ST1 general advice

In ST1, you are expected to have no knowledge of histopathology. You're allowed (and expected) to make a lot of mistakes.

Don't be afraid to ask questions, or to have a go at reporting a case even if you have no idea what it is. Don't be disheartened if your reports are heavily modified by the consultant or even re-written: it's these experiences that you learn most from.

Trying to see as much as possible in your first year will pay dividends later in your training.

Different departments have different arrangements for trainees' working. In general, you will work with a specific consultant for a certain period of time, rotating through the department over the course of the year. You should establish what the arrangement in your department is at the beginning of your rotation.

When starting work with a particular consultant, the most important thing is to be aware of their expectations and not to interfere with provision of the service. Particularly useful questions to answer at the beginning of an attachment are:

• Does your consultant have any particular expectations about how much work they think you should be doing? Most of the time, in ST1, you will not be expected to report many cases each day; if there are particular expectations, however, it is much better to know about them up front!

• How are you going to get work? Does the consultant want to allocate you work, or are they happy for you to pick up what you like? If the latter, do they want you to keep them updated re what is on your desk?

• What are the arrangements for requesting extra work (e.g. levels, immunohistochemistry, special stains)? At the beginning, if you think extra work is needed, you should take the case for discussion with your consultant. As you become more experienced, you may feel confident enough to know that extra work will be needed: while some consultants will be happy for you to request this independently, others will not, and you should clarify this at the beginning of your attachment.

• How and when would the consultant like to review your cases? In general, a consultant will look at each case you report with you, and make any corrections necessary to your report, but some consultants - at certain times - may prefer to look at your cases on their own and feed back to your afterwards. You will learn most if you write a report for every case you see, even if you have no idea what is going on. Be clear when you will review cases with the consultant, and you must let the consultant know if you have cases of theirs which need reporting.

• What are the arrangements for doing post-mortems? Will you do them with your consultant, or will you need to work with somebody else for this?

• What are the arrangements of gynaecological/non-gynaecological cytology? Again, will you report cases with your consultant, or will you need to work with somebody else/be put on a rota?

• What are the arrangements for frozen sections?

• What are you going to trim? Would the consultant like you to observe them trimming, or are they happy for you to trim specimens which you are happy with? Regardless, if you are unhappy with a specimen, you must seek help.

• What are the arrangements for MDTs? MDT are very helpful particularly at the beginning of training, and so it is a good idea to attend as many as possible.

In histopathology, you need to develop an entirely new set of skills which can be very daunting. Writing reports is difficult in ST1 but it gets much easier as you report more.

At the beginning, it might be helpful to ask a more senior trainee to show you examples of their reports for common specimens (e.g. colonic biopsies, endometrial currettings) to get an idea of what you should be mentioning.

It may also be helpful to keep a list of common specimens, with the important features to comment on. As time goes by, this becomes second nature but you may need to prompt yourself at the beginning.

Above all, though, you will learn and gain confidence by writing more reports and by making mistakes!

Remember that you have a responsibility to ensure that cases are reported in a timely fashion. If you have too much work to report, you must let your consultant know; as well as being an important aspect of patient safety, the ability to gauge your own limitations is a vital skill for future practice.

Different departments have different policies with regards to trainees trimming specimens, and you should clarify the set-up in your department at the earliest opportunity.

In general, though, you will likely start by observing more experienced individuals trimming before eventually doing it yourself.

Before trimming specimens yourself, make sure that you have spoken to the laboratory staff and that you are aware of any particular expectations on their part. Golden rules, however, are to always discard your own sharps and to leave the bench clean for the next person. Your department may have Standard Operating Procedures (SOPs) for the dissection of various specimens: you should be familiar with these.

It may be helpful to follow the journey of a specimen through the laboratory before attempting to trim specimens yourself. This gives you an opportunity to learn how you can make life easier for staff in the lab by the way you trim.

Trimming a specimen yourself is the best way of learning how to do it, and becoming confident and fast. You need to balance this, though, against the risk of making a mistake which could have serious consequences. Only attempt to trim a specimen independently when you are confident that you know what to do, and be sure to have made yourself familiar with the appropriate Dataset(s) or departmental SOPs beforehand. If you encounter any problems, call for help: as a trainee you are very much allowed to ask for help!

Bear in mind that, as an ST1, you should be slow! Speed comes with practice. Do not allow yourself to be pressured into rushing: this leads to mistakes and to injuries.

Again, different departments have different policies with regards to trainees reporting non-gynaecological cytology. It is certainly an extremely difficult skill at the beginning, and you should expect to make a lot of mistakes!

Cytology, however, gets much easier with practice. You should also be aware (although it is a long way off) that cytology is the most-often failed component of the FRCPath Part II exam. Seeing as many cases as possible over the course of your training will be an asset to you in the future.

Arrangements for black box vary considerably between departments.

In general, the consultants will select interesting cases for the trainees to review. Trainees will usually have an opportunity to look at the slides in advance and read around the entities. At the black box meeting, trainees will give a description of the case and arrive at a conclusion.

This can seem daunting for junior trainees, and you will often find that you cannot arrive at the correct diagnosis. Everybody is aware that this is a very difficult task for an ST1 trainee and you are not necessarily expected to come to the correct conclusion: the important thing is learning to describe a case, and understanding how the consultant arrived at the diagnosis.

For ST1, the RCPath histopathology curriculum is quite explicit in what knowledge needs to have been attained by the end of the year. The Leeds Virtual Pathology website very helpfully matches each curriculum requirement with online macroscopic and microscopic cases.