Presentation is loading. Please wait.

Presentation is loading. Please wait.

Experiences of Specimen Dissection

Similar presentations

Presentation on theme: "Experiences of Specimen Dissection"— Presentation transcript:

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

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!

Download ppt "Experiences of Specimen Dissection"

Similar presentations

Ads by Google