Scottish Pathology Network
BMS Dissection Training School
Monday 14th
May – Friday 18th
May 2018
Queen Elizabeth University Hospital, Glasgow #pathologycommunity
Contents
Introduction ............................................................................................................................................................ 3
Clinical Introduction ............................................................................................................................................ 4
Learning Objectives ............................................................................................................................................. 5
Programme ............................................................................................................................................................. 6
Breakdown of categories dissected according to RCPath guidelines ................................................... 9
Biographies .......................................................................................................................................................... 11
About SPAN ......................................................................................................................................................... 14
Notes ...................................................................................................................................................................... 15
Contact Us ............................................................................................................................................................ 16
Mrs Jackie Walker
SPAN Scientific Manager
Technical Services Manager,
NHS Greater Glasgow & Clyde
Introduction
Welcome to SPAN’s first BMS Dissection National training
school, which has been made possible by the hard work of the
SPAN BMS Dissection Implementation Group.
We are delighted at the interest that has been generated in
expanding BMS Dissection across the country, and the
national training school presents the ideal opportunity to
enable new dissectors to obtain initial training in the
practicalities of dissection, and also become familiar with the
principles and governance.
BMS Dissection already takes place in most Pathology
departments across Scotland, at variable levels. A data
collection exercise undertaken in 2016/17 determined that, of
the dissection time commitment in Scotland, 21% is delivered
by BMS staff. SPAN’s long term goal is to increase BMS Dissection to enable medical time to be
released from dissection to diagnostic reporting or other clinical work. This is a key deliverable in the
Scottish Government’s National Delivery Plan for Healthcare Science – to develop sustainable services
through workforce modernisation.
Attendance at the Training School is the first step in achieving our long term goal, and will be followed
by a training programme undertaken at local department level, which is intended to result in new
dissectors obtaining competence in dissection off category B&C specimens. Successful completion of
local practical training programmes will ultimately improve patient care by reducing medical time in
dissection which can be reinvested in diagnostics reporting and improved patient turnaround times.
An excellent Training School programme has been developed to provide theoretical training and a
basic practical overview of all of the main tissue specialities in Histopathology, and is intended to equip
attendees with a strong basis from which to continue their dissection training.
On behalf of the BMS Dissection Implementation Group, and the SPAN Steering Group, I hope that all
attendees realise the intended benefits and, most importantly, enjoy the Training School. SPAN is
committed to continuous improvement therefore please do provide feedback on the Training School to
allow us to plan our next programme.
Dr Colin Moyes &
Mrs Vanda McTaggart
SPAN BMS Implementation Group
Clinical Introduction In association with SPAN, it is with great pleasure we introduce the first National
BMS dissection school in Scotland. Our aim is to support and advance the practice of BMS dissection
throughout Scotland thereby improving the quality and efficiency of our Pathology Service. The thorough
and systematic analysis and scrutiny of the surgical specimen is the first step to achieving an accurate
diagnosis for the patient. Traditionally performed by medical staff, in recent years many aspects of specimen
dissection have been successfully devolved to keen and trained biomedical scientists (BMS) who have a
desire to expand their clinical skills. This shift has potential for more job satisfaction, closer work with
medical and clinical teams and a clinically orientated career progression pathway through RCPath/IBMS
training programmes and qualifications. We are very pleased to see the expansion of Advanced
Practitioners here locally in Glasgow and hope this will be a continued trend across Scotland. The National
BMS dissection school will provide all NHS departments in Scotland the opportunity to provide basic training
of category B and C specimens for BMS, both theoretical and practical. The training will be provided by staff
from across Scotland, incorporating the experience and expertise of both medical consultants and advanced
biomedical scientists.
Dissection by BMS is not solely a shift of resources to maximise Pathologist time and improve turnaround
times but an opportunity to extend the practice of BMS staff working within Pathology Laboratories. Here in
the West of Scotland we have experienced the benefits of assuming the role of dissectors working closely
with our pathologists to ensure we maintain a high quality, standardised mode of working. Scientific staff
gain control of workflow through the laboratory, enabling efficient time management and allocation of
laboratory staff while increasing skill mix across the entire team. Multidisciplinary participation raises the
profile of the BMS role and improves relations with Clinical staff throughout the hospital.
BMS dissection, together with the introduction of Trainee and Advanced Practitioners’ dissection, offers an
alternative career pathway for BMS in Pathology. Implementation of BMS dissection is an example of
modernising pathology and central to development of BMS reporting.
