding the specific requirements for sections for molecular testing.
What is your prior experience of this activity?
- Think about your previous experience with microtomy, particularly for sections requiring high quality or specific preparation.
- Consider possible challenges you might face, such as obtaining appropriately sized and thickness sections, avoiding contamination from previous blocks, or handling specific tissue types (e.g., friable tissue), 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 Molecular Scientist when required, for example:
- If you are unsure about the anti-contamination protocols needed when sectioning a block containing minimal tumour material prior to molecular analysis
- If the required section thickness for the molecular assay is non-standard and requires verification before cutting
- Acknowledge how you feel about performing microtomy techniques in the context of the training activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in performing microtomy to the standards required for molecular testing.
- Identify the specific insights you hope to gain into the critical factors in microtomy that impact the quality of material for molecular analysis.
What additional considerations do you need to make?
- Consult actions identified following previous experience with microtomy, especially for specialised purposes.
- Identify important information you need to consider before embarking on the activity, such as specific protocols for handling tissue for molecular testing, required section thickness, or need for dedicated equipment.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing microtomy on the specimen?
- Are you encountering situations such as:
- The sections are not coming off cleanly or are curling excessively, making it difficult to collect sections of the correct thickness for molecular analysis
- There are unexpected issues with the tissue consistency e.g., unexpected friability or residual calcification, impacting section quality
- You are concerned about potential contamination from a previous block cut on the microtome, jeopardising the sensitive molecular test
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 technique?
- Consider the steps you are taking in the moment, such as:
- Immediately making adjustments to the microtome settings (e.g., knife angle or clearance) to improve section quality
- Seeking immediate advice from the Molecular Scientist to verify the anti-contamination protocols required for this specific block, especially if the tumour burden is minimal
- Deciding, in real-time, how to handle and collect the sections to ensure they are placed into the correct, sterile receptacle for molecular testing
- How are you feeling in that moment? For instance, are you finding it difficult to maintain precision? Is it affecting your confidence in ensuring the material meets quality management standards?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully achieving the required section thickness and quality? Or are you needing support because the tissue is unusually complex and requires the input of a senior colleague to ensure suitability for onward molecular analysis (Training Officer or Molecular Scientist)?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for adjusting microtomy settings for difficult tissue? Or gaining insight into the critical factors that impact the quality of material for molecular analysis?
On action
What happened?
- Begin by summarising your microtomy process for this specimen intended for molecular testing.
- Consider specific events, actions, or interactions which felt important, such as the consistency of the block and any immediate challenges with cutting or collecting the sections.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, if you encountered an unexpected issue like tissue artefacts or difficulty with section thickness, and how this affected your technique or collection strategy. How did you feel during this experience, e.g., did you feel pressure to ensure sections were contamination-free for molecular accuracy?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding microtomy for molecular studies. What strengths did you demonstrate, e.g., accurate application of anti-contamination protocols? What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the required section thickness for a specific molecular assay?
- Compare this experience against previous engagement with similar activities – Has your practice improved in your understanding of the specific requirements and considerations for preparing sections for molecular testing?
- Identify any challenges you experienced, such as needing to seek advice regarding block handling precautions for molecular integrity, and what you learned about ensuring quality control.
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 technique at performing microtomy.
- What specific aspects of your microtomy technique or handling will you focus on improving for specimens intended for molecular testing, for instance, adjusting the blade angle or cooling temperature for optimal section quality?
- Do you need to practise any aspect of the activity further, such as reviewing pre-analytical factors critical for molecular testing accuracy?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences performing microtomy for molecular testing on different tissue types, handling challenging blocks, or learning about the specific requirements for molecular samples since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about the importance of obtaining high-quality sections for molecular analysis, minimising contamination risk, 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 microtomy technique for molecular samples based on further learning and experiences?
- Has discussing issues with molecular sectioning, the impact of section quality on molecular results, or cases requiring 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 performing microtomy for molecular testing, contributed to your overall confidence and ability in preparing specimens for onward molecular testing and practicing safely?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about molecular pathology, shaped your current approach to microtomy for molecular samples? 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 microtomy experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to practicing safely and the relevant specified outcomes?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Use histological techniques to demonstrate the different types of immunological disease. |
| # 6 |
Outcome
Use histological techniques to demonstrate the different types of abnormal proliferation. |
| # 9 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |