Frozen Sections Subspecialty
Henry S. Crist, MD
Goals and Objectives:
Residents must demonstrate a satisfactory level of diagnostic accuracy and the ability to provide appropriate and effective intraoperative consultation. Residents are expected to:
- Understand the nature of the information needed by the surgeon intraoperatively.
- Examine a gross specimen and select appropriate section(s) for frozen section.
- Be technically proficient in preparing cytologic smears, touch and squash preps, and scrape preps.
- Be technically proficient in cutting and staining a frozen section.
- Formulate appropriate differential diagnoses based on the histologic findings.
- Correlate pathologic lesions with clinical and radiographic findings.
- Communicate results to surgeon in a clear unambiguous manner.
- Be swift and efficient in the entire FS process.
- Understand the utilization of ancillary diagnostic testing and triage specimen as indicated.
Residents must demonstrate knowledge about the broad spectrum of pathology that might be encountered in this context. Residents are expected to:
- Recognize, compare and contrast the gross characteristics of common benign and neoplastic conditions in all organ systems.
- Be able to articulate and recognize microscopic characteristics that differentiate benign from malignant conditions in all organ systems on frozen sections and other types of preparations used in intraoperative evaluation.
- Be able to articulate and recognize microscopic characteristics that differentiate the major forms of malignancy in all organ systems on frozen sections and other types of preparations used in intraoperative evaluation.
Practice-based Learning and Improvement:
Residents must be able to demonstrate the ability to evaluate and improve their clinical practices based on new and evolving scientific evidence. Residents are expected to:
- Apply current medical knowledge and recent literature to current cases.
- Utilize library, web-based, and other educational sources to evaluate cases.
- Prepare clinical cases in an optimal timeframe.
- Utilize performance evaluations to improve practice.
- Acquire skills to engage in "lifelong" learning through appraisal and assimilation of scientific studies related to the preparation and interpretation of frozen sections and other forms of intraoperative consultation.
- Facilitate learning of medical students, residents and fellows, and other health care professionals.
Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide optimal pathology services. Residents are expected to:
- Prepare FS efficiently to avoid unnecessary operative and anesthesia time.
- Demonstrate ability to access and utilize the resources, providers, and systems necessary to provide optimal care.
- Advocate for quality patient care.
Interpersonal and Communication Skills:
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and learning with other health care providers, patients, and patients' families. Residents are expected to:
- Exhibit effective listening skills and the ability to follow standard operating procedures and verbal instructions.
- Interact with departmental and extradepartmental personnel, including healthcare professionals, administrators, and other staff in an appropriate manner.
- Provide effective and professional consultation to other health care professionals demonstrating care and respect for them, and sustain ethically sound professional relationships with colleagues, staff, patients, and patients' families.
- Communicate with surgeon if necessary to clarify the reason for performing a frozen section or intraoperative consultation.
- Communicate results quickly and accurately.
- Be respectful in interactions with perioperative staff.
- Collaborate with gross room staff and other residents to accomplish work in gross room when not actively involved in a FS.
- Provide accurate communication of pathology information using non-verbal and verbal skills.
- Work effectively as a team with other health care professionals and other staff.
Residents must demonstrate a commitment to fulfilling professional responsibilities and ethical principles and sensitivity to a diverse patient population. Residents are expected to:
- Demonstrate commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices.
- Demonstrate respect, compassion and integrity in all interactions with patients, their families, faculty, other trainees, technologists, and other staff.
- Demonstrate sensitivity and responsiveness to the ethnicity, diversity, age, gender, sexual orientation, and disabilities of patients, colleagues, and staff.
- Attend all required conferences and actively participate in them to enhance individual and group learning.
- Demonstrate a commitment to excellence and on-going professional development.
- Demonstrate adherence to guidelines and regulations set forth by regulatory and accrediting agencies.
- Demonstrate ability to identify deficiencies in peer performance.
- Discuss expectations for Surgical Pathology rotations with attending pathologists at beginning of each rotation
- Review and sign "Expectations for Surgical Pathology Rotations" form
Resident Graduated Responsibility in Frozen Sections Subspecialty Core Rotations:
Increasing levels of responsibilities are expected of each resident as their training time progresses in each subspecialty area. See explanation of Expectations by Resident Experience Level. Simple, moderately complex and complex cases are defined on the Checklist for Surgical Pathology Competencies. All residents have a personal copy of this spreadsheet, which they use to record their competency with gross dissections of increasingly complex cases. This checklist is reviewed by the Program Director during semi-annual evaluations.
- Anatomic Pathology faculty
- Daily FS service and assisting in dissection of gross specimen
Method(s) of Evaluation:
The resident will be evaluated at the end of the rotation using New Innovations. The evaluations will be based on the resident's daily performance including diagnostic accuracy, and oral "quizzes" throughout the rotation. Performance on the rotation components will be assessed. The resident should be able to formulate appropriate differential diagnoses in >90% of cases in this area.
Residents will be expected to evaluate faculty and the rotation using New Innovations. These evaluations will be collated and reviewed by the program director and chair and the results will be reported yearly to each faculty member and submitted for review to the Residency Program Committee for feedback.