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1 Experiences of Specimen Dissection Andy Munro. 2 Histology Specimen Dissection.

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Presentation on theme: "1 Experiences of Specimen Dissection Andy Munro. 2 Histology Specimen Dissection."— Presentation transcript:

1 1 Experiences of Specimen Dissection Andy Munro

2 2 Histology Specimen Dissection

3 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 4 Why Did we Need It? Release of Consultant Time

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

6 6 Initial Stages Endless Meetings Draft SOP’s

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

8 8 Handed one of These

9 9 Mastectomy

10 10 Ink

11 11 Ink Management

12 12 Coronal Slices

13 13 Coronal Slices

14 14 Colorectal Resection

15 15 Ink Margins

16 16 Open & Pin Out

17 17 Documentation

18 18 Certificate of Competence In Breast & Colon

19 Decision was made to extend BMS dissection Role

20 20 Consultant Supervisor

21 21 Training 4 stages 1.Observation 2.Direct supervision 3.Indirect supervision 4.Unsupervised

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

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

24 24 Stage 2 Direct Supervision Allocation Dictation Cutting Block Selection

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

26 26 Dictation Major Challenge?

27 27 Dictation

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

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

30 30 I Subsequently Became A Macro snob

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

32 32 Placenta

33 33 Placenta

34 34 Umbilical Cord

35 35 Membranes

36 36 Membranes

37 37 Membranes

38 38 Foetal Aspect

39 39 Haemorrhage

40 40 Blocks Taken

41 41 Uterus

42 42 Amputate Cervix

43 43 Bisect Body

44 44 Block Selection A B

45 45 Fibroid

46 46 Block Selection C D E F

47 47 Block Selection C D E F

48 48 Cutting

49 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 50 Stage 2 Direct Supervision Ran Jan Specimens 9 Errors Slide Reviews on all Specimens

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

52 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 53 Stage 3 Indirect Supervision Ran Feb 07 – Aug Specimens 11 Errors Slide Reviews on 20 cases

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

55 55 Audit sheets Specimen number Number of blocksadequateinadequate Quality of blocksadequateinadequate Quality of macroadequateinadequate Reviewed specimen?noyes Needed Extra Blocks?noyes Substantial Macro Changes?noyes Comments: Signature of Pathologist

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

57 57 Additions to the Team

58 58 Portfolio Submitted in May 2010 Sat Exam September 2010

59 59 IBMS Diploma Expert Practice Exam Mandatory Modules 1.Clinical Governance 2.Principles of Dissection 3.Surgical Procedures 4.Pathological Processes 5.Anatomical Nomenclature

60 60 IBMS Diploma Expert Practice Exam Optional Modules 1.Endocrine 2.Skin 3.Breast 4.Bones & Soft Tissues 5.Cardio-thoracic 6.Gastro-intestinal 7.Gynae 8.Genito-urinary 9.Haemopoietic 10.Neuropathology 11.Head, Neck & ENT

61 61 Utter Relief

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

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


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