AP Introductory Pathology Rotation - Northwell Health · Review basic histology ... AP Introductory...

Goals:

To provide introductory training in AP with an emphasis on basic grossing skills. To provide an introduction to the function of

histology lab, the gross room and frozen section room. To review basic histology.

Objectives: MK PC Prof PBL IP/CS SBP PGY-1 PGY-2 PGY-3 PGY-4

Show basic proficiency in gross techniques, initial handling of specimens, understand and demonstrate gross exam; resident

will be given graduated reponsibility so that by the last week of the rotation she/he will begin grossing independantly under

a a a a a a

Be able to orient specimens, describe and measure lesions and take appropriate sections for microscopy a a a a a a

Demonstrate ability to take high quality photographs of gross specimens a a a

Show proficiency in handling and submission of small biopsies for histologic processing a a a a a

Describe the reasons for tissue fixation in preparation of sections for light, IF and electron microscopy examination a a

Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a

Show knowledge of different fixatives, pros and cons, used in surgical path, the function of different solutions a a

Explain the different sections of the surgpath report, using correct terminology a a a a a

Review basic histology: Skin, Breast, Bone and Soft Tissue, Lung, GI, GU, Lymph Node, Bone Marrow, Uterus, Ovary,

Thyroid

a a a

Read assigned chapters in Robbins and Lester (see below) a a a

Evaluation tools:

Direct observation and feedback MK: medical knowledge

Faculty evaluation PC: patient care

End of Rotation Multiple Choice Exam Prof: professionalism

PBL: practice-based learning and improvement

IP/CS: interpersonal and communication skills

SBP: systems-based practice

Recommended Reading:

Pathologic Basis of Disease. Robbins and Cotran 8th Ed. Chapters 1-4, 6-8

Manual of Surgical Pathology. Lester. 2nd ed. Chapters 1-10

AP Introductory Pathology Rotation

Competency Involved Level Acquired

Competency Key:

Goals:

To train residents to competently perform autopsies, examine, interpret and report gross and microscopic findings

of fetal, infant, pediatric, adult and forensic autopsies; to interact appropriately and professionally with physicians,

families and other relevant persons and agencies.


Describe the criteria and procedures for accepting a body for autopsy, including order of authority for granting permission a a a a a

Describe the criteria for assignment to medicolegal status or consultation with appropriate medicolegal authority a a a a

Interact appropriately with ordering physicians and/or families to determine specific issues to be addressed (if any) a a a a a

Know and assist the diener in methods of organ/organ block removal from the body, including brain and spinal cord a a a a a

Demonstrate competent autopsy prosection using routine techniques, completing gross examination in a period of 3 hours for

uncomplicated cases, or 4 hours for complicated ones.a a a a

Know and meet the ACGME requirements for performing 50 autopsies a a

Recognize and understand indications for abbreviated autopsy procedures, and be able to perform such procedures a a a a a

Interact approriately and effectively with morgue, admitting and funeral home personnel a a a a

Teach PGY-1 residents correct methods of autopsy procedures and performance a a a a

Recognize the need for and institute special precautions and/or procedures in unique (e.g. infectious) cases a a a a a

Recognize normal organ morphology grossly and microscopically a a

Identify abnormal organ/tissue morphology and know how to sample appropriately for histological or other examination a a a

Show the ability to correctly describe common abnormalities of diseased organs by gross and microscopic examination, including

congenital, degenerative, inflammatory, neoplastic, and autoimmune disorders.

Correlate the clinical, gross and histologic findings in the major causes of sudden death (acute myocardial infarction, cardiac arrhythmias,

cardiac tamponade, pulmonary embolism, dissecting aortic aneurysm)a a a a

Demonstrate an ability to compose a provisional anatomic diagnostic report of autopsy findings within 24 hours of completing the

postmortem examinationa a a a a a a

Demonstrate an ability to compose a final autopsy report according to an approved format & within 30 days of completing the postmortem

examination, including accurate and complete anatomic diagnoses, thorough gross and microscopic descriptions, and pertinent

clinicopathologic correlations and mechanistic interpretations, including an accurate cause of death statement.

a a a a a a a

Participate in autopsy gross conference, intradepartmental autopsy conference, brain cutting, and interdisciplinary mortality conferencesa a a a a a

Participate in quality improvement and quality assurance activities (TAT and Autopsy Major Differences indicators) a a a a

Evaluation tools:



360° evaluation Prof: professionalism

RISE examination PBL: practice-based learning and improvement


Recommended Reading: SBP: systems-based practice

Autopsy Performance and Reporting. College of American Pathologists 2nd ed.

Cause of Death and the Death Certificate. Randy Hanzlick, MD editor College of American Pathologists

Autopsy Pathology: A Manual and Atlas. Finkbeiner et al. 2nd Ed. Saunders Elsevier

Competency Involved Level Aquired

Competency Key:

Autopsy Rotation

Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of adult surgical

specimens in a timely manner; to interact appropriately and professionally with physicians,and other relevant persons and

agencies


Show proficiency in gross techniques, initial handling of specimens, understand and demonstrate gross exam a a a a a a






Enumerate potential areas of specimen contamination along processing, discuss ways of troubleshooting for errors a a a a

Distinquish between special stains, enzyme histochemistry and immunohistochemistry, be able to list all stains a a

Know special stains used for diagnosis of various infectious organisms (fungal, mycobacterial, bacterial, etc.) a a a

Demonstrate ability to generate meaningful antibody panels that are appropriate for diagnosis a a a

Be able to accurately describe light microscopic features of neoplasms and other disease entities a a a a

Be able to generate meaningful differential diagnoses in tumor diagnoses a a a a

Generate appropriate surgpath report, using correct terminology, including necessary parameters to stage tumor a a a a a

Be able to classify disease processes and neoplasms of Bone and Soft Tissue a a a a

Enumerate and describe the microscopic features of different types of soft tissue neoplasms, know grading a a a a

Give a classification of the disease entities of bones and joints, inflammatory, degenerative, tumors etc. a a a a

Gross & Signout Schedule: Thursday and Friday (Start at Noon); Signout Everyday

Evaluation tools:







Generals Rotation


Competency Key:

Goals:



agencies















Be able to classify disease processes and neoplasms of the breast a a a a

Classify and discuss the diagnostic criteria of breast cancer a a a a

Know the breast cancers of special type a a a a

Know the grading systems of breast carcinoma a a a a

List and discuss the common non-neoplastic diseases of the breast a a a a

Classify and discuss the diagnostic criteria of breast cancer a a a a

Compare and contrast breast proliferative lesions: Duct hyperplasias, ADH, FEA, DCIS, LCIS a a a a

Gross & Signout Schedule: Monday and Tuesday Gross; Signout BX Wednesday, Bigs Thursday and Friday

Evaluation tools:







Breast Rotation


Competency Key:

Goals:

Develop expertise in the methodological, diagnostic, scientific, and management aspects of blood bank/tranfusion medicine

Competence in integrating diagnostic results and arrive at proper conclusions necessary for the diagnosis and treatment of transfusion and

coagulation problems.

Have appropriate and professional interactions with physicians, families and other relevant persons and agencies.

Competence with quality systems, quality management, quality assurance, and quality control in the regulatory environment of the BB/TM

Develop expertise in eliciting patient history and performing physical exam to evaluate patient for BB/TM clinical consultations

Objectives:

MK PC Prof PBL IP/CS SBP PGY-1 PGY-2 PGY-3 PGY-4

Observe, understand and perform (as needed) routine and special procedures in the transfusion service

Manual methods in BB lab: T&S, X-match, Ab-ID, DAT, titer, elution, phenotype, enhanced ID techniques, etc. a a a a

Grading and interpretation of serological reactions, using reagents according to manufacturer's instructions such as in ABO/Rh testing a a a a

Automated methods and technologies in the blood bank with attendant safety and efficiency measures a a a a

Pretransfusion testing and evaluation a a a a

Pretransfusion sample integrity and patient ID a a a a

Principles and practice of administration of blood components a a a a

Post transfusion evaluation, e.g. work-up, management and diagnosis of adverse reactions to blood transfusion a a a a

Understand and apply component therapy principles in transfusion service for:

RBC, Plasma, Platelets, and WBC a a a a

Blood Derivatives; albumin, factor 8, factor 9, Novo7, etc. a a a a

Understand and apply Information Systems principles in transfusion service for:

Software and computer systems for blood bank activities, e.g. transfusion committee, PICG, etc. a a a a a

Learn the basics of bar-code technology and its application in patient, product, and sample identification a a a a a

Understand and apply Blood Management principles in transfusion service for:

Evidence based practice for component therapy a a a a

Alternatives to blood transfusion a a a a

Team based methods of modifying clinical transfusion practice a a a a

Pre, peri, intra, and post operative blood management

Understand and apply quality management principles in transfusion service for

Quality Systems a a a a

Quality Assurance a a a a

Quality control a a a a a

Regulatory issues a a a a a

CAP and other regulatory inspection with understanding of questions - including performing mock inspections a a a a a

Proficiency testing a a a a a

Laboratory PI and BB Method Committee meetings - mandatory attendance a a a a a

Participate in quality improvement and quality assurance activities and projects, e.g. transfusion committee, PICG, etc. a a a a a

Understand and apply blood collection, preparation, and storage principles in transfusion service for:

Donor Selection a a a a

Whole Blood Collection and Component Processing a a a a

Blood Component Collection by Apheresis a a a a

Infectious Disease Screening a a a a


Blood Bank/Transfusion Medicine Rotation

Storage, Monitoring, Pretransfusion Processing, and Distribution of Blood Components a a a a

Donor room operations at NSUH Manhasset (with option to go to community blood center) a a a a a

Understand and apply principles of apheresis in transfusion service for:

Therapeutic Procedures: Plasma and cytopheresis a a a a

Stem Cell Collection a a a a

Understand and apply principles of clinical consultation in transfusion service including activities such as

First call duties during regular working hours a a a a a a a

On-call duties (evening and weekends with on site requirements) a a a a a a a

Maintaining daily "problem and interesting" case list for transfusion service for daily discussion/rounds a a a a a a a

Preparing, including seeing patients on clinical floors, for early AM BB rounds on problem cases a a a a a a a

Writing clinical consultation and orders with Attending supervision a a a a a a a

Consulting on clinically appropriate use of therapeutic phlebotomy and therapeutic apheresis as treatment options a a a a a a a

Coordinating the work-up, management and diagnosis of adverse reactions to blood transfusion a a a a a a a

Knowledgeable about the clinical indications, doses and appropriate laboratory monitoring for all therapeutic blood products a a a a a a a

Understanding the etiology and mechanisms of anemia, thrombocytopenia and coagulopathies and their treatment a a a a a a a

Becoming competent in performing a focused clinical history, physical exam, and developing a plan of care a a a a a a a

Participating in sign-out of panels, transfusion reactions and exception reports a a a a a a a

Teaching responsibilities

Prepare for twice weekly 1:1 session with BB attending a a a a a a

Present two continuing education conference to technologists each month of the rotation a a a a a a

Present 30 minute case discussion to fellow residents on laboratory topic (to be saved on HP shared drive) a a a a a a

Independent reading in Texts: AABB Technical Manual, Practical Guide to TM, Apheresis P&P, Principles of TM a a a a

Professionalism demonstrated by:

Ethical behavior a a

Respects all clients and client information (HIPPA compliant) a a

Commitment to excellence a a

Professional dress and behavior a a

Demonstrates Interpersonal and Communication skills:

Presentations to residents, attendings, and laboratory staff a a a a

On call communication a a a a

Conference presentations a a a a

Uses computer to obtain clinical information for diagnosis a a a a

Interact effectively and appropriately with medical technologists and other laboratory personnel a a a a

Communicate effectively with nursing staff and laboratory personnel to gather and transmit information for patient care a a a a a

Educate other health care providers in a considerate manner when the opportunity arises a a a a

Attend and participate in blood bank/transfusion medicine teaching conferences a a a a a a

Evaluation tools:

Direct observation and feedback

Faculty evaluation MK: medical knowledge

360° evaluation PC: patient care

RISE examination Prof: professionalism




Competency Key:

Transfusion Medicine Rotation 2013-14

Basic Reading list:

1) AABB technical Manual 17th Edition 2011

2) Tranfusion Medicine Self-assessment and Review 2nd Edition Blackall, Figueroa, and Winters 2009

3) Practical Guide to Transfusion Medicine 2nd Edition Petrides, Stack, Cooling, and Maes 2007

4) Apheresis Principles and Practice 3nd Edition McLeod, Szczepiorkowski, Weinstein, and Winters 2010

5) Rossi's Principles of Transfusion Medicine 4th Edition Simon, Synder, Solheim, Stowell, Strauss, and Petrides 2009

6) Transfusion Medicine and Hemostasis Clinical and Laboratory Aspects 2nd Edition Shaz, Hillyer, Roshal, and Abrams 2013

Completion of self assessment sponsored by ASCP is required - link below

Pathologist Recertification Individualized Self-Assessment Examination (PRISE)

Location:

PGY-1 Two Months at LIJMC

PGY-3 One Month at NSUH

PGY-3 One Month at LIJMC

Week 1 Lab objectives Clinical Objectives Reading for 2X/week meetings with Attending

NUMC (3 days) T&S, Ab ID, Compatibity Test, DAT, Elution, Cord Blood, Phenotype Correlation of lab work with case material Practical Guide Chap 3,4,5

LIJMC Session 1: AABB Chaps 6,7

LIJMC Observe, understand and perform routine and special procedures Maintain problem case list Session 2: AABB Chaps 10, 12

Week 2

LIJMC Observe, understand and perform routine and special procedures First Call duties begins Session 1: AABB Chaps 11, 13

Session 2: AABB Chaps 14, 15

Week 3

LIJMC Observe, understand and perform routine and special procedures Review antibody w/u Session 1: AABB Chaps 16, 17

Observe and understand IS issues for BB Complete Transfusion Reaction w/u Session 2: AABB Chaps 8, 27

Week 4

LIJMC Observe, understand and perform routine and special procedures Physical exam and history - Attending observed Session 1: AABB Chaps 20, 21

In-service to BB Staff Session 2: AABB Chaps 18, 19

Week 5

LIJMC Assist BB Mgr in managing lab staff regarding medical issues Write Clinical Consultations - Attending Co-sign Session 1: AABB Chaps 22, 23

Observe and understand IS issues for BB Write Apheresis Orders - Attending Co-sign Session 2: AABB Chaps 24, 28

Week 6

LIJMC Assist BB Mgr in managing lab staff regarding medical issues Session 1: AABB Chaps 25, 29

Session 2: AABB Chaps 26

Week 7

LIJMC Assist BB QA Mgr in QA activity and projects Session 1: AABB Chaps 1, 3

Session 2: RISE Topics Review

Week 8

LIJMC In-service to BB Staff Session 1: RISE Topics Review

Assist BB QA Mgr in QA activity and projects Written and Oral Examination

Final Exam 1) Written and 2) Oral

Week 9

NUMC and Mobile Blood Collection, component production, Trace life of whole blood collection to patient transfusion AABB Chap 5, 6, 9 and PG Chaps 1, 2

NYBC (3 days) donor recruitment, testing, and logistics

NSUH Review laboratory routine and special procedures Refresh clinical skills acquired in 1st two months Session 1: PG 3,4,5

Apheresis and Hospital Donor Room Activity Session 2: PG chaps 7, 8

Week 10

NSUH In-service to BB Staff First Call for donor room medical issues Session 1: PG 11, 12

Apheresis and Hospital Donor Room Activity

Assist Donor Room Manager managing staff regarding medical issues Session 2: PG 15, TMH 18

Week 11 Function as Assistant Director of BB

NSUH Session 1: TMH 47-51

Session 2: TMH 52-56

Week 12 In-service to BB Staff

NSUH Session 1: TMH 57-61


Week 13

LIJMC Literature Search Project - Current TM topic Session 1: TMH 67-71


Week 14

LIJMC In-service to BB Staff Session 1: TMH 76-80


Week 15 Literature Search Project - Current TM topic

LIJMC Session 1: TMH 84-87

Session 2: Journal articles and select textbook readings

Week 16

LIJMC Session 1: Journal articles and select textbook readings

Written and Oral Examination

Final Exam 1) Written and 2) Oral

Revised Feb 10, 2014

http://www.ascp.org/prise

Goals:

Objectives:MK PC Prof PBL IP/CS SBP PGY-1PGY-2PGY-3PGY-4

Be familiar with clinical laboratory regulations & standards; know how they are applied & what constitutes compliance a a a a a

Knows requirements for Standard Operating Procedures (SOP) & reviews these along with other laboratory documents a a a a

Interpretets & applies statistical Quality Control analysis in relation to accuracy & precision requirements for specific tests a a a a a

Know how to establish, verify and evaluate reference ranges for laboratory tests a a a a a

Review, interpret & evaluate Proficiency Test results, calibration verification & linearity studies a a a a a a

Demonstrates knowledge in qualitative & quantitative methods/instrumentation & participates in selecting & validating new methods a a a a a a

Understands & can evaluate specimen variables, interferences & lab errors in all phases of testing a a a a a

Participates in the lab Performance Improvement & Safety processes & PI, operational & methods committee meetings a a a a a a a

Participates in lab management processes including personnel policies, staff development, performance & competency assessment & budget preparation a a a a a a a

Understands the role of Information Technology/computers in providing lab information/results can utilize this technology in problem solving a a a a a a

Understands the importance of critical values & the critical value notification process & can interpret these results in a clinical context a a a a a a

Provides clinical consultations based on lab results, patient history & current evidence based medicine reports a a a a a a

Takes regular rotations being on-call for chemistry & clinical pathology & demonstrating problem solving, consultative skills and presenting problems/cases at the CP on-call conference a a a a a a

Provides continuing education to the lab technical staff by presenting case studies or technical reviews a a a a a a a

Signs out lab reports including SPEP, IFE, Western Blot analysis and interpretation of autoantibody test results a a a a a a a

Participates in basic & clinical research as appropriate a a a a a a

Understands the unique role of the Medical Director and can solve problems & make decisions in that role a a a a a a

Review and evaluate preventive maintenance processes & logs and participate in trouble shooting activities a a a a a a a

Understands the principles & applications of all analytical techniques including ISE, FPIA, EIA, chromatography, nephelometry/turbidimetry, spectrophotometric, mass spectroscopy & atomic absorptiona a a a

Demonstrates competence in interpreting test results to assess disease processes and understanding the limitations of methodology/instrumentation utillized in the following areas:

1. Liver & pancreatic function tests a a a a a

2. Cardiac enzymes & markers of cardiac injury & risk stratification a a a a a a

3. SPEP & the major serum proteins a a a a a

4. Renal function tests a a a a a

5. Toxicology, Therapeutic Drug Monitoring and Trace Element Analysis a a a a a

6. Dyslipoproteinemias a a a a a

7. Diabetes, HgbA1c and carbohydrates a a a a a

8. Endocrinology of thyroid, adrenals & pituitary a a a a a

9. Markers of bone resorption and formation a a a a a

10. Vitamins, iron and porphyrins a a a a a

11. Tumor markers a a a a a

12. Pregnancy evaluation including maternal serum screening & fetal lung maturity testing a a a a a

13. Disorders of inborn errors of metabolism (biochemical genetics) a a a a a

14. Autoantibody testing including ANA, ANCA & other IFA tests a a a a a

15. Automated EIA Serology tests for viral diseases a a a a a

16. Manual Serology tests including dsDNA, Lyme Western Blot & heterophile antibodies a a a a a

17. Allergy testing (ImmunoCap) a a a a a

18. Manual & automated urinalysis with microscopy a a a a a

19. Point of Care Testing a a a a a

20. Cystic Fibrosis & Sweat Chloride testing a a a a a

21. Parathyroidectomy and Intraoperative PTH testing a a a a a

Pathology Board exam review and knowledge-base assessment a a a a a a

Perform mock CAP inspection and/or participate in a real Cap inspection if possible a a a a a a

Evaluation tools:







Competency Required Level Aquired

NS-LIJ CLINICAL CHEMISTRY ROTATION

Competency Key:

The clinical chemistry resident rotation is a four and a half month rotation comprised of a two month sequence followed by two separate one month periods wherein one week of this time is spent in forensic toxicology at the Medical Examiners Lab. There is an

additional two week rotation in serology/immunology at the Core Lab usually in the 3rd or 4th year. The goal of these rotations is to provide a comprehensive overview of subjects relating to pathology and clinical laboratory practice. This will provide a basis for

residents to be successful on the CP section of the board exam, as well as develop into clinicians who are able to evaluate, provide clinical consultation to others, promote laboratory improvement, and assist in the implementation of new laboratory testing. The

Clinical Chemistry rotation is designed to provide training and competency in various aspects of the field, including understanding the pathophysiology of various disease states and the diagnostic utility of tests used to evaluate these disease states. An additional

focus is to provide the opportunity for residents to become acquainted with the research process and scientific presentation of research. This rotation encompasses the clinical chemistry, immunology/serology, clinical & forensic toxicology, urinalysis and point of

care testing areas.

Goals:

The resident on rotation is to gain an understanding of daily laboratory function with focus on

medical lab management from the perspective of a medical lab director. The rotation includes

specific opportunities for learning about the management side of the resident’s specific career

interest areas.


Demonstrates knowledge of the business model of the laboratory: including staffing, sales,

negotiation, expenses, equipment, accounting, billing, and coding. a a a a a

Attends management conferences which impact the function of the Laboratory and/or affect the

future outlook of the industry.a a a a a

Demonstrates an understanding of the political and national issues relating to laboratory

medicine.a a a a a

Participates in interdepartmental meetings where lab administration and clinical medicine

practitioners discuss practical laboratory issues related to testing and results.a a a a a

Actively participates in projects related to individual resident interests and career advancement.

The rotating resident is encouraged to identify their specific interests in Pathology and pursue

administrative and management aspects of those interests.

a a a a a

Demonstrates and understanding of new technology, systems, and integration of novel

laboratory tests and ideas.a a a a a

Evaluation tools:





Pre and Post Tests IP/CS: interpersonal and communication skills


Clinical Laboratory Management Rotation

Competency Key:


Goals:

To obtain a working knowledge of the basic science and technologies involved in cytogenetic and molecular cytogenetic

testing of patients for inherited and acquired genetic disorders

To obtain an understanding of the laboratory techniques and tests used in clinical cytogenetics and molecular

cytogenetics, their applications and limitations

To gain knowledge of each of the three different branches of clinical cytogenetics; prenatal, constitutional and oncology

and the challenges unique to each branch

To learn about molecular cytogenetic methods including fluorescence in situ hybridization (FISH), comparative Genomic

Hybridization (CGH), microarray technology, and other newly developed technologies

To use the knowledge gained to integrate the cytogenetic and molecular cytogenetic results with morphologic, clinical, and other

relevant laboratory data to arrive at a single interpretation for diagnostic and prognostic purposes.

To understand the organization and running of a Cytogenetics laboratory


Begin rotation in the accession area and follow all specimen types from set up to sign out a a a a

Know the specimen requirements for cytogenetic and molecular cytogenetic testing a a a a

Determine the reason for referral and obtain clinical information on patients referred for cytogenetic testing as needed a a a

Determine appropriate testing methodology based on clinical indication provided; cytogenetics only or cytogenetics and

FISH for initial diagnosis, FISH for follow up visits, etc.a a a a

Learn about culture specifications for different specimen types, limits of testing, and additional testing needs a a a a

Initiate a culture of their own peripheral blood, harvest, and G-band the metaphases. a a a a

Perform microscopic analysis and karyotype metaphase cells using an image analysis system under direct supervision a a a a a

Use the International System for Cytogenetic Nomenclature (ISCN) to describe both normal and abnormal karyotypes a a a a

Learn the common numerical and structural chromosomal abnormalities associated with genetic diseases a a a

Correlate karyotypic abnormalities in constitutional disorders with phenotype, risks, family history, and prognosis. a a a a

Learn the major recurrent karyotypic abnormalities associated with leukemias, lymphomas and solid tumors, and their

utilization in the subclassification of diseases, therapy planning and prognosticationa a a a

Correlate karyotypic abnormalities in hematopoietic neoplasms and solid tumors with response to treatment and disease

prognosis.a a a a a

Understand the principles of FISH, the various types of probes currently used, their validation and use in various

specimen types including archival tissuea a a a

List the commonly used FISH probes used in prenatal diagnosis and the diagnosis of constitutional disorders a a a

List the FISH probes used individually and in Panels in the detection of chromosomal abnormalities in hematopoietic

malignanciesa a a a

Learn to interpret cytogenetic and molecular cytogenetic results in relation to morphologic, clinical and pathological

findingsa a a a a a a

Describe potential problems in the interpretation of cytogenetic and FISH data for hematopathological specimens. a a a a a a

Understand the use of cytogenetic and molecular cytogenetic testing in the diagnosis and management of disease and

the relationship/overlap between this testing and other laboratory tests including microarrays, molecular, flow cytometry,

hematopathology, histopathology, etc.

a a a a a

Review cases with the Director(s) as they interpret and sign out cases a a a a a a

Learn to read the Cytogenetic report and discuss the findings with referring physicians a a a a a

Learn to interact effectively and appropriately with technologists and other laboratory personnel a a a

Perform literature searches with regard to difficult/unusual cases and discuss the findings with the Director and Staff a a a a a

Explain the cost effective utilization of cytogenetics/FISH in the diagnosis of hematopoietic neoplasms. a a a a a

Understand the Certification, QA, QC, and QI requirements of a cytogenetics laboratory a a a a

Know the basic Cytogenetics standards of various certifying agencies, CAP, NYS DOH, CLIA, and Proficiency testing a a a a a a

Give a 30 minute presentation to technologists on a related topic selected in consultation with the Directors for CME a a a a

Evaluation tools:



Presentation Prof: professionalism

Examination PBL: practice-based learning and improvement



Cytogenetics Rotation


Competency Key:

Goals:

To acquire and refine the knowledge of cytopathology as necessary for the up-to-date practice of pathology.

To demonstrate diagnostic competency in cytopathology.

To develop the skills to oversee cytopathology operations in a pathology laboratory.

To demonstrate responsibility and high ethical standards in providing patient focused care.

Objectives: MK PC Prof PBL IP/CS SBP PGY-1 PGY-2PGY-3PGY-4

Define & list 2001 Bethesda terminology in reporting GYN Cytology √ √Recognize benign process, infectious agents, LSIL, HSIL, and malignant cell changes in gynecological cytology √ √Recognize & describe normal cytomorphology of all body sites √ √Recognize & describe benign proliferative, inflammatory, pre-malignant, and malignant cell changes in all body systems √ √Describe cytologic patterns associated with infections, various infectious agents, chemotherapy agents, and radiation √ √Acquire appropriate knowledge in interpretation of Non-gynecological specimens (i.e.-effusions, urines, csf, & bronchial specimens) √ √Acquire appropriate knowledge in interpretation of FNA specimens √ √Define & recall cytopathology preparatory techniques, and appropriate submission of various samples √ √Define & list NCI guidelines of standardized thyroid FNA terminology √ √Recognize the role of special diagnostic techniques, including immunocytochemistry, flow cytometry and molecular analysis in the work- √ √Acquire proficiency in FNA procedures recognizing its use & limitations √ √Function independently to assess adequacy, communicates clearly with clinicians, and demonstrates appropriate level of confidence √ √Obtain pertinent clinical & radiologic data, prepare smears, & triage cytologic material during FNA procedures √ √Comprehend regulatory issues relevant to a cytopathology service, including retention of slides & reports √ √Outline QA & QC procedures in cytopathology (i.e.- cyto/histo correlations, retro-review, etc) √ √Participate in cytopathology quality assurance program & interdepartmental conferences √ √Acquire and correlate information on selected and complex cases, such as cases for presentation at conferences √ √Comprehend importance of verifying accuracy of information provided on requisition, slide labels and reconciling discrepancies √ √Assume responsibility for screening, documenting interpretation , and signing out cases with Cytopathologist √ √Demonstrate understanding of how Cytopathology diagnosis affects health care decisions for clinicians & patients √ √Demonstrate ability to use literature search to aid in learning & workup of cases √ √Demonstrate ability to investigate & evaluate cases & assimilate scientific evidence (i.e.- journal club) √ √Present prepared & completed project as Cytopathology Conference at the end of rotation √ √Operate laboratory information system for searching of previous pathology reports, editing of reports, & correlating with current histology √ √Attend weekly cytopathology conferences √ √Demonstrate understanding of limitations of cytopathology & when cytopathology is beneficial & cost effective decision for patient and √ √Operate & apply proper use of ancillary testing (i.e.- immunocytochemistry, flow cytometry, genetic studies) √ √Comprehend departmental performance improvement, quality assurance, & quality control procedures √ √Demonstrate awareness and responsiveness to the larger context and system of health care and the ability to call on system resources √ √List & differentiate federal CLIA' 88, JCAHO, CAP, & NY state regulations √ √Demonstrate caring and respectful behaviors when interacting with physicians, patients, and patient families √ √Display ability to clearly explain FNA procedure & obtain consent & time out procedures with an appropriate level of confidence √ √Gather & record essential & accurate information from physicians & patients √ √Display ability to advise other physicians in the appropriate technique for obtaining an adequate specimen √ √Compile all pertinent information (i.e.- clinical history, radiologic findings, surgical reports) on cases examined √ √Work with health care professionals to provide patient-focused care √ √Demonstrate knowledge of psychosocial & cultural factors influencing technical & clinical staff, as well as patients √ √Accept criticism & follow advice √ √Interact well with other health care professionals, technical, lab assistants and clerical staff √ √Demonstrate initiative and independence in performing duties √ √Demonstrate responsibility in completing tasks within a timely manner √ √Conduct patient care activities with high ethical standards & accepts responsibility √ √

Evaluation tools:





Daily interactions/question and answer during sign-out IP/CS: interpersonal and communication skills

End-of-rotation evaluation SBP: systems-based practice

Weekly case presentations

Cytopathology Rotation


Competency Key:

Goals:

To train residents to be able to 1) interpret biopsies of common skin diseases; 2) gross skin specimens; 3) understand histological

preparation and commonly used special procedures and their uses in diagnostic dermatopathology.

Objectives MK PC Prof PBL IP/CS SBP PGY-1 PGY-2 PGY-3 PGY-4

Define the histologic criteria for the diagnosis of melanocytic nevus and melanoma a a a a a a a

Define the histologic criteria for the diagnosis of squamous cell carcinoma, basal cell carcinoma, seborrheic keratosis, verruca

vulgarisa a a a a a a

Define the histologic criteria for the diagnosis of bullous pemphigoid, pemphigus, herpes virus infection, erythem multiforme,

dermatophytosis, psoriasis, dermatitis herpetiformisa a a a a a a

Know when and which special histochemical or immunohistochemical stains should be utilized in dermatopathology diagnosis a a a a a a

Be able to interpret special stains and panels in relation to dermatopathology differential diagnoses a a a a a a

Become proficient in gross examination, sectioning and appropriate sampling of cutaneous specimens a a a a a a a

Gross & Signout Schedule: Gross every day 1(Afternoon) of 4 weeks; Signout every day

Evaluation tools:

Direct observation and feedback during daily sign-out MK: medical knowledge






Dermatopathology Rotation


Competency Key:

Goals

To introduce residents to medicolegal autopsies via attendance and participation in specific sections of the Nassau

County Medical Examiner

Objectives MK PC Prof PBL IP/CS SBP PGY-1 PGY-2 PGY-3 PGY-4

Participates in the forensic autopsy under the supervision of the forensic pathologist a a a a a a a

Participates in the in-house investigative process familiarizing himself with the circumstantial information of each casea a a a a a

Demonstrates knowledge of: a. Investigation and examination of the body

b. Examination of evidence collected from the scene

c. The importance of documentation

d. Correlation of the circumstances, the pathological findings and laboratory testing (toxicolo

a a a a a a a

Attends four hours of lectures on selected topics in Forensic Pathology provided by a forensic pathologist from the

Medical Examiners’ Officea a

Evaluation tools:



RISE examination Prof: professionalism




Forensic Pathology Rotation

Competency Key:


Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of specimens

received for frozen sections and communicate the results to the clinician.




Demonstrate ability to prepare, cut and stain frozen sections in a timely manner, triage specimens for cytogenetics, flow, EM a a a a a

Show ability to do "touch" or "squash" prep for sentinel lymph node and brain biopsies a a a a a




Show ability to perform interpretation of frozen sections with supervision and communicate results to surgeons a a a a a a a

Demonstrate ability to consult frozen sections utilizing telepathology a a a a a a a

Utilize the frozen section diagnostic tracking form to record all diagnosis and then correlate with frozen section attending

pathologist diagnosis and ultimately signout diagnosisa a a a a a a

Evaluation tools:







Frozen Section Rotation


Competency Key:

Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of adult

surgical specimens in a timely manner; to interact appropriately and professionally with physicians,and other relevant

persons and agencies















Be able to classify disease processes and neoplasms of the GI tract a a a a

List and describe the diseases of esophagus, including infectious and malignant processes a a a a

Describe diagnostic criteria of Barrett's esophagus, dysplasia arising from metaplastic mucosa and risk of carcinoma a a a a

List and describe the histologic features of different kinds of chronic gastritis, including atrophic gastritis a a a a

Describe the different types of gastric neoplasms, lymphomas, GIST, etc, and understand the role of H. pylori in ca a a a a

describe the histologic features of colonic adenocarcinoma, carcinoid tumors, small and large intestinal stromal tm a a a a

Classify and describe the features of inflammatory bowel disease (crohn's, ulcerative colitis, microscopic colitis, etc.) a a a a

List and describe other colitides including ischemic, infectious, drug related and others a a a a

Classify and describe the pathologic features of pancreato-biliary neoplasms a a a a

Enumerate and describe the features of different forms of viral and non-viral hepatitis, neonatal hepatitis a a a a

Describe the features of metabolic/inherited forms of liver diseases (Wilson's, hemachromatosis, etc.) a a a a

Give a classification and/or cause of liver cirrhosis a a a a

Indicate and describe different types of benign and malignant liver neoplasms a a a a

Gross & Signout Schedule: Tuesday and Gross; Signout BX Thursday, Bigs Friday and Monday

Evaluation tools:







Generals Rotation


Competency Key:

Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of common

diseases seen in the female genital tract system in a timely manner; to interact appropriately and professionally with

physicians,and other relevant persons and agencies.

Objectives: MK PC Prof PBL IP/CS SBP PGY-

1

PGY-2 PGY-3 PGY-4

Show proficiency in handling and submission of small endometrial, cervical, vaginal and vulvar biopsies for histologic

processing

a a a a a

Show proficiency in gross technique and initial handling of cervical cone excision, hysterectomy, salpingo-oophorectomy and

vulvectomy specimens; Understand and demonstrate gross exam of various specimens for benign conditions as well as for

malignancies

a a a a a a

Be able to orient large Gyn specimens, describe and measure polyps, leiomyomas, endometrial cancer, ovarian cystic and

solid tumors and take appropriate sections for microscopy

a a a a a a


Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a a a

Gather all relevant information (ie clinical history, previous pathology, surgical/clinical reports, discussion with clinicians if

needed) for cases which have assigned to the resident, organize slides, and be ready for sign-out.

a a a a a a a

Demonstrate knowledge of the normal histology of gyn organs versus abnormal/tumor histology. a a a a a

Be able to accurately describe light microscopic features of neoplasms and other disease entities a a a a a

Generate appropriate pathology report, using correct terminology and including necessary parameters to stage cancers of the

cervix, endometrium, ovary and vulva

a a a a a a

Demonstrate ability to prepare, cut and stain good frozen sections of endometrial curettge, endometrial carcinomas, ovarian

tumors and lymph nodes in a timely manner under supervision of attending pathologist

a a a a a a

Be able to communicate with surgons and discuss frozen section diagnosis under supervision of attending pathologist a a a a a a a

Be able to interprete histologic sections of endometrial biopsies for abnormal bleedings, recognize dysfuntional and non-

dysfunctional causes

a a a a a a

Be able to recognize features of dysplasias, AIS, invasive squamous cell carcinoma and adenocarcinomas in cervical

biopsies, understand role of HPV in cervical carcinogenesis

a a a a a a

Be able to differentiate CIN from benign mimickers, know the common immuno markers used a a a a a a

Be familier with common vulvar conditions including lichen sclerosis and VIN a a a a a a

Understand endometrial carcinogenesis and know the fundamental difference between type I and type II cancer a a a a a a

Be able to show work-up strategy to differentiate endometrial cancer from endocervical cancer in biopsy or curettage

specimen, including anxillary studies if needed

a a a a a a a a

Be able to diagnose benign diseases in hysterectomy specimen (leiomyoma, adenomyosis, endometrial polyp etc.) a a a a a a

Be familier with diagnostic criteriea for uterine leiomyosarcoma a a a a a

Know the difference between endometrial stromal nodule and endometrial stromal sarcoma a a a a a a

Understand and be able to diagnose the most common benign ovarian cyst/mass (functional cyst, benign epithelial tumors,

etc.)

a a a a a

know the criteria to diagnose ovarian borderline tumors and invasive epithelial carcinomas a a a a a

know the classifications and histologic grading of ovarian epithelial carcinomas a a a a a

Be familiar with current understainding of ovarian/peritoneal carcinogenesis and fundamental difference between type I and

type II pathways

a a a a a

Undestand the rationale for prophylactic salpingo-oophorectomy in patients with BRCA mutation and know the importance of

adequate grossing technique (SEE FIMB protocol)

a a a a a a

Be able to differentiate metastatic tumors involving the ovary from primary ovarian epithelial neoplasms a a a a a a

List and describe the most common benign and malignant germ cell tumors in the ovary a a a a a

Know the features of most common sex-cord stromal tumor of the ovary a

know common lesions in peritoneum including endometriosis and understand the concept of second mullerian system a a a a a a

Be able to recognize chorionic villi in product of conception or ectopic pregnancy, understand clinical implication if no

chorionic villi identified and act appropriately in a timely fashion to discuss with submitting clinician

a a a a a a a a

Attend multidisciplinary Gyn tumor boards (Wednesdays from 10-11 AM). a a a a a a a a

Attend Gyn quality assurance conference and journal club. a a a a a a a

Stronly encurage participation in research project as related to Gyn pathology. a a a a a

Gross & Signout Schedule: Monday and Tuesday Gross; Signout BX Wednesday, Bigs Thursday and Friday

Evaluation tools:







Gynecologic Pathology Rotation


Competency Key:

Goals:



agencies















Be able to classify disease processes and neoplasms of the Head and Neck region a a a a

Know and be able to identify the common head and neck and oral tumors a a a a

Classify and enumerate the diagnostic features of benign and malignant salivary gland tumors a a a a

Classify and discuss the microscopic features of sino-nasal polyps, benign and malignant tumors a a a a

Gross & Signout Schedule: Monday and Wednesday Gross at LIJ (Start at Noon); Signout Everyday

Evaluation tools:







Head and Neck Rotation


Competency Key:

Goals:

To develop expertise in the methodological, diagnostic and management aspects of the clinical hematology laboratory

Objectives: MK PC Prof PBL IP/CS SBP PGY-1/2 PGY-2/3 Assessment

Observe and understand:

Manual methods in hematology lab: ESR, retic count, manual cells counts (WBC, plt, fluids), cytospin a a a a

Principles of automated cell analysis a a a a

Robotics and middle ware use a a a a

Interpretation of:

Peripheral blood a a a a

CSF and body fluid a a a a

Hemoglobin electrophoresis, HPLC, IEF, solubility a a a a

Understand use of QC and QA in the hematology laboratory a a a a

Observe and understand principles and interpretation of:

PT, PTT, fibrinogen, thrombin time, Ddimer, mixing studies a a a a

Factor assays a a a a

Lupus anticoagulant testing a a a a

Platelet aggregation a a a a

Thrombosis evaluation a a a a

Develop skills in interpretation of:

Bone marrow aspirate and biopsy, iron stores, cytochemistry a a a a

Flow cytometry principles and interpretation of PB, fluids, bone marrow, tissues, FNA a a a a

Performance of flow panel a a a a

Perform mock CAP inspection with understanding of questions a a a a a a a

Understand proficiency testing a a a a

Present continuing education conference to technologists a a a a a a

Independent reading in Henry, Foucar, Coagulation a a a

Attend laboratory PI and Hematology Method Committee meetings a a a a a

Present 30 minute case discussion to fellow residents on laboratory topic (to be saved on HP shared drive) a a a a


Ethical behavior a a

Respects all clients and client information (HIPPA compliant) a a

Commitment to excellence a a

Professional dress and behavior a a


Presentations to residents, attendings, and laboratory staff

On call communication and conference presentations a a

Uses computer to obtain clinical information for diagnosis a a a a

Interact effectively and appropriately with medical technologists and other laboratory personnel a a a a a

Attend and participate in Check Sample, Checkpath, microscopy ;and hematology teaching conferences a a a a

a a a a a a

Evaluation tools:

Direct observation and feedback

Faculty evaluation MK: medical knowledge

RISE examination PC: patient care





Clinical Hematology/Hematopathology Rotation

Level Aquired Competency Involved

Competency Key:

Name Clinical Hematology/Hematopathology Rotation 1

Lab objectives Clinical Reading (All mandatory; bold even more than)Week 1 Manual methods in hematology lab: Peripheral blood/fluid study set Intro to Hematopoiesis

NS ESR, retic count, manual cell counts, Bone marrow study set Foucar: Ch1,2

(WBC, plt, fluids), cytospin Review current slides: PB, Hematopoiesis

Normal and abnormal PB fluids, bone marrow cases Bone marrow exam

CAP: Color Atlas of Body Fluids

CAP: Color Atlas of Hematology

WHO Classification of Tumours

ASCP: 6415 Non-neoplastic BM: Rdrive

Week 2 Principles of automated cell analysis Review current slides: PB, Henry: Basic Methodology automated methods

LIJ Robotics and middle ware use fluids, bone marrow cases Henry: Anemia, RBC membrane, metabolism,

Hemoglobin electrophoresis, HPLC Sign out hemoglobin electrophoresis globin synthesis and hemoglobinopathies/

IEF, solubilitiy thalassemias

CAP: Color Atlas of Hemoglobin disorders

Foucar: Anemia, aplastic, erythroblastopenic disorders

erythrocytosis

CAP Checklist/Inspection (R drive, LIJ pathology as below

Week 3 Hematology QC at NS, LIJ, Core Review current slides: PB, As above

LIJ Understand proficiency testing fluids, bone marrow cases

CAP checklist Sign out hemoglobin electrophoresis

Week 4 Observe/interpret platelet aggregation Review current slides: PB, As above

NS/6 ohio fluids, bone marrow cases

Sign out hemoglobin electrophoresis

and platelet aggregation

Week 5 Bone marrow aspirate, biopsy, iron stores Review current slides: PB, Henry: Leukocytic non-neoplastic and neoplastic

NS/6 ohio cytochemistry fluids, bone marrow cases Foucar, Henry, WHO: Myeloproliferative,

Flow cytometry principles and Sign out hemoglobin electrophoresis MDS, AML, plasma cell dyscrasias,

interpretation of all specimens lymphoproliferative disorders

Carey et akL Flow Cytometry in Clinical Diagnosis

Week 6 Perform flow panel Review current slides: PB, Review of flow cytometry principles

NS Understand subset analysis and CD34 fluids, bone marrow cases 2006 Bethesday Flow cytometry (R drive, LIJ pathology

quantitation Sign out hemoglobin electrophoresis Teaching files/clinical pathology/hematopathology/

hematology references

Flow cytometry (Blood): Rdrive, as above

Week 7,8 Routine coagulation: PT, PTT, fibrinogen Sign out hemoglobin electrophoresis Henry: Coagulation Chapters

CORE D Dimer, thrombin time, mixing studies and platelet aggregation Kottke-Marchant: Algorithmic Approach

Factor assays, lupus anticoagulant to Hemostasis Testing

and specific inhibitors Laboratory Procedure manuals

Platelet aggregation

Thrombosis evaluation: Proteins C, S,

AT3, APC resis/Factor V Leiden,

Prothrombin gene mutation

QC in coagulation

CAP checklist

Week 9 Hemoglobin, bone marrow Present 30 minute comprehensive

6 Ohio case study of laboratory or BM topic

CHOOSE ONE: RISE TOPICS for reviw

1. Automated: Calculated parameters, indicies, spurious

results (high and low MCHC), cold agglutinin,

low platelet, laboratory reporting

2. RBC morphology: Drying artefact, Pyropoikilocytosis

(HE) pathophysiology, Parvovirus morphology, TTP,

H10-5 Babesiosis

3. Hgb electrophoresis methods and findings: CEA, CA,

HPLC, IEF, for common variants

4. Hgb SC and CC: morphology and clinical; H08-3

Sickle cell disease

1. Tests used in anemia diagnosis: Ret. Production index,

Soluble transferrin receptors, serum ferritin in iron deficiency

and inflammation (normal), hepcidin lever production and ACD

2. Testing for megaloblastic anemia, B12 and folate, other

causes of megaloblastic morphology

3. WBC morphology and function: Hereditary disorders,

May-Hegglin, Chediak-Higashi, Alder Reilly, Pelger-Huet,

Human erlichiosis

1. CML, chronic, accelerated, blast; genetics, treatment

2. JAK2, Megakaryocyte MPD morphology (WHO), H06-6 MPD

3. H11-6 SMCD-ANMCD, 05-5 CEL

4. 07-8 CMML, 08-6 JCMML

1. Causes of ring sideroblasts, RAEB-1 (WHO summary)

compare to MDS; H09-7 RARS-T

2. 07-6 APL, AML t(9;11)

3. AML with inv(16), 07-2 M7

4. Immunophenotype of B-ALL, hematogone, T-ALL (selected

WBC disorder teleconference review

1. 08-4 CLL, 11-5 B PLL

2. 09-1 LPL, 10-3 Multiple myeloma

3. 09-5 Hairy cell leukemia, 06-8 Burkitt lymphoma

4. 07-4 LGL, T-PLL morph and review

1. Review of APTT and PT and factors affecting, TM11-2

Screening coagulation tests

2. Thrombin time, reptilase time, heparin, anti-Xa testing

for LMW heparin, testing for HIT (PF4 Elisa)

3. H10-2 Vitamin K, CC10-3 INR, TM10-2 Coumadin

4. 08-7 Factor XI deficiency, 08-2 Factor 8 assays.

DIC: pathophysiology and diagnosis

1.vWD: classification, 2A, 2B clinical and laboratory diagnosis,

treatment, 10-8 Acquired vWD

2. Platelet function and aggregation, testing

09-4 Glanzmann's, 08-3 Acquired platelet disorders

3. Criteria for lupus anticoagulant, 08-5 APS, CC11-3 APS

4. Algorithm for congenital hypercoagulable state (testing)

Name:

Laboratory assignments: Clinical Hematology/Hematopathology rotation 1

Date completed

1. ESR

2. Manual WBC, PLT, fluids

3. Cytospin

4. Manual reticulocyte count

5. Automated cell counter including differential and reticulocytes

6. Robotics and middle ware

7. Normal and abnormal peripheral blood smear

8. Hemoglobin electrophoresis, HPLC, IEF, solubility

9. Hematology QC methods

10. PT, APTT, fibrinogen, Thrombin time, DDimer, mixing studies

11. Factor assays, specific and non-specific lupus like inhibitors

12. Platelet aggregation

13. Thrombosis evaluation

14. CAP inspection checklist

15. Flow cytometry panel

Goals:

To train residents in the interpretation and diagnosis of hematopathology specimens including peripheral blood, bone marrow aspirates

and biopsies, lymphoid tissue with integration of morphologic, immunophenotypic, and molecular diagnostic findings

Objectives: MK PC Prof PBLIP/CS SBP PGY-1/2 PGY-2/3 Assessment

Recognize normal organ morphology grossly and microscopically a a

Identify abnormal organ/tissue morphology in hematopathology specimens and know how to sample a a a a

appropriately for histological or other examination (e.g. flow cytometry, cytogenetic, molecular)

Prepare and stain touch imprints of lymph node a a a a

Develop further skills in morphologic interpretation of

peripheral blood smears, bone marrow aspirates and biopsies, cytochemical stains a a a a a

Participation in clinical Hematology/Oncology Service and observe/perform bone marrow procedures a a a a a a a

Further develop skills in interpretation of flow cytometry of:

Peripheral blood, fluids, tissues, bone marrow, FNA a a a a a

Interpret morphology of

Lymph nodes, spleens, and other hematopathologic surgical pathology specimens (reactive and neoplastic) a a a a a

Classify tumors of hematopoietic and lymphoid tissue according to the WHO classification a a a a a

List and interpret common immunohistochemical stains used in the diagnosis of malignant lymphoma and acute leukemia a a a a a

Understand cytogenetic, FISH and molecular methods and application to hematopathology a a a a a

Prepare accurate and concise diagnostic pathology reports for hematopathology specimens that include pertinent information a a a a a a a

from immunophenotyping (flow cytometry and IHC), cytogenetics, and molecular diagnostics.

Present and discuss hematopathology cases at divisional and intradepartmental conferences a a a a a a

Present 30 minute case discussion to fellow residents (on HP shared drive) a a


Ethical behavior a a a

Respects all clients and client information (HIPPA compliant) a a a

Commitment to excellence a a a

Professional dress and behavior a a a


Presentations to residents, attendings, and laboratory staff a a a

On call communication and conference presentations a a a a a

Uses computer to obtain clinical information for diagnosis a a a a a a

Interact effectively and appropriately with medical technologists and other laboratory personnel a a a a a

Attend and participate in Check Sample, Checkpath, microscopy ;and hematology teaching conferences a a a a a a a

Evaluation tools:







Diagnostic Hematopathology rotation


Competency Key:

Name Hematopathology Rotation 2 WEEKLY TOPICS

Week 1 Lab objectives Clinical Reading

LIJ Flow cytometry review Review Bone marrow study set WHO: Classification of Tumours 1. Review of follicular lymphoma, LN, bone marrow,

Touch imprints of lymph nodes Lymph node/hemepath study set Ioachim: Lymph node Pathology genetics, FISH etc

Recognize normal and abnormal Sign out current cases: BM, LN, Foucar: Bone Marrow Pathology

organ morphology grossly and surgical hemepath cases Carey: Principles of Flow Cytometry 2. 10-4 ENMZL, 10-3 mantle cell lymphoma

microscopically Sign out flow cytometry

Sample for flow, histology, cytogenetic Sign out immunohistochemistry 3. 08-1 Kikuchi's, Cat scratch fever, reactive viral

molecular

4. Hodgkin's: NLP, Classical, LN morphology review

Week 2 Review of cytogenetic, molecular and Review Bone marrow study set as above

NS FISH testing Lymph node/hemepath study set 5. Marginal zone lymphoma: WHO review

Flow cytometry review Sign out current cases: BM, LN,

surgical hemepath cases 6. 08-1 ALK+ B cell lymphoma

Observe, perform BMA and BMB Sign out flow cytometry

Sign out immunohistochemistry 7. Angioimmunoblastic T cell lymphoma: WHO review

Weeks 3-8 Case sign out Sign out current cases: BM, LN, as above 8. Nasal NK/T cell lymphoma: WHO review

6 Ohio Correlation with flow cytometry, surgical hemepath cases

immunohistochemistry Sign out flow cytometry 9. 06-7 Sezary, cutaneous lymphoma

Sign out immunohistochemistry

10. 11-1 CD15 in Lymph nodes

Week 9 Case sign out Sign out current cases: BM, LN, as above

6 Ohio Correlation with flow cytometry, surgical hemepath cases 11. 07-1 HLH

immunohistochemistry Sign out flow cytometry

Sign out immunohistochemistry

Present 30 minute comprehensive

case study of hematopathology topic

Name:

Laboratory assignments: Diagnostic Hematopathology Rotation 2

Date completed

1. Touch imprints of lymph node, bone marrow

2. Grossing of hematopathology specimens: lymph node, spleen

3. Flow cytometry review

Goals:

To train residents to identify medical important bacteria, fungi, and parasites; recommend appropriate specimens and tests; competently examine, interpret

and report gram stain findings and results of stains for acid-fast bacilli; interpret and report antimicrobial susceptibility test results


Review the clinical presentation, pathogenesis, and treatment of common infectious diseases caused by bacteria, mycobacteria, fungi, and parasites a a a a a a

Provide clinical advice to physicians and nurses, graduated with experience, for appropriate tests and specimen collection a a a a a a a

Interpret and communicate to physicians, graduated with experience, the clinical significance of organisms isolated from various body sites a a a a a a a

Learn proper method of handling infectious agents/chemicals, biosafety levels, waste disposal, and overall lab safety a a a a a

Learn the appropriate specimen collection and transport conditions for common pathogens a a a a

Understand the procedure and work flow for each bench (blood culture, respiratory, wounds, respiratory, etc) a a a a a

Learn the quality control requirements for testing in all areas of the microbiology laboratory a a a a a

Learn different types of media and incubation conditions for bacteria including fastidious organisms a a a a

Become proficient in preparing and interpreting Gram stains of clinical specimens a a a a

Describe typical Gram stain appearance, colony morphology, and hemolysis patterns for commonly isolated gram-positive and gram-negative pathogens. a a a a

Recognize important biochemical reactions used to identify common bacterial pathogens a a a a

Describe characteristics of pathogens that could be used as agents of bioterrorism a a a

Discuss non-culture-based testing methods including antigen tests, serology, and molecular that are available for diagnosis of major bacterial pathogens a a a a a

Review antimicrobials, their mechanisms of action, and become familiar with the CLSI guidelines a a a a a

Compare antimicrobial susceptibility testing (AST) methods, including broth dilution methods, disk diffusion testing, agar dilution testing, and the Etest. a a a a a

Explain the principles and work flow of the BACTEC blood culture system and the automated Microscan ID/AST system a a a a a

Describe when and how the phenotypic tests for inducible clindamycin resistance (D-test) and ESBL are performed a a a a

Describe mechanisms and special detection methods for important resistant organisms: MRSA, VRE, penicillin-resistant S. pneumoniae, ESBL producing

enterobacteriaceae, and KPC enterobacteriaceae

a a a a a a

Describe the compilation and use of an antibiogram a a a

Describe the processing, media, growth conditions, and incubation time of medically important mycobacteria a a a a

Read and interpret fluorochrome- and carbolfuchsin-stained smears in mycobacteria part of rotation a a a a

Define rapid grower, scotochromogen, photochromogen, and nonchromogen and provide examples of mycobacteria in each category a a a a

Compare and contrast the Mantoux skin test and interferon gamma release assays for detection of latent tuberculosis a a a a

Explain the specimen collection, transport, and special media for yeasts and molds from different body sites a a a a

Describe common pathogenic yeast species, identifying features, and resistance to anti-fungals a a a a a

Describe common pathogenic hyaline and dematiaceous molds, morphological features, and clinical associations a a a a a

Define thermal dimorphic fungus and give examples a a a

Identify medically important fungi based on colony morphology, microscopic appearance, phenotypic tests, and their appearance in tissue. a a a a

Describe the route of infection and life cycles of important intestinal, tissue, and blood parasites a a a a

Discuss proper specimen collection, transport, and testing methods for diagnosis of parasite infections a a a a a a

Identify pathogenic and non-pathogenic intestinal protozoa by direct microscopy and interpret non-microscopic test results a a a a

Identify blood parasites and where applicable, determine parasitemia in blood smears a a a a a

Identify medically important arthropods such as lice and ticks a a a a

Recognize artifacts that resemble parasites in patient samples a a a a a

Recognize medically important parasites in stool ova and parasite preparations, in blood smears, and in tissue. a a a a

Understand CLIA, New York State and CAP requirments for microbiology testing and reporting a a a a a a

Participate in quality improvement and quality assurance activities a a a a a a a

Evaluation tools:



Evaluation by technologists, supervisors, and managers (360° evaluation) Prof: professionalism

Post Rotation Exam PBL: practice-based learning and improvement

RISE examination IP/CS: interpersonal and communication skills



General Microbiology

Competency Key:

Goals:

To understand the basic principles of molecular diagnostics and competently interpret molecular diagnostic assays;

To consult with clinicians on the appropiate applications of molecular diagnostic assays

To learn the appropriate precautions necessary for laboratory safety and prevention of assay contamination and overall quality control of

laboratory testing.

To interact appropriately and professionally with physicians and technologists and other relevant persons and agencies.

Objectives: MK PC Prof PBL IP/CSSBP PGY-1 PGY-2 PGY-3 PGY-4

Know which molecular infectious disease assays are performed at the North Shore-LIJ Core laboratory including which tests are FDA

approveda a a a

Develop skills and knowledge to address clinical issues through cost effective and evidence based use of Health System and other

available resourcesa a a a a a

Provide clinical consultation to physicians and nurses on proper use of clinical laboratory resources a a a a a a a

Understand FDA, CLIA, NY state and CAP regulations regarding molecular laboratory tests and reporting a a a a

Know New York State Department of Health regulations on HIV and other reportable diseases a a a a a

Learn methods of evaluating, selecting, validating, and verifying molecular assays a a a a a

Understand basic principles of bacterial and viral genetics a a

Explain the principles of the polymerase chain reaction (PCR) including reverse-transcriptase, multiplex and quantitative PCR and

diagram the steps in these reactionsa a a

Explain the principles of nucleic acid sequence-based amplification (NASBA) and diagram the steps in NASBA. a aExplain the principles of the hybrid capture (Digene) reaction and interpretation of the Human Papilloma Virus High Risk (HPV-HR)

assay a a a a a

Explain the principles of transcription mediated amplification (TMA) and diagram the steps in TMA. a a

Explain the advantages and disadvantages of different nucleic acid amplification tests (NAAT) such as PCR, NASBA, bDNA, hybrid

capture, and TMA.a a a a

Explain the different methods used for detection of amplified targets a a

Learn about basic laboratory safety equipment and precautions a a a a

Explain the design and work flow of a molecular laboratory a a a a a

Explain methods to detect and avoid contamination in molecular testing a a a a a

Learn common causes of inhibition in nucleic acid amplification tests and ways to avoid inhibition a a a a a

Explain and describe methods for manual and automated nucleic acid purification. a a

Perform a manual DNA and RNA extraction from a sample specimen. a a a

Explain the use of positive, negative, and internal controls in molecular testing a aa a

Explain preventive maintenance and quality control of instruments and reagents a a a a a a

Understand the appropiate application of molecular infectious disease assays for different diseases such as HIV viral load, Amplified

MTD, and Digene Hybrid Capture HPV testing a a a a a

Competently perform a manual molecular assay and interpret the results a a a a a

Analyze and interpret molecular diagnostic data including appropriate reporting and medical significance of positive and negative test

results.a a a a a a

Interpret virals load results assays for HIV, hepatitis B, and hepatitis C and when it is appropriate to order a a a a a

Analyze and interpret results for HIV genotyping and hepatitis C genotyping a a a a a

Perform a literature search on an assigned clinical test and present a verbal summary to the rotation director and laboratory staff. a a a a a a

Plan and conduct a research project related to clinical molecular testing a a a a

Attend and participate in departmental activities and conferences a a a a a a

Evaluation tools:


Post-rotation examinations PC: patient care

Faculty evaluation Prof: professionalism

Evaluation by technologists, supervisors, and managers (360° evaluation) PBL: practice-based learning and improvement



Molecular Diagnostics for Infectious Diseases

Level acquiredCompetency Involved

Competency Key:

Goals:

To train residents to competently perform and interpret molecular diagnostic assays; to correlate such findings with

the clinical picture; to interact appropriately and professionally with physicians and other relevant persons and agencies.


Explain and describe methods for manual and automated nucleic acid purification. a a

Perform a manual DNA and RNA extraction from a sample specimen. a a a

Quantitate purified nucleic acid samples by UV spectrophotometry. a a a

Compare and contrast the chemical structure and stability of DNA and RNA. a a a a a

Explain the principles of gel and capillary electrophoresis of nucleic acids and perform a gel-based electrophoretic analysis of DNA a a a

Explain the principles of the polymerase chain reaction (PCR) and diagram the steps in the PCR reaction. a a

List and describe applications of PCR (including reverse-transcriptase, multiplex and quantitative PCR) in hematopathology and

infectious diseases.a a a a a

Perform a real-time PCR quantification of DNA and carry out an RT-PCR analysis for the molecular detection of chromosomal

translocations associated with acute and chronic leukemia.a a a a a

Diagram the mechanism of action of restriction enzymes and list the applications of restriction enzymes in the molecular diagnosis of

hematopathology and other pertinent pathology specimens.a a a a

Describe the following methods for nucleic acid detection: staining, blotting, hybridization, and fragment analysis. a a

Explain how the nucleotide sequence of DNA is determined and list applications of DNA sequencing to molecular diagnosis.a a a a

Describe the method and interpret results of the molecular diagnostic test for immunoglobulin heavy chain and T-cell receptor gene

rearrangements. a a a a

Describe the clinical settings in which various molecular tests are ordered, including the distinction between diagnostic testing and

minimal residual disease testingi.e.:Detection of KRAS and EGFR mutations in colon and lung cancer. Patient outcome predictors in

AML: FLT3, NPM1 and BRAF mutation analysis.

a a a a

Analyze and interpret molecular diagnostic data for hematopathology, genetics and other pertinent pathology specimens; including

appropriate reporting and medical significance of positive and negative test results.a a a a a a

Correlate molecular diagnostic data with morphology and clinical information in diagnosing hematopathology, genetics and other

pertinent pathology specimens. a a a a a

Integrate molecular diagnostic results into hematopathology, genetics and other pertinent pathology reports. a a a a a

Evaluation tools:


Pre- and post-rotation examinations PC: patient care

Faculty evaluation Prof: professionalism

360° evaluation PBL: practice-based learning and improvement



Molecular Pathology Rotation

Level acquiredCompetency Involved

Competency Key:

Goals:

To develop the general skills and competency to comfortably and confidently handle neurosurgical and neuroautopsy

specimens in a general pathology practice setting.


Perform gross examination and intraoperative consultations under the supervision of Neuropathologist. a a a

Preview microscopic slides and prepare for sign-out of cases with neuropathology faculty. Read the cases and search relevant literature, as appropriate. a a a a

Demonstrate diagnostic knowledge of the common CNS and peripheral nerve tumors. Define the peaks of occurrence, locations, clinical presentations, histologic and

cytologic characteristics of common primary CNS tumors (meningioma and other dura-based lesion, astrocytoma, oligodendroglioma, ependymal tumors,

medulloblastoma, pituitary adenoma, choroid plexus tumors, pineal region tumors, mixed glio-neuronal tumors, CNS cystic lesions, schwannoma, neurofibroma and

MPNST). Recognize the histologic differences among primary CNS tumors, metastatic tumors, lymphomas and pseudotumors. Become familiar with the current WHO

classification for tumors of CNS.

a a a

Demonstrate understanding of the common neurodegenerative diseases (Alzheimer's disease, Pick's disease, Parkinson's disease, Lewy body dementia, Amyotrophic

lateral sclerosis, progressive supranuclear palsy, and corticobasal degeneration and multiple system atrophy).a a a

Demonstrate diagnostic knowledge of common CNS infections (bacterial, fungal, viral, parasitic and prion infections) a a a

Demonstrate understanding of malformations (Arnold–Chiari malformation, neural tube defects, agenesis of the corpus callosum, holoprosencephaly, Dandy-Walker

Syndrome, polymicrogyria, lissencephaly and heterotopia) a a a

Demonstrate knowledge of cerebral vascular diseases [hypoxia/ischemic changes, infarct, hemorrhage (SDH, EDH, SAH), aneurysm, vascular malformation], CNS

vasculopathy and brain trauma a a a

Demonstrate understanding of demyelinating diseases, perinatal disorders, metabolic, nutritional and toxic diseases. a a a

Demonstrate knowledge of basic muscle pathology (neurogenic atrophy, inflammatory myositis, and common congenital myopathies) and nerve pathology and common

enzyme histochemical stains used in muscle biopsy interpretation.a a a

Demonstrate knowledge of the common special stains, immunostains and molecular studies used in neuropathology a a a

Become comfortable removing brain and spinal cord in autopsies. Become familiar with basic anatomy of the brain and spinal cord, basic gross description of the normal

brain, the routine sections to be taken for microscopic examination of the brain and spinal cord.a a a

Supervise junior autopsy resident on service in regards to neuropathologic autopsies. a a

Review teaching sets and discuss major topics with faculty. a a

Attend CNS lectures for tumors and non-tumors, and neuropathology microscopic review sessions. a a a a

Review the cases for and attend CNS Tumor Board. a a a a

Attend pre-test, post-test and glass slide test. a a

Become familiar with on-line and printed neuropathology resources a a a

Identify the national and international centers and resources to consult in special situations, such as CJD. a a a

Develop a basic understanding of various components of neuropathology operations, and related billing and consultation-related issues. a a a a

Communicate with clinical faculty, residents and staff to communicate results or obtain information. a a a

Evaluation tools:



360° evaluation as part of general pathology evaluation Prof: professionalism

RISE examination as part of general pathology evaluation PBL: practice-based learning and improvement

End of Rotation Slide Exam IP/CS: interpersonal and communication skills

End of Rotation Written Exam SBP: systems-based practice


1. Louis, DN, Ohgaki, H, Wiestler, OD, Cavenee, WK. WHO Classification of Tumours of the Central Nervous System, Fourth Edition, 2007

2. Fuller, GN and Goodman, JC. Practical Review of Neuropathology , Lippincott Williams & Wilkins, Philadelphia, 2001

3. Prayson R: Neuropathology Review , Second Edition, Humana Press, Wotawa, NJ, 2008.

4. Burger PC, Scheithauer BW, Vogel FS: Surgical Pathology of the Nervous System and Its Coverings, Edition 4, WB Saunders, Philadelphia, 2002.

Neuropathology Rotation


Competency Key:

Goals:

To train residents to competently perform gross tissue examination, interpret and report gross and microscopic findings of

biopsy and surgical specimens from the oral and maxillofacial regions, including the salivary glands.





Demonstrate ability to prepare, cut and stain frozen sections in a timely manner, triage specimens for cytogen, flow, EM a a a a a

Show proficiency in handling and submission of small biopsies for histologic processing a a a a a







Be able to accurately describe light microscopic features of odontogenic cysts and tumors a a a a


Show ability to perform interpretation of frozen sections with supervision and communicate results to surgeons a a a a a a a


Classify, list and discuss diagnostic features of the different mucosal disease, especially the vesiculo-erosive prcesses a a a a

Know and be able to identify the common head and neck and oral tumors a a a a

Classify and enumerate the diagnostic features of benign and malignant salivary gland tumors a a a a

Classify and discuss the microscopic features of sino-nasal polyps, and Schneiderian papillomas a a a a

Discuss the features of dysplastic lesions, invasive squamous cell of the oral and oropharyngeal region & role of HPV a a a a

Know the most recent classification of lymphomas, including extra-nodal lymphomas a a a a

Know the ancilllary studies in the diagnosis and management of lymphomas a a a a a

Enumerate and describe the microscopic features of different types of soft tissue neoplasms, know grading a a a a

Give a classification of the disease entities of bones and joints, inflammatory, degenerative, tumors, fibro-oseous lesions a a a a

Evaluation tools:




Rise evaluation PBL: practice-based learning and improvement


Recommended Reading SBP: systems-based practice

Oral and Maxillofacial Pathology. Neville, Damm, Allen, Bouquot 3rd ed. 2009

Oral Pathology Clinical Pathologic Correlations. Regazi, Sciubba, Jordan 5th ed. 2007

Atlas of Tumor Pathology 3rd Series Tumors and Cysts of the Jaw, AFIP Fascicle #29 Sciubba, Fantasia, Kahn 2001

Head and Neck Pathology. LDR Thompson, 2006

Oral and Maxillofacial Pathology Rotation


Competency Key:

Goals:

1. The trainee will have skills in specimen handling, clinician interaction, and case evaluation that are appropriate

and effective for pediatric patient care.

2. The trainee will demonstrate medical knowledge in perinatal pathology, placental pathology, pediatric neoplasia,

and pediatric surgical pathology.

3. The trainee will exhibit practice-based learning and improvement in pediatric pathology as demonstrated by

effective presentations at pathology and interdisciplinary conferences, composition of surgical pathology reports.

4. The trainee will demonstrate effective interpersonal and communication skills in his/her dealings with

transcriptionists, histologists, clinicians, and pathology faculty.

5. The trainee will demonstrate professionalism by effective working habits, including specimen grossing and timely

report generation.


