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

nss.SPAN@nhs.net