PATHOLOGY RESIDENCY
A.
Philosophy and Goals
The residency program has been and continues to be a major priority of The
Ohio State University Pathology Department. The major goal is to train residents
to become competent diagnosticians and clinical consultants who will contribute
to maintain the high standards of the specialty. Therefore, we are committed to
training our residents to develop their skills in the six areas of competencies
mandated by the ACGME to the level expected of a new practitioner. Goals,
objectives and assessment measures are in place to ensure mastery of these
competencies: 1) patient care, 2) medical knowledge, 3) practice-based learning
and improvement, 4) interpersonal and communication skills, 5) professionalism
and 6) systems-based practice. A thorough understanding of pathology is
essential for the resident to become a competent consultant who can function
optimally in a patient care situation. Participation in scholarly activities and
teaching are also considered components of resident training. Our goal is to
develop a spirit of inquiry that will allow the practitioner to participate in the
generation of new knowledge, learn to critically evaluate research findings, and
provide the tools to continue to expand their knowledge upon completion of their
training. Exposure of the resident to the administrative, fiscal, ethical, legal and
sociopolitical aspects of pathology practice are also a major importance.
B.
Curriculum
1.
The basic curriculum is combined AP/CP program that consists of 108
weeks of anatomic pathology, 76 weeks of clinical pathology and 24
weeks of additional AP/CP electives. A 3-year program in either straight
anatomic or straight clinical pathology is also offered.
2.
Combined Anatomic and Clinical Pathology Program – 4 years
a.
The 4-year curriculum is arranged as follows: year 1 – anatomic
pathology; year 2 – clinical pathology and one elective; year 3 and
4 – anatomic and clinical pathology and AP/CP electives. The
rotations are listed below:
1
PGY-1
PGY-2
PGY-3 & PGY-4
AP
Introduction to AP
Surgical Pathology (includes 4 wks of
Cytopathology)
Autopsy Pathology
CP
Hematopathology
Medical Microbiology
Clinical Chemistry
Transfusion Medicine
Molecular Pathology
Cytogenetics
Flow Cytometry
Electives
AP & CP
Surgical Pathology
Gross Room Rotation
Cytology Block
Forensic Pathology
Neuropathology
Renals/Transplant
Dermatopathology
Pediatric Anatomic Pathology
AP Subspecialty
(choice of Gyn, Head & Neck,
Gastrointestinal, Breast/GU)
Hematopathology
Transfusion Medicine
Pediatric Clinical Pathology
Chemistry/Toxicology
Chemistry
Medical Microbiology
Flow Cytometry
AP/CP Electives or Research
(approval of Program Director)
2
LENGTH
(weeks)
4
36
12
14
8
4
8
4
4
2
8
16
4
8
4
4
4
8
4
4
8
8
4
4
4
2
2
12
3.
Straight Anatomic or Clinical Pathology – 3 years
a.
A 2-year core curriculum is offered in AP and CP.
AP
LENGTH
(weeks)
4
32
12
4
LENGTH
(weeks)
4
14
8
8
4
4
2
8
Introduction to AP
Surgical Pathology
Autopsy Pathology
Cytopathology
CP
Chemistry
Hematopathology
Transfusion Medicine
Medical Microbiology
Cytogenetics
Molecular Pathology
Flow Cytometry
Electives
C.
b.
The third year for AP consists of 32 weeks in AP rotations in the
following areas: surgical pathology including a gross room rotation,
cytology, neuropathology, pediatric pathology, forensic pathology,
transplant/renal pathology, hematopathology, dermatopathology
and up to 20 weeks in non-AP rotations. The non-AP rotations can
include any area in pathology and are subject to approval by the
program director.
c.
The third year for CP is tailored to the individual’s interest and
previous experience. Individual curriculum must be approved by
program director.
General Competencies
1.
Patient Care
Residents must demonstrate a satisfactory level of diagnostic competence
and the ability to provide appropriate and effective consultation in the
context of pathology services.
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a.
b.
c.
d.
e.
f.
2.
Communicate effectively and demonstrate caring and respectful
behaviors when interacting with physicians, laboratory personnel,
patients and clerical staff.
Gather essential and accurate information about their patients
and/or patient specimens.
Educate staff, students and other physicians.
Use information technology to support diagnostic decisions.
Perform competently the medical and invasive procedures
considered essential for pathology.
Work with health care professionals, including those from other
disciplines, to provide patient-focused care.
Medical Knowledge
Residents must demonstrate knowledge about established and evolving
biomedical, clinical and cognate (e.g. epidemiological and socialbehavioral) sciences and the application of this knowledge to pathology.
a.
b.
3.
Demonstrate an investigatory and analytic thinking approach to
clinical situations.
Know and apply the basic and clinically supportive sciences which
are appropriate to pathology.
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and
evaluate their diagnostic and consultative practices, appraise and
assimilate scientific evidence and improve their patient care practices.
a.
b.
c.
d.
e.
f.
Analyze practice experience and perform practice-based
improvement activities using a systematic methodology.
Locate, appraise, and assimilate evidence from scientific studies
related to patient specimens.
Obtain and use information about their population of patients and
the larger population from which their patients are drawn.
Apply knowledge of study designs and statistical methods to the
appraisal of clinical studies and other information on diagnostic
effectiveness.
Use information technology to manage information, access on-line
medical information; and support their education.
Facilitate the learning of students and other health care
professionals.
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4.
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication
skills that result in effective information exchange and teaming with other
health care providers, patients’ and patients’ families.
a.
b.
c.
5.
Create and sustain a therapeutic and ethically sound relationship
with physicians, laboratory personnel, clerical staff and students.
Use effective listening skills and elicit and provide information using
effective verbal, nonverbal, explanatory, questioning, and writing
skills.
Work effectively with others as a member or leader of a health care
team or other professional group.
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
a.
b.
6.
Demonstrate respect, compassion, and integrity; a responsiveness
to the needs of patients and society that supercedes self-interest;
accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development.
Demonstrate a commitment to ethical principles pertaining to
provision or withholding of clinical care, confidentiality of patient
information, informed consent, and business practices.
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 pathology services that are of optimal value.
a.
b.
c.
d.
Understands how their patient care and other professional practices
affect other health care professionals, the health care organization,
and the larger society and how these elements of the system affect
their own practice.
Know how types of medical practice and delivery systems differ
from one another, including methods of controlling health care
costs and allocating resources.
Practice cost-effective health care and resource allocation that
does not compromise quality of care.
Advocate for quality patient care and assist others in dealing with
system complexities.
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e.
C.
Research Opportunities
1.
Research is strongly encouraged with the results published in a
manuscript and presented at an annual meeting.
Clinically-oriented research is available with faculty or fellows in all of the
rotations.
More basic research opportunities are also available, especially in the
following areas:
a.
Cancer immunobiology
b.
Membrane biochemistry and signal transduction regulation
c.
Transplantation immunology
d.
Hemostasis
e.
Molecular biology and cytogenetics
f.
Laboratory-related outcomes research
2.
3.
D.
Teaching Opportunities
1.
2.
E.
Know how to partner with health care managers and health care
providers to assess, coordinate, and improve health care and know
how these activities can affect system performance.
During required and elective rotations, residents are expected to teach
medical technologists, medical students, rotators, and other pathology
residents.
Formal teaching by the residents is expected in the following courses:
a.
Presentations at conferences
(1)
Intradepartmental conferences
(2)
Interdepartmental conferences and tumor boards
Duty Hours, Work Environment and Supervision of Residents
Duty hours are defined as all clinical and academic activities related to the
program; i.e., patient care (both inpatient and outpatient), administrative duties
relative to patient care, the provision for transfer of patient care, time spent inhouse during call activities, and scheduled activities, such as conferences. Duty
hours do not include reading and preparation time spent away from the duty site.
1.
Duty hours are determined by the director of service and clearly
communicated to the residents on a given service. Residents will always
be provided appropriate back-up support consisting of either another
resident, fellow or attending physician to ensure that patient care is not
jeopardized. It is the responsibility of the Program Director and faculty to
ensure that duty hours correspond to the appropriate program
requirements so that residents are not required to perform excessively
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difficult or prolonged duties on a regular basis. The educational goals of
the program and learning objectives of residents must not be
compromised by excessive reliance on residents to fulfill institutional
service obligations.
a. On select months, residents log work hours on E*Value.
b. Duty hours must be limited to 80 hours per week, averaged over a
four-week period, inclusive of all in-house call activities and all
moonlighting.
c. Residents must be provided with one day in seven free from all
educational and clinical responsibilities, averaged over a four-week
period, inclusive of call activities.
d. Adequate time for rest and personal activities must be provided. This
should consist of a 10-hour time period provided between all daily duty
periods and after in-house call.
e. Scheduled or expected duty hour periods should be separated by 10
hours. If there are inevitable and unpredictable circumstances that
occur in which a resident’s duty hours are prolonged, they must still
have a minimum of eight hours free from duty before the next
scheduled duty period begins.
2. On-call Activities
a. PGY-1 residents are limited to a 16-hour shift and are not allowed to
take at-home call.
b. In-house call must occur no more frequently than every third night,
averaged over a four-week period.
c. Continuous on-site duty, including in-house call, must not exceed 24
consecutive hours. Residents may remain on duty for up to six
additional hours to participate in didactic activities, transfer care of
patients, conduct outpatient clinics, and maintain continuity of medical
and surgical care.
d. No new patient may be accepted after 24 hours of continuous duty.
i. A new patient is defined as any patient for whom the resident
has not previously provided care.
e. At-home call (or pager call)
i. The frequency of at-home call is not subject to the every-third
night, or 24+6 limitation. However at home-call must not be so
frequent as to preclude rest and reasonable personal time for
each resident.
ii. Residents taking at-home call must be provided with one day in
seven completely free from all educational and clinical
responsibilities, averaged over a four-week period.
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iii. When residents are called into the hospital from home, the
hours residents spend in-house are counted toward the 80-hour
limit.
iv. The Program Director and the faculty must monitor the
demands of at-home call in their programs and make scheduling
adjustments as necessary to mitigate excessive service
demands and/or fatigue.
3. Sleeping Quarters and Meal Allowance
a. Residents on duty in the hospital are provided with a meal allowance,
sleeping quarters and lounge areas.
b. Appropriate security and personal safety measures are provided to
residents in all locations including parking facilities and sleeping
quarters.
4. Logging of Duty Hours
a. Residents and fellows are required to log duty hours on E*Value once
a year for a 3 month period (January – March) to assure that we are in
compliance with ACGME requirements.
b. After that period, only residents who have not complied with duty hour
requirements will be asked to state why they were not in compliance.
This will allow the program to determine whether the resident should
continue to log hours. This will assist the department and the
institution in keeping compliant and addressing any issues of concern.
If a trainee does not comply with this policy, the program director may
take disciplinary action.
5. Moonlighting
a. Moonlighting must not interfere with the ability of the resident to
achieve the goals and objectives of the educational program.
b. Internal moonlighting must be considered part of the 80-hour weekly
limit on duty hours.
6. Supervision
a. Each PGY-1 resident must be directly supervised during performance
of, at least, his or her three initial procedures in the following areas:
autopsies (complete or limited), gross dissection of surgical pathology
specimens by organ system, frozen sections, apheresis, and fine
needle aspirations and interpretation of the aspirate.
b. They will have direct or indirect with direct supervision immediately
available provided by faculty, PGY-3 & 4 residents, fellows, and
pathologists’ assistants.
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c. Blood Banking/Transfusion Medicine fellows, PGY-3 or PGY-4
residents, or attending pathologists may directly supervise apheresis.
d. PGY-2 residents are considered to be at the intermediate level.
e. Residents in the final two years of the program (PGY-3 and PGY-4)
are considered to be in the final years of education.
f. The resident’s responsibilities for patient care decisions, supervision of
other residents/students/technologists, and administration are
progressively increased according to ability and level of training.
Faculty back-up is readily available at all times, and faculty must sign
and take the ultimate responsibility for all consultative reports.
F.
Conferences
There are many departmental conferences and interdisciplinary conferences
within the medical center that residents have the opportunity to participate in.
Conferences in anatomic pathology are held approximately twice a week from
7:30-8:30 am to include didactic sessions, unknown slide conference and journal
club.
Conferences in clinical pathology are held approximately twice a week from 7:308:30 am to include didactic sessions, unknown slide conference, journal club,
and a review of on-call cases.
There is also a regular two year cycle of Business and Laboratory Management
lectures covering legal, economic, research design, statistics, ethical, and social
issues related to laboratory management.
Interdisciplinary conferences are held in various disciplines throughout the week
in the areas of autopsy, dermatopathology, gynecologic pathology, bone and soft
tissue, gastrointestinal and liver, as well as a general Tumor Board Conference.
Pathology Grand Rounds is held the 2nd and 4th Tuesday’s from noon-1:00 pm
between September through June. This conference provides the opportunity to
listen to research efforts among the faculty within and outside of the department.
Chief Residents provide the Pathology Education Office with attendance sheets
for logging of attendance on E*Value for required conferences.
The majority of conferences require mandatory attendance.
The resident is to notify Program Director when requesting to be excused from
conference. Travel at meetings, vacation and ill days are automatically excused.
Semi-annually, resident attendance will be calculated. If conference attendance
falls below 80%, the resident will need to discuss the reasons for absences with
9
Program Director or Associate Program Director. If attendance falls below 70% a
letter will be placed in resident’s file as well as possible disciplinary action
depending on the recommendation of the Resident Advisory Committee.
1.
Clinical Pathology Didactic Lectures
a.
Monday, 7:30 am, year-round
b.
Didactic presentations, primarily by faculty
c.
2-year cycle covering clinical pathology
d.
Attendance: mandatory for all residents
e.
Course Director: Michael G. Bissell, MD, PhD, MPH
2.
Clinical Pathology Unknown Conference
a.
Wednesday, 7:30 am, year-round
b.
Given by faculty
c.
Case presentations: instructive cases, technology, quality
control/assurance, management, ethical issues
d.
Once a month CP Journal Club occurs during this time period
e.
Attendance: mandatory for all residents PGY-2 and above and
strongly encouraged for PGY-1 residents
f.
Course Director: Arwa Shana’ah, MD
3.
Clinical Pathology Journal Club
a.
Wednesday, 7:30 am, approximately 1 per month
b.
Faculty and resident(s) assigned to each journal club
c.
Selection of no more than 2 articles
d.
Articles will be available at least 1 week prior
e.
Discussion will be led by assigned resident(s), all residents in
attendance are expected to have reviewed the article and reached
their own conclusions and validity of the study and to offer their
overall review of the article as it is being discussed.
f.
Review/criticism/discussion of current research and developmental
literature in Clinical Pathology, basic or applied
g.
Attendance: mandatory for all residents PGY-2 and above and
strongly encouraged for PGY-1 residents
h.
Course Director: Arwa Shana’ah, MD
4.
Clinical Pathology Call Review
a.
Monday, noon-1:00 pm, July – August
b.
Primarily discuss CP call issues and AP call issues as they arise
c.
Resident driven with a CP faculty in attendance
d.
Attendance: mandatory, PGY-2 and above residents
e.
Course Director: CP Chief Resident and Arwa Shana’ah, MD
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5.
Anatomic Pathology Didactics
a.
Tuesday and Thursday, 7:30-8:30 am
b.
Given primarily by faculty
c.
Didactic organ system review
d.
2-year cycle covering surgical pathology
e.
Attendance: mandatory for all residents
f.
Course Director: Adrian Suarez, MD
6.
Anatomic Pathology Unknown Slide Conference
a.
Monthly (1-2 times/month)
b.
Given primarily by faculty
1) glass slide conference on surgical pathology or subspecialties
2) covers organ systems, histochemistry, immunoperoxidase,
electron microscopy, flow cytometry, molecular biology
3) didactic presentations, microscopic slides available
c.
Attendance: mandatory for all residents
d.
Course Director: Adrian Suarez, MD
7.
Anatomic Pathology Journal Club
a.
Given approximately 4 times per year by presiding attending
pathologist
b.
Faculty and resident(s) assigned to each journal club
c.
Selection of no more than 2 articles
d.
Articles will be available at least 1 week prior
e.
Discussion will be led by assigned resident(s), all residents in
attendance are expected to have reviewed the article and reached
their own conclusions and validity of the study and to offer their
overall review of the article as it is being discussed.
f.
Attendance: mandatory for all AP/CP residents
g.
Course Director: Adrian Suarez, MD
8.
Surgical Pathology Diagnostic Conference
a.
Opportunity to learn more surgical pathology and occasionally
cytopathology
b.
Glass slides to be discussed will not be available beforehand, so
no specific preview is necessary
c.
After review, slides will be available for study during the weekend
and returned on Monday
d.
Given approximately every other Friday, 8:00-8:45 am, 4th floor
multi-headed scope room
e.
Attendance: optional
f.
Course Director: Paul E. Wakely, Jr., MD
9.
Neuropathology Gross Conference
a.
Thursday, noon; year round, Room 005 DHLRI
11
b.
c.
d.
Given by faculty
Attendance: mandatory for resident on autopsy service and those
with case to present
Faculty: Abhik Ray Chaudhury, MD
10.
Weekly Autopsy Teaching Conference
a.
Wednesday, 4:00-5:00 year round
b.
Given by faculty and residents
c.
Attendance: mandatory for residents with case to present. All
other residents encouraged to attend
d.
Faculty: Charles Hitchcock, MD, PhD
11.
Dermatopathology Conference
a.
2nd and 4th Wednesday, 4:30 pm; year round
b.
Attendance: highly recommended and mandatory for residents on
Dermatopathology service, conference concentrated towards
dermatology residents.
c.
Course Director: Sara Peters, MD
12.
Transfusion Medicine Rounds
a.
Friday, noon, monthly
b.
Given by residents and fellows
c.
Case presentations, antibody problem solving literature review and
critique, topic presentation and discussion, and ethics discussions
d.
Attendance: mandatory, residents and fellows on Transfusion
Medicine rotation and Clinical Pathology rotations
e.
Course Director: Scott Scrape, MD
13.
Transplant & Kidney Conference
a.
Wednesday, 2:00 pm; year round
b.
Surgical Pathology Sign-Out Room
c.
Attendance: mandatory for resident and fellow on Transplant
rotation
d.
Course Director: Tibor Nadasdy, MD
14.
CTTR Conference (California Tumor Tissue Registry)
a.
Friday, 8:00 am; one/month
b.
Surgical Pathology Sign-Out Room
c.
Course Director: O. Hans Iwenofu, MD
15.
Lymphoma Conference
a.
Thursday, noon-1:00 pm
b.
4th Floor, Starling-Loving Hall
c.
Heme Onc driven with Hematopathology faculty/fellow presenting
pathology
12
d.
Attendance: strongly encouraged for all residents
16.
Pathology Grand Rounds
a.
Tuesday, 2nd & 4th, noon-1:00 pm, September-June
b.
Seminars on research or clinically-oriented subjects given by
faculty, residents, fellows or guest faculty
c.
Attendance: mandatory for all residents
17.
The Business of Pathology & Topics in Lab Medicine
a.
Last Wednesday of each month; noon, 137 Hamilton Hall; year
round
b.
Given by faculty, selected guest speakers
c.
2-year cycle covering topics related to ethics, finance, investing,
federal regulations/laws, coding, contract negotiation, research
design, statistics, etc. as each of these pertain to pathology
d.
Attendance: Mandatory for all residents
e.
Course Directors: Harry Pukay-Martin, MBA, CPA, FHFMA and
Michael Bissell, MD, PhD, MPH
18.
Chat with the Chair
a.
Held every 3 months
b.
Discuss resident concerns
19.
Chat with the Program Director
a.
Held every 4 months
b.
Discuss resident concerns
20.
Resident Business Meetings
a.
Bi-monthly, 11:30-12:30
b.
To discuss resident concerns among each other
21.
Oncology Tumor Board
a.
Thursday, 8:30 am; year round
b.
518A James Cancer Hospital
c.
Attendance: mandatory for residents on AP
d.
Course Director: William Farrar, MD
22.
Gynecologic Oncology Tumor Board
a.
Friday, 7:00-8:30 am
b.
137 Hamilton Hall
c.
Attendance: optional
d.
Course Director: Adrian Suarez, MD
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G.
Evaluation of Residents and Residency Program
1.
The following policies and evaluation forms are used for the evaluation of
residents in the department (see appendices).
a. Resident Applicant Interview Form (Appendix A)
1) Filled out by all faculty who interview resident applicants
2) Returned within 3 days to Education Coordinator
3) Used by Residency Advisory Committee as part of resident
selection process
b. Resident Evaluation Form for Anatomic and Clinical Pathology
(Appendix B)
1) Resident/fellow evaluation form (Appendix B) is e-mailed via
E*Value, a web based software program, to all faculty
members and laboratory support staff at the end of every one
or two months for PGY-1 residents, at the end of the rotation
for PGY-2 and above or monthly at the discretion of the
Program/Associate Program Director. Individual faculty are
encouraged, but not required, to also give in-person feedback
to residents at each evaluation point.
2) Division Director’s are able to view statistical analysis and
comments on E*Value of the trainees evaluations completed
by faculty and laboratory personnel on their rotation.
3) Evaluation is discussed between the Division Director and
resident/fellow within 1 week before or after the end of the
rotation.
4) On each service it is recommended that all faculty involved in
teaching have input into the evaluation. With respect to the
resident’s attitude and effectiveness, the ACGME
recommends that the evaluator interview allied health
personnel, and other residents for added input.
5) Program Director or Associate Director will meet with all
residents and perform evaluations a minimum of two times per
year. More frequent, interim evaluations can also be
performed at the discretion of the Program Director, Associate
Director, or upon the recommendation of the faculty, as
needed.
6) A Resident Evaluation Signature page (Appendix C) is signed
by both the Program Director and/or Associate Program
Director and resident and placed in their file documenting that
they have gone over their evaluations. Trainee may disagree
and submit a written response.
7) Evaluations are used to document progress of residents,
including positive feedback for good performance and early
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identification/correction of problem areas. They are also used
to document unsatisfactory performance.
8) Used as a data file to answer inquiries about residents who
have left the program.
c. Evaluation of Rotations by Resident (Appendix D)
1) Monthly or at the end of rotation, residents and fellows will
evaluate all rotations on E*Value.
2) Pathology Education Coordinator monitors and prints out
statistical summary for review annually.
3) Statistical summaries are reviewed by Chairman, Residency
Director, Associate Program Director, Residency Advisory
Committee and Chief Residents annually.
4) A statistical summary given to the appropriate division director
annually for review and appropriate changes if needed.
d. Evaluation of Faculty by Resident (Appendix E)
1) Monthly or at the end of the rotation, residents will complete
an Evaluation of Faculty Teaching Form (Appendix E) on
E*Value for each faculty member encountered during the
rotation.
2) Pathology Education Coordinator monitors and prepares
statistical summaries for review.
3) Faculty evaluations summaries are reviewed by the Chairman,
Program Director, Associate Program Director, and AP and
CP Directors annually.
4) Changes will be made if there is a deficiency and individuals
counseled.
5) Statistical summaries are given to the faculty member and
Division Director annually.
6) Evaluations may be used as follows:

To commend those faculty with favorable evaluations

To improve resident teaching where indicated

Promotion and tenure process
e. Pathology Conference Evaluation (Appendix F)
1) The form includes a brief overall evaluation of all departmental
conferences related to resident teaching (Appendix F).
2) To be completed by residents/fellows once a year on E*Value.
3) Pathology Education Coordinator prints out statistical
summary for review.
4) Statistical summaries are reviewed by Chairman, Residency
Director, Associate Program Director, Residency Advisory
Committee and Chief Residents annually.
15
5) Statistical summaries are given to the appropriate conference
director.
6) Used to commend those responsible for highly-rated
conferences and to correct deficiencies in suboptimal
conferences.
2.
ACGME regulations require a final evaluation of each graduating resident.
The final evaluation must have input from more than one faculty member
and should address the resident’s performance during the final period of
education and verify that the resident has demonstrated sufficient
competence to enter practice without direct supervision.
a. It is recommended that the final evaluation be written by the Residency
Director, with input from other faculty.
b. Uses of final evaluation:
1) For recommendation to the American Board of Pathology
2) To answer inquiries about residents after they have left the
program.
3.
Annual Faculty Program Survey (Appendix G)
A Faculty Program Survey is e-mailed once a year to all clinical faculty
asking for their perception of the program. A summary of the results are
discussed once a year with the Residency Advisory Committee (Appendix
G).
4.
Annual Resident Program Survey (Appendix H)
A Resident Program Survey is e-mailed once a year to all residents asking
for their perception of the program. A summary of the results are
discussed once a year with the Residency Advisory Committee (Appendix
H).
5.
Appendix: Blank Evaluation Forms
a.
b.
c.
d.
e.
f.
g.
h.
Resident Applicant Interview Form
Resident Evaluation Form
Resident/Fellow Evaluation Signature Page
Resident and Fellow Evaluation of Rotation
Evaluation of Faculty Teaching
Pathology Conference Evaluation Form
Annual Faculty Program Survey
Annual Resident Program Survey
16
H.
Resident Advancement
The following are the general guidelines for resident advancement in the
Department of Pathology:
1.
2.
3.
4.
5.
I.
Advancement of each member of the limited medical staff is determined
annually by the Residency Advisory Committee in accordance with the
guidelines of the OSU Limited Medical Staff Agreement.
During the last 4 months (March-June) of the academic year, the Resident
Advisory Committee will meet and determine the advancement of each
resident. The Committee will also meet at other times of the year, if
necessary.
Resident advancement will be based primarily on the written faculty
evaluations of resident performance on rotations.
The most important determinations of advancement are made during the
latter portions of the first and second year. Emphasis should be on early
detection of problems and regulation of such problems in a fair and
equitable manner.
For each resident, the Committee will make a recommendation to the
Program Director for advancement, remediation, or sanctions (probation,
termination, suspension). The Program Director will discuss all
recommendations for sanctions with the Department Chair.
Program Evaluation
In addition to the above methods for program evaluation, other methods of
evaluation will include maintaining the pass/fail rate for the American Board of
Pathology examinations, and job placement.
J.
Probation and Remediation
1.
2.
3.
If a resident receives a substandard evaluation, sequential counseling by
Division Director or designee, Program Director or Associate Director, and
Department Chair occur as necessary; counseling should be documented
by placing a letter in the resident’s file. If warranted, a remedial plan is
initiated by Division Director. If remediation fails, Division Director notifies
Program Director.
The Residency Committee will generally consider probation if the resident
has received overall evaluations of “improvement needed” or
“unsatisfactory” on 2 or more rotations or has failed remediation. The
committee may also choose to consider probation on the basis of 1
adverse evaluation if the deficiencies are severe or considered difficult to
remediate.
Residents placed on probation will receive oral and written notice of the
probation from the Residency Program Director.
17
4.
5.
6.
7.
8.
K.
The Department will assist the resident during the probation period.
Specifically, the Committee will appoint a faculty advisor for the resident.
In addition, the appropriate Division Director will counsel the resident. The
chief resident(s) may also assist the resident.
During the probation the resident will be evaluated after every rotation or
as often as the Director of Service deems appropriate. The Committee
will officially evaluate the resident between 4 to 6 months. If the resident
on probation has not satisfactorily addressed their deficits during the
rotations in this period, possible consequences include, but are not
restricted to, lack of reappointment to the residency or further remediation.
Probation periods will generally be 4 to 6 months, and will not go beyond
the current contract year.
The Committee may assign remediation for deficiencies of lesser
magnitude than those requiring probation.
In general, residents must remediate all rotations with overall evaluations
of “improvement needed” or “unsatisfactory” in order to satisfactorily
complete the residency.
Resident Grievance and Due Process
A resident is provided the opportunity to raise a concern at any time regarding
non-performance related to the Limited Staff Agreement or non-compliance with
any GME or Hospital policy. Resident complaints and concerns with any aspect
of the program are to be discussed initially with the Rotation Director, and if
unresolved at this level, are to be discussed with the Residency Program Director
or Associate Program Director. If not satisfactorily resolved at this level, they are
to be brought before the Residency Advisory Committee and/or Chairman within
the Pathology Department, and ultimately the hospital’s Graduate Medical
Education DIO for resolution. The institution has policies and procedures listed
in the Limited Staff Agreement Outlining Due Process and Grievance
Procedures. All residents, as a basis for employment are required to sign the
Limited Staff Agreement. This agreement is the overarching institutional policy
with regard to discipline, grievance, and due process issues. A copy of this
agreement is provided at the applicant’s interview and in their appointment
application packet to the OSUMC.
18
APPENDIX A
EVALUATION FORM
The Ohio State University
Pathology Residency Program
Name:
Medical
School:
Interview Date:
Interviewer:
Based on your review of the applicant’s file and their interview with you, please rate the likelihood
that this candidate will:
The Applicant:
Very
Unlikely
Unlikely
Uncertain
Likely
Very
Likely
0
1
2
3
4
1. Function well as a resident in this program (key characteristics:
organization, multitasking ability, equanimity, experience in a tertiary care
center as a student)
2. Function well as a supervising resident in this program (key characteristics:
teaching skills, leadership skills, organization, delegation, judgment)
3. Feel comfortable in the OSU pathology culture (autonomy,
assertiveness, enthusiasm, flexibility, teamwork)
4. Successfully complete the residency without need for remediation (either
knowledge, skills or attitudes) (any past history of the same?)
5. Has the desire to participate in scholarly activities (research, publication
submission, presentations at meetings)
Based on your interview, what did you feel were this candidate’s unique strengths?
Do you have concerns about any aspects of this candidate’s record or interview performance?
Conclusion
Definitely
don’t rank
The Applicant:
0
5. Where would you rank this individual within this
pool of applicants
Please return form to:
Jill Hostetler
Fax: 293-7273
Email: Jill.Hostetler@osumc.edu
19
Would
consider
not ranking
1
Bottom
1/3
Middle
1/3
Top 1/3
2
3
4
Drop off: N-308 Doan Hall
THANK YOU for your participation!
Ohio State University
Pathology – Resident/Fellow Evaluation
APPENDIX B
Subject:
Evaluator:
Site:
Period:
Dates of Activity:
Activity:
Evaluation Type: Resident
Method (Question 1 of 16 - Mandatory)
Methods used in evaluation
Selection
Option
Written Exam
Observation
Patient Care (Question 2 of 16 - Mandatory)
Observes compassionate, appropriate, and effective patient care.
Demonstrates diagnostic competence including the use of information technology to support patient care decisions
Effectively communicates and is dependable
Works well with health care professional, including those from other disciplines, to provide patient-focused care
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Medical Knowledge (Question 3 of 16 - Mandatory)
Is conversant with established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences
and the application of this knowledge to patient care.
Demonstrates knowledge about established and evolving biomedical, clinical, and cognate sciences
Demonstrates an investigatory and analytic thinking approach to clinical and pathological situations
Knows and applies the basic and clinically supportive sciences appropriately to pathology
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Practice Based Learning and Improvement (Question 4 of 16 - Mandatory)
Demonstrates efforts for continuous improvement of patient care and for ongoing appraisal and assimilation of scientific evidence.
Applies knowledge of study designs and statistical methods from scientific studies related to their patients' health
problems
Uses information technology to manage information and support self-education
Facilitates the learning process of students and other health care professionals
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
20
Interpersonal and Communication Skills (Question 5 of 16 - Mandatory)
Demonstrates effective information exchange with colleagues, patients, their families, and other health care professionals.
Demonstrates effective information exchange and teaming with other health care professionals, patients, and their
families
Works effectively with others (including faculty, other residents, and laboratory staff)
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Professionalism (Question 6 of 16 - Mandatory)
Shows a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.
Demonstrates sensitivity and responsiveness to patients', colleagues', and laboratory personnel
Responds to the needs of patients that supercedes self-interest
Committed to ethical principles pertaining to confidentiality of patient information and business practices
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Systems-Based Practice (Question 7 of 16 - Mandatory)
Demonstrates an awareness of and responsiveness to the larger context and system of health care.
Is able to effectively call on system resources to provide pathology services that are of optimal value
Understands how pathology services and professional practices affect other health care professionals and organizations
Understands the principles of cost-effective health care and resource allocation without compromising quality care
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Diagnostic Ability (Question 8 of 16 - Mandatory)
Demonstrates appropriate progress in diagnostic skills for level of training
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Accountability and Dependability (Question 9 of 16 - Mandatory)
Follows procedures faithfully and always follows cases through to completion
Is dependable and consistent in performance of duties
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Laboratory Skills (Question 10 of 16 - Mandatory)
Follows established guidelines and shows appropriate levels of competence for level of training in the dictation and
grossing of surgical specimens and/or performance of autopsies
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
21
Participation in Conferences (Question 11 of 16 - Mandatory)
Regularly attends and participates in assigned conferences
Adequately works-up and presents assigned cases at conferences
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Research and Other Initiatives (Question 12 of 16 - Mandatory)
Participates in research projects and other academic activities
Demonstrates independent thinking and initiative in teaching and research
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
Overall Assessment of Competencies and Performance (Question 13 of 16 - Mandatory)
Has the resident achieved a level of competency consistent with their level of training?
Selection Option
Yes
No
Resident Deficiencies (Question 14 of 16)
Does this resident have any deficiencies that require remedial attention at this time?
Selection Option
Yes
No
Comments (Question 15 of 16)
Overall Evaluation (Question 16 of 16)
N/A
Well Below
Expectations/Unsatisfactory
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Outstanding
0
1
2
3
4
5
22
APPENDIX C
RESIDENT/FELLOW EVALUATION SIGNATURE PAGE
RESIDENT
ROTATION
MONTH(S)
Program Director’s Signature
I have reviewed and discussed my evaluations with my Program Director. I understand
that my signature does not imply agreement with the contents of this evaluation.
Resident Signature:
Date:
23
Ohio State University
APPENDIX D
Pathology – Resident/Fellow Evaluation of Rotation
Subject:
Evaluator:
Site:
Period:
Dates of Activity:
Activity:
Evaluation Type: Rotation
Goals/Objectives (Question 1 of 15 - Mandatory)
A set of goals/objectives were provided at the beginning of the rotation to insure an educational experience that assists in achieving
competency
Selection
Option
Yes
No
Not Applicable
Goals/Objectives Accomplished (Question 2 of 15 - Mandatory)
The goals/objectives were, for the most part, accomplished during the rotation
Selection
Option
Yes
No
Not Applicable
Daily Duties (Question 3 of 15 - Mandatory)
A list of daily duties were provided and explained to me at the beginning of the rotation
Selection
Option
Yes
No
Not Applicable
Availability (Question 4 of 15 - Mandatory)
Faculty members were readily available for daily sign-out, didactic teaching sessions, and discussions of clinicopathologic
correlations and reference materials
Selection
Option
Yes
No
Not Applicable
'Sign-out' Sessions (Question 5 of 15 - Mandatory)
Daily “sign-out” sessions, involving current case material were done
Selection
Option
Yes
No
Not Applicable
24
Laboratory Management (Question 6 of 15 - Mandatory)
Laboratory management issues, including quality control, quality assurance, budget, and personnel were discussed in a manner
appropriate to my level of training
Selection
Option
Yes
No
Not Applicable
Feedback (Question 7 of 15 - Mandatory)
I was getting constant feedback on the quality of my daily sign-out preparations and my diagnostic skills
Selection
Option
Yes
No
Not Applicable
Work Place (Question 8 of 15 - Mandatory)
I was provided a place to work during the rotation
Selection
Option
Yes
No
Not Applicable
Quality of the facilities (Question 9 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Quality of teaching material (Question 10 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Quality of secretarial/clerical assistance (Question 11 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Quality of assistance by technologists (Question 12 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Quality of faculty teaching (Question 13 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Overall quality of rotation (Question 14 of 15 - Mandatory)
Poor
Adequate
Good
Outstanding
1
2
3
4
Comments (Question 15 of 15 - Mandatory)
(please comment on strengths and weaknesses of rotation):
25
Ohio State University
Pathology – Evaluation of Faculty Teaching
APPENDIX E
Subject:
Evaluator:
Site:
Period:
Dates of Activity:
Activity:
Surgical Pathology
Evaluation Type: Faculty
Evaluation information entered here will be made available to the
evaluated person in anonymous and aggregated form only.
Availability, willingness to spend time (Question 1 of 6 - Mandatory)
NA
Poor
Adequate
Average
Good
Outstanding
0
1
2
3
4
5
Depth and accuracy of knowledge (Question 2 of 6 - Mandatory)
NA
Poor
Adequate
Average
Good
Outstanding
0
1
2
3
4
5
Ability to communicate knowledge (Question 3 of 6 - Mandatory)
NA
Poor
Adequate
Average
Good
Outstanding
0
1
2
3
4
5
Interest in teaching (Question 4 of 6 - Mandatory)
NA
Poor
Adequate
Average
Good
Outstanding
0
1
2
3
4
5
Overall quality of teaching (Question 5 of 6 - Mandatory)
NA
Poor
Adequate
Average
Good
Outstanding
0
1
2
3
4
5
Additional comments (Question 6 of 6)
26
Ohio State University
Pathology – Conference Evaluation
APPENDIX F
Subject:
Evaluator:
Site:
Period:
Dates of Activity:
Activity:
Conference Evaluation
Evaluation Type: Conference
Conference Evaluation
Please check the appropriate box: (Question 1 of 24 - Mandatory)
Selection Option
Resident
Other
This form is to survey faculty and resident attitudes towards departmental conferences. Check the
appropriate response according to the key provided. Constructive criticisms and suggestions are
encouraged. Please use the drop-down box beside each conference that you are evaluating and rank the
conference from poor to excellent.
Pathology Grand Rounds (Question 2 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Anatomic Pathology Didactics (Question 3 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Anatomic Pathology Unknown Slide Conference (Question 4 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Anatomic Pathology Journal Club (Question 5 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Anatomic Pathology Interesting Case Conference (Question 6 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Weekly Autopsy Review Conference (Question 7 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Neuropathology Gross Conference (Question 8 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
27
Dermatopathology Conference (Question 9 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Transplant and Kidney Conference (Question 10 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Journal Club (Question 11 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Didactic Lecture Series (Question 12 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Unknown Conference (Question 13 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Closing Rounds (Question 14 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Interesting Case Conference (Question 15 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Clinical Pathology Call Review (Question 16 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Topics in Lab Management (Question 17 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Transfusion Medicine Rounds (Question 18 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Oncology Tumor Board (Question 19 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Lymphoma Conference (Question 20 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Excellent
N/A
Comprehensive Cancer Center Grand Rounds (Question 21 of 24 - Mandatory)
Poor
Below Average
Average
Good
28
1
2
3
4
5
6
Chat With The Chair/Program Director (Question 22 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Resident Meetings (Question 23 of 24 - Mandatory)
Poor
Below Average
Average
Good
Excellent
N/A
1
2
3
4
5
6
Comments or Suggestions (Question 24 of 24)
29
APPENDIX G
ANNUAL FACULTY PROGRAM SURVEY
1.
Is the program designed to produce competent AP and CP residents?
2.
Are residents responding to the opportunities afforded to them?
3.
Do you have specific suggestions for improvement of the residency
program?
4.
Does our program provide adequate opportunity and exposure for
potential development of residents into academic pathologists?
30
APPENDIX H
ANNUAL RESIDENT PROGRAM SURVEY
1.
Does the program provide adequate teaching by faculty and staff?
Yes/No
2.
Are you satisfied with your AP training to date?
Yes/No
3.
Are you satisfied with your CP training to date?
Yes/No
4.
Does our program provide adequate opportunity and exposure for
potential development of residents into academic pathologists?
Yes/No
5.
Does our program provide adequate opportunity and exposure for
potential development of residents into community pathologists?
Yes/No
6.
Do you have specific suggestions or comments for improvement of
the residency program?
Comments:
31
PROGRAM DIRECTOR (RESIDENCY DIRECTOR)
AND GRADUATE MEDICAL EDUCATION COMMITTEE IN PATHOLOGY
(RESIDENCY ADVISORY COMMITTEE)
A.
Program Director for Graduate Medical Education in Pathology
1. The Program Director for Graduate Medical Education is appointed by the
Chair of the Department of Pathology. The Chair may serve in this
capacity herself/himself.
2. The major duties and responsibilities of the Program Director are as
follows:
a.
b.
c.
d.
e.
f.
g.
Chair of Graduate Medical Education Committee
Graduate Medical Education (Residency) Program, with
oversight of:
(1)
Interviewing, recruiting, selecting prospective residents
(2)
Evaluation of resident performance(s)
(3)
Counseling of residents
(4)
Administration of residency program, including resident
schedules
(5)
General curriculum of residency program
(6)
Preparation of residency program for internal and national
accreditation inspections
(7)
Represent department at national, intersociety, etc. meetings
relating to residency education as needed.
Meet periodically with Department Chair to discuss matters relating
to residents and fellows.
Consult with Division Directors of AP, and Director of CP, as
appropriate.
Meet with Chief Residents monthly.
Meet with residents for a Chat with the Program Director/Chair
quarterly.
Oversee fellowship programs.
3. Generally will serve for accreditation period and renewable at the
discretion of the Chairman.
B.
Associate Program Directors and Executive Subcommittee of Residency
Committee
1. Associate Program Directors are appointed by Department Chair, in
consultation with the Program Director.
32
2. Will assist the Program Director, including delegated signatory authority
when necessary.
C.
Composition of the Graduate Medical Education Committee
1. Chair: The Program Director for Graduate Medical Education (see
above).
2. Members: Members appointed by Department Chair with input from the
Program Director and Associate Program Director, as follows:
a.
Executive subcommittee: Program Director and Associate Director
b.
Advisory subcommittee: Members of the Department of Pathology
including faculty from AP, CP, Research and Chief Residents
D.
Responsibilities of the Resident Advisory Committee
1. Residency selection:
a.
b.
c.
Applications are accepted to our residency training program only
through ERAS (Electronic Residency Application Service) via the
Internet. Applications received in the mail will not be reviewed.
Applicants will accumulate their materials on ERAS and filter
materials to the programs of their choice. Applicants to our
program must have passing scores on USMLE Steps 1 and 2
exams. Application to the program is highly competitive and in the
past, persons with all USMLE scores equal to or over 200 (3-digit
scale) have been reviewed. Preference is given to applicants with
less than five years out of medical school. One of the more
important requirements in being considered for our program is that
applicants must have excellent English communication skills which
is essential for being an effective resident and learning the
discipline of pathology, which includes interactions with physicians,
patients, faculty, fellows, residents, pathologists’ assistants,
graduate students, medical students, and staff. Per INS
guidelines, we only sponsor J-1 visas. For more information about
our program, we direct applicants to our website at:
www.pathology.med.ohio-state.edu.
The Committee ranks resident applicants on the basis of medical
school performance, USMLE scores, letters of recommendation,
publications, ability in written and spoken communication, and
results of the interview process. This procedure is applied to all
residents without regard to sex, race, religion or nationality.
The final ranking of the applicants for the resident matching
program in Pathology is determined by the Program Director and
Associate Program Director.
33
2. The Committee is responsible for periodic review of the residency
curriculum.
a.
b.
The residency curriculum should conform to such guidelines as
may be established by the ACGME Institutional Review Committee
and National Residency Review Committee for Pathology, the
American Board of Pathology and the Association of Pathology
Chairmen.
The residency curriculum should also conform to guidelines set by
The Ohio State University Medical Center post Graduate Medical
Education Committee and the Chair of Pathology.
3. The Committee is responsible for periodic review of Pathology Fellowship
Programs.
4. The Committee participates in the evaluation of residents and the
determination of resident advancement and sanctions, as needed.
5. Some members of the Committee may participate in selection and/or
administration of the Pathology Fellowship programs.
34
PATHOLOGY RESIDENT BENEFITS AND INFORMATION
I.
Title and Appointments
A. All residents and fellows have the title of Clinical Instructor.
B. Completion of an Application for Appointment to the Medical Staff, a
Limited Staff Agreement, and Council for Affordable Quality Healthcare
(CAQH) documents are required along with supporting documentation.
C. Permanent or temporary Ohio medical license is required.
1. The training certificate and permanent license fee is reimbursed
by the Department.
2. Resident must obtain and maintain either a training certificate or
full licensure from the Ohio State Medical Board prior to beginning
training.
3. A resident must successfully complete USMLE Step 3 prior
to completion of the PGY-2 training year. Residents entering a
program at the PGY-3 level or higher must have completed
USMLE Step 3 prior to their appointment to the Medical Staff.
4. After passing USMLE Step 3, the resident must go through the
Federation Credentials Verification Service (FCVS) and establish
a portfolio. FCVS provides a centralized, uniform process for the
verification of a physician’s core medical credentials. This
repository of information allows a physician to establish a
confidential, lifetime professional portfolio which can be
forwarded, at the physician’s request.
5. Upon receiving verification from FCVS the resident will apply for a
permanent Ohio medical license.
6. Reimbursement for all expenses related to licensure including
State of Ohio training certificates and permanent license fees,
FCVS fees and background checks.
D. Identification badges (Clinical Instructor) are obtained in the Hospital
Security Department, Room 127 Rhodes Hall (7:00 am – 4:15 pm, closed
during lunch 11:30-12:30, closed on Friday’s, by appointment only).
Residents should wear identification badges while on the hospital
premises. Residents may be asked to show their IDs at any time,
particularly at night to enter the hospital buildings. An ID badge is also
required to use the Health Sciences Library, to obtain scrubs and to use
the University athletic facilities. If a resident loses his/her ID badge, it can
be replaced with a letter from the Education Coordinator confirming your
35
employment status and employee ID number. A replacement fee is
charged.
II.
Salary and Insurance
A. Salary
1. Same scale for all hospital housestaff and determined by PGY
status.
2. Funded by hospital or department.
3. List of current salaries: 2011/2012 – PGY-1 $47,168; PGY-2
$48,787; PGY-3 $50,191; PGY-4 $51,725; PGY-5 $53,342;
PGY-6 $54,876.
4. The two main options for employees to receive their pay are via
direct deposit into a bank account of their choice or into a secure
account maintained by a private company that is linked to a “pay
card,” which is similar to a debit card. Paychecks are deposited
on the last working day of each month.
B. Malpractice Insurance
1. At least $1 million and $3 million aggregate
2. Funded by The Ohio State University Medical Center (selfinsured)
C. OSU Life Insurance
1. Life, Accidental Death, and Dismemberment
II. Two and one-half times annual salary
III. Premiums paid by department
2. Dependent Group Life Insurance (optional)
D. OSU Health Coverage
1. Eligible for enrollment in one of several University-sponsored
health insurance plans
2. Includes single or dependent coverage
3. Prescription drug coverage is included in all plans. Coverage,
deductibles, and co-payments vary by plan
III.
Vacation, Meetings, Leave, Moonlighting
A. Vacation
36
Ten (10) regular vacation days per year are allowed for PGY-1 and PGY-2
residents, 15 days for PGY-3 and above residents and fellows. The week
of vacation which has traditionally been offered at Christmas/New Year’s
will be approved/disapproved depending on service needs. Residents are
also free on the holidays recognized by the University, unless on call.
Vacations should be requested at least one month in advance, when
possible, if duration of vacation is one week or more. Advance notice for
any vacation time off is recommended. An OSU Application for Leave
form is to be signed by Program Director or Associate Program Director or
Division Director and initialed by Chief Resident and then turned in to the
Education Coordinator. Resident is responsible for notifying Division
Director and pathologists on the service immediately upon approval of
vacation. Aside from the Christmas and New Year’s holiday break,
residents may take vacation at any time during the year, subject to
approval. Vacation during the last 2 weeks of June is discouraged except
for graduating residents and must be approved by Division Director or
Program Director or Associate Program Director and Chief Resident. No
more than one week of vacation per rotation may be taken. Taking
vacation at the same time as other residents on the same service is
generally not allowed, with the exception of Christmas/New Year’s and
national meetings. The Christmas and New Year’s breaks are not
considered regular vacation and may be taken at no other time.
Exceptions or special requests to this policy must be approved by the
Program Director.
Vacation days not taken during the year are not transferrable to the next
year; exceptions require permission of the Residency Program Director.
Coverage during the Christmas/New Year’s break and national meetings
is determined by the co-chief residents in consultation with the Program
Director.
B.
Book Fund and Meeting Allowance
All residents are allotted up to $1,500 to be used towards academic
materials related to residency training. A resident may carryover a
maximum of $500 to the next training year. If conference attendance is
kept above 70% book fund and meeting allowance monies will be
distributed as follows:
PGY-1
July 1st
$1500.00
PGY-2 and above
December 1st
May 1st
$750.00
$750.00
37
Residents are strongly encouraged to attend one national scientific
meeting per year. All residents are allotted 5 working days to attend
meetings/year. The $1,500 “book fund” mentioned above may be used
towards attending a meeting. If a resident is presenting at a meeting, an
additional $1,250 will be provided. To receive the additional $1,250, the
resident must submit a draft of a paper in addition to a poster/abstract
within 90 days after the meeting to receive the full $1,250. A copy of the
submitted paper or an e-mail from the faculty member who the resident
collaborated with should be forwarded to the Pathology Education
Coordinator as proof of submission. Otherwise the resident will receive
$625 in additional travel money. The resident book fund of $1,500 may be
used to cover remaining travel expenses. If a resident has more than one
presentation accepted in a given academic year, a request for additional
funds (up to $1,250/meeting) and an additional 3 meeting days per
presentation may be requested. Approval for the additional funding and
time off service must be approved by the respective Director of service
and the Residency Program Director. Board Review Courses, including
the Osler is not acceptable as an annual meeting or presentation. If a
resident or fellow wishes to attend a course, they must use regular
vacation time but may spend book fund monies. See the Education
Coordinator for all travel arrangements which must be made well in
advance in order for University travel forms to be completed and approved
and processed prior to the travel. A copy of the meeting registration form
to verify date and location of the meeting must accompany all travel
requests, in addition to the invite letter if presenting at a meeting. Request
for reimbursement of travel related expenses must be submitted within 60
days after the trip.
C.
Interview Days
Residents are allowed up to 7 working days to interview during their
residency training. This remains separate from their vacation and ill days.
These days are at the discretion of the Director of Service on which they
are rotating. If all 7 working days are not used they may use up to 3 days
of their interview days as moving days and must be the last days of their
residency training.
D.
National Board Exams
The resident is given one (1) travel day and the days of the exam.
38
E.
Board Review Course
A resident may use their book fund monies to attend a Board Review
Course, including the Osler. Vacation time must be used to attend these
courses. Meeting time cannot be used for this purpose.
F.
Leave of Absence
Leave of absence other than for pregnancy (see III.G below) will be
granted only in extraordinary circumstances and must be approved by the
Residency Committee and the Department Chair.
G.
Sick Leave
Residents are eligible to accrue 120 hours of sick leave per year. Sick
leave pertains to unexpected events necessitating time off for either
personal or dependent’s illness. In order to receive sick leave, each
resident must fill out an OSU Application for Leave form upon returning to
work, have it signed by the Division Director, and return it to the Education
Coordinator.
H.
Special Approved Leave Policy
Special Approved Leave Policy is established to cover special approved
leave for residents and fellows in the Department. It is exclusive of current
vacation and meeting leave. Ordinarily, it will apply to maternity/paternity
leave as delineated in the policy.
a.
In the event a resident becomes pregnant or adopting a child, it is
her responsibility to inform the Program Director as soon as
possible so that appropriate arrangements in the schedule can be
made in the best interests of all concerned.
b.
There shall be two types of leave available to pregnant residents:
1. Maternity/Paternity leave: For the birth or adoption of a child,
mothers are provided with six weeks of regular pay.
Birth/adopted fathers or domestic partners are provided with
three weeks of regular pay. The three weeks of paternity
leave must be used within six weeks of the birth. If maternity
leave is taken beyond six weeks you may use your
accumulated sick leave and/or vacation time it will be unpaid
leave. Maternity/Paternity leave is designated as a qualifying
event for Family Medical Leave which carries a maximum of
twelve weeks (84 days) within a twelve month period. In view
of the specific requirements of the American Board of
Pathology regarding number of weeks of training required for
ABP certification, the following points must be adhered to:
39
a) The American Board of Pathology requirements state “1
year of approved training credit toward ABP certification
requirements must be 52 weeks in duration, and the
resident must document an average of 48 weeks per
year of full-time pathology training over the course of the
training program.”
b) To meet this board requirement, the resident may elect to
pursue and provide evidence of academic activity during
4 weeks of the maternity leave and 1 week of the
paternity leave or forfeit vacation time in upcoming years
to make up the 4 weeks of maternity leave and 1 week of
paternity leave.
c) Evidence of academic activity can be in the form of emails with faculty in the writing of abstracts, manuscripts,
preparation of presentations, etc.
2. Disability or sick leave: Complications of pregnancy requiring
time off work shall be covered by sick leave or if an individual
is eligible for Family Medical Leave. This shall not infringe on
maternity leave and is counted toward the twelve week (84
days) maximum for FML within any twelve month period. Both
paid and unpaid leave count toward the FML maximum.
c.
d.
I.
Accommodations in the schedule, including decreased night call
and part-time work, are discouraged, unless medically indicated.
When disability occurs, leave can be taken as noted in H.b.2
above. Notification of the Program Director as soon as the
pregnancy is recognized should result, in most instances, in
adequate advanced planning to avert such part-time work
schedules.
Please refer to the University Human Resources Policy 6.05 and
your Medical Staff Agreement for additional information on
maternity/paternity or disability/sick leave.
OSU Application for Leave Form
An OSU Application for Leave form must be completed, approved and
turned in to the Education Coordinator when requesting any type of leave
(e.g. vacation, meetings, ill, etc.)
J.
Moonlighting
Moonlighting is generally not recommended and requires prior approval of
the Program Director and Department Chair. If approved, the policy and
guidelines set forth by the hospital GME office will be followed.
40
IV.
Resident Weekend and Night Call Schedules
A. Autopsy Coverage:
PGY 1 residents will be assigned to the Autopsy service for weekdays,
and for selected Saturdays and Holidays. NO autopsies will be performed
on Sundays, Christmas Day, Thanksgiving Day, or January 1 st. On
Mondays through Fridays, the resident will be located in the autopsy area.
For Saturday and holiday assignments, the resident must be available for
any case that is ready for autopsy by 1pm. An attending pathologist will be
available to provide direct supervision or indirect supervision with direct
supervision immediately available for the duration of the resident’s
presence on site.
B. Frozen Section Evening Call
1.
2.
3.
4.
Second through fourth year residents
On call approximately once in every 7 weeks
Responsibilities begin approximately 5:00 pm, Monday-Friday
At 5:00 pm check with faculty member on call to plan the evening
coverage
5. Be available to do frozen sections with faculty supervision
6. Routine coverage ends at 10:00 pm with the exception of rare
cases with multiple frozen sections where, for patient care
concerns, there is a need for the resident to stay later
7. Be available to come in for stat after hours frozen sections and
alert the attending on call
C. Frozen Section Weekend and Holiday Call
1.
2.
3.
4.
5.
6.
Second through fourth year residents
Approximately once a month for first years
24 hour responsibility
Be available to do frozen sections with faculty supervision
Identify biopsy cases to be signed out Saturday and/or Sunday.
Resident will review the clinical history and contact submitting
physician to confirm urgency of the case and secure phone
numbers or contact information to provide a diagnosis.
7. Resident is responsible for contacting the attending pathologist on
weekend call to communicate this information.
8. If necessary, the resident will have previous slides pulled to be
reviewed at the time of sign out.
9. Resident will notify the attending pathologist when the biopsy
(biopsies) are ready to be reviewed and will sit with the attending
pathologist for this activity.
41
10. Resident on frozen section call during the weekend will also
review the OR schedule on Saturday and notify the attending if
any frozen sections are expected.
D. Clinical Pathology Call
1. Second through fourth years
2. Take week night clinical pathology/frozen section call about 2-3
times per month.
3. Take weekend clinical pathology/frozen section call one weekend
in about every six weeks.
4. Weekend CP coverage includes Hematopathology, BALs,
Transfusion Medicine and other laboratory issues.
5. Refer to Transfusion Medicine “On Call Manual” for Transfusion
Medicine issues. Manual located on Resident Web pages.
6. Refer to Hematopathology statement for Hematopathology
weekend call issues.
V.
Logging of Information
Logging of information is required on E*Value and the ACMGE web site.
Both are two separate web-based computer software programs that can be
accessed from any computer with internet access.
A. E*Value
E*Value is a web based program that allows the department and GME
Office to manage, collate and analyze the overwhelming volume of
information associated with graduate medical education. It also helps us
to meet the rigorous requirements of the ACGME.
You are able to access E*Value from any computer with internet access
through a browser (home, office, library, etc.).
The web site address is https://www.e-value.net. It will ask you for your
Log In and Password. Please use the following Log In and password to
get you started. You may change your password at any time.
If you see your name at the top of the Welcome Page then you are logged
in correctly. Please complete the Training History on the front page.
You are required to track the following items:
Duty Hours (3 month block, 1x per year)
42
Go to User Menu on the left hand side of screen and click on “Duty
Hours”, click date on calendar you would like to record and insert
information.
Procedures – autopsies, bone marrow transplants, fine needle
aspirations, gross specimens, literature searches, formal and
informal presentations
Click on “Procedures” over in the User Menu and then click on “Add New.”
Input information and then submit. At the bottom of the page you are able
to view your submitted procedures.
View evaluations completed by the faculty and laboratory staff:
Click on “Reports” and then “Performance,” insert date and name of the
rotation you would like to view.
You may view the User Manual by clicking the “Help” menu button on the
left hand side of the screen.
View Conference Attendance Status
Click on “Users” and then “Conferences Menu”. You may review the topic,
location and date for that conference.
If you feel that your attendance status for a past conference should be
changed, click the link in the “Your Attendance Status” column to request
a change.
You will be taken to a screen where you can indicate your requested
status and include a reason for the requested change. This request will
be e-mailed to Jill Hostetler, your E*Value Administrator.
B. ACGME Case Logging System
As of July 1, 2004 the ACGME requires residents to use the ACGME’s
internet-based Case Log System to document their experience in three
areas: autopsy, fine needle aspiration, and bone marrow aspiration and
biopsy.
Instruction for system use are provided in manuals that are available from
www.acgme.org. Questions about system use may be directed to the
RRC staff or the ACGME Help Desk at 312. 755.7464.
43
C. Portfolios
Residents are required to keep a portfolio during their residency training
which is theirs to keep. The Education Office provides a binder with index
tabs to include the following items. Current CV, Presentations,
Publications, Achievements/Awards, Committees, Quizzes/Exams and
Procedure Check Off lists. The portfolio is to be shared at the semiannual review with the Program Director or Associate Program Director.
D. Procedure Check Off Lists
Procedure Check Off Lists are used on the following rotations and once
completed should be included in your Portfolio.
Cytogenetics, Flow Cytometry, Hematopathology, Medical Microbiology,
Surgical Pathology and Transfusion Medicine.
VI.
Library
Library – OSUMC ID card allows the resident to have library privileges. An ID
card is necessary for borrowing materials. Medline searches may be done
either in the library or from a remote site (hospital or personal computer).
http://library.med.ohio-state.edu/.
VII.
Computers
A. Clinical Information System (CIS)
1. All residents and fellows have accounts on CIS
2. Electronic mail (E-mail)
E-mail is used to communicate efficiently in the department.
Residents should check e-mail at least every other day, if not
every day. Messages from the Education Coordinator and
Program Director are often sent only via e-mail.
3. Residents have access to Hospital and Laboratory Computer
Systems (e.g. CoPath, Thor/Sunquest and eResults).
B. Office Computers
Computers and laser printers are available for resident use in preparing
for conferences, posters and manuscripts.
C. Purchase of Personal Computers
1. Full reimbursement if computer is purchased in first year of
training.
44
2. Portion decreases by 1/36 for each month after the first year of
training.
3. Total amount of computer divided by 36 months (length of
program) times number of months in program.
4. Computer software, printers, accessories are reimbursable.
5. Fellows are not eligible for computer reimbursement.
VIII.
Mailboxes and Mailing Address
Departmental mailboxes for residents are located at the end of the hall of the
North wing on the 3rd floor of Doan Hall, at the back elevator. The fellows will
be assigned a mailbox in their respective Divisions. Residents should check
mailboxes at least every other day. The Departmental address which
residents should use for journal mailings, etc. is the following:
Department of Pathology
The Ohio State University
N-308 Doan Hall
410 W. Tenth Avenue
Columbus, OH 43210
In addition to the 3N Doan Hall mailbox, mailboxes are provided in
Autopsy Pathology (081 Heart & Lung Research Institute). These
mailboxes are primarily for use within the Autopsy Service, returning
autopsy protocols, temporary slide storage, etc.
IX.
Miscellaneous
A. Parking
All residents need valid parking permits. Permits are effective September
1 – August 31 and can be purchased on-line. Department reimburses for
parking permit through payroll deduction. Resident is taxed for this
reimbursement as additional pay.
Traffic and parking information may be found at the following web site:
http://www.tp.ohio-state.edu/Eservices/index.shtml.
B. Keys – Key card swipe for S-307 Rhodes Hall (CP Resident Office) and
Autopsy Suite. Keys provided for E-420 (AP Resident Office).
C. Scrubs – Scrubs are dispensed from Room S-537 Rhodes Hall between
the hours of 6:30 AM and 3:25 PM, Monday through Friday, closed for
lunch between 11:30-12:30. You may obtain up to a total of six (6) sets of
scrubs at one time. ID badge must be presented when obtaining scrubs.
45
Clean scrubs will be issued when soiled scrubs are returned to room S537M Rhodes Hall in the water soluble bags which are provided at the
time of issue. If scrubs are needed in an emergency, the Materials and
Supplies Supervisor should be paged.
D. Lab Coats (2 per resident): provided by the Hospital.
E. Dry Cleaning – Dry cleaning is provided for all residents free of charge (N020 Doan Hall). Turnaround time is 2 weeks. Include your pager # on
your dry cleaning slip and complete a duplicate for your reference. You
will be paged when your dry cleaning is ready for pick up. Dry cleaning
must be picked up within 30 days of the time they are dropped off.
F. Meal Allowance – Limited staff are provided with an additional $500 (after
taxes) per year for a meal allowance. The money is evenly distributed in
monthly paycheck and is itemized on pay stub. Additionally, evening
snacks (i.e., pizza) are provided on Friday, Saturday and Sunday
evenings.
G. Badge It – Benefit for employees to make day-to-day purchases more
convenient. OSUMC employees with a current medical
center ID badge can make purchases from Seasons Garden Café (East),
Seasons Café (Campus), Seasons Express @ Martha Moorehouse
Medical Plaza, Seasons Express @ Ackerman and the Scarlet Ribbon Gift
Shops through payroll deduction. No charge to sign up and use the
program. Go online to OneSource and select “Payroll Deduct” under the
“Workplace” tab. Fill out the application and submit it online. This is a
one-time sign up. If you no longer wish to participate in the payroll deduct
program, you can access the same activation form through this site and
choose the “Deactivate” button. Your spending limit is established based
on biweekly and monthly pay status. https://www.osumc.edu/
H. Junior membership in the College of American Pathologists (CAP) is
offered free-of-charge to non-Board certified residents who are actively
enrolled in or have completed an accredited training program leading
toward certification by the American Board of Pathology. CAP and ASCP
applications can be obtained on-line.
I. Membership in national organizations: AACC, ASC, AABB, ASM, ASH,
etc. may be obtained on an individual basis at the resident’s expense.
USCAP membership fee is taken from travel money when registering for
the meeting.
46
J. An ACLS training certificate must be valid for all residents and fellows.
ACLS training may be arranged through the Department of Educational
Development and Resources (ED & R). An online course catalog will
provide information, available dates and registration forms. This can be
accessed through the following web site: https://edr.medctr.ohiostate.edu/index.htm.
K. On Call Facilities are provided to housestaff with access to vending,
lounge, computer and study facilities on 3 West Doan Hall. Pathology
residents have access to the following on call float rooms: W301, W303,
W318, W330, W340.
X.
Athletics
Recreational and Physical Activity Center (RPAC)
Residents and fellows have full use of the Recreational and Physical Activity
Center and any other recreational facilities on campus. They must show their
ID to gain admittance and to the facility. There is a fee of $115/quarter or
$437 annually or $36.42/month, which may be paid through payroll deduction
to use the facilities. http://www.recsports.osu.edu
XI.
Immunization Policy
A. Appointment to the Medical Staff requires proof of immunization to
Hepatitis B, rubella, rubeola, and varicella zoster virus (VZV). A yearly TB
test (PPD) or chest x-ray and Influenza vaccine is also required. Contact
Employee Health (Clinic 2A) for information. Persons who have received
BCG may be required to have an x-ray.
B. Before starting residency or fellowship, trainees must complete the HIPAA
modules on-line, take the post test, print transcripts, and forward a copy to
the Education Coordinator for trainees file. They may be found at
http://edr.medctr.ohio-state.edu.
XII.
GME Mandatory Requirements
A. Computer Based Learning Modules (CBLs)
The following computer based learning modules must be completed by
December 1st each year.
Annual HIPAA Privacy & Research
Annual HIPAA Privacy & Security
Annual Infection Control for Physicians
Annual Universal Protocol – Physicians
47
If you are unable to receive the seasonal influenza vaccine - You are
required to complete the “Influenza Pandemic Prevention and Response
Plan” which is located on the following web site: https://edr.medctr.ohiostate.edu/index.htm.
B. Introduction to the Practice of Medicine Modules
The Introduction to the Practice of Medicine (IPM) is an online, on demand
lecture series housed on the following web site:
http://ipm.knowbase.com/login.asp. The lecture series was designed to
increase the exposure of housestaff to non-traditional curricular topics
mandated by the ACGME. Residents are required to complete 10
modules throughout the course of their training program. Fellows are
exempt from this IPM requirement but are encouraged to participate in the
lecture series. All Residents and Fellows must complete the “Sleep
Deprivation” and “Impaired Physician” lectures within the first year
of their training program. The post test and evaluations must be
completed for credit.
C. Annual Compliance Modules
An annual mandatory two-hour compliance education requirement is to be
completed on-line each year through the IPM website:
http://ipm.knowbase.com.login.asp. The required compliance modules are
#1 Conflict of Interest, #2 Fraud and Abuse Regulatory Overview, #3
Physicians at Teaching Hospitals, #4 Understanding Clinical Trials. The
post tests and evaluations must be completed by December 1st to receive
credit.
D. CITI Training (Collaborative IRB Training Initiative)
All residents and fellows must participate in basic education in research
ethics, human subject’s protection, and research regulations. Training is
completed on a web-based course at the following web link:
http://www.citiprogram.org. All residents at the PGY-2 level must have
completed the modules prior to completion of their PGY-2 year. All fellows
must complete the training during their first year and prior to being
promoted to the second year of their training program or completion of
their program.
48
CHIEF RESIDENTS
A.
Appointment of Chief Resident(s) in Pathology
1.
2.
B.
In the spring of each year the Pathology Residency Program Director
appoints either a single chief resident or two co-chief residents for the
following academic year. Should co-chief residents be appointed one
would serve as the Anatomic Pathology Chief and the other for Clinical
Pathology Chief.
The Department supplements the chief residents’ salary.
Duties and Responsibilities of the Chief Residents
1.
2.
3.
The chief resident(s) are primarily responsible to the Pathology Residency
Program Directors.
The chief resident(s) function as an intermediary between the residents
and the faculty. Although primarily an advocate for the residents, the chief
resident(s) must also serve as an advocate for the entire residency
program and for the Department as a whole.
The chief resident(s) are responsible for the preparation of several
schedules in a fair, accurate, and timely manner. These schedules must
be approved the Program Director in advance.
a. Night and Weekend Call Schedule:
1) Prepared in the spring for the following academic year.
2) Includes weeknight, weekend and holiday call, as applicable,
for both AP/CP residents and autopsy service.
3) Before making the schedule, request input from all residents
and CP faculty.
4) Second year residents do not take CP call until August.
5) Consult previous schedules and previous chief residents to
ensure that schedules are consistent and fair.
6) Schedule is typed and distributed to the department.
b. Resident Coverage Schedule for Christmas Holiday and National
Pathology Meetings:
1) For the two week Christmas Holiday period and for national
meetings attended by several residents, revisions of the
resident rotation schedules may be necessary in order to
cover all of the laboratories. The revisions should be prepared
well in advance and all residents and faculty should be
notified.
c. Scheduling of Conferences
1) AP Didactics
2) Call Review (July-August)
3) Gross Room Conference
49
4.
5.
6.
7.
8.
9.
10.
C.
Orientation of New Residents
a. Assist Education Coordinator and Program Director with orientation of
new residents.
b. Make sure residents are aware of departmental policies on vacation,
conference attendance, evaluations, moonlighting, duty hours, and
procedure logging, etc.
Make Resident Office Assignments
Residency Executive Committee
a. The chief resident(s) meet with the Program Director and Associate
Program Director once a month.
b. Chief resident(s) present resident concerns and suggestions to this
committee.
Pathology Resident Advisory Committee
a. The chief resident(s) are members of the Committee and should attend
the meetings.
b. The chief resident(s) are responsible for assisting in the recruitment of
residents.
c. After applicant interviews, the chief resident(s) may write a short letter
to the applicant or be asked, by the Program Director, to contact an
applicant by phone.
Other Departmental Committees
a. The chief resident(s) may be appointed to other divisional committees
(e.g. Clinical or Surgical Pathology) as deemed appropriate by the
committee chairs.
b. Chief resident(s) may attend Faculty meetings.
Resident Vacations
a. The chief resident(s) should ensure that not too many residents are
absent at any one time due to vacations/meetings and to ensure
adequate coverage of the laboratories.
b. Chief resident(s) initials OSU Application for Leave form when resident
is requesting time away.
Additional details of duties and responsibilities are included in a packet of
information that is transferred from the current chief resident(s) to the new
co-chief residents each year.
Resident Teacher of the Year Award
1.
Selection of the “Clinical Pathology Faculty Teacher of the Year”,
“Anatomic Pathology Faculty Teacher of the Year”, and “Staff Excellence
in Teaching Award” are managed by the chief resident(s). The awards are
given by the residents to faculty and staff members who have consistently
demonstrated a commitment to quality resident education. The award is
particularly important to both the residents and faculty and staff since it is
one of the few ways in which faculty and staff teaching can be recognized.
50
2.
3.
4.
Three awards are given each year (Anatomic, Clinical, and Staff).
Residents make their selection by nomination followed by popular vote
during one of the spring residents’ meetings.
The chief resident(s) present the awards to the recipients at the von Haam
Recognition Dinner in May.
A list of recipients of the award is attached.
51
PAST CHIEF RESIDENTS
2010-11
2009-10
2008-09
2007-08
2006-07
2005-06
2004-05
2003-04
2002-03
2001-02
2000-01
1999-00
1998-99
1997-98
1996-97
1995-96
1994-95
1993-94
1992-93
1991-92
1990-91
1989-90
1988-89
1987-88
1986-87
1985-86
Camille Elkins, M.D.
Mitchell Weinberg, M.D.
Elizabeth Biller, M.D.
Jonathan Rock, M.D.
Shadia Alam, M.D.
Sabrina Simpson, M.D.
Irene Aguilera-Barrantes, M.D.
Robert Shott, M.D.
Lynn Cooper, M.D.
Carl Gable, M.D.
Brian Plasil, M.D.
Jeffrey Kneile, M.D.
Jose Plaza, M.D.
Jeffrey Kneile, M.D.
Jose Plaza, M.D.
JoAnna Williams, M.D.
Martha Yearsley, M.D.
Jason Nash, D.O.
Adina Cioc, M.D.
Carl Morrison, M.D.
Dmitry Baschinsky, M.D.
Mona T.I. Ishag, M.D.
Geoffrey K. Hahm, M.D.
Virginia L. Tranovich, M.D.
Timothy E. Gorman, D.O.
Richard L. Morgan, M.D.
Gina M. Fino, M.D.
Randolph C. Sosolik, M.D.
S. Nayyer H. Jafri, M.D.
William J. Becker, D.O.
Sandra T. Maia-Cohen, M.D.
David M. Marmaduke, M.D.
James M. Uhlenbrock, M.D.
Kevin F. Forsthoefel, M.D.
Nasir K. Amra, M.D.
Adonica L. Walker, M.D.
Jeffrey A. Houck, M.D.
Jeffrey A. Houck, M.D.
Kim J. Wajda, M.D.
Morgan S. Wilson, M.D.
Rose Goodwin, M.D.
Andrew J. Britton, M.D.
Sue Hammond, M.D.
52
1984-85
1983-84
1982-83
1981-82
1980-81
1979-80
1978-79
1977-78
1976-77
1975-76
Stephen L. Strobel, M.D.
Steven E. Tuttle, M.D.
William H. Roberts, M.D.
Peter B. Baker, M.D.
Susan H. Prasher, M.D.
Jeffrey Russell, M.D.
John T. Brandt, M.D.
Joel G. Lucas, M.D.
Melanie S. Kennedy, M.D.
Melanie S. Kennedy, M.D.
N.T. Shah, M.D.
Farrukh S. Sheikh, M.D.
53
FACULTY TEACHERS OF THE YEAR AWARD
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
Abhik Ray Chaudhury, M.D. (Anatomic)
Thomas W. Prior, M.D. (Clinical)
Martha Yearsley, M.D. (Anatomic)
Melanie S. Kennedy, M.D. (Clinical)
Rulong Shen, M.D. (Anatomic)
Haifeng Wu, M.D. (Clinical)
Hans O. Iwenofu, M.D. (Anatomic)
Michael Bissell, M.D., Ph.D., M.P.H. (Clinical)
Rafael Jimenez, M.D. (Anatomic)
Gerard Lozanski, M.D. (Clinical)
Saul Suster, M.D. (Anatomic)
Amy Gewirtz, M.D. (Clinical)
Paul E. Wakely, Jr., M.D. (Anatomic)
Thomas Prior, Ph.D. (Clinical)
Manju Prasad, M.D. (Anatomic)
Samir Kahwash, M.D. (Clinical)
Ping Wen, M.D., Ph.D. (Anatomic)
Gerard Lozanski, M.D. (Clinical)
Gerard J. Nuovo, M.D. (Anatomic)
Michael G. Bissell, M.D., Ph.D., M.P.H. (Clinical)
Wendy L. Frankel, M.D. (Anatomic)
Amy S. Gewirtz, M.D. (Clinical)
Wendy L. Frankel, M.D.
Wendy L. Frankel, M.D.
Carmen J. (CJ) Julius, M.D.
William J. Becker, D.O.
Ted Niemann, M.D.
Carmen J. Julius, M.D.
Julio C. Cruz, M.D.
Joel K. Greenson, M.D.
Karl S. Theil, M.D.
Sue Hammond, M.D.
Carl P. Boesel, M.D.
William L. Marsh, M.D.
John T. Brandt, M.D.
Carl P. Boesel, M.D.
Joel G. Lucas, M.D.
54
SURGICAL PATHOLOGY
The program statement for the Surgical Pathology rotation applies to Pathology
residents, fellows, and rotating residents and fellows from other departments. Rotators
and Medical students who spend a limited time in the department are also allowed to
participate in these activities under the supervision of the Chief Resident, pathology
residents, fellows and faculty. The program statement includes the following major
headings:
A.
B.
C.
D.
E.
F.
G.
A.
General Philosophy
Duration of Surgical Pathology Rotation
List of Teaching Faculty
Goals and Objectives of the Rotation
Educational Curriculum
Lines of Responsibility
Description of Duties and Responsibilities
General Philosophy
The core surgical pathology rotations represent the foundation on which your
future performance will be based once you begin your practice. These rotations
are meant to provide you with the basic tools, orientation, skills, and philosophy
that will guide you in your growth as a diagnostic surgical pathologist. The
purpose of the surgical pathology experience is not only to expose you to the
material available in the department, familiarize you with the gross and histologic
aspects of the specimens, and teach you the mechanics of surgical pathology
signout, but also to help you develop effective and efficient work habits that will
allow you to confidently function in your specialty once you have concluded your
formal training. Whether you acquire the proper work habits and develop a solid
work ethic or not will be largely dependent on your own efforts. The department
expects that you will conduct yourself at all times as a responsible and mature
adult individual, and that you demonstrate the capability to progressively acquire
and assume responsibility for the quality of your work and the performance of
your duties. We believe every resident in pathology should approach every
specimen as if it were his or her own or that of a loved one. We expect that all
residents will assume responsibility for their cases from beginning to end of the
process, from accessioning to final signout. Residents will be held accountable
for pending cases and will be considered responsible for monitoring the progress
of their cases. Learning to assume responsibility for one’s work is one of the
most vital skills that you will learn as part of your training.
B.
Duration of Surgical Pathology Rotation
1.
Pathology Residents
55
a. The first year consists of 36 weeks in subspecialty areas of surgical
pathology, a 12 week autopsy rotation and a four week introduction to
AP. The subspecialty areas are gastrointestinal (GI) and liver, breast
and genitourinary (Breast/GU), gynecology (GYN) and obstetrics, head
and neck combined with soft tissue and bone, and thoracic. Each
resident does four to eight week rotations in GI and liver, breast and
GU, and Gyn, and four week rotations in the remaining areas.
b. The third and fourth year is divided into 16 weeks in surgical pathology
which is comprised of four subspecialty rotations, eight weeks in
cytology and dermatopathology, and four weeks in each of the
following AP services: neuropathology, forensic pathology, pediatric
pathology, renals/transplant pathology, and dermatopathology.
C.
2.
Fellows
a. Oral pathology fellows: 6 month rotation in surgical pathology
3.
Medical Students (Med III or IV): 1 month
4.
Rotators from other departments: 1 month
a. Obstetrics/Gynecology
b. Surgical Oncology
c. General Surgery and surgical specialties (ENT, Urology, etc.)
d. Radiotherapy
Teaching Faculty Responsible for Supervision and Instruction
Gary Barnett, M.D., Clinical Associate Professor; frozen section
Saeed Bajestani, M.D., Assistant Professor-Clinical; cytopathology
and breast
Sergey Brodsky, M.D., Ph.D., Assistant Professor; autopsy, renal
Abhik Ray Chaudhury, M.D., Associate Professor-Clinical; neuropathology
Larry DeRenne, M.D., Clinical Assistant Professor; frozen section
Wendy Frankel, M.D., Professor and Director of Anatomic
Pathology; gastrointestinal and liver
Charles L. Hitchcock, M.D., Ph.D., Associate Professor-Clinical; autopsy,
pulmonary
Iouri Ivanov, M.D., Ph.D., Assistant Professor-Clinical; gynecologic
O. Hans Iwenofu, M.D., Assistant Professor-Clinical; gynecologic, head
and neck, bone and soft tissue
James Liu, M.D., Assistant Professor-Clinical; gastrointestinal and liver,
gynecologic, cytopathology
William L. Marsh, Jr., M.D., Professor-Clinical; gastrointestinal and liver
56
Stephen Moore, M.D., Clinical Assistant Professor; gynecologic, breast
and genitourinary
Tibor Nadasdy, M.D., Professor, Director of Renal Pathology and Medical
EM Services; transplant and renal, electron microscopy,
immunofluorescence
Sara Peters, M.D., Ph.D., Associate Professor-Clinical, Director of
Dermatopathology; dermatopathology
Andreana Rivera, M.D., Assistant Professor-Clinical; neuropathology
Anjali Satoskar, M.D., Assistant Professor-Clinical; renal and transplant
Alessandra Schmitt, M.D., Assistant Professor-Clinical; cytology,
gastrointestinal, head and neck
Adrian Suarez, M.D., Assistant Professor-Clinical; gynecologic,
cytopathology
Rulong Shen, M.D., Associate Professor-Clinical, Director of
Cytopathology; cytopathology and gynecologic
Konstantin Shilo, M.D., Associate Professor-Clinical, thoracic and
genitourinary
Paul Wakely, Jr., M.D., Professor-Head and Neck, soft tissue and lymph
node pathology
Martha Yearsley, M.D., Assistant Professor-Clinical; gastrointestinal and
liver
Debra Zynger, M.D., Assistant Professor-Clinical; breast and genitourinary
D.
Goals and Objectives:
Provide residents with an educational experience that meets the following
competencies:
a) Patient care
b) Medical knowledge
c) Practice-based learning and improvement
d) Interpersonal and communication skills
e) Professionalism
f) Systems-based practice
1.
Ability to obtain pertinent information from the patients’ clinical record. (c)
2.
Demonstrate knowledge of information that is necessary to provide
adequate clinical history on submission forms for anatomic pathology
specimens. (c, f)
3.
Demonstrate knowledge of the general principles and terminology for
processing anatomic pathology specimens, including patient identification,
gross examination, and dissection. (a, b, c)
Ability to dissect tissues in such a way as to preserve important pathologic
findings and fix them so that they may be used for clinicopathologic
correlations as well as teaching. (a, b, c)
4.
57
5.
Ability to select correct pieces of tissue for sectioning and preservation,
and maintenance and identification of tissue orientation during processing.
(a, b)
6.
Ability to list common stains used for microscopic sections, as well as their
indications and the expected results for various tissue types. (a, b)
7.
Ability to enumerate the elements of a satisfactory histologic sections and
stains, and identify the possible reasons for unsatisfactory preparations.
(a, b, f)
8.
Ability to select correct fixatives for special histologic preparations. (a, b, f)
9.
Demonstrate knowledge of the specimens that commonly require special
handling (flow cytometry, microbiological cultures, recovery of crystals,
electron microscopy, immunohistology, etc.). (a, b, f)
10.
Ability to select an appropriate piece of tissue for frozen section, and to cut
and stain the section satisfactorily. (a, b)
11.
Ability to collect and preserve appropriate tissues and fluids for
immunofluorescence and flow cytometric studies. (a, b)
12.
Ability to select and submit tissue appropriately for electron microscopy.
(a, b)
13.
Ability to take suitable gross and microscopic photographs. (a, b, f)
14.
Proficiency in doing special hematological studies, including touch
preparations and blood smears. (a, b, f)
15.
Proficiency in initiating routine microbiological studies, including
appropriate cultures, smears, and stains, and involving knowledge of
methods of collection and preservation, if needed. (a, b, f)
16.
Demonstrate familiarity with the detailed organization, equipment, and
techniques of the histology laboratory, including tissue processing, tissue
embedding, preparation and staining of glass slides, information that
histotechnologists must have to process tissue properly, and orientation of
specimens. (a, b, f)
17.
Ability to present cases at conferences with clarity, completeness, and
high quality illustrations, and to reach reasonable interpretative
conclusions. (b, c, d, f)
58
18.
Demonstrate knowledge of precautions to be taken against infections and
other hazards in the handling of fresh tissue during intraoperative
consultations. (b, c, f)
19.
Demonstrate knowledge of the appropriate storage and disposal of tissues
and fixatives. (b, c, f)
20.
Demonstrate knowledge of the common pathogens that can be
transmitted to laboratory personnel in pathology, as well as basic safety
precautions to be taken in the anatomic pathology laboratory, including
universal precautions for infectious agents. (b, c, f)
Skill Level – Novice