1. Show proficiency in accurately describing, measuring gross lesions and the appropriate selection of sections for

microscopic evaluation. a a a a a

2. Develop an approach to examining terminated fetuses with congenital anomalies a a a a a

3. Know how to examine a placenta, what sections to take a a a a a a

4. Give a classification of pediatric renal tumors. a a a a a a

5. Discuss the histopathologic features of Wilms’ Tumor and list the features that indicate favorable prognosis. a a a a a a

6. Discuss the syndromes / associations seen in Wilms’ Tumor. a a a a a a

7. Describe the histopathologic and molecular features of the primitive neural tumors of childhood (Ewings / PNET,

neuroblastoma).a a a a a a

8. Give a classification of rhabdomyosarcoma and describe the histopathologic features of each sub-type. a a a a a a

9. Discuss the immunohistochemical staining and the genetic abnormality of rhabdomyosarcoma. a a a a a a

10. Give a classification of pediatric brain and spinal cord tumors. Describe the histopathologic features of the

common childhood brain tumors (juvenile pilocytic astrocytoma, medulloblastoma, astrocytoma, ependymoma,

oligodendroglioma).

a a a a a a

11. Describe the histopathologic features of benign soft tissue lesions (nodular fasciitis, proliferative fasciitis,

fibromatosis colli, soft tissue myofibroblastoma, inflammatory myofibroblastic tumor, fibrohistiocytic tumors,

xanthoma, and others).

a a a a a a

12. Give a classification of vascular lesions (hemangioma, venous malformations, arterio-venous malformation,

lymphangioma, hemangioendothelioma, and others.a a a a a a

13. List and discuss the common benign and malignant bone tumors of childhood. a a a a a a

14. Give a classification of childhood lymphoma and describe their histopathologic and genetic/chromosomal

aberrations.a a a a a a

15. Describe the benign and malignant tumors of the liver (hepatoblastoma, hepatocellular carcinoma, hepatic

adenoma, focal nodular hyperplasia, hamartoma, and others).a a a a a a

16. List and discuss the common congenital lesions and neoplasms of the respiratory system (juvenile

laryngotracheobronchial papillomatosis, hamartoma, pleuropulmonary blastoma, desmoplastic small round cell

tumor).

a a a a a a

Compentency involved Level acquired

Pediatric Pathology Rotation

17. List and discuss the surgical pathology of selected pediatric lung diseases (e.g. sequestrations, adenomatoid

lesions, cilia ultrastructure)a a a a a a

18. List and discuss the morphologic and clinical features of common pediatric gastrointestinal diseases, e.g. reflux,

gastritis, duodenitis, colitis, infectious lesions, appendicitis, hepatitis, biliary atresia, paucity of intrahepatic ducts,

Hirschprungs disease.

a a a a a a

19. List and discuss the morphologic, clinical, and genetic features of common immunodeficiency disease of

childhood, e.g. chronic granulomatous disease, DiGeorge syndrome, SCID. a a a a a a

20. Attends/presents at the Neuro-oncology tumor board, general tumor board and Ped GI Conference a a a

Gross & Signout Schedule: Monday all day and rest of week as needed ; Signout Everyday

Evaluation tools:


Faculty evaluation PC: patient carePractice exam at the end of the rotation Prof: professionalism



Conferences: SBP: systems-based practice

1. Neuro oncology tumor board: Tuesday 5-6

2. General tumor board: Wednesday 3-4

3. Peds GIT: Friday 12.30 - +/-1:15

4. Intermittent:

Surgical rounds: Variable.

Cardiology path: Varaible.

Maternal fetal rounds: Variable

Muskuloskeletal: Variable

Competency Key:

Goals:

After the two-week rotation in renal pathology, the resident will be able to recognize the basic patterns of glomerular injury,

and render a diagnosis or differential diagnoses of medical kidney diseases, based on light, immunofluorescence (IF) and

electron (EM) microscopic examination.


Explain the basic methodologies involved in renal pathology (light, IF and EM). a a a a a a

Demonstrate the skills to systemically evaluate compartments in renal biopsy. a a a a a a

Demonstrate the knowledge the common medical kidney diseases and clinical syndromes. a a a

Demonstrate the knowledge of renal allograft pathology. a a a a a

Identify the basic patterns of glomerular injury in light, IF and EM examination. a a a a a a

Demonstrate the ability to integrate light, IF and EM findings and formulate diagnosis. a a a a a a

Rotation Structure

The rotation will be a combination of case self-study, mini-lectures and sign out sessions. Each day, the resident will be

assigned topics. Slides will also be provided along with the topics. The resident will study these cases and then sign out with

renal pathologist. EM and IF photos will be reviewed at the sign out session. During the rotation, the resident will also

preview current cases and sign out with pathologist. The rotation also includes a mandatory half day EM technique session.

Evaluation tools:




RISE examination (Formative Evaluation) PBL: practice-based learning and improvement

End of Rotation Virtual Slide Exam (Summative Evaluation) IP/CS: interpersonal and communication skills

BiMonthly AP Board Review Exam (Formative Evaluation) SBP: systems-based practice


Kumar et al: Robbins and Cotran Pathologic Basis of Disease, Chapter 20, the Kidney

Fogo et al: Diagnostic Atlas of Renal Pathology, Elsevier Saunders 2005

Weening et al: The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. 2004 Feb;15(2):241-50.

Racusen LC et al: The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999 Feb;55(2):713-23.

Sis B et all Banff '09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups.Am J Transplant. 2010 Mar;10(3):464-71.

Renal Pathology Rotation


Competency Key:

Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of adult surgical specimens in neoplastic and non neoplastic pulmonary and mediastinal disease in a

timely manner; to interact appropriately and professionally with physicians,and other relevant persons and agencies















Be able to classify disease processes and neoplasms of the Lung and Mediastinum a a a a

Be able diagnose common benign and malignant tumors of trachea, lungs, pleura microscopically a a a a

Enumerate and discuss the neoplasms of mediastinum, especially the histologic subtyping of thymomas a a a a

Describe the clinico-pathologic features of the pulmonary vasculitides, especially Wegener's granulomatosis, Churg Strauss Syndrome and Microscopic Polyangiitis

Discribe the pathologic and radiologic findings in chronic hypersensitivity pneumonitis

Discribe the pathologic findings of interstitial lung disease in collagen vascular disease (SLE, Rheumatoid, etc) a a a a

Describe the TNM staging of lung cancer

Describe the use of molecular diagnostics and targeted therapy in lung cancer

Compare and contrast UIP, NSIP, BOOP and LIP

Compare and contrast the diffuse alveolar hemorrhage syndromes of the lung

Describe the changes in the new proposed classification of lung adenocarcinoma (AIS, MIA, Pure lepidic growth adenocarcinoma, etc.)

Describe the clinico-pathologic features of pulmonary sarcoidosis including the necrotizing variant

Gross and Signout Schedule: Residents gross everday at 3 PM (NS 1 week/LIJ 1 week); Complex thoracic specimens only; Signout every day

Evaluation tools:







Thoracic Pathology Rotation


Competency Key:

Goals:

To train residents to competently perform gross exams, interpret and report gross and microscopic findings of urologic

surgical specimens in a timely manner; to interact appropriately and professionally with physicians,and other relevant

persons and agencies, and develop an ability to critically analyze the current knowledge base in urologic pathology, as well

as contribute to evidence based medicine.

Residents will be expected to gross specimens, review slides, and prepare for signout daily.


Demonstrate knowledge of basic anatomy of the urologic organs: prostate, seminal vesicles, bladder, kidney,

ureters, testis and penis.a a a a a a

Show proficiency in gross techniques, initial handling of urologic specimens, understand and demonstrate gross exam a a a a a a a

Be able to orient specimens, describe and measure lesions and take appropriate sections for microscopy a a a a a a a

Demonstrate ability to take high quality photographs of gross specimens a a a a

Show proficiency in handling and submission of small urologic biopsies for histologic processing a a a a a a

Gather all relevant information (ie clinical history, previous pathology, surgical/clinical reports, discussion with clinicians if

needed) for cases which have assigned to the resident, organize slides, and be ready for sign-out.a a a a a a a

Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a a a

Show knowledge of different fixatives, pros and cons, used in urologic surgical path, the function of different solutions a a a

Enumerate potential areas of specimen contamination along processing, discuss ways of troubleshooting for errors a a a a a

Distinquish between special stains, enzyme histochemistry and immunohistochemistry that may be used in urologic

specimens, be able to list all stains

a a a

Know special stains used for diagnosis of various infectious organisms (fungal, mycobacterial, bacterial, etc.) as it relates

to urologic pathology

a a a a

Demonstrate ability to generate meaningful antibody panels that are appropriate for diagnosis a a a a a

Demonstrate knowledge of the normal histology of urologic organs versus abnormal/tumor histology. a a a a a

Be able to accurately describe light microscopic features of neoplasms and other disease entities a a a a a

Be able to generate meaningful differential diagnoses in tumor diagnoses a a a a a

Demonstrate basic understanding of the common urologic diseases. a a a a a a

Show ability to perform interpretation of frozen sections with supervision and communicate results to surgeons a a a a a a a a

Generate appropriate surgpath report, using correct terminology, including necessary parameters to stage urologic tumors a a a a a a

Attend multidisciplinary GU tumor boards. a a a a a a a

Attend GU quality assurance conference and journal club. a a a a a a a

Optional participation in research project as related to GU pathology/urology. a a a a a a

Assume responsibility for screening and signing out GU cases, including consults, under the direct supervision of the

attending pathologist.

a a a a a a a a

Demonstrate knowledge of the histopathological criteria for diagnosing renal tumors. a a a a a

Demonstrate knowledge of the histopathological criteria for diagnosing testis tumors a a a a a

Demonstrate knowledge of the histopathological criteria for diagnosing bladder tumors a a a a a

Demonstrate knowledge of the histopathological criteria for diagnosing prostate tumors a a a a a

Demonstrate knowledge of the histopathological criteria for diagnosing penile tumors a a a a a

Demonstrate knowledge of the pathologic staging criteria for urologic tumors a a a a a a

Demonstrate proficiency in interpreting immunohistochemical and special stains used in the diagnosis of urologic diseases.a a a a a a

Demonstrate understanding of the clinical implications for the common urologic pathology diagnoses. a a a a a a

Participate in GU quality assurance conference and journal club. a a a a a a a a

Attend multidisciplinary GU tumor boards, and present the pathology for selected cases. a a a a a a a a

Participation in research project as related to GU pathology/urology. a a a a a a

Gross & Signout Schedule: Gross every day in afternoon; Signout every day in morning

Evaluation tools:







Urologic Pathology Rotation


Competency Key:

AP Introductory Pathology Rotation - Northwell Health · Review basic histology ... AP Introductory...

Documents

Transcript of AP Introductory Pathology Rotation - Northwell Health · Review basic histology ... AP Introductory...