Training activity information
Details
Perform microtomy and haematoxylin and eosin staining to demonstrate various tissue features in relation to the assessment of:
- Non-malignant disease
- Pre-malignant disease
- Malignant disease
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
- Internal quality control
- National and local policies and guidelines
- RCPath tissue pathways
- RCPath cancer datasets
- Screening programme guidance
- NICE guidance
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 and haematoxylin and eosin staining for different disease types.
- Review the learning outcomes related to employing microtomy and haematoxylin and eosin staining to demonstrate various tissue features and practicing safely.
- Consider how the expectations might differ when preparing sections for malignant, pre-malignant, or non-malignant assessment.
- Discuss with your training officer to gain clarity of what is expected of you for this specific activity, perhaps focusing on expected quality standards for sections intended for complex assessment.
What is your prior experience of this activity?
- Think about what you already know about microtomy and haematoxylin and eosin staining techniques from previous modules or experiences. Have you previously prepared sections specifically for the assessment of pre-malignant or malignant disease?
- Consider possible challenges you might face during microtomy e.g., difficult tissue blocks, sectioning malignant or pre-malignant tissue types or staining e.g., troubleshooting staining issues, ensuring consistency. Think about how you might handle these challenges.
- Recognise the scope of your own practice for this activity, particularly regarding the types of tissue or complexity you are permitted to handle; know when you will need to seek advice or help and from whom.
- Acknowledge how you feel about embarking on this training activity, especially if it involves new or challenging tissue types or diagnostic contexts.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as refining your microtomy technique for optimal section quality across different tissue types and pathologies, or improving your troubleshooting skills for haematoxylin and eosin staining.
- Identify the specific insights you hope to gain into how subtle differences in microtomy or staining can impact the ability to assess non-malignant, pre-malignant, or malignant tissue features.
What additional considerations do you need to make?
- Consult actions identified following previous experiences with microtomy or haematoxylin and eosin staining, particularly those where you identified areas for improvement in section or staining quality.
- Identify important information you need to consider before embarking on the activity, such as reviewing safety protocols for handling potentially infectious or hazardous tissue blocks, or confirming specific departmental protocols for section thickness or staining protocols for these types of cases.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing microtomy or H&E staining?
- Are you encountering situations such as:
- The tissue block or section quality is immediately compromised e.g., chatter, tearing, or poor adherence to the slide
- Unexpected issues are arising during the staining process, such as uneven staining or the appearance of precipitates
- The tissue type or cutting behaviour is significantly different from previous experiences, challenging your standard microtomy technique
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 the technique?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your microtomy technique e.g., blade angle, speed, or cooling in real-time based on the cutting issues
- Attempting to immediately troubleshoot or adapt the staining process if issues like precipitation occur
- Making real-time decisions regarding stain intensity or differentiation to ensure features necessary for assessing malignant/non-malignant disease are visible
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your technique to the specific tissue type? Is it affecting your confidence in ensuring optimal section quality?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully adapting your technique to resolve the cutting issues yourself? Or are you needing support because the staining malfunction requires intervention from senior technical staff?
- Identify what you learnt as a result of the unexpected development. For example, are you mastering a more effective technique for adjusting microtomy settings for difficult blocks? Or gaining insight into the nuances of H&E stain differentiation?
On action
What happened?
- Begin by summarising the key steps of performing microtomy and H&E staining for this specific case or batch.
- Describe the quality of the sections and the staining result. What specific tissue features were you aiming to demonstrate e.g., nuclear morphology for malignant assessment, and how successfully was this achieved?
- Consider specific events, actions, or interactions which felt important.
- Include any ‘reflect-in-action’ moments where you adjusted your technique or troubleshooting staining issues as they occurred.
How has this experience contributed to your developing practice?
- Identify what learning you can take from the experience. What did you learn about the relationship between microtomy technique and section quality?
- How did this experience enhance your understanding of H&E staining principles and their impact on demonstrating tissue features?
- What strengths did you demonstrate e.g., technical precision or problem-solving? What skills or knowledge gaps were evident?
- Compare this experience to previous microtomy and staining activities. Has your practice improved
- Identify any challenges you experienced e.g., difficult tissue, staining artefacts and how you reacted to them.
What will you take from the experience moving forward?
- Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received on your microtomy and specific staining techniques for different tissue features specific to the assessment of all the listed disease types.
- What specific adjustments will you make to your microtomy or staining approach next time, especially for challenging tissue types?
- Do you need to practise any aspect of the activity further, such as reviewing aspects of the H&E staining protocol or troubleshooting steps?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences performing microtomy and haematoxylin and eosin staining on different tissue types, or encountering more challenging specimens, since completing this specific training activity led you to revisit your initial technique or considerations during that activity?
- Considering your current understanding of quality management and accreditation standards related to haematoxylin and eosin staining, 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 technique based on further learning and experiences? For example, how an instance where a subsequent challenging specimen forced you to adapt your microtomy technique e.g., adjusting the blade angle for difficult blocks, demonstrating an implemented improvement.
- Has discussing challenging microtomy or staining results, or the impact of stain quality on diagnosis, 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 microtomy and staining experiences, contributed to your overall confidence and skill in performing microtomy and haematoxylin and eosin staining and practicing safely, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since about tissue processing and staining, shaped your current approach to microtomy and haematoxylin and eosin staining? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your accumulated experience shapes your current approach to troubleshooting haematoxylin and eosin artifacts, allowing you to quickly identify when something is beyond your scope of practice (e.g., equipment failure vs. human error) and escalate the issue appropriately.
- Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to employing microtomy and haematoxylin and eosin staining and practicing safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Employ microtomy and H&E staining to demonstrate various tissue features. |
| # 4 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |