Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
Page 5
RE: Resident Responsibilities
Reviewed June 21, 2010
NAME OF ROTATION: Surgical Pathology
YEARS of RESIDENCY ROTATION TAKEN; DURATION: Year I-IV; minimum 10
months
SITES: University Medical Center (UMC), TTUHSC Anatomic Pathology; Covenant Health
Systems
GOALS: The goal of this program is to develop:
1. A general clinical and pathologic knowledge base, in surgical pathology and related
clinical disciplines
2. Technical skills to apply this knowledge in the evaluation of patients and clinical
specimens
3. Basic administrative and management skills
4. Appropriate computer skills to acquire clinical information and report findings in a timely
fashion and access and disseminate information using current technologies such as the
Internet
5. Possible areas of research or publication, a focus strongly encouraged
6. Written and oral communication skills to achieve the above goals
7. Life long learning tools;
All to allow independent evaluation and application of the ever-changing body of medical
knowledge. This will allow the resident to practice general surgical pathology in an up-to-date,
ethical and cost effective manner in either a private practice or academic setting. The ability to
collate and coordinate surgical pathology findings with other laboratory and clinical information
for both patient care and research and staging protocols is expected.
OBJECTIVES:
Skill Level IA - RECOMMENDED 1-3 MONTHS
Goal: Develop everyday expertise in the basic laboratory skills in surgical pathology, while
beginning to develop a fund of knowledge from a variety of sources for evaluating the
specimens commonly encountered.
Medical Knowledge and Patient care:
 Demonstrate proficiency in basic anatomic pathology skills (see above) and level of
knowledge appropriate to training level (see appendix).
o Reliance on extensive reading in basic surgical pathology texts as well as signout
tutorial and conference participation.
o The topics covered in the Knowledge base list are those covered in general
surgical pathologic practice. The list is not meant to be all-inclusive. A greater
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010
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o depth and breadth of knowledge in areas of common practice and/or interest is
expected and encouraged.
Demonstrate knowledge of the common and basic elements of the surgical pathology
report, including required demographic and clinical, gross and microscopic information
needed for interpretation, diagnosis and coding.
Ability to determine when a microscopic description and/or interpretation is necessary
and provide such information.
Demonstrate competency in selecting representative tissue samples for intraoperative
frozen sections, preparing the same and staining the sections.
Be able to evaluate margins of tumor resection specimens using frozen sections and touch
preparations and cut routine frozen sections
Systems-based practice:
 Demonstrate knowledge of the standards (JCAHO, CAP) required for submitting surgical
pathology specimens.
 Demonstrate knowledge of the basic recommendations/requirements (JCAHO, CAP,
regional legal requirements) pertaining to retention of pathology specimens and records.
Practice based learning and improvement:
 Know the procedures for the reporting of untoward incidents in the laboratory.
Informatics:
 Demonstrate knowledge of the basic principles of informatics in anatomic pathology, and
ability to effectively utilize the local computer network.
 Demonstrate knowledge of web-based or organization (CAP, ASCP, USCAP, etc.)related learning and CME tools in anatomic pathology.
Skill Level IB – RECOMMENDED 3 to 6 MONTHS: Goal: Development of general
independence of action in general routine surgical pathology, with identification of areas
requiring more experience. Successful completion of this section should adequately
prepare the resident for participation in Surgical Pathology at Covenant Medical Center
Patient care:
 Intraoperative consults
o Demonstrate knowledge of the common indications for an intraoperative
consultation.
o Demonstrate proficiency in interpreting & reporting frozen sections within 15
minutes of receiving a specimen for that purpose in the pathology laboratory.
o Demonstrate the techniques for preparing intraoperative cytology smears.
o Enumerate the indications and the limitations pertaining to intraoperative frozen
section examinations.