Demonstrate proficiency in basic anatomic pathology skills (a, b, f)
Demonstrate knowledge of the standards (JCAHO, CAP) required for
submitting surgical pathology specimens (a, b, f)
Demonstrate knowledge of the common and basic elements of the surgical
pathology report, including:
o
Identifiers (patient and institution)
o
Input from the responsible pathologist
o
Input from the responsible clinician
o
Necessary dates and times that must be in the report
o
Necessary clinical information
o
Documentation of the specimens that were submitted
o
Thorough and accurate gross description
o
Ability to determine when a microscopic description and/or
interpretation is necessary, and provide such information
(a, b, c, f)
Demonstrate competency in selecting representative tissue samples for
intraoperative frozen sections, preparing the same, and staining the sections
(a, b, c)
Know the procedures for the reporting of untoward incidents in the laboratory
(b, c, f)
Demonstrate knowledge of the basic recommendation/requirements (JCAHO,
CAP, regional legal requirements) pertaining to retention of pathology
specimens and records (b, f)
Demonstrate knowledge of the basic principles of informatics in anatomic
pathology, and ability to effectively utilize the local computer network (a, b, c,
f)
Demonstrate knowledge of web-based or organization (CAP, ASCP, USCAP,
etc.) related to learning and CME tools in anatomic pathology (b, f)
59
Surgical Pathology – Advanced

















