Anatomic Pathology Program
Surgical Pathology Overview
- The primary goal is to train residents in surgical pathology and each Anatomic Pathology subspecialty. Diagnostic accuracy and efficiency are the first priority. Confident assumption of the responsibilities of independent practice is the expected outcome.
- Interpersonal and communication skills are emphasized. The expected outcome is the ability to effectively communicate results and interpretations to everyone who uses pathologists' services, and to understand the role of pathologists in the health care system.
During surgical pathology rotations, the resident is expected to:
- Recognize normal anatomy and histology of organs
- Recognize general categories of pathological processes including tissue injury and repair, infection, inflammation, degenerative and neoplastic processes
- Understand the pathophysiology and morphology of congenital abnormalities
- Understand the epidemiology, gross and microscopic pathology, natural behavior, molecular alterations and prognostic features of benign and malignant neoplasms
- Grossly examine, dissect, and sample a wide variety of pathologic samples including simple and complex cases
- Apply ancillary diagnostic techniques appropriately, including immunohistochemistry, electron microscopy, flow cytometry, molecular diagnostic studies, cytogenetic studies, and others
- Skillfully construct a complete and articulate pathology report using language understood by pathologists and other physicians
- Minimum 26 required 2-week blocks on core subspecialty services; additional time may be scheduled as selective rotation (additional sign-out rotation) or elective rotation (format flexible). Residents are strongly encouraged to apply for semi-independent sign-out privileges prior to graduation.
Frozen section, grossing, heart
1. Background reading (covered independently by resident)
- Robbins and Kotran Pathologic Basis of Disease for general pathologic processes
- Organ-based surgical pathology textbooks and fascicles for daily sign out and preparation for conferences
- Regular reference to current literature is expected
2. Practical exposure to surgical pathology
- Gross dissection, microscopic slide review and report creation on subspecialty surgical pathology rotations
3. Didactic learning
- Resident core curriculum lecture series
4. Active learning/teaching activities
- Mandatory surgical pathology gross conference and unknown slide conferences
- Frozen section conference
- Subspecialty conferences and multidisciplinary tumor boards
- Supervision of medical students on Pathology elective
Method(s) of Evaluation:
- Residents will be evaluated based on direct observation by faculty.
- Verbal feedback should be sought from attending pathologists at end of each week of service.
- After each rotation, residents will be evaluated by faculty in New Innovations.
- Resident Milestone achievements will be assessed semi-annually.
Resident Graduated Responsibility in Surgical Pathology
A Checklist for Surgical Pathology Competencies is provided so that residents may use it for self-assessment as they progress through the program.
Appropriate reading from text and journals should be done prior to sign out with the attending. The resident should review and bring pertinent prior cases to sign out. If the clinical history provided on a requisition is not adequate to interpret case, the resident should obtain additional history prior to sign out, whether through the electronic medical record or through communication with clinicians and surgeons. The resident assumes ownership of all cases through completion, with appropriate oversight from attending as indicated below. This includes ordering and incorporating the results of additional immunohistochemical or histochemical stains, consultations with other pathologists, and obtaining additional blocks or levels. The attending will assist junior residents in determining which additional testing is necessary. As the resident gains significant experience they may be granted responsibility to request this testing independently.
Initially, residents will write descriptions and diagnoses for cases and discuss them with the attending pathologist at sign-out. When the resident becomes sufficiently proficient, he or she may write, dictate or enter preliminary descriptions and diagnoses for simple cases. The final report format must follow Anatomic Pathology Policy #1 Uniform Reporting Format for Surgical Pathology.
After significant experience on surgical pathology rotations, a resident will be eligible for the Lead Resident in Surgical Pathology elective. After additional experience (minimum 10 months or 20 rotations on surgical pathology), a resident will be eligible for semi-independent sign-out privileges. This requires consensus approval from the AP faculty.
Hand-off of Surgical Pathology cases when switching services
This procedure is for the transfer of "big" or "late" surgical pathology cases from the resident leaving a service at the end of a 2-week block to the resident coming on service for the next 2-week block. This is analogous to residents on other clinical services signing off their patients to another resident when they leave a service, and assures seamless continuity of care for our patients.
The resident going off service will "sign off" big/late cases that are grossed on Thursday and Friday of their second week to the resident coming on service the following Monday. Signing off means sharing all important information about the big/late cases so that the incoming resident is able to take over on these cases. It may or may not be necessary for the incoming resident to actually view some of the gross specimens. The transfer of information between residents should be interactive (face to face), patient confidentiality must be maintained, and the receiving resident must have the opportunity to ask questions of the resident handing off the cases. The preliminary draft of the patient report is the hand-off documentation and serves to identify all key patient demographic information. Slides and reports for these cases will be delivered to bin 1 of the appropriate subspecialty shelf on Friday (cases grossed on Thursday) and Monday (cases grossed on Friday).
Residents are not expected to preview slides prior to beginning a subspecialty service but will be expected to begin previewing slides on the first Monday of the 2-week block, as time allows with sign-out and grossing. This may include some of the late cases from Thursday. Cases from Friday, which are cut and delivered on Monday, will be previewed by the resident. The resident and attending on each service should discuss expectations on Monday morning.
Surgical Pathology Senior Resident Semi-Independent Sign-out Guidelines
- The Semi-Independent Sign-out option provides senior Residents with the opportunity, under the supervision of an Attending Physician, to assume primary responsibility for all aspects of assigned cases. The Attending Physician member will, however, supervise the handling of cases. Only the attending physician ultimately signs out each case.
- The rotation is part of the graduated responsibility for Anatomic Pathology Residents. It is available to senior residents after they have met the qualifications (see Qualification for Rotation below). The qualified resident will then participate in semi-independent sign out whenever she or he is assigned to a surgical pathology rotation.
- Patient Care: Provide accurate, timely diagnosis of cases.
- Education: Provide senior Residents with increased responsibility and experience in advanced aspects of diagnosis and sign-out with the goal of preparation for their future career.
- Regulatory and Financial Compliance: Follow all regulatory and reimbursement guidelines.
Qualification for Rotation:
- A Resident will be considered eligible for Semi-Independent sign out after she or he:
- Has completed a minimum of 10 months of surgical pathology rotations
- Is deemed ready by the Anatomic Pathology Attending Physicians, by consensus opinion
- Evaluation will be carried out by the usual routes:
- Direct verbal feedback by Attending Physician
- Evaluation form. Each Attending Physician who supervises the senior Resident on this rotation will be responsible for evaluation of the performance of the Resident, using the Semi-Annual review form (see below).
Handling of Cases:
- The resident will meet with the attending physician and triage cases. Cases designated ‘rush' or ‘stat', or those with other special considerations may be given priority, and the workup may be determined by the attending in order to expedite completion.
- Resident will make corrections to gross description on CoPath or on the working draft, dictate a diagnosis and, if appropriate, microscopic description.
- Paperwork from case will be returned by clerical staff to the Resident; the Resident will proofread the typing, make any necessary corrections in CoPath directly, and release the case to the attending pathologist.
- The attending pathologist will make any additional necessary changes and officially sign out the case. ALL SIGNIFICANT CHANGES will be discussed with the resident.
- Most interactions with clinicians will be handled by the resident.
- Clerical staff and Attending Physician will forward all inquiries to the Resident.
- The resident will inform Attending Physician of communications with the clinicians immediately.
Method(s) of Evaluation:
- Residents will be evaluated based on direct observation by faculty
- After each rotation, residents will be evaluated by faculty in New Innovations
Updated: 9/1/2015 CSA