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010

Interpretation and reporting.
o Demonstrate knowledge of the common situations requiring expedited processing
of a pathology specimen and those that do not.
o Developing expertise in independent gross and microscopic diagnosis of routine
non-neoplastic specimens, including evaluation of special stains; of diagnosis of
major neoplasms, including grading and staging, as well as variants of the major
neoplasms and less commonly seen neoplasms
o Demonstrate the ability to effectively construct a complex surgical pathology
report.
o Demonstrate knowledge of the common grading and staging systems applied to
malignant neoplasms.
o Be able to properly prepare synoptic surgical pathology reports for common
malignancies.
o Demonstrate the ability to dictate necessary amendments and/or addenda for
surgical pathology reports.
o Demonstrate knowledge of how and when to obtain external consultations in
anatomic pathology and document the results appropriately.
o 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.
Interpersonal/communication skills:
o 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.
o 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.
Systems-based practice:
o Demonstrate knowledge of quality control pertaining to histologic sections and special
stains, including trouble-shooting of mistakes in accessioning, labeling and
misidentification of specimens.
o Demonstrate an ability to participate in performance improvement activities in the
department.
o Participate in at least one CAP inspection (as opportunity allows; more than one is
strongly encouraged)
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010
SKILL Level II: (Most at Covenant Medical Center): Months 7 onward (minimum 4
months) Goal: Development of competency and advanced proficiency in all areas, with
special selected experience in areas to be designated by previous experience as well as
interest.
RECOMMENDED Reading/Resources:
A.
Textbooks and hardcover sources:
o The most recent Robbins, Pathologic Basis of Disease, Philadelphia: WB Saunders
Co., 7th edition 2001, with companion CD; are provided to each resident
o Basic general Surgical Pathology textbooks. Several are available and constantly
being updated.
o Armed Forces Institute of pathology (AFIP) Fascicles of Tumor Pathology; Third
series, is complete and available for reference. The fourth edition has just begun in
hardcover; significant resident discounts are available.
Surgical Pathology grossing Manual – several are available, including Rosai. You MUST
become familiar with your favorite.
Area specific monographs and specialty textbooks – Departmental library and faculty
libraries are of particular use for advanced residents
Preston Smith Library of the Health Sciences Center: Full service library including
extensive book and journal inventory and excellent research staff and expanding access to
on-line electronic journals.
Internet access for a variety of every changing sources. PATHMAX.com is the best
constantly updated source. Look for Virtual microscopy sources especially.
B.
C.
D.
E.
SUPERVISION AND EVALUATION:
All cases, including paperwork and all glass slides, are reviewed by a pathologist licensed to
practice in Texas, and is verified by that pathologist. At no time is a final report issued without
that verification.
Residents are evaluated on a monthly basis by each of the attendings involved in their training
that month and by the program director on a quarterly basis and finally on a yearly basis prior to
signing of new contracts. Both the resident and pathologist sign each of these evaluation forms
at the time of evaluation. The monthly evaluation will serve to identify areas of improvement
early, as well as the resident’s achievement of the goals and objectives.
Subjective (Residency Competency Assessment) and Objective Evaluations:

The standard form (Residency Competency Assessment will be completed by each
attending pathologist on rotation with the resident each month (not just at the end of a
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
Revised June 1, 2009
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multimonth rotation), including the elements as noted previously for competency based
evaluation.
The results of additional objective evaluation tools used must be noted on the form, with
additional documentation as appropriate. This may be in the form of checklists. Such
checklists should promptly be completed by each supervising faculty member. The
evaluation should be discussed with the resident at the time of completion, with both the
attending physician and resident signing the form after discussion.
Pertinent constructive written comments are REQUIRED for evaluations of borderline
(4) or unsatisfactory (1-3) ratings.
Plans for remediation of borderline or unsatisfactory ratings must be documented in
writing.
LIST of specific evaluation tools other than case by case review:
360 reviews
Skills test for Anatomic Call (Gross, Histopathology, Surgical Pathology and Basic LIS
skills test) (IA)
RESIDENT DOCUMENTATION of activities for evaluation and ABP:
Residents must keep track of the numbers and organ system types of cases as they do them.
These numbers will be needed for application to the American Board of Pathology. This sheet
should be presented at the time of evaluation, and its contents entered into the Innovations
system.