Demonstrate knowledge of the common situations requiring expedited
processing of a pathology specimen, and those that do not (a, b, c, f)
Demonstrate knowledge of the common indications for an intraoperative
consultation (a, b, c)
Demonstrate proficiency in interpreting and reporting frozen sections within
15 minutes of receiving a specimen for that purpose in the pathology
laboratory (a, b, c)
Demonstrate the ability to effectively construct a complex surgical pathology
report (a, b, c, f)
Demonstrate knowledge of the common grading and staging systems applied
to malignant neoplasms (a, b, c, f)
Be able to properly prepare synoptic surgical pathology reports for common
malignancies (a, b, c, f)
Demonstrate knowledge of how and when to obtain external consultations in
anatomic pathology and document the results appropriately (a, b, c, f)
Demonstrate the steps for preparation of consultation reports on outside
slides and/or paraffin blocks, and transmittal of those reports to responsible
clinicians and/or referring pathologists (a, b, c)
Demonstrate the techniques for preparing intraoperative cytology smears (a,
b, c)
Enumerate the indications and the limitations pertaining to intraoperative
frozen section examinations (a, b, c)
Demonstrate an ability to manage workflow in the gross room, assist junior
residents with gross dissection, provide accurate gross descriptions of routine
and complex specimens, use the local anatomic pathology laboratory
information system, and practice safety in the pathology laboratory (a, b, c, d,
f)
Demonstrate knowledge of available procedures for locating a missing
specimen and resolving questions of specimen identity (f)
Be able to evaluate margins of tumor resection specimens using frozen
sections and touch preparations (a, b, c)
Be able to independently report the histopathologic aspects of routine and
complex cases, including cases prepared by junior residents and/or pathology
assistants, with attention to organization of diagnostic format, development of
differential diagnosis, and ordering of necessary special stains and other
ancillary techniques (a, b, c)
Demonstrate knowledge of quality control pertaining to histologic sections and
special stains, including trouble-shooting of mistakes in accessioning,
labeling, and misidentification of specimens. (a, b, c, f)
Demonstrate proficiency in digital imaging techniques (a, c)
Review consultation slides on referral cases with attention to pertinent clinical
information, requests for additional slides or blocks if needed, and formatting
of the final consultative report (a, b, c, f)
60
E.
Curriculum
1.
Conferences
a. Anatomic Pathology Didactics
Course Director: Adrian Suarez, M.D.
This is a series of conferences held on Tuesday and Thursday
morning, 7:30-8:30 AM, year round. Conferences are rotated among
the faculty and include the use of both powerpoint presentations and
glass slides. The lectures provide a basic overview of organ systems
and covers the most common pathology encountered at the various
anatomical locations
b. Anatomic Pathology Unknown Slide Conference
Course Director: Adrian Suarez, M.D.
This is a glass slide conference on surgical pathology or
subspecialties. This conference is held approximately once a month
during Anatomic Pathology Didactics. The conference covers organ
systems, histochemistry, immunoperoxidase. Attendance is
mandatory for all residents. Given primarily by faculty.
c. Anatomic Pathology Journal Club
Course Director: Adrian Suarez, M.D.
This conference is held approximately four times per year during
Anatomic Pathology Didactics and moderated by an attending
pathologist. Journal articles are chosen by the pathologist and
disseminated in advance and reviewed during conference. Attendance
is mandatory for all residents.
d. Surgical Pathology Diagnostic Conference
Course Director: Paul E. Wakely, Jr., M.D.
This conference is held approximately every other Friday, 8:00-8:45
AM in the multi-headed scope room. Attendance is optional. An
opportunity to learn more surgical pathology and occasionally
cytopathology. Glass slides to be discussed will not be available
beforehand, so no specific preview is necessary. After review, slides
will be available for study during the weekend and returned on
Monday.
e. Interdepartmental Specialty Conferences
1) Surgical Oncology Tumor Board, weekly, Thursday 8:30-9:30
AM. Required for all residents rotating on surgical pathology;
highly recommended for all others.
2) Gynecologic Oncology Tumor Board, weekly, Friday 7:00-8:30
AM
2.
Daily Workload
In Surgical Pathology the residents are split into rotations by subspecialty
61
during the first year. The subspecialty groups are GI/Liver, Breast/GU,
Gyn, Thoracic and Soft Tissue, and Head and Neck. The services consist
of signout of biopsies and regulars (resection cases) generally in the
morning with an attending. In the afternoon the residents review and
prepare regular cases for signout the following morning. They also gross
specimens for their subspecialty. Due to the large volume of cases on the
GI service and gyn service, the signout may be split into biopsies one
morning and regulars the following morning.
a.
First year resident
The first year residents will complete 8 months of subspecialty
rotations in surgical pathology. The residents are placed on a
subspecialty schedule whereby each one is assigned the
responsibility for the sign-out of small biopsy specimens and
“regular” (larger) specimens with a faculty member. The residents
will also participate in the grossing of specimens by subspecialty in
the gross room every afternoon for 1 to 3 hours depending on the
specimen volume in their subspecialty area.
Due to clinical turnaround time constraints, the small biopsies are
reviewed and signed-out on the morning after the day of
accessioning. The larger surgical resection specimens are signed
out on the second morning after the day of accessioning, and the
histologic glass slides are available for review by the residents the
following day after accessioning. The residents are thus allowed
ample time to review the paperwork and slides the day before the
signout of the “regulars”, and are required to write down their
diagnoses prior to review of the slides with the faculty the following
day. Residents are also responsible for verifying gross
descriptions, summary of cassettes, and for pulling previous slides
from pertinent biopsies as well as obtaining additional clinical
information on the cases prior to signout with the faculty. It is the
resident’s responsibility to get in touch with the PA, PA student, or
other individual who grossed the case (if someone other than
themselves) to clarify any issues with the gross description,
summary of cassettes, or histologic glass slides. Residents are
also responsible for following-up cases to their final stages. The
resident should regard each case assigned to them as “his” or “her”
case.
Typically all first year residents rotate for 2 months (1 month blocks)
on GI, Gyn, and Breast/GU services and 1 month each on Head
and Neck, Soft Tissue and Thoracic services.
62
First year residents spend 2 weeks on the frozen section service.
All residents are responsible for frozen section during night and
weekend call.
b.
Third year resident
The third year residents will spend 5 months in surgical pathology.
The rotations include: GI, Gyn, Breast/GU and either/or both Head
and Neck, Soft Tissue and Thoracic. For the AP Subspecialty
month the resident may choose a month of Gyn, Head and Neck,
GI or Breast/GU. A greater degree of independence and
responsibility will be expected of the third year resident during
signout of surgicals than for the junior residents. They will be
expected to have all regular cases thoroughly worked up and ready
for signout with the attending the following day.
The third year resident will also participate in the grossing of
specimens in the gross room every day. Third year residents will
be expected to learn and acquire progressive experience in the
grossing of difficult and complicated specimens, and will receive
assistance when requested from the fellows, PA’s and faculty.
However, more initiative and a higher level of performance will be
expected at this stage in the grossing of surgical pathology
material. Third year residents are also expected to help the first
year residents in terms of grossing and preparing cases. Also, it is
their responsibility to help teach junior residents and to help orient
them during their initial period of residency. They will be expected
to choose the cases for the first year residents to gross and assign
their own cases. They are also responsible for presenting cases at
the weekly surgical oncology tumor board under the supervision of
an attending pathologist.
c.
Oral Pathology Fellow
During rotation through surgical pathology, the Oral Pathology
Fellow will be assigned to a pathology resident/fellow in order to
“shadow” that resident during their daily responsibilities. On these
days the Oral Pathology Fellow will participate in daily signouts of
biopsy material, and/or surgical regular specimens. The Oral
Pathology Fellow will be involved in preparation of signout materials
with the respective resident, including preparation of paperwork and
slides, as well as previewing and working-up cases prior to signing
out with an attending. The Oral Pathology Fellow will also be
involved in the signout of either biopsies or “regulars” with the
surgical pathology resident.
63
The responsibilities of the Oral Pathology Fellow as they pertain to
gross surgical specimens will be limited. The Oral Pathology
Fellow will primarily be expected to observe the dissection of gross
specimens as it is performed by the pathology resident in the
afternoons. In doing so the Oral Pathology Fellow will gain an
appreciation for the accessioning process, concise description of
specimens, adequate and efficient dissection with selection of
appropriate tissue blocks, clerical work involved, and gross
photography.
After appropriate experience has been attained, the Oral Pathology
Fellow will be assigned surgical specimens for which they will be
responsible to gross. The senior surgical pathology resident will
select the specimens, as they are deemed appropriate in terms of
complexity and relevance to the Oral Pathology Fellow. These
specimens will be grossed under the direct supervision of the
assigned surgical pathology resident.
While on the surgical pathology rotation, the Oral Pathology Fellow
will be assigned to the frozen section area intermittently under the
direct supervision of the frozen section fellow or resident and
attending. During this time the Oral Pathology Fellow will
participate in handling, cutting, and reading all frozen sections.
Frozen sections will be reviewed with the assigned faculty prior to
calling the submitting surgeon.
The Oral Pathology Fellow will also be involved in the review of
head and neck consultation cases. This will involve the Oral
Pathology Fellow checking with the appropriate attendings
throughout the course of each day to see if any consults are
available, reviewing the case on his/her own, formulating a
diagnosis, and sitting with the attending during the signout of these
consult cases. The respective attending pathologist will determine
the time of signout of these cases.
3.
Evaluation
Multiple assessments will be used for the evaluation process in order to
obtain a global and 360° evaluation of the residents. Residents will be
evaluated by the surgical pathology attendings and gross room staff
according to the six competencies. Additionally, they will be evaluated by
medical students, chief residents and administrative personnel.
An annual and objective practical unknown glass slide exam will be given
to all pathology residents (AP & AP/CP). This will represent one portion of
64
the overall evaluation. The Surgical Pathology Procedure Checklist must
be completed, signed and placed in Portfolio for review at semi-annual
review.
4.
Scholarly Activity
The residents are strongly encouraged to participate in surgical pathology
scholarly activity with the anatomic pathologists. Opportunities for
scholarly research are available within the division in several areas, and
collaboration with researchers outside of the department is also
encouraged. First year residents are encouraged to work on the
preparation of case reports and to collaborate in more elaborate projects
under the guidance and supervision of senior residents and faculty
members. Senior residents are encouraged to pursue independent study
and more complex projects involving special techniques such as
immunohistochemistry, molecular pathology, electron microscopy,
cytogenetics, etc., as applied to diagnostic surgical pathology. Recent
abstracts and publications are prominently displayed in the surgical
pathology area. Every effort is made to allow all residents to attend parts
or all of the OSU Update in Surgical Pathology course.
F.
Lines of Responsibility
1. The resident’s responsibilities for patient care decisions, supervision of other
residents/students/Allied Health personnel, and administration are
progressively increased according to ability and level of training.
2. Faculty supervision
a. Faculty members are assigned to residents on a daily basis and are
available to answer questions or assist with cases.
b. Faculty must sign and take the ultimate responsibility for all surgical
pathology reports.
H.
Specific Statement of Resident Responsibilities in Surgical Pathology
1.
Introduction
This document delineates the responsibilities of pathology residents, oral
pathology fellows, pathologists’ assistant students, rotators, and students
on the surgical pathology rotation. Faculty responsibilities are also
discussed, insofar as they relate to residents. The purpose of these
guidelines is twofold: (1) to promote quality resident education; and (2) to
promote consistent production of quality surgical pathology reports with a
reasonable turnaround time. These guidelines will be used by faculty to
evaluate residents and other rotators on the service.
65
2.
Gross Surgical Specimens
a. Resident Responsibilities
1) Description: Concise but complete description of relevant
findings in a logical sequence, using a standard format and
proper English. Specimen should be described as it appeared
on arrival in surgical pathology, and not as it appeared after
processing for frozen sections or tissue procurement.
2) Dissection: Thorough dissection performed in a standard
fashion. Gross dissection templates are available in the gross
room for consultation. A more senior resident or chief resident
is also available for consultation. Faculty members are also
available for consultation on difficult or problem cases. The
surgical pathologist attending covering frozen sections for the
day is the primary contact.
3) Selection of Tissue Blocks: Thoughtful selection of relevant
tissue blocks; careful trimming of blocks so that quality slides
can be produced. Large numbers of poorly selected blocks do
not compensate for an inadequate gross examination.
4) Clerical Work: Accurate and legible log sheets; correct
labeling of blocks. Clerical errors may result in major clinical
consequences.
5) Gross Photography: Quality gross photographs of unusual or
class specimens are essential for education and publication.
b. Faculty and PA Responsibilities
1) Frozen Section Specimens:
a) Brief written measurement/description of specimen and
gross lesion (if present) is mandatory for all specimens.
b) Written instructions if special handling required; e.g.
special stains or studies, number of location of blocks,
gross photograph, rush specimen, etc.
c) Unless the specimen is virtually self-explanatory, a gross
room resident/fellow must be called in at the time of the
frozen section for a demonstration and explanation of the
case.
2) Tissue Procurement Specimen:
a) For all complicated cases, the resident responsible for
the attending case must be called in to see the specimen
before tissue is given to tissue procurement.
b) Dissection should be in a standard fashion so that
specimen can be readily reconstructed.
3) Supervision of the Gross Room:
a) Immediate supervision by senior surgical pathology
resident. Any queries or concerns that cannot be
addressed by the senior resident should be brought to
the attention of the faculty members assigned to frozens
66
for the day and/or the specific faculty member who
signed out the case.
3.
Sign-out of Surgical Pathology Cases
a. Resident Responsibility:
1) Responsibilities prior to sign-out
a) Proofread gross description for accuracy and grammar.
b) Checks summary of cassettes to make sure that all
necessary and appropriate sections have been taken
prior to sign-out.
c) Review paperwork for accuracy and completeness.
d) Look up relevant previous material and pull slides and
reports for pertinent cases.
e) Review slides, write down diagnosis (enter into computer
if allowed or required by faculty member in charge), and
be prepared to give a microscopic description if
requested.
f) Make a list of suggested immunohistochemical stains.
2) Responsibilities during and after sign-out
a) Have cases ready for sign-out with the attending at the
designated time.
b) Inform faculty members of important cases or cases of
clinical interest prior to sign-out.
c) Follow-up on held-over cases and alert attending to
pending cases.
d) When necessary place orders in computer for special
stains, deeper sections, etc. and follow-up on them.
e) Fill out synoptic reports for the reporting of cancer
resection of specimens.
f) Regross cases, as per instruction of faculty member
signing out the case.
g) Call clinician for additional history or pertinent
information.
h) Review the literature and pursue independent reading on
selected cases.
i) Enter each case grossed in by the resident in the
E*Value system as a procedure.
b. Surgical Pathology Subspecialty Fellow Responsibilities
1) Responsible for supervising the grossing of complicated
specimens in the gross room.
2) Insure that residents and rotators perform duties listed above.
3) Help residents/rotators with their cases prior to sign-out.
4) Sign-out cases with the assigned faculty member.
67
c. Faculty Responsibilities
1) Be available for the sign-out of assigned surgical pathology
cases and frozen sections.
2) Teach the residents diagnostic criteria, differential diagnosis,
clinicopathologic correlation, and clinical consequences of
diagnoses.
3) Carefully proofread reports (gross description, diagnosis,
comments) for accuracy, completeness, and proper use of
language.
4) Utilize synoptic reports for the diagnosis of cancer resection
specimens.
5) If possible sign reports the same day they are typed.
4.
Frozen Section Evening Call
a. First through fourth year residents
b. On call approximately once in every 7 weeks
c. Responsibilities begin approximately 5:00 pm, Monday-Friday
d. At 5:00 pm check with faculty member on call to plan the evening
coverage
e. Be available to do frozen sections with faculty supervision
f. Routine coverage ends at 10:00 pm with the exception of rare cases
with multiple frozen sections where, for patient care concerns, there is
a need for the resident to stay later
g. Be available to come in for stat after hours frozen sections and alert
the attending on call
5.
Frozen Section Weekend and Holiday Call
a. First through fourth year residents
b. Approximately once a month for first years
c. 24 hour responsibility
d. Be available to do frozen sections with faculty supervision
e. Identify biopsy cases to be signed out Saturday and/or Sunday.
f. Resident will review the clinical history and contact submitting
physician to confirm urgency of the case and secure phone numbers or
contact information to provide a diagnosis.
g. Resident is responsible for contacting the attending pathologist on
weekend call to communicate this information.
h. If necessary, the resident will have previous slides pulled to be
reviewed at the time of sign out.
i. Resident will notify the attending pathologist when the biopsy
(biopsies) are ready to be reviewed and will sit with the attending
pathologist for this activity.
j. Resident on frozen section call during the weekend will also review the
OR schedule on Saturday and notify the attending if any frozen
sections are expected.
68
6.
Faculty Responsibilities on Frozen Section Call
a. Be available to supervise resident on frozen section call. Notify
pathology resident of your whereabouts, pager number, phone number
b. Teach residents about frozen sections: flow of paperwork, gross exam
and block selection, cutting and staining slides, differential diagnosis,
consequences of diagnosis
7.
Conferences
a. Resident Responsibilities
1) Prepare for/attend all Anatomic Pathology Didactics, 7:30 AM,
Tuesday and Thursday, Grand Rounds, noon, 2nd and 4th
Tuesday, and CP Conferences, 7:30 AM, Monday and
Wednesday, mandatory.
2) Attend Oncology Tumor Board, Thursday’s, 8:30 Am,
mandatory if presenting.
3) As time permits attend autopsy and departmental seminars.
Residents on autopsy must attend Autopsy and Brain Cutting
conferences.
b. Faculty Responsibilities
1) Prepare and present high quality Anatomic Pathology
Didactics.
8.
Schedule for Surgical Pathology
Residents and Rotators
a. Chief resident is responsible for the schedule with input from surgical
pathology faculty.
b. Residents will follow the schedule in their rotations as stipulated under
E.2 (Daily workload).
c. The rotators (Ob-Gyn, medical students, Radiation Oncology) will
participate in the sign-out of cases, conferences, and other regular
activities in the department every day under the supervision of the
surgical pathology resident(s). Rotators will not be assigned any
duties in the grossing of specimens, except under special
circumstances and on a case-by-case basis, as determined by the
Director of Service and senior resident on surgical pathology.
Surgical Pathology Faculty
a. Residents are assigned to a subspecialty service with sign-out
occurring each day with a faculty member. Subspecialty services are
GI/Liver, Breast/GU, Gyn, Soft Tissue, and Thoracic and Head and
Neck.
b. Small biopsies: Slides are available from histology around 7:30 AM,
and are matched with the paperwork and distributed. The residents
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review the paperwork and slides for accuracy and sign out the cases
with the pathologist beginning between 8:30 AM and 10:30 AM and
ending at 12:30 PM.
c. “Regular” surgicals (“regs”): Slides are available from histology after
11:00 AM the previous day, allowing the resident ample time to
preview the slides. The slides are matched with the paperwork and
distributed. The residents review the paperwork and slides, write down
their diagnoses, and sign-out the case with the attending pathologist
between 8:30 AM to 12:30 PM the following day or as specifically
rescheduled.
d. Frozen sections: Each day a pathologist is assigned to frozen section
area and supervision of gross room. The period of coverage is 7:00
AM to 6:00 PM.
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SURGICAL PATHOLOGY PROCEDURE CHECKLIST
Procedure
Surgical Pathology
eResults (Introduction)
CoPath (edit gross description)
CoPath (Histology log)
CoPath (Ordering special stains)
Gross Room (Orientation)
Gross Room Safety and
Operation
Gross Room Templates
Immunohistochemistry
(Introduction)
Immunohistochemistry
Interpretation
Histochemical Stains
Interpretation
Histology Lab (Introduction)
Observe Paraffin Block Process
Observe Paraffin Block Cutting
Observe H&E Staining
Competency
Met
Systems Based
Interpersonal &
Communication
Skills
Patient Care
Patient Care
Patient Care
Systems Based
Patient Care
Medical
Knowledge
Patient Care
Patient Care
Medical
Knowledge
Medical
Knowledge
Medical
Knowledge
Medical
Knowledge
Sign off by Dr. Suarez
Frozen Section Area
Cryostat operation and safety
H/E frozen section stain
Tissue selected for special
studies
Touch preparations and smears
Patient Care
Patient Care
Patient Care
Patient Care
Sign off by Dr. Barnett or
Dr. DeRenne
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Date Completed
THORACIC PATHOLOGY SUBSPECIALTY ROTATION
I.
Definition, Duration and Scope of Education
A. Thoracic pathology rotation encompasses all aspects of thoracic neoplastic and
non-neoplastic lesions.
B. Duration of Rotation – 4 weeks
C. The thoracic pathology rotation provides an organized and comprehensive
educational experience for residents in the field of thoracic pathology
II.
Teaching Staff, Practical and Teaching Experience and Recourses
A. Teaching Staff
c. Konstantin Shilo, M.D., Director, Thoracic Pathology Division, Associate
Professor
d. Charles Hitchcock, M.D., Ph. D. Staff Pathologist, Thoracic Pathology
Division, Associate Professor
e. Anjali Satoskar, M.D., Staff Pathologist, Thoracic Pathology Division,
Assistant Professor
B. Resources:
1. Pathology and Genetics of Tumors of the Lung, Pleura, Thymus and Heart,
Ed: William D. Travis, WHO Blue Book, 2004
2. Non-neoplastic Disorders of the Lower Respiratory Tract, Atlas of Nontumor
Pathology, AFIP, ARP, 2002
3. Cardiovascular Pathology, Ed: Malcolm D. Silver, third edition, 2001
4. Staging Manual in Thoracic Oncology, IASLC, Ed: Peter Goldstraw,
2009
5. Practical Pulmonary Pathology, Ed: Kevin O. Leslie and Mark R. Wick.,
Churchill Livingstone, 2005.
C. Practical Experience:
1.
2.
3.
4.
Grossing of small biopsies
Grossing of resection specimens
Small biopsies diagnosis
Resection specimens diagnosis
D. Teaching Conferences
1. Thoracic Pathology Lectures (7:30-8:30 am, Multiheaded
microscope/Residents Room; 4 hours per year, 2 year cycle)
72
2. Interdisciplinary Thoracic Conference (Wednesday at 7:00-8:00 am, E410,
Starling-Loving 4x/month)
3. Pathology Grand Rounds (2nd & 4th Tuesday’s at 12:00 noon, 170 HLRI, Sept
- June)
4. Thoracic Oncology Conference (Friday’s at 9:00-10:00 am, E410, StarlingLoving 4x/month)
5. Interstitial Lung Disease Conference (Fridays, 4:00-5:00 pm, OSU East,
1103B)
E. Teaching Responsibilities
1. Medical students on rotation
III. Learning Objectives for Thoracic Pathology Rotation
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and evaluate their
diagnostic material and correlate with clinical and radiological findings on a case by
case basis. During the rotation:
a.
b.
c.
d.
e.
f.
g.
h.
i.
The resident will review all cases, alone or with a fellow or medical
student, including consults, prior to signing out or ordering of special
stains.
The resident will write or enter his/her appropriate special stains or
molecular testing for the case as well as the diagnosis.
The resident reviews the patient's clinical record, including imaging
studies, for each case prior to signing out.
1st year residents will gross at least 5 VATS and all lobectomy and
pneumonectomy cases, as well as resections for mesothelioma that are
submitted during the month.
By the end of the 1st year rotation, residents are expected to have a
diagnostic accuracy of 60-70% for all cases.
By the end of the 3rd year rotation, residents are expected to have a
diagnostic accuracy of 90% for all cases; 100% accuracy in staging of
thoracic malignancies.
The faculty will provide an "open book" exam of classic thoracic pathology
cases (slides or virtual slides) at the end of the first and third year
rotations. Diagnostic competency is set at 95%.
Thoracic Pathology Sign out is scheduled from 1-4 P.M. each day.
The faculty member is responsible for training the resident in key
diagnostic and/or prognostic features of each case and how to work up a
particular case including special stains and the appropriate
clinical/radiological information needed to support the diagnosis.
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Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills
that result in effective information exchange and teaming with other health care
providers
a.
b.
Create and sustain a therapeutic and ethically sound relationship with
physicians, laboratory personnel, clerical staff and students.
Work effectively with others as a member or leader of a health care team or
other professional group.
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
a.
b.
c.
Demonstrate respect, compassion, and integrity; a responsiveness to the
needs of patients and society that supersedes self-interest; accountability
to patients, society, and the profession; and a commitment to excellence
and on-going professional development.
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices.
Handle patient specimens in a professional manner.
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 transfusion services that are of optimal value.
a.
b.
Understands how their patient care and other professional practices
affect other health care professionals, the health care organization, and the
larger society and how these elements of the system affect their own
practice.
Practice cost-effective health care and resource allocation that does not
compromise quality of care.
74
GROSS ROOM ROTATION
A. Duration:
Advanced residents (rotation is mandatory for PGY3 but may also be available
for PGY4) rotate for four weeks from July – November of each academic year
B. Teaching and staff responsible for supervision
1) Adrian Suarez, M.D. (General Issues, Gynecological and Obstetrical
Pathology)
2) Sandra Banky, B.S., PACASCP(General Gross Room Issues)
3) All Surgical Pathology Attending Pathologists (according to usual sign out
role).
C. Goals and Objectives According to ACGME Competency
Several of this rotation’s goals and objectives fall under more than just one
ACGME defined competency. Accordingly, they may be listed more than once in
points C.1 to C.6 below. C7 lists each goal and objective followed by the ACGME
defined competency or competencies it falls under.
C.1.
Patient Care
C.1.1. To gross in all types of specimens and complete at least minimum
requirements according to checklist (Appendix 1).
C.1.2. To become familiar with tissue procurement procedures.
C.2.
Medical Knowledge
C.2.1. To independently follow up his/her specimens, including selfdirected review of slides and diagnoses after cases have been signed out.
This with emphasis on large/complicated specimens.
C.2.2. To organize one gross pathology conference.
C.3.
Practice Based Learning and Improvement
C.3.1. To enter in the E*Value system each specimen grossed in including
descriptive information of the case.
C.3.2. To independently follow up his/her specimens, including selfdirected review of slides and diagnoses after cases have been signed out.
This with emphasis on large/complicated specimens.
75
C.3.3. To organize one gross pathology conference.
C.4.
Interpersonal and Communication Skills
C.4.1. To lead and organize the gross room responsibilities of the
residents, coordinating with the PA team and the junior residents.
C.4.2. To assign specimens to junior residents according to complexity
and degree of experience.
C.4.3. To be available for and teach junior residents, PA students, and
medical students rotating through the gross room. This includes digital
photography as well as grossing of all kinds of specimens received.
C.5.
Professionalism
C.5.1. To lead and organize the gross room responsibilities of the
residents, coordinating with the PA team and the junior residents.
C.5.2. To assign specimens to junior residents according to complexity
and degree of experience.
C.6.
Systems Based Practice
C.6.1. To lead and organize the gross room responsibilities of the
residents, coordinating with the PA team and the junior residents.
C.6.2. To assign specimens to junior residents according to complexity
and degree of experience.
C.6.3. To become familiar with the gross room work flow (receiving and
accessioning specimens including proper patient identification, triaging of
tissue, formalin fixation and beginning the billing process).
C.7. Goals and Objectives Listed Above, Followed by ACGME Defined
Competency or Competencies
To lead and organize the gross room responsibilities of the residents,
coordinating with the PA team and the junior residents (Professionalism,
Interpersonal and Communication Skills, Systems Based Practice).
To assign specimens to junior residents according to complexity and degree
of experience (Professionalism, Interpersonal and Communication Skills,
Systems Based Practice).
76
To gross in all types of specimens and complete at least minimum
requirements according to checklist (Appendix 1) (Patient Care).
To enter in the E*Value system each specimen grossed in including
descriptive information of the case (Practice Based Learning).
To independently follow up his/her specimens, including self-directed review
of slides and diagnoses after cases have been signed out. This with
emphasis on large/complicated specimens (Practice Based Learning, Medical
Knowledge).
To be available for and teach junior residents, PA students, and medical
students rotating through the gross room. This includes digital photography as
well as grossing of all kinds of specimens received (Interpersonal Skills).
To become familiar with tissue procurement procedures (Patient Care).
To become familiar with the gross room work flow (receiving and
accessioning specimens including proper patient identification, triaging of
tissue, formalin fixation and beginning the billing process) (Systems Based
Practice).
To organize one gross pathology conference (Medical Knowledge, Practice
Based Learning and Improvement).
D. Curriculum for rotation
This one month senior resident rotation in the gross room is designed to provide
an intense and in-depth experience in overall surgical pathology, with emphasis
on specimen handling and processing prior to microscopy, and to develop
leadership skills. Experience is obtained by interaction with attending
pathologists, fellows, tissue procurement personnel and PAs. Additionally, a
complete digital grossing manual is available.
E. Resident supervision
The residents will be supervised by fellows (Surgical Pathology fellow,
Gastrointestinal Pathology fellow), pathologist assistants and attending
pathologists.
F. Duties and responsibilities of the faculty with respect to resident education
1) Faculty members assigned to sign out each specimen will be available to
answer questions regarding appropriate processing.
77
2) When requested by the resident, faculty members will be available to go over
slides and answer questions after cases have been signed out and the senior
resident has reviewed slides on his/her own.
3) A faculty member will run the gross pathology conference along with the
senior resident in charge.
G. Residents duties and responsibilities
1) The resident is expected to be physically in the gross room or anatomic
pathology area from 8:30am – 5:30pm, Monday – Friday. Exceptions will be
approved on a case by case basis.
2) After cases have been accessioned, the senior residents will assign cases to
all junior residents and to themselves (Appendix 1).
3) The senior resident will be available during the above specified hours to
assist junior residents, fellows, attending pathologists, PAs and surgeons or
residents/faculty from other clinical services.
4) The senior resident is responsible for entering the cases he or she has
grossed in as procedures in E*Value system (case log).
5) The senior resident will follow up on cases he or she has grossed in after they
have been signed out. This includes review of microscopic slides, including
immunohistochemical stains and diagnostic reports.
6) The senior resident will communicate promptly with the appropriate faculty
member any issues/problems that may arise with any member of his team
(junior residents, PAs, medical students, gross room staff).
7) The senior resident will assist his/her fellow senior resident in preparing the
James Cancer Center Tumor Board.
H. Resident evaluations
The resident will be evaluated by faculty members of each main division (GI
pathology, Head/Neck, Bone/Soft Tissue, Thoracic, Gyn, Breast/GU) at the end of
every month. This will be based on the following competencies.
1) Patient care
 Demonstrates diagnostic competence including the use of
information technology to appropriately gross in specimens.
78
Effectively communicates and is dependable. Works well with other
members of his team (see above).
2) Medical knowledge
 Is conversant in biomedical, clinical and cognate sciences and the
application of this knowledge to gross room issues.
3) Practice based learning and improvement
 Demonstrates efforts for continuous improvement of the gross room
including appraisal and assimilation of scientific evidence.
4) Interpersonal and communication skills
 Demonstrates effective information exchange with colleagues,
PA’s, surgeons, and tissue procurement techs.
5) Professionalism
 Shows a commitment to carrying out professional responsibilities
and adherence to ethical principles.
6) System based practice
 Demonstrates an awareness of and responsiveness to the larger
context and system of healthcare.
7) Diagnostic ability
 Demonstrates appropriate macroscopic diagnostic skills.
8) Accountability and dependability
 Follows procedures faithfully and always follows cases through to
completion, is dependable and consistent in performance of duties.
9) Laboratory skills
 Follows established guidelines and shows appropriate levels of
competence for level of training in the dictation and grossing of
surgical specimens.
79
Appendix 1
Minimum requirements: specimens to be grossed-in by senior resident in gross
room rotation
1. Small Biopsies (GYN, GI, Head/Neck, Bone/Soft Tissue, Thoracic, etc.)
 100
2. Medium Sized Specimens
a.
GYN suggested specimens
o Cervical Cone – 4
o Salpingectomy – 4
o Single placenta – 4
o Twin placenta – 2
o TOTAL REQUIRED GYN Medium Sized Specimens = 14
b.
GI suggested specimens
o Gallbladders – 4
o Appendix – 4
o Liver wedge – 2
o TOTAL REQUIRED GI Medium Sized Specimens = 10
c.
Breast/GU suggested specimens
o Turp specimens (prostate chips) – 2
o Reduction mammoplasty – 2
o Lumpectomy specimens – 5
o TOTAL REQUIRED Breast/GU Medium Sized Specimens =9
d.
Head/Neck suggested specimens
o Thyroidectomy – 4
o Salivary Gland – 2
o TOTAL REQUIRED Head/Neck Medium Sized Specimens = 6
e.
Bone/Soft Tissue suggested specimens
o Hernia sac – 2
o Lipoma – 2
o Benign Amputations – 4
o TOTAL REQUIRED Bone/Soft Tissue Medium Sized
Specimens = 8
f.
Thoracic suggested specimens
o Lung wedges – 4
o Heart valves – 2
o TOTAL REQUIRED Thoracic Medium Sized Specimens = 6
80
3. Large Sized Specimens
a.
GYN suggested specimens
o Staging specimens for cervical, endometrial, ovarian cancer – 4
o Vulvectomy – 1
o TOTAL REQUIRED Large Sized GYN Specimens = 5
b.
GI suggested specimens
o Colectomy, ischemia, diverticulosis, perforation – 3
o IBD colon – 1
o Colon with polyps – 1
o Colectomy for cancer – 3
o Whipple – 1
o Explant liver – 1
o Gastrectomy – 1
o Esophagectomy/Esophagogastrectomy – 1
o TOTAL REQUIRED Large Sized GI Specimens = 12
c.
Breast/GU suggested specimens
o Mastectomy for cancer – 4
o Cystectomy – 1
o Cystoprostatectomy – 1
o Nephrectomy – 1
o Prostatectomy – 3
o TOTAL REQUIRED Large Sized Breast/GU Specimens = 10
d.
Head/Neck suggested specimens
o Radical neck dissection – 1
o Larynx/glossectomy and other large head and neck dissections
–3
o TOTAL REQUIRED Large Sized Head/Neck Specimens = 4
e.
Bone/Soft Tissue suggested specimens
o Large soft tissue mass – 2
o Bone tumor – 1
o TOTAL REQUIRED Large sized Bone/Soft Tissue
Specimens = 3
f.
Thoracic suggested specimens
o Lobectomy/Pneumonectomy – 2
o TOTAL REQUIRED Large Sized Thoracic Specimens = 2
81
Appendix 2
Estimated time commitment at gross room bench during gross room rotation
Small biopsies – 100 specimens at ~5 minutes/specimen = 500 minutes = 9
hours
Medium sized specimens – 53 specimens at ~20 minutes/specimen =
1060 minutes = 18 hours
Large sized specimens – 36 specimens at ~2hours/specimen = 72 hours
Total number of hours = 100 hours
Total number of hours/day calculated based on 20 work days per month =
5 hours
Total number of hours/day calculated based on 15 work days per month (If one week of
vacation/leave is taken) = 7 hours
82
AUTOPSY PATHOLOGY ROTATION
A. Duration.
1st Year Resident: 4 weeks of the Introduction to Anatomic Pathology Rotation, and
12 weeks of the regular Autopsy Rotation.
B. Teaching Faculty Responsible for Supervision and Instruction.
1. Patricia A. Allenby, M.D.
2. Sergey V. Brodsky, M.D., Ph.D.
3. Charles L. Hitchcock, M.D., Ph.D., Director
4. Stephen Moore, M.D. (weekend only)
5. Abhik Ray-Chaudhury, M.D. (neuropathology only)
6. Konstantin Shilo, M.D.
C. Objectives.
By the end of the rotation, the resident will be able to meet the following objectives.
1. By the end of the 5th case, independently provide a thorough written summary of
a patient’s clinical records that take into account all of the following: progress
notes, operation notes, radiologic findings, and laboratory results.
2. By the end of the 5th case, based on the clinical review, plan an autopsy that
includes special studies and expected findings.
3. By the end of the 5th case, write a coherent preliminary note that includes a
thorough review of the patient’s clinical record and gross and any histopathologic
findings made at autopsy.
4. By the end of the 10th case, write a final autopsy report that coherently explains
the underlying and immediate anatomic causes of death, as well as integrates
the gross and microscopic findings with the clinical summary.
5. By the end of the 1st month, master effective communication of pathologic
findings and their clinical implications to colleagues during the weekly Autopsy
Teaching Conference and the weekly Brain Cutting Conference.
6. By the end of the rotation, perform all aspects of the autopsy to include taking of
the brain, incision and evisceration, blood, tissue and ocular fluids for special
studies, and sampling of the appropriate organs for the case
7. By the end of the rotation, be able to recognize, sample, and diagnose the
pathologic lesions encountered during the autopsy.
8. By the end of the rotation, make accurate microscopic diagnoses of the common
pulmonary, cardiac, renal, pancreatic, and hepatic findings.
83
D. Specific Goals
1. General: Competencies identified with an “*” must be demonstrated before the
resident is allowed to perform an autopsy with indirect supervision with direct
supervision available.
2. PATIENT CARE: Residents must be able to provide patient care that is
compassionate, appropriate, and effective for the treatment of health problems
and the promotion of health. In the context of pathology, residents must
demonstrate a satisfactory level of diagnostic competence and the ability to
provide appropriate and effective consultation. Residents should be able to:
* Determine that an autopsy permit is valid, determine that the appropriate next
of kin, as defined by statute, have signed the permit, and noted restrictions.
* Adhere to and apply universal precautions in the autopsy room.
* Perform an external examination of the body, appropriate for the
circumstances, including positive patient identification.
* Know how to take macroscopic photographs (and photomicrographs) that
adequately document pertinent positive and negative findings.
Perform a routine autopsy utilizing standard dissection techniques, e.g.,
Virchow and Letulle/Rokitansky types, in such a way that it will not
compromise preparation and viewing of the body at a funeral.
Open the heart appropriately along the pathway of blood flow.
For cases of suspected acute myocardial infarction, cut ventricles parallel to
base and understand the use and limitations of TTC solution.
As necessary, remove and dissect coronary arteries and bypass grafts and
decalcify to demonstrate vascular pathology.
Remove and inflate lungs with formalin and other solutions as needed.
Dissect pulmonary arterial tree to demonstrate thromboemboli and webs.
Dissect the entire gastrointestinal tract.
Dissect the biliary tree maintaining appropriate relationships of gallbladder,
bile ducts, pancreas and ampulla.
Dissect the kidneys, ureters, bladder and, in males, the prostate, maintaining
continuity of organs for demonstration.
Dissect the female reproductive organs.
Examine the testes in males.
Examine the breasts in females and males.
84
Dissect the thyroid and, as appropriate, the parathyroid glands.
Remove the tongue and tonsils when appropriate.
Obtain samples of bones, bone marrow, peripheral nerve, and striated
muscle.
Dissect the calf veins in cases of suspected pulmonary emboli.
Remove the brain in adult, pediatric and perinatal cases, using electric saw
and hand tools as appropriate.
Be familiar with methods to remove the spinal cord partially by anterior
approach, intact by posterior approach and via foramen magnum with cord
extractor.
Weigh all organs and dictate a detailed gross description of major organs and
organ systems.
Be familiar with special dissection techniques such as removing eyes, middle
and inner ears, paranasal sinuses, and bones and joints as permitted by
regulations of the institution, laws of the state, and wording of the autopsy
permit.
Obtain spinal fluid using sterile technique.
Obtain vitreous humor (medical legal cases and/or forensic rotation).
Select appropriate tissues for histologic examination.
Know how to order and use appropriate special stains,
immunohistochemistry, electron microscopy, and selection of materials for
freezing or flow cytometry as appropriate.
Formulate diagnoses based on gross and microscopic examination.
Prepare well-organized, thorough preliminary autopsy report.
Prepare final autopsy report combining and integrating gross and
microscopic diagnoses after review of case with staff pathologist.
Perform a pediatric and/or perinatal autopsy using appropriate physical
measurements such as crown-rump and head circumference, etc.
Examine placenta and incorporate findings into perinatal autopsy.
Obtain appropriate tissue for cytogenetics.
Independently perform all aspects of an autopsy at least five times by the end
of the rotation.
85
3. MEDICAL KNOWLEDGE: Residents must demonstrate knowledge about
established and evolving biomedical, clinical, and cognate (e.g., epidemiological
and social-behavioral) sciences and application of this knowledge to patient care
in pathology. Residents should be able to:
Abstract pertinent information from the medical record necessary to perform
a thorough autopsy and determine cause of death.
Determine which cases fall under the jurisdiction of the coroner.
Demonstrate an understanding of clinical signs, symptoms, and diagnostic
studies and how they manifest themselves in pathology identified at autopsy.
Demonstrate knowledge of the gross and microscopic manifestation of
disease by converting observations and findings at autopsy into diagnoses.
Prepare a thorough autopsy summary in which there is documentation of the
cause of death and a clinicopathological analysis, integrating an
understanding of the pathological basis for disease.
Perform an appropriate literature search to support pathologic findings.
4. PRACTICE-BASED LEARNING AND IMPROVEMENT: Residents must be able
to demonstrate the ability to investigate and evaluate their diagnostic and
consultative practices, appraise and assimilate scientific evidence, and improve
their patient care practices. They should be able to:
Actively search for previous pathology diagnoses within the anatomic
pathology database.
Make use of on-line resources to identify recent advances in understanding
disease processes manifested in a particular autopsy case.
Monitor their own case mix, such as numbers of adult, neonatal/pediatric, and
neuropathological cases, and types of diseases to assure a broad-based
exposure to both diagnostic and technical aspects of autopsy pathology.
Attend departmental Autopsy Teaching and Brain Cutting conferences in
order to maximize exposure to findings of different diseases.
Accept and learn from constructive feedback and guidance from staff
physicians, clinicians, laboratory supervisors, pathologists’ assistants (PA),
anatomic pathology technicians (APT), and house staff colleagues, and
modify behavior as appropriate.
86
5. INTERPERSONAL AND COMMUNICATION SKILLS: Residents must be able
to demonstrate interpersonal and communication skills that result in effective
information exchange in teaming with other health care providers, patients, and
patient’s families. Residents should be able to:
* Present a concise organized clinical summary of the patient’s history to the
attending pathologist prior to beginning the autopsy.
Contact members of the clinical team and/or primary care provider prior to
beginning the autopsy and elicit appropriate key information about the
patient’s medical history and determine specific questions to be addressed
during the autopsy.
Consult and interact with pathologist assistants (PA), anatomic pathology
technicians (APT), medical students, and fellow residents during the
performance of a case to obtain assistance without losing primary
responsibility for the case.
Prepare and present cases at the Autopsy Teaching Conference with
synoptic clinical history and appropriate selection of organs for illustration of
gross pathology.
Prepare and present cases at Brain Cutting Conference with synoptic clinical
history.
Teach fellow residents, medical students and pathology assistants (PA) in
various aspects of autopsy practice and the pathologic evaluation of organs
and tissue.
Write a well-organized and grammatically correct final report with accurate
listing of findings, mechanism of death, immediate and underlying causes of
death, and clear presentation clinicopathologic correlation as warranted, but
which does not overly criticize or inflame a potential reader with regard to the
quality of clinical care.
Communicate autopsy findings to clinicians and staff pathologists.
Meet or speak with families of the deceased to discuss findings in an open
and supportive atmosphere (with appropriate supervision).
6. PROFESSIONALISM: Residents must demonstrate a commitment to carrying
out professional responsibilities, adherence to ethical principles, and sensitivity to
a diverse patient population. Resident should:
Where appropriate, be able to assist clinicians and family members in
obtaining proper informed consent for performance of an autopsy.
Demonstrate unconditional respect for the body of the deceased patient.
87
Demonstrate respect for clinical colleagues, ancillary laboratory staff, and the
medical profession.
Promote the efficient, thorough, and expeditious performance of an autopsy
so as not to compromise family funeral arrangements or departmental work
schedules.
Demonstrate an understanding of the importance of preserving patient
privacy and confidentiality in the performance of the autopsy.
Gain a working knowledge of universal safety precautions and protect the
safety of all employees taking part in the performance of a given autopsy.
Interact with and help fellow residents needing assistance in the performing of
autopsies in order to assure efficient running of the service.
Respect the clinician’s interpretations of patient care and consider the case
from their point of view when dealing with apparent discrepancies.
Interact with clinical colleagues in a non-confrontational and professional
manner in discussing issues of appropriateness of clinical care with reference
to the case at hand.
Demonstrate an ability to communicate with family members regarding
autopsies in general, and in particular, the findings of the case.
7. SYSTEMS-BASED PRACTICE: Residents must demonstrate an awareness of
and responsiveness to the larger context and system of health care and the
ability to call on system resources to provide pathology services that are of
optimal value. Pathologists occupy a unique position with health care delivery.
Free from the day-to-day details of direct patient care delivery, pathologists have
the opportunity and obligation to analyze and explore human disease. Residents
should acquire the ability to assume this role by learning to:
Actively seek out additional clinical/laboratory information by consulting
patient care information systems within the hospital and consulting with
clinicians.
Demonstrate an awareness of regulations such as CLIA (Clinical Laboratories
Improvement Act), HIPAA (Health Insurance Portability and Accountability
Act) Privacy and Security rules, and CAP laboratory accreditation standards.
Advocate for the role of the autopsy in performance improvement, promoting
the practice of obtaining autopsy permissions to other departments within the
institution.
Complete the preliminary autopsy report within 2 working days and, for the
majority of cases, the final autopsy report within 30 working days such that
88
the findings can be released to family and clinicians per CAP laboratory
accreditation standards.
Collaborate with other members of the health care team to improve patient
care by learning from the autopsy results and developing evidence-based
health care delivery strategies.
Demonstrate judicious use of special procedures such as freezing and
retaining tissues and performing cultures to assure accurate diagnoses
without over utilizing laboratory resources.
Understand how diagnoses are coded for retrieval by a lab information
system and how to retrieve diagnoses for use in studying human disease
while maintaining patient confidentiality.
Understand the role of the autopsy in quality assurance and risk
management.
Curriculum.
1. Introduction to Anatomic Pathology Rotation.
a. This is the first 4 week rotation for a resident entering the program in July of
their PGY 1 year.
b. Each resident will conduct at least three autopsies under direct supervision of
the attending pathologist and anatomic pathology technician.
c. The resident is responsible for assigned material including a recent autopsy
performance manual, CAP-approved autopsy practice guidelines and the
CAP Autopsy Performance and Reporting manual.
d. A series of lectures and demonstrations will be provided on universal
precautions, safety, autopsy permission, performing an adult and
fetal/perinatal autopsy, autopsy microbiology and toxicology, access to
electronic medical records and images, and photography.
2. Autopsy Rotations
a. The 12 week rotation on Autopsy Services provides autopsy experience at
OSU with adult, fetal, and neonatal cases from both within and outside the
OSU system.
b. Four week rotation at Columbus Children's Hospital provides pediatric
autopsy experience.
c. Four week rotation at the Franklin County Coroner's office provides
experience with forensic autopsies during the 3rd year.
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3. Quality Assurance
a. The organization of the Autopsy Pathology Rotation quality assurance
program is discussed during the Introduction to Anatomic Pathology early in
the rotation, and the resident will attend all faculty and staff meeting held
during their rotation where these issues are discussed.
b. By the end of the rotation the resident will have reviewed with an attending
pathologist
1) monthly report of discrepant findings
2) updated TAT spreadsheet
3) pathologist indicators
4. Laboratory Management
a. Issues in management are discussed throughout the course of the rotation.
b. Attend monthly Autopsy Service faculty and staff meetings.
5. Teaching by Residents
a. First year residents are involved in teaching 3rd and 4th-year medical students
who elect to spend one month in Autopsy Services.
6. Opportunity for Scholarly Activity
a. In preparation for presentations at the Autopsy Teaching Conference,
residents review the literature pertinent to a specific aspect of the autopsy. A
literature review is also done in the course of preparing the final report for
many autopsies and references are included in the report.
b. Residents are encouraged to actively participate in preparation of
manuscripts of both interesting cases and in-depth analysis judged to be
worthy by the teaching faculty.
7. Autopsy Related Conferences
a. Wednesday 4 PM Autopsy Teaching Conference is a mandatory
conference where the resident will review the pertinent history and gross
autopsy findings with those attendings, house staff, and medical students in
attendance.
b. The Brain Cutting Conference, held at noon on Thursdays, is a mandatory
conference conducted by a Neuropathologist who reviews the morphologic
features and significance of all pathologic findings. The residents also
receive instruction on and perform brain dissections and selection of tissue
for histological preparation.
c. Perinatal conferences are held weekly. Pathology residents and faculty
occasionally present pertinent autopsy findings and clinical-pathologic
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correlation. This is a joint conference including Obstetrics & Gynecology and
Neonatology.
F. Resident Supervision
1. Each day a member of the teaching faculty is assigned as the Attending Autopsy
Pathologist.
a. The attending pathologist is responsible for the performance of the autopsy,
as well as subsequent preparation of the preliminary and final autopsy reports
for every autopsy performed on his or her assigned days.
b. Each resident will require direct supervision for at least three autopsies, or
until they meet the competencies noted in the Specific Goals.
c. After a resident has met the necessary competencies, the attending
pathologist will provide indirect supervision with direct supervision available.
2. Before the autopsy is performed the attending pathologist will work with the
resident to:
a. Review the autopsy permit to determine the legality.
b. Review the patient's clinical history/course to assist in developing a list of
clinical problems to be addressed during the autopsy, and the resident’s plan
for special studies.
3. After the resident has demonstrated the necessary competencies in at least three
autopsies, the attending pathologist will be available during the entire procedure
and in attendance for critical parts of the autopsy procedure.
a. As the resident gains experience, he or she is provided the opportunity to
work more independently during prosection.
b. The autopsy pathologist and/or APT/PA will be available to assist in
photographic documentation.
4. The attending pathologist will work with the resident to issue a Preliminary
Autopsy Report within 48 hours of the autopsy.
5. The attending pathologist will be available for selection of tissue samples for
histology.
6. After an initial review by the resident, the attending pathologist will review all of
histopathology findings and help to select the appropriate special stains needed
to define the pathologic processes of a case.
7. The attending pathologist will work with the resident to issue a Final Autopsy
Report within 30 working days of the autopsy.
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G. Resident Responsibilities and Procedures to be Accomplished
1. Check the legality of the autopsy permit and have the permit reviewed by the
responsible autopsy pathologist.
2. Review the clinical history and available imaging studies to develop a list of the
clinical problems to be addressed at autopsy; contact the clinical house-staff
before beginning the autopsy.
3. Develop a plan or approach for examining the clinical problems including special
dissections and special studies.
4. Identify the body by checking the attached name tag, usually attached to a toe.
5. Following the guidelines provided in the Autopsy Service Manual, perform the
autopsy dissections to include external examination, and, when possible, the Y
incision, tying off of vessels, evisceration, removal of the brain and, when
needed, the spinal cord.
a. Collect and properly label tissue and fluid samples for appropriate special
studies (e.g. cytogenetics, electron microscopy, frozen section, cytology,
toxicology, immunofluorescence, and/or culture).
b. Review appropriate radiographic and laboratory findings.
c. Carefully examine each organ for a disease process.
d. Obtain appropriate digital images of gross pathologic findings.
e. Select appropriate tissue samples to save for tissue archives and the Autopsy
Teaching Conference.
6. Present the gross pathologic findings and results of immediate special studies
(touch preparations, frozen sections, etc.) with the Attending Autopsy Pathologist
immediately after the dissections are completed.
7. Contact the clinical attending physician and/or residents as soon as possible
after the autopsy and report the preliminary findings.
8. Prepare and review with the Attending Autopsy Pathologist the Preliminary
Autopsy Report that includes a concise, but thorough, summary of clinical history
and gross anatomic findings in a logical sequence. This report must be signed
out within 2 working days of completing the autopsy.
9. Sample appropriate lesions and normal tissue for histology.
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10. Prepare/dictate a complete and accurate gross description of the organs and
cavities.
11. Present the clinical histories and preliminary gross autopsy findings at the
Autopsy Teaching Conference.
12. Attend brain cutting conference, cut brains, and select tissue for histology.
13. Prepare a list of tissue diagnoses for each of the histopathology slides submitted,
and review these findings with the attending pathologist for that case.
14. Within 25 working days after performance of the autopsy, prepare the final
diagnoses, final autopsy note with pertinent references when indicated, and
review the report with the attending pathologist for that case.
15. Proofread the final autopsy report after final typing.
16. By the end of the rotation, assist in preparation of manuscripts for publication
developed from personal autopsy experience.
17. By the end of the rotation, assist in the education of medical students and PA
students on the service.
18. By the end of the service, perform all aspects of the autopsy with minimal faculty
and diener involvement.
I. Responsibilities of the Attending Pathologist
1. The attending pathologist has overall responsibility for performance and reporting
of the autopsy.
2. Approve the autopsy permit – appropriate signatures and any limitations. This
will be repeated during the Time Out procedure.
3. Insure proper body identification.
4. Review the patient's clinical history, clinical problems and autopsy plan with the
resident.
a. Check to be sure that clinical physicians have been contacted prior to
beginning the autopsy.
b. Plan for ancillary studies
5. Be readily available during the autopsy procedure and be in attendance during
critical parts of the autopsy.
a. In attendance throughout HIV (+), TB (+), and hepatitis virus (+) cases,
(Neuropathologist and APT/PA only).
93
b. Review external examination and exposure of the internal organs prior to
evisceration.
c. Be available for immediate consultation.
6. At completion of the autopsy
a. Review the gross findings with the resident.
b. Determine the tissue specimens to be retained.
c. Determine if any photographs are needed.
7. Discuss the diagnoses and their listing, as well as the immediate and underlying
causes of death.
8. Contact the clinical attending physician as soon as possible after the autopsy
(unless done by the resident) to report the preliminary autopsy findings.
9. Review the preliminary report and insure that it is completed within two working
days.
10. Review the histology and final autopsy report with the resident for language,
accuracy, and completeness.
11. Insure that the following CAP mandated deadlines are met
a. 50% + 1 of cases are signed out within 30 working days
b. 100% of cases are signed out within 60 working days, or document extending
circumstances
12. Provide instruction during the autopsy, histology review, and final autopsy report
review.
13. Whenever possible, attend the Autopsy Teaching Conference. It is particularly
important for the responsible faculty to be present when his or her cases are
being discussed.
J.
Methods for Resident Evaluation
1. Each resident on the service will be evaluated according to the previously noted
Specific Goals.
2. By the end of the 12 week rotation, the resident will be able to perform each
major component of the autopsy – incision of the head and body, brain removal,
block removal, block dissection, and suturing of the body – at least five times.
3. Subjective Evaluations
a. Resident presentations at the Autopsy Education Conference will be
evaluated based on:
1) The ability of the resident to clearly describe the clinical case as he/she
94
knows it
2) To clearly demonstrate the relevant autopsy findings
3) To demonstrate an understanding of the underlying mechanism, including
immediate and underlying causes of death, of the patient’s disease
process when questioned.
b. Evaluation of the final autopsy report will be based on:
1) Clear and accurate listing of the Final Diagnosis in the order of underlying
cause of death, immediate cause of death, and other findings.
2) Clear and accurate description of the Gross Autopsy Findings.
3) Clear and accurate description of the Microscopic Findings.
4) Clear and accurate description of the Special Studies Findings.
5) Clear and accurate Final Note that includes:
a) Clear and accurate description of the patient’s clinical history and
clinical course.
b) Integration of the gross and microscopic findings, and the findings from
special studies, with the patient’s clinical course.
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LABORATORY HEMATOPATHOLOGY
A.
The rotation in Laboratory Hematopathology is designed for a 14 week period of
time during the first clinical pathology (CP) year and eight weeks during the
second CP year. This includes 2 weeks at The Children’s Hospital focusing on
pediatric hematopathology.
B.
Teaching Faculty:
C.
Learning Objectives of the Rotation
1.
Amy S. Gewirtz, MD
Samir Kahwash, MD
Gerard Lozanski, MD
Frederick Racke, MD
Arwa Shana’ah, MD
Haifeng Wu, MD
Weiqiang John Zhao, MD, PhD
Patient Care
Residents must demonstrate a satisfactory level of diagnostic competence
and the ability to provide appropriate and effective consultation in the
context of pathology services. This includes being able to gather essential
and accurate information about their patients and/or patient specimens.
They should perform competently the medical and invasive procedures
considered essential for hematopathology. They should use information
technology to support diagnostic decisions and work with health care
professionals, including those from other disciplines, to provide patientfocused care. Specific areas of patient care of particular importance
include but are not limited to those listed below.
a.
b.
c.
d.
e.
f.
g.
Review and interpret hemostasis evaluations.
Review and interpret abnormal peripheral blood and body fluid
smears.
Review and interpret immunophenotyping cases.
Review and interpret bone marrow biopsies and other tissues
involved by hematolymphoid diseases.
Review and interpret hemoglobin electrophoreses
Review and discuss 1-5 with attending faculty on a daily basis.
Be available to clear "special" procedures and communicate the
results.
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2. Medical Knowledge
Residents must demonstrate knowledge about established and evolving
biomedical, clinical and cognate (e.g. epidemiological and social-behavioral)
sciences and the application of this knowledge to hematopathology. A
comprehensive examination will be taken at the end of the rotation. Below is
the complete list of material that the residents should acquire during their
rotations in hematology.
I. Hemostasis
A.
Understand basic mechanisms including:
1.
2.
3.
4.
5.
6.
7.
B.
Discuss testing procedures including:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
16.
17.
18.
19.
C.
Platelet function and physiology
Vessel wall function and physiology
Coagulation physiology
Fibrinolytic system physiology
Protein C system
Serine protease inhibitors
Tissue factor pathway inhibitor
PT, APTT
Thrombin time and reptilase time
Fibrinogen by clotting and immunologic techniques
Factor assays
Inhibitor evaluation
Fibrinogen degradation products including D-dimers
Platelet aggregation
PFA-100
Antithrombin III
Protein C
Protein S
Plasminogen
Alpha-2-antiplasmin
Factor XIII
Euglobulin clot lysis time
Crossed immunoelectrophoresis
Antiphospholipid antibody assays
Evaluation for heparin-induced thrombocytopenia
Know the criteria for diagnosis, clinical and laboratory
findings of and differential diagnosis for:
97
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
D.
Hereditary factor deficiencies
DIC
Liver disease
Acquired vitamin K deficiency
Heparin effect
Coumadin effect
Dysfibrinogenemia
Lupus anticoagulant
Specific factor inhibitors
Effect of monoclonal proteins
ITP
TTP and HUS
Von Willebrand's disease
Bernard-Soulier syndrome
Glanzmann's thrombasthenia
Storage pool defects
Release defects
Drug-induced platelet disorders
Acquired thrombotic tendency
Uremia
Effect of cardiopulmonary bypass on hemostasis
Hereditary thrombotic disorders
Antiphospholipid antibody syndrome
Heparin-induced thrombocytopenia
Understand the indications and mechanisms for the following
therapeutic agents:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Heparin
Oral anticoagulants
Direct thrombin inhibitors
FFP
Cryoprecipitate
Platelet concentrates
Vitamin K
AHF (factor VIII) concentrates
Factor IX concentrates
Activated Factor IX concentrates
DDAVP (desmopressin)
Fibrinolytic inhibitors
Fibrinolytic therapy (streptokinase, urokinase and
TPA)
98
II. Red Cell Disorders
A.
Understand function and development of RBC's
1.
2.
3.
4.
5.
6.
7.
B.
Describe the following testing procedures:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
C.
Morphology of red cell development
Synthesis of heme
Synthesis of globin
Red cell metabolism
Functional characteristics of hemoglobin
2,3-DPG
Structure and function of red cell membrane
Cell counting techniques and indices
Wright stain morphology, including bone marrow
Reticulocyte stain and counting
Iron stain
Osmotic fragility
Evaluation of PNH
Hemoglobin electrophoresis: alkaline and acidic
Evaluation of sickle cell disorders
Evaluation of Hgb, A2, and F
B12 and folate
Serum iron, TIBC, and ferritin
Erythrocyte sedimentation rate
Porphyrin metabolism
Heinz body staining
Reticulocyte staining
Know the criteria for diagnosis, clinical and laboratory findings of and
differential diagnosis for:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Iron deficiency anemia
Megaloblastic anemia
Anemia of chronic disease
Aplastic anemia
Anemia of liver disease
Other hypoplastic anemias
Hereditary spherocytosis
Hereditary elliptocytosis
Hereditary pyropoikilocytosis
Thalassemias
Hemoglobinopathies
Metabolic defects
99
13.
14.
15.
16.
17.
Extrinsic hemolysis - immune mediated
Infections, e.g. malaria
Sideroblastic anemias
Paroxysmal nocturnal hemoglobinuria
Microangiopathic hemolytic anemias
III. White Cell Disorders
A.
Understand myeloid differentiation and function
1.
2.
3.
B.
Describe the following testing procedures:
1.
2.
3.
4.
5.
6.
7.
C.
Cell counting techniques, including eosinophil counts
Wright stain morphology, peripheral blood and bone
marrow
H & E morphology, bone marrow
Cytochemistries, including peroxidase, Sudan Black
B, specific esterase and non-specific esterase
Nitro blue tetrazolium
Leukocyte alkaline phosphatase
Immunologic phenotyping
Understand lymphocyte function, development and testing
1.
2.
3.
4.
5.
6.
D.
Development of neutrophil, basophil, eosinophil and
monocyte cell lines
Morphologic variants, including Pelger-Huet,
Chediak-Higashi, Alder-Reilly, May-Hegglin
Process of phagocytosis and digestion
T & B cell lines
Wright stain morphology, peripheral blood and bone
marrow
H & E morphology, bone marrow
Acid phosphatase
PAS stain
Immunologic phenotyping
Know the criteria for diagnosis, clinical and laboratory findings of and
differential diagnosis for:
1.
2.
3.
Etiology for quantitative problems of neutrophils,
eosinophils, basophils, monocytes, and lymphocytes
Leukemoid reactions
Chediak-Higashi syndrome
100
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Membrane abnormalities associated with infection
Chronic granulomatous disease
Acquired causes of neutrophil dysfunction
Acute myelogenous leukemia
Chronic myelogenous leukemia
Precursor B and T lymphoblastic leukemia/lymphoma
Prolymphocytic leukemia
Chronic lymphocytic leukemia
Myelofibrosis
Polycythemia rubra vera
Essential thrombocythemia
Chronic myelomonocytic leukemia
Myelodysplastic syndromes
Hairy cell leukemia
Non-Hodgkin lymphoma
Hodgkin lymphoma
T cell lymphoproliferative disorders, including large
granular lymphocytosis
Metastatic carcinoma
Granulomatous disorders of bone marrow
Plasmacytosis
Multiple myeloma
Waldenstrom's macroglobulinemia
Systemic mastocytosis
Mycosis fungoides/Sezary syndrome
IV. Cytogenetics
A.
Define cytogenetic defects in hematopoietic malignancies and their
role in diagnosis and management
1.
2.
3.
4.
5.
6.
7.
8.
Myeloproliferative disorders
AML
Myelodysplasia
Myeloproliferative/myelodysplastic disorders
Burkitt lymphoma
Precursor B and T lymphoblastic leukemia/lymphoma
Non-Hodgkin’s Lymphomas (B and T cell types)
Plasma cell neoplasms
V. Flow Cytometry
A.
Define the utility and abnormalities of flow cytometric
immunophenotypic analysis in the diagnosis of
101
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Myeloproliferative disorders
AML
Myelodysplasia
Burkitt lymphoma
Precursor B and T lymphoblastic leukemia/lymphoma
Non-Hodgkin Lymphomas (B and T cell types)
Plasma cell neoplasms
Paroxysmal nocturnal hemoglobinuria
Idiopathic thrombocytopenic purpura
Stem cell collection
VI. Clinical Microscopy
A.
B.
C.
Urinalysis
1.
2.
3.
4.
Identify normal and abnormal cells in urine
Identify casts which may be found in urine
Identify crystals which may be found in urine
Understand techniques for urine chemistries (dipstick)
1.
2.
Know the role of protein determination and analysis
Be able to identify:
a.
Inflammatory reactions
b.
Malignancy in CSF
c.
Infectious disorders
CSF
Pleural, pericardial, peritoneal
1.
2.
D.
Know the role of protein analysis
Be able to identify:
a.
Inflammatory and reactive processes
b.
Malignant processes
c.
Infectious processes
Joint fluid
1.
2.
3.
Be able to identify normal and abnormal cells in
synovial fluid
Be able to identify crystals in synovial fluid
Identify infectious processes in synovial fluid
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3.
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and
evaluate their diagnostic and consultative practices, appraise and
assimilate scientific evidence and improve their patient care
practices
a.
Attend and participate in conferences, journal clubs, and grand
round activities that pertain to hematopathology. Apply knowledge
of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic effectiveness.
b.
