EDUCATION AND TRAINING
‘Demands placed on biomedical scientists require them to display levels of skill, dexterity and judgement to perform these techniques to a high standard’
Over the past few years, many centres have seen significant growth in Mohs activity and also in terms of the complexity of cases. The introduction of multiple sites when removing tumours has resulted in the need for increased speed and greater efficiency on the part of laboratory staff to ensure all tumours are adequately embedded, cut and stained for microscopy evaluation. There has also been a steady rise in the use of so-called slow Mohs procedures, which involve the use of rapidly fixed and processed tissues for assessment the following day. Slow Mohs offers the benefits of improved tissue morphology over conventionally used frozen section material. More recently, the complexity of the techniques has increased with the introduction of immunocytochemical assessment for confirmation of tumour margin clearance, which is an increasingly demanding requirement, particularly in cases of lentigo maligna melanoma, SCC and also rare tumours such as DFSP.
MOHS SOCIETY
As Mohs has gained in popularity it has become clear that some form of professional standards would need to be developed. As part of this process, the British Society of Mohs Histologists (BSMH) was formed in January 2013 at St John’s Institute of Dermatology. The society was formed in collaboration with the British Society of Dermatological Surgeons (BSDS), part of the British Academy of Dermatology (BAD). A key objective for the newly formed society was felt to be the establishment of a recognised examination pathway for biomedical scientists. I have seen at first hand the development of Mohs in the UK over the past nearly three decades, and the one significant observation I have made during that time is the demands placed on biomedical scientists to display high levels of skill, dexterity and judgement to perform these techniques to a high standard. Those involved in Mohs know all too well how cases can continue throughout the day, with multiple tissue layer removals, making time management and organisational skills an absolute priority. When dealing with multiple sites and numerous patient cases, the
732 THE BIOMEDICAL SCIENTIST
DIPLOMA OF EXPERT PRACTICE IN MOHS HISTOLOGICAL PROCEDURES The BSMH approached the IBMS with the aim of establishing a similar examination pathway for those wishing to acquire a recognised qualification in Mohs histological procedures. After considering the requirements and several drafts of the training logbook, the BSMH submitted a logbook proposal and accompanying formal request to the IBMS Education and Professional Standards Committee. The logbook was divided into the following five mandatory modules: Clinical governance General principles of conventional cryostat Mohs histological procedures
Specimen types Quality Microscopic recognition of key tumour types.
Inking of tissue margins.
demands on the skills of biomedical scientists in this area of cellular pathology has increased steadily. So, how can these practitioners be recognised for their skills?
RECOGNISING PROFESSIONAL KNOWLEDGE
The IBMS has established Diplomas of Expert Practice in several key areas of cellular pathology, sometimes in collaboration with other organisations, most notably The Royal College of Pathologists. The aims of these examinations are clearly defined. They aim to recognise the acquisition of professional knowledge, skills and competence by candidates beyond the level of a Specialist Diploma. Successful candidates demonstrate that they have the necessary professional knowledge, skills and competences that contribute to the provision of services and the care of patients at the highest level. The learning strategy behind these examinations is to encourage candidates to undertake a range of activities that will prepare them for the assessment. These activities include: continuing professional development (CPD)
reading and critical review of scientific and technical papers
self-structured reading attendance at seminars/lectures both as speaker and audience member
undertaking training programmes related to the diagnosis, treatment and monitoring of patients appropriate to the diploma being undertaken
use of other forums to engage in discussion with experts appropriate to the diploma being undertaken (eg email, discussion groups, multidisciplinary team meetings).
In addition, a suggested optional module was also submitted: Slow Mohs and immunocytochemistry.
The IBMS committee reviewed the proposals and has approved its establishment as an IBMS Diploma of Expert Practice in Mohs Histological Procedures. As I am a director on the board of the American Society of Mohs Histotechnologists (ASMH), it was evident to me that the American society has yet to produce its own framework for a similar venture through the US Mohs College, and there is no formally recognised examination in Mohs histological procedures anywhere in the world.
The establishment of this examination jointly between the IBMS and BSMH represents the first official attempt to set a standard for Mohs histological procedures and will allow those practitioners the chance to gain a formally recognised qualification in this growing specialist area of cellular pathology.
Belief that Mohs procedures simply involve the production of frozen sections for microscopy assessment displays a profound ignorance of the level of expertise involved, as any individual performing Mohs will understand. Clearly, setting the standards of requirement with the IBMS and BSMH is a positive and progressive step forward.
Dr Guy Orchard CSci FIBMS is laboratory manager in histopathology at St John’s Institute of Dermatology, GSTS Pathology, London. He is a director of the American Society of Mohs
Histotechnologists (ASMH) and chairman of the British Society of Mohs Histologists (BSMH).
DECEMBER 2013
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