TEACH STAFF RESPONSIBILITIES FOR SUPERVISION:
Texas Tech Medical Center: Suzanne Graham, M.D.
Other Anatomic Pathology Faculty
Covenant Medical Center:
Technician Staff:
Joseph Sonnier, M.D.
Other Covenant Medical Center Pathologists
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
Page 10
RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010
SURGICAL PATHOLOGY APPENDIX
Specifics for Goals and Objectives
I. Medical Knowledge and Skill Base (Surgical Pathology; Also overlaps with
Cytology/Autopsy)
A. Overall
1. The depth and breadth of knowledge will depend on the clinical exposure
during the first three months and will be taken into consideration both in
evaluation and in setting additional learning objectives for the following
months in surgical pathology at both institutions.
2. Additional sources of early information for less common lesions will be
didactic faculty lectures and unknown conferences.
3. Review of normal histology is imperative initially, and will be achieved by
didactic microscope sessions daily over the first few weeks of PGY1. Review
of normal again at the time of surgical pathology rotation as certain tissues are
evaluated is expected.
4. The resident will develop familiarity with the uses and interpretation of
special stains and procedures through case related practice and didactic
lectures, specifically:
a. Common special stains for microorganisms, mucin substances,
architectural features and intracytoplasmic components available in the
laboratory (See Special Stain Order Sheet)
b. The approach to immunohistochemical (immunoperoxidase) stains
will be initiated during the first 3 months, with competence in basic
differentiation of major tumor types being to goal at the end of 6
months.
c. Immunofluorescent techniques will be taught/practiced during
evaluation of specific renal and skin specimens.
d. Molecular techniques as applied to surgical pathology (PCR, etc)
e. The costs versus benefits of special stains and procedures, especially
as relates to immunoperoxidase stains and rapidly developing
molecular techniques, should be part of the decision-making
B. General pathologic entities affecting multiple organ systems, as applied to many of
the entities below, including:
1. Adaptation, metaplasia, ectopias, accumulations and cell aging, apoptosis and
necrosis
2. Congestion, edema, thrombosis; inflammation and repair including acute and
chronic inflammation, inflammatory patterns of selected infectious diseases
granulomatous inflammation; tissue repair;
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
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3. Tissue manifestations of autoimmune diseases (e.g. Hashimoto’s thyroiditis,
rheumatoid arthritis) (to be correlated with Immunology)
4. Principles of dysplasia and neoplasia
5. Neuroendocrine system hyperplasias and neoplasias
6. Smooth muscle tumors of the female genital system, gastrointestinal tract and
soft tissue compartments
7. Systemic accumulation diseases: amyloidosis, hemochromatosis
8. Systemic anatomic effects of nutritional disorders (e.g. liver changes)
9. Pathophysiologic correlations as related to development of differential
diagnoses and informative reporting of information for clinical correlation
C. Gross only specimens:
1. Accurately describe for documentation the following
2. Urinary tract stones, with referral for chemical analysis
3. Artificial implants and devices
4. Other specimens as noted on Gross Specimen List
D. Head & Neck, including larynx and trachea:
1. Head and Neck Cysts and non-neoplastic masses, including (also QV
Pediatric Pathology)
a. Mucoceles
b. Branchiogenic, thyroglossal duct, lymphoepithelial, and selected oral
cysts
c. Irritation fibro as, hyperplasias, gynogenic granuloma.
d. Compare to other soft tissue and skin cysts
2. Laryngeal papillomas and other polyps
3. Squamous dysplasia and carcinoma and variants, lip, oral cavities, and larynx
4. Nasopharyngeal carcinoma
5. Oral ulcers and inflammatory conditions: herpes, candida, aphthous ulcers,
glossitis and hairy leukoplakia
6. Sialadenitis; autoimmune salivary gland diseases
7. Common salivary gland neoplasms, including pleomorphic adenoma,
Warthin’s tumor; Acinic cell, adenoid cystic, and mucoepidermoid
carcinomas.