Locate, appraise, and assimilate evidence from scientific studies
related to patient specimens. On particularly interesting or difficult
cases, residents will be asked to perform literature searches or
critically evaluate papers provided by attending on topics related to
patient’s disease.
c.
Obtain and use information about their own patients and the larger
population from which their patients are drawn. While not
mandatory, residents are encouraged to participate in research
projects or case reports related to patients they encounter or are an
area of expertise for an attending with which they wish to work.
d.
Use information technology to manage information, access on-line
medical information, and support their own education.
f.
Facilitate the learning of students and other health care
professionals.
g.
Correlation of Wright-stained body fluids with Cytopathology
results.
h.
Correlation of abnormal blood smear findings and bone marrow
findings with flow cytometry results
i.
Be able to compare current and previous pathology results to
understand treatment effects on disease processes.
j.
Correlate bone marrow results with other pathology on patients
k.
Understand the limitations of sub-optimal or inadequate bone
marrow specimens
4.
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication
skills that result in effective information exchange and teaming with other
health care providers.
a.
b.
Communication with clinicians to obtain history for interpretation of
test results and/or appropriateness of tests ordered
Communication with laboratory technologists about test methods,
additional test requests, etc.
103
c.
d.
e.
f.
5.
Communication of test results to clinicians and development of
consultative skills to maximize positive interaction with the clinical
staff.
Communication with attending pathologists about patient material
Write bone marrow reports that provide appropriate descriptions
and synthesize findings into a comprehensive diagnosis.
Participate in the ongoing teaching programs of the division and
department. Presentation of journal articles on
hematopathology/laboratory hematology topics at Journal Club
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
a.
b.
c.
6.
Demonstrate respect, compassion, and integrity; a responsiveness
to the needs of patients and society that supersedes self-interest;
accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development.
Demonstrate a commitment to ethical principles pertaining to
provision or withholding of clinical care, confidentiality of patient
information, informed consent, and business practices.
Handle patient specimens in a professional manner.
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 pathology services that are of optimal value.
a.
b.
c.
d.
e.
Understand how hematopathology tissue examinations fit into the
overall care and management of patients with hematological and
malignant conditions.
Know how types of medical practice and delivery systems differ
from one another, including methods of controlling health care
costs and allocating resources.
Understand cost-effective laboratory utilization in the evaluation of
hematologic disorders.
Advocate for quality patient care and assist others in dealing with
system complexities.
Be familiar with Laboratory Information System and entry/retrieval
of laboratory results, including hematology information system
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The initial resident rotation in the Hematology Laboratory is designed to
give the resident an in-depth introduction to clinical hematopathology. The
resident is expected to make use of the available resources and is
responsible for reading suggested material in the basic areas of
hematopathology.
The resident rotation during the second clinical pathology year builds on the
knowledge acquired during the first year. The residents are expected to
perform at a higher level, with greater efficiency and with greater
independence. In addition, as the residents gain experience, they participate
in the teaching of their younger colleagues.
D.
Curriculum for the Rotation
1.
Statement of educational philosophy: The rotation is designed to be a
"hands-on," case-oriented learning experience for the resident. In addition
to the teaching- learning process which occurs through the case discussion
method, the resident is expected to construct a self-directed reading
program to cover the major areas of hematology. An example of such a
program is attached. Reference materials (see attached list) are readily
available to the resident.
2.
Methods of achieving goals:
a.
Extensive discussions of current cases which span the range of
hematologic problems. Case material available on an annual basis
is approximately:
2300 Bone marrow biopsies
3800 Body fluid samples
1200 Coagulation consults
1703 Abnormal peripheral smears
700 Hemoglobinopathy evaluations
4500 Flow cytometry immunophenotyping evaluations
480 Hematopoietic neoplasms in lymph nodes and tissues
2500 Cytogenetic interpretations relating to hematologic
specimens
b.
One-on-one discussions of topics between faculty and resident.
These occur regularly during the rotation and are designed to cover
the major areas in hematopathology. Topics covered include (but
are not limited to):
Differential diagnosis of anemia
Laboratory approach to the diagnosis of anemia
Interpretation of hemoglobin electrophoresis
Measurement of hemoglobin A2
105
Differential diagnosis of polycythemia
Differential diagnosis of neutrophilia, eosinophilia,
monocytosis, basophilia
Differential diagnosis of lymphocytosis
Classifications and diagnosis of acute leukemias
Classification and diagnosis of chronic myeloproliferative
disorders
Classification and diagnosis of chronic myelodysplastic
syndromes
Diagnosis of chronic lymphocytic leukemia
Classification and diagnosis of other lymphoproliferative
disorders
Non-malignant morphologic abnormalities of WBC's
Automated blood cell counters
Mechanisms of hemostasis
Screening tests of hemostasis (PFA-100, PT, APTT, platelet
count)
Hereditary platelet disorders
Acquired platelet disorders
Hereditary coagulation disorders
Acquired coagulation disorders
Performance of factor assays
Evaluation of circulating anticoagulants
Monitoring anticoagulant therapy
Evaluation of cerebrospinal fluid
Evaluation of synovial fluid
Evaluation of serous fluids
Urinalysis
Cytogenetic abnormalities associated with hematologic
malignancies
3.
c.
Resident self-directed reading program. The resident is encouraged
to develop his/her own program to cover the major areas of
hematology. Questions which arise from this program are answered
during staff-resident interaction sessions.
d.
Through use of teaching files of case material; approximately 1000
cases reflecting the spectrum of hematopathology are available for
review and study.
Laboratory Management
The resident participates in discussions concerning commonly occurring
problems in the hematology laboratory including:
Personnel issues
106
Development of test procedures
Recognizing discordant results as a marker of test problems
Use of the Laboratory Information System (LIS)
4.
Quality Assurance
Issues of quality assurance are discussed during the rotation, usually on a
case-oriented approach. The resident is actively involved in working
through and acquiring data to resolve problems related to Quality
Assurance.
5.
Data Processing
The flow of data through the laboratory is reviewed with the resident.
Various programs of the LIS are taught to the resident. Through solving of
clinical problems, the resident becomes very familiar with the patient
database kept in the LIS.
6.
Teaching of Other Residents/Medical Students
The resident reviews clinical case material with medical students rotating
through the laboratory. At the appropriate level the resident may actively
teach morphology and hemostasis to medical students. The resident
presents case discussions to fellow residents on a regular basis at Clinical
Pathology Case Conference.
7.
Opportunity for Scholarly Activity
The resident is encouraged to participate in many of the ongoing projects in
the laboratory. However, due to the workload and amount of material to be
covered during the rotation, such efforts usually occur during a subsequent
elective rotation in the laboratory.
E.
Supervision of Resident
As indicated in section (F), the resident is responsible for initial review of the case
material. Each case is then reviewed with the attending pathologist who signs off
on the case. During the initial stages of the rotation, an approach to solving the
problem is discussed with the attending. With experience, the resident is expected
to devise his/her own approach and gather the necessary data to solve the
problem and prepare a consultative report as needed. Similarly, a plan of action,
including communication with the physicians primarily responsible for the patient's
care, is discussed. With experience, the resident is expected to develop and carry
out this plan.
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The attending staff "on service" is available throughout the day to assist in this
process. Two major periods of "sign-out" are used during the day to review clinical
hematology cases; late morning and late afternoon. Bone marrow biopsies are
reviewed in the early afternoon.
G.
Pathology Faculty Responsibilities
The faculty shares coverage of the Division of Laboratory Hematology on a
rotation basis. The faculty member on service for laboratory hematology is
responsible for:
1.
2.
3.
4.
Review and sign-out of clinical cases with residents. This includes:
coagulation consults, body fluid analysis, peripheral blood film cases,
abnormal hemoglobin electrophoreses and other problem cases (e.g. QA
cases) as they arise, including discussion of techniques for handling the
various cases.
Discuss target topics as outlined in II.D.
Participate in Clinical Pathology Conferences and Lectures related to
hematopathology.
Be available to answer and assist with questions that may arise during the
day.
The faculty member on service for bone marrows is responsible for review and
sign-out of bone marrow biopsies with the resident. This includes discussion of
differential diagnosis, criteria for diagnosis, techniques for evaluating bone
marrows (e.g. special stains) and clinical implications of the diagnosis.
H.
Resident Evaluation
Residents will be given a global evaluation by the division director following each
month of the hematology rotation. This will include input from medical
technologists and others with whom the resident interacts (360 evaluation). At the
completion of the third hematology month in CP years 1 and 2 each resident will
be given a written exam which will include morphologic and laboratory test
interpretation of the various studies that the residents are exposed to during this
rotation. The results of this examination will be generally summarized in the
general comments section of the evaluation form. Any laboratory techniques
directly observed and or procedures/performed by the resident will be summarized
by the resident (experience tracking) and are to be included in the resident’s
portfolio of work products. It is highly recommended that the resident track the
numbers and types of cases that they personally review while on this rotation and
that this information is also placed in their portfolio.
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RESIDENT ON-CALL RESPONSIBILITIES
DIVISION OF LABORATORY HEMATOLOGY
Weekend call:
1.
2.
3.
Review and interpret DIC evaluations.
Review and interpret abnormal peripheral blood smears.
Review and interpret body fluid smears.
The above will be signed out with the attending physician.
4.
Be available to consult with clinicians regarding diagnostic workups and
interpretation of results.
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SUGGESTED READINGS FOR LABORATORY HEMATOLOGY
Reference Books:
Foucar K.
Bone Marrow Pathology, 1st Ed. ASCP Press, 1995
Henry JB (ed):
Clinical Diagnosis and Management by Laboratory Methods,
19th Ed. WB Saunders Co., 1996.
Howanitz JH, et al. (ed):
Laboratory Medicine: Test Selection and Interpretation.
Churchill Livingstone, 1991.
Hoffman R, et al. (ed):
Hematology: Basic Principles and Practice, 2nd Ed. Churchill
Livingstone, 1995.
Tumours of Haematopoietic and Lymphoid Tissues – WHO
Classification of Tumours
Jaffe ES, et al (ed):
Knowles DM (ed):
Neoplastic Hematopathology. Williams and Wilkins, 1992.
Kjeldsberg C & Knight J: Body Fluids, 3rd Ed. ASCP Press, 1993
Assignments:
Week 1-2: RBC disorders
Read Chapters 24-26 in Henry
Review hemoglobin electrophoresis
Week 4-6:
WBC disorders
Read Chapters 27 and 34 (Flow Cytometry) in Henry
Read selected review articles
Week 7:
Cytogenetics
Read Chapter 59 in Hoffman
Read NEJ Med 1993; 329: 177-189 and Blood 1993; 92: 691-703
Week 8-10: Hemostasis
Read Chapter 18 in Howanitz and Chapters 28 and 29 in Henry
Week 11:
Urinalysis
Read Chapter 18 in Henry
Week 12:
Body fluid analysis
Read Chapter 19 in Henry
Week 13:
Review and exam
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Hemepath Laboratory Check Off
Name_____________________________
The following laboratory tests should be reviewed/observed/performed by the resident during their time on the
hematopathology and flow service. The suggested timing listed corresponds to the reading assignments for the rotation,
however the items can be completed during any month including the introductory clinical pathology month. The role of
“observation” entails, review of the laboratory procedure, review of the basic principles of the assay with the technologist
and discussion of interpretive issues with a pathologist.
Activity
Competency
Assessed
First Month
1. Prepare a peripheral blood smear.
2. Prepare a buffy coat smear from peripheral blood.
3. Observe an ESR
4. Review principles of cell counting, Coulter histograms
5. Review indicators of spurious results
6. Perform a phase platelet count.
7. Review a differential on the Micro 21
Second Month
8. Observe/review the testing offered on the STA and the general principles
behind each test (PT, PTT, TT, fibrinogen, protein C, etc)
9. Observe a STA CLOT
10. Observe a phospholipid antibody test
11. Observe a dilute Russell viper venom test
12. Observe a factor assay/inhibitor titer
13. Observe PFA-100 assay
14. Observe a platelet aggregation study – HIT or standard aggregation
Third month
15. Observe/perform a fluid chamber count
16. Prepare a cytocentrifuge smear.
17. Perform a Gram stain on a decolorized cytocentrifuge preparation.
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Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Medical Knowledge
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Date
completed
18. Observe the automated urine dipstick analysis
19. Review urine sediment/kodachromes
20. Perform a peroxidase stain and non specific esterase stain
Fourth Month
21. Observe hemoglobin electrophoresis – both cellulose acetate and citrate
agar and HPLC
22. Observe quantitative hemoglobin A2, hemoglobin F
23. Observe a sickling test
Fifth Month
24. Review principles of procedures for hemolysis work up – osmotic fragility,
G-6-PD, DAT,
25. Review procedures for thick malaria prep
26. Completed 6 bone marrow aspirate and biopsy procedures while on the
flow month
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Patient Care Skills
Medical Knowledge
Patient Care Skills
Patient Care Skills
Patient Care Skills
Patient Care Skills
Medical Knowledge
Patient Care Skills
Patient Care Skills
DIVISION OF LABORATORY HEMATOLOGY
RESOURCES AVAILABLE
Reference Books
Henry: Clinical Diagnosis and Management by Laboratory Methods, 19 th Ed
Williams: Hematology
Hoffman: Hematology: Basic Principles and Practice
Colman: Hemostasis and Thrombosis, 3rd Ed
Hathaway & Goodnight: Disorders of Hemostasis and Thrombosis
Ratnof & Forbes: Disorders of Hemostasis
Thomson: Blood Coagulation and Hemostasis
Foucar: Bone Marrow Pathology
Naeim: Pathology of the Bone Marrow
Brunning & McKenna: Tumors of the Bone Marrow
Bunn & Forget: Hemoglobin: Molecular, Genetic and Clinical Aspects
Knowles: Neoplastic Hematopathology
Wintrobe: Clinical Hematology, 8th Ed.
McKenzie: Textbook of Hematology
Fairbanks: Hemoglobinopathies and Thalassemias
Glassy: Color Atlas of Hematology
Mandell, Douglas, Bennett: Principles and Practice of Infectious Disease
Kjeldsberg & Knight: Body Fluids
Kjeldsburg: Practical Diagnosis of Hematologic Disorders
Brunzel: Fundamentals of Urine and Body Fluid Analysis
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Hayhoe & Quaglino: Haematologic Cytochemistry
Gaiter: A Practical Handbook of Joint Fluid Analysis
Stamatoyanopoulos, Nienhuis, Majerus, Varmus: The Molecular Basis of Blood
Diseases
Jacobs: Laboratory Test Handbook with DRG Index
Freeman: Laboratory Medicine Clinical Microscopy
Koneman: Color Atlas and Textbook of Diagnostic Microbiology, 3rd Ed.
Loukopoulos: Prenatal Diagnosis of Thalassemic and the Hemoglobinopathies
Heim: Cancer Cytogenetics
Ringsrud: Urinalysis and Body Fluids
Triplett: Platelet Function: Laboratory Evaluation and Clinical Application
Wellington: An Atlas of Urinary Sediment (x2)
Bowie & Sharp: Hemostasis and Thrombosis
Abramson: Sickle Cell Disease
Friedman: Effects of Disease on Clinical Laboratory Tests
Bloom & Thomas: Hemostasis and Thrombosis, 2nd Ed.
Rywlon: Histopathology of the Bone Marrow
Warnke: Tumors of the Lymph Node and Spleen
Schmidt: Abnormal Haemaglobins and Thalassemia
Young: Effects of Preanalytical Variables on Clinical Laboratory Tests
Dorland: Medical Dictionary
Simson: Atlas of Automated Cytochemical Hematology
Prankerd: Clinics in Hematology: Hemolytic Anemias
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Spaet: Progress in Hemostasis and Thrombosis, Vol. 6 & 7
Diggs: The Morphology of Human Blood Cells
Rodgers: Case Studies in Hemostasis
McKay: Disseminated Intravascular Hemolysis
Young: Effects of Drugs on Clinical Laboratory Tests, 4th Ed.
Jaroff: The New Genetics – The Human Genome Project and Its Impact on the Practice
of Medicine
Merck: Antiplatelet and Antithrombotic Prescribing Guide (x2)
Caldwell: Evaluation of Peripheral Blood Lymphocytosis
Boggs: White Cell Manual, 4th Ed.
Coulter Diagnostics: Hematology Quality Control
Coulter Diagnostics: Moving To Standard Deviation: A New Type Quality Control
Program
OSUMC: Transfusion Service “On Call” Manual
Kessler: Acquired Hemophilia, 2nd Ed.
Green: Acquired Hemophilia Continuing Medical Education Monograph
Azuz: Use and Interpretation of Tests in Endocrinology
Beuteer: Red Cell Metabolism: A Manual of Biochemical Methods, 2nd Ed.
Snyder: Blood Transfusion Therapy
Mollring: Microscopy From the Very Beginning
Ames: Modern Urine Chemistry
Coulter: How to Interpret Histograms for Coulter Counter Instruments
Webster: New Expanded Webster Dictionary
Peter: Use and Interpretation of Laboratory Tests in Neurology
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Jaffe: WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues
Medicode: Physician ICD9 Code Manual, Vol. 1 and 2
Suggested Journals
Blood
American Journal of Hematology
British Journal of Haematology
American Journal of Clinical Pathology
Archives of Pathology and Laboratory Medicine
European Journal of Haematology
(formerly Scandinavian Journal of Haematology)
Thrombosis and Haemostasis
Thrombosis Research
Seminars in Hematology
Seminars in Thrombosis and Hemostasis
Progress in Hemostasis and Thrombosis
Clinics in Haematology
North Am. Clinics in Hematology/Oncology
New England Journal of Medicine
Annals of Internal Medicine
Archives of Internal Medicine
Journal of Clinical Investigation
Journal of Biological Chemistry
Blood Coagulation and Fibrinolysis
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CLINICAL MICROBIOLOGY RESIDENT ROTATION
I.
Definition, Duration and Scope of Education
Duration of Rotation – 10 weeks total to include 8 weeks during PG2 and 2 weeks
during PG4
A. Rotations will take place from 9AM -5 PM weekdays
B. The rotation provides an organized and comprehensive educational experience
for residents to have a basic knowledge of the Clinical Microbiology laboratory
operations.
II.
Teaching Staff Responsible for Supervision and Instruction
A. Teaching Staff
1. Primary Responsibility
a. Preeti Pancholi, Ph.D. D (ABMM), Residency Director; Director,
Clinical Microbiology
b. Joan-Miquel Balada-Llasat, PharmD, Ph.D., D (ABMM), Associate
Director
c. Jane Poulson, MS,MT, (ASCP)SM) Microbiology Manager
d. Cheryl Kelly, MT (ASCP), Lead Technologist, Virology
e. Michell Raczkowski, MT (ASCP), Lead Technologist, Bacteriology
f. Lettie Swyers, MLT (ASCP), Lead Technologist, Bacteriology
g. Heidi LaRue, MT (ASCP), Lead Technologist, Molecular Microbiology
h. Kamal Kamboj, M (ASCP), Lead Technologist, Mycology and
Mycobacteriology
i. Kaely Snider, BS,Microbiology. Lab Customer Service Supervisor,
Microbiology Processing
2. Secondary Responsibility:
a. Diagnostic Bench technologists.
III.
Curriculum
I. Resources:
1. Henry’s Clinical Diagnosis and management by laboratory methods.
21th Edition. McPherson, Pincus.
a. Bacteriology: Generals, Respiratory, Urines- Chapter 56 and 58
b. Susceptibilities: Chapter 57
c. Bloods/Processing- Chapter 63
d. Mycology- Chapter 60
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e.
f.
g.
h.
i.
Mycobacteriology: Chapter 59
Virology- chapter 54 and 55.
Molecular Microbiology- Chapter 63
Parasitology- Chapter 61
Bioterrorism- Chapter 64
2. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology.
6th edition. Winn et al.
a. Anaerobes- Chapter 16
3. Diagnostic Microbiology (Bailey and Scott’s; 12th edition)
4. Indiana Pathology images. CDs.
a. Bacteriology I Images
b. Mycology. Images and Quiz
c. Parasitology. Images and Quiz.
5. Parasitology CD. DPDX (CDC) and powerpoint presentations.
6. Cases in Medical Microbiology and Infectious diseases. 3rd edition.
Gilligan et al. (see folder: CASES)
7. Cases in Human Parasitology. Heelan. (see folder: CASES)
8. Cases in Molecular Microbiology. Foxman. (see folder: CASES)
9. Review Questions. (see folder. Questions Review).
II. Rotations:
1. OSU East Lab :
a. Bacteriology (Urines, respiratory, generals, anaerobes, stools,
antimicrobial susceptibilities, bloods)
b. Parasitology
c. Mycobacteriology
d. Mycology
e. Virology
f. Molecular Microbiology
2. OSU Main Lab
a. Microbiology specimen processing/ Special stains
III. Meetings:
a. Directors meeting with lab supervisors (second and sixth Monday 10 AM)
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b. Antimicrobial Stewardship Program meeting (weekly; 10:30-12 PM.
Attendance encouraged when microbiology topics are discussed;
schedule with Director)
c. Antimicrobial Subcommittee meeting (once/month; 2nd Thursday of the
month; 8:30-10 AM);
d. Infection Control Meeting (once/month; 2nd Thursday of the month; 2-3
PM; schedule with Director)
IV. Teaching Conferences
a. Event: Topic/case discussions
Location: Attending office
Time: Monday, 2:00 to 3:00 pm
b. Event: Lab rounds
Location: Microbiology East Lab
Time: Tuesday/Thursday, 10:00 to 11:00 am
c. Event: Infectious Diseases (ID) Conference
Location: Doan Hall (N1109); Attending office for teleconference or Doan
Hall 11th floor ID conference room.
Time: Wednesday, 12:15 to 1:15 pm
V. Teaching Responsibilities
a. Event: Weekly case presentation relating to a current culture/methodology
in the Micro. lab.
Location: Microbiology East Lab
Time: Friday, 7:30am First and Third Friday’s of the month (60 minutes)
Also 5th Fridays.
Time: Friday, 9:30am Second and Fourth Friday’s of the month
(approximately 30-60 minutes)
VI. Learning objectives for the rotations
Patient Care
Residents must demonstrate a satisfactory level of diagnostic competence and
the ability to provide appropriate and effective consultation in the context of
microbiology services.
a. Communicate effectively and demonstrate caring and respectful behaviors
when interacting with laboratory personnel and physicians.
b. Gather essential and accurate information about their patients
and/or patient specimens.
c. Educate staff, students and other physicians.
d. Use information technology to support diagnostic decisions.
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e. Work with health care professionals, including those from other
disciplines, to provide patient-focused care.
Medical Knowledge
I. Specimen Processing and Blood Cultures. University Hospitals.
1. Observe the primary processing of specimens for the culture
isolation of aerobic and anaerobic bacteria, mycobacterium and fungi. Be
able to describe the various types of growth, differential, selective and
selective/differential media used for the isolation of these organisms from
clinical specimens.
2. Describe the types of culture systems used for the isolation of
bacteria, fungi and Mycobacterium from blood.
3. Understand the needs for blood anticoagulation, volume, draw timing and
culture conditions.
4. Observe and be able to describe the procedures used for the rapid
identification of bacteria isolated from blood cultures, including the
GeneXpert MRSA/SA assay.
5. Become familiar with the incidence of the various
microorganisms isolated from blood cultures. Be familiar with what is
considered contaminants versus pathogen and how they are reported.
Monthly blood culture contamination rate-hospital monitor.
6. Observe the utilization of the Real time PCR MRSA screen from
nares with the GeneXpert.
II. Bacteriology - Respiratory Cultures. OSU Hospitals East.
1. Review Gram stained smears (including sputum Q-score) to
determine: the type and extent of the host response; the morphology and
quantity of bacteria present; the relationship of observed bacteria to
inflammatory and other cellular elements; the quality of the specimen for
diagnosis.
2. Recognize the bacterial colony morphologies on the various isolation
media of common respiratory pathogens.
3. Perform and interpret tests for identification of isolated bacteria.
4. Know the antibiograms of common bacterial respiratory pathogens.
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III.
Bacteriology – General Cultures: Tissue, Body Fluid and Wound
Cultures. OSU Hospitals East.
1. Review Gram stained smears to determine: the type and extent of
the host response; the morphology and quantity of bacteria present;
the relationship of observed bacteria to inflammatory and other
cellular elements; the quality of the specimen.
2. Recognize the colony morphologies on the various isolation media of
commonly encountered bacterial pathogens.
3. Perform and interpret tests for identification of isolated bacteria.
4. Know the antibiograms of common bacterial pathogens isolated
from these specimen types.
IV. Bacteriology - Urine and Stool Cultures. OSU Hospitals East.
1. Recognize the colony morphology of common uro- and enteric
pathogens on the commonly used primary isolation media.
2. Understand the principles of the semi quantitative urine culture and
the interpretation of culture results.
3. Describe the reactions of selective media for common pathogens..
4. Describe the methods used for identification of common enteric
pathogens.
5. Know the antibiogram of commonly isolated bacterial pathogens
from urine and stool.
6. Understand the principles, application and interpretation of nonculture methods for the detection of enteric pathogens.
V.
Bacteriology - Anaerobic Bacteria: OSU Hospitals East.
1. Recognize and describe the Gram morphology of commonly
encountered anaerobic bacteria. Review specimen Gram stains for
typical anaerobic morphotypes.
2. List specimens that are inappropriate for anaerobe testing.
3. Recognize the colony morphologies of commonly isolated anaerobic
bacteria.
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4. Know the biochemical tests and non-culture methods utilized for
identification of anaerobic bacteria.
5. Know the antibiograms of commonly encountered anaerobic
bacterial pathogens.
VI.
Bacteriology – MicroScan and Special Procedures. OSU
Hospitals East.
1. Review and become familiar with the MicroScan instrumentation and
technology used for the routine identification and antimicrobial
susceptibility testing of bacterial isolates.
2. Review and become familiar with the principles of the common
methods for determining the antimicrobial susceptibility of
aerobic bacteria. This will include a review of the appropriate Clinical Lab
Standard Institute (CLSI) guidelines.
3. Review and become familiar with the structure, mechanism of action
and spectrum of activity of the major classes of antibiotics.
4. Understand the principles and procedures used to determine the
quantity of bacteria in a clinical specimen (e.g. quantitative tissue)
and be able to interpret the results of this culture.
5. Review of significant cultures-daily. At this time the resident will
review with the clinical microbiologist the Gram stained smear and culture
results of completed cultures. Emphasis is placed on correlation of smear
with culture results, significance and interpretation of both smear and
culture results and review of the antibiograms of isolated organisms.
VII. Molecular Assays. OSU Hospitals East.
1. Understand the principles of common molecular microbiology testing
methods.
2. Discuss different specimen sample types, collection criteria, and
processing requirements for amplification tests.
3. Compare sensitivity, specificity, specimen type, and cost of assay
with other tests that are available on the market.
4. Understand clinical significance and limitations of molecular testing
in the diagnosis, prognosis, and monitoring of infectious diseases in
the context of culture, antigen detection, and serologic methods.
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5. Understand and discuss the differences between traditional and
real-time PCR.
6. Observe extraction method used for CMV, EBV, HIV, HCV, HBV,
TB, and BK.
7. Discuss advantage of and limitations of as well as interpretations of
the Viral Respiratory Assays.
8. Discuss and understand the results obtained from the Abbot M2000
(HIV, HBV, HCV) and the ABI 7500 (CMV, EBV).
9. Discuss how the Focus 3M instrument is different from other real
time thermocyclers.
10. Discuss and interpret Southern Blot obtained from HCV Genotype
procedure. Discuss the principle behind line probe assays.
11. Discuss sequencing and strain typing, procedure and applications.
12. Observe and discuss NAAT testing for GC and Chlamydia;
compare and contrast with conventional culture methods.
VIII. Special Stains. University Hospitals.
1. Understand the process for obtaining a Bronchoalveolar Lavage
(BAL).
2. Be able to stain, interpret and report results for BALs to include:
a.
b.
c.
Diff Quik and Gram Staining
Differential of macrophages, neutrophils, lymphocytes and
eosinophils.
Overall impressions: presence of blood, microorganisms and
viral changes
3. Understand the process for obtaining TZANK prep from a skin
lesion.
4. Be able to stain a TZANK slide and interpret the presence of viral
changes.
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IX. Virology. OSU Hospitals East.
1. Observe, and be able to describe the procedures for the primary
processing of specimens for rapid and conventional viral cultures
and for Chlamydia trachomatis.
2. Describe the types of cell cultures utilized routinely in the Virology
laboratory.
3. Describe the procedure for toxigenic C. diffiicle PCR and be able to
interpret the results of the assay.
4. Observe and interpret the immunoperoxidase assay for CMV
immediate early antigen assay.
5. Observe the performance of the immunofluorescent stain for the
detection of C. trachomatis in cell culture; read and interpret the
results of the stain.
6. Examine conventional viral cultures for the presence of typical viral
cytopathic effects (CPE). Be able to recognize characteristic CPE
for the following viral agents: herpes simplex virus, cytomegalovirus,
Varicella-zoster virus, and adenovirus.
7. Be able to describe the various methods used for the identification of
viral agents isolated from clinical specimens.
X.
Mycology, Mycobacteriology, Legionella. OSU Hospitals East.
1. Observe and be able to describe the primary processing of
specimens for the culture isolation of fungi, mycobacteria, aerobic
actinomycetes and Legionella sp. from clinical specimen and
environmental sources.
2. Perform and be able to interpret appropriate stains for the
microscopic detection of fungi, mycobacteria aerobic actinomycetes,
and Legionella from clinical specimen and/or culture.
3. Become familiar with the various laboratory tests, including nucleic
acid hybridization assays and nucleic acid sequencing, utilized for
the identification of fungi, mycobacteria, and Legionella sp isolated in
culture.
4. Observe and describe the antimicrobial susceptibility tests for yeast
and mycobacteria and be able to interpret the results of these tests.
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Know the antibiograms of commonly encountered yeasts and
mycobacteria.
XI. Parasitology: OSU Hospitals EAST
1. Be able to identify common clinically encoundered animal parasites
through the review of stained clinical specimens, CDC CD-Rom,
powerpoint presentations located on I drive
(I/common/everyone/Micro/Micro CE/CE Presentations/Path resident
Parasitology Review), preserved material, and textbooks.
2. Resident will spend morning of 1 day reviewing powerpoint
presentations and CD-ROM as time allows. In afternoon, Resident
will spend time with manager reviewing stained slides and gross
spedimens. If additional study is required, resident should consult
textbooks.
3. Understand the principles, application and interpretation of non
culture methods for the detection of common intestinal parasites.
XII. Other Educational Experiences of the Curriculum
1. Laboratory Management
a. The resident is expected to become familiar with the laboratory
quality control program, the quality assurance program, CAP
readiness, training and competency assessment, method
validation procedures, test cost analysis including test
reimbursement and CPT coding, and report review and correction.
2. Teaching Opportunities
a. Residents present weekly clinical case conference to the medical
technologists within the division and to Infectious Diseases
Fellows.
3. Scholarly Activity
a. Residents, with guidance from the directors, are expected to
become involved in a microbiology laboratory related project.
This may take the form of a defined laboratory study or a case
report. Publication is encouraged.
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4. Research
a. Concepts of conducting research
1. Describe the process of finding a problem, conducting
literature review and stating the problem
b. Organize a research design
1. Experimental
2. Descriptive
3. Observational
4. Randomized controlled trial (RCT)
c. Prepare data collection forms, IRB, etc
d. Laboratory experiments
1. Selection of the experiment
2. Scientific background of the techniques
3. Laboratory skills
4. Troubleshooting
e. Describe analysis of results and statistical methods
f.
Drafting manuscript and publishing the results
1. Prepare an abstract
2. State the problem
3. Describe the methods
4. Present the results
5. State the conclusions
6. provide references
5. Formal Meetings, Conferences and Rounds
a. Teaching Rounds. The resident will meet periodically with the
laboratory Director. A different topic will usually be discussed at each
meeting. Discussions normally follow the order of the Microbiology
rotation or a mutually agreeable topic of interest to the resident.
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and evaluate
their diagnostic and consultative practices, appraise and assimilate scientific
evidence and improve their patient care practices.
a.
Analyze practice experience and perform practice-based improvement
activities using a systematic methodology.
126
b.
c.
d.
e.
f.
Locate, appraise, and assimilate evidence from scientific studies related to
patient specimens.
Obtain and use information about their population of patients and
the larger population from which their patients are drawn.
Apply knowledge of study designs and statistical methods to the
appraisal of clinical studies and other information on diagnostic
effectiveness.
Use information technology to manage information, access on-line
medical information; and support their own education.
Facilitate the learning of students and 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 teaming with other health care
providers.
a.
b.
c.
Create and sustain a therapeutic and ethically sound relationship with
physicians, laboratory personnel and students.
Use effective listening skills and elicit and provide information using
effective verbal, nonverbal, explanatory, questioning, and writing skills.
Work effectively with others as a member or leader of a health care team or
other professional group.
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
a.
b.
c.
Demonstrate respect, compassion, and integrity; a responsiveness to the
needs of patients and society that supercedes self-interest; accountability
to patients, society, and the profession; and a commitment to excellence
and on-going professional development.
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices.
Handles patient specimens in a professional manner.
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 microbiology services that are of optimal value.
127
a.
b.
c.
d.
e.
Understands how their patient care and other professional practices affect
other health care professionals, the health care organization, and the larger
society and how these elements of the system affect their own practice.
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources.
Practice cost-effective health care and resource allocation that does not
compromise quality of care.
Advocate for quality patient care and assist others in dealing with system
complexities.
Know how to partner with health care managers and health care
providers to assess, coordinate, and improve health care and now how
these activities can affect system performance.
VII. Evaluation of Resident Performance
Multiple assessment methods will be utilized for the evaluation process. At the end
of each month of the rotation, the resident will receive a global evaluation by the
Division Directors. This will include a 360-degree evaluation with input from
microbiology personnel and others with whom the resident interacts during the
training period. In addition, the resident will be given unknown
specimens/organisms for analysis or identification. The resident will be expected to
maintain a log of diagnostic procedures performed especially staining procedures
and to comment on the significance of these procedures for practice-based
improvement. This will be included in the resident’s portfolio. Performance in a
laboratory related study will also be evaluated.
The following Tables list procedures which each pathology resident is expected to
either perform or observe and perform where possible and practical during the
Medical Microbiology rotation.
128
Bacteriology/Parasitology
Procedures to be observed and performed when possible Date
Area: Urines / Generals / Respiratory
1.
Gram stain
2.
Catalase
3.
Oxidase
4.
Staphylococcus latex test
5.
Trehalose Mannitol Salt (TMS)
6.
PYR
7.
Bile Esculin (BE)
8.
Beta Streptococcus latex grouping
9.
Be able to recognize major organism groups based on
colony
morphology on selective and nonselective
media (enterics, non-fermenters and gram positives)
10.
Affirm DNA probe assay for diagnosis of vaginosis
Area: Respiratory
1.
X and V strips for Haemophilus
2.
Catarrhalis disk test for Moraxella
3.
Beta-lactamase test
4.
Optochin (P-disc) for S. pneumoniae
Area: Microscan (MS)
1.
Inoculation of Microscan panels for ID and AST
2.
Inoculation and reading of disc diffusion susceptibility
test
3.
Set up and interpretation of E-test gradient strips for
detection of ESBL producing organisms.
Area: ONP
Area: Stools
1.
TSI and LIA tests
Area: Anaerobes and Stools:
1.
ID of anaerobic bacteria by rapid tests and Microscan
panels.
2.
Anaerobic antimicrobial susceptibility testing
Area: Bloods
1.
Observe the identification of positive blood cultures
and Genexpert
Reviewed by:__________________________________________ Date:________
Laboratory Director
129
Mycobacteriology and Legionella
Procedures to be observed and performed when possible
Date
1.
Fluorochrome stain
2.
Kinyoun’s stain
3.
Examine growth characteristics and colony morphology of
common
Mycobacteria species from QC organisms grown
on Middlebrook
plates.
4.
Familiarize with Runyoun classification: nonchromogens,
scotochromogens, photochromogens, rapid growers, slow
growers.
5.
Familiarize with the operation of the MGIT 960 instrument
including required preventive maintenance and QC.
6.
Perform nitrate and 3 day arylsulfatase tests
7.
Review the QC requirements.
8.
Observe processing of a positive MGIT tube.
9.
Observe AFB susceptibility testing using the MGIT 960
10.
Observe AFB susceptibility testing by the proportion method
using
Trek panels for slow and rapid growers and interpretation
11.
Observe AFB identification using DNA probe hybridization
assay
12.
Examine Legionella QC culture plates for colony morphology
13.
Observe DFA test for Legionella
Reviewed
by:___________________________________________Date:_____________
Laboratory Director
130
Mycology
Procedures to be observed and performed when possible
Date
1.
Fungifluor stain: preparation and examination
2.
Partial acid fast stain
3.
Scotch tape prep with MycoPerm stain and identification of
common molds
4.
Germ tube test
5.
API 20C set up and interpretation
6.
Chromagar yeast: inoculation and interpretation
7.
Trek antifungal susceptibility panel: inoculation and interpretation
8.
Reading primary plates for examination of yeast and mold colony
morphology.
9.
Review the QC requirements.
Reviewed
by:___________________________________________Date:_____________
Laboratory Director
131
Virology
Date
Procedures to be observed and performed when possible
1. Read and recognize visual CPE in the tissue culture teaching set
for:
a. CMV
b. Adenovirus
c. Herpes simplex
d. Varicella zoster
e. Enterovirus
2. Observe and interpret the toxigenic C. difficile PCR assay
3. Interpret a FA stain for C. trachomatis cultures
4. Interpret an immunoperoxidase stain for CMV immediate early
antigen
5. Observe the processing of specimens for viral culture.
6. Discuss the cell lines used in the Virology Lab.
Reviewed
by:___________________________________________Date:_____________
Laboratory Director
132
Special Stains
Procedures to be performed when possible
Date
1. Understand the processes for obtaining BAL and TZANK
specimens
2. Stain, interpret and report BAL preps.
3. Stain, interpret and report TZANK preps.
Reviewed
by:___________________________________________Date:_____________
Pathologist Performing Special Stains
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Molecular Area
Procedures to be Observed and Performed when possible
Date
1. Understand the principles of molecular testing
2. Understand the sample requirements
3. Observe extraction methods for HIV, HCV, EBV, BK, CMV,
Respiratory
viruses and TB assays
4. Understand Amplification instrumentation: real time PCR versus
Traditional PCR
5. Discuss the results from the Abbott (HIV, HBV and HCV) ;
ABI7500
(CMV, EBV, TB, and FLU A/B RSV) 3M instrument (BK) and
Luminex xTAG respiratory viral panel.
6. Discuss Monitoring viral loads vs diagnosis
7. Understand the principles of HCV Genotyping
8. Understand the principles of Sequencing and Strain Typing
9. Review the QC requirements.
10. Cost analysis
11. Molecular cases
Reviewed
by:___________________________________________Date:_____________
Laboratory Director
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OSU Department of Pathology Residency Program
CP Rotation: Clinical Chemistry and Humoral Immunology
A. DURATION OF ROTATION: For AP/CP residents: 8 weeks
For CP only residents: 4 weeks
B. TEACHING STAFF responsible for supervision and instruction:
Michael G. Bissell, MD, PhD, MPH, Director of Clinical Chemistry and
Toxicology; Director, Special Functions Laboratory
Also:
Michael Dougherty, MT(ASCP), Lead Technologist, Special Functions
Laboratory
Alissa Dirkhop MT (ASCP), Lead Technologist, Special Functions
C. LEARNING OBJECTIVES FOR CLINICAL CHEMISTRY / HUMORAL
IMMUNOLOGY ROTATIONS
Patient Care
Residents must demonstrate a satisfactory level of diagnostic competence and
the ability to provide appropriate and effective consultation in the context of
clinical chemistry/ humoral immunology testing in the Critical Care and Special
Functions Laboratories.
-Functioning as a liaison between the laboratory and clinician inquiries, as
needed.
-Learning to interpret various laboratory procedures, in particular, serum/urine
protein electrophoresis, serum/urine immunofixation electrophoresis and HIV1 Western Blots, by daily reviewing these cases with oversight by the
attending pathologist.
-Understanding basic principles and concepts of clinical chemistry and the
typical consultations encountered in everyday practice at OSU Medical
Center and other rotation sites.
-Recognizing problems in clinical medicine that are related to clinical
chemistry/ humoral immunology testing, and applying concepts and principles
to clinical situations
135
Medical Knowledge
Residents must demonstrate a practical and applied understanding of the
techniques, applications and interpretations of Clinical Chemistry and Humoral
Immunology testing by:
-Formally reviewing basic biochemistry and immunology in
sufficient detail to understand the basic diagnostic laboratory
procedures in clinical chemistry and immunology provided by the
Special Functions and Critical Care Laboratories: their applications,
limitations and clinical significance.
-Observing the performance of and learning the analytical methodology of a
subset of laboratory procedures at the bench, thereby
developing an
appreciation of clinical laboratory instrumentation and automation.
-Understanding our internal quality control scheme and how an internal quality
control system works to guarantee the quality of assays and
control
mistakes. The resident will also understand the “delta check” system for
identifying laboratory mistakes, and the purpose and operation of external
proficiency testing surveys. The resident will understand how we establish
quality control limits for all routine tests such as blood gases, colorimetric,
enzymatic, and potentiometric tests, know how quality control rules are
applied in the routine laboratory, and understand the decision making process
in an “out of control” situation and what steps are taken to rectify such
occurrences.
-Having a basic understanding of the automation in the Clinical Chemistry
Laboratory, and the various subcomponents and modules of the
Beckman/Coulter IDS Total Laboratory Automation (TLA) System.
-Being able to describe the category of basic wet-chemical procedures in use
in various groups of analytes (enzymes, electrolytes, hormones, etc.). Be able
to discuss spectrophotometry in the visible, and ultraviolet regions, be able to
describe fluorescence measurements and the use of fluorescence
polarization in the assay of various analysts, particularly therapeutic drugs.
-Understanding the principles of zone electrophoresis, and why it is
possible to separate proteins, lipoproteins and enzymes by this technique.
136
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and evaluate
their diagnostic and consultative practices, appraise and assimilate scientific
evidence and improve their patient care practices.
-Becoming involved, if interested and if other objectives are being
satisfactorily accomplished, in a laboratory project involving an
aspect of clinical chemistry, humoral immunopathology, laboratory
management or informatics relevant to clinical laboratory
operations
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills
that result in effective information exchange and teaming with other health care
providers, patients’ and patients’ families
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
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 laboratory services that are of optimal value.
-Beginning to appreciate the basic quantitative, conceptual and
administrative skills required to manage a clinical laboratory.
-Understanding flow of information through the laboratory including such
categories of test as STAT, “life threatening”, routine, emergency
and other types of specimens coming to the laboratory. The resident
is responsible for becoming familiar with safety requirements for the
handling of all specimens, and general safety instructions for all
personnel in the laboratory. The resident MUST also become
familiar with OSUMC critical values and how these are managed.
137
D. Curriculum
1. Formal Meeting Times
a. Daily didactic review: the resident formally reviews the subject
matter of the curriculum based on assigned textbook reading and
lecture materials according to weekly lesson plan. This will include
written testing of the resident’s mastery weekly.
b. Sign-out of cases: 1-2 hours daily. During the first two weeks, at these
times the resident reviews all cases with the attending pathologist. The
resident will have previously reviewed material, obtained additional
information when appropriate, and rendered a diagnosis. After the initial
period, the resident will enter interpretations and the attending will review
them subsequently.
c. Didactic and laboratory administration lectures: Mondays 7:30am weekly
and Wednesday’s noon, monthly, respectively.
2. Curriculum Content
Each week the rotation will focus on a group of analytes forming a portion of the
test menu. Residents will review fundamentals of the underlying biochemistry,
analytical methodology, and clinical significance, and practice diagnostic
interpretation. They will also be introduced to the corresponding workstations
involved in production and to a series of related quantitative skills, topics in
medical informatics and aspects of lab management. Throughout the rotation,
they will be involved in clinical consultation, sign-out of case material,
troubleshooting of operational and quality problems and work-up of any assigned
short term operational projects or presentations, as circumstances allow.
Assigned reading is in
1. Bishop ML, Fody EP, Schoeff LE. Clinical Chemistry: Principles,
Procedures, Correlations, 5th ed. Lippincott Williams Wilkins, Philadelphia,
2005.
2. Christensen RH, Gregory LC, Johnson LJ. Appleton and Lange’s Outline
Review of Clinical Chemistry. McGraw-Hill, New York, 2001.
Additional reading:
1. Bissell MG. Handouts from CP Didactic Lecture Series
2. Bissell MG. Med Tech 645.01 Clinical Chemistry. Lecture Notes.
3. Bissell MG. Med Tech 604 Clinical Correlations in Chemistry.
Lecture Notes
138
Week #
1
2
3
Analytes
Proteins and
iso-enzymes
Enzymes: Liver,
Pancreas, GI, etc.
Mineral metabolism: Ca,
P, Mg
Workstations
Related Topics
Electrophoresis
Basic chemical
immunoelectrophoresis calculations
iso-enzymes
Protein quantitations
Routine automated
chemistry analyzers
Point-of-service or lab
4
Acid/base, electrolytes,
blood gases
Blood gas analyzers,
respiratory therapy
5
Urine and other body
fluids
Carbohydrate
metabolism
Lipid metabolism, cardiac
markers
Urinalysis
Serum tumor markers,
endocrinology
Special Chemistry
6
7
8
Point-of-care testing
Special chemistry
Statistics and
quality control
Statistical
method
evaluation
Acid/base, fluid
and electrolyte
calculations
Principles of
Instrumentation
Cost/benefit
analysis
Reference
intervals,
decision limits
Predictive value
and ROC
calculations
Week by Week Activities:
Week 1:
Reading:
Bishop, et al: Chapters 1, 2, 4 (Electrophoresis section only), 8
Christensen, et al: Chapters 3, 13 (sections I, II only), 19, 20
CP Didactic Lectures: Serum proteins, Monoclonal Gammopathies 1, 2, 3,
Proteinuria, Immunoblots and HIV testing
MT 645.01 Lecture Notes: Proteins
Review of:
Protein structure and function
Principles of electrophoresis, isoenzyme analysis and protein quantitation
The serum proteins and their physiological functions
Immunoglobulin structure and function
Monoclonal gammopathies
HIV Western blots
139
Introduction to:
Protein workstation in Special Functions Lab
Interpretation of serum, urine protein electrophoresis, immunofixation
Electrophoresis, immunoglobulin quantitation and HIV Western blots
Week 2:
Reading:
Bishop, et al: Chapters 3 (Statistical concepts and QA/QC sections only), 4
(Spectrophotometry and photometry section only), 5, 6, 10, 22
Christensen, et al: Chapter 4, 5 (sections I, II only), 10A, 11 (sections I, II
only), 12, 15, 16, 18
CP Didactic Lectures: Basic statistics, Statistical QC, Lab testing in
Hepatobiliary Diseases, Immunoassays and Viral Hepatitis Testing
MT 645.01 Lecture Notes: Enzymology, Liver
MT 604 Lecture Notes: Liver
Review of:
Principles of spectrophotometry
Basic enzymology
Interpretation of hepatic function tests and hepatitis markers
Basic statistics
Introduction to:
Principles of laboratory automation
Laboratory quality control statistics
Week 3:
Reading:
Bishop, et al: Chapters 3 (Method selection and evaluation section only), 4
(Electrochemistry section only), 15, 16, 21, 25, 26, 31
Christensen, et al: Chapter 4, 5, (sections VII, VIII, IX), 10D, 11(Section III
only), 17
CP Didactic Lectures: Calcium and Mineral Metabolism, FE, Vit B12, folate
MT 645.01 Lecture Notes: Bone (CA, Mg, Phosphate), Vitamins, GI,
Pancreas, Iron, Porphyrins
MT 604 Lecture Notes; Pancreas
Review of:
Basic principles of electrochemistry
Basics of mineral metabolism
Bone diseases and pathophysiology
Nutrition, vitamins, trace, elements, Fe, Porphyrins
Pancreas, GI
Statistical methods of correlation and regression
Introduction to:
140
Ion-specific electrode (ISE) technology
Principles of laboratory statistical method evaluation
Week 4:
Reading:
Bishop, et al: Chapters 13, 14, 24
Christensen, et al: Chapter 5 (sections III, IV, V, VI), 6
CP Didactic Lectures: Fluid/electrolytes, Acid/Base
MT 645.01 Lecture notes; Renal Function, Renal Function Tests, Body
Fluids/Electrolytes, Acid Base
MT 604 Lecture Notes: Renal/Electrolytes, Acid Base
Review of:
Basic principles of acid/base measurement
Acid/base physiology
Blood gas physiology
Electrolyte physiology
Renal disease and pathophysiology
Introduction to:
ISE workstation
Chemistry blood-gas workstation
Respiratory therapy workstation
Week 5:
Reading:
Bishop, et al: Chapters 4 (Osmometry section only) 9, 27
Christensen, et al: Chapter 6 (Section II), 16 (Section II)
CP Didactic Lectures: Testing Renal Function, Humoral Immunology and
Serology Testing, Optical Immuno methods and Syphilis Testing
Review of:
Colligative properties
Basic laboratory techniques
Urine composition
Extravascular body fluids
Humoral immunology serology
Introduction to:
Microscopic urinalysis
Urine and fluid chemistries
141
Week 6:
Reading:
Bishop, et al: Chapters 4 (Chromatography, Analytic techniques for POCT
section only), 7, 11, 32, 33
Christensen, et al: Chapter 1, 6 (Section II), 13 (Section III), 16 (Section II)
CP Didactic Lectures: Carbohydrates and Diabetes
MT 604 Lecture Notes: Diabetes
Review of:
Basic carbohydrate metabolism
Endocrine pancreatic function
Diabetes and hypoglycemia
Introduction to:
Hemoglobin A1c measurements
Point-of-care testing
Week 7 :
Reading:
Bishop, et al: Chapters: 3 (Reference Intervals section only), 12, 23,
Christensen, et al: Chapter 2, 10C
CP Didactic Lectures: Lipids and Cardiac risk, Cardiac and Muscle Disease
Markers, Disorders of Pregnancy with lab Manifestations
MT 645.01 Lecture Notes: Lipids, Lipoproteins, Fetal Lung Maturity
MT 604 Lecture Notes: Lipids, Heart and Skeletal Muscle
Review of:
Basic lipid metabolism
Pathophysiology of atherosclerosis
Pathophysiology of myocardial infarction
Fetal Maturity testing
Statistical confidence intervals
Introduction to:
Troponins and other cardiac markers
Cholesterol and cardiac risk assessment
Reference intervals and clinical decision limits
Week 8:
Reading:
Bishop, et al: Chapters: 3 (Diagnostic Efficacy section only), 17, 18, 19, 20, 30
Christensen, et al: Chapter 7, 10B, 14
CP Didactic Lectures: Endocrinology 1, 2, 3, 4 Serum Tumor Markers,
Molecular Techniques and Viral Load Testing
MT 645.01 Lecture Notes: Tumor Markers, Endocrinology, Thyroid, Adrenal
142
MT 604 Lecture Notes: Thyroids, Endocrinology
Review of:
Endocrinology
Basic Predictive value theory
Lab tests use in diagnosis and monitoring
Lab tests in the clinical workup of cancer
Viral load testing
Introduction to:
Specific tumor markers
Workstations
D. Manner in which resident is supervised, including duties and responsibilities of the
resident and faculty:
There are three levels of supervision of residents. These include technical, administrative
and interpretive supervision. Technical supervision occurs when residents perform the
procedures within the laboratories and is provided by the medical technologist assigned
to that area of the laboratory. The next level of supervision is administrative.
Administrative supervision occurs when the resident is asked by the laboratory staff to
respond to requests for stat test or technical information on a procedure. The pathology
faculty are also available for this resident activity. The third level of supervision is directly
provided by the faculty. This supervision consists of review by the attending of the
resident’s interpretation of various procedures.
Graded resident responsibility: As residents gain increasing abilities within the
laboratories they are given increasing responsibility. In particular with regard to
chem./immuno signouts, during the first week of the first rotation period, the resident is
exposed to the theoretical background underlying the tests in the protein area that
required interpretation, then beginning with the second week, the resident joins the
attending in the signout area. Initially merely watching the attending and being instructed
the signout results alone and enters them for later review and signout by the attending.
The attending at this point provides daily feedback from his signout that is no longer
“real-time” unless a serious lapse of skill is identified.
E. Resident Evaluation: Residents will be given a global evaluation by the section
chief following each month of the Chem/immuno rotation. This may include in put
from medical technologists and other with when the resident interacts (360
evaluation). It will also be supplemented by weekly written exams and a written
proctored objective multiple-choice final exam, the results of which will be
generally summarized by the section chief in the ‘general comments’ section of the
evaluation form.
143
MOLECULAR PATHOLOGY ROTATION
I.
Definition, Duration and Scope of Education
A. Definition – Molecular Diagnostics consists of all the tests and methods used to
identify a disease or a predisposition to a disease by analyzing the DNA and/or
RNA of an organism.
B. Duration - The rotation in molecular pathology is designed for four weeks which
includes one week at Polaris.
C. Scope of Education – The Molecular Pathology rotation will provide a practical
and applied understanding of molecular diagnostics as related to genetic
diseases and cancers. Residents will be exposed to molecular theory, methods,
instrumentation and disease diagnosis in a clinical setting, including pre and post
analytical quality control and quality improvement measures in preparation for
Clinical Pathology Board molecular questions.
II. Teaching Staff Responsible for Supervision and Instruction
A. Teaching staff
1. Primary Responsibility
a. Thomas W. Prior, Ph.D., Professor of Pathology and Neurology, and
Director of Molecular Pathology
b. John Zhao Weiqiang, M.D., Ph.D., Assistant Professor (Polaris)
2. Secondary Responsibility
a. Pamela Snyder, Supervisor, Molecular Pathology
b. Michele Fuchik, Technologist, Molecular Pathology
c. Mary Sedra, Technologist, Molecular Pathology
d. Joe Carr, Technologist, Molecular Pathology
e. Tatiana Gavrilina, Technologist, Molecular Pathology
f. Jin Fang, Technologist, Molecular Pathology
g. Ben Frey, Technologist, Molecular Pathology
h. Tina McKeegan, Technologist, FISH and ISH (Polaris)
i. Susie Jones, Technologist, FISH and ISH (Polaris)
j. Susan Long, Technologist, Molecular Pathology (Polaris)
k. Nehad Mohammed, Technologist, Molecular Pathology (Polaris)
l. Abby Bailey, Technologist, Molecular Pathology (Polaris)
144
III. Curriculum
A. Resources
1. Genetics in Medicine 6th ed., Elsevier 2007, Thompson &
Thompson
2. Molecular Pathology in Clinical Practice, Springer, 2007,
Leonard, D.
3. Molecular Pathology Procedure Manual, The Ohio State
University
4. Teaching Binders 1, 2 & 3, The Ohio State University
5. Other molecular diagnostic textbooks, journals, articles and
references as appropriate
B. Rotations (within Molecular Pathology Lab)
1. DNA Extraction
2. Southern Analysis
3. PCR
4. RTPCR
5. Fragment Analysis
6. Sequencing
7. VNTR/Maternal Contamination
C. Practical Experience
1. Review of Procedures and References as needed
2. DNA Quantitation (hands on)
3. DNA QC (hands on)
4. Restriction Digestion (hands on)
5. DMD Multiplex PCR (hands on)
6. Magnesium Titration (hands on)
7. ACE PCR (hands on)
8. Sequence Reading (hands on)
9. VNTR/Maternal Contamination Interpretation (hands on)
10. Southern Transfer Analysis
a. Gel Electrophoresis
b. Transfer (of DNA to Nylon Membrane)
c. Probe Labeling
d. Hybridization
e. Fragile X
f. DMD
g. Myotonic
h. Friedreich’s Ataxia
i. Kearns-Sayer
11. PCR Interpretation
a. Factor V/Prothrombin
b. MTHFR
145
12.
13.
14.
15.
c. Hemochromatosis
d. ACE Genotyping
e. SMA
f. Mitochondrial Myopathies
i. MERRF/MELAS
ii. LHON
g. MCAD
h. MEN
Fragment Analysis Interpretation
a. Fragile X
b. Friedreich’s Ataxia
c. FLT3
d. Huntington
e. Kennedy’s Syndrome
f. SMN Dosage Analysis
g. LKB MLPA
h. DMD Quantitation
i. Proband duplication/deletion
ii. Carrier studies
RT PCR Analysis
a. RNA Extraction
b. cDNA Synthesis
c. HPRT (RNA QC)
d. AML (t(8:21) and inv(16))
e. bcrabl
f. APML
g. BCL2 – DNA based
Sequencing Analysis
a. PTEN
b. SMAD4
c. BMPR1A
d. LKB
e. MEN
f. SMN (compound heterozygote testing)
g. SMN (allele specific)
h. FGFR3 (skeletal dysplasias)
i. MEN
j. DNA Repair Genes (HNPCC)
Polaris Testing
a. IgVH Hypermutation
b. FISH
c. EGFR
d. KRAS
e. BRAF
f. EPV (infectious disease testing)
146
g. EBER (infectious disease testing)
D. Teaching (Didactic Sessions) 16 total
1. Introduction to Mutations (1)
2. Challenges and Limitations of Molecular Testing (1)
3. Techniques for Molecular Testing (1)
4. Molecular Calculations – Hardy Weinberg (1)
5. DMD (1)
6. SMA (1)
7. Cystic Fibrosis (1)
8. Mitochondrial (1)
9. Hemoglobinopathies (2)
10. Triplet Repeat Testing (2)
11. Biochemical Genetics (2)
12. Cancer/Hereditary Cancer (2)
13. Case Problems/Puzzlers (2)
IV. Learning Objectives
A. Medical Knowledge
1. Theory and Mechanisms
a. The resident will understand the clinical utility of genetic
disease testing and the differences between “direct” and
“indirect” (RFLP) DNA diagnosis. The resident will be able to
give examples of specific application and limitations of direct and
indirect DNA diagnosis.
b. The resident will appreciate the types of mutations for
genetic testing performed in the Molecular Pathology
Laboratory
c. The resident will understand the important relationship
between the genotype and phenotype for the genetic
diseases being tested.
d. The resident will understand the specific pathogenesis
for diseases tested for in the Molecular Pathology
Laboratory.
2. Specific Applications
a. Duchenne/Becker muscular dystrophy
i. Deletion analysis
ii. Carrier testing (dosage and RFLPs)
iii. Prenatal diagnosis
iv. Spontaneous mutations
v. Germline mosaicism
vi. CK testing
b. Fragile X
i. Triplet repeats
147
ii. Full mutation
iii. Premutation
B. Practice-Based Learning and Improvement
1. Administration, Quality Control and Interpretation
a. The resident will be familiar with the equipment needed
in a molecular pathology laboratory and the approximate cost
of analysis
b. The resident will understand the specimen requirements
for molecular testing
c. The resident will understand the clinical applications of
molecular testing and the appropriate role of nucleic acid-based
testing relative to other methodologies
d. The resident will understand the general flow of specimens
processed for molecular diagnosis from receipt to reporting of
results. This will include specimen collection, handling,
storage, record keeping, and report format
e. The resident will understand the rationale for quality control at
various steps during the procedures to the extent that a technical
problem can interfere with obtaining accurate results
f. The resident will develop a familiarity with the principles and
techniques used in the design and validation of molecular tests.
g. The resident will be able to interpret autoradiographs,
sequence chromatographs, and PCR assay results generated
in the Molecular Pathology Laboratory
2. Interpersonal and Communication Skills
a. The resident will able to demonstrate interpersonal and
communication skills that results in effective information
exchange with laboratory personnel
3. Professionalism
a. The resident must demonstrate a commitment to carrying out
the responsibilities of the rotation by being available punctually
to the laboratory director and laboratory personnel for
instruction.
C. System Based Practice
1. The resident will demonstrate an awareness of the role of Molecular
Diagnosis in the patient care
2. The resident will learn the role of the genetic counselor as a liaison
between the Molecular Pathology Laboratory and the patient and/or
ordering physician
3. The resident will demonstrate an awareness of the role of Molecular
Diagnosis in prenatal/OBGYN care.
148
CLINICAL CYTOGENETICS
A. Duration of rotation: 4 weeks
B. Teaching staff responsible for supervision and instruction:
Nyla A. Heerema, Ph.D., Director, Clinical Cytogenetics Laboratory,
The Ohio State University
Carol Cole, CLSp(CG), Lead Technologist, Clinical Cytogenetics
Laboratory
Andrew McFadden, CLSp(CG), Lead Technologist, Clinical
Cytogenetics Laboratory
Julie Gastier-Foster, Ph.D., Director, Cytogenetics/Molecular Genetics
Laboratory,Nationwide Children’s Hospital
Caroline Astbury, Ph.D., Associate Director, Cytogenetics/Molecular Genetics
Laboratory, Nationwide Children’s Hospital
Shalini Reshmi, Ph.D., Assistant Director, Cytogenetics/Molecular Genetics
Laboratory, Nationwide Children’s Hospital
Robert Pyatt, Ph.D., Assistant Director, Cytogenetics/Molecular Genetics
Laboratory, Nationwide Children’s Hospital
Devon Lamb-Thrush, M.S., CGC, Genetic Counselor, Cytogenetics/Molecular
Genetics Laboratory, Nationwide Children’s Hospital
C. Goals and Objectives:
Overall Goal: To gain a practical and applied understanding of the techniques,
applications and interpretations of Clinical Cytogenetics
Competencies:
Patient Care
The residents will be exposed to cytogenetic techniques and interpretation in all
areas of clinical cytogenetics [prenatal diagnosis, tissue, peripheral blood, bone marrow,
solid tumor, and molecular cytogenetics (FISH and array CGH)]. This is accomplished
through two diagnostic cytogenetics laboratories, the Cancer Cytogenetics Laboratory at
The Ohio State University Medical Center, and the Constitutional Cytogenetics Laboratory
at Nationwide Children’s Hospital.
Medical Knowledge
The residents will understand the various types of cytogenetic techniques,
specimen requirements for each and the significance of different results. They will, in
particular, know the clinical significance of common recurring cytogenetic abnormalities
in hematologic malignancies. This will be accomplished though the above, directed
reading assignments and interactions with the technologists and directors.
Practice-based Learning and Improvement
149
Residents will learn the techniques used in cytogenetics [cell culture and harvest,
banding, microscopic analysis, karyotyping, molecular cytogenetics (FISH), and
chromosomal microarray], the significance of cytogenetic abnormalities, particularly
in neoplasia and prenatal diagnosis. They will learn interpretation of results,
technical, clinical, and molecular cytogenetic topics through directed reading
assignments, preparation of peripheral blood, observations in the laboratory, various
types of practice cases at the microscope, and interaction with the technicians and
directors of the laboratories. The resident will participate with the directors in the
review of karyotypes, FISH and arrays of cases, as well as generation of interpretive
reports but will not actually generate these reports themselves. The residents will
attend the monthly Quality Assurance /Quality Improvement meeting of the
Cytogenetics Laboratory.
Interpersonal and Communication Skills
The residents will interact extensively with the technologists and faculty of the
two cytogenetic laboratories. The residents also have an opportunity to discuss
interesting cases they have seen at Clinical Pathology Rounds, Prenatal Conference,
Genetic Case Conference and weekly or bi-weekly laboratory meetings. Consultative
reports and activities involve interacting with referring physicians to obtain additional
information or report abnormal results. Due to the limited exposure to cytogenetics
available to the resident, much of this activity is done by the laboratory director, but
the residents are involved in the discussions. There is opportunity for interaction
with perinatal pathology concerning pregnancy loss specimens. Pathology reports
and flow cytometry reports for OSU cases are available in the hospital information
system. Both hematopoietic and solid tumor cases are correlated with pathology
reports. Cytogenetic results of tissue obtained during autopsies are included with
the autopsy report.
Professionalism
The resident will participate in formal and informal discussions with the laboratory
directors, technologists and any fellows and students rotating through the laboratory
simultaneously with the resident. They will understand how cytogenetics relates to other
areas of pathology.
Systems-based Practice
The residents will attend the cytogenetics monthly quality assurance/ quality
improvement (QA/QI) meeting. This will expose them to QA/QI within cytogenetics, as
well as to cost containment and cost-saving procedures in cytogenetics as these are
discussed at this meeting.
150
Pediatric Anatomic Pathology Residency Education Program
Nationwide Children’s Hospital Department of Pathology
The rotation in Pediatric Anatomic Pathology is designed for a four week period of time
and is spent at Nationwide Children’s Hospital.
Program Director:
Samir Kahwash, MD, Vice Chair of Education
-surgical pathology, lymph node pathology, hematopathology
Teaching Faculty:
Peter B. Baker, MD, Vice Chair and Chief of Anatomic Pathology
-autopsies, surgical pathology, renal pathology, cardiac pathology and transplant
pathology
Carl Boesel, MD
-autopsy pathology, neuropathology
Daniel R. Boué, MD, PhD
-neuropathology, muscle biopsies, hematopathology
Bonita Fung, MD
-surgical pathology, autopsies
Sue Hammond, MD, Department of Pathology and Laboratory Medicine Chief
-autopsies, surgical pathology, renal pathology, and hematopathology
Kathleen Nicol MD, Vice Chair of Clinical Pathology
-surgical pathology, cytopathology, transfusion medicine
Christopher Pierson, MD, PhD
-neuropathology
Vinay Prasad, MD
-perinatal pathology
Nilsa Ramirez, MD
-surgical pathology, perinatal and placenta pathology, ob-gyn pathology
Program Information Included in this Document:
A. Goals and Objectives of the Rotation
B. Trainee's General Responsibilities
C. Curriculum for the Rotation
D. Resident Supervision
E. Resident Evaluation
A. Goals and Objectives of the Rotation
The rotation goals and objectives are listed below, divided based on Anatomic
Pathology disciplines:
I- Pediatric Surgical Rotation and II- Pediatric Autopsy Rotation
151
I- Pediatric Surgical Rotation
□ Be able to identify, describe, and submit the appropriate sections from
specimens encountered in the daily pediatric surgical pathology practice.
Diagnostic &
□ Be able to determine whether slides received are adequate in quality and
Patient Care
to take appropriate corrective steps if they are not satisfactory. Learn the
Activities
proper use of special stains, recuts, etc., when indicated.
□ Be able to perform a technically adequate frozen section.
□ Be able to recognize the limitations of a frozen section and to know when
a diagnosis must be deferred.
□ Be able to write a clinically relevant, concise, but complete, organized
microscopic description, diagnosis, and comment.
□ Develop a systematic approach to slide examination in ensure that
lesions are not overlooked. Be able to relay histological findings to the
clinical and gross features of the case.
□ Be adaptive to new and specialized techniques in such fields as electron
microscopy, immunohistochemistry, immunofluorescence, in-situ
hybridization, flow cytometry, etc., and their application to pediatric
surgical pathology.
□ Be familiar with the routine and special technical aspects of
histopathology as it is related to surgical pathology: fixation, embedding,
sectioning, staining, tissue processing, etc.
□ Become familiar with the technique of in-situ dissection for the commonly
encountered congenital heart anomalies.
□ To learn the morphologic appearances of normal and abnormal pediatric
tissues at various ages (gestational ages and post natal ages)
Medical
□ To learn the morphologic appearances of common pediatric tumors,
Knowledge &
other pediatric disease processes, placental lesions and gestational
Its Application
trophoblastic disease
□ To develop an investigative and analytic approach to surgical pathology
diagnosis
□ To understand and learn the genetic alterations in pediatrics, especially
as it relates to tumors, other common pediatric diseases, and perinatal
disease
□ To understand the prognosis and general treatment concepts of pediatric
disease
□ To utilize individual cases to acquire knowledge of disease processes
Practice-Based
□ To utilize study set cases to acquire knowledge of disease processes
Learning &
□ To demonstrate effective problem solving by utilizing a variety of
Improvement
information resources
□ To communicate clearly with the attending pathologists and clinicians
Interpersonal &
regarding diagnoses and supporting evidence both verbally and in written
Communicatio
reports
n Skills
□ To learn to communicate effectively with members of the laboratory and
all support staff
□ To demonstrate respect and integrity in encounters with patients,
152
Professionalism
□
□
SystemsBased Practice
□
□
□
Teaching &
Research
□
□
□
clinicians, staff pathologists, and ancillary staff
To work effectively with the medical technologists and support staff
To adhere to the highest standards of conduct during conferences and
