1. Experiences of Specimen Dissection
Andy Munro

2. Histology Specimen Dissection

3. Ninewells Histology Department
Accredited by CPA (UK)
Receives over 30 thousand cases / year
15 consultant pathologists
5 trainee pathologists
5 BMS Involved in Specimen Preparation
3 BMS Involved in block selection

4. Why Did we Need It?
Release of Consultant Time

5. How it all Began? Closure of PRI lab 2004
Still requirement to prepare fresh Specimens
6 BMS volunteers

6. Initial Stages
Endless Meetings
Draft SOP’s

7. Training Shadowing / Supervision Specimen Logging Slide Review Audit
Signing competencies

8. Handed one of These

9. Mastectomy

10. Ink

11. Ink Management

12. Coronal Slices

13. Coronal Slices

14. Colorectal Resection

15. Ink Margins

16. Open & Pin Out

17. Documentation
Audit form goes here

18. Certificate of Competence In Breast & Colon

19. 2006
Decision was made to extend BMS dissection Role

20. Consultant Supervisor

21. Training 4 stages Observation Direct supervision Indirect supervision
Unsupervised

22. Each Stage Assessment Reflective Learning Statement Error Log Review
Audit of Error Log
Slide Review

23. Stage 1 Observation Ran throughout Dec 06 16 specimens No Errors
Slide Reviews on all Specimens

24. Stage 2 Direct Supervision
Allocation
Dictation
Cutting
Block Selection

25. Stage 2 Allocation Nature of Specimen Specimen Category
Clinical History

26. Dictation
Major Challenge?

27. Dictation
Non medical Picture

28. Dictation Create image for someone else
Keep it systematic and methodical
Keep it standardised
Verbally punctuate sentences
Describe using medical terminology + Protocol

29. Dictation
Lee
“ 3 coronal sections reveal an admixture of fibrofatty breast tissue with some stromal density towards the central and lateral aspects of the specimen”
Me “Eh???”

30. I Subsequently Became A
Macro snob

31. Cutting Describe what you find Don’t compromise structures
Maintain orientation
Don’t hesitate to get help

32. Placenta

33. Placenta

34. Umbilical Cord

35. Membranes

36. Membranes

37. Membranes

38. Foetal Aspect

39. Haemorrhage

40. Blocks Taken

41. Uterus

42. Amputate Cervix

43. Bisect Body

44. Block Selection B A

45. Fibroid

46. Block Selection F E D C

47. Block Selection E D C F

48. Cutting

49. Block selection Patient’s diagnosis based solely on blocks selected
Keep to Sop’s + anything else of interest
Make sure Specimen is fixed

50. Stage 2 Direct Supervision
Ran Jan 07
46 Specimens
9 Errors
Slide Reviews on all Specimens

51. Types of Error Misidentification of specimen Mislabelling of specimen
Dictation Style
Dictation error
Inadequate description specimen
Inadequate/excessive number of blocks

52. Types of Error Blocks of incorrect size/thickness
Need for pathologist to revisit the specimen
Need for extra blocks to be taken
Clinically significant error
Tissue loss
Tissue contamination
Failure to contact pathologist for assistance

53. Stage 3 Indirect Supervision
Ran Feb 07 – Aug 07
181 Specimens
11 Errors
Slide Reviews on 20 cases

54. Stage 4 Unsupervised Aug 07 – May 2010 1661 specimens 6 errors
23 Slide Reviews
Audit Sheets

55. Audit sheets Specimen number Number of blocks adequate inadequate
Quality of blocks
Quality of macro
Reviewed specimen? no
yes
Needed Extra Blocks?
Substantial Macro Changes?
Comments:
Signature of Pathologist

56. Stage 4 Introduced to GI / GU & Skin Specimens
Introduction of Category D specimens

57. Additions to the Team

58. Portfolio Submitted in May 2010 Sat Exam September 2010

59. IBMS Diploma Expert Practice Exam Mandatory Modules
Clinical Governance
Principles of Dissection
Surgical Procedures
Pathological Processes
Anatomical Nomenclature

60. IBMS Diploma Expert Practice Exam Optional Modules
Endocrine
Skin
Breast
Bones & Soft Tissues
Cardio-thoracic
Gastro-intestinal
Gynae
Genito-urinary
Haemopoietic
Neuropathology
Head, Neck & ENT

61. Utter Relief

62. Reflections on Experience
Anxiety
Trust
Team Competition
Better Understanding
Pathologists Perspective
Rewarding & Satisfying
Confidence Boost

63. Complimentary Drink at The Bar!
End On A High???
Complimentary Drink at The Bar!