8. Eye: pinguecula, pterygium, dermoid cysts, sebaceous carcinoma of the eyelid
9. Correlation with cytology/FNA of the head and neck is expected
E. Lower Respiratory System:
1. Differentiate non-small cell carcinomas (squamous, large cell,
adenocarcinoma) from small cell undifferentiated carcinoma, atypical and
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010
typical carcinoid tumors, including the application of special stains and
procedures
2. Non-neoplastic pulmonary diseases: idiopathic pulmonary fibrosis, acidosis,
pneumoconiosis, BOOP, emphysema; abscesses; organizing pneumonia,
bacterial and fungal pneumonias (including histoplasmosis, coccidiomyocosis,
cryptococcosis, invasive aspergillus); tuberculosis (typical and atypical);
Pneumocystis carinii pneumonia. Correlation and addition of knowledge from
Autopsy experience required.
3. Pleural diseases: Pleuritis including organizing empyema; differentiation of
malignant mesothelioma from adenocarcinoma, sarcoma and localized fibrous
tumor (solitary fibrous tumor), including the application of immunoperoxidase
special stains.
4. Correlation with pleural fluid analysis, as well as bronchial and FNA cytology
is expected
F. Cardiovascular system:
1. Myocardial and endocardial diseases: See autopsy. (Ischemic heart disease,
myocarditis including infectious etiologies (Chagas’ disease); infectious
endocarditis; acute and chronic rheumatic heart disease myocardiopathies
(dilated, restrictive, hypertrophic)
2. Congenital heart disease (Left to right shunts; right to left shunts; obstructive
disorders (QV Pediatric Pathology)(QV Autopsy pathology)
3. Pericardial disease: pericarditis, metastatic disease
4. Atherosclerotic vascular disease; vascular dissections; aneurysms and
pseudoaneurysms
5. Vasculidities: temporal arteritis, polyarteritis nodosa
6. Neoplasms: Angiomas, angiosarcomas, atrial myxoma, and rhabdomyoma
7. Endomyocardial biopsy for rejection and other diseases
8. Correlation with pericardial fluid cytology is expected
G. Gastrointestinal System:
1. Esophagus:
a. Non-neoplastic: Esophagitis (reflux and infectious; special stains),
ectopias, rings, Tracheo-esophageal fistulae (QV Pediatric Pathology)
b. Neoplastic: Barrett’s esophagus (including use of special stains),
squamous cell carcinoma, adenocarcinoma.
2. Stomach:
a. Non-neoplastic: Helicobacter pylori gastritis (including special stains),
atrophic gastritis including intestinal metaplasia, peptic ulcer disease
b. Gastric polyps, inflammatory, fundal gland, adenomatous
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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Surgical Pathology
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c. Neoplastic: adenocarcinoma; gastrointestinal stromal tumors,
lymphoma
3. Small intestine:
a. Non-neoplastic: Celiac sprue, infectious enterocolitis (e.g.
