Transcript Experiences of Specimen Dissection Andy Munro Histology Specimen Dissection Ninewells Histology Department • • • • • • Accredited by CPA (UK) Receives over 30 thousand cases / year 15 consultant pathologists 5 trainee pathologists 5

Experiences of
Specimen Dissection
Andy Munro
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Histology
Specimen Dissection
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Ninewells Histology Department
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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
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Why Did we Need It?
• Release of Consultant Time
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How it all Began?
• Closure of PRI lab 2004
• Still requirement to prepare fresh
Specimens
• 6 BMS volunteers
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Initial Stages
• Endless Meetings
• Draft SOP’s
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Training
• Shadowing / Supervision
• Specimen Logging
• Slide Review
• Audit
• Signing competencies
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Handed one of These
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Mastectomy
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Ink
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Ink Management
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Coronal Slices
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Coronal Slices
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Colorectal Resection
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Ink Margins
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Open & Pin Out
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Documentation
Appendix 2
Lab Number
BMS
BMS
Specimen Type
Pathologist
Date Received
Date Trimmed
The macroscopic description and handling met the requirements of the appropriate SOP for
this specimen : Y/N ?
If No, please comment:
Photograph : Y/N
Comments:
Inking : Y/N
Comments:
Slide Review :
Date :
BMS Comment;
Pathologist Comment;
Error logging.
Details;
This specimen has been competently handled
Pathologist Signature………………………………..
Date ……………….
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Certificate of Competence
In Breast & Colon
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2006
• Decision was made to extend BMS
dissection Role
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Consultant Supervisor
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Training
4 stages
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2.
3.
4.
Observation
Direct supervision
Indirect supervision
Unsupervised
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Each Stage
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Assessment
Reflective Learning Statement
Error Log Review
Audit of Error Log
Slide Review
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Stage 1
Observation
• Ran throughout Dec 06
• 16 specimens
• No Errors
• Slide Reviews on all Specimens
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Stage 2
Direct Supervision
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Allocation
Dictation
Cutting
Block Selection
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Stage 2
Allocation
• Nature of Specimen
• Specimen Category
• Clinical History
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Dictation
• Major Challenge?
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Dictation
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Dictation
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Create image for someone else
Keep it systematic and methodical
Keep it standardised
Verbally punctuate sentences
Describe using medical terminology +
Protocol
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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???”
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I Subsequently Became
A
Macro snob
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Cutting
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Describe what you find
Don’t compromise structures
Maintain orientation
Don’t hesitate to get help
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Placenta
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Placenta
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Umbilical Cord
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Membranes
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Membranes
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Membranes
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Foetal Aspect
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Haemorrhage
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Blocks Taken
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Uterus
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Amputate Cervix
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Bisect Body
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Block Selection
A
B
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Fibroid
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Block Selection
F
E
D
C
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Block Selection
C
D
E
F
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Cutting
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Block selection
• Patient’s diagnosis based solely on
blocks selected
• Keep to Sop’s + anything else of
interest
• Make sure Specimen is fixed
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Stage 2
Direct Supervision
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Ran Jan 07
46 Specimens
9 Errors
Slide Reviews on all Specimens
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Types of Error
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Misidentification of specimen
Mislabelling of specimen
Dictation Style
Dictation error
Inadequate description specimen
Inadequate/excessive number of blocks
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Types of Error
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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
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Stage 3
Indirect Supervision
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Ran Feb 07 – Aug 07
181 Specimens
11 Errors
Slide Reviews on 20 cases
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Stage 4
Unsupervised
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Aug 07 – May 2010
1661 specimens
6 errors
23 Slide Reviews
Audit Sheets
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Audit sheets
Specimen number
Number of blocks
adequate
inadequate
Quality of blocks
adequate
inadequate
Quality of macro
adequate
inadequate
Reviewed specimen?
no
yes
Needed Extra Blocks?
no
yes
Substantial Macro Changes?
no
yes
Comments:
Signature of Pathologist
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Stage 4
• Introduced to GI / GU & Skin
Specimens
• Introduction of Category D specimens
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Additions to the Team
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Portfolio Submitted in May 2010
Sat Exam September 2010
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IBMS Diploma Expert Practice
Exam
Mandatory Modules
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2.
3.
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Clinical Governance
Principles of Dissection
Surgical Procedures
Pathological Processes
Anatomical Nomenclature
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IBMS Diploma Expert Practice
Exam
Optional Modules
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Endocrine
Skin
Breast
Bones & Soft
Tissues
5. Cardio-thoracic
6. Gastro-intestinal
7. Gynae
8. Genito-urinary
9. Haemopoietic
10.Neuropathology
11.Head, Neck & ENT
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Utter Relief
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Reflections on Experience
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Anxiety
Trust
Team Competition
Better Understanding
Pathologists Perspective
Rewarding & Satisfying
Confidence Boost
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End On A High???
Complimentary Drink at The Bar!
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