The Pathologist and BMS must work together as a team to develop a trusting environment with easy
communication and open, frank discussion encouraging the BMS to grow in experience and ability. By
adopting a training plan of educational sessions and slide reviews the pathologists can be confident that
each case will be meticulously described, dissected and appropriate tissue selected on which to base a
diagnosis. The scope of specimens to be dissected by the BMS must be defined; a teaching hospital may
find it more beneficial to dissect in specialist areas but generally the largest impact is achieved dissecting
the simpler more numerous cases listed within the RCPath/IBMS Category B and C range, which is
available online. The appropriate Standard Operating Procedures and Risk Assessments for specimen
dissection should be in place before commencing training. Although the onus of responsibility falls to the
reporting Pathologist the BMS has a professional and ethical responsibility to ensure the correct procedures
are followed. Balancing the issues of laboratory processing with the requirements of the reporting
pathologist culminates in changes of perspective on both sides.
Alongside the lead Pathologist, and with support from laboratory management, you have been selected to
develop your skills as a dissector and promote BMS dissection within your department. The purpose of this
training school is to share the knowledge and experience from multiple sites throughout Scotland to assist
you to create such an environment.
Learning Objectives By the end of the one week training course, candidates will be able to:
• Demonstrate a theoretical understanding of the principles of dissection for the
specialties undertaken in this course;
• Describe the clinical governance aspects of dissection;
• Demonstrate an understanding of Standard Operating Procedures (SOPs) for
dissection in the specialt ies undertaken in this course;
• Identify their further training needs to allow career progression in dissection;
• Demonstrate an understanding of anatomy and pathology in the specialties
undertaken in this course;
• Outline the surgical procedures in the specialt ies undertaken in this course.
Candidates will also have an opportunity to observe and gain practical exposure to the dissection of selected tissues relevant to the specialties discussed in this course.
Monday 14th May 2018
10.30-11.00 Coffee and registration 11.00-12.00 Introduction and principles to dissection Dr Colin Moyes,
Consultant Pathologist, NHS Greater Glasgow & Clyde
12.10-13.10 Clinical governance 1 Mrs Vanda McTaggart, Advanced Practitioner, NHS Ayrshire & Arran
13.10-14.00 Lunch 14.00-15.00 Clinical governance 2 Mrs Vanda McTaggart,
Advanced Practitioner, NHS Ayrshire & Arran
15.00-15.20 Tea/coffee 15.20-15.30 Visit to the dissection bench 15.30-16.45 Introduction to knife handling skills Ms Layla Goodings and
Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
Tuesday 15th May 2018
Skin
09.00-09.30 Coffee and registration 09.30 Anatomy Dr Colin Moyes,
Consultant Pathologist, NHS Greater Glasgow & Clyde
Basic Pathology Dr Colin Moyes, Consultant Pathologist, NHS Greater Glasgow & Clyde
11.00 Surgical procedures Dr Marie Mathers, Consultant Pathologist, NHS Lothian
Specimen types Dr Marie Mathers, Consultant Pathologist, NHS Lothian
12.30-13.30 Lunch 13.30-16.30 Practical demonstration and opportunity
for hands-on dissection Ms Layla Goodings and Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
Programme
Wednesday 16th May 2018
GI
09.00-09.30 Coffee and registration 09.30 Anatomy Dr Cath Dhaliwal
Consultant Pathologist, NHS Lothian
Basic Pathology Dr Cath Dhaliwal Consultant Pathologist, NHS Lothian
11.00 Surgical procedures Dr Amanda Paton, Consultant Pathologist, NHS Forth Valley
Specimen types Dr Amanda Paton, Consultant Pathologist, NHS Forth Valley
12.30-13.30 Lunch 13.30-16.30 Practical demonstration and opportunity
for hands-on dissection Ms Layla Goodings and Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
Thursday 17th May 2018
Gynaecology
09.00-09.30 Coffee and registration 09.30 Anatomy Dr Abi Oakley
Consultant Pathologist, NHS Greater Glasgow & Clyde
Basic Pathology Dr Abi Oakley Consultant Pathologist, NHS Greater Glasgow & Clyde
11.00 Surgical procedures Dr Kate Struthers, Consultant Pathologist, NHS Fife