cryptosporidia, mycobacteria, Whipple’s); diverticula
b. Neoplastic: Lymphoma, carcinoid, and adenocarcinoma
4. Colon:
a. Non-neoplastic: Idiopathic inflammatory bowel disease (Crohn’s and
ulcerative colitis); other colitis (acute self-limited/infectious, ischemic,
radiation, pseudomembranous, cryptosporidiosis; collagenous,
lymphocytic); melanosis coli; diverticulosis and diverticulitis
b. All polyps (regenerative, juvenile, hamartomatous, adenomatous)
c. Adenocarcinoma; variants and genetic syndromes; APC sequence (QV
Molecular pathology)
5. Appendix: Appendicitis; carcinoid; adenocarcinoma; variants
6. Peritoneum: Reactive peritoneal change: mesothelioma; metastatic tumor
spread
7. Anus: hemorrhoids; tags, condylomata, anal canal carcinoma
8. Correlation with GI cytology, brushings and FNA, is expected
H. Liver:
1. Non-neoplastic: Acute and chronic hepatitis (viral, alcoholic, autoimmune,
other); cirrhosis; hemochromatosis; inborn errors (QV Pediatric Pathology);
bile duct adenoma versus Meyenberg complex. Correlation with Clinical
Chemistry and Hepatitis testing required. Expertise in hepatitis reporting and
grading is expected
2. Neoplastic: Adenoma versus focal nodular hyperplasia, hepatocellular
carcinoma, including fibrolamellar variant; cholangiocarcinoma,
angiosarcoma hepatoma. Correlation with cytology is expected
I. Gallbladder and Biliary system:
1. Non-neoplastic: cholecystitis, mucosal hyperplasia and metaplasia;
adenomyosis; stones
2. Polyps
3. Adenocarcinoma
J. Pancreas:
1. Non-neoplastic: Chronic pancreatitis, (Others QV Autopsy: nesidioblastosis,
diabetic changes)
2. Neoplasms: (ductal adenocarcinoma; other variants; Islet cell tumors)
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
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Surgical Pathology
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3. Correlation with FNAs and ERCP cytology is expected
K. Urinary Tract, including kidney and bladder, ureters and urethra:
1. Chronic cystitis including interstitial cystitis and treatment effects
2. Polyps (nephrogenic adenomas); diverticula; caruncles
3. Transitional cell atypia, carcinoma in situ and carcinoma, both flat and
papillary
4. Kidney non-neoplastic: pyelonephritis, renal calculi and hydronephrosis;
nephrosclerosis and malignant hypertension; xanthogranulomatous
pyelonephritis, malakoplakia; reflux syndromes (QV Pediatric pathology)
5. Kidney neoplastic or tumor like: Renal cell carcinoma; angiomyolipoma;
pelvic transitional cell carcinomas
6. Congenital Renal anomalies: QV Pediatric Pathology
7. Glomerulonephritis, interstitial nephritis (QV Renal Pathology Elective)
8. Correlation with urine cytology and Renal biopsy/FNA is expected
L. Male Genital Tract:
1. Non-neoplastic testis: Testicular biopsy in infertility and cryptorchidism (QV
Pediatric pathology); torsion
2. Neoplastic testis: Testicular germ cell neoplasia and lymphoma
3. Paratesticular tissue: common lesions (adenomatoid tumor, appendix testis
torsion, epididymitis and local cysts).
4. Prostate: Prostatitis, granulomatous; Prostate carcinoma, Gleason grading and
PIN (prostatic intraepithelial neoplasia).
5. Penis: Sexually transmitted diseases, including syphilis, herpes and
condyloma acuminatum; squamous cell carcinoma
M. Female Genital Tract:
1. Surgical pathology findings in sexually transmitted disease in FCT, including
herpes, chlamydia, gonorrhea. (SEE Microbiology)
2. Vulva:
a. Non-neoplastic: Cysts, lichen sclerosus and squamous hyperplasias
b. Neoplastic: VIN and squamous cell carcinoma; Paget's disease of the
vulva
3. Vagina:
a. Non-neoplastic: Polyps, DES changes; condyloma
b. Neoplastic: VAIN and squamous cell carcinoma; adenocarcinoma;
rhabdomyosarcoma
4. Cervix:
a. Non-neoplastic: Cervicitis, including herpes and lymphofollicular
cervicitis; polyps; condyloma
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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RE: Resident Responsibilities
Surgical Pathology
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b. Neoplastic: CIN and squamous cell carcinoma; AIS and
adenocarcinoma
5. Endometrium:
a. Non-neoplastic: Normal endometrial cycle (dating); anovulatory
cycles, secretory phase delays, chronic endometritis; atrophy;
hormonal changes
b. Hyperplasia, simple versus complex, typical versus atypical
c. Neoplasia: endometrioid adenocarcinoma, carcinosarcoma, other
variants; other unusual tumors
6. Myometrium: Adenomyosis; leiomyoma versus leiomyosarcoma; endometrial
stromal tumors
7. Ovaries and peritoneum:
a. Non-neoplastic: Cysts; endometriosis; polycystic ovaries
b. Neoplastic: Mucinous and serous neoplasms; germ cell tumors; sex
cord stromal tumors
8. Fallopian tubes: paratubal cysts; salpingitis, including tuberculosis; ectopic
pregnancies; adenomatoid tumors, adenocarcinoma (rare)
9. Gestational Disease and Placenta: Placental Pathology:
a. Common types of gestational trophoblastic disease (hydatidiform
mole, partial mole, choriocarcinoma and histologic differences).
b. SEE Pediatric, Fetal and Placental Pathology
10. Correlation with cytology – PAP cervical smears, washings, FNAs, etc, is
expected.
