Malignant Dissection —
Training activity: 3

Details

Prepare malignant resection specimens for specimen dissection

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
• RCPath datasets
• Health and safety
• Infection control

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 malignant resection specimens, specifically learning outcomes related to the appropriate specimen preparation, based on the clinical history for malignant specimens.
• Discuss with your training officer to gain clarity of what is expected for the specific type of malignant resection specimen you will be preparing.

What is your prior experience of this activity?

• Think about your previous experience preparing any type of specimen for dissection, particularly large resections or those requiring specific handling like fixation.
• Consider possible challenges you might face, such as handling large specimens, ensuring adequate fixation, dealing with potentially hazardous samples, or interpreting complex clinical details relevant to preparation, and think about how you might handle them.
• Recognise the scope of your own practice for preparing malignant resections; 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 Senior Dissection Scientist when required, for example:
  • When dealing with unusually large or fragmented malignant specimens that complicate initial fixation or orientation steps
  • If the preparation requires specialist equipment not typically used e.g., advanced fixation chamber
  • When the clinical details suggest specific infection or contamination that mandates advanced safety protocols during preparation
• Acknowledge how you feel about preparing malignant resection specimens for specimen dissection.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in preparing malignant resection specimens, such as appropriate fixation techniques, handling large or complex samples, and documenting the initial state of the specimen.
• Identify the specific insights you hope to gain into why certain preparation steps are critical for malignant resections to ensure optimal subsequent dissection and microscopic assessment.

What additional considerations do you need to make?

• Consult actions identified following previous experiences with specimen preparation, especially for resections.
• Identify important information you need to consider before embarking on the activity, such as specific fixation times, necessary equipment for handling large specimens, safety protocols for malignant or contaminated samples, or reviewing relevant guidelines for the specific type of resection.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the malignant resection specimen?
• Are you encountering situations such as:
  • The specimen is much larger or smaller than expected, complicating initial fixation and orientation.
  • There are unexpected anatomical variations or distortion due to previous treatment (neoadjuvant therapy) that impact standard preparation protocols.
  • Immediate safety concerns arise unexpectedly e.g., the specimen appears contaminated or excessively bloody.

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, did you respond appropriately to the situation, such as altering your handling technique or fixation approach? Are you adapting or changing your usual approach to preparing this type of specimen?
• Consider the steps you are taking in the moment, such as:
  • Immediately documenting the need for prolonged fixation due to specimen size and applying safety protocols for handling
  • Seeking immediate advice regarding orientation due to anatomical distortion or fragmentation
• How are you feeling in that moment? For instance, did you find it difficult to adapt to the unexpected specimen complexity? Did it affect your confidence in ensuring adequate fixation?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully applying the required safety protocols during handling? Or are you needing support because the size or complexity of the malignant resection requires specialist input for initial preparation and dissection planning?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for ensuring optimal fixation for large malignant specimens? Or gaining insight into the necessity of reviewing safety protocols prior to complex preparations?

On action

What happened?

• Begin by summarising the key steps you took when preparing this specific malignant resection specimen.
• Consider specific events, actions, or interactions which felt important, such as how you managed the initial fixation of a large specimen or dealt with anatomical distortion due to neoadjuvant therapy during preparation.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking input when the specimen was unexpectedly large or if safety concerns arose. How did you feel during this experience, e.g., did you feel focused on maintaining the dissection rationale despite the complexity?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding malignant preparation. What strengths did you demonstrate, e.g., technical precision in handling large malignant specimens? What skills and/or knowledge gaps were evident, e.g., difficulty ensuring adequate fixation for different malignant tissue types or interpreting complex clinical preparation details?
• Compare this experience against previous engagement with similar activities – Has your practice improved in managing the initial preparation and fixation of complex resections?
• Identify any challenges you experienced, such as difficulty with specimen integrity, fixation, or safety considerations, and how you successfully overcame these challenges.

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 with regards to your ability to prepare malignant resection specimens for specimen dissection
• What aspects of preparing this type of malignant resection specimen will you approach differently next time, for instance, performing a more methodical check of fixation times and preparation protocols for large malignant resections?
• Do you need to practise any aspect of the activity further, such as reviewing specific safety protocols for malignant or contaminated samples or techniques for ensuring optimal initial fixation?

Beyond action

Have you revisited the experiences?

• How has your continued practice preparing a wider range of malignant resection specimens from different organ systems or encountering specimens with challenging macroscopic features, sizes, or fixation issues since your initial reflection on this specific training activity led you to revisit your initial preparation technique or approach during that activity? For example, how encountering a subsequent complex malignant resection e.g., a large colonic tumour with extensive peritumoural fat led you to refine the systematic sectioning and fixation pattern you used for specimens with bulky margins, which was less optimal during your initial preparation.
• Considering what you now understand about employing the appropriate specimen preparation, orientation, and inking techniques based on the clinical history for various malignant specimens, including safety considerations and the link to macroscopic features, 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 preparation technique based on further learning, additional experiences, or discussions with supervisors? For example, how you implemented the use of specialised fixation support materials e.g., pinning boards for opened bowel to ensure consistent orientation and adequate fixation depth, which you had initially identified as a gap in your first reflection.
• Has discussing challenging malignant specimen preparations, the impact of preparation quality on subsequent dissection, or safety protocols with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how a discussion about specimen contamination risk with a biosafety officer reinforced the necessity of meticulous PPE and handling protocols during the initial preparation of large, fresh malignant resections, improving upon your initial technique.

How have these experiences impacted upon current practice?

• How has the learning from your initial engagement with this training activity, in combination with subsequent preparation and dissection experiences, contributed to your overall confidence and ability in preparing malignant resection specimens and practicing safely in accordance with quality standards, particularly in preparing for assessments where you might be observed orientating and inking?
• How has reflecting back on this specific training activity, combined with everything you’ve learned since about handling malignant specimens, shaped your current approach to preparing malignant resection specimens? How does this evolved understanding help you identify when something is beyond your scope of practice or requires seeking advice? For example, how your current approach involves routinely consulting a senior scientist when a specimen preparation requires non-standard fixation methods e.g., vascular perfusion due to extreme specimen size, recognising this requires specialist technique.
• Looking holistically at your training journey, how has this initial experience of preparing a malignant resection specimen, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to handling malignant specimens, employing appropriate preparation techniques, and practicing safely? For example, how mastering the technical skills of specimen preparation informs your ability to later summarise the macroscopic features and block sampling for accurate microscopic assessment required for reporting.

Relevant learning outcomes

#	Outcome
# 2	Outcome Dissect the most common malignant specimens from a range of organ systems.
# 3	Outcome Employ the appropriate specimen preparation, orientation, inking, block sampling and dissection rationale based on the clinical history for malignant specimens.
# 5	Outcome Practice safely in accordance with quality management and accreditation standards.