Specimen types Dr Kate Struthers, Consultant Pathologist, NHS Fife
12.30-13.30 Lunch 13.30 IBMS portfolio Ms Layla Goodings and
Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
Practical demonstration and opportunity for hands-on dissection
Ms Layla Goodings and Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
19.00 Social event Waxy O’Connors
Friday 18th May 2018
Head & Neck / Urology
09.00-09.30 Coffee and registration 09.30-11.00 Head and Neck Dr Sylvia Wright
Consultant Pathologist, NHS Greater Glasgow & Clyde
11.15-12.45 Urology Dr Monica Agarwal Consultant Pathologist, NHS Lanarkshire
12.30-13.30 Lunch 13.30-14.30/15.00
Q&A session - feedback
Ms Layla Goodings and Ms Marianne McIntosh, Advanced Practitioners, NHS Greater Glasgow & Clyde
Dr Colin Moyes, Consultant Pathologist, NHS Greater Glasgow & Clyde
Dr Marie Mathers, Consultant Pathologist, NHS Lothian
Mrs Vanda McTaggart, Advanced Practitioner, NHS Ayrshire & Arran
Breakdown of categories dissected according to RCPath guidelines
A B C
1. Aural Polyp 2. Bladder Curettings 3. Bone Cores/Trephines 4. Cell Blocks 5. Cervical Biopsies 6. Cervical Polyp 7. Conjunctival Biopsies 8. Endoscopic Biopsies 9. Incisional Skin Biopsies 10. Myocardial biopsies 11. Needle Core Biopsies 12. Prostate TURPs 13. Skin Tags 14. Small Colonic Polyps 15. Synovial Biopsies 16. Temporal Arteries 17. Testicular Biopsies 18. Uterine Curettings 19. Vocal Cord Biopsies
1. Abscess or Sinus Tract (incl. Pilonidal sinus)
2. Appendix 3. Benign Ovarian Cyst 4. Benign Skins 5. Bullous skins 6. Cervix (Amputated) 7. Colonic Polyps (large) 8. Cysts (all cysts - not
solid) 9. Dental Cysts 10. Ectopic Pregnancy 11. Endometrial Polyps 12. Epididymal Cysts 13. Fallopian Tubes 14. Foreskin 15. Gall Bladder 16. Ganglion 17. Gingiva 18. Heart Valves 19. Hydatid of Morgani 20. Lipomata 21. Lymph Nodes 22. Malignant Skin
Biopsies (excluding MOHs)
23. Meckel’s Diverticulum 24. Molar Pregnancy 25. Nasal Polyps 26. Nipple Biopsies 27. Perianal Warts 28. Products of Conception 29. Small Ovaries 30. Temporal Arteries 31. Tonsils 32. Uterus +/- Cervix
(Negative History) 33. Vas Deferens 34. Veins 35. Vertebral discs
1. Anus 2. Aorta 3. Bone 4. Branchial Cysts 5. Breast Duct Excision 6. Breast Reduction 7. Cervical Cone Biopsies 8. Coronary Arteries 9. Diverticular Disease
Bowels 10. Duodenum 11. Femoral Head 12. Fibroids 13. Fresh Lymph Nodes 14. Gastrectomy (benign
ulcer) 15. Gastrointestinal
Resections (non-neoplastic, non-inflammatory bowel disease)
16. Jejunal Biopsies (capsule)
17. Lung – wedge 18. Muscle Biopsies 19. Myomectomy 20. Nerves 21. Complex Ovarian Cysts 22. Parathyroid Glands 23. Placentas 24. Salivary Glands - benign 25. Small Breast
Lumpectomies (removed to confirm previously diagnosed benign disease)
26. Soft Tissue Tumours (small)
27. Solid Skin Lump 28. Thyroids 29. Skin - wedge ear/eyelid 30. Spleen (benign) 31. Stoma 32. Suprapubic
Prostatectomies 33. Testes - simple 34. Thyroglossal Duct Cyst 35. Ureter 36. Urethra 37. Uterus and Cervix
(Positive History – CIN)
D & E
1. Adrenal Glands 2. Bladder - Cystectomy 3. Bone Tumour Resections 4. Breast Localisation 5. Breast tumours – wide excision,
large lumpectomies 6. Brain 7. Bronchus - resection 8. Caecum (malignant or
inflammatory bowel disease) 9. Cervix for Malignancy 10. Colonic Resections (malignant or
inflammatory bowel disease) 11. Eye 12. Gastrectomy (Carcinoma) 13. Head and Neck Resection 14. Heart 15. Hirschprung’s Disease 16. Kidney 17. Laryngectomy 18. Limb/Digital Amputation 19. Liver 20. Lung – Lobectomy 21. Lung - Pneumonectomy 22. Malignant Breast Lump Resection
23. Mastectomy 24. Mediastinum MOHs skin biopsies 25. Oesophagectomy 26. Ovarian Tumours - mucinous 27. Pancreatic Resections 28. Neck Dissection 29. Penile Carcinoma 30. Pleurectomy 31. Pituitary 32. Radical Prostatectomy 33. Rectum (malignant or inflammatory
bowel disease) 34. Renal Tumours 35. Salivary Gland tumours 36. Small Bowel Tumour 37. Soft Tissue Tumours 38. Spinal chord 39. Spleen (malignant) 40. Testes – neoplastic 41. Thymus 42. Tongue 43. Uterine Carcinoma 44. Vulvectomy 45. Whipple’s Resection
Biographies
Dr Colin Moyes, Consultant Pathologist,
NHS Greater Glasgow & Clyde
Dr Colin Moyes is a consultant
dermatopathologist from Glasgow. He works in