N. Breast:
1. Proliferative and non-proliferative fibrocystic change
2. Mastitis; subareolar abscesses; silicone implant changes
3. Stromal tumor: fibroadenoma, phyllodes tumors; sarcoma (rare)
4. Ductal neoplasia (DIN including atypical ductal hyperplasia, invasive ductal
carcinoma, including Paget’s disease of the nipple and inflammatory
carcinoma) including hormone receptor and Her-2/neu evaluation; lobular
neoplasia (atypical lobular hyperplasia, LIS, and invasive lobular carcinoma.
5. Intraductal papillomas and papillary carcinomas
6. Other: Medullary carcinoma, colloid carcinoma, tubular carcinoma
7. Correlation with breast FNA is expected
O. Endocrine:
1. Non-neoplastic thyroid: Treated Graves’ disease; Reidel's struma,
DeQuervains thyroiditis; lymphocytic and Hashimoto’s thyroiditis; diffuse
and multinodular goiter.
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
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Surgical Pathology
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2. Neoplastic thyroid: Adenoma versus follicular carcinoma; Hürthle cell
tumors; Papillary carcinoma; Medullary carcinoma, anaplastic carcinoma,
lymphoma
3. Parathyroid: differentiation of hyperplasia, adenoma and carcinoma
4. Adrenal gland: Cortical hyperplasia adenoma and adrenocortical carcinoma;
medullary hyperplasia and pheochromocytoma (medullary and extra-adrenal)
5. Pituitary: See CNS
P. Skin:
Common skin diseases, including inflammatory and neoplastic diseases are
encountered in weekly Dermatopathology Unknown Conferences which are
repeated yearly, as well as in daily surgical pathology signout and a one month
required course in Dermatopathology (QV).
Q. Neuropathology, including pituitary gland:
1. Common neoplasms of the CNS: differentiate by age, site, MRI/CT findings
the following: Metastatic tumor; pilocytic astrocytoma; astrocytoma,
anaplastic astrocytoma and glioblastoma multiforme; oligodendroglioma,
meningioma and schwannoma; pituitary adenoma; ependymoma, including
papillary ependymoma; medulloblastoma; hemangioblastoma;
2. Non-neoplastic, especially tumor like lesions: multiple sclerosis; abscess;
toxoplasmosis; pituitary sarcoid
3. Other CNS entities: Autopsy pathology
4. Muscle biopsy: differentiation of clinical and major Neuropathic, myopathic
and inflammatory muscle disease by use of H&E stains, selected
histochemical stains on frozen sections (ATP/NADP); muscle diseases
requiring electron microscopy for diagnosis.