tumor boards.
To learn the work flow process in surgical pathology at Nationwide
Children's Hospital and to maximize its efficiency
To develop an awareness of the differences between a community based
practice and an academic practice
To recognize the appropriate and cost-effective techniques for evaluating
pediatric surgical pathology, placental and perinatal pathology and
hematological and coagulation disorders while ensuring excellent quality
of services
Utilize electronic medical records.
Regularly attends and participates in appropriately assigned conferences
Participates in departmental teaching activities and investigative research
activities
II- Pediatric Autopsy Rotation
Diagnostic & □ The fellow should develop an understanding of the goals, special
Patient Care
techniques and differential diagnosis pertinent to the post-mortem
Activities
examination for the following:
 Fetal examination in spontaneous abortion, pregnancy termination for
prenatally diagnosed abnormalities, including placenta examination
 Late gestation stillbirth, including placental examination.
 Complications of prematurity, and problems of neonatal adaptation,
including review of placental findings where appropriate
 Multiple congenital anomaly syndromes (with good dysmorphology
examination)
 Sudden unexpected death in childhood, including the SIDS age group
and beyond.
 Medical and surgical mortalities in childhood diseases, including
complications of antineoplastic therapy.
□ The fellow should learn to execute the following techniques:
 Sampling of placenta and/or fetus for cytogenetic studies and fibroblast
cultures
 Examination of small fetus using dissecting microscope
 Basic forensic external and internal examination in sudden unexpected
death
 Metabolic autopsy protocol for suspected inborn error of metabolism
 Plan and quality assure x-rays, and sample bone/cartilage in skeletal
dysplasia
 Specialized dissection and photographic documentation of anomalies,
especially native and post-surgical congenital heart disease,
genitourinary anomalies, central nervous system anomalies.
153
□
□
Medical
Knowledge &
Its
Application
□
□
□
 Develop concise but detailed case presentation for Morbidity and
Mortality rounds, and for teaching
The fellow should learn several indications and techniques for appropriate
sampling for the following adjunct studies:
 Cytogenetics, fibroblast culture, FISH, and other molecular techniques
 Flow cytometry
 Post-mortem toxicology and electrolytes from serum, urine, vitreous
 Tissue sampling for direct enzyme analysis and/or RNA or DNA
preservation
 Electronmicroscopy
The fellow should be able to recognize and describe the major findings in
the following disorders:
 Trisomies 21, 13, 18, 45, X and Triploidy
 Anencephaly and other TNDs, Meckel Gruber Syndrome, fetal akinesia,
oligohydramnios sequence, Vater Association
 Thanatophoric dysplasia, Type II Osteogenesis Imperfecta, general short
rib polydactyly transposition of the Great arteries, Truncus arteriosus,
Anomalous pulmonary venous correction, Atrioventricular septal defect,
and the major operations used in each.
Initiate appropriate case work up based on available information and
clinical questions.
Generate accurate and comprehensive differential diagnosis with a plan to
arrive at a definite diagnosis.
Demonstrate the ability to utilize basic science in medical problem solving.
PracticeBased
Learning
□ To utilize individual cases to advance knowledge of disease processes
□ Utilize the teaching points in cases to advance the academic medical
missions and teach rotating medical students and residents.
Interpersonal
&
Communicati
on Skills
Professionali
sm
□ Works effectively as a member of a team and follows instructions.
□ Communicates effectively and participate in relevant work up and
discussions.
SystemsBased
Practice
□ Facilitates and contribute to proper turnaround time.
□ Adheres to a cost effective practice.
□ Utilize electronic medical records.
Teaching &
Research
□ Demonstrate respect to patients during performance of autopsy.
□ Demonstrate responsiveness and accountability, and thoroughness in
completing tasks
□ Follows a pattern of independent reading to improve skills and knowledge
□ Regularly attends and participates in appropriately assigned conferences
□ Participates in departmental teaching activities and investigative research
activities.
154
B. Trainee's General Responsibilities
The resident is expected to be physically in the section of Anatomic Pathology from 8:30
am to 5:30 pm Monday through Friday. Exceptions are made for the following:
pathology activities elsewhere in Nationwide Children’s Hospital, required conferences
at OSU, pre-arranged time away from the rotation as stipulated and approved by The
OSU Department of Pathology. The resident should be available on a daily basis for
sign-out (or autopsy), as arranged by the attending pathologist. For assigned autopsy
cases, the resident is responsible for participating in the dissection of the case, trimming
in of tissue, preliminary review of glass slides, and draft of final note. For assigned
surgical cases, the resident is responsible for preliminary review of the glass slides, and
draft of the microscopic description and final diagnoses. For selected cases, the
resident will also be responsible for grossing the specimen. Because of conflicting
requirements of coverage at Ohio State University, after hours or weekend coverage
are not expected of the residents. See also Sections C and D.
C. Curriculum for the Rotation
The resident will divide his/her responsibilities between the autopsy and surgical
pathology services. The resident may participate in up to four pediatric or perinatal
autopsies. The resident is encouraged to present a didactic seminar to the pathology
department involving a pediatric disease. This subject may evolve from his/her autopsy
cases or a particularly interesting surgical case. The resident will review, with
appropriate staff, the major categories of congenital heart disease seen at autopsy from
the congenital heart disease collection. These are to include: Tetralogy of Fallot,
atrioventricular canal defect, transposition of great vessels, total anomalous pulmonary
venous return, hypoplastic left heart syndrome and ventricular septal defect. The
resident will attend the monthly neonatology-pathology conference. The resident will
attend brain cutting and process his/her cases with review by the consultant
neuropathologist.
On the surgical pathology service, the resident will gross selected pediatric specimens,
and sign-out surgicals daily. This will be obviated by performance of an autopsy on the
same day. The resident will offer his/her own written opinion on the surgical cases prior
to sign-out of the cases with the attending pathologist. This surgical experience can be
supplemented by review of selected bone marrow aspirates and biopsies with the
attending hematopathologist, according to interest.
The resident will attend weekly anatomic pathology meetings, tumor board, G.I.
conference, bi-weekly neuroscience conference and Surgery-Pathology-Radiology
conference at Nationwide Children’s Hospital. The resident will attend all frozen
sections with the responsible pathologist during regular working hours. All
immunofluorescence and ultrastructural studies ensuing from the resident's surgical
pathology rotation will be reviewed by the resident with the attending pathologist. A
microscopic teaching collection is available for review of diverse pediatric lesions not
encountered in service work during any particular rotation.
155
These autopsy and surgical pathology rotations should provide the resident with
exposure to major areas of pediatric pathology. Areas of emphasis include: congenital
heart disease, perinatal pathology, pediatric infectious disease, malignancy, renal and
gastrointestinal disease and neuropathology. Opportunities for exposure to laboratory
management, quality assurance and digital imaging may also be available.
Cardiothoracic M&M, pediatric surgery M&M, and renal conferences can also be
attended.
The resident's opportunity for scholarly activity is realized through his/her preparation of
a seminar on a pediatric disease or area of research. This study may eventuate in an
abstract presentation at the annual Spring or Fall meeting of the Society for Pediatric
Pathology.
D. Resident Supervision
All autopsy, surgical and special procedures are done under direct or indirect
supervision of the responsible attending pathologist. A Pediatric Pathology Fellow
and/or Pathologists' Assistant may also teach and supervise some resident activities,
where appropriate. The resident does not have sign-out responsibility.
E. Resident Evaluation
The residents overall curriculum and final evaluations will be supervised by the Director
of the fellowship/Resident Training Program in consultation with the other attending
pathologists, pathologists’ assistants, and others as appropriate. The six general
competencies will be addressed as is appropriate to pathology training, particularly in
the setting of the Nationwide Children’s Hospital. Each attending the resident works
with on an autopsy case, or spends a week with on surgicals will complete an
evaluation, including narrative comments. There will also be a short written test. The
presentation at the end of the rotation will be evaluated, as well.
156
Pediatric Clinical Pathology Residency Education Program
Nationwide Children’s Hospital Department of Pathology
The rotation in Pediatric Clinical Pathology is designed for a four week period of time
and is spent at Nationwide Children’s Hospital.
Program Director:
Samir Kahwash, MD, Vice Chair of Education Director, Hematology
Teaching Faculty:
Dennis Bartholomew, MD, Director of Biochemical Genetics
Daniel Boué, MD, PhD
Julie Gastier-Foster, PhD, Director of Cytogenetics/Molecular Genetics
Sue Hammond, MD, Department of Pathology and Laboratory Medicine Chief
Amy Leber, PhD, Associate Director of Specialty Functions Labs
Donald Long, PhD
Mario Marcon, PhD, Director of Specialty Functions Labs
Kathleen Nicol MD, Vice Chair of Clinical Pathology
David Thornton, PhD, Director Core Laboratory Service, Clinical Chemistry, Lab
information System
Program Information Included in this Document:
A. Goals and Objectives of the Rotation
B. Trainee's General Responsibilities
C. Curriculum for the Rotation
D. Resident and Faculty Responsibilities
E. Resident Evaluation
F. Resident's Contributions to Teaching of Rotating Trainee
A. Goals and Objectives of the Rotation:
This rotation is designed to provide the resident with a general overview of various
aspects of clinical pathology in a pediatric setting. It includes the opportunity to be
exposed to clinical chemistry, urinalysis, hematology, bone marrow examination, body
fluids, point of care testing, microbiology, transfusion medicine and specimen collection
that has unique issues associated with the patient population this laboratory serves.
The rotation goals and objectives are listed below, divided based on Clinical Pathology
disciplines:
I- Pediatric Hematology Rotation
II- Pediatric Clinical/Molecular Microbiology, Virology, and Immunoserology
III- Pediatric Cytogenetics/Molecular Genetics Rotation (Molecular
Pathology/Genetics)
IV- Pediatric Core Laboratory Rotation
V- Transfusion Medicine Rotation
157
I- Pediatric Hematology Rotation
Diagnostic &
□ Recognize and diagnose peripheral blood and bone marrow
Patient Care
changes in major hematological disorders in children,
Activities
including types of anemias, thrombocytopenias, leukemias
and others.
□ Interpretation of cell marker studies by flow cytometry in
hematologic malignancies and reactive conditions with
emphasis on correlation with morphologic findings.
□ Work-up and interpretation of disorders of hemostasis and
thrombosis.
□ Diagnose and provide consultation on hemoglobinopathies
and special hematology testing.
□ Cytological examination of body fluids, urine and bronchial
alveolar lavage
Medical
□ To learn the morphologic appearances of normal and
Knowledge &
abnormal pediatric blood smears, bone marrow, fluids and
Its Application
lymph node specimens.
□ To learn and interpret results of special techniques
including Flow cytometry, Hemoglobin electro-phoresis, and
coagulation testing.
□ To develop an investigative and analytic approach to
pediatric hematologic diagnosis.
□ To understand and learn the genetic alterations in pediatric
hematologic tumors.
□ To understand the prognosis and general treatment
concepts of pediatric hematologic disorders.
Practice-Based □ To utilize individual cases to acquire knowledge of pediatric
Learning &
hematology/fluid pathology.
Improvement
□ To utilize study set cases to acquire knowledge of pediatric
hematology/fluid pathology.
□ To demonstrate effective problem solving by utilizing a
variety of information resources.
□ Contribute to Quality Improvement projects and CAP
surveys.
Interpersonal & □ To communicate clearly with the attending pathologists and
Communication
clinicians regarding diagnoses and supporting evidence
Skills
both verbally and in written reports.
□ To learn to communicate effectively with members of the
technical and support staff
Professionalism □ To demonstrate respect and integrity in encounters with
patients, clinicians, staff pathologists, and support staff
□ To work effectively with the medical technologists and other
trainees.
□ To adhere to the highest standards of conduct during
conferences and tumor boards.
158
□ To learn the work flow process in hematopathology at
Nationwide Children's Hospital and to maximize its
efficiency
□ To recognize the appropriate and cost-effective techniques
for evaluating pediatric hematological and coagulation
disorders while ensuring excellent quality of services
Teaching &
□ Regularly attends and participates in appropriately assigned
Research
conferences
□ Participates in departmental teaching activities and
investigative research activities.
II- Pediatric Clinical/Molecular Microbiology, Virology, and Immunoserology
Optimal for a 1-3 month rotation - ½ days to accommodate ID fellow and clinical
responsibilities
Diagnostic &
□ Review basic microbiological principles in sufficient detail to understand
Patient Care
pathogenesis of infectious diseases, microbial virulence factors, hostActivities
parasite relationships, and the basic principles of microbiologic
laboratory procedures.
□ List the major groups of microorganisms which comprise the indigenous
microflora of the following anatomical regions of the human body: skin,
ear, eye, mouth, nasopharynx, oropharynx, tonsils, nares and nasal
passages, upper and lower gastrointestinal tract, and the genitourinary
tract of males and females.
□ Learn the types of specimens required for the laboratory diagnosis of
infectious diseases and describe the procedures for appropriate
acquisition and transport of these specimens.
□ Understand basic laboratory skills required for the primary processing of
clinical specimens for the culture isolation of the following: aerobic and
anaerobic bacteria, fungi, mycobacteria, chlamydia, mycoplasma, and
viruses.
□ Practice supervised microscopic examination of stained smears,
cytocentrifuge preparations, and tissue for the diagnosis of infectious
diseases and where appropriate for the assessment of specimen quality.
□ Learn and perform the basic laboratory tests required for the
identification from culture of the following groups of microorganisms:
aerobic and anaerobic bacteria, fungi, mycobacteria, chlamydia,
mycoplasma, and viruses.
□ Identify the common animal parasites causing human infections based
on their microscopic and/or macroscopic morphology.
□ Describe the major non-cultural methods utilized for the identification of
microorganisms or for the detection of these organisms and/or their
antigens, nucleic acids or metabolic products in clinical specimens.
□ Learn the principles and procedures used by the laboratory for the
antimicrobial susceptibility testing of bacteria, fungi and yeast and
mycobacteria, and develop the skills required for the interpretation of
these results.
Systems-Based
Practice
159
□ Function as the primary liaison between the laboratory and clinician
inquiries.
□ Describe the laboratory’s quality control program and the qc
responsibilities for each bench rotation.
□ Practice interpretive and consultative skills as apply to the diagnosis and
treatment of infectious diseases by daily review of significant smear and
culture results
Medical
□ To learn the characteristics of the common organisms encountered in a
Knowledge & Its
pediatric practice.
Application
□ To develop an investigative and analytic approach to pediatric
microbiology.
□ To understand the prognosis and general treatment concepts of pediatric
infections.
Practice-Based □ To utilize individual cases to acquire knowledge of pediatric
Learning &
microbiology.
Improvement
□ To utilize study set cases to acquire knowledge of pediatric microbiology.
□ To demonstrate effective problem solving by utilizing a variety of
information resources.
Interpersonal & □ To communicate clearly with the attending pathologists and clinicians
Communication
regarding diagnoses and supporting evidence both verbally and in
Skills
written reports.
□ To learn to communicate effectively with members of the technical and
support staff
Professionalism □ To demonstrate respect and integrity in encounters with patients,
clinicians, pathologists, and support staff.
□ To work effectively with the medical technologists and other trainee.
□ To adhere to the highest standards of conduct during conferences.
Systems-Based □ To learn the work flow process in the microbiology/Virology lab at
Practice
Nationwide Children's Hospital and to maximize its efficiency.
□ To recognize the appropriate and cost-effective techniques for
evaluating pediatric infectious diseases while ensuring excellent quality
of service
Teaching &
□ Regularly attends and participates in appropriately assigned conferences
Research
□ Participates in departmental teaching activities and investigative
research activities
III- Pediatric Cytogenetics/Molecular Genetics Rotation (Molecular Pathology/Genetics)
Specific
□ Observe and/or perform procedures required for preparation and
Objectives
analysis of high resolution peripheral blood karyotype:
a. Specimen set up and culture, synchronization procedures
b. Specimen harvest
c. Slide preparation and Giemsa staining
d. Microscopic analysis
e. PSI karyotyping system
160
□ Observe procedures required for preparation and analysis of amniotic
fluid specimens:
a. Specimen set up and culture
b. Specimen culture and evaluation for harvest
c. Coverslip harvest using robotic harvester
d. Giemsa staining
e. Microscopic analysis and karyotyping
□ Observe procedures required for preparation and analysis of other
prenatal and perinatal specimens:
a. Chorionic villus samples
b. Pregnancy loss specimens
□ Become familiar with fluorescence in situ hybridization (FISH) methods
a. Specimen requirements and preparation
b. Probes and procedures
c. Analysis and documentation considerations
d. Reporting considerations
□ Observe examples of utilization of FISH in clinical diagnostic testing
a. Microdeletion analysis: DGS/VCFS, Williams syndrome, etc
b. FISH analysis of uncultured prenatal or newborn peripheral blood
specimens
c. Characterization of structural rearrangements including use of
whole chromosome paint reagents
d. Use of specialized reagents: Cytocell
e. Comparative genomic hybridization (CGH)/microarray CGH
f. M-FISH
□ Observe and/or perform standard techniques used in molecular
diagnostic testing
a. DNA and RNA isolation
b. Polymerase Chain reaction (PCR)
c. Reverse-transcriptase PCR
d. Quantitative/Real time PCR
e. Methylation-specific PCR
f. Gel electrophoresis
g. Southern blotting
h. Microsatellite analysis and genotyping
i. DNA sequencing
□ Observe performance and interpretation of clinical molecular diagnostic
tests
a. Methylation-specific SNRPN PCR analysis for diagnosis of PraderWilli/Angelman syndrome
b. Uniparental disomy analysis
c. Analysis for maternal cell contamination in CVS samples
d. RT-PCR analysis of fusion transcripts in pediatric tumors
e. Analysis for translocations in pediatric ALL
f. Cystic fibrosis screening
161
□
□
Diagnostic &
Patient Care
Activities
□
□
Medical
□
Knowledge & Its
Application
□
□
Practice-Based
Learning &
Improvement
□
□
□
Interpersonal &
Communication
Skills
□
□
Professionalism □
Systems-Based
Practice
□
□
□
□
Teaching &
Research
□
□
g. Connexin 26 and 30 mutation analysis
h. Bone marrow transplant engraftment monitoring
i. Noonan syndrome sequence analysis
j. SCAD analysis
Case review with directors
Attend case review and other conferences:
a. Cytogenetics/Molecular Genetics review of abnormal cases (twice
per month)
b. Prenatal Genetics conference at Ohio State (twice per month)
c. Clinical Genetics Post-clinic conference (every week)
To become familiar with methods and cytogenetic analysis of amniotic
fluid and other prenatal specimens, peripheral blood specimens (high
resolution cytogenetic analysis), and molecular cytogenetic testing
To become familiar with the techniques used in molecular diagnostic
testing and with testing offered for the diagnosis of specific genetic
disorders
To learn the characteristics of the common cytogenetics/Molecular
genetics abnormalities encountered in a pediatric practice.
To develop an investigative and analytic approach.
To understand the prognosis and general treatment concepts of pediatric
genetic abnormalities.
To utilize individual cases to acquire knowledge of pediatric
Cytogenetics/ molecular genetics.
To utilize study set cases to acquire knowledge of pediatric
Cytogenetics/ molecular genetics.
To demonstrate effective problem solving by utilizing a variety of
information resources.
To communicate clearly with the attending pathologists and clinicians
regarding diagnoses and supporting evidence both verbally and in
written reports
To learn to communicate effectively with members of the technical and
support staff
To demonstrate respect and integrity in encounters with patients,
clinicians, scientists, and support staff.
To work effectively with the medical technologists and other trainee.
To adhere to the highest standards of conduct during conferences.
To learn the work flow process in the cytogenetics/molecular genetics
lab at Nationwide Children's Hospital and to maximize its efficiency
To recognize the appropriate and cost-effective techniques while
ensuring excellent quality of services.
Regularly attends and participates in appropriately assigned conferences
Participates in departmental teaching activities and investigative
research activities.
162
IV- Pediatric Core Laboratory Rotation
The Core Laboratory rotation comprises routine chemistry, routine urinalysis, routine
hematology, rapid response laboratory, point of care testing, blood lead testing, specimen
collection and laboratory information systems.
Objectives: Become familiar with the methods, quality control and quality assurance aspects
of the Core Laboratory, Point of Care Testing, and Laboratory Information System.
Diagnostic and
□ Understand the unique aspects of pediatric specimen collection including
Patient Care
specimen handling, volume, tube type, stability and reasons for
Activities specimen rejection. Specimen types will include urine, capillary blood,
Specific
venous blood and sweat collection.
Objectives
□ Understand the unique aspects of pediatric testing, including method
choice, instrument choice, reference ranges and reporting issues.
□ Observe the various methods used throughout the Core Laboratory.
□ Observe the review of quality control for automated instrumentation,
manual tests on a daily and monthly basis and across instruments and
facilities.
□ Observe the management of the Point of Care testing program, including
training issues, review of competency, instrumentation and method
selection.
□ Observe the methods used to monitor quality assurance throughout the
laboratory to find problems and improve them in a timely manner.
□ Discuss the unique aspects of the Laboratory Information System and
how it can provide useful information to the clinician. Provide
information about its security features, calculations, data retrieval,
software validation, and disaster prevention and recovery.
Medical
□ To learn the characteristics of the common testing modalities,
Knowledge & its
instrumentation and significance of abnormalities encountered in a
Application
pediatric practice.
□ To develop an investigative and analytic approach.
Practice-Based □ To utilize individual cases to acquire knowledge.
Learning &
□ To demonstrate effective problem solving by utilizing a variety of
Improvement
information resources.
Interpersonal & □ To communicate clearly with the attending pathologists and clinicians
Communication
regarding diagnoses and supporting evidence both verbally and in
Skills
written reports
□ To learn to communicate effectively with members of the technical and
support staff
Professionalism □ To demonstrate respect and integrity in encounters with patients,
clinicians, scientists, and support staff.
□ To work effectively with the medical technologists and other trainee.
□ To adhere to the highest standards of conduct during conferences.
Systems-Based □ To learn the work flow process in the Core lab at Nationwide Children's
Practice
Hospital and to maximize its efficiency
□ To recognize the appropriate and cost-effective techniques while
ensuring excellent quality of services
163
□ Regularly attends and participates in appropriately assigned conferences
□ Participates in departmental teaching activities and investigative
research activities.
Diagnostic &
□ Understand the cause of hemolytic disease of the newborn (HDN)
Patient Care
a. Diagram Rh and ABO incompatibility
Activities
b. Describe the clinical effects of hemolytic disease in the fetus and
newborn
c. Understand the diagnosis and management of HDN
d. Describe the methods of prenatal diagnosis (e.g. maternal antibody
titer, amniocentesis, maternal history, maternal and paternal
phenotypes)
e. Define the indications and rationale for each form of therapy of
HDN: early delivery, intrauterine transfusion, phototherapy,
plasmapheresis of mother
f. Identify two common antibodies which cause HDN requiring
exchange transfusion
g. Describe selection of blood type and component for exchange
transfusion in HDN
h. Describe kinetics of exchange
i. List the possible complications of exchange transfusion
□ Know compatibility testing for neonatal and pediatric transfusions
a. Identify appropriate blood samples for testing
b. Identify appropriate ABO types for component transfusion
□ Understand post-transfusion risks to neonates and unique pediatric
populations
a. Identify situations in which recipient is at risk for graft vs. host
disease
b. Identify situations in which neonate is at risk for posttransfusion
CMV infection
□ Understand pathophysiology of neonatal isoimmune thrombocytopenia
and neutropenia
a. Identify clinical syndrome
b. Identify mechanism
□ Understand the utilization of Extracorporeal Membranous Oxygenation
(ECMO)
a. Demonstrate understanding of product utilization
□ Understand erythrocytopheresis in patients with Sickle Cell Anemia
b. List factors determining product utilization
Medical
□ To learn the characteristics of the common transfusion practices
Knowledge & Its
encountered in a pediatric hospital.
Application
□ To develop an investigative and analytic approach to pediatric
transfusion medicine.
□ To understand the prognosis and general transfusion concepts of
pediatric diseases.
Practice-Based □ To utilize individual cases to acquire knowledge of pediatric transfusion
Teaching &
Research
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Learning and
Improvement
□
□
Interpersonal &
Communication
Skills
□
□
Professionalism □
Systems-Based
Practice
□
□
□
□
Teaching &
Research
1.
2.
3.
4.
□
□
medicine.
To utilize study material to acquire knowledge of neonatal and pediatric
transfusion medicine.
To demonstrate effective problem solving by utilizing a variety of
information resources.
To communicate clearly with the attending pathologists and clinicians
regarding diagnoses and supporting evidence both verbally and in
written reports, when applicable.
To learn to communicate effectively with members of the technical and
support staff
To demonstrate respect and integrity in encounters with patients,
clinicians, pathologists, and support staff.
To work effectively with the medical technologists and other trainees.
To adhere to the highest standards of conduct during conferences.
To learn the work flow process in the Transfusion Service at Nationwide
Children's Hospital and to maximize its efficiency.
To recognize the unique blood product features and cost-effective
techniques specific to age or diagnosis while ensuring excellent quality
of service
Regularly attends and participates in appropriately assigned conferences
Participates in departmental teaching activities and investigative
research activities
B. Trainee's General Responsibilities
Adhere to pertinent regulations and policies of the Institution and department.
Follow instructions and work closely with Pathologists on service and other support
staff and become familiar with procedure manuals.
Attend educational conferences and lectures.
Communicate effectively and provide timely feedback regarding the quality of the
learning process.
C. Curriculum for the Rotation
Statement of educational philosophy: The rotation is designed to be a "hands-on,"
case-oriented learning experience for the resident. In addition to the teaching-learning
process which occurs through the case discussion method, the resident is expected to
construct a self-directed reading program to cover the major areas reviewed and is
responsible for reading suggested material and reviewing teaching cases and directed.
D. Resident and Faculty Responsibilities
When appropriate, the resident is responsible for initial review of the case material.
Each case is then reviewed with the attending pathologist who signs off on the case.
During the initial stages of the rotation, an approach to solving the problem is discussed
with the attending. With experience, the resident is expected to devise his/her own
approach and gather the necessary data to solve the problem and prepare a
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consultative report as needed. Similarly, a plan of action, including communication with
the physicians primarily responsible for the patient's care, is discussed. With
experience, the resident is expected to develop and carry out this plan. The attending
staff "on service" is available throughout the day to assist in this process.
E. Resident Evaluation
Residents will be given evaluations at the end of the month with input from the various
attendings and staff that interacted with the resident. Any laboratory techniques directly
observed and or procedures/performed by the resident will be summarized by the
resident (experience tracking) and are to be included in the resident’s portfolio of work
products. It is highly recommended that the resident track the numbers and types of
cases that they personally review while on this rotation and that this information is also
placed in their portfolio.
F. Resident's Contributions to Teaching of Rotating Trainee
The Pediatric Pathology Fellow will assist with consultative and teaching activities, and
serve as an instructor to trainees rotating through the department under the following
guidelines. Along with the teaching faculty, the Fellow works to promote the following
goals, objectives and responsibilities for these rotations.
Additional supplemental information:
We provide training to rotating trainees at various levels of pathology training. Our
Department has arrangements in place to train residents from the pathology programs
at The Ohio State University (OSU) in Pediatric Pathology and Clinical Pathology, and
also from Allegheny General Hospital, Pittsburgh, PA (Pediatric Pathology electives).
Training is also provided to residents and fellows from clinical specialties (e.g.
Pediatrics, Hematology/ Oncology, etc.) to medical students and pathology assistant
students.
The service schedules of residents and fellows are designed and tailored to optimize
learning opportunities for trainees at all levels.
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Introduction to Forensic Pathology and Medicolegal Death Investigations
Franklin County Coroner’s Office
During the course of the four week rotation, the student becomes an integral part of the
death investigation team at the Franklin County Coroner’s Office participating first hand
in all conferences, performing autopsies, attending scene investigations, viewing expert
witness testimony and interpreting postmortem toxicology tests. Students soon learn
that death investigation is more than "just an autopsy."
A large volume of material reflecting both natural disease and unnatural death makes
this a popular and informative rotation. Residents are expected to perform the autopsies
including natural deaths, accidents, and suicides under the supervision and direction of
a forensic pathologist when appropriate cases are available. Residents and medical
students are not assigned homicides, but are encouraged to observe these cases. They
are not typically expected to perform more than one case in a day unless they have a
particular interest in a case. When the resident or med student is not performing an
autopsy, they are expected to be available to observe those cases that are being
performed by the staff and fellows Residents and students also have an opportunity to
go to an at-scene examination, accompanying the investigator to the scene of death.
The coroner's office has modern facilities, with many ancillary studies available on a
routine basis. Gross and microscopic pathology are covered. Approximately 80
autopsies are performed during this month, ensuring an overall adequate number of
autopsies for board eligibility. During the forensic pathology rotation weekly didactic
lecture on basic forensic pathology will be available for the resident in addition to inhouse conferences of forensic science topics. Excellent crime and toxicologic
laboratories are part of the facility. Exposure to the Crime and Toxicology Laboratory
studies also is available during the rotation and strongly encouraged.
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FACULTY
Franklin County Coroner
Jan M. Gorniak, D.O.
Facility Director
Cindy Coleman
Education Program Director
TBA, M.D. Office phone
Teaching Faculty Members
Jan M. Gorniak, D.O., Coroner and Forensic Pathologist
Tae An, M.D., Forensic Pathologist
Kenneth Gerston, M.D., Forensic Pathologist
Obi Ugwu, M.D., Forensic Pathologist
Bonita Ward, M.D., Forensics Pathologist
Calvin McGuire, Chief Toxicologist
Lead Technical and Clerical Personnel
Jack Sudimack, Chief of Investigations
Coordinates Forensic Technicians and death scene investigations
Greg Rolfsen, Morgue Supervisor
Coordinates Morgue Technician support for the autopsies
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TRAINING SITE
Franklin County Coroner’s Office
520 King Ave, Columbus, Ohio 43201
DURATION
Four weeks
PREREQUISITES
Residents attending the forensic pathology rotation must have completed at least one
year of residency with at least six months in hospital autopsy.
Medical students/allied med student must be in good academic standing and have
completed the first two years of OSU medical school curriculum or at least a structured
anatomy class and related basic science courses.
Goals:
1. Learn and understand the Coroner versus Medical examiner System.
2. Learn what types of death require investigation.
3. Become familiar with the reporting forms used during a forensic
investigation.
4. Learn what steps are necessary to maintain the "chain of custody" for
evidence collected.
5. Learn how a scene of death is properly investigated.
6. Learn how bodies are identified.
7. Learn the proper method of external examination.
8. a. Learn the proper technique of photograph documentation of the
pertinent external findings.
b. Learn how time of death may be determined.
9. Learn the nature of various types of wounds and deaths with their
important associated findings: blunt-force injuries, sharp-force injuries,
gunshot and shotgun wounds, asphyxial injuries, sudden unexplained
death in infancy, fire-related injuries and hypothermia, motor vehicle
related injuries, no anatomic cause of death.
10. Learn about special investigative techniques related to decomposed
bodies, burnt bodies, apparent drowning.
11. Learn about forensic toxicology and specimen collection.
12. Learn about forensic pathology autopsy techniques.
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PATHOLOGY RESIDENT OBJECTIVES
In accordance with the ACGME requirements, the following objectives are outlined in
the six prescribed areas that will develop competencies in forensic pathology.
I. Patient Care
Procedural Skills:
A) Objective – Many of the skills learned in this rotation overlap with those of the
hospital setting. While some of those are reiterated below, additional procedures
particular to forensics pathology are also listed. It is not expected that the
resident will perform or observe every one of these findings within a single
month, however they should be familiar with them through observation of other
staff cases and through the required reading.
a. Ability to perform an adequate dissection (Virchow method) including:
i. Dissection of the heart and sectioning of coronary arteries
ii. Appropriate sectioning of upper respiratory system (including
vessels and bronchi of the lungs), gastrointestinal tract (esophagus,
stomach, duodenum, small and large intestine), liver, pancreas,
spleen, kidneys, bladder, and prostate, testes, ovaries, uterus,
fallopian tubes and ovaries (as appropriate).
iii. Location and dissection of adrenal glands, thyroid gland,
parathyroid glands
iv. Dissection of the brain; including removal of brain:
1. Dissection of Circle of Willis
2. Dissection of cerebrum, brainstem and cerebellum
b. Ability to perform additional procedures:
i. Reflection of scalp (without cosmetic damage) and removal of
calvarium
ii. Removal of the pituitary gland
iii. Stripping of the dura mater
iv. Examination of the middle and inner ear
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v. Removal of the tongue and neck organs (without causing cosmetic
damage)
vi. Removal of the spinal cord with and without dura
vii. Ability to test in-situ for pulmonary thromboemboli, air embolus, and
pneumothorax
viii. Removal of testes
ix. Examination of the legs for deep venous thrombi
x. Open the sphenoid sinus
c. Forensic pathology procedures:
i. Gunshot wounds and shotgun wounds:
1. Be familiar with basic differences between handguns, rifles,
and shotguns
2. Identify entrance and exit wound characteristics
3. Establish direction of fire and involved (injured) structures
4. Identify range characteristics (soot, stippling, muzzle
abrasions)
5. Describe bullet characteristics and estimate caliber (small,
medium, large)
6. Identify buckshot, birdshot, and wad material
ii. Sharp force injuries :
1. Identify stab wounds and incised wounds
2. Identify sharp and blunt angles
3. Establish direction and depth of penetration
iii. Blunt force injuries:
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1. Identify abrasions, lacerations, contusions and fractures
2. Identify chop injuries
iv. Asphyxia
1. Examine hanging findings including ligatures and ligature
furrows
2. Identify petechial hemorrhages (skin, eyes)
3. Identify fractures of the hyoid bone and thyroid cartilage
4. Perform and interpret anterior and posterior neck dissections
v. Drug related deaths
1. Acquire basic knowledge of common street drugs (cocaine,
marijuana, methamphetamine, heroin, etc.)
2. Interpret toxicology results and their implications to the
autopsy
vi. Ancillary testing
1. Understand when additional pediatric procedures such as
metabolic screening and microbiology cultures are
appropriate
2. Understand when histologic examination is appropriate and
what sections are appropriate for a given case.
3. Identify cases that require special testing such as
carboxyhemoglobin levels and testing for volatiles
B) Plan:
a. Procedural skills will be taught by attending pathologists; and experienced
residents on their second rotation
b. Residents are not expected to keep a procedure log, however, they are
expected to keep a log of their cases. This will be signed off by the
program director.
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C) Assessment:
a. The residents receive verbal assessment by the staff during the autopsy.
Interpretive skills:
A) Objectives:
1) Ability to interpret, present, and concisely summarize (in writing or during
morning pathology conference) gross pathologic findings, with a particular focus
on description of injuries.
2) Competently perform an external, internal and microscopic examination (with
interpretation of gross and microscopic pathologic changes) on one or a
combination of cases.
B) Plan:
1) Interpretative skills are taught by the attending pathologists and experienced
residents
C) Assessment:
1) Interpretative skills will be assessed by attending pathologist informally through
editing/correcting of resident’s autopsy reports which have been turned in for
review prior to finalization
II. Medical Knowledge
A) Objectives:
1) Demonstrate familiarity with laws regarding classification of autopsies requiring
medicolegal status
2) Demonstrate a clear understanding of cause/manner/mechanism of death
3) Understand infectious disease precautions
4) Correlation of autopsy findings (gross and microscopic) with history
B) Plan
1) The knowledge base is obtained through:
a) Informal teaching by attending pathologists during the autopsy
b) Conferences (see conference list)
c) Basic reading requirements (see suggested reading)
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C) Assessment
1) Informally: questions asked during conferences, autopsies or on assignments.
2) Formally: Examination at completion of rotation
III. Practice-based Learning
A) Objectives:
1) Demonstrate active pursuit of forensic pathology knowledge
2) Develop concise, accurate dictation styles
B) Plan:
1) Basic reading requirements
2) Obtain additional literature pertaining to a particular case when necessary
C) Assessment:
1) Informally, during editing/correcting of resident's autopsy reports
IV. Interpersonal and Communications Skills
A) Objectives:
1) Effectively interact with autopsy assistants, funeral home personnel, family
members, forensic pathologists, other medical personnel, law enforcement
agencies, and attorneys
2) Perform medical student or staff seminar of individual interest or assigned topic
during the rotation.
B) Plan
1) Document communications with outside contacts (family, attorneys, investigating
agencies) in the chart
C) Assessment
1) The resident's interpersonal and communication skills with be subjectively
assessed by the attending pathologists during their rotation
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V. Professionalism
A) Objectives:
1) Ability to independently prepare an preliminary autopsy report, including gross
and microscopic descriptions, findings and a concise conclusion which is free (or
nearly free) of significant errors
2) Ability to show respect for the body during the autopsy
B) Plan:
1) The resident will prepare one autopsy report to be presented to the attending
pathologist.
C) Supervision/Assessment:
1) Objectively, by review of turn-around time of the autopsy report by the resident,
tabulated and determined by the Autopsy Director, or a duly appointed designee
2) Subjectively by the attending pathologist during editing/correction of the autopsy
report
3) Informally, during interactions with the resident during the month by the attending
pathologists
VI. Systems-based Practice
A) Objectives:
1) Understanding the social, professional, economic, educational, and health &
safety ramifications of forensic pathology within society as a whole is the goal of
this competency.
B) Plan:
1) Acquire knowledge during the performance of the autopsy and conferences, as
well as in interaction with attending pathologists, investigative agencies, and
other involved groups
C) Supervision/Assessment:
1) Informal
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MONTGOMERY COUNTY CORONER’S OFFICE
MIAMI VALLEY REGIONAL CRIME LABORATORY
(Optional Rotation)
The Montgomery County Coroner's Office provides forensic autopsy services for over
26 counties in Ohio. The office reviews over 4500 deaths in the community annually
and autopsies over 1300 of those cases. Within the facility resides the Miami Valley
Regional Crime Laboratory, which evaluates over 20,000 criminal cases for over 100
law enforcement agencies in southwest Ohio. With a combined staff of over
70 employees, the office is accredited by N.A.M.E., A.S.C.L.D., LAB and A.C.G.M.E.
FORENSIC PATHOLOGY
I.
Duration: The duration of the rotation in Forensic Pathology is for four weeks.
II.
Teaching staff responsible for supervision and instruction:
The teaching staff for the Forensic Pathology rotation at the Office of the
Montgomery County Coroner includes the following members:
James H. Davis, M.D., Coroner
Kenneth M. Betz, Director
Lee D. Lehman, Ph.D., M.D., Chief Deputy Coroner
Russell L. Uptegrove, M.D.
Kent E. Harshbarger, M.D., J.D.
Bryan D. Casto, M.D.
Susan L. Allen, D.O.
Robert S. Shott, M.D.
Laureen Marinetti, Ph.D., Chief Toxicologist
III.
Learning Objectives:
At the completion of the one month rotation the resident will have a basic
understanding of forensic pathology a subspecialty of pathology.
Patient Care
Residents must demonstrate a satisfactory level of technical skill and diagnostic
competence and ability to clearly convey their findings and opinions.
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A.
Gather essential medical history on patients from investigators and
medical records,
B.
Evaluate death cases to determine which need a medicolegal autopsy.
C.
Employ acceptable procedures to protect/collect trace evidence.
D.
Perform competent autopsies under direct supervision of attending
pathologist.
E.
Use information technology to support diagnostic decisions.
F.
Communicate autopsy findings to investigators, coroners, law
enforcement personnel, staff pathologists and family.
G.
Correctly complete a death certificate.
H.
Use basic techniques to estimate time of death and their limitations.
I.
Maintain acceptable “chain of evidence”.
J.
Retain appropriate specimens.
K.
Interpret postmortem toxicology reports.
Medical Knowledge
Residents must demonstrate broad based medical knowledge including anatomic
and clinical pathology and the major medical specialities and apply that
knowledge to medical legal cases.
A.
Apply analytical thinking to medical legal cases.
B.
Base autopsy diagnoses, opinions and findings on solid scientific
principals.
C.
Know which deaths fall into the jurisdiction of the coroner/medical
examiner.
D.
Know the role of an expert witness in criminal trials.
E.
Know how a witness is qualified as an expert.
F.
Become familiar with courtroom procedure.
G.
Know how to approach courtroom testimony in the event of receiving a
subpoena.
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H.
Know how to document injuries by photography which will be acceptable
for submission in a court of law.
Practice – Based Learning and Improvement
Resident must be able to demonstrate ability to evaluate their autopsy skills and
diagnostic ability and assimilate scientific evidence to improve their performance.
A.
Analyze their practice experience and perform practice–based
improvement.
B.
Assimilate and apply evidence from scientific studies related to their
cases.
C.
Apply knowledge obtained from their cases to other cases.
D.
Use information technology to obtain and manage information.
E.
Facilitate the learning of students and other health care professionals.
Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills resulting in
effective information exchange and productive work as a team member.
A.
Elicit and provide essential information using verbal and nonverbal skills.
B.
Be able to prepare a medicolegal autopsy report.
C.
Work effective with others as a member of a professional team.
D.
Develop and maintain ethically sound relationships
Professionalism
Residents must carry out their professional responsibilities, adhere to ethical
principles, and demonstrate sensitivity to a diverse patient population.
A.
Demonstrate respect for the deceased.
B.
Perform autopsies in a professional manner.
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C.
Demonstrate commitment to ethical principles.
Systems-Based Practice
Residents must demonstrate an awareness and responsiveness to the larger
context and system of health care and call on system resources to fulfill the
needs of medical legal cases.
IV.
A.
Understand how forensic pathology affects other health care
professionals, the health care system, and how these affect the practice of
forensic pathology.
B.
Know how types of death investigation systems differ from one another
including controlling costs and allocating resources.
C.
Use cost-effective practices that do not compromise quality.
D.
Know when and what type of expert assistance may be required in a
particular case.
E.
Advocate for quality death investigation and health care.
Curriculum: The curriculum for the Forensic Pathology rotation will include:
A.
B.
C.
D.
E.
The medicolegal autopsy
Courtroom appearance and testimony
Interpretive toxicology
Death scene investigation (MCCO has 9 full-time forensic investigators)
Crime Laboratory (exposure to DNA analysis/trace evidence/evidence
recognition and collection/firearms evidence).
During the month’s rotation, the resident is free to attend teaching conferences
offered by The Ohio State University Department of Pathology.
V.
Resident Supervision
During the Forensic Pathology rotation, the resident is directly supervised by one
of the staff pathologists. When attached to Toxicology (usually a one-day
experience) the resident is supervised by Dr. Marinetti. Supervision is one-toone, staff with resident.
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VI.
Resident Duties
The resident is expected to perform medicolegal autopsies under the supervision
of the responsible staff pathologist, complete microscopic examination and the
autopsy report in a timely manner. He/she will accompany pathologists to court
when they are called to give testimony. The resident will go to the death scenes
with the investigators and pathologists. The resident will spend at least one day
in the Toxicology Laboratory. The resident will consult with crime laboratory
personnel on death investigations as needed and attend lecture(s) by crime
laboratory staff.
VII.
Faculty Duties
The duties and responsibilities of the faculty are to provide instruction. The staff
pathologist will demonstrate the approach to the medicolegal autopsy. He/she
will discuss the reasoning as to which cases are or are not autopsied. The staff
member will demonstrate the means to perform an adequate external
examination of the deceased, and the means to document findings or injuries by
means of diagrams, and photography for presentation in court. The faculty
members will teach the resident the format for the medicolegal autopsy report.
The faculty members will attempt to bring the resident with them to court,
whereby the resident will be able to witness typical courtroom procedure. At
death scenes, the faculty members will demonstrate standard conduct, and the
rudiments of the on-scene examination of the deceased.
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NEUROPATHOLOGY
A. Duration of Rotation – Four weeks
B. Teaching Staff Responsible for Supervision and Instruction:
Abhik Ray Chaudhury, M.D.
Support staff:
Eleanor Borem - Division Secretary, keys and library
Karen Scott - histotechnologist
C.
Goals and Objectives:
Provide residents with an educational experience that meets the following
competencies:
g) Patient care
h) Medical knowledge
i) Practice-based learning and improvement
j) Interpersonal and communication skills
k) Professionalism
l) Systems-based practice
21.
Ability to obtain pertinent information from the patients’ clinical record. (c)
22.
Demonstrate knowledge of information that is necessary to provide
adequate clinical history on submission forms for anatomic pathology
specimens. (c, f)
23.
Ability to enumerate the elements of a satisfactory histologic sections and
stains, and identify the possible reasons for unsatisfactory preparations.
(a, b, f)
24.
Ability to collect and preserve appropriate tissues and fluids for
immunofluorescence and flow cytometric studies. (a, b)
25.
Ability to select and submit tissue appropriately for electron microscopy.
(a, b)
26.
Proficiency in initiating routine microbiological studies, including
appropriate cultures, smears, and stains, and involving knowledge of
methods of collection and preservation, if needed. (a, b, f)
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27.
Ability to present cases at conferences with clarity, completeness, and
high quality illustrations, and to reach reasonable interpretative
conclusions. (b, c, d, f)
28.
Ability to select an appropriate piece of tissue for frozen section, and to cut
and stain the section satisfactorily. (a, b)
29.
Demonstrate knowledge of the common pathogens that can be
transmitted to laboratory personnel in pathology, as well as basic safety
precautions to be taken in the anatomic pathology laboratory, including
universal precautions for infectious agents.
D. Curriculum for the Rotation
1.
Study the teaching sets of glass slides and syllabi:
(a) General Neuropathology
(b) Infections
(c) Vascular diseases
(d) Tumors etc
2.
Optional teaching sets
(a) Neuroanatomy lectures on DVD.
(b) Perinatal neuropathology
(c) Diseases of myelin
(d) Other teaching sets in Division of Neuropathology
3.
Review glass slide examples of brain tumors and discuss selected or
problem cases with attending staff at the multiheaded microscope
4. Review all current neurosurgical cases with neuropathology staff at sign-out
5.
Attend Gross Neuropathology conferences:
(a) 12:00 PM Thursdays at OSU morgue.
6.
Attend Neuro-Oncology conferences on Thursdays at 12:00 AM.l
7.
Study suggested reading materials (one of the basic neuropathology texts
from the list):
(a) Pathologic Basis of Diseases, Robbins, Cotran and Kumar, Elsevier,
8th edition.
(b) WHO Classification of Tumors of the Central Nervous system, IARC
Press, 6th edition, 2007.
(3) Neuropathology, A Reference Text of CNS Pathology, David Ellison
and Seth Love, Mosby, 2007.
(4) Greenfield’s Neuropathology, 6th Edition, Arnold, 2006.
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All of these texts are available in the Neuropathology Division.
E. Resident Responsibilities:
1. Laboratory Management. The resident assists the senior staff in working up
neurosurgical specimens and selected autopsy cases. In so doing he/she will
order special stains when necessary, interact with laboratory staff in reading
slides, and in quality control of routine slides and special stains.
2. Quality assurance. In cases they participate in signing-out, the resident assists
the senior staff in working up surgical specimens and selected autopsy cases.
In so doing he/she will order special stains when necessary, interact with
laboratory staff in reading slides, and in quality control of routine slides and
special stains.
3. Data processing. We have an integrated PC Computer System with an on-line
Hospital Information System for patient data, and all cases are coded for rapid
retrieval.
4. Teaching of other residents, medical students. Depending on rotations, there
may be clinical residents and/or medical students in the Division. In that case,
the resident reviews cases with them, and assists in the teaching of basic
pathologic principles.
a.
Neurology and Neurosurgery residents spend one or more months in the
Neuropathology Division. They attend conferences, review cases with
staff, study teaching sets, present a case at Clinical Neuroscience Grand
Rounds (they work case up with the senior Neuropathology staff member),
and may do clinical research and/or write papers.
b.
Medical Students. During their four weeks elective in Neuropathology they
attend conferences, sit in on case review with staff and residents, study
teaching sets, and may in certain cases do clinical research and/or write
papers.
5. Attendance at clinical correlation conferences such as Brain Tumor Boards.
Though this is never a direct function of the Neuropathology Division, the
resident will, if possible, attend these conferences with the senior staff.
F. Manner in Which Resident is supervised:
1. Autopsy Service Rotation
Residents on the autopsy service will be responsible for the following on all
neurological materials removed during the prosection:
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a.
Cutting of all autopsy brains, including processing of dementia brains for
the Buckeye Brain Bank, under the supervision of the staff
neuropathologist.
b.
Gross description of all materials dissected by him/her. These must be
submitted to the Neuropathology secretary by e-mail no later than one day
after brain cutting.
c.
Assists in submitting tissue samples for histology on all cases reviewed at
brain cutting.
c.
Reviews neurohistology on cases assigned by the autopsy service.
d.
Brain-only-autopsies will be done by the pathology resident under the
supervision of Drs. Ray-Chaudhury. The morgue and Pathologic Anatomy
office will be notified of the neuropathology faculty call schedule in
advance.
e.
Complete autopsies with major brain pathology will be done by the
anatomic pathology resident on-call. The neural tissue of interest in such
cases will be removed by the pathology resident under the direction of the
neuropathologist. A Neuropathology call schedule is always available. For
each weekday, weekend or holiday there is a designated neuropathologist
on call day or night.
2. Optional Rotations:
a.
H.
Neuromuscular Pathology. The resident will work closely with Drs. Mendel
and Sahenk at the Nationwide Children’s Hospital. The rotation can be
arranged by contacting the Department of Pathology at the Children’s
Hospital.
During the rotation they will do the following (1) Observe and assist with nerve and muscle biopsies to learn the
importance of an appropriate and properly-handled biopsy.
(2) Become acquainted with interpretation of relevant morphological
techniques (histochemistry, light and electron microscopy).
(3) Review diagnostic neuromuscular material (glass slides).
Rotation evaluation:
(1) An end of rotation objective test will be given to the residents.
(2) Attendance will be taken and will be part of the evaluation.
(3) Focused performance, ie. Tissue handling, communication with the
clinicians, interpretation of slides etc., will be evaluated.
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Diagnostic Neuropathology Schedule
A. Day of Brain Cutting - Note: The resident responsible for the case must be present
at the brain cutting session in order that the brain will be cut or must make prior
arrangements if
not able to attend.
1. At the brain cutting conference the resident who prosected the autopsy will
summarize the clinical history. The staff neuropathologist will cut brains initially.
As the residents advance they will assume progressively more of the brain
cutting responsibilities.
2. Photographs will be taken and stored in Paxit during brain cutting by the
resident
3. Following brain cutting the Fellow or resident responsible for the case will do the
following:
a.
Take tissue blocks for histology on "routine" cases, i.e. with no
neuropathological findings. This will include anterior cerebral artery-middle
cerebral artery watershed region; cerebellum, and hippocampus.
b.
Take blocks of any brain with pathology will be submitted according to the
pathology. These must be cassetted, coded, and subsequently special
stains will be requested.
c.
The resident responsible for the case will dictate the gross description of all
neuropathology material dissected by him/her. These must be submitted to
the Neuropathology secretary by e-mail no later than one day after brain
cutting. They will be corrected by the staff neuropathologist and typed by
the neuropathology secretary. A copy is sent to the Anatomical Pathology
office.
B. Neurohistology Review
Residents who have neurohistological material from previous routine brains will
review it first with the anatomical pathologist responsible for the autopsy. If there
are any questions concerning this material after the initial review, the resident will
then contact the staff neuropathologist who cut the case to review the slides. At this
review the resident must have a written microscopic description of the slides.
The slides from the cases with brain pathology will be reviewed by the resident with
the neuropathologist in charge of the case. The resident will order the special
and/or immunohistochemical stains as needed. Finally, a microscopic description
will be written by the resident.
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C. Finalization and Review
The finalized case will be reviewed with the attending anatomic pathologist or
neuropathologist depending on the case.
D. Tissue Disposal
Unless the staff neuropathologist wants to retain material in his own research lab all
wet tissue will be routinely discarded after the case has been signed out.
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RENAL AND TRANSPLANT PATHOLOGY/ELECTRON MICROSCOPY (EM)
The rotation is physically based in the Renal Pathology/EM Laboratory in M018 Starling
Loving Hall. In addition to renal biopsies and nonrenal EM specimens, the resident will
be exposed to cardiac transplant biopsies.
A.
Duration of Rotation
Four weeks
B.
Teaching Faculty and Staff Responsible for Supervision and
Instruction
Tibor Nadasdy: Professor of Pathology, Director of Renal Pathology and
Medical EM Services
Anjali Satoskar: Assistant Professor of Pathology
Sergey Brodsky: Assistant professor of Pathology
Daniel Sedmak: Professor of Pathology, Chair, Department of Pathology
September Bland: Program Assistant
Edward Calomeni: Electron Microscopist, Director of EM lab
Gyongyi Nadasdy: Renal Lab Manager
Cherri Bott: Immunofluorescence Senior Technologist
Phillip Winnard: Technician
C.
Goals of the Renal Rotation
1. Patient Care
-
-
-
The resident is able to handle and triage a renal biopsy specimen
appropriately. This includes recognition of renal medulla and cortex under a
dissecting microscope.
The resident will become familiar with basic technical aspects of electron
microscopy. He/she is not expected to be able to use an electron microscope
independently, but will be able to screen a thin section with supervision.
The resident will be able to take good quality light and immunofluorescence
digital images and handle the image database.
The resident will be capable of creating a renal biopsy report.
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2. Medical Knowledge
-
The resident will be able to recognize basic renal morphology
The resident will be capable of correlating the clinical history with the
morphology.
3. Problem Based Learning
-
The resident will be able to recognize and classify rejection patterns in heart
and kidney transplant biopsies.
The resident will become familiar with basic ultrastructural anatomy and
pathology, including basic cell differentiation patterns.
The resident will be able to use an immunofluorescence microscope and
differentiate background and nonspecific staining from specific fluorescence
and will be able to recognize and localize basic immunofluorescence patterns.
4. Interpersonal and Communication
-
-
The resident will communicate effectively and demonstrate caring and
respectful behaviors when interacting with nephrologists, transplant surgeons,
laboratory personnel and clerical staff.
The resident will gather and organize essential and accurate information
about the patient’s clinical history and/or patient specimens.
5. Professionalism
-
The resident will demonstrate respect, compassion, and integrity; a
responsiveness to the needs of the patients and the renal/transplant biopsy
services, accountability to society and the profession; and a commitment to
excellence and on-going professional development.
6. Systems-Based Practice
-
The resident will understand how the renal/transplant biopsy service affects
other health care professionals, the health care organization, and the larger
society.
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D.
Resident Responsibilities
-
-
-
-
E.
Organize renal biopsies and heart biopsies with paperwork. If no clinical
history is received, every effort has to be made to obtain it.
Review biopsies
Present the cases at the daily signout.
If there is an overnight transplant rush, the case has to be immediately
reviewed with the attending in the morning.
Review of immunofluorescence (IF), including taking digital images. Gyongyi
Nadasdy will help in that.
Electron microscopy (EM) on kidney biopsies is done usually on the following
day. The resident is expected to coordinate with Ed Calomeni the EM
scoping of renal biopsies. This is usually done in the afternoon.
The EM findings have to be correlated with previous results, and the case has
to be updated accordingly.
The pending biopsies have to be kept organized in the Renal/Electron
Microscopy Laboratory.
Light microscopic digital images on all outside renal biopsies and interesting
in house biopsies have to be taken.
If there is a same day rush, the biopsy has to be picked up at around 4 p.m.
from Histology. The same day rush biopsy has to be presented to the
attending immediately.
The resident is expected to help in triaging and grossing renal biopsies.
The resident helps with preparing and organizing the material for the regular
renal biopsy and transplant conferences.
The resident is expected to collect appropriate information on nonrenal
specimens for EM, including a review of the light microscopy of the specimen,
and coordinates the evaluation process with Ed Calomeni, Dr. Tibor Nadasdy
and the attending requesting EM examination.
The resident is expected to read and actively learn about diseases
represented by the current biopsy material.
Resident Evaluation
1. The resident will be evaluated at the end of the month rotation.
2. Multiple assessments will be used for the evaluation process in order to
Obtain a global (360) evaluation.
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TOXICOLOGY
A. Duration of rotation
Four weeks
B. Teaching Staff Responsible for supervision and instruction
Michael G. Bissell MD PhD MPH, Director, Chemistry and Toxicology
Also:
Virginia O’Neill MT (ASCP), Lead Medical Technologist
Karen Gebhardt MT (ASCP), Lead Medical Technologist
C. LEARNING OBJECTIVES FOR TOXICOLOGY ROTATION
Patient Care
Residents must demonstrate a satisfactory level of diagnostic competence and the
ability to provide appropriate and effective consultation in the context of toxicology/
therapeutic drug monitoring testing in the Toxicology Laboratory.
-Becoming familiar with those areas of clinical medicine in which
therapeutic drug monitoring and drugs of abuse testing.
-Becoming familiar with chain of custody considerations.
Medical Knowledge
Residents must gain a practical and applied understanding of the techniques,
application and interpretation regarding clinical toxicology:
-Understanding basic principles of toxicology including
metabolism, excretion and toxicity of the most frequently
encountered therapeutic drugs and drugs of abuse.
-Learning the basic techniques of initial drug screening and
subsequent confirmatory testing
-Understanding basic methodologies and concepts involving
instrumentation and analytical techniques used in toxicology
laboratories including the biochemical and immunological bases for
them.
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-Understanding laboratory issues, including instrument calibration,
quality control and limits of detection.
Practice-Based Learning and Improvement
Residents must be able to demonstrate the ability to investigate and evaluate
their diagnostic and consultative practices, appraise and assimilate scientific
evidence and improve their patient care practices.
-Understanding therapeutic monitoring including panic values and
appropriate method of notification of clinicians
-Understanding proper collection and handling of both medical and
medico-legal toxicology specimens.
-Understand the concept of chain of custody including the handling,
storage and documentation of medico-legal specimens.
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills
that result in effective information exchange and teaming with other health care
providers, patients’ and patients’ families
-Becoming familiar with the role of Medical Review Officer
Professionalism
Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse
patient population.
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 laboratory services that are of optimal value.
-Understand laboratory management issues including accreditation
and proficiency testing.
-Understand the organizational hierarchy of federal agencies
involved in toxicology laboratory accreditation and policy
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making including the Substance Abuse and Mental Helath
Services Administration (SAMHSA) and the Department of
Transportation (DOT).
-Understand the role of the Medical Review Officer (MRO) in the
review and defense of laboratory results.
-Understand the legal side of toxicology by attending court session
when necessary.
C. Curriculum
1. Curriculum Content
a. OSUMC Toxicology Laboratory
b. Working with Medical Review Officer (responding to subpoenas and going
to court) – as available
2. Assigned reading is in
a. Kaplan LA, Pesce AJ, Kazmierczak SC, Clinical Chemistry: Theory,
Analysis, Correlation, 4th edition, Mosby-Elsevier, St. Louis, 2003.
b. Klaassen CD, Watkins JB, Cassaret and Doulls’s Essentials of Toxicology,
McGraw-Hill, New York, 2003.
c. Wills S, Drugs of Abuse, 2nd edition, Pharmaceutical Press, London, 2005.
Week-by Week Activities
Week 1
Reading:
- Kaplan et al. Chapters 5, 6, 7, 8, 9 and 13
- Cassaret and Doul Chapters 1 through 27
Review of:
- Immunoassay technology
- Principles and types of chromatography
- Mass spectrometry
Introduction to:
- Basic principles of Toxicology
- Instrumentation calibration, quality control and limits of detection
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Week 2
Reading:
- Kaplan et al. Chapters 34, 42, 50, 51, 52 and 56
- Cassaret and Doul Chapters 28 through 34
Review of:
- Metabolism, excretion and toxicity of the most frequently
encountered therapeutic drugs and drugs of abuse
Introduction to:
- Basic principles of therapeutic drug monitoring
Week 3
Reading:
- Wills, Chapters 1 through 10
Introduction to:
- Working with forensic toxicologist at Franklin County Coroner’s
Office
Week 4
Reading:
- Kaplan et al. Chapter 2
- Wills, Chapters 11 through 20
Review of:
- Laboratory management issues including accreditation and
proficiency testing
Introduction to:
- Role of Medical Review Officers (MRO) in workplace drugs of
abuse testing
- Forensic review and defense of laboratory results (responding to
subpoenas and going to court)
- Proper collection and handling of both medical and medico-legal
toxicology specimens
- Chain of custody including handling, storage, and documentation
of medico-legal specimens
An in-service talk regarding a toxicology topic can be given by resident to
toxicology staff, by arrangement.
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Graded resident responsibility: Residents sign out chemistry results on their own
with attending feedback, throughout the rotation. This provides a refresher for
these skills learned on the Chemistry/Humoral Immunology rotation in year two.
During the first week of the rotation, the resident meets daily with the attending
for didactic teaching and review. Beginning in the second week, the resident
spends time in the laboratory with the technologists at the bench learning the
different methods involved. As available the resident joins the attending on any
court appearances and provides the technologists with an inservice talk on a
current literature topic in toxicology.
D. Resident Evaluation
Residents will be given a global evaluation by the Director of toxicology. This may
also include input from medical technologists and others with whom the resident
interacts (360 degree evaluation). It may also be supplemented by a written
objective multiple-choice exam, the results of which will be generally summarized by
the attending in the “general comments” section of the evaluation form.
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COMMUNITY PATHOLOGY
(Elective Rotation)
I. SCOPE: To allow senior pathology residents to learn about the role of a general
pathologist and laboratory medical director in a community hospital setting by providing
an educational experience that meets the following competencies:
o
o
o
o
o
o
Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
Systems-based practice
II. LENGTH OF ROTATION: Four week, elective
III. TEACHING STAFF RESPONSIBLE FOR SUPERVISION AND INSTRUCTION:
a.
b.
c.
d.
Melinda Schumacher, M.D.
Daniela Proca, M.D.
Jeffrey Kneile, M.D.
Tisha Farrell, D.O.
IV. SITES OF ROTATION include: OSU Hospital East (UHE) (2 weeks) and Memorial
Hospital of Union County (MHUC) (2 weeks). Optional time in other outreach facilities
maybe scheduled.
V. EDUCATIONAL PROGRAM
A. Regularly scheduled didactic sessions with the Attending Pathologists will be
provided.
B. Delineation of resident responsibilities and close supervision during the program
will be ensured.
Daily active participation in carrying out the tasks and responsibilities of the pathologist
on site include, but are not limited to:
a. Surgical pathology specimen grossing and signout, including one
on one discussion of cases.
b. Performance of frozen sections, lymphoma work-ups, sign-out of
peripheral blood smears and fluids, transfusion reactions.
c. Assisting in FNAs interpretation of adequacy.
195
d. Interaction with lab personnel, hospital medical staff, as well as with
affiliated physician groups through consultation and meetings.
e. Daily involvement in the clinical laboratory activities which require
pathologist input.
f. One on one educational sessions with the attending pathologist and
active participation in all medical staff didactic conferences.
C. Educational Goals: ACGME Competencies
1. Patient Care