a team of around 6
dermatopathologists in the Queen Elizabeth
Hospital Glasgow where they received up to
21000 skin specimens per year including
referred cases. He is an author on national
SIGN 140 guidelines on the managements of
cutaneous squamous carcinoma (2012) and
cutaneous malignant melanoma update 72
(2014). He also co-authors the most recent
edition of the dermatopathology chapter in
Underwoods undergraduate textbook which in
2014 won the BMA undergraduate award. He
lectures at Glasgow University and the
University of the West of Scotland. He is the
lead pathologist in Glasgow for BMS dissection
and has developed the service over the last 5
years with the appointment of 2 advanced
practitioners and 6 BMS dissectors. He
recently joined the IBMS/RCPath BMS
dissection Conjoint board. He is currently
working with other colleagues in SPAN to set
up a national BMS dissection training, to be
based in school in Glasgow, and to start in the
spring of 2018.
Mrs Vanda McTaggart, Advanced
Practitioner, NHS Ayrshire & Arran
As an employee of NHS Ayrshire & Arran
Health for more years than I’d like to mention, I
have gone from a time where Biomedical
Scientists were not allowed to handle a
specimen to present days where BMS staff
handle 85% of the specimens passing through
the laboratory. Back in 1999 as part of a
forward planning department facing a shortage
of pathologists we began to look at formally
training BMS staff. We were indebted to
colleagues in County Antrim who provided an
intensive weeks training. The following years
saw us involved in the RCPath/IBMS pilot
scheme, contributing our findings and getting
involved with the joint venture. The Pathology
Department at University Hospital Crosshouse
currently has 4 BMS staff with Diploma of
Expert Practice and 2 in training. We have
always supported other departments and
colleagues who wish to take on the role of BMS
dissection, sharing our SOPs and our
experiences, both good and bad. On a personal
level I passed the Diploma in 2006, joined the
Conjoint Examination Board 2009, chairperson
from 2013-2016. Since 2015 I have lectured at
the North of England Pathology and Screening
Education Centre (NEPSEC) BMS Dissection
Course. In 2012, A&A developed an advanced
role in dissection to which I was successfully
appointed and have since led the dissection
team developing and improving our techniques
and training. January this year I attended
SPAN’s BMS Dissection Working Group giving
me a chance to meet like minded pathologists
and BMS’s and now through SPAN’s BMS
Dissection Implementation Group we have the
opportunity to offer a training school in
Category B & C specimen dissection for
Scotland.
Ms Layla Goodings, Advanced
Practitioner, NHS Greater Glasgow &
Clyde
I am a trainee Advanced Practitioner working
within NHS Greater Glasgow and Clyde. I have
worked in Pathology for 18 years now. After
graduating from Napier University with a BSc
(Hons) in Toxicology in 2000, I started at the
Vale of Leven DGH where I completed my
training to become a Biomedical Scientist. In
2004 our department merged with the RAH in
Paisley and in 2007 I successfully applied for a
Senior BMS post there.
Since the start of my career I had always found
the dissection area extremely interesting and
loved working within that environment and so I
was delighted to be offered the opportunity to
train in BMS dissection in 2008. In 2011 I
completed my MSc in Biomedical Science
which was largely influenced by my enjoyment
of dissection and part of my project analysed
the performance, time and cost of BMS
dissection versus medical dissection.
When the Greater Glasgow and Clyde
Pathology laboratories merged to our current
site in 2012, I was appointed to the role of
Team Leader within the dissection area. I
continued with BMS dissection within this role
and I passed the Diploma of Expert Practice in
Histological Dissection in November 2016. In
September 2017 I was lucky enough to be
offered my current post. The Advanced
Practitioner role is a brand new role for
Pathology in Glasgow and I’m excited to be
involved.
Ms Marianne McIntosh, Advanced
Practitioner, NHS Greater Glasgow &
Clyde
Started training as an MLSO in 1992 in the
Southern General Hospital in the
neuropathology department. Free floating
frozen and extra large blocks stuck to wooden
chucks.
