Clinical Pathology Program

Clinical Pathology Consultation (CP Consult)

 

Rotation Director:
William Castellani, MD


This rotation is designed to provide an insight into the laboratory director's role in Clinical Pathology laboratory services. The Clinical Pathology consultation (CP consult) rotation focuses on the directorship activities in the clinical laboratory. During this rotation the residents will interact with all medical directors in clinical pathology in dealing with clinical and technical issues. Exposure to instrumentation principles, lab management, proficiency testing, regulatory issues, molecular assays are obtained through didactic lectures, one-on-one meetings with the resident, CP sign-out, CP on-call activities, participation in test method validations, CAP inspections (mock self-inspections and off-site CAP inspections) and attendance at laboratory administration meetings while on the rotation.


Goals and Objectives:

Patient Care:

Residents must understand the technical requirements necessary for medical decision-making and the role of the medical director in ensuring that the needs of the patient and the ordering clinician are served. Residents are expected to:

  • Recognize and correctly interpret the clinical significance of common chemistry, molecular pathology, hematologic and coagulopathy tests, including test patterns that characterize specific organ involvement or disease states (e.g., interpret and report specialized procedures in molecular diagnostics and protein and hemoglobin electrophoresis)
  • Assess aberrant or atypical laboratory findings and understand the strategies to evaluate and resolve them.

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving test methodologies and application of this knowledge to patient care. Residents are expected to:

  • Develop knowledge of the standard chemistry test offerings through discussion and reading as described in the Components section of this rotation description
  • Understand the relationships between laboratory test findings, the underlying pathophysiology, and disease associations.
  • Understand the workup of test findings or disease states and serve as a resource to the clinical services for test interpretation, utilization and selection

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 unusual cases
  • Recognize the value and limitations of resources that can be used to understand and evaluate laboratory findings (manufacturer's instructions for use, proficiency testing results, quality control data, reference laboratory manuals)
  • Utilize library, web-based, and other educational sources to evaluate methodologies and laboratory findings

Systems-based Practice:

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:

  • Understand regulatory issues and regulatory compliance requirements
  • Become involved with management issues in the clinical pathology laboratory, including quality control issues and unusual findings, and communicate their significance to other health care professionals as necessary
  • Oversee the evaluation of a standard automated test method and ensuring compliance with regulatory requirements
  • Recognize and develop skills necessary to serve as a medical director of clinical laboratory services
  • Consider cost-effectiveness in laboratory testing without compromising patient care
  • Understand the pathologist's role and professional practices in relation to other health care professionals

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 interact with laboratory personnel in addressing issues that arise
  • 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 as necessary
  • 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

Professionalism:

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
  • 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


Requirements:

  • Exposure to all areas of clinical pathology
  • Clinical pathology call experience
  • Preferably PGY-3 and PGY-4 levels, although may take first month late as PGY-2


Duration and Timing of the Rotation:

  • Five 4-week blocks, not necessarily contiguous


Teaching Staff:

  • William Castellani, MD, Medical Director of Clinical Chemistry
  • Michael Creer, MD, Keri Donaldson, MD, Melissa George, DO for formal sessions
  • Ronald Domen, MD and Hiroko Shike, MD will also participate in interpretive experience


Components:

1.  Background reading (covered independently by resident) and select topics discussed with Rotation Director and other rotation faculty

  • Molecular Pathology (on-line self-study)
    • Molecular Biology
    • Nucleic Acid Extraction
    • Molecular Detection Techniques
    • Assay Development and Validation
    • Basics of Genetic Testing
      • Note: practical applications will be covered and demonstrated in specific disciplines throughout the residency training
  • Proficiency Testing
    • Regulatory Requirements
    • Statistical Assessment
    • Review of Participant Reports
    • Review of Investigation/ Corrective Action
    • Educational Challenges
    • Review of "Acceptable" Outliers
  • Quality Control
    • Basics of Quality Control
    • Regulatory Requirements
    • Statistical Tools
    • QC Methods
    • Troubleshooting Daily Controls
    • Troubleshooting Monthly Review
    • QC-based Quality Assurance
  • Electrophoresis Interpretation
    • Serum Protein/Immunotyping
    • Urine Immunofixation
    • Hemoglobinopathy and Thalassemia

No standard text is required for this rotation. Resources are available in the Clinical Pathology Residents' Room, on line, and through guided interaction with the attending pathologists. Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st edition, edited by McPherson and Pincus, the CAP Atlas of Hemoglobin Electrophoresis, and Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 4th edition, edited by Burtis, Ashwood and Bruns will be used as necessary; the Participant Summary reports for proficiency testing reports with also be discussed.


Method(s) of Evaluation:

  • Residents will be evaluated based on direct observation by faculty
  • Resident evaluation by faculty for each rotation block
  • Staff assessment
  • After each rotation, residents will be evaluated by faculty in New Innovations

 

 Updated:  4/2012 WJC