Grossing, sign out, frozen sections, lymphoma workups and specimen triage of a
typical community pathology caseload, performed according to the existent
standards at OSU Surgical Pathology.

Assisting Radiology in performing FNA’s and attesting for adequacy of the
samples obtained. Review and diagnose peripheral blood smears, when PathDiff
is requested, review and diagnose fluids, such as CSF, peritoneal, pleural fluids.

Review of indications for transfusions of blood products in the community setting.

Monitor and report Adverse Effects of Blood Transfusion.

Become familiar with the test menu for a typical community hospital and the
factors considered when determining which tests to perform on site and which
tests to send out.
2. Medical Knowledge

Understanding the general pathologist’s role as a professional consultant for
clinicians, nursing staff and laboratory personnel and learning how to effectively
communicate with the clinical team.

Review of indications for transfusions of blood products in the community setting.

Demonstrate the concept of usage of autologous blood in surgery.

Recognize causes of blood wastage.
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
Monitor and report Adverse Effects of Blood Transfusion.

Participate in proficiency testing activities that occur during the rotation.

Become familiar with different areas of the clinical laboratory typical for a
community hospital (microbiology, hematology, chemistry, and special chemistry,
immunology, blood bank) including circumstances that require pathologist input,
types of analyzers, general workflow, turnaround time, etc.

Become familiar with the test menu for a typical community hospital and the
factors considered when determining which tests to perform on site and which
tests to send out.

Review of terms such as panic values, QA, QC, critical values, delta checks,
spurius results, turnaround time, callback, etc. and the general pathologist’s role
in the determination/evaluation of such values in the setting of a community
hospital.
3. Practice-Based Learning and Improvement

Understanding the general pathologist’s role as a professional consultant for
clinicians, nursing staff and laboratory personnel and learning how to effectively
communicate with the clinical team.

Overview the activity of the Transfusion Medicine Service in a small hospital,
including review of transfusion reactions, and audit of charts to determine
necessity of transfusion for the Hospital QA Committee.

Review of terms such as panic values, QA, QC, critical values, delta checks,
spurius results, turnaround time, callback, etc. and the general pathologist’s role
in the determination/evaluation of such values in the setting of a community
hospital.Become familiar with other administrative and managerial tasks including
validation of new laboratory instruments if occurring at the time of the rotation.

Participate in proficiency testing activities that occur during the rotation.

Become familiar with the test menu for a typical community hospital and the
factors considered when determining which tests to perform on site and which
tests to send out.

Overview the activity of the Transfusion Medicine Service in a small hospital,
including review of transfusion reactions, and audit of charts to determine
necessity of transfusion for the Hospital QA Committee.
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
Review of indications for transfusions of blood products in the community setting.


Demonstrate the concept of usage of autologous blood in surgery.
Recognize causes of blood wastage.

Monitor and report Adverse Effects of Blood Transfusion.

Learn about appropriate communication and support provided by ARC.

Overview of the Microbiology, Chemistry, Serology and Immunology and
Hematology sections of the laboratory in a small community hospital.
4. Interpersonal and Communication Skills

Understanding the general pathologist’s role as a professional consultant for
clinicians, nursing staff and laboratory personnel and learning how to effectively
communicate with the clinical team.

Demonstrate the ability to obtain pertinent patient information from the clinical
and electronical records or through verbal communication with clinician.

Learn about appropriate communication and support provided by ARC.

Understand the role of different technologists in the laboratory and observe/learn
interactions needed to give and obtain information.

Overview the activity of the Transfusion Medicine Service in a small hospital,
including review of transfusion reactions, and audit of charts to determine
necessity of transfusion for the Hospital QA Committee.

Assisting clinicians and physician offices in proper specimen collection
techniques/media and sending specimens to OSU for specialized tests, as well
as functioning as a liaison between the UH Laboratory System and UHE, MHUC
or other doctor’s office.
5. Professionalism

Assisting clinicians and physician offices in proper specimen collection
techniques/media and sending specimens to OSU for specialized tests, as well
as functioning as a liaison between the UH Laboratory System and UHE, MHUC
or other doctor’s office.

Participate in laboratory administrative meetings.
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
Become familiar with different areas of the clinical laboratory typical for a
community hospital (microbiology, hematology, chemistry, and special chemistry,
immunology, blood bank) including circumstances that require pathologist input,
types of analyzers, general workflow, turnaround time, etc.

Become familiar with the test menu for a typical community hospital and the
factors considered when determining which tests to perform on site and which
tests to send out.

Review of terms such as panic values, QA, QC, critical values, delta checks,
spurius results, turnaround time, callback, etc. and the general pathologist’s role
in the determination/evaluation of such values in the setting of a community
hospital.

Overview the activity of the Transfusion Medicine Service in a small hospital,
including review of transfusion reactions, and audit of charts to determine
necessity of transfusion for the Hospital QA Committee.
6. Systems-Based Practice

Become familiar with the steps necessary for sending samples to other
laboratories (send-out testing).

Become familiar with the surgical pathology procedure manuals and CAP
guidelines for smaller surgical pathology laboratories, as well as smaller clinical
laboratories including the limited services checklist.

Learn about safety in the laboratory and identify safety office for contact in case
of emergency.

Overview of the Microbiology, Chemistry, Serology and Immunology and
Hematology sections of the laboratory in a small community hospital.

Become familiar with different areas of the clinical laboratory typical for a
community hospital (microbiology, hematology, chemistry, and special chemistry,
immunology, blood bank) including circumstances that require pathologist input,
types of analyzers, general workflow, turnaround time, etc.

Become familiar with other administrative and managerial tasks including
validation of new laboratory instruments if occurring at the time of the rotation.
199
D. Scholarly Activity
a. Residents are encouraged to participate in clinical and laboratory
research, review sessions with the attending pathologists and
literature surveys.
b. Are expected to participate in Tumor Board Presentations,
as well as didactic sessions with the medical staff and laboratory
personnel.
c. Residents will become familiar with obtaining digital images of specimens
and the use of telepathology for future scientific presentations or immediate
consultation with other pathologists.
.
VI. EVALUATION
Evaluations by all teaching staff will be provided to each rotating resident at the end of
the program.
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DERMATOPATHOLOGY
A.
Duration of rotation:
The duration of the rotation in Dermatopathology is for eight weeks.
B.
Teaching Staff for Supervision and Instruction
Sara Peters, M.D.
C.
Goals and Objectives:
Provide residents with an educational experience that meets the following
competencies:
a) Patient care
b) Medical knowledge
c) Practice-based learning and improvement
d) Interpersonal and communication skills
e) Professionalism
f) Systems-based practice
1.
Proper handling of skin specimens (a, b, c, f)
The residents should be aware of how to process all types of skin specimens,
this includes punch biopsies, shave biopsies, curettage specimens, incisional
biopsies for the diagnosis of inflammatory skin disease and panniculitis and
excisional specimens. The directions for how to process such specimens
already exist in the resident handbook. In addition, the residents should have
direct hands on experience in the processing of these specimens. They should
also be aware of the proper handling of specimens submitted for
immunofluorescence testing.
2.
The interpretation of cases for histologic diagnosis (a, b, c, d, e, f)
The types of cases encountered in the dermatopathology division are quite
varied and include the routine cases such as seborrheic keratoses, dermal nevi,
fibrous papules, skin tags, dysplastic nevi and the more challenging cases
including unusual neoplasms, malignant melanoma, and inflammatory skin
disease. This varied case material is encountered both in the context of the
specimens directly processed in the laboratory as well as those cases received
as external consults.
3.
Required reading (b)
The recommended textbooks will be Ackerman’s Surgical Pathology, Lever's
Histopathology of the Skin, Weedon's Skin Pathology, McKee’s Pathology of the
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Skin with Clinical Correlations and the chapters dealing with skin in Rosai’s.
During the month rotation the resident should consult these texts to become
familiar with the fundamental concept presented in each chapter, especially
focusing on the non-infectious papule squamous disorders of the skin, vasculitis,
vesicular bullous lesions, collagen vascular disease, hypersensitivity reactions to
drug toxic irritant dermatoses, granulomatous conditions, epithelial tumors,
melanocytic lesions, adnexal neoplasms, mesenchymal tumors, tumors of
neuroidal derivation and infectious disease.
4.
Additional supplemental slides for review (b, c)
During the month of routine sign-out there may of course be many entities that
the student will not see yet or read about. It should be emphasized that critical to
this rotation is the additional review of slides present in the teaching set library.
All of the teaching sets are organized according to the Weedon chapters.
Therefore the student should supplement his or her reading activities with a
review of these teaching boxes.
D.
Curriculum
The curriculum consists of attending case sign out, consulting texts mentioned
above in C3 and reviewing supplemental slides mentioned in C4.
E.
Resident Evaluation and Documentation
General competencies will be addressed as is appropriate to pathology training,
particularly in the setting of dermatopathology and a global evaluation will be
completed after the 30 day rotation. A formal test will not be given.
F.
Resident Supervision
The residents are expected to spend the majority of their day in the Office of
Dermatopathology primarily during sign out time. Residents will be supervised
by Dr. Peters and Dermpath fellows.
G.
Resident Duties and Responsibilities
The residents are expected to attend sign out sessions as determined by Dr.
Peters. The residents will help with preparation of conferences given during the
month such as the Dermatopathology Grand Rounds as directed by either Dr.
Peters.
202
H.
Faculty Duties
The faculty's main duty is one of diagnostic interpretation with teaching largely
based on the daily case material review. There are didactic sessions given
throughout the year. Some projects may be offered to the residents and/or
students rotating through the division.
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CLINICAL FLOW CYTOMETRY ROTATION
A. Duration of rotation: For AP/CP residents: 2-4 weeks (PGY2)
B. Teaching staff responsible for supervision and instruction:
Gerard Lozanski M.D.
Amy Gewirtz M.D.
Arwa Shana’ah, M.D.
Frederick Racke M.D. PhD
John Zhao M.D PhD
Becky Pearson, MLT
Rachel Bennet, MT (ASCP)
Rhonda Kitzler, MS, PA(AAPA), MT(ASCP)
C. Goals and Objectives:
To gain a practical and applied understanding of the techniques, applications and
interpretations of Clinical Flow Cytometry testing. These goals and objectives are
designed to be in compliance with the six competencies outlined by ACGME listed
below:
A=Patient Care
B=Medical Knowledge
C=Practice Based Learning and Improvement
D=Interpersonal and Communication Skills
E=Professionalism
F=Systems Based Practice
a.
Formal studies of the flow cytometry hardware and software. (B, C)
b.
Observing, performing and learning the flow analytical methodology
including flow cytometer daily maintenance, setup, QC, compensation,
isotype and autofluorescence control. (A, B, C)
c.
Observing, performing and learning clinical specimens processing including
staining procedure of blood, body fluids and tissue samples (including cell
isolation), viability assessment, gating, back gating and different forms of
data projecting. (A, B, C, E)
d.
Learning to interpret various flow data analysis including dual, triple and
quadruple dot plots, density plots, contour plots, isometric plots and
counting statistics. (A, B, C, F)
204
e.
Practicing with analysis of the representative cases using list mode data
repository. (Please see Attachment A). (A, B, C, F)
f.
Learning to incorporate flow cytometric data into the work up of
hematopoietic material (including bone marrow, lymph node, spleen and
other tissues and body fluids) to ensure communicating accurate results to
colleagues and clinicians. (A, B, C, D, E, F)
g.
The resident will be required to deliver an academic talk to the flow
cytometry technologists, residents and faculty at the end of the rotation. (B,
D, E)
h.
During flow rotation resident is expected to observe and participate in
bone marrow aspirate and core biopsy procurement procedure. The
resident is obligated to observe/participate in at least six (6) bone
marrow aspiration and biopsy procedures. The resident should
coordinate this activity with technologists from the outpatient
laboratory at James Cancer Center. (Please see Attachment B). (A, B,
C, D, E)
D. Curriculum
1. Formal Meeting Times
a.
Weekly didactic review:
At these times the program director or designee formally reviews the
subject matter of the week with the resident according to the weekly subject
covered. .
b.
Sign-out of cases: daily (Starting from the first week of the rotation).
At these times the resident reviews all cases. The resident will have
previously reviewed the material, obtained additional information when
appropriate, and rendered a diagnosis. The attending hematopathologists
will provide daily feedback after final review of each case.
Week by Week Activities:
Week 1:
Review of:
Flow cytometer hardware and software and daily review of all clinical cases, as well
as studies of representative and interesting cases of acute leukemias and
lymphomas (from archives). Studies of patterns of antigen expression by
lymphomas and leukemias.
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Day 1
Fluidics including pumps, flow chamber, vacuum trap as well as daily
maintenance, QC and trouble shooting. Studies of characteristic
immunophenotype of chronic lymphocytic leukemia (CLL), mantle cell
lymphoma (ML), follicular lymphoma (FL) and marginal zone lymphoma
(MZL).
Day 2 Optical system including laser, filters, photo-multipliers as well as daily
maintenance, QC and trouble shooting. Studies of characteristic
immunophenotype of plasma cell myeloma, hairy cell leukemia, Burkitt
lymphoma and diffuse large B cell lymphoma.
Day 3
Formal review of fluidics and optics. Review of electronics including
discussion of log amplifiers, electronic gating, compensation and flow
cytometer-computer interface, as well as list mode data storage and
maintenance. Studies of characteristic immunophenotype of acute
lymphoblastic leukemia
Day 4
The resident will prepare set of notes that will be useful for the future study
and preparation for board examination. It will also serve as final review of
the material and give the resident opportunity to prepare list of topics that
were not well understood during firs week of rotation. Studies of
characteristic immunophenotype of acute myeloid leukemia.
Day 5
Review of the weekly material and independent study time to cover
shortcomings. Studies of characteristic immunophenotype of acute myeloid
leukemia. Independent study time to cover shortcomings. Discussion of the
clinical cases from the week.
Week 2:
Review of:
Principles of clinical material processing, cell isolation, staining, fixation, and sample
analysis with two, three and four color technique. Daily review of all clinical cases,
as well as studies of representative and interesting cases of acute leukemias and
lymphomas (from archives). Studies of patterns of antigen expression by
lymphomas and leukemias.
Day 1
Using a split specimen of peripheral blood the resident will perform an
experiment in which he/she will manually stain the whole blood specimen
and the leukocytes isolated by density gradient centrifugation for CD45,
CD3,CD4 and
CD8. Parallel portion of the whole blood and isolated
leukocytes will be left at room temperature to deteriorate for further studies
of viability by trypan blue and 7AAD methods. Studies of characteristic
immunophenotype of T cell lymphoproliferative disorders, including T cell
precursor acute lymphoblastic leukemias.
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Day 2
The resident with the assistance of the technician will analyze specimens
from the previous day’s experiment. The resulting data will be stored as a
list mode file and the data will be expressed as dot plots and histograms.
The results will be compared and interpreted by the resident. Monitoring of
T cell subsets in patients with HIV and immunosuppressed (OKT3)
transplant recipients. Studies of materials regarding the significance
of activation markers in T cell malignancies, AIDS and autoimmune
disorders with emphasis on CD25, CD38 and CD69.
Day 3
Formal review of experiment progress by the pathologists or designee.
Studies of viability staining techniques and their principles, as well as the
influence of poor viability on flow cytometric analysis. Day 3 Studies of
characteristic immunophenotype of cells from patients with PNH
and principles of flow PNH diagnosis.
Day 4
The resident will prepare set of notes that will be useful for the future study
and preparation for board examination. It will also serve as final review of
the material and give the resident opportunity to prepare list of topics that
were not well understood during firs week of rotation. Preparation of a
LECTURE for flow lab on the topic of choice pertinent to
clinical flow laboratory (must be a very recent article or material not older
than 1 year).
Day 5
Trypan blue and 7AAD studies of Monday’s whole blood and leukocyte
preparation samples and comparison of viability between these samples
and methods.. Formal review of the weekly material and evaluation by the
pathologist. Independent study time to cover shortcomings. Lecture
presentation. Formal review of the flow material by the pathologist.
global evaluation of the resident by the pathologists and flow laboratory
staff. Discussion of the evaluation.
Evaluation of the resident performance: Final evaluation will be comprised of an
objective evaluation based on testing of resident ability to interpret representative
clinical flow cases and discussion on topics pertinent to the technical aspects of flow
technology. Global (360) evaluation of the residents will be based on pathologists and
technologists evaluation of the resident performance during the entire rotation. Final
evaluation will be reviewed and discussed with the resident and will be attached to the
resident’s portfolio.
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ATTACHMENT A
Log of procedures performed by resident during the flow rotation
Procedures
Date
Participation in instrument (FC500) startup, QC
and maintenance
Review of instrument fluidics, optics and electronic
components
Manual staining of whole blood for CD3, CD4 and
CD8 and CD45
Density gradient isolation of PBMC
Manual staining of isolated PBMCs for CD45, CD3,
CD4 and CD8
Supervised analysis of stained cells
Viability analysis using 7AAD and Trypan Blue
Techniques
Supervised analysis of aged stained cells
Supervised analysis of list mode data files
Interpretation of flow analysis of clinical cases
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Technologist
signature
Pathologist
Signature
Resident
Name
ATTACHMENT B
Log of bone marrow procedures performed by resident
Bone Marrow
Aspirate #
Bone Marrow Procedure
Biopsy #
Date
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Procedure
Supervisor
Signature
Resident
Name
CYTOPATHOLOGY
A. Duration of Rotation: Eight weeks
B. Teaching Staff Responsible for Supervision and Instruction
Teaching Staff:
Paul Wakely Jr. M.D., Professor, Director of Cytopathology Fellowship
Program and FNA Section. Responsible for teaching GYN, Non-GYN
cytology and FNA cytology
Saeed Bajestani, M.D., Assistant Professor, Responsible for teaching
Cytology and Breast pathology
James Liu, M.D., Assistant Professor. Responsible for teaching GYN,
Non-GYN cytology and FNA cytology
Alessandra Schmidt, M.D. Assistant Professor, Responsible for teaching
Cytology, Gastrointestinal and Head and Neck pathology
Rulong Shen, M.D., Associate Professor, Director of Cytopathology.
Responsible for teaching GYN, Non-GYN cytology and FNA cytology.
Adrian Suarez, M.D., Assistant Professor. Responsible for teaching GYN,
Non-GYN cytology and FNA cytology.
C. Goals and Objectives of Rotation:
Provide residents with an educational experience that meets the
following competencies:
a) Patient care
b) Medical knowledge
c) Practice-based learning and improvement
d) Interpersonal and communication skills
e) Professionalism
f) Systems-based practice
To identify the different cytologic preparations used in the laboratory
(direct smears, cytospins, SurePath, ThinPrep, cell blocks) and be aware
of their technical differences. (a, b)
To identify the different stains used in the cytology laboratory
(Papanicolaou, Diff Quik) and be aware of their differences. (a, b)
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To be aware of air drying and the rehydration technique used in the
cytology laboratory. (a, b)
To be aware of the different groups of specimens processed by the
laboratory and their overall significance and applications: Pap tests, “nonG’s” (body fluids), fine needle aspirations. (a, b, f)
To apply the Bethesda System to report cervicovaginal cytology
specimens. (a, b, c, f)
To apply the Bethesda System to report thyroid cytology specimens. (a, b,
c, f)
To recognize indications and contraindications for fine needle aspiration
biopsy of superficial and deep masses with and without radiologic
guidance. (a, b, c, f)
To list and understand the different elements (physician request, patient
informed consent, patient identification, procurement of the biopsy,
preparing smears, specimen triage and allocation for ancillary techniques)
of the fine needle aspiration biopsy procedure as performed by
pathologists at this institution. (a, b, c, e, f)
To conduct and present his/her self appropriately in the clinical areas
when dealing with health care professionals and patients. (d, e)
To obtain pertinent clinical information in an efficient manner from
electronic resources and from health care professionals.(a, b, c, d, e, f)
To communicate cytologic findings effectively to other health care
professionals. (a, b, d, e)
To recognize broad categories of neoplasms using cytologic preparations
(lymphoma, carcinoma, sarcoma, melanoma, benign neoplasms). (a, b, c)
To diagnose neoplasms of increasing complexity based on cytologic
specimens and appropriate ancillary techniques (immunocytochemistry,
fluorescent in situ hybridization, in situ hybridization, polymerase chain
reaction).(a, b, c, f)
To correlate cytologic findings with surgical pathology specimens. (a, b, c,
f)
To be aware of quality assurance and improvement procedures used in
the cytology laboratory. (a, b, c, f)
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To be aware of the proficiency testing at the cytology laboratory. (a, c, f)
D. Curriculum for the Rotation
Each four week rotation in the cytology service is designed to provide a
foundation for the diagnosis of clinical specimens including both exfoliative
and find needle aspiration cytology. Experience is obtained by selfdirected review of the available teaching materials and the sign-out of
clinical specimens with the attending physician. There is a large collection
of material available including microscopic teaching slide sets and a
variety of cytology textbooks and atlases. The residents are urged to make
full use of this material, particularly as an introduction to the field for
specific body sites.
The Division of Cytopathology also provides opportunities for research
and other scholarly activities. Current research opportunities include:
variety of molecular biology techniques and automated cytology such as
Thin Prep. Interested residents may participate in these or other projects
involving clinical cytology. Faculty members in the division discuss their
respective research activities with interested residents.
E. Resident Supervision
The residents will be supervised by the Fellow, cytotechnologists, the
cytotechnology supervisor and the cytopathologists.
F. Duties and Responsibilities of the Faculty with Respect to Resident
Education
1. The Faculty will participate in the final sign-out sessions for atypical
gynecologic smears, non-gyn specimens and biopsy-cytology
correlations with the resident .
2. The faculty will participate in the scheduled cytopathology
conferences, including unknown slide presentations and formal
lectures.
3. The faculty will participate in scholarly and extracurricular activities,
including research in clinical cytology and diagnostic molecular
biology techniques, as the residents demonstrate interest and
ability.
G. Description of Duties and Responsibilities of the Resident in
Cytopathology Rotation
Section I: GYN Cytology
1. The resident will review negative GYN cases with a member of the
cytology staff, learning to screen negative pap smears. They will be
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able to identify negative, inflammation, reparative changes,
etiologic agents and atypical cells that need further review. These
are recorded on the daily count sheet. Residents are encouraged to
screen pap smears everyday and at the end of each one-month
rotation, they are expected to show a record of at least 20 pap
smears screened with supervision of a cytotechnologist and/or a
cytopathologist.
2. They will participate in CAP proficiency testing and any other
proficiency testing done in the department. Copy of participation
must be kept in the workbook.
3. The resident will sign out all abnormal GYN cytologies with the
cytopathologist daily.
4. The resident will sign out all cytology/biopsy correlation with the
cytopathologist daily.
5. The resident will review with the cytotechnology supervisor all of
the QC and QA programs in the department
6. The resident will also learn to use the CoPath computer system in
cytology from order entry to resulting cases.
Section II: Non-GYN Cytology
1. The resident will sign out all non-GYN cytology with the
cytopathologist daily.
2. They are responsible for all of the non-GYN follow-up. They will
check for any tissue follow-up on non-GYN cytology. In the cases of
spinal fluid/body fluids, flow cytometry and hematology results must
be correlated. These are to be recorded.
3. The resident will attend the formal lectures in GYN and non-GYN
cytology and microscopic unknown, Seminar in Surgical Pathology
(Pathology 793.9).
Section III: Fine Needle Aspirations
The cytology resident learns to perform and interpret FNAs through the
director of the FNA service and the Cytopathology Fellow. The resident
accompanies the attending and/or fellow on all FNAs and performs FNAs
under the strict guidance of these supervisors. The resident is expected to
render an interpretation on each case and then discuss their findings with
the cytopathologist. The cytology resident is also expected to review the
teaching collection available from Dr. Wakely, cytopathology division and
the cytopathology fellow, and render written diagnoses on all cases which
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then will be discussed with the fellow. FNA procedures are logged on
E*Value.
Section IV: Special Project
Each resident in cytology is encouraged to do a project, under the
supervision of the cytopathologist, to result in an abstract and/or paper to
be presented at a national cytology meeting. This can include any aspect
of GYN, non-GYN or fine needle aspiration. Although as special project is
not mandatory, it will help in the resident’s final evaluation.
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TRANSFUSION MEDICINE
I. Definition, Duration and Scope of Education
A. Blood banking/transfusion medicine encompasses all aspects of blood
transfusion, including the scientific basis of transfusion medicine, selection
and recruitment of donors, blood utilization, quality control and quality
processes, preparation of blood components, pretransfusion testing,
adverse effects of blood transfusion, autoimmune blood diseases,
transplantation, histocompatibility, therapeutic apheresis and phlebotomy,
management aspects and ethical issues.
B. Duration of Rotation
a. Required rotation during first year of clinical pathology – Eight
weeks
b. Second rotation during year four of residency – Eight weeks
C. Duty Hours
Residents on rotation are expected to be available in person or by pages
8:30 AM to 5:00 PM Monday through Friday, and as needed on Clinical
Pathology call.
D. The Transfusion Medicine rotation provides an organized and
comprehensive educational experience for residents preparing for careers
in academic or private practice pathology.
II. Teaching Staff Responsible for Supervision and Instruction
A. Teaching Staff
1. Primary Responsibility
a. Haifeng Wu, M.D., Associate Professor Transfusion Medicine and
Director, Coagulation
b. Mary Ellen Wissel, M.D., Medical Director, American Red Cross
Blood Center and Hematologist/Oncologist
c. Melanie Kennedy, M.D., Transfusion Medicine, Associate Professor
Emeritus
d. Scott Scrape, M.D., Assistant Professor, Director of Transfusion
Medicine
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2. Secondary Responsibility:
a. Sandy Deitrich, MT(ASCP) SBB, Lead Teachnologist:
Pretransfusion testing, prenatal testing and immunohematology
problem solving
b. Marni Grebenow, (ASCP)SBB, Management and Administration,
Transfusion Service
c. Beverly Robinson, MT(ASCP)SBB, Compliance Officer and Quality
Processes, Transfusion Service
d. Transfusion Service Staff, testing techniques
e. Kim Weirick, RN, Apheresis, Nurse Manager, policies and
procedures
f. American Red Cross Staff, Central Ohio Region: component
preparation, donor recruitment and selection, donor blood
collection, inventory management, frozen RBC program
g. Nicholas DiPaula, Ph.D., Director, Histocompatibility
3. Manner in Which Resident is Supervised
a. Residents are judged as to their abilities according to their answers
to questions from the faculty, during scheduled educational
meetings, review of consults, and other discussions. Closer
supervision is given to those residents having less knowledge,
regardless of level of rotation. Residents are urged to discuss
consults with faculty over the phone or in person. The Transfusion
Service On Service Schedule indicates which attending should be
contacted on any particular day.
b. Residents are given progressively increasing responsibility under
appropriate supervision according to ability, experience, and level
of training for patient care, supervision of residents/students/allied
health personnel, and administration.
III.
Curriculum
A. Resources:
1. Harmening D, Modern Blood Banking and Transfusion Practices, 5th
Ed., 2005, F.A. Davis
2. Blood Transfusion Therapy: A Physician’s Handbook, current edition,
AABB
3. Transfusion Services On-Call Manual, The Ohio State University
4. Standards for Blood Banks and Transfusion Services, current edition,
AABB
5. Technical Manual, current edition, AABB
6. Other immunohematology and transfusion medicine textbooks,
journals, articles and references as appropriate
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B. Rotations:
1. OSU Main Lab
a. ABO & Rh typing
b. Antibody screen
c. Crossmatch
d. Antibody identification (panel workup)
e. Direct antiglobulin (Coombs) test
2. OSU – Apheresis, therapeutic apheresis, phlebotomy and HPC-A
collection
3. OSU Reference and Prenatal Lab
a. Kleihauer-Betke
b. Amniotic fluid studies (spectrophotometric scan)
c. Antibody titration
d. Elution
e. Complex antibody problems
f. Cordocentesis (IUT) (arrange with Dr. O’Shaughnessy)
4. OSU Bone Marrow Transplant
a. HPC processing and storage
5. Tissue Typing Laboratory
a. Donor and recipient HLA type and antibody screen
6. Red Cross Blood Center (2 days)
a.
Donors, component preparation, blood distribution, donor
recruitment
b.
Reference lab
C. Practical Experience:
5. ABO and Rh typing (self and patients)
6. Red cell antigen typing (self)
7. Red cell antibody screen (patients)
8. Direct antiglobulin test (patients)
9. Crossmatch (patients)
10. HLA typing (patients) (Tissue Typing Laboratory)
11. Complex immunohematology techniques
D. Teaching Conferences
1. Transfusion Medicine Rounds (Friday at 12:00 noon, S311 Rhodes,
1x/month)
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2. Pathology Grand Rounds (2nd & 4th Tuesday’s at 12:00 noon, 170
HLRI, Sept - June)
3. Transfusion Committee Meetings (quarterly, Tuesday’s, 11:30am)
4. Clinical Pathology Didactics (Mondays, 7:30am, S311 Rhodes)
5. Topics in Lab Management (last Wednesday of the Month, noon, 137
Hamilton)
6. Transfusion Service Staff Meetings (Tuesdays, 2:30pm, 325 Doan)
7. Bone Marrow Census Meetings (when on BMT, 1/week)
E. Teaching Responsibilities
1.
2.
3.
4.
Transfusion Medicine Rounds – present once during each rotation
Medical students on rotation
Junior residents on rotation
Other trainees
LEARNING OBJECTIVES FOR ROTATIONS
Provide residents with an educational experience in the areas of transfusion
medicine that meets the following competencies:
a. Patient care
b. Medical knowledge
c. Practice-based learning and improvement
d. Interpersonal and communication skills
e. Professionalism
f. Systems-based practice
At the completion of the first and second rotations, the resident will:
1. Understand the basic principles and concepts of apheresis and the
typical transfusion medicine consultations encountered in everyday
practice at OSU Medical Center and other rotation sites.
2. Recognize problems in clinical medicine that are related to
transfusion.
3. Apply the concepts and principles to clinical situations.
During the third and forth rotations, the resident will additionally:
a. Construct appropriate therapeutic solutions to transfusion medicine
problems.
b. Accurately evaluate the strengths and weaknesses of his/her
knowledge in transfusion medicine and recognize when
consultation should be sought
c. Recognize the significance of important research in the
advancement of transfusion medicine
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d. Recognize requirements for organization function and accreditation
of blood centers and hospital transfusion services
Therapeutic Apheresis and Phlebotomy
A. Know basic principles of therapeutic apheresis and phlebotomy (a, b, c, f)
1. Define terms (e.g. therapeutic apheresis, plasma exchange,
phlebotomy, plateletpheresis)
2. Describe mechanics of procedures
3. Describe rationale for procedures
B. Understand common indications for therapeutic procedures (a, b, c, f)
1. List disorders for which phlebotomy and plasma exchange are
indicated
2. Distinguish appropriate and inappropriate use of therapeutic
procedures
C. Recognize when iron overload occurs with transfusion (a, b, c, f)
1. Describe how iron overload can be prevented
2. Describe how iron overload can be treated
D. Understand use of crystalloids, colloids and artificial colloids (a, b, c, f)
1. List the volume expanders, their advantages and disadvantages
2. Describe intra vs. extravascular distribution
3. Identify side-effects
E. Understand the hemodynamic of the circulation (a, b, c, f)
1. State normal values for blood volume
2. Identify mechanisms for abnormalities in blood volume
3. Recognize symptoms and signs associate with abnormalities in blood
volume
Transfusion Medicine Rotation
A. History of Transfusion Medicine (a, b, c,)
1. Know the important features of the history of transfusion medicine
a. Outline the scientific benchmarks in the evolution of transfusion
medicine
b. Outline recent trends in the practice of transfusion medicine
B. Scientific Basis of Transfusion
1. Understand the properties and characteristics of the major surface
antigens of the formed elements of the blood (a, b, c)
a. List common polymorphic antigen systems and alleles
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b. Recognize the biochemical nature of the ABO antigens
c. Recognize the common antigens and their clinical significance
d. Recognize the biochemical nature of Rh, MNS blood group
systems
2. Understand the genetics of the major surface antigens of the formed
elements of the blood (a, b, c)
a. Describe the principles of antigen inheritance
b. Identify the phenotypes and genotypes associated with ABO and
Rh inheritance
c. Order the ABO and Rh blood group frequencies in the major
population groups
C. Pretransfusion Testing
1. Know basic procedures used for blood compatibility (a, b, c, d, e, f)
a. Define the basic terms associated with test for blood compatibility
b. Describe methods of determining compatibility of donor blood with
recipient
c. Distinguish between emergency and non-emergency selection of
blood
d. Distinguish testing procedures for red cell and red cell-free
components
e. Explain the principles of red cell compatibility
f. Explain what “compatible crossmatch” means
2. Recognize basic immunologic principles of blood cell compatibility
(a, b, c)
a. Identify clinical situations associated with formation of antibodies to
blood
b. Describe the clinical importance of antibodies to red cell antigens;
identify laboratory findings associated with reactions in-vitro
3. Understand the pathophysiologic significance of antibodies to blood
cell antigens (a, b, c)
a. Distinguish naturally occurring antibodies from those requiring prior
immunization
b. Describe techniques for detection of antibodies/complement on red
cell membrane
c. Interpret results of test for detection of red cell antibodies
d. Identify frequently occurring red cell antibodies
e. Outline mechanisms of red cell destruction caused by antibody
f. Describe clinical and pathological consequences of antibody to
various types of blood cells (red cells, white cells, platelets)
g. Describe the importance of complement activation on antibody
mediated red cell destruction
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4. Understand the kinetics and function of the cellular elements of the
blood (a, b)
a. Describe the process of cell production
b. State the lifespan of blood cells in normals and disease states
c. Describe how the neutrophil functions in defense against bacterial
infection
d. Describe the role of the various subpopulations of lymphocytes in
normal and abnormal humoral and cellular immunology
e. Describe the role of the various subpopulations of lymphocytes in
normal and abnormal humoral and cellular immunology
e. Outline the pathophysiology and clinical features of disorders
associated with abnormalities of cell function or decreased number
of cells
5. Understand the role and nature of hemoglobin (a, b)
a. Describe the role of hemoglobin in carrying oxygen
b. Describe the structure of hemoglobin
c. Describe how abnormalities in hemoglobin may affect the ability of
the red cell to carry oxygen
d. Outline the steps in hemoglobin degradation
e. State the amount of iron normally present in blood and in marrow
storage compartments
D. Transfusion of Blood Components
1. Describe the major indications for use of (and proper procedures for
administering) the major blood components and derivatives (a, b, c, d,
e, f)
a. Whole blood
b. Red blood cells (including additive solutions)
c. Leukocyte-poor red blood cell products (such as washed blood
cells, previously frozen deglycerolized red blood cells, and filtered
red blood cells)
d. Platelet concentrates, (e.g. random donor, single donor matched
and unmatched and frozen)
e. Granulocyte concentrates
f. Single donor plasmas, (e.g. random donor, single donor matched
and unmatched and frozen)
g. Cryoprecipitate
h. Coagulation factor concentrates, (e.g. factor VIII, prothrombin
complex, anti-inhibitor coagulant complex)
i. Colloid solutions (albumin and plasma protein fraction)
j. Immune globulins (IVIG, VZIG, HBIG, and RhIG)
k. Autologous blood (including; presurgical deposit and intraoperative
or traumatic salvage)
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2. Construct an appropriate plan for administering the above components
considering dosage, rate of administration and use of transfusion
equipment (a, b, e, f)
3. Know the hemostatic complications in cardiopulmonary bypass
(a, b, e, f)
a. Evaluate clinical information regarding a patient bleeding post-CPB
b. Select proper use of blood components
4. Demonstrate the concept of usage of autologous blood in surgery
(a, b, c, d, e, f)
a. List procedures for autologous transfusion
b. List advantages of autologous transfusion
5. Construct the appropriate pre-operative orders for blood
(a, b, c, d, e, f)
a. Indicate how hemostatic safety for operative procedures is
determined
b. Identify appropriate orders for blood and blood components
c. Identify appropriate orders for blood and blood components,
including use of type and screen and maximum surgical blood order
schedule
6. Evaluate intra/post-operative transfusion needs (a, b, d)
a. Describe methods to predict estimated blood loss
b. Describe treatment for hypovolemia
7. Recognize causes of blood wastage (a, b, d)
a. Define time limits for non-refrigerated blood
b. Define desirable crossmatch/transfusion ratio
8. Construct appropriate orders for compatibility testing in massive
transfusion (a, b, c, d, e, f)
a. Identify correct use of “type-specific” blood
b. Identify correct use of “O” negative blood
9. Interpret the rationale for use of various components in massive
transfusion (a, b, c, d)
a. Define indications for platelet transfusion
b. Compare indications for whole blood vs. packed cells
c. Define indications for fresh frozen plasma
10. Understand complications of massive transfusion (a, b, c, d)
a. List clinically significant changes
b. List changes of questionable significance
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11. Describe fluid losses associated with burns (a, b, c, d)
a. Describe mechanisms of fluid and protein loss post-burn (operative
and non-operative)
b. Describe appropriate fluid therapy
12. Understand the use of blood support in patients with neoplastic
disease (a, b, c, d)
a. Identify special hematologic problems in patients with neoplastic
disease
b. Describe appropriate use of blood components in the treatment of
neoplastic disease
13. Understand appropriate blood support in the treatment of anemia
(a, b, f)
a. Identify special transfusion problems in patients with chronic
hypoproliferative anemias
b. Identify special transfusion problems in patients with hemolytic
anemia
c. Identify clinical indications and contraindications for red cell
transfusion
14. Understand the diagnosis and blood support in the treatment of
thrombocytopenias caused by accelerated platelet destruction
(a, b, f)
a. Distinguish between different types of accelerated platelet
destruction
b. Identify the appropriate blood support for patients with accelerated
platelet destruction
15. Understand the role of Rh immunoprophylaxis in prevention of HDN
(include antepartum and postpartum)
(a, b, f)
a. Define Rh immunoprophylaxis and its indications
b. Identify dosage, timing and administration of Rho(D) immune
globulin
E. Blood Substitutes
1. Understand the oxygen carrying compounds under investigation
a. Evaluate the usefulness of hemoglobin solutions (a, b)
2. Know religious objections to transfusion (a, b)
a. Identify the religious groups who interdict transfusion
b. Identify the legal avenues that can be tested when transfusion is
medically indicated
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F. Adverse Effects of Blood Transfusion
1. Demonstrate knowledge of the incidence and significance of adverse
immunologic effects of blood transfusion (a, b, d, e, f)
a. Describe intravascular “immediate” hemolytic transfusion reactions,
i.e. their etiology, pathogenesis and clinical significance
b. Describe extravascular and delayed anamnestic transfusion
reactions, i.e. their etiology, pathogenesis and clinical significance
c. Describe steps to prevent hemolytic transfusion reactions
d. Outline the steps to be taken by physician, floor nurse
and laboratory in response to suspected hemolytic transfusion
reactions
e. Outline the laboratory tests done for suspected hemolytic reactions
and describe the significance of possible results
f. Describe febrile reactions; indicate their cause and clinical
significance
f. Outline the steps to prevent and treat febrile reactions
g. Describe allergic and anaphylactic transfusion reactions
h. Outline the steps to prevent and treat allergic and anaphylactic
transfusion reactions
i. Recognize the special significance of immunologic reactions, which
occur intraoperatively
j. Identify the incidence and significance of alloimmunization to
platelet and white cell transfusions and their prevention and
treatment
k. Identify non-immunologic causes of hemolysis and distinguish them
from immunologic causes
2. Demonstrate an understanding of metabolic adverse effects of
transfusion (a, b, d, e, f)
a. Describe pathogenesis and management of acidosis
b. Describe pathogenesis and management of hypocalcemia
c. Describe pathogenesis and management of hyperkalemia
3. Describe possible adverse pulmonary complications of transfusion
(a, b, d, e, f)
a. Describe current knowledge TRALI
b. Describe the role of fluids and/or oncotic activity
4. List infectious complications that can result from transfusion (including
bacteria, hepatitis B, A, C, non-A, HIV, CMV, malaria)
(a, b, d, e, f)
a. For each complication describe the circumstances when it occurs,
its incidence and severity, how it can be prevented and treated
b. Describe what physician, nurse, transfusion service and blood
center should do when a case occurs
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5. Identify the cause, incidence and clinical course of post transfusion
graft vs. host disease. (a, b, d, e, f)
G. Transplantation
1. Know important development in organ transplantation (a, b, c, f)
a. Identify organs being transplanted
b. Contrast living organ vs. tissue transplantation
c. Identify problems limiting transplantation
2. Understand importance of antigen matching/compatibility in
transplantation (renal, bone marrow, other) (a, b, c, f)
a. Describe role of major histocompatibility complex antigens
b. Describe role of non-HLA linked antigens
c. Describe importance of ABO compatibility
3. Know appropriate transfusion practice in patients undergoing
transplantation (a, b, c, f)
a. Contrast the effect of pre-transplant transfusion on graft survival in
renal and bone marrow transplantation
b. Discuss the proposed immunologic mechanisms for the above
effects
c. Identify adverse effects associated with transfusion of
immunocompromised recipients
d. Describe appropriate transfusion support for blood group
incompatible bone marrow transplantation
4. Be aware of ethical and legal consideration pertaining to donation of
bone marrow by unrelated donors and recipients (a, b, c, f)
a. Describe procedures to assure confidentiality and informed consent
b. Discuss the proposed immunologic mechanisms for the above
effects
c. Identify adverse effects associated with transfusion of
immunocompromised recipients
d. Describe appropriate transfusion support for blood group
incompatible bone marrow transplantation
5. Be aware of ethical and legal consideration pertaining to donation of
bone marrow by unrelated donor and recipients (a, b, c, f)
a. Describe procedures to assure confidentiality and informed consent
6. Understand blood support requirements for bone marrow
transplantation (a, b, c, f)
a. Describe use of blood components during the pre-marrow
transplantation period
b. Describe use of blood components during post-marrow
transplantation period
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Rotations for Stem Cell Laboratory, Molecular Pathology, Flow cytometry, and
Cytogenetics
1. Learn the scientific rationale and procedures for HPC processing,
storage, quality control, and administration. (a, b, d, f)
2. Understand different techniques used in DNA extraction, PCR,
southern blots, DNA sequencing, fragment analysis, etc., and their
applications in the diagnosis of diseases. (a, b, d, f)
3. Learn the applications of Flow cytometry in the practice of transfusion
medicine. (a, b, d, f)
4. Understand the role of the major histocompatibility complex (a, b, d, f)
a. Define terms (e.g. HLA-A, B, DR)
b. Describe inheritance of HLA antigens
c. Recognize the biochemical nature of Class I and II antigens of the
major histocompatibility complex
c. Describe the role of the MHC in cellular immunology
d. Identify blood cell distribution of HLA antigens
e. Identify significant HLA disease associations
5. Describe principles and applications of the techniques for HLA typing
and crossmatching (a, b, d, f)
a. Microlymphocytotoxicity assay and mixed lymphocyte reactions
(MLR)
b. PCR/SPP sequence-specific primers
c. PCR/SSOP sequence-specific oligonucleotide probes
d. SBT sequence-based typing
e. RSCA reference strand conformation analysis
f. Flow cytometry in detecting and characterizing Class I and Class II
antibodies:
American Red Cross Rotation
A. Preparation of Blood Components
1. Evaluate the acceptability of individuals for blood donation
(a, b, d, e, f)
a. Identify the risks of blood donation to the donor
b. Identify the risks to the potential recipient
2. Construct a plan to care for blood donors (a, b, d, e, f)
a. Recognize the potential complications of blood donations
b. Describe the prevention and management of the complications of
blood donation
3. Demonstrate understanding of the significant issues in donor
recruitment (a, b, d, e, f)
a. Explain concepts of community responsibility and individual
226
responsibility
b. Compare paid and volunteer blood donation systems
c. Define directed donations and autologous donations and describe
their impact on safety and the blood supply
4. Know the preparation of blood components (a, b, d, e, f)
a. List the functional composition of blood components
b. Outline the basic steps in component production
5. Interpret the rationale for the testing performed in donor blood
processing (a, b, d, e, f)
a. Name the tests required for donor blood processing
b. Recognize the potential patient complications if errors in donor
blood processing occur
6. Recognize the changes in blood component composition with storage
(a, b, d, e, f)
a. Describe the changes in each component with storage
b. Identify potentially adverse effects of transfusion which result from
storage induced changes in blood components
c. Compare the potential risks of transfusion with the expected benefit
for blood products stored for varying lengths of time
d. State the outdate periods for each blood component
B. Autoimmunity
1. Understand the concept of hemolytic disease (a, b, d, e)
a. Distinguish between hemolytic and nonhemolytic anemia
b. Distinguish between immune nonimmune hemolytic anemia
c. Classify autoimmune hemolytic anemia according to immunologic
and clinical criteria
2. Understand the concept of warm-reactive autoimmune hemolytic
anemia (AIHA) (a, b, d, e)
a. Describe the pathogenesis of warm-reactive AIHA
b. Distinguish between immune and nonimmune hemolytic anemia
c. Describe appropriate therapy for patients with warm-reactive AIHA;
identify considerations for transfusion
3. Understand concepts related to cold-reactive AIHA (a, b, d, e)
a. Distinguish between different types of cold-reactive antibody
b. Identify the different syndromes produced by cold-reactive
antibodies
c. Define characteristics and pathogenetic effects of cold-reactive
antibodies
d. Describe the use of transfusion therapy in cold reactive AHA
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4. Understand concepts of drug-induced immune hemolytic anemia
(a, b, d, e)
a. Distinguish between different mechanisms of drig-induced immune
injury
b. Describe the differential diagnosis of drug-induced immune
hemolytic anemia
c. Describe appropriate treatment for patients with drug-induced
hemolytic anemia
5. Understand concepts of immune thrombocytopenia (a, b, d, e)
a. Distinguish between immune and nonimmune thrombocytopenia
b. Outline the pathophysiology and clinical features of idiopathic
Thrombocytopenic Purpura (ITP, also know as Autoimmune
Thrombocytopenic Purpura, ATP)
C. Organization and function of Regional Blood Services and Hospital
Transfusion Services
1. Demonstrate a working knowledge of the organization and function of
blood centers and transfusion services (a, b, c, d, e)
a. Describe the principle organizational features of blood centers
b. Distinguish between the functions of regional and hospital blood
c. Describe the organization of transfusion services
d. Describe the function of the transfusion committee and peer review
e. Describe the Quality Plan and its implementation
Research
1. Concepts of conducting research (b, c, d, e, f)
a. Describe the process of finding a problem, conducting literature
review and stating the problem
b. Organize a research design
1. Experimental
2. Descriptive
3. Observational
4. Randomized controlled trial (RCT)
2. Prepare data collection forms, and IRB etc (b, c, d, e, f)
3. Laboratory experiments (b, c, d, e, f)
5. Selection of the experiment
6. Scientific background of the techniques
7. Laboratory skills
8. Troubleshooting
4. Describe analysis of results and statistical methods (b, c, d, e, f)
228
5. Drafting manuscript and publishing the results (b, c, d, e, f)
a. Prepare an abstract
b. State the problem
c. Describe the methods
d. Present the results
f. State the conclusions
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CYTOPATHOLOGY FELLOWSHIP
A. Duration of Fellowship
1 year
B. Teaching Staff Responsible for Supervision and Instruction
Primary Teaching Staff:
• P. E. Wakely, Jr., M.D., Professor and Fellowship Director
• Rulong Shen, M.D., Clinical Associate Professor, Director of
Cytopathology
• James Liu, M.D., Clinical Assistant Professor
• Saeed Bajestani, M.D., Clinical Assistant Professor
• Alessandra Schmitt, M.D., Clinical Assistant Professor
• Adrian Suarez, M.D., Clinical Assistant Professor
C. Mission Statement
The mission of the cytopathology fellowship is to provide a climate and
foundation for a physician to excel and develop special competence in the
diagnosis and evaluation of clinical cytology specimens, in the practice of fineneedle aspiration biopsy, and to develop an interest in research applications of
the cytologic method.
D. General Core Competencies
1. Patient Care
The fellow should be able to demonstrate a satisfactory level of diagnostic
competence and the ability to provide appropriate, effective consultation in the
context of cytopathology services.
Objectives
Assignments and Activities
• Competency in all aspects of
1. answering telephone queries regarding
the performance of fine-needle
FNA specimens.
aspiration (FNA) biopsy
2. responding to requests from clinicians for
specimens, needle handling,
the performance of FNA.
construction of smears and all
3. attending the performance of
patient interaction.
radiographically-guided FNA biopsy with the
purpose of preparing smears and assessing
adequacy
4. demonstrating knowledge of how to rapidly
evaluate common FNA biopsy specimens
230
5. demonstrate a working familiarity with the
instruments and materials used to obtain FNA
biopsy specimens
6. demonstrating competency in the actual
needle puncture and performance of FNA
biopsy of patients
7. demonstrating competency in history
taking, obtaining informed consent, examining
the patient and lesion to be biopsied,
physically procuring the specimen, preparing
and staining the smears along with
preliminary microscopic interpretation of
smears
7. informing clinicians of the results of
immediate adequacy and/or preliminary
interpretation of a pathologist-performed FNA
biopsy.
8. keeping a log of the actual number of FNA
biopsies the fellow has performed on the
ACGME Web Ads Resident Case Log
System:
https://www.acgme.org/residentdatacollection/
9. verify that cytopathology requisitions are
completed correctly
10. being physically present at the time of
FNA cytology case sign-out
• Answer clinicians’ questions
• Discussion with clinician prior to
concerning expected FNA
performance of FNA and call back of
results.
preliminary interpretation
• Accurately gather essential
• Learn how to use the computer, and e-
information about patients and
results for patient history, information relevant
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patient specimens in gynecologic to patient’s immediate problem
and non-gynecologic, non-FNA
specimens
2. Medical Knowledge
The fellow should be able to demonstrate knowledge about established and
evolving findings in biomedical, clinical and cognate sciences as they relate to
cytopathology.
Objectives
Assignments and Activities
• Demonstrate familiarity with collection
• Review process with cytopreparatory
methods, cytopreparatory processing,
personnel.
& turnaround times for common
• Spend half a day in cytopreparatory
cytopathology specimens.
lab for instruction on cytopreparatory
techniques.
• Read: appropriate sections in
cytopathology lab manual
• Demonstrate familiarity with routine
• Review process of Pap smear
screening and principles of automated
screening.
screening.
• Provide fellows with cervicovaginal
smears (Pap smears) to screen
individually which are re-screened by
cytotechnologist supervisor
• Provide feedback on screening ability
• Read: sections on automated
screening in Bibbo et al., 2008,
Geisinger et al, 2004.
or Cibas & Ducatman, 2009 textbooks.
• Enhance diagnostic and teaching
• Review relevant cytology case
skills.
material including large collection of
study packets with residents, rotating
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medical students, and individually
• Enhance medical knowledge,
• Mandatory attendance at formal
limitations and pitfalls in cytology.
cytology didactic lectures
•Mandatory attendance during
cytopathology sign-out of daily cases.
• Preview slide specimens to gauge
• Re-review of cases with attending
diagnostic skills.
pathologist of the day during sign-out.
• Demonstrate knowledge of the
• Read: The Bethesda System
current Bethesda System terminology
Handbook, Solomon & Kumar, 2nd ed.,
for reporting on gynecologic
2004.
cytopathology specimens
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
• Demonstrate knowledge of ASCCP
• Read relevant sections in:
guidelines for management of
Cytopathology text, Cibas & Ducatman,
abnormal cervicovaginal specimens.
2009. ASCCP Guidelines, Am J Obstet
Gynecol 2007:197:346.
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
• Demonstrate knowledge of the
• Read relevant sections in:
elements of adequacy and current
Cytopathology texts by Cibas &
laboratory reporting system for fine-
Ducatman, 2009, Bibbo et al., 2008, or
needle and exfoliative non-gynecologic
Geisinger et al, 2004.
cytopathology specimens from
• Q and A teaching at formal didactic
commonly sampled body site
lectures and during daily case sign-out.
• Describe the cytopathologic features
• Read relevant sections in:
of normal, reactive, infectious,
Cytopathology texts by Cibas &
dysplastic, and neoplastic conditions as Ducatman, 2009, Bibbo et al., 2008, or
seen in common cytopathology
Geisinger et al, 2004.
specimens.
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
• Demonstrate knowledge of adequacy
• Read: The Bethesda System For
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and current laboratory reporting system
Reporting Thyroid Cytopathology, Ali &
for thyroid FNA.
Cibas, 2010
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
Demonstrate how to compose a clear,
• Q and A teaching at formal didactic
concise, and complete cytopathology
lectures and during daily case sign-out.
report.
3. Practice-Based Learning and Improvement
The fellow should be able to demonstrate the ability to investigate and evaluate
consultative practices, appraise and assimilate scientific evidence in order to
improve their own patient care
practice.
Objectives
Assignments and Activities
• Assessment of individual strengths
• Mandatory participation in the PEC
and weaknesses
(progressive evaluation of competency)
program administered by the American
Society of Cytopathology and given
three times throughout the year
• Review: Individual PEC scores with
the director to focus on areas of
needed improvement and strengths
• Demonstrate knowledge of how to
• Read: relevant sections in
apply concepts of quality control, risk
cytopathology texts by Cibas &
management, and regulatory
Ducatman, 2009, Bibbo et al., 2008, or
compliance including correct coding as
Geisinger et al, 2004.
pertains to cytopathology.
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
• Demonstrate knowledge of ancillary
• Read: relevant sections in
techniques as applicable to
cytopathology texts by Cibas &
234
cytopathology
Ducatman, 2009, Bibbo et al., 2008, or
Geisinger et al, 2004.
• Q and A teaching at formal didactic
lectures and during daily case sign-out.
• Appraise and assimilate scientific
• Observe: Procedures used by
evidence
attending pathologists during daily case
sign-out of computer technology to
manage individual patient information,
and access on-line medical information
to support direct patient care and one’s
own continuing education
• Locate, appraise, and assimilate
• Observe: Procedures used by
evidence from scientific studies related
attending pathologists during daily case
to patient specimens
sign-out to accomplish this
4. Interpersonal and Communication Skills
The fellow should be able to demonstrate interpersonal and communication
skills that result in effective information exchange and teaming with other health
care providers, patients, and patient families.
Objectives
Assignments and Activities
• Use effective listening skills and elicit
• Performs consultation, informed
and provide information with effective
consent and follow-up for patients
verbal, nonverbal, explanatory,
undergoing FNA biopsy
questioning, and writing skills.
• Create and sustain an ethically sound
• Performs call back of preliminary FNA
relationship with other physicians,
interpretations, consultation cases from
laboratory personnel, clerical staff, and
hematology
students.
• Communicate effectively and
• Observation: by attending
235
demonstrate caring and respectful
pathologists at daily case sign-out and
behavior during interactions with
during patient interaction at time of
physicians, laboratory personnel,
FNA biopsy
patients, and clerical staff.
• Present risks, benefits, indication for
FNA biopsy to patients, residents, and
attending clinical staff
5. Professionalism
The fellow should demonstrate a commitment to carrying out professional
responsibilities with an adherence to ethical principles, and sensitivity to a
diverse patient population.
Objectives
Assignments and Activities
• Demonstrate respect, compassion,
• Requires: neatness and
and integrity to peers, patients, and
appropriateness in dress, and
staff
interaction with patients, staff, faculty
• Requires: neatness in office
workplace
• Demonstrate a commitment to ethical
• Requires: respecting patient privacy in
principles pertaining to confidentiality of public places including elevators, and
patient information, and informed
hallways
consent.
• Demonstrate a commitment to patient
• Expectation: be at work Monday
welfare and is accountable to the
through Friday from 7:30 am until 6:00
patients and the profession
pm.
• Expectation: respond in a timely
manner to requests for an FNA
procedure
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6. Systems-Based Practice
The fellow should be able to demonstrate an awareness and responsiveness to
the larger context and system of health care and the ability to call on system
resources to provide pathology services that are of optimal value.
Objectives
Assignments and Activities
• Develop an understanding of how
• Attendance: required at all
their patient care and other
cytopathology national teleconference
professional practices affect other
lectures given at regular intervals
health care professionals, the health
• Become involved in national societies
care organization, and society as a
such as American Society of
whole.
Cytopathology, American Society of
Clinical Pathology, College of American
Pathologists, and AMA
• Educate pathology residents and
• Review and discuss current and past
non-pathologist physicians regarding
cases with non-pathologist physician
cytopathology policy and procedures.
• Become an advocate for quality
• Become involved in national societies
patient care
such as American Society of
Cytopathology, American Society of
Clinical Pathology, College of American
Pathologists, and AMA
• Knowledge of clinical protocols
• Required: become knowledgeable
regarding safe FNA biopsy technique
• Required: become knowledgeable
regarding cytopathology protocols for
gynecologic cytology and clinical
guidelines
• Practice cost-effective health care
• Learn: proper role and ordering of
and resource allocation
immunocytochemistry, FISH testing,
special stains as applied to
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cytopathology
• Participates in 10% QA sign-out of
cervical biopsy specimens with surgical
pathologists in patients with prior
cervicovaginal smears
• Learn about the types of medical
• Attendance: national and regional
practice and delivery systems
meetings of cytopathology
including methods of controlling health
care costs and allocation of resources
E. Goals and Requirements of the Fellow
The fellow is expected to abide by the institutional policies as developed
by the Graduate Medical Education Office of OSUMC:
https://onesource.osumc.edu/departments/GME/Pages/GMEPolicies.aspx
The desired end-result of the fellowship is to produce a physician skilled in
the collection, evaluation, and diagnosis of cytopathologic material obtained from
patients. This is accomplished by active participation in the evaluation of
gynecologic and non-gynecologic cytopathology on a daily basis.
F. Curriculum
The fellowship is designed to provide a foundation for the diagnosis of
clinical specimens including both exfoliative and fine needle aspiration cytology.
Experience is obtained by self-directed review of the available teaching materials
and sign-out of clinical specimens with the attending physician. There is a large
collection of material available including microscopic slide sets and a variety of
cytology textbooks and atlases. The fellow is urged to make full use of this
material, particularly as an introduction to the field for specific body sites. The
fellow completes objective testing through ASC three times a year.
The Division of Cytopathology also provides opportunities for research
and other scholarly activities. Current research opportunities include: variety of
molecular biology techniques and automated cytology such as Thin Prep or Sure
238
Path. Fellows are expected to participate in these or other projects involving
clinical cytology. Faculty members in the division discuss their respective
research activities with interested fellows.
G. Duties and Responsibilities of the Faculty and the Fellowship Program
a. Attending faculty will participate in final sign-out of all forms of cytology
specimens with the fellow unless otherwise directed. It is expected that faculty
will provide an educational climate during cytology sign-out through discussion
and query.
b. Attending faculty will participate in scheduled cytopathology conferences of
various types.
c. Attending faculty will involve the fellow in scholarly activities as the fellow
develops interest and ability in such pursuits.
d. The program will make available to the fellow various national teleconferences
and unknown slide sets from national program as teaching tools as time and
funds permit.
e. Attending faculty are required to complete an evaluation of the fellow on a
semi-annual basis.
f. The program will make available to the fellow teaching sets of cytology
specimens for individual-based and formal conference-based learning.
H. Fellow Supervision, Duty Hours and Work Environment
The Cytopathology Fellowship Director at the beginning closely supervises the
fellow. The fellow also assumes supervision from cytotechnologists, and
attending faculty in cytopathology, the Director of Anatomic Pathology and the
Chairman of the Department. The fellow is given more responsibility for patient
care and consultations as their skills are mastered. Faculty that are on service
are available at all times for consultation. Supervision is tailored to the fellow’s
level of performance. Faculty evaluate the fellow twice a year both in context of
written evaluations as well as in person reviewing strengths and weaknesses and
planned measures to facilitate improvement in problem areas.
239
The fellow is expected to be present during the day, normally Monday through
Friday from 7:30 am until 6:00 pm. No in-house call is required. The program
follows the duty hour rules set by the ACGME. Duty hours will be logged from
January – March of each year.
I. Evaluation
a. The fellow will participate in the PEC progressive evaluation of competency
program administered by the American Society of Cytopathology three times
throughout the year.
b. Evaluations will be completed regarding the fellow on E*Value by the attending
faculty and Fellowship Director semi-annually and also by the Fellowship Director
after the first 3 months and on as needed basis.
c. The fellow will evaluate the program, conferences, and the faculty on an
annual basis at the completion of the fellowship.
d. The fellowship will be evaluated annually by the Fellowship Director and
cytopathology faculty members.
J. Resolution of Grievances
a. Issues and concerns regarding any aspect of the fellowship should be brought
to the Director’s attention as they arise, or at the time of regularly scheduled
evaluations depending on their urgency. Any grievances will be handled in the
manner delineated by OSUMC. Due process policy is located the following link:
https://onesource.osumc.edu/sites/Audience/Physicians/Documents/due%20proc
ess%20policy.pdf
b. A record of all evaluations and issues pertaining to the fellow are kept with the
Residency/Fellowship Coordinator in the Pathology Education Office.
K. Miscellaneous
a. Duty hours are limited to 80 hours per week averaged over a 4-week period as
delineated by OSUMC.
240
b. Vacation time is 15 working days (3 weeks) annually. A vacation request form
must be submitted in a reasonable time frame prior to vacation approval by the
Fellowship Director except in the event of an emergency. Vacation request form
is brought to the Pathology Education Office after approval of Director.
c. Upon satisfactory completion of the fellowship, the fellow receives a graduation
certificate from the Department of Pathology.
d. A permanent record is kept on each fellow in the Pathology Education Office
that includes semi-annual and final evaluation letters written by the Fellowship
Director with input from cytopathology faculty. The final letter will address the
fellow’s current ability to practice cytopathology and any deficiencies. Uses of
final evaluation: (1) for recommendation to the American Board of Cytopathology
and (2) to answer inquiries about fellows after they have left the program.
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GASTROINTESTINAL PATHOLOGY FELLOWSHIP
1.
Fellowship Director
Wendy L. Frankel, M.D.
2.
Program Duration
1 year
3.
Number of Positions (per year/total)
1
4.
Sites of Training