2000 moved to Paisley Royal Alexandra
Hospital, Histopathology department.
2004 Dr Steven Dahill offered to train me in
BMS dissection. I then spent a few weeks
down in Crosshouse Hospital in the wonderful
company of Vanda McTaggart. Who was
championing BMS dissection in Scotland in a
trial instigated by the RCPath. There I was able
to see how the BMS staff helped with dissection
and the standard of the SOP documentation
required for the specimens. Dr Moyes taught
derm dissection. Layla joined the dissection
team 2008.
We all moved to the Queen Elizabeth in 2012.
Dissection has always been my passion and I
am very lucky to be able to include this in my
career. Initially I was a senior specialist in BMS
dissection. A trainee advance practitioner post
became available in June 2017 and I was
successful in achieving this post. I hope to lose
the trainee title shortly.
I am delighted to be a part of the Dissection
school.
Dr Marie Mathers, Consultant
Pathologist, NHS Lothian
Dr Marie Mathers is a consultant pathologist
with a specialist interest in skin pathology,
based at the Western General Hospital in
Edinburgh. She was a member of the guideline
development group for SIGN 140 –
Management of primary cutaneous squamous
cell carcinoma. She has an interest in
postgraduate medical education, and has
supervised both medical trainees and BMS
Dissectors for the past 15 years.
Dr Cath Dhaliwal, Consultant
Pathologist, NHS Lothian
Dr Catharine Dhaliwal is a Consultant
Pathologist with a special interest in breast and
GI pathology based at the Western General
Hospital, Edinburgh.
Dr Amanda Paton, Consultant
Pathologist, NHS Forth Valley
I am a consultant at FVRH where I practice
general histopathology, cytology and autopsy
pathology. My area of specialist interest if
breast pathology, although I report all general
specimens received at FVRH. Myself and Dr
Mark Brown last year started our FVRH BMS
dissection programme and have successfully
trained one BMS dissector and are in the
process of training another. I teach pathology
trainees both locally and at regional training
sessions, and also enjoy BMS dissection
training in FVRH.
Dr Kate Struthers, Consultant
Pathologist, NHS Fife
Kate Struthers is a consultant histopathologist
in Victoria hospital, Kirkcaldy. She reports
general histopathology and has a special
interest in haematopathology and
gastrointestinal pathology. She has an interest
in teaching students, pathology trainees and
biomedical scientists. She was a member of
the BMS dissection working group.
Dr Abi Oakley, Consultant Pathologist,
NHS Greater Glasgow & Clyde
Dr Sylvia Wright, Consultant
Pathologist, NHS Greater Glasgow &
Clyde
Sylvia Wright is a Consultant Pathologist at the
Queen Elizabeth University Hospital with a
specialist interest in Head and Neck,
Cardiovascular and Autopsy Pathology.
Dr Wright provides pathology input for a range
of ongoing clinical studies and also has an
interest in molecular pathology.
Dr Monica Agarwal, Consultant
Pathologist, NHS Lanarkshire
Dr Monica Agarwal is a Consultant Pathologist since 2008. She is currently based in NHS Lanarkshire. Her areas of specialist interest are breast and skin pathology. In Lanarkshire she is the Lead Pathologist for BMS dissection training where she has streamlined the teaching protocol. She is also involved in training of postgraduate medical students.
About SPAN
The Scottish Pathology Network (SPAN) has been in existence
formally for over ten years, making it the longest established of
four national managed diagnostic networks (NMDNs). In that time
there has significant change in pathology services, from
modernisation of equipment to rationalisation of laboratory sites.
SPAN has supported this, by leading on agreeing a consortium model for
cervical cytology labs which brought them together into collaborative
clusters. The network has achieved a great deal in ensuring excellent intra-
Board communications and developing a Scotland-wide approach. There are
currently ten NHS Boards providing pathology services for the
whole of Scotland.
SPAN was established to improve pathology services by creating and
developing a Scotland-wide National Managed Diagnostic Network, which
would: steer modernisation, including service change and redesign, improve
quality, ensure provision of an effective pathology service which anticipates
and responds to user needs, future requirements, national guidelines and
meets laboratory accreditation standards.
Notes
Contact Us Scottish Pathology Network National Services Division NHS National Services Scotland Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Tel: 0131 275 7612
Further details can be found on the SPAN website:
Or, contact us at
The National Managed Diagnostic Networks are on Twitter at @NMDNScot
Get involved
www.pathology.scot.nhs.uk