R. Bone and Joint
1. Non neoplastic: osteomyelitis; osteoarthritis versus rheumatoid arthritis;
crystal arthropathies; RF factor negative spondyloarthropathies; infectious
arthritis; tuberculosis; Paget’s disease of bone; Osteomalacia,
hyperparathyroidism; osteoporosis; fractures; avascular necrosis of the
femoral head
a. Correlation with microbiology findings expected (infections)
b. Correlation with serologic findings expected (autoimmune diseases)
2. Neoplasm: metastases; enchondroma, osteochondroma,
chondromyxoidfibroma, chondrosarcoma and common variants
(mesenchymal and dedifferentiated chondrosarcoma); osteoma, osteoid
osteoma, osteoblastoma, osteosarcoma and common variants (paraosteal and
periosteal osteosarcomas); fibrous cortical defect, fibrous histiocytoma,
benign and malignant; Ewing’s sarcoma of bone versus metastatic small round
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Department of Pathology
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blue cell tumors of childhood; giant cell tumor of bone; multiple
myeloma/plasmacytoma; Langerhans histiocytoses, including eosinophilic
granuloma
3. Demonstrate ability to review radiographs with assistance for all bone cases;
apply cytogenetic findings and special stains to differential diagnosis
S. Soft tissue:
1. Non-neoplastic: cellulitis, nodular fasciitis, proliferative myositis and fasciitis,
ganglion cysts, digital mucus cysts; myositis ossificans
2. Giant cell tumor of tendon sheath, fibroma of tendon sheath, localized and
general pigmented villonodular synovitis
3. Neoplasm: lipoma and liposarcoma; leiomyoma and leiomyosarcoma;
rhabdomyosarcoma, Ewing’s sarcoma of soft tissues, PNET; angioma and
angiosarcoma; cystic hygromas; synovial sarcoma; epithelioid sarcoma;
Kaposi’s sarcoma; benign fibrous histiocytoma, malignant fibrous
histiocytoma
II. Technical skills – Patient care
A.
Gross Room Procedures:
1.
Requisition evaluation, specimen accessioning, cassette and slide preparation,
tissue grossing techniques, and gross dictation for biopsies and most nonneoplastic specimens. The proper technique for each specimen will be
demonstrated by the teaching pathologist and is available in a Surgical
Pathology Manual. The cases will include at least:
a.
Gross only specimens
b.
Routine skin, mucosal and needle or wedge biopsies
c.
Small uncomplicated tissue specimens (benign soft tissue m
asses,gallbladders, hernias, foreskins, polyps, skin tags, etc)
d.
Non-neoplastic organ resections (testis, vas deferens spleens, etc)
e.
Amputations, traumatic and non-neoplastic
f.
Segmental organ resections, non-neoplastic (stomach, small and
large bowel, etc)
g.
Female genital tract, neoplastic and non-neoplastic specimens
h.
Non-neoplastic bone, including fragments, femoral heads and
others as encountered, including the proper use of the bone saw
and decalcification
2.
Demonstration of familiarity with Gross Room and Histopathology Safety
procedures, including Universal precautions, personal protective devices
and MSDS sheets, with participation in all drills and demonstrations.
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Department of Pathology
Resident Guidelines
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B. Intraoperative Tissue evaluation and Frozen Section preparation, including:
1. Familiarity with University Medical Center (UMC) Operating Room (OR)
procedures related to protective clothing and personnel access to the OR
2. Evaluation of the operative cases as to the cost effectiveness of frozen sections
and intraoperative evaluations done related to information gained for patient
care, resident teaching, and research
3. Case evaluation for preservation of tissue for special diagnostic techniques as
well as preservation of tissue for tissue banks and research purposes according
to established rules and procedures.
4. Frozen section: demonstrate:
a. Able to computer accession case and evaluate requisition (RAA)
b. End month 1 – Evaluation, Embedding, cutting and staining of simple
(non-oriented) frozen sections – (i.e. muscle, fibrous tissue, simple
mucosal), with cutting of sections of all frozens done.
c. End month 3 – able to orient, ink, cut, embed, and stain all routine
frozen sections with supervision and begin to evaluate simple cases as
encountered.
5. Fresh tissue evaluation without frozen section will include demonstration of
proficiency, in evaluating and processing certain specimens, including sterile
technique, intraoperative gross evaluation and specimen demonstration to
surgeons, cytological preparations and submission of tissue for special
procedures, in tissue such as breast, lymph nodes and certain neoplasms.
C. Photography
The resident will demonstrate proficiency in gross photography and photomicroscopy
by use of material in conference presentations, with demonstration and assistance by
senior residents and staff as required until proficiency is obtained.
