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Experiences of Specimen Dissection

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 BMS Involved in Specimen Preparation

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Experiences of Specimen Dissection

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  1. Experiences ofSpecimen Dissection Andy Munro

  2. HistologySpecimen 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

  18. Certificate of CompetenceIn Breast & Colon

  19. 2006 • Decision was made to extend BMS dissection Role

  20. Consultant Supervisor

  21. Training4 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 1Observation • 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 2Allocation • Nature of Specimen • Specimen Category • Clinical History

  26. Dictation • Major Challenge?

  27. Dictation

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

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

  30. I Subsequently BecameA 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 2Direct Supervision • Ran Jan 07 • 46 Specimens • 9 Errors • Slide Reviews on all Specimens

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