Anatomic Pathology Program
Pulmonary Pathology Subspecialty
Dani S. Zander, MD
This rotation is designed to provide an in-depth exposure to the pathology of pulmonary diseases. It utilizes a teaching set, active in-house cases, conferences, and reading materials to build the resident's familiarity with this group of diseases. The specific categories of pulmonary diseases focused on during the rotation are chosen to meet the resident's individual needs.
Goals and Objectives:
Residents must demonstrate a satisfactory level of diagnostic accuracy and the ability to provide appropriate and effective consultation about the pathology of lung diseases. Residents are expected to:
- Recognize and correctly interpret the pathology of common pulmonary diseases, including common lung neoplasms, obstructive and interstitial lung diseases, vascular abnormalities, infections, and pleural processes. As the resident progresses, greater attention will be given to the differential diagnosis of more unusual processes, including lymphoid processes, collagen vascular diseases, lung transplant pathology, unusual infections and tumors, angiitides, congenital abnormalities, etc.
- Formulate appropriate differential diagnoses based on the histologic findings.
- Correlate pathologic lesions with clinical and radiographic findings.
- Appropriately use immunohistochemistry, electron microscopy, flow cytometry and molecular testing for evaluation of lung diseases.
Residents must demonstrate knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to lung pathology. Residents are expected to:
- Develop knowledge of the spectrum of neoplastic and non-neoplastic lung diseases through reading of textbooks and primary literature
- Identify specific morphologic changes in tissues, and their significance
- Understand the relationships between anatomic pathology findings, pathophysiology, patient signs and symptoms, and effects of therapies
- Understand the utilization of ancillary diagnostic testing (immunohistochemical and special stains, electron microscopy, flow cytometry, molecular testing) in evaluation of lung diseases
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 specific pulmonary pathology problems
- 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:
- Become involved with management issues related to pulmonary pathology and their effects on other health care professionals, organizations, and society
- Consider cost-effectiveness in their practice of pulmonary pathology without compromising patient care
- Understand the pathologist's role and professional practices in relation to other health care professionals
- 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
- Present pulmonary pathology material at a conference in an organized, coherent fashion, with well-constructed audiovisual materials
- 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 Pulmonary 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.
- Dani S. Zander, MD
- Michael Bayerl, MD
1. Background reading (covered independently by resident)
- There are many pulmonary pathology textbooks which can be used for background reading during this rotation: Zander and Farver's Pulmonary Pathology, Dail and Hammar's Pulmonary Pathology, Travis et al's fascicle Non-Neoplastic Disorders of the Lower Respiratory Tract, Leslie and Wick's Practical Pulmonary Pathology, Corrin's Pathology of the Lungs, Travis et al's WHO fascicle on Tumours of the Lungs and Pleura, and others.
2. Review of pulmonary pathology teaching set slides
- This rotation utilizes a basic collection of teaching cases to provide the resident with an exposure to the pathology of pulmonary diseases.
- The resident may, in addition, select disease categories of interest in consultation with Dr. Zander/Dr. Mani, and will independently review slides representing these processes (optional and not a required component).
- In meetings with the faculty, teaching set slides selected by the resident will be reviewed together and discussed to highlight important features and differential diagnoses.
3. In-house cases
- Active pulmonary cases will be reviewed independently and then with the faculty member on service.
- The resident should present a lung case at SP unknown case conference once during the rotation
4. Pulmonary Multidisciplinary Conference
- Slides that the resident will present at the Pulmonary Multidisciplinary Conference will be reviewed prior to the conference with a faculty member.
- The resident will attend this conference when it occurs during the rotation.
5. Research or educational project (optional)
- If desired, the resident can work on a small research or educational project.
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 choose at least 1 area of concentration within pulmonary pathology to focus on (review of teaching set cases and reading about the entities) each week, and 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.
Updated: 9/2011 HM