III. Administrative and Management skills
A. Report preparation: Through didactic teaching and clinical practice, the resident will be
able to:
1. Evaluate requisitions and specimens initially for adequacy of identification
and clinical information for both pathological evaluation and coding purposes
2. Gather and organize clinical and laboratory information, both present and
past, to effectively process and evaluate the case prior to signout, so as to
maximize the clinical usefulness of surgical pathology cases. Specifically, the
resident will demonstrate the ability to access and use:
a. Medical Records Departments of University Medical Center (UMC)
and Texas Tech Medical Center and Departments
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
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Surgical Pathology
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b. Computer accessible records (QV) at UMC
c. Laboratory Information System, specifically for Anatomic Pathology,
including retrieval of previous surgical and cytological reports.
3. Effectively and accurately code specimens for billing according to Federal and
State Regulations.
B. Participate in Performance Improvement activities of the Division, including
accreditation self inspections (i.e. CAP)
C. Apply management principles and skills as derived from Management lectures and
teaching sessions, specifically cost benefit analysis, timely report issuance and case
billing.
IV. Computer Skills
The resident is provided with a personal computer linked to the Texas Tech Medical
Center Computer system to which s/he was oriented and will use throughout the
residency. Related to surgical pathology, the resident is expected to demonstrate his/her
ability to access the following, with increasing proficiency in their use:
A.
B.
C.
C.
D.
The Laboratory Information System
Computerized Hospital (UMC) Medical Record
PACS system for internet based access to the digital radiographic system
Appropriate Web Sites accessible via the Internet
Preston Smith Library of the Health Sciences, with access to PubMed and other
search Engines and on-line journals and texts
E. Use of site licensed word processing programs, spreadsheets and Presentation
programs
V. Research and publication:
The resident is encouraged to evaluate his/her case load for material for case reports, and
to develop a research project applying the research design principles, regulatory
guidelines, and statistical modalities learned in didactic lectures and by regular
attendance at departmental Journal club.
VI. To develop written and oral skills both in informal and formal settings for effective
communication with others in the medical community. Specifically, this will require:
A. Acute surgical pathology report preparation using established protocols and/or
narrative description.
Texas Tech University Health Sciences Center
Department of Pathology
Resident Guidelines
VIII
Page 20
RE: Resident Responsibilities
Surgical Pathology
Reviewed June 21, 2010
B. Preparation of and regular participation in:
1. Intradepartmental conferences
2. Teaching of Second year medical students in Gross Teaching Laboratories
and selected lecture and small group situations throughout the year
3. Interdepartmental conferences.
IV. Development of Life Long Learning Skills will be demonstrated by the ability to:
A. Effectively access the information search engines available on the Internet or through
the medical center Library, particularly the National Library of Medicine (PubMed)
for the preparation of daily cases, and for case reports or reviews for the literature
B. Participate and present in the departmental Journal club, with effective evaluation of
the articles presented
C. Evidence of regular evaluation of the current literature in Surgical Pathology and
related disciplines
V. Regular review Practice based and systems based aspects of Pathology Practice,
A. Ethical considerations; examples:
1. Special stains, their use and abuse (overcharges if used for interest and/or
research purposes rather than diagnostic purposes)
2. Confidentiality of specimen findings
3. Use of tissue for research purposes re required patient permission and IRB
review
B. Socioeconomic issues; examples of issues under daily scrutiny:
1. Provision of equivalent services to both paying and non-paying patients
2. Provision of services at all to non-paying patients
C. Medical –Legal issues: areas of high risk constantly reviewed by CQI
1. Frozen section diagnoses and final diagnosis discrepancies
2. Misdiagnoses of malignancies and other entities that cause physical or
emotional harm to patients
3. Followup of abnormal cervical PAP smears
4. Accurate coding and billing appropriate to complexity and diagnosis,
following state and federal guidelines
D. Cost-containment issues: examples
1. Adequate sectioning of resected specimens providing acceptable sampling
with a minimum of cost, a topic hotly debated in the literature
2. Special stains – use for diagnostic versus research purposes
3. Cost benefit analysis done for institution of all new administrative procedures
as well as use of new technology and instrumentation
4.
Increased expectations of staff related to both cost and morale issues