5.
Program Faculty






6.
The Ohio State University Medical Center
Wendy L. Frankel, M.D.; Vice Chair and Director of Anatomic
Pathology; Professor of Pathology; GI Fellowship Director; Chief,
Liver and GI Pathology
William L. Marsh, Jr., M.D.; Professor-Clinical; surgical pathology
Martha Yearsley, M.D.; Assistant Professor-Clinical; surgical
pathology
James Liu, M.D.; Assistant Professor-Clinical; surgical pathology
and cytology
Xiaoping Zhou, M.D., Ph.D., Assistant Professor-Clinical; surgical
pathology
Mark Bloomston, M.D.; Associate Professor of Surgery; Director,
Surgical Oncology Fellowship Program
Program Goals/Objectives/Curriculum
A.
Program Goals
1)
2)
Allow fellows to integrate their medical knowledge with the
use of traditional and modern techniques for the diagnosis of
gastrointestinal and liver disorders. The fellow will become
proficient in the use of ancillary studies such as
immunohistochemistry and molecular testing.
Development of investigational skills. The gastrointestinal
fellow is encouraged to participate in ongoing research
242
3)
B.
projects in gastrointestinal pathology and prepare interesting
case reports with reviews of the literature.
Development of teaching and presentation skills. The
gastrointestinal pathology fellow will be scheduled to review
interesting cases with pathology residents and students
utilizing direct examination of the cases(s) under microscopic
review or formal lectures. A monthly Tumor Board
Interdisciplinary Conference includes gastrointestinal
pathology cases which the fellow will present. Liver
transplant cases will be presented at the weekly Transplant
Conference. Medical liver cases will be presented at the
weekly Liver Conference. In addition, the fellow will be
involved in informal medical student and resident teaching.
Objectives
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Ability to obtain pertinent information from the patient’s
clinical record.
Ability to dissect gastrointestinal tissues in such a way as to
preserve important pathologic findings and fix them so that
they may be used for clinicopathologic correlations as well
as teaching.
Ability to select correct pieces of tissue for sectioning and
preservation, and maintenance and identification of tissue
orientation during processing.
Ability to list common stains used for gastrointestinal
microscopic sections, as well as their indications and the
expected results for various tissue types.
Demonstrate knowledge of the specimens that commonly
require special handling (flow cytometry, microbiological
cultures, recovery of crystals, electron microscopy,
immunohistology, etc.).
Ability to select an appropriate piece of tissue for frozen
section, and to cut and stain the section satisfactorily.
Ability to take suitable gross and microscopic photographs
using digital cameras.
Ability to present cases at conferences with clarity,
completeness, high resolution quality illustrations, and to
reach reasonable interpretative conclusions.
Demonstrate knowledge of the common pathogens that can
be transmitted to laboratory personnel in pathology, as well
as basic safety precautions to be taken in the anatomic
pathology laboratory, including universal precautions for
infectious agents.
Gastrointestinal Surgical Pathology – Advanced Skills:
243













Demonstrate knowledge of the common situations
requiring expedited processing of a pathology specimen,
and those that do not
Demonstrate knowledge of the common indications for
an intraoperative consultation
Demonstrate the ability to effectively construct a complex
surgical pathology report
Demonstrate knowledge of the common grading and
staging systems applied to malignant neoplasms
Be able to properly prepare synoptic surgical pathology
reports for common malignancies
Demonstrate knowledge of how and when to obtain
external consultations in anatomic pathology and
document the results appropriately
Demonstrate the steps for preparation of consultation
reports on outside slides and/or paraffin blocks, and
transmittal of those reports to responsible clinicians
and/or referring pathologists
Demonstrate the techniques for preparing intraoperative
cytology smears
Enumerate the indications and the limitations pertaining
to intraoperative frozen section examinations
Demonstrate an ability to manage workflow in the gross
room, assist junior residents with gross dissection,
provide accurate gross descriptions of routine and
complex specimens, use the local anatomic pathology
laboratory information system, and practice safety in the
pathology laboratory
Be able to independently report the histopathologic
aspects of routine and complex cases, including cases
prepared by junior residents and/or pathology assistants,
with attention to organization of diagnostic format,
development of differential diagnosis, and ordering of
necessary special stains and other ancillary techniques
Demonstrate knowledge of quality control pertaining to
histologic sections and special stains, including troubleshooting of mistakes in accessioning, labeling, and
misidentification of specimens
Review consultation slides on referral cases with
attention to pertinent clinical information, requests for
additional slides or blocks if needed, and formatting of
the final consultative report
244
C.
Curriculum
1)
7.
Conferences:
 GI and Liver Conference. A clinicopathological
correlation conference with GI fellows. Held once a
month, Friday 7:30-8:30am, multiheaded scope room.
 Oncology Tumor Board. Held each Thursday, 8:30-9:30
am, year round. GI topics monthly.
 Pathology resident and medical student GI/Liver teaching
conferences held throughout the year, Tuesday and
Thursday from 7:30-8:30 am.
 Transplant Conference, liver transplant cases presented,
weekly
 Medical Liver Conference, includes GI pathology faculty,
hepatologists, residents and fellows, weekly
Clinical Duties/Responsibilities
Daily signout and supervision of residents on GI/Liver service.
Responsible for all outside consults. Involved in complicated GI/Liver
intra-operative consults.
8.
Research Duties/Responsibilities
The fellow is expected to do a clinically-oriented or basic science project,
under the supervision of the GI Fellowship Director, to result in an abstract
and/or paper to be presented at a national meeting.
9.
Educational Duties/Responsibilities
The fellow is expected to help orient and teach medical students and
residents.
10.
Program Policies
A.
Selection of fellow
Completion of Anatomic Pathology (AP) or combined AP/Clinical
Pathology training is necessary.
B.
Evaluation of fellow
A comprehensive evaluation with a detailed discussion of the
fellow’s performance will be done after 6 months and 12 months.
245
C.
Promotion of housestaff
NA
D.
Dismissal of housestaff
If serious disciplinary problems emerge, the fellow can be
terminated according to University guidelines.
E.
Supervision of housestaff
The fellow will be supervised by the Gastrointestinal Fellowship
Director as well as GI faculty.
F.
Duty hours for housestaff
Duty hours are determined by the director of service and clearly
communicated to the fellow. It is essential that the fellow duty
hours do not interfere with the educational goals of the program. It
is the responsibility of the Fellowship Director and faculty to ensure
that fellows are not required to perform excessively difficult or
prolonged duties on a regular basis.
G.
Moonlighting for housestaff
Moonlighting is generally not recommended and requires prior
approval of the Fellowship Director and Department Chair. If
approved, the policy and guidelines set forth by the hospital GME
Office will be followed.
11.
Impact of new program on research/clinical/educational opportunities for
housestaff in current GME programs (positive and negative).
The fellow will have a positive teaching impact on residents on the GI
Service. The fellow will help supervise the grossing of complicated
specimens and will be available to help prepare cases for signout. Due to
the large GI/Liver caseload, there are adequate numbers of cases to be
split amongst the residents and fellow. The fellow will primarily work up
outside consultation cases. Additionally, the fellow will help teach the
basics of GI and Liver to the incoming residents and the Gastrointestinal
Medical Fellows.
246
HEMATOPATHOLOGY FELLOWSHIP
A.
The Hematopathology fellowship is a one-year program and is accredited
for one fellow/year. While the time spent in the various areas is somewhat
flexible, the year is typically as follows:
General hematopathology
Coagulation
Cytogenetics
Molecular Pathology
Flow cytometry
Pediatric hematopathology
Elective
B.
C.
Teaching Faculty:
24 weeks
4 weeks
4 weeks
4 weeks
4 weeks
4 weeks
8 weeks
Amy S. Gewirtz, MD
Nyla Heerema, PhD
Samir Kahwash, MD
Gerard Lozanski, MD
Thomas Prior, PhD
Frederick K. Racke, MD PhD
Arwa Shana’ah, MD
Haifeng Wu, MD
Weiqiang Zhao, MD
General Competencies
Learning Objectives of the Fellowship
1.
Patient Care
Residents must demonstrate a satisfactory level of diagnostic
competence and the ability to provide appropriate and effective
consultation in the context of pathology services. This includes
being able to gather essential and accurate information about their
patients and/or patient specimens. They should perform
competently the medical and invasive procedures considered
essential for hematopathology. They should use information
technology to support diagnostic decisions and work with health
care professionals, including those from other disciplines, to
provide patient-focused care. Specific areas of patient care of
particular importance include but are not limited to those listed
below.
a.
b.
Review and interpret hemostasis evaluations.
Review and interpret abnormal peripheral blood and body fluid
smears.
247
c.
d.
e.
f.
g.
2.
Review and interpret immunophenotyping cases.
Review and interpret bone marrow biopsies and other tissues
involved by hematolymphoid diseases.
Review and interpret hemoglobin electrophoreses
Review and discuss 1-5 with attending faculty on a daily
basis.
Be available to clear "special" procedures and
communicate the results.
Medical Knowledge
Fellows must demonstrate knowledge about established and
evolving biomedical, clinical and cognate (e.g. epidemiological and
social-behavioral) sciences and the application of this knowledge to
hematopathology. A comprehensive examination will be taken at
the end of the rotation. Below is the complete list of material that
the residents should acquire during their rotations in hematology.
I. Hemostasis
A.
Understand basic mechanisms including:
1.
2.
3.
4.
5.
6.
7.
B.
Platelet function and physiology
Vessel wall function and physiology
Coagulation physiology
Fibrinolytic system physiology
Protein C system
Serine protease inhibitors
Tissue factor pathway inhibitor
Discuss testing procedures including:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
PT, APTT
Thrombin time and reptilase time
Fibrinogen by clotting and immunologic
techniques
Factor assays
Inhibitor evaluation
Fibrinogen degradation products including
D-dimers
Platelet aggregation
PFA-100
Antithrombin III
Protein C
Protein S
Plasminogen
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13.
14.
16.
17.
18.
19.
C.
Know the criteria for diagnosis, clinical and laboratory
findings of and differential diagnosis for:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
D.
Alpha-2-antiplasmin
Factor XIII
Euglobulin clot lysis time
Crossed immunoelectrophoresis
Antiphospholipid antibody assays
Evaluation for heparin-induced
thrombocytopenia
Hereditary factor deficiencies
DIC
Liver disease
Acquired vitamin K deficiency
Heparin effect
Coumadin effect
Dysfibrinogenemia
Lupus anticoagulant
Specific factor inhibitors
Effect of monoclonal proteins
ITP
TTP and HUS
Von Willebrand's disease
Bernard-Soulier syndrome
Glanzmann's thrombasthenia
Storage pool defects
Release defects
Drug-induced platelet disorders
Acquired thrombotic tendency
Uremia
Effect of cardiopulmonary bypass on
hemostasis
Hereditary thrombotic disorders
Antiphospholipid antibody syndrome
Heparin-induced thrombocytopenia
Understand the indications and mechanisms for the
following therapeutic agents:
1.
2.
5.
6.
5.
6.
Heparin
Oral anticoagulants
Direct thrombin inhibitors
FFP
Cryoprecipitate
Platelet concentrates
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7.
8.
9.
10.
11.
12.
13.
Vitamin K
AHF (factor VIII) concentrates
Factor IX concentrates
Activated Factor IX concentrates
DDAVP (desmopressin)
Fibrinolytic inhibitors
Fibrinolytic therapy (streptokinase, urokinase
and TPA)
II. Red Cell Disorders
A.
Understand function and development of RBC's
1.
2.
3.
4.
5.
6.
7.
B.
Describe the following testing procedures:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
16.
17.
C.
Morphology of red cell development
Synthesis of heme
Synthesis of globin
Red cell metabolism
Functional characteristics of hemoglobin
2,3-DPG
Structure and function of red cell membrane
Cell counting techniques and indices
Wright stain morphology, including bone
marrow
Reticulocyte stain and counting
Iron stain
Osmotic fragility
Evaluation of PNH
Hemoglobin electrophoresis: alkaline and
acidic
Evaluation of sickle cell disorders
Evaluation of Hgb, A2, and F
B12 and folate
Serum iron, TIBC, and ferritin
Erythrocyte sedimentation rate
Porphyrin metabolism
Heinz body staining
Reticulocyte staining
Know the criteria for diagnosis, clinical and laboratory findings
of and differential diagnosis for:
1.
2.
Iron deficiency anemia
Megaloblastic anemia
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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Anemia of chronic disease
Aplastic anemia
Anemia of liver disease
Other hypoplastic anemias
Hereditary spherocytosis
Hereditary elliptocytosis
Hereditary pyropoikilocytosis
Thalassemias
Hemoglobinopathies
Metabolic defects
Extrinsic hemolysis - immune mediated
Infections, e.g. malaria
Sideroblastic anemias
Paroxysmal nocturnal hemoglobinuria
Microangiopathic hemolytic anemias
III. White Cell Disorders
A.
Understand myeloid differentiation and function
1.
2.
3.
B.
Describe the following testing procedures:
1.
2.
3.
4.
5.
6.
7.
C.
Development of neutrophil, basophil,
eosinophil and monocyte cell lines
Morphologic variants, including Pelger-Huet,
Chediak-Higashi, Alder-Reilly, May-Hegglin
Process of phagocytosis and digestion
Cell counting techniques, including eosinophil
counts
Wright stain morphology, peripheral blood and
bone marrow
H & E morphology, bone marrow
Cytochemistries, including peroxidase, Sudan
Black B, specific esterase and non-specific
esterase
Nitro blue tetrazolium
Leukocyte alkaline phosphatase
Immunologic phenotyping
Understand lymphocyte function, development and testing
1.
2.
3.
T & B cell lines
Wright stain morphology, peripheral blood and
bone marrow
H & E morphology, bone marrow
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4.
5.
6.
D.
Acid phosphatase
PAS stain
Immunologic phenotyping
Know the criteria for diagnosis, clinical and laboratory findings
of and differential diagnosis for:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Etiology for quantitative problems of
neutrophils, eosinophils, basophils, monocytes,
and lymphocytes
Leukemoid reactions
Chediak-Higashi syndrome
Membrane abnormalities associated with
infection
Chronic granulomatous disease
Acquired causes of neutrophil dysfunction
Acute myelogenous leukemia
Chronic myelogenous leukemia
Precursor B and T lymphoblastic
leukemia/lymphoma
Prolymphocytic leukemia
Chronic lymphocytic leukemia
Myelofibrosis
Polycythemia rubra vera
Essential thrombocythemia
Chronic myelomonocytic leukemia
Myelodysplastic syndromes
Hairy cell leukemia
Non-Hodgkin lymphoma
Hodgkin lymphoma
T cell lymphoproliferative disorders, including
large granular lymphocytosis
Metastatic carcinoma
Granulomatous disorders of bone marrow
Plasmacytosis
Multiple myeloma
Waldenstrom's macroglobulinemia
Systemic mastocytosis
Mycosis fungoides/Sezary syndrome
IV. Cytogenetics
A.
Define cytogenetic defects in hematopoietic malignancies and
their role in diagnosis and management
1.
Myeloproliferative disorders
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2.
5.
6.
5.
6.
7.
8.
AML
Myelodysplasia
Myeloproliferative/myelodysplastic disorders
Burkitt lymphoma
Precursor B and T lymphoblastic
leukemia/lymphoma
Non-Hodgkin’s Lymphomas (B and T cell
types)
Plasma cell neoplasms
V. Flow Cytometry
A.
Define the utility and abnormalities of flow cytometric
immunophenotypic analysis in the diagnosis of
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Myeloproliferative disorders
AML
Myelodysplasia
Burkitt lymphoma
Precursor B and T lymphoblastic
leukemia/lymphoma
Non-Hodgkin Lymphomas (B and T cell types)
Plasma cell neoplasms
Paroxysmal nocturnal hemoglobinuria
Idiopathic thrombocytopenic purpura
Stem cell collection
VI. Clinical Microscopy
A.
B.
Urinalysis
1.
2.
3.
4.
Identify normal and abnormal cells in urine
Identify casts which may be found in urine
Identify crystals which may be found in urine
Understand techniques for urine chemistries
(dipstick)
1.
Know the role of protein determination and
analysis
Be able to identify:
a.
Inflammatory reactions
b.
Malignancy in CSF
c.
Infectious disorders
CSF
2.
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C.
Pleural, pericardial, peritoneal
1.
2.
D.
Joint fluid
1.
2.
3.
3.
Know the role of protein analysis
Be able to identify:
a.
Inflammatory and reactive processes
b.
Malignant processes
c.
Infectious processes
Be able to identify normal and abnormal cells
in synovial fluid
Be able to identify crystals in synovial fluid
Identify infectious processes in synovial fluid
Practice-Based Learning and Improvement
Fellows must be able to demonstrate the ability to investigate and
evaluate their diagnostic and consultative practices, appraise and
assimilate scientific evidence and improve their patient care
practices.
a.
b.
c.
d.
e.
f.
Attend and participate in conferences, journal clubs, and
grand round activities that pertain to hematopathology. Apply
knowledge of study designs and statistical methods to the
appraisal of clinical studies and other information on
diagnostic effectiveness.
Locate, appraise, and assimilate evidence from scientific
studies related to patient specimens. On particularly
interesting or difficult cases, residents will be asked to
perform literature searches or critically evaluate papers
provided by attending on topics related to patient’s disease.
Obtain and use information about their own patients and the
larger population from which their patients are drawn. While
not mandatory, residents are encouraged to participate in
research projects or case reports related to patients they
encounter or are an area of expertise for an attending with
which they wish to work.
Use information technology to manage information, access
on-line medical information, and support their own
education.
Facilitate the learning of students and other health care
professionals.
Correlation of Wright-stained body fluids with Cytopathology
results.
254
g.
h.
i.
j.
4.
Correlation of abnormal blood smear findings and bone
marrow findings with flow cytometry results
Be able to compare current and previous pathology results
to understand treatment effects on disease processes.
Correlate bone marrow results with other pathology on
patients
Understand the limitations of sub-optimal or inadequate
bone marrow specimens
Interpersonal and Communication Skills
Fellows must be able to demonstrate interpersonal and
communication skills that result in effective information exchange
and teaming with other health care providers.
a.
b.
c.
d.
e.
f.
5.
Communication with clinicians to obtain history for
interpretation of test results and/or appropriateness of tests
ordered
Communication with laboratory technologists about test
methods, additional test requests, etc.
Communication of test results to clinicians and development
of consultative skills to maximize positive interaction with the
clinical staff.
Communication with attending pathologists about patient
material
Write bone marrow reports that provide appropriate
descriptions and synthesize findings into a comprehensive
diagnosis.
Participate in the ongoing teaching programs of the division
and department. Presentation of journal articles on
hematopathology/laboratory hematology topics at Journal
Club
Professionalism
Fellows must demonstrate a commitment to carrying out
professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
a.
b.
Demonstrate respect, compassion, and integrity; a
responsiveness to the needs of patients and society that
supersedes self-interest; accountability to patients, society,
and the profession; and a commitment to excellence and ongoing professional development.
Demonstrate a commitment to ethical principles pertaining to
provision or withholding of clinical care, confidentiality of
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c.
6.
patient information, informed consent, and business
practices.
Handle patient specimens in a professional manner.
Systems-Based Practice
Fellows 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
pathology services that are of optimal value.
a.
b.
c.
d.
e.
2.
Understand how hematopathology tissue examinations fit
into the overall care and management of patients with
hematological and malignant conditions.
Know how types of medical practice and delivery systems
differ from one another, including methods of controlling
health care costs and allocating resources.
Understand cost-effective laboratory utilization in the
evaluation of hematologic disorders.
Advocate for quality patient care and assist others in dealing
with system complexities.
Be familiar with Laboratory Information System and
entry/retrieval of laboratory results, including hematology
information system
Methods of achieving goals:
a.
b.
Extensive discussions of current cases which span the range
of hematologic problems. Cases of particular interest are then
shared with other residents and staff in the Clinical Pathology
Case Conference (see the compilation of cases
accompanying the Clinical Pathology information). Case
material available includes approximately:
2300 Bone marrow biopsies per year
3800 Body fluid samples per year
1200 Coagulation consults per year
1700 Abnormal peripheral smears per year
700 Hemoglobin electrophoresis per year
4500 Flow cytometry immunophenotyping evaluations per
year
480 Hematopoietic neoplasms in lymph node and tissue
biopsies
2500 Cytogenetic interpretations relating to hematologic
specimens
One-on-one discussions of topics between faculty and fellow.
These occur regularly during the rotation and are designed to
256
cover the major areas in hematopathology. Topics covered
include (but are not limited to):
Differential diagnosis of anemia
Laboratory approach to the diagnosis of anemia
Interpretation of hemoglobin electrophoresis
Measurement of hemoglobin A2
Differential diagnosis of polycythemia
Differential diagnosis of neutrophilia, eosinophilia,
monocytosis, basophilia
Differential diagnosis of lymphocytosis
Classifications and diagnosis of acute leukemias
Classification and diagnosis of chronic
myeloproliferative disorders
Classification and diagnosis of chronic
myelodysplastic syndromes
Diagnosis of chronic lymphocytic leukemia
Classification and diagnosis of other
lymphoproliferative disorders
Non-malignant morphologic abnormalities of WBC's
Automated blood cell counters
Mechanisms of hemostasis
Screening tests of hemostasis (BT, PT, APTT, platelet
count)
Hereditary platelet disorders
Acquired platelet disorders
Hereditary coagulation disorders
Acquired coagulation disorders
Performance of factor assays
Evaluation of circulating anticoagulants
Monitoring anticoagulant therapy
Evaluation of cerebrospinal fluid
Evaluation of synovial fluid
Evaluation of serous fluids
Urinalysis
Cytogenetic abnormalities associated with
hematologic malignancies
Molecular abnormalities associated with hematologic
malignancies
Immunophenotypic profiles of various hematologic
malignancies
c.
Attendance at formal teaching conferences. The fellow is
expected to attend the weekly clinical pathology noon review
conference and the weekly afternoon hematology/oncology
case conference. In addition, when the topic is appropriate
they are to attend the weekly morning didactic lectures and
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morning unknown conferences.
3.
d.
Conference presentations: The fellow is expected to present
a minimum of 5 conferences for the residents and faculty
during the course of the year. These conferences may be
didactic sessions or unknown conferences. The fellow is
encouraged to actively participate in both departmental and
interdepartmental conferences.
e.
Fellow self-directed reading program. The fellow is
encouraged to develop his/her own program to cover the
major areas of hematology. Questions which arise from this
program are answered during staff-resident interaction
sessions. Numerous standard hematopathology textbooks
are available including those related to general hematology,
lymph node pathology, bone marrow pathology, coagulation,
cytogenetic and molecular diagnostics, flow cytometry and
pediatric pathology. Faculty files of hematopathology articles
from various journals are also available.
f.
Teaching files of case material are available. This is true for
blood smears, bone marrows, lymph nodes and flow
cytometry.
Laboratory Management
The fellow participates in discussions concerning commonly
occurring problems in the hematology laboratory including:
Personnel issues
Development of test procedures
Cost containment
Recognizing discordant results as a marker of test problems
Use of the Laboratory Information System (LIS)
4.
Quality Assurance
Issues of quality assurance are discussed during the rotation, usually
on a case-oriented approach. The fellow is actively involved in
working through and acquiring data to resolve problems related to
Quality Assurance.
5.
Data Processing
The flow of data through the laboratory is reviewed with the fellow.
Various programs of the LIS are taught to the resident. Through
258
solving of clinical problems, the fellow becomes very familiar with the
patient database kept in the LIS.
6.
Professional Development
The issues relating to professional development such as ethics,
socioeconomics, and medical-legal issues relating to the practice of
hematopathology are openly discussed by the faculty members as
they relate to cases that are being reviewed.
7.
Teaching of Residents/Medical Students
The fellow reviews clinical case material, morphology and
hemostasis cases with medical students and residents rotating
through the laboratory. The fellow presents case discussions to the
residents and faculty on a regular basis at Clinical Pathology Case
Conference.
8.
Opportunity for Scholarly Activity
The fellow is expected to prepare at least one written manuscript
during the course of the program. This manuscript may be a review
of a topic, presentation of research activities or an American Society
of Clinical Pathology Check Sample.
F.
Supervision of the Fellow
As indicated in section (F), the fellow is responsible for initial review of the
case material. Each case is then reviewed with the attending pathologist
who signs off on the case. During the initial stages of the rotation, an
approach to solving the problem is discussed with the attending. With
experience, the fellow is expected to devise his/her own approach and
gather the necessary data to solve the problem and prepare a consultative
report as needed. Similarly, a plan of action, including communication with
the physicians primarily responsible for the patient's care, is discussed.
With experience, the fellow is expected to develop and carry out this plan.
The attending staff "on service" is available throughout the day to assist in
this process.
G.
Fellow Responsibilities
The fellow's major daily responsibilities include:
1.
2.
Review and interpret all hemostasis evaluations.
Review and interpret all abnormal peripheral blood and body fluid
smears.
259
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
H.
Review and interpret all immunophenotyping cases.
Review and interpret all bone marrow biopsies.
Review abnormal hemoglobin electrophoreses
Review and discuss 1-5 with attending faculty on a daily basis.
Be available to clear "special" procedures and communicate the
results.
While on the lymph node service the fellow is expected to work-up
new OSU cases and consult cases, followed by sign out with the
attending pathologist.
While on the cytogenetic rotation the fellow is expected to engage in
the discussions related to various specimens and participate in
weekly laboratory meetings. They are to complete directed reading
assignments, observation of technical aspects of cytogenetics and
participate in formal and informal discussions with the laboratory
director. During the cytogenetic rotation the fellow is expected to
attend the Clinical Pathology Case Conference lecture and present
at least one case concerning cytogenetic diagnosis.
While on the molecular rotation the fellow is expected to attend the
Clinical Pathology Case Conference lecture and present at least one
case concerning molecular diagnosis. The fellow is encouraged to
write up interesting cases, photograph cases for teaching files and
teach hematopathology to residents in pathology.
While on the pediatrics rotation the fellow is expected to review all
appropriate laboratory hematology studies and surgical
hematopathology specimens similar to those listed in items 1-7
above.
Participate in continuing education programs, including (but not
limited to) Clinical Pathology Case Conference, Seminars in
Pathology, and Hematology Case Conference.
Pathology Faculty Responsibilities
The faculty shares coverage of general hematology on a rotation basis.
The faculty member on service for laboratory hematology is responsible for:
1.
2.
3.
4.
Review and sign-out of clinical cases with the fellow. This includes:
coagulation consults, body fluid analysis, peripheral blood film cases,
abnormal hemoglobin electrophoreses and other problem cases (e.g.
QA cases) as they arise, including discussion of techniques for
handling the various cases.
Discuss target topics as outlined in II.D.
Participate in Clinical Pathology Case Conference and Hematology
Case Conference.
Be available to answer and assist with questions that may arise
during the day.
260
5.
Review and sign-out of bone marrow biopsies and lymph nodes with
the fellow. This includes discussion of differential diagnosis, criteria
for diagnosis, techniques for evaluating bone marrows (e.g. special
stains) and clinical implications of the diagnosis.
The faculty member overseeing the pediatric hematopathology rotation is
responsible for items 1,2, 4 and 5 above.
The faculty member overseeing the cytogenetic rotation is responsible for
review and sing-out of consultative reports. Due to the limited exposure to
cytogenetics available to the fellow, much of this activity is done by the
laboratory director, but the fellows are involved in the discussions. The
laboratory director is responsible for training the fellow in the indications for
cytogenetic studies, the techniques available (cell culture, banding,
molecular cytogenetics (FISH) and the significance of cytogenetic
abnormalities in various hematologic conditions.
The faculty member overseeing the molecular diagnostics rotation is
responsible for answering and assisting the fellow with questions that arise
during the day as well as review sign out of molecular studies related to
hematologic conditions.
I. Fellow Evaluation
Fellows will be given a global evaluation by the division director of each of
the various rotations following each rotation. This will include input from
medical technologists and others with whom the resident interacts (360
evaluation). At the completion of each rotation the fellow will be given a
written exam which will include morphologic (if appropriate) and laboratory
test interpretation of the various studies that the residents are exposed to
during this rotation. The results of this examination will be generally
summarized in the general comments section of the evaluation form. Any
laboratory techniques directly observed and or procedures/performed by
the fellow will be summarized by the resident (experience tracking) and are
to be included in the fellow’s portfolio of work products. It is highly
recommended that the fellow track the numbers and types of cases that
they personally review and that this information is also placed in their
portfolio.
POLICIES AND PROCEDURES FOR HEMATOPATHOLOGY FELLOWS
Selection of Fellows
1.
Inquires are answered by letter or e-mail requesting a CV, personal
statement, completed OSUMC residency application form and three letters
261
2.
3.
4.
of recommendation.
When applications are complete, the materials are reviewed according to
the following criteria: citizen, permanent resident or J-1 visa,
USMLE(Parts I, II and III) or current ECFMG, excellent English skills,
pathology training, pathology board eligible, strong recommendation
letters and goal to practice hematopathology.
Applicants are invited for a daylong interview with program director, faculty
and current hematopathology fellow. Each interviewer completes an
evaluation form and ranks the applicant.
Program director discusses candidates with faculty. “Desirable” or
“Recruit” consensus prompts an offer to the candidate.
Supervision of Fellows
1.
2.
The fellow is closely supervised by faculty during the early months and is
given more responsibility for patient care and consultations as
competency of material is demonstrated.
Faculty is available at all times for consultation. Faculty must review, sign
and take responsibility for all consultative reports.
Evaluation of Fellows
1.
2.
3.
4.
5.
Evaluation forms are provided to each faculty member after fellow’s
completion of each corresponding rotation. (See form at the end of the
program statement)
Completed evaluation forms are reviewed by the program director. A
composite evaluation form is completed by the program director at a
minimum of 6 month intervals.
The composite evaluation if shared with the fellow with a face to face
interview with the program director.
The form is signed by the program director and fellow.
Completed forms are submitted to the Residency Program Coordinator. A
copy is kept in the Program Director’s files.
Evaluation of Rotations and Faculty
1.
2.
The fellow completes evaluation forms at lest once each year (Appendix
D, E and F of the Departmental resident handbook)
Completed evaluation forms are reviewed by the program director and
problems addressed.
Evaluation of the Hematopathology Fellowship
262
Evaluation of Hematopathology Fellowship
1.
Once a year the hematopathology teaching faculty will evaluate the
effectiveness of the training program.(See form at the end of the program
statement).
Academic Discipline and Fellow Complaints or Grievances
2.
Probation and Remediation
a.
The fellow is counseled about substandard evaluations by the
faculty member and the Program Director. Counseling is
documented by a letter to the file.
b.
A remedial plan is initiated by the Program Director as needed.
c.
The fellow will receive notice of probation and expectations to be
met.
d.
The Program Director will provide close supervision and
counseling. A faculty mentor may be appointed.
e.
The Fellow will be evaluated monthly until remediation and or
probation is completed.
3.
Fellow Complaints or Grievances
a.
The fellow must discuss complaints or grievances with any aspect
of the program with the Program Director. If not resolved, the
Residency Program Director hears the complaint or grievance. If
not resolved, resolution is provided by the Medical Center’s
Graduate Medical Education Committee.
b.
The Department adheres to the procedures listed in the Resident
Agreement for Limited Medical Staff for ASUMC, Section IX,
entitled, The Right of Due Process within the Training Program
c.
The Program adheres to the University Policy regarding sexual
harassment.
Permanent Record for Fellow Evaluations
1.
Each fellow has an individual file in the Residency Secretary’s office. All
fellow composite rotation evaluations are kept in the fellow’s file after they
have been completed, reviewed with the fellow, and signed by both the
fellow and Director of the Program whom has met with the fellow.
Vacation and Leave of Absence
1.
2.
15 days are allowed per year. An additional “week” is allowed during
Christmas or New Year’s week and must be taken at that time. The fellow
is free on University holidays. Vacation may be taken at any time of the
year, with one month advance notice.
Vacation request form must be completed and signed by both Fellow and
Program Director.
263
3.
Leave of Absence is granted only for extraordinary circumstances. For
pregnancy, see below.
Special Approved Policy for Pregnancy, Paternity, Family and Medical Leave
1.
2.
3.
For pregnancy/paternity leave, refer to the Special Approved Leave Policy
in the Pathology Resident Handbook.
For Family and Medical Leave, the Program adheres to the University
Policy.
Drug and Substance Abuse
The Program adheres to the University Policy regarding a Drug-Free
Campus.
Fellow Stress
1. If a fellow experiences significant stress and we are notified, we will offer
advice on organizational and study skills. If these do not suffice, we will
suggest psychological counseling. However, treatment of stress cannot
result in a decrease in the requirements for pathology residency education.
Thus, it may be ultimately necessary to promote an alternative less-stressful
career.
Duty Hours and Work Environment.
1. Duty hours are determined by the director of service and clearly
communicated to the fellow on a given service. It is essential that the fellow
duty hours do not interfere with the educational goals of the program. Fellows
do not take call. Fellows will always been provided appropriate back-up
support consisting an attending physician to ensure that patient care is not
jeopardized. It is the responsibility of the Program Director and faculty to
ensure that duty hours corresponding to the appropriate program
requirements so that fellows are not required to perform excessively difficult
or prolonged duties on a regular basis.
2. The fellow is given an appropriate work area consisting of a desk, microscope
and reasonable computer access. Appropriate security and personal safety
measures are provided to fellows in all locations.
Suggested self directed reading program:
RBC disorders
Chapters 24-26 in Henry
Review hemoglobin electrophoresis – Fairbanks:
Hemoglobinopathies and thalassemias
Foucar – Bone marrow pathology – appropriate chapters
Burrning and McKenna – Tumors of the bone marrow – appropriate
chapters
264
Swerdlow – WHO Classification of Tumors of haematopoietic and
lymphoid tissues – appropriate chapters
WBC disorders
Chapters 27 and 34 (Flow Cytometry) in Henry
Foucar – Bone marrow pathology – appropriate chapters
Brunning and McKenna – Tumors of the bone marrow – appropriate
chapters
Warnke – Tumors of the lymph node and spleen
Swerdlow – WHO Classification of Tumors of haematopoietic and
lymphoid tissues – appropriate chapters
Hemostasis
Chapters 28 and 29 in Henry
Hathaway and Goodnight – Disorders of Hemostasis and
thrombosis
Rodgers – Case studies in hemostasis
Urinalysis
Chapter 18 in Henry
Ringsrund – Urinalysis and body fluids
Body fluid analysis
Chapter 19 in Henry
Ringsrund – Urinalysis and body fluids
Kjeldsberg & Knight: Body fluids
Reference Books available:
Henry: Clinical Diagnosis and Management by Laboratory Methods, 19 th Ed
Williams: Hematology
Hoffman: Hematology: Basic Principles and Practice
Colman: Hemostasis and Thrombosis, 3rd Ed
Hathaway & Goodnight: Disorders of Hemostasis and Thrombosis
Ratnof & Forbes: Disorders of Hemostasis
Thomson: Blood Coagulation and Hemostasis
Foucar: Bone Marrow Pathology
Naeim: Pathology of the Bone Marrow
265
Brunning & McKenna: Tumors of the Bone Marrow
Bunn & Forget: Hemoglobin: Molecular, Genetic and Clinical Aspects
Knowles: Neoplastic Hematopathology
Wintrobe: Clinical Hematology, 8th Ed.
McKenzie: Textbook of Hematology
Fairbanks: Hemoglobinopathies and Thalassemias
Glassy: Color Atlas of Hematology
Mandell, Douglas, Bennett: Principles and Practice of Infectious Disease
Kjeldsberg & Knight: Body Fluids
Kjeldsburg: Practical Diagnosis of Hematologic Disorders
Brunzel: Fundamentals of Urine and Body Fluid Analysis
Hayhoe & Quaglino: Haematologic Cytochemistry
Gaiter: A Practical Handbook of Joint Fluid Analysis
Stamatoyanopoulos, Nienhuis, Majerus, Varmus: The Molecular Basis of Blood
Diseases
Jacobs: Laboratory Test Handbook with DRG Index
Freeman: Laboratory Medicine Clinical Microscopy
Koneman: Color Atlas and Textbook of Diagnostic Microbiology, 3rd Ed.
Loukopoulos: Prenatal Diagnosis of Thalassemic and the Hemoglobinopathies
Heim: Cancer Cytogenetics
Ringsrud: Urinalysis and Body Fluids
Triplett: Platelet Function: Laboratory Evaluation and Clinical Application
Wellington: An Atlas of Urinary Sediment (x2)
Bowie & Sharp: Hemostasis and Thrombosis
266
Abramson: Sickle Cell Disease
Friedman: Effects of Disease on Clinical Laboratory Tests
Bloom & Thomas: Hemostasis and Thrombosis, 2nd Ed.
Rywlon: Histopathology of the Bone Marrow
Warnke: Tumors of the Lymph Node and Spleen
Schmidt: Abnormal Haemaglobins and Thalassemia
Young: Effects of Preanalytical Variables on Clinical Laboratory Tests
Dorland: Medical Dictionary
Simson: Atlas of Automated Cytochemical Hematology
Prankerd: Clinics in Hematology: Hemolytic Anemias
Spaet: Progress in Hemostasis and Thrombosis, Vol. 6 & 7
Diggs: The Morphology of Human Blood Cells
Rodgers: Case Studies in Hemostasis
McKay: Disseminated Intravascular Hemolysis
Young: Effects of Drugs on Clinical Laboratory Tests, 4th Ed.
Jaroff: The New Genetics – The Human Genome Project and Its Impact on the
Practice of Medicine
Merck: Antiplatelet and Antithrombotic Prescribing Guide (x2)
Caldwell: Evaluation of Peripheral Blood Lymphocytosis
Boggs: White Cell Manual, 4th Ed.
Coulter Diagnostics: Hematology Quality Control
Coulter Diagnostics: Moving To Standard Deviation: A New Type Quality Control
Program
OSUMC: Transfusion Service “On Call” Manual
267
Kessler: Acquired Hemophilia, 2nd Ed.
Green: Acquired Hemophilia Continuing Medical Education Monograph
Azuz: Use and Interpretation of Tests in Endocrinology
Beuteer: Red Cell Metabolism: A Manual of Biochemical Methods, 2nd Ed.
Snyder: Blood Transfusion Therapy
Mollring: Microscopy From the Very Beginning
Ames: Modern Urine Chemistry
Coulter: How to Interpret Histograms for Coulter Counter Instruments
Webster: New Expanded Webster Dictionary
Peter: Use and Interpretation of Laboratory Tests in Neurology
Swerdlow: WHO Classification of Tumors of Haematopoietic and Lymphoid
Tissues
Medicode: Physician ICD9 Code Manual, Vol. 1 and 2
Suggested Journals
Blood
American Journal of Hematology
British Journal of Haematology
American Journal of Clinical Pathology
Archives of Pathology and Laboratory Medicine
European Journal of Haematology
(formerly Scandinavian Journal of Haematology)
Thrombosis and Haemostasis
Thrombosis Research
Seminars in Hematology
Seminars in Thrombosis and Hemostasis
Progress in Hemostasis and Thrombosis
Clinics in Hematology
North Am. Clinics in Hematology/Oncology
New England Journal of Medicine
Annals of Internal Medicine
Archives of Internal Medicine
Journal of Clinical Investigation
Journal of Biological Chemistry and Fibrinolysis
268
APPENDIX D
FELLOW EVALUATION OF FELLOWSHIP
Rotation
Name (optional)
Date of Rotation (optional)
Yes
1
2
3
4
5
6
7
8
No
Not
Applicable
A set of goals/objectives were provided at the
beginning of the rotation
The goals/objectives were, for the most part,
accomplished during the rotation
A list of daily duties were provided and explained
to me at the beginning of the rotation
Faculty members were readily available for daily
sign-outs, didactic teaching sessions, and
discussions of clinicopathologic correlations and
reference materials
Daily “sign-out” sessions, involving current case
material were done
Laboratory management issues, including quality
control, quality insurance, budget, and personnel
were discussed in a manner appropriate to my
level of training
I was getting constant feedback on the quality of
my daily sign-out preparations and my diagnostic
skills
I was provided a place to work during the rotation
POOR
ADEQUATE
GOOD
OUTSTANDING
Quality of the facilities
Quality of teaching material
Quality of
secretarial/clerical
assistance
Quality of assistance by
technologists
Quality of faculty teaching
Overall quality of the
rotation
Comments (please comment on strengths and weaknesses of rotation):
PLEASE RETURN TO: Residency Committee, Department of Pathology,
129 Hamilton Hall, 1645 Neil Ave., Columbus, OH 43210
APPENDIX E
269
HEMATOPATHOLOGY FELLOW CONFERENCE EVALUATION
This form is to survey faculty and resident attitudes towards departmental
conferences. Circle the appropriate response according to the key provided.
Constructive criticisms and suggestions are encouraged. Please return to the
Education Office, Department of Pathology, 129 Hamilton Hall, 1645 Neil Ave.,
Columbus, OH 43210.
Please evaluate the conferences listed below based on the scale that follows:
Excellent
5
Generally
Good
Often below
Average
4
3
CP Didactic Lecture Series
Clinical Pathology Closing
Rounds
Clinical Pathology Unknown
Conference
Hematology Conference
Topics in Laboratory
Management
Clinical Pathology Journal Club
Others:
COMMENTS/SUGGESTIONS:
270
Consistently
below average
2
Poor
1
APPENDIX F
DEPARTMENT OF PATHOLOGY
EVALUATION OF FACULTY TEACHING
Departmental Division:
Name of staff member being evaluated:
Date of evaluation:
Please evaluate each faculty member encountered during the rotation. The
evaluations are anonymous and are evaluated once yearly for each faculty
member. The purpose of the evaluation is to improve resident teaching and to
document excellence in faculty teaching.
POOR ADEQUATE AVERAGE GOOD OUTSTANDING
Availability, willingness to
spend time
1
2
3
4
5
Depth and accuracy of
knowledge
1
2
3
4
5
Ability to communicate
knowledge
1
2
3
4
5
Extra effort put forth
1
2
3
4
5
Interest in teaching
1
2
3
4
5
Overall quality of teaching
1
2
3
4
5
Additional comments:
ATER COMPLETION, PLEASE RETURN TO:
Gretchen Staschiak, Pathology Education Coordinator, Department of Pathology,
The Ohio State University, 129 Hamilton Hall, 1645 Neil Avenue, Columbus, OH
43210
271
HEMATOPATHOLOGY FELLOWSHIP FACULTY PROGRAM SURVEY
1.
Is the program designed to produce competent Hematopathologists?
2.
Are fellows responding to the opportunities afforded to them?
3.
Do you have specific suggestions for improvement of the
hematopathology fellowship program?
4.
Does our program provide adequate opportunity and exposure for
potential development of fellows into academic pathologists?
Please return to: Gretchen Staschiak, Pathology Education Coordinator,
129 Hamilton Hall, 1645 Neil Ave., Columbus, OH 43210
Suggested self directed reading program:
272
RENAL/TRANSPLANT PATHOLOGY FELLOWSHIP
(Two Year)
The Ohio State University (OSU) has one of the largest renal transplant
programs in the country. The university also has pancreas, cardiac, lung
and liver transplant programs. The clinical transplant service is
complemented with an experimental transplantation research program. In
addition, OSU has a strong, academically oriented nephrology group,
which is one of the largest in the country. The Renal Pathology
Laboratory has an increasingly busy renal biopsy referral service with
submitting institutions from 7 states Therefore, we both have extensive
clinical material as well as clinical and research expertise to establish a
superb renal/transplant pathology fellowship. The combination of renal
pathology and transplant pathology training will make a fellow quite
marketable. Unfortunately, renal biopsies are still evaluated by
suboptimally trained non-specialized pathologists at several institutions;
therefore, formally trained renal pathologists are in need. Expertise in
transplant pathology is also in demand because at many institutions
transplant programs are growing and more and more institutions are
looking for pathologists specialized in transplant pathology.
1.
The fellowship is a 2-year program:
a.
Initial appointment will be for one year.
b.
Appointment for the second year will depend on the fellow’s
performance.
2.
Curriculum of the program:
a.
The fellow will spend 12 months on routine service and participate
in the signout of native and transplant kidney biopsies, cardiac
transplant biopsies and liver transplant biopsies.
b.
The fellow will spend 1 month in the tissue-typing laboratory.
c.
Eleven months will be primarily devoted to research (basic and/or
clinical) involving kidney diseases and experimental or human
transplant rejection. During this research month the only clinical
responsibility of the fellow will be to help in the signout of lung
transplant biopsies.
3.
Faculty of the Program:
a.
Tibor Nadasdy, MD, Program Director, Professor of Pathology
b.
Anjali Satoskar, MD, Assistant Professor of Pathology
c.
Sergey Brodsky, MD, Assistant Professor of Pathology
d.
Daniel Sedmak, MD, Professor of Pathology
e.
Wendy Frankel, MD, Professor of Pathology.
273
4.
Policy on Selection of Fellows:
a.
Completion of Anatomical Pathology (AP or combined AP/Clinical
Pathology) training is necessary.
b.
The fellowship candidate has to show a proven academic interest
and a carrier goal in academic pathology.
5.
Policy on Evaluation of Fellows:
a.
The fellow will be evaluated on a monthly basis by the teaching
faculty.
6.
Policy on Promotion of fellows (if only one year, not necessary):
a.
A comprehensive evaluation with a detailed discussion of the
fellow’s performance will be done after 6 months and 12 months.
7.
Policy on Dismissal of Fellows:
a.
The fellow will not be extended for a second year if he or she does
not meet expectations (see below).
b.
If serious disciplinary problems emerge, the fellow can be
terminated according to University guidelines.
8.
Policy on Supervision of Fellows:
a.
The clinical and research work of the fellow will be supervised by
the teaching faculties listed above. Although the fellow will prepare
biopsy reports under the supervision of teaching faculty, only the
teaching faculty can sign out the finalized biopsy case.
b.
The supervising teaching faculty is responsible to provide an initial
orientation, to clarify details of the program and expectations from
the fellow.
c.
The teaching faculty is responsible to assign duties and research
projects to the fellow and to follow up on these research projects
and clinical duties to assure they are performed accordingly.
d.
Teaching faculty provides the fellow with relevant
references/literature to read.
e.
The teaching faculty will regularly interact with the fellow and
discuss the cases/research projects during regular
signouts/meetings.
9.
Expectations/Responsibilities:
a.
During clinical service the fellow’s responsibility is to organize
incoming biopsies with the paperwork and review the clinical
history.
b.
Obtain additional clinical information if necessary.
c.
Pull previous biopsies of the same patient (organ).
d.
Organize and keep track of pending biopsies.
e.
Review the material in the morning and prepare the cases for
signout.
274
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
10.
Signout with the attending faculty.
Review immunofluorescence and electron microscopy and
correlate those findings with the clinical history and light
microscopy.
Dictate biopsy reports.
If the attending requests, report and discuss findings by phone with
the attending nephrologist/transplant physician.
Take representative images on biopsies and help in the
development of a light microscopic immunofluorescence and
electron microscopic image database.
Prepare biopsy material for renal/transplant conferences and
present cases at these conferences.
Participate in medical student teaching (laboratory sessions)
involving renal/transplant pathology.
Participate in teaching residents at teaching conferences and
during regular rotations of residents through the kidney/transplant
biopsy service.
Study the literature relevant for the daily material.
Show superior communication skills with laboratory personnel and
colleagues. During the research month the fellow is expected to
produce and analyze data. Although the research studies will be
performed with supervision, the fellow is encouraged and expected
to actively participate in the research process and have
independent ideas
By the end of the first year the fellow is expected to develop
substantial diagnostic skills. By the this time the fellow is expected
to solve routine kidney/transplant biopsy cases with minimal
supervision.
The fellow has to become knowledgeable and up to date in the
published literature on the research project he or she is working on.
The fellow is expected to be able to write publications (clinical or
basic science).
Goals of the Fellowship:
a.
At the end of the fellowship the fellow will be able to appropriately
diagnose various rejection processes in different transplanted
organs, and to differentiate subtypes of rejections from each other
and from disease processes not related to transplant rejection.
b.
The fellow will be able to diagnose native kidney diseases by
integrating relevant clinical data with light immunofluorescence and
electron microscopic findings.
c.
The fellow will be familiar with methodologies used in
renal/transplant pathology including immunofluorescence and
electron microscopy.
d.
The fellow will be proficient in the evaluation of immunofluorescent
and ultrastructural findings.
275
e.
f.
g.
h.
i.
j.
11.
The fellow will have an in-depth clinical knowledge on renal
diseases and organ transplantation.
The fellow will be able to provide detailed differential diagnosis
based on the renal/transplant biopsy findings.
The fellow will become familiar with the issues of laboratory
management, quality assurance, data processing and image
processing.
The fellow will be able to develop an effective renal/transplant
biopsy service independently or with little help from the mentors.
The fellow will show a proven academic track record in form of
publications and manuscripts prepared by him/her.
The fellow will be able to conduct clinical or basic research studies
independently.
Policy on Duty Hours for Fellows:
a.
Workday usually begins at 8:00 a.m. unless otherwise specified by
the teaching faculty.
b.
Weekend on-call duties will have to be performed particularly
during the second year of fellowship.
c.
Weekend duties will include triaging renal biopsies if necessary and
reporting preliminary findings on the weekend transplant biopsies.
d.
The fellow will have 3 weeks of vacation in a year.
e.
The fellow will be encouraged to present research data at national
conferences. Paid leave is provided to attend conferences
particularly if presentation(s) is given. Without a presentation
attendance of only one conference per year will be possible.
276
TRANSFUSION MEDICINE FELLOWSHIP
Program Rotations and Responsibilities
IV.
Definition, Duration and Scope of Education
A. Blood banking/transfusion medicine encompasses all aspects of blood
transfusion, including the scientific basis of transfusion medicine, selection
and recruitment of donors, blood utilization, quality control and quality
processes, preparation of blood components, pretransfusion testing,
adverse effects of blood transfusion, autoimmune blood diseases,
transplantation, histocompatibility, therapeutic apheresis and phlebotomy,
management aspects and ethical issues.
B. Duration of Rotation – 12 Months
1. 1 month - Orientation/Transfusion Service
2. 1 month – Apheresis
3. 2 months at Central Ohio American Red Cross
4. 2 weeks to 1 month at Nationwide Children’s Hospital
5. 2 weeks to 1 month in Coagulation, Bone Marrow Transplant,
Molecular Pathology, Flow
6. 3 months – Research/Coagulation
7. Elective, if desired
C. The fellowship program provides an organized and comprehensive
educational experience for fellows preparing for transfusion medicine
careers.
V.
Teaching Staff Responsible for Supervision and Instruction
A. Teaching Staff
1. Primary Responsibility
a. Haifeng Wu, M.D. Fellowship Director, Transfusion Medicine and
Director, Coagulation, Associate Professor
b. Mary Ellen Wissel, M.D., Medical Director, American Red Cross
Blood Center and Hematologist/Oncologist
c. Melanie Kennedy, M.D., Transfusion Medicine, Associate Professor
Emeritus
d. Kathleen Nicol, M.D., Director of Transfusion Service, Children’s
Hospital: pediatric transfusion therapy
e. Scott Scrape, M.D., Assistant Professor, Director of Transfusion
Medicine, The Ohio State University
277
2. Secondary Responsibility:
a. Sandy Deitrich, MT(ASCP) SBB, Lead Teachnologist:
Pretransfusion
testing, prenatal testing and immunohematology problem solving
b. Marni Grebenow, (ASCP)SBB, Management and Administration,
Transfusion Service
c. Beverly Robinson, MT(ASCP)SBB, Compliance Officer and Quality
Processes, Transfusion Service
d. Transfusion Service Staff, testing techniques
e. Janet Hanson-Vittorio, RN, Apheresis, Nurse Manager, policies and
procedures
f. American Red Cross Staff, Central Ohio Region: component
preparation, donor recruitment and selection, donor blood
collection, inventory management, frozen RBC program
g. Thomas Prior, Ph.D., Director, Molecular Pathology
h. Steven Devine, M.D., Director, Bone Marrow Transplant
i. Nicholas DiPaula, Ph.D., Director, Histocompatibility
j. Amy Geiwirtz, M.D., Hematopathology/Coagulation
k. Arwa Shana’ah, M.D., Hematopathology/Coagulation
3. Secretarial Support
a. Administrative Secretaries, E310 Doan
VI.
Curriculum
A. Resources:
1. Harmening D, Modern Blood Banking and Transfusion Practices, 5th
Ed., 2005, F.A. Davis
2. Blood Transfusion Therapy: A Physician’s Handbook, current edition,
AABB
3. Transfusion Services On-Call Manual, The Ohio State University
4. Standards for Blood Banks and Transfusion Services, current edition,
AABB
5. Technical Manual, current edition, AABB
6. Other immunohematology and transfusion medicine textbooks,
journals, articles and references as appropriate
B. Rotations:
1. OSU Main Lab
a. ABO & Rh typing
b. Antibody screen
c. Crossmatch
d. Antibody identification (panel workup)
e. Direct antiglobulin (Coombs) test
278
2. OSU – Apheresis, therapeutic apheresis, phlebotomy and HPC-A
collection
3. OSU Reference and Prenatal Lab
a. Kleihauer-Betke
b. Amniotic fluid studies (spectrophotometric scan)
c. Antibody titration
d. Elution
e. Complex antibody problems
f. Cordocentesis (IUT) (arrange with Dr. O’Shaughnessy)
4. OSU Bone Marrow Transplant
a. HPC processing and storage
5. OSU Coagulation Laboratory
a. Coagulation workups
6. Tissue Typing Laboratory
a. Donor and recipient HLA type and antibody screen
7. Red Cross Blood Center
c. Orientation (2 days)
d. Donors, component preparation, blood distribution, donor
recruitment
e. Reference lab
C. Practical Experience:
1.
2.
3.
4.
5.
6.
7.
ABO and Rh typing (self and patients)
Red cell antigen typing (self)
Red cell antibody screen (patients)
Direct antiglobulin test (patients)
Crossmatch (patients)
HLA typing (self) (Tissue Typing Laboratory)
Complex immunohematology techniques
D. Teaching Conferences
1. Transfusion Medicine Rounds (Fridays at 12:00 noon, S311 Rhodes)
2. Clinical Pathology Seminar (Wednesdays at 12:00 noon, S311
Rhodes)
3. Clinical Pathology Rounds (noon daily during July)
4. Pathology Grand Rounds (Tuesday’s at 12:00 noon, 170 HLRI)
5. Transfusion Committee Meetings (quarterly, Tuesday’s, 11:30am)
6. Clinical Pathology Didactics (Mondays, 7:30am, S311 Rhodes)
7. Topics in Lab Management (last Wednesday of the Month, noon, 137
Hamilton)
8. Transfusion Service Staff Meetings (Tuesdays, 2:30pm, 325 Doan)
9. Bone Marrow Census Meetings (when on BMT)
279
E. Teaching Responsibilities
1.
2.
3.
4.
5.
6.
VII.
Transfusion Medicine Rounds – present at least six times
Clinical Pathology Rounds – bring interesting cases to discuss
Medical students on rotation
Junior residents on rotation
Hematology/Oncology fellows on rotation
Other trainees
Educational Goals and Objectives of the Fellowship
1. At the completion of the orientation, the fellow will:
a. Understand the basic principles and concepts of apheresis and the
typical transfusion medicine consultations encountered in everyday
practice at OSU Medical Center.
b. Recognize problems in clinical medicine that are related to
transfusion
c. Apply the concepts and principles to clinical situations
2. During the year, the fellow will:
a. Construct appropriate therapeutic solutions to transfusion medicine
problems.
b. Accurately evaluate the strengths and weaknesses of his/her
knowledge in transfusion medicine and recognize when
consultation should be sought
c. Recognize the significance of important research in the
advancement of transfusion medicine
d. Recognize requirements for organization function and accreditation
of blood centers and hospital transfusion services
e. Be prepared to assume a junior position in a blood center or
transfusion service
Rotation Goals and Objectives
Therapeutic Apheresis and Phlebotomy
A. Know basic principles of therapeutic apheresis and phlebotomy
1. Define terms (e.g. therapeutic apheresis, plasma exchange,
phlebotomy, plateletpheresis)
2. Describe mechanics of procedures
3. Describe rationale for procedures
B. Understand common indications for therapeutic procedures
1. List disorders for which phlebotomy and plasma exchange are
indicated
280
2. Distinguish appropriate and inappropriate use of therapeutic
procedures
C. Recognize when iron overload occurs with transfusion
1. Describe how iron overload can be prevented
2. Describe how iron overload can be treated
D. Understand use of crystalloids, colloids and artificial colloids
1. List the volume expanders, their advantages and disadvantages
2. Describe intra vs. extravascular distribution
3. Identify side-effects
E. Understand the hemodynamic of the circulation
1. State normal values for blood volume
2. Identify mechanisms for abnormalities in blood volume
3. Recognize symptoms and signs associate with abnormalities in blood
volume
Transfusion Medicine Rotation
A. History of Transfusion Medicine
1. Know the important features of the history of transfusion medicine
a. Outline the scientific benchmarks in the evolution of transfusion
medicine
b. Outline recent trends in the practice of transfusion medicine
B. Scientific Basis of Transfusion
1. Understand the properties and characteristics of the major surface
antigens of the formed elements of the blood
a. List common polymorphic antigen systems and alleles
b. Recognize the biochemical nature of the ABO antigens
c. Recognize the common antigens and their clinical significance
d. Recognize the biochemical nature of Rh, MNS blood group
systems
2. Understand the genetics of the major surface antigens of the formed
elements of the blood
a. Describe the principles of antigen inheritance
b. Identify the phenotypes and genotypes associated with ABO and
Rh inheritance
c. Order the ABO and Rh blood group frequencies in the major
population groups
C. Pretransfusion Testing
1. Know basic procedures used for blood compatibility
a. Define the basic terms associated with test for blood compatibility
b. Describe methods of determining compatibility of donor blood with
281
c.
d.
e.
f.
recipient
Distinguish between emergency and non-emergency selection of
blood
Distinguish testing procedures for red cell and red cell-free
components
Explain the principles of red cell compatibility
Explain what “compatible crossmatch” means
2. Recognize basic immunologic principles of blood cell compatibility
a. Identify clinical situations associated with formation of antibodies to
blood
b. Describe the clinical importance of antibodies to red cell antigens;
identify laboratory findings associated with reactions in viro
3. Understand the pathophysiologic significance of antibodies to blood
cell antigens
a. Distinguish naturally occurring antibodies from those requiring prior
immunization
b. Describe techniques for detection of antibodies/complement on red
cell membrane
c. Interpret results of test for detection of red cell antibodies
d. Identify frequently occurring red cell antibodies
e. Outline mechanisms of red cell destruction caused by antibody
f. Describe clinical and pathological consequences of antibody to
various types of blood cells (red cells, white cells, platelets)
g. Describe the importance of complement activation on antibody
mediated red cell destruction
4. Understand the kinetics and function of the cellular elements of the
blood
a. Describe the process of cell production
b. State the lifespan of blood cells in normals and disease states
c. Describe how the neutrophil functions in defense against bacterial
infection
d. Describe the role of the various subpopulations of lymphocytes in
normal and abnormal humoral and cellular immunology
e. Describe the role of the various subpopulations of lymphocytes in
normal and abnormal humoral and cellular immunology
f. Outline the pathophysiology and clinical features of disorders
associated with abnormalities of cell function or decreased number
of cells
5. Understand the role and nature of hemoglobin
a. Describe the role of hemoglobin in carrying oxygen
b. Describe the structure of hemoglobin
282
c. Describe how abnormalities in hemoglobin may affect the ability of
the red cell to carry oxygen
d. Outline the steps in hemoglobin degradation
e. State the amount of iron normally present in blood and in marrow
storage compartments
D. Transfusion of Blood Components
1. Describe the major indications for use of (and proper procedures for
administering) the major blood components and derivatives
a. Whole blood
b. Red blood cells (including additive solutions)
c. Leukocyte-poor red blood cell products (such as washed blood
cells, previously frozen deglycerolized red blood cells, and filtered
red blood cells)
d. Platelet concentrates, (e.g. random donor, single donor matched
and unmatched and frozen)
e. Granulocyte concentrates
f. Single donor plasmas, (e.g. random donor, single donor matched
and unmatched and frozen)
g. Cryoprecipitate
h. Coagulation factor concentrates, (e.g. factor VIII, prothrombin
complex, anti-inhibitor coagulant complex)
i. Colloid solutions (albumin and plasma protein fraction)
j. Immune globulins (IVIG, VZIG, HBIG, and RhIG)
k. Autologous blood (including; presurgical deposit and intraoperative
or traumatic salvage)
l. Vaccines (e.g. Hepatitis B vaccine)
2. Construct an appropriate plan for administering the above components
considering dosage, rate of administration and use of transfusion
equipment
3. Know the hemostatic complications in cardiopulmonary bypass
a. Evaluate clinical information regarding a patient bleeding post-CPB
b. Select proper use of blood components
4. Demonstrate the concept of usage of autologous blood in surgery
a. List procedures for autologous transfusion
b. List advantages of autologous transfusion
5. Construct the appropriate pre-operative orders for blood
a. Indicate how hemostatic safety for operative procedures is
determined
b. Identify appropriate orders for blood and blood components
c. Identify appropriate orders for blood and blood components,
including use of type and screen and maximum surgical blood order
283
schedule
6. Evaluate intra/post-operative transfusion needs
a. Describe methods to predict estimated blood loss
b. Describe treatment for hypovolemia
7. Recognize causes of blood wastage
a. Define time limits for non-refrigerated blood
b. Define desirable crossmatch/transfusion ratio
8. Construct appropriate orders for compatibility testing in massive
transfusion
a. Identify correct use of “type-specific” blood
b. Identify correct use of “O” negative blood
9. Interpret the rationale for use of various components in massive
transfusion
a. Define indications for platelet transfusion
b. Compare indications for whole blood vs. packed cells
c. Define indications for fresh frozen plasma
10. Understand complications of massive transfusion
a. List clinically significant changes
b. List changes of questionable significance
11. Describe fluid losses associated with burns
a. Describe mechanisms of fluid and protein loss post-burn (operative
and non-operative)
b. Describe appropriate fluid therapy
12. Understand the use of blood support in patients with neoplastic
disease
a. Identify special hematologic problems in patients with neoplastic
disease
b. Describe appropriate use of blood components in the treatment of
neoplastic disease
13. Understand appropriate blood support in the treatment of anemia
a. Identify special transfusion problems in patients with chronic
hypoproliferative anemias
b. Identify special transfusion problems in patients with hemolytic
anemia
c. Identify clinical indications and contraindications for red cell
transfusion
284
14. Understand the diagnosis and blood support in the treatment of
thrombocytopenias caused by accelerated platelet destruction
a. Distinguish between different types of accelerated platelet
destruction
b. Identify the appropriate blood support for patients with accelerated
platelet destruction
15. Understand the role of Rh immunoprophylaxis in prevention of HDN
(include antepartum and postpartum)
a. Define Rh immunoprophylaxis and its indications
b. Identify dosage, timing and administration of Rho(D) immune
globulin
E. Blood Substitutes
1. Understand the oxygen carrying compounds under investigation
a. Evaluate the usefulness of hemoglobin solutions
2. Know religious objections to transfusion
a. Identify the religious groups who interdict transfusion
b. Identify the legal avenues that can be tested when transfusion is
medically indicated
F. Adverse Effects of Blood Transfusion
1. Demonstrate knowledge of the incidence and significance of adverse
immunologic effects of blood transfusion
a. Describe intravascular “immediate” hemolytic transfusion reactions,
i.e. their etiology, pathogenesis and clinical significance
b. Describe extravascular and delayed anamnestic transfusion
reactions, i.e. their etiology, pathogenesis and clinical significance
c. Describe steps to prevent hemolytic transfusion reactions
d. Outline the steps to be taken by physician, floor nurse
and laboratory in response to suspected hemolytic transfusion
reactions
e. Outline the laboratory tests done for suspected hemolytic reactions
and describe the significance of possible results
f. Describe febrile reactions; indicate their cause and clinical
significance
g. Outline the steps to prevent and treat febrile reactions
h. Describe allergic and anaphylactic transfusion reactions
i. Outline the steps to prevent and treat allergic and anaphylactic
transfusion reactions
j. Recognize the special significance of immunologic reactions, which
occur intraoperatively
k. Identify the incidence and significance of alloimmunization to
platelet and white cell transfusions and their prevention and
treatment
285
l.
Identify non-immunologic causes of hemolysis and distinguish them
from immunologic causes
2. Demonstrate an understanding of metabolic adverse effects of
transfusion
a. Describe pathogenesis and management of acidosis
b. Describe pathogenesis and management of hypocalcemia
c. Describe pathogenesis and management of hyperkalemia
3. Describe possible adverse pulmonary complications of transfusion
a. Describe current knowledge TRALI
b. Describe the role of fluids and/or oncotic activity
4. List infectious complications that can result from transfusion (including
bacteria, hepatitis B, A, C, non-A, HIV, CMV, malaria)
a. For each complication describe the circumstances when it occurs,
its incidence and severity, how it can be prevented and treated
b. Describe what physician, nurse, transfusion service and blood
center should do when a case occurs
5. Identify the cause, incidence and clinical course of post transfusion
graft vs. host disease
Children’s Hospital Rotation
1. Understand the cause of hemolytic disease of the newborn (HDN)
a. Diagram Rh and ABO incompatibility
b. Describe the clinical effects of hemolytic disease in the fetus and
newborn
c. Understand the diagnosis and management of HDN
d. Describe the methods of prenatal diagnosis (e.g. maternal antibody
titer, amniocentesis, maternal history, maternal and paternal
phenotypes)
e. Define the indications and rationale for each form of therapy of
HDN: early delivery, intrauterine transfusion, phototherapy,
plasmapheresis of mother
f. Identify two common antibodies which cause HDN requiring
exchange transfusion
g. Describe selection of blood type and component for exchange
transfusion in HDN
h. Describe kinetics of exchange
i. List the possible complications of exchange transfusion
2. Know compatibility testing for neonate transfusion
a. Identify appropriate blood samples for testing
b. Identify appropriate ABO types for component transfusion
286
3. Understand post-transfusion risks to neonate
a. Identify situations in which recipient is at risk for graft vs. host
disease
b. Identify situations in which neonate is at risk for posttransfusion
CMV infection
4. Understand pathophysiology of neonatal isoimmune thrombocytopenia
and neutropenia
a. Identify clinical syndrome
b. Identify mechanism
5. Formulate treatment for neonatal alloimmune thrombocytopenia and
neutropenia
a. Choose appropriate component therapy
b. Predict response to therapy
Bone Marrow Transplant Rotation
A. Transplantation
1. Know important development in organ transplantation
a. Identify organs being transplanted
b. Contrast living organ vs. tissue transplantation
c. Identify problems limiting transplantation
2. Understand importance of antigen matching/compatibility in
transplantation (renal, bone marrow, other)
a. Describe role of major histocompatibility complex antigens
b. Describe role of non-HLA linked antigens
c. Describe importance of ABO compatibility
3. Know appropriate transfusion practice in patients undergoing
transplantation
a. Contrast the effect of pre-transplant transfusion on graft survivial in
renal and bone marrow transplantation
b. Discuss the proposed immunologic mechanisms for the above
effects
c. Identify adverse effects associated with transfusion of
immunocompromised recipients
d. Describe appropriate transfusion support for blood group
incompatible bone marrow transplantation
4. Be aware of ethical and legal consideration pertaining to donation of
bone marrow by unrelated donors and recipients
a. Describe procedures to assure confidentiality and informed consent
b. Discuss the proposed immunologic mechanisms for the above
effects
287
c. Identify adverse effects associated with transfusion of
immunocompromised recipients
d. Describe appropriate transfusion support for blood group
incompatible bone marrow transplantation
5. Be aware of ethical and legal consideration pertaining to donation of
bone marrow by unrelated donor and recipients
a. Describe procedures to assure confidentiality and informed consent
6. Understand blood support requirements for bone marrow
transplantation
a. Describe use of blood components during the pre-marrow
transplantation period
b. Describe use of blood components during post-marrow
transplantation period
Coagulation Rotation
1. Understand the basic mechanisms of blood coagulation
a. Diagram the coagulation sequence, listing the order of factor
activation in the coagulation cascade
b. Identify abnormalities in the coagulation mechanism in common
diseases of abnormal hemostasis
c. Describe the role of fibrinolysis in normal and abnormal hemostasis
d. List the steps in the fibrinolytic pathway
e. Describe the interactions between the coagulation, complement,
kallikrein, and immunologic systems
f. Describe the principles of the common screening tests for
abnormalities in hemostasis
g. Interpret results of coagulation tests
h. Integrate clinical information with results of coagulation tests to
describe diagnosis and treatment plan
i. Describe how soluble coagulation factors interact with platelets
2. Know the diagnosis and management of hemostatic defects, including
thrombocytopenia
a. Describe clinical features of coagulopathies
b. Describe use of blood components in the treatment of
coagulopathies and thrombocytopenia
c. Identify the special management problems present in patients
receiving anticoagulants
Histocompatibility Rotation
1. Understand the role of the major histocompatibility complex
a. Define terms (e.g. HLA-A, B, DR)
288
b. Describe inheritance of HLA antigens
c. Recognize the biochemical nature of Class I and II antigens of the
major histocompatibility complex
d. Describe the role of the MHC in cellular immunology
e. Identify blood cell distribution of HLA antigens
f. Identify significant HLA disease associations
2. Describe principles of the microlymphocytotoxicity assay and mixed
lymphocyte reactions (MLR) and how they are used for HLA typing and
crossmatching
3. Describe principles and applications of PCR-based molecular typing
techniques
a. PCR/SPP sequence-specific primers
b. PCR/SSOP sequence-specific oligonucleotide probes
c. SBT sequence-based typing
d. RSCA reference strand conformation analysis
4. Understanding the application of flow cytometry in detecting and
characterizing Class I and Class II antibodies:
a. Screening
b. Crossmatching
American Red Cross Rotation
A. Preparation of Blood Components
1. Evaluate the acceptability of individuals for blood donation
a. Identify the risks of blood donation to the donor
b. Identify the risks to the potential recipient
2. Construct a plan to care for blood donors
a. Recognize the potential complications of blood donations
b. Describe the prevention and management of the complications of
blood donation
3. Demonstrate understanding of the significant issues in donor
recruitment
a. Explain concepts of community responsibility and individual
responsibility
b. Compare paid and volunteer blood donation systems
c. Define directed donations and autologous donations and describe
their impact on safety and the blood supply
4. Know the preparation of blood components
a. List the functional composition of blood components
b. Outline the basic steps in component production
289
5. Interpret the rationale for the testing performed in donor blood
processing
a. Name the tests required for donor blood processing
b. Recognize the potential patient complications if errors in donor
blood processing occur
c. Evaluate the effectiveness of pretransfusion hepatitis, syphilis and
HIV testing
6. Recognize the changes in blood component composition with storage
a. Describe the changes in each component with storage
b. Identify potentially adverse effects of transfusion which result from
storage induced changes in blood components
c. Compare the potential risks of transfusion with the expected benefit
for blood products stored for varying lengths of time
d. State the outdate periods for each blood component
B. Autoimmunity
1. Understand the concept of hemolytic disease
a. Distinguish between hemolytic and nonhemolytic anemia
b. Distinguish between immune nonimmune hemolytic anemia
c. Classify autoimmune hemolytic anemia according to immunologic
and clinical criteria
2. Understand the concept of warm-reactive autoimmune hemolytic
anemia (AIHA)
a. Describe the pathogenesis of warm-reactive AIHA
b. Distinguish between immune and nonimmune hemolytic anemia
c. Describe appropriate therapy for patients with warm-reactive AIHA;
identify considerations for transfusion
3. Understand concepts related to cold-reactive AIHA
a. Distinguish between different types of cold-reactive antibody
b. Identify the different syndromes produced by cold-reactive
antibodies
c. Define characteristics and pathogenetic effects of cold-reactive
antibodies
d. Describe the use of transfusion therapy in cold reactive AHA
4. Understand concepts of drug-induced immune hemolytic anemia
a. Distinguish between different mechanisms of drig-induced immune
injury
b. Describe the differential diagnosis of drug-induced immune
hemolytic anemia
c. Describe appropriate treatment for patients with drug-induced
hemolytic anemia
290
5. Understand concepts of immune thrombocytopenia
a. Distinguish between immune and nonimmune thrombocytopenia
b. Outline the pathophysiology and clinical features of idopathic
Thrombocytopenic Purpura (ITP, also know as Autoimmune
Thrombocytopenic Purpura, ATP)
C. Organization and function of Regional Blood Services and Hospital
Transfusion Services
1. Demonstrate a working knowledge of the organization and function of
blood centers and transfusion services
a. Describe the principle organizational features of blood centers
b. Distinguish between the functions of regional and hospital blood
c. Describe the organization of transfusion services
d. Describe the function of the transfusion committee and peer review
e. Describe the Quality Plan and its implementation
Research
1. Concepts of conducting research
a. Describe the process of finding a problem, conducting literature
review and stating the problem
b. Organize a research design
1. Experimental
2. Descriptive
3. Surveying
4. Randomized controlled trial (RCT)
2. Prepare data collection forms
3. Describe analysis of results and statistical tests
4. Publishing the results
a. Prepare an abstract
b. State the problem
c. Describe the methods
d. Present the results
f. State the conclusions
5. Outline the steps in writing an article
291
DERMATOPATHOLOGY FELLOWSHIP
A.
DURATION
One year and accredited for two fellows.
B.
TEACHING STAFF RESPONSIBLE FOR SUPERVISION AND
INSTRUCTION
Sara B. Peters, M.D., Ph.D.
C.
GENERAL COMPETENCIES
1.
Patient Care
Fellows must demonstrate a satisfactory level of diagnostic
competence and the ability to provide appropriate and effective
consultation in the context of pathology services.
a.
b.
c.
d.
e.
f.
2.
Communicate effectively and demonstrate caring and
respectful behaviors when interacting with physicians,
laboratory personnel, patients and clerical staff.
Gather essential and accurate information about their
patients and/or patient specimens.
Education staff, students and other physicians.
Use information technology to support diagnostic decisions.
Perform competently the medical and invasive procedures
considered essential for pathology.
Work with health care professionals, including those from
other disciplines, to provide patient-focused care.
Medical Knowledge
Fellows must demonstrate knowledge about established and
evolving biomedical, clinical and cognate (e.g. epidemiological and
social-behavioral) sciences and the application of this knowledge to
pathology.
a.
b.
Demonstrate an investigatory and analytic thinking approach
to clinical situations.
Know and apply the basic and clinically supportive sciences
which are appropriate to pathology.
292
3.
Practice-Based Learning and Improvement
Fellows must be able to demonstrate the ability to investigate and
evaluate their diagnostic and consultative practices, appraise and
assimilate scientific evidence and improve their patient care
practices.
a.
b.
c.
d.
e.
f.
4.
Analyze practice experience and perform practice-based
improvement activities using a systematic methodology.
Locate, appraise, and assimilate evidence from scientific
studies related to patient specimens.
Obtain and use information about their own population of
patients and the larger population from which their patients
are drawn.
Apply knowledge of study designs and statistical methods to
the appraisal of clinical studies and other information on
diagnostic effectiveness.
Use information technology to manage information, access
on-line medical information; and support their own
education.
Facilitate the learning of students and other health care
professionals.
Interpersonal and Communication Skills
Fellows must be able to demonstrate interpersonal and
communication skills that result in effective information exchange
and teaming with other health care providers, patients’ and patients’
families.
a.
b.
c.
5.
Create and sustain a therapeutic and ethically sound
relationship with physicians, laboratory personnel, clerical
staff and students.
Use effective listening skills and elicit and provide
information using effective verbal, nonverbal, explanatory,
questioning, and writing skills.
Work effectively with others as a member or leader of a
health care team or other professional group.
Professionalism
Fellows must demonstrate a commitment to carrying out
professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
293
a.
b.
c.
6.
Demonstrate respect, compassion, and integrity; a
responsiveness to the needs of patients and society that
supercedes self-interest; accountability to patients, society,
and the profession; and a commitment to excellence and ongoing professional development.
Demonstrate a commitment to ethical principles pertaining to
provision or withholding of clinical care, confidentiality of
patient information, informed consent, and business
practices.
Handles patient specimens in a professional manner.
Systems-Based Practice
Fellows 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 pathology services that are of
optimal value.
a.
b.
c.
d.
e.
D.
Understands how their patient care and other professional
practices affect other health care professionals, the health
care organization, and the larger society and how these
elements of the system affect their own practice.
Know how types of medical practice and delivery systems
differ from one another, including methods of controlling
health care costs and allocating resources.
Practice cost-effective health care and resource allocation
that does not compromise quality of care.
Advocate for quality patient care and assist others in dealing
with system complexities.
Know how to partner with health care managers and health
care providers to assess, coordinate, and improve health
care and how these activities can affect system
performance.
GOALS AND OBJECTIVES
Dermatopathology trainees are responsible for the interpretation of
specimens (prior to review by the Fellowship Director), and interpretation
of special studies, as well as communication with clinicians. The
Dermatopathology trainee is given increasing responsibility which includes
preparation of reports and communication with clinicians as their skills
increase through the year. Progress is assessed almost on a daily basis.
The trainee, at the beginning of training, is responsible for reviewing
routine slides and preparation of cases for evaluation by the Director. By
the end of training, the trainee prepares reports, routine and consultation
294
cases, communicates with clinicians regarding results of cases, and
presents cases to the Director that are ready for review and signature.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
To become fully competent in the processing and interpretation of
specimens for the study of skin and mucous membranes,
cutaneous appendages, hair, nails, and subcutaneous tissues.
(C1, C2, C3, C6)
To develop expert knowledge about the structure and function of
normal cells and tissues, and how they are changed in
inflammation, repair, developmental abnormalities, degenerative
and metabolic conditions, preneoplastic conditions, and benign and
malignant neoplasms. (C2, C3, C5, C6)
To develop consultative skills to become an expert consultant to
clinicians and other colleagues regarding the interpretation of gross
and microscopic pathology of the skin, with reference to clinical and
laboratory findings. (C1, C2, C3, C4, C5, C6)
To develop an understanding of the appropriate uses of ancillary
techniques, such as histochemical, immunological, microbiological,
molecular, and ultrastructural techniques. (C2, C3, C6)
To develop skills necessary to dictate and complete the preparation
of a diagnostic dermatopathology report that will include all the
necessary data for accurate interpretation of the findings for routine
and special techniques. The trainee needs to accept increasing
responsibility in this area. (C1, C2, C3, C4, C5, C6)
To develop the recognition of limitations of knowledge and to be
able to communicate the need for additional tests or for additional
research in this area. (C2, C4, C5)
To develop the skills necessary to present dermatopathology in the
classroom setting to dermatology and pathology residents and to
medical students. The trainee needs to accept increasing
responsibility in this area. (C2, C3, C4, C5)
To develop an understanding of all aspects of laboratory
management, quality assurance, continuous quality improvement,
and informatics as they pertain to dermatopathology.
(C2, C3, C4, C5, C6)
To recognize that dermatopathology tissues are entrusted to the
dermatopathologist for evaluation that protects the confidentiality of
the doctor-patient relationship, within the constraints of the need for
adequate and prompt care of the patient. Preserving these goals,
the trainee should recognize the importance of tissues for scientific
investigation. (C1, C3, C4, C5, C6)
To learn relevant aspects of entomology, mycology, and
bacteriology. (C2, C3)
To comply with the need to maintain universal precautions with
fresh human tissues and fluids. (C2, C3)
295
12.
To maintain the highest levels of professional and ethical conduct,
with appropriate regard to the importance of good patient care,
good maintenance of the equipment necessary for
dermatopathology studies and teaching, and to the confidentiality of
the patients within and outside of the hospital setting.
(C1, C2, C3, C4, C5, C6)
Pathology-Based Trainees
1.
2.
3.
4.
5.
In the cross-training in clinical dermatology, the goals are to acquire
sufficient knowledge of clinical dermatology to understand the basis
of the clinical diagnosis of dermatologic diseases, and the role of
differential diagnoses, based on the clinical history and gross
appearance of disease, as well as laboratory findings and
histopathological interpretations.
A required goal is to participate in the examination and care of 1000
dermatology patients.
The trainee needs to use the dermatology experience to study
clinical dermatology, correlating patient care with the relevant
dermatopathology material, including the review of slide sets
relevant to these diseases of the patients.
The trainee must complete an evaluation of the training program at
the end of the training period.
The trainee should participate in some aspect of investigation in
dermatopathology, which has been previously approved by the
training director, and may involve any of the three training
institutions.
Dermatology-Based Trainees
1.
2.
3.
4.
5.
In the cross-training in Pathology the goals are to acquire sufficient
knowledge of anatomic pathology to understand the basis of
diagnosis of diseases from the examination of anatomical
specimens by a variety of techniques, including routine
histopathology and special techniques, such as cultures,
immunohistochemistry, and ultrastructural study when appropriate.
To develop an understanding of the diagnosis of diseases most
relevant to dermatopathology, including those in subspecialties
such as hematopathology, gynecologic pathology, cytopathology,
immunopathology and molecular pathology.
To participate in autopsies.
To participate in diagnostic sign-out sessions in Surgical Pathology,
to gain an appreciation of the diagnostic expertise required as well
as the difficulties and limitations of current medical knowledge.
To complete an evaluation of the training program at the end of the
training period.
296
6.
E.
To participate in some aspect of investigation in dermatopathology,
which has been previously approved by the Training Director.
Specific Duties and Responsibilities
Dermatopathology
During their daily dermatopathology signouts the fellows will gain expertise
in the diagnosis of dermatologic disorders. The specific goals and
objectives are as follows:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Demonstrate ability to synthesize clinical and histologic findings to
develop a differential diagnosis or specific diagnosis for
dermatologic disorders.
Communicate findings to clinicians through the written microscopic
description, diagnosis and any relevant comments concerning the
diagnosis.
Develop patient management recommendations for additional
therapy or consultation with subspecialists.
Effectively communicate consultation results and recommendations
for patient management.
Recognize histologic patterns for inflammatory and neoplastic
dermatologic processes.
Order and interpret any ancillary tests necessary for rendering a
diagnosis.
Access and evaluate current dermatopathologic, pathologic and
dermatologic literature, as appropriate.
Recognize diagnostic difficulties requiring consultation with an
expert dermatopathologist.
Supervise medical students and residents rotating on the
dermatopathology service.
Participate in teaching dermatopathology to medical students and
pathology and dermatology residents as requested.
Read a designated textbook on dermatopathology.
Participate in an approved research project with the goal of
poster/platform presentation at a national meeting and publication
of findings in a peer-reviewed journal.
General Dermatology
The faculty clinic is the experience that most simulates the private
practice. The goals and objectives are as follows:
1.
Develop skills in practice in a “high” volume setting with 15-20
patients being seen in a half day.
297
2.
3.
4.
5.
Develop skills in managing common dermatologic problems and
more complex medical dermatology consults.
Coordinate the clinical encounter with faculty, nursing personnel,
scheduling personnel and other support personnel.
Use patient based problems for self study.
Gain experience and then proficiency in routine office procedures
such as KOH, acne surgery, cryosurgery and routine biopsies.
Nationwide Children’s Hospital
Children’s Hospital is a pediatric institution in which the trainee gains
experience with pediatric patients in a hospital based clinic. The clinic has
a large number of indigent patients. The goals and objectives are as
follows:
1.
2.
3.
Develop skill in diagnosis and management of pediatric
dermatologic conditions.
Use pediatric patient based problems for self study.
Develop scholarly activity as applied to the pediatric patient.
Veteran’s Administration Clinic
The VA clinic is a high volume clinic where the patient is seen by a trainee
under the supervision of a faculty member. The goals and objectives are
as follows:
1.
2.
3.
4.
Develop a facility seeing a large volume of patients in which the
trainee is the primary physician caring for the patient.
Coordinate care with nursing personnel, supervising faculty, the
trainees and the VA system.
Use patient based problems for study.
Mentor medical students on dermatology rotation.
Surgical Pathology
1.
2.
3.
4.
Demonstrate ability to obtain pertinent information from the
patient’s clinical record.
Demonstrate knowledge of information that is necessary to provide
adequate clinical history on submission forms for anatomic
pathology specimens.
Demonstrate knowledge of the general principles and terminology
for processing anatomic pathology specimens, including patient
identification, gross examination, and dissection.
Demonstrate ability to dissect tissues in such a way as to preserve
important pathologic findings and fix them so that they may be used
for clinicopathologic correlations as well as teaching.
298
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Demonstrate ability to select correct pieces of tissue for sectioning
and preservation, and maintenance and identification of tissue
orientation during processing.
Demonstrate ability to list common stains used for microscopic
sections, as well as their indications and the expected results for
various tissue types.
Demonstrate ability to enumerate the elements of a satisfactory
histologic sections and stains and identify the possible reasons for
unsatisfactory preparations.
Demonstrate ability to select correct fixatives for special histologic
preparations.
Demonstrate knowledge of the specimens that commonly require
special handling (flow cytometry, microbiological cultures, recovery
of crystals, electron microscopy, immunohistology, etc.).
Ability to select an appropriate piece of tissue for frozen section,
and to cut and stain the section satisfactorily.
Ability to collect and preserve appropriate tissues and fluids for
immunofluorescence and flow cytometric studies.
Ability to select and submit tissue appropriately for electron
microscopy.
Ability to take suitable gross and microscopic photographs.
Proficiency in doing special hematological studies, including touch
preprations and blood smears.
Proficiency in initiating routine microbiological studies, including
appropriate cultures, smears, and stains, and involving knowledge
of methods of collection and preservation, if needed.
Demonstrate familiarity with the detailed organization, equipment,
and techniques of the histology laboratory, including tissue
processing, tissue embedding, preparation and staining of glass
slides, information that histotechnologists must have to process
tissue properly, and orientation of specimens.
Demonstrate ability to present cases at conferences with clarity,
completeness, and high quality illustrations, and to reach
reasonable interpretative conclusions.
Demonstrate knowledge of precautions to be taken against
infections and other hazards in the handling of fresh tissue during
intraoperative consultations.
Demonstrate knowledge of the appropriate storage and disposal of
tissues and fixatives.
Demonstrate knowledge of the common pathogens that can be
transmitted to laboratory personnel in pathology, as well as basic
safety precautions to be taken in the anatomic pathology
laboratory, including universal precautions for infectious agents.
299
Hematopathology
1.
2.
3.
4.
5.
6.
7.
8.
9.
Become familiar with the clinical implications of CBC parameters.
Discuss laboratory workup of anemia.
Be exposed to morphologic review of blood smears.
Be exposed to various tests for the workup of bleeding and
thrombotic disorders.
Become familiar with body fluid chemical analysis and morphologic
review.
Be familiar with the various clinical situations that result in bone
marrow evaluation.
Be exposed to morphologic analysis of bone marrow aspirate and
biopsy material and associated ancillary studies such as flow
cytometric, cytogenetic and molecular analysis.
Appreciate the classification of hematolymphoid malignancies as is
outlined by the WHO with emphasis on acute and chronic
leukemias, myeloproliferative and myelodysplastic disorders,
Hodgkin and non-Hodgkin lymphoma (as relates to bone marrow
involvement) and plasma cell neoplasm.
Read chapters 4, 13 and 14 in Robbins.
Cytopathology
The cytology service is designed to provide a foundation for the diagnosis
of clinical specimens including both exfoliative and fine needle aspiration
cytology. Experience is obtained by self-directed review of the available
teaching materials and the sign-out of clinical specimens with the
attending physician.
Molecular Pathology
1.
2.
3.
To gain a practical and applied understanding of the techniques,
applications, and interpretations concerning molecular diagnosis in
the clinical laboratory.
This is a basic/primary rotation, and the emphasis is on
technical/quality control aspects, and basic interpretive procedures
of molecular diagnosis.
The fellow is expected to attend Clinical Pathology Case
Conference.
Autopsy
1.
Gain knowledge and technical skills to recognize, interpret, and
explain pathologic processes in the clinical practice of autopsy
pathology as it relates to dermatological conditions.
300
2.
F.
Effectively communicate gross pathologic findings with an
understanding of their clinical implications.
Schedule
DP Fellow 1 with Pathology Background (weekly schedule)
Mon
Tues
Wed
Thurs
Children’s (50%)
Dr. Lambert (50%)
Dermatopathology
(50%)
Dermatopathology
(50%)
Dermatopathology
(50%)
Dermatology
Didactics and Book
Review (50%)
Dermatopathology
(50%)
Dermatology
Resident Clinic
(50%)
Fri
Dermatopathology
(50%)
VA Clinic (50%)
DP Fellow 2 with Pathology Background (weekly schedule)
Mon
Tues
Wed
Thurs
VA Clinic (50%)
Dermatopathology
(50%)
Dermatopathology
(50%)
Dermatology
Resident Clinic (50%)
Dermatopathology
(50%)
Dermatology
Didactics and Book
Review (50%)
Stoneridge (50%)
Dermatopathology
(50%)
Fri
Dermatopathology
(50%)
VA Clinic (50%)
Sample
DP Fellows with Dermatology Background (weekly schedule)
Mon
Tues
Wed
Thurs
Fri
Surg Path 9 mo
Hemepath 1 mo
Cytopath 1 mo
Molecular Path 1 mo
(50%)
Dermatopathology
(50%)
G.
Surg Path 9 mo
Hemepath 1 mo
Cytopath 1 mo
Molecular Path 1 mo
(50%)
Dermatopathology
(50%)
Surg Path 9 mo
Hemepath 1 mo
Cytopath 1 mo
Molecular Path 1 mo
(50%)
Dermatology
Didactics and Book
Review (50%)
Surg Path 9 mo
Hemepath 1 mo
Cytopath 1 mo
Molecular Path 1 mo
(50%)
Dermatopathology
(50%)
Surg Path 9 mo
Hemepath 1 mo
Cytopath 1 mo
Molecular Path 1 mo
Dermatopathology &
Research Projects
(50%)
Cases and Procedures
Fellows will log biopsies performed and patients evaluated on E*Value.
The Fellowship Director will review procedure logs on a quarterly basis to
assess that the variety and volume of specimens has been met.
H.
Educational Program Curriculum
All fellows participate in conferences and seminars in the Department of
Pathology and Division of Dermatology.
Biopsy Review Session
Dermatopathology Session
Dermatology Lecture Series
Weekly
Weekly
Weekly
Dermatology Journal Club
Monthly
Sara Peters, MD
Sara Peters, MD
Dermatology faculty and
visiting lecturers
Dermatology faculty, residents
and fellows
301
Dermatology Book Review
Weekly
Pharmacology & Basic
Science
Dermatology Grand Rounds
Kodachrome Session
Anatomic Pathology Didactic
Lectures
Pathology Grand Rounds
Weekly
Dermatology faculty and
residents
Dermatology faculty
Monthly
Monthly
2x/week
Dermatology faculty
Dermatology faculty
Pathology faculty
Weekly (Sept-May)
Topics in Laboratory
Management
Monthly
Wright State University
Mycology Course
Indiana Basic Science Course
Annually
Charles L. Hitchcock, MD,
PhD, Pathology
Michael Bissell, MD, PhD,
MPH
Harry Puka-Martin, MBA,
CPA, FHFMA, Pathology
Wright State University
Annually – 1 ½ days
October 23 & 24, 2009
Department of Dermatology,
IUPUI (optional)
Recommended Reading
Textbooks
Lever Textbook of Dermatopathology
Barnhill Textbook of Dermatopathology
Weedon Textbook of Dermatopathology
McKee Pathology of the Skin
Dermatology in Internal Medicine
Journals
American Journal of Dermatopathology
Journal of the American Academy of Dermatology
Archives of Dermatology
Journal of Cutaneous Pathology
The fellows have access to the large library resources of John A. Prior Health
Sciences Library, which provides health information to meet the needs of the
faculty, staff and students of the medical center campus along with medline, online journals and multiple databases (http://library.med.ohio-state.edu/). This
includes all major journals in dermatopathology. The fellow also has access to
several libraries as well as personal libraries of the faculty within the institution
including Dermatopathology, Dermatology, Surgical Pathology, Cytopathology,
Molecular Pathology and Hematopathology.
Teaching
The fellow(s) will be involved in a variety of formal and informal educational
activities throughout the course of the program. Informal activities include case
review and discussion with dermatology residents, pathology residents, and
medical students rotating through the Division of Dermatopathology while the
fellow is on service.
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Fellow(s) will regularly attend and present at Dermatology Grand Rounds.
The fellow(s) will discuss cases and/or topics in dermatopathology with the
Dermatology residents during the regular weekly teaching sessions.
Research
The fellows have access to a wide variety and volume of material for educational
and research purposes and are expected to complete a clinically oriented or
basic science research project, under the supervision of the Dermatopathology
Fellowship Director, with the goal of preparing an abstract/and or paper at a
national meeting. The fellows’ goal is to publish the results of their research in a
peer-reviewed journal. Fellows have time dedicated for their research projects
each week and are given a stipend toward educational materials and travel to
participate in meetings.
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Fellow Supervision, Duty Hours and Work Environment
The fellow is closely supervised by the Director of Dermatopathology and
Dermatology faculty at the beginning of their fellowship. The fellow is
given more responsibility for patient care and consultations as the material
and skills are mastered. Faculty are available at all times for consultation.
Supervision is tailored to the fellow’s level of performance. Faculty
evaluate the fellow twice a year both in the context of written evaluations
as well as in person reviewing strengths and weaknesses and planned
measures to facilitate improvement in problem areas.
The fellow is expected to be present during the day, normally Monday
through Friday from 8:00 am until 5:00 pm. No in house call is required
except for 5 weekend autopsy calls for dermatology trained fellows. The
program follows the duty hour rules set by the ACGME.
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