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Cytopathology Curriculum Goals and Objectives*

 

I. OVERVIEW

Residents in Anatomic Pathology at SUNY Downstate generally spend two months in Cytopathology. Training of residents occurs in at least two of the three major teaching hospitals within the residency training program. To date, cytopathology training has been implemented predominantly at Kings County Hospital Center (KCHC) and the New York Harbor Healthcare System at Brooklyn (mainly at the Brooklyn VA campus but also at the Manhattan VA).

Experience in fine needle aspiration (FNA) is obtained as part of the Cytopathology rotation at the University Hospital of Brooklyn (UHB) and Kings County Hospital. Fine needle aspiration experience is also provided during resident rotations at the VA under the supervision of Dr. Andrew Seymour.

At KCHC, where Dr. Constantine Axiotis is the Director of Anatomic Pathology, he and three other anatomic pathologists (Drs. Janet Schneller, Y.D. Kim, and Elena Estuita) work with the residents in signing out cytopathology cases. At University Hospital of Brooklyn, there are two cytopathologists, Dr. Patrick Chen and Dr. Teresa Alasio. Dr. Andrew Seymour is the cytopathologist at the VAMC.

All residents on Cytopathology receive copies of this Cytopathology curriculum, including goals and objectives, as well as copies of evaluation forms that will be used for their assessment, all organized within the context of the six competencies. These materials are distributed either at orientation or on the first day of their rotation.

II. OBJECTIVES (Please note that many of these objectives overlap in terms of the six competencies that they reflect)

A. ROUTINE CYTOPATHOLOGY
(GYNECOLOGICAL & NON-GYNECOLOGICAL)

Patient Care
At the conclusion of training in Cytopathology, the pathology resident should be able to

  • Obtain pertinent clinical information using all appropriate sources
  • Complete cases in a timely fashion

Medical Knowledge
At the conclusion of training in Cytopathology, the pathology resident should

  • Be able to correctly interpret and diagnose routine cytology materials including smears, cell blocks, and special studies as indicated (special stains, Immunohistochemistry, etc).
  • Be able to distinguish normal, reactive, infectious, pre-neoplastic, and malignant cellular elements
  • Identify common infectious agents causing inflammatory changes
  • Be familiar with the Bethesda System 2001 for gynecologic specimens as pertains to the classification of abnormal cells as well as to quality indicators and criteria for unsatisfactory specimens
  • Understand principles and application of various techniques applied to cytopathology. These techniques include microbiological studies, immuno-cytochemistry, molecular diagnostics (FISH and PCR), and electron microscopy.
  • Be able to provide correct diagnoses on substantive percentage of Gyn and non-Gyn cytology cases on a practical examination given upon completion of the Cytopathology rotation.
  • Residents on Cytopathology should participate in the following educational activities (in addition to the three mandatory conferences for all residents each week):
  • Attend the monthly ASC Cytopath-teleconference held on the last Wednesday of each month in the Cytopathology Laboratory at KCHC at 3 PM
  • Whenever possible, meet with attendings and technologists at KCHC who review the CAP and STAR slide sets as well as CHECKPATH cases on a quarterly basis or as available. This conference which serves both educational and quality assurance purposes usually occurs at 11:00 AM at KCHC.

 

Practice-based Learning and Improvement

During the Cytopathology rotation, the resident should

  • Screen gyn slide preparations (both prior to and after screening by cytotechnologist)
  • Read relevant cytopathology textbooks and journal articles pertaining to cases being reviewed
  • Utilize web-based learning materials as learning aides.  Two excellent sites are http://www.cytopathology.org/nih/ (gyn cytology and the Bethesda System) and www.cytologystuff.com (liquid-based gyn and non-gyn cytopathology)
  • Participate in Cytopathology didactic sessions as appropriate

At the conclusion of training in Cytopathology, the pathology resident should

  • Assess adequacy of specimen using appropriate staining technique and microscopic interpretation
  • Be familiar with the operation of the Cytopathology laboratory, including workflow, processing, staining, and handling of specimens
  • Be familiar with the responsibilities of the cytotechnologists and technicians in terms of screening of specimens and specimen preparation
  • Understand differences between conventional smears and liquid-based preparations in Gynecologic Cytopathology
  • Be able to interpret exfoliative (spontaneous deposit of cells into urine, CSF, effusions, etc.) as well as non-exfoliative (washings, brushings, and lavage specimens.)
  • Be able to determine adequacy of non-gyn specimens and to communicate these criteria to clinicians
  • Recognize specimen artifacts and contaminants and know how to resolve such problems for quality assurance and diagnosis
  • Recognize importance of correlation of Cytopathology findings with prior and subsequent histopathological case material for diagnosis, quality improvement, and educational purposes.

Interpersonal and Communication Skills

The resident should

  • Communicate effectively with health-care professionals including physicians, nurses, technologists, and others
  • Interacts effectively with administrative, secretarial, and technical staff members
  • Appropriately uses and responds to e-mail and other electronic communications


Professionalism

The resident should

  • Comply with all HIPAA, other regulatory, and hospital guidelines for privacy, safety, and patient care
  • Exhibit a professional demeanor in terms of appearance, conduct, attitude, and communication
  • Demonstrate commitment to ethical principles, including but not limited to patient confidentiality
  • Show willingness to present cases in consultation with other physicians, at teaching conferences, etc.
  • Be punctual and attend required conferences regularly
  • Complete service responsibilities in a timely manner to benefit patient care
  • Demonstrate sensitivity to diversity of technical and professional staff as well as patients and their family members with whom he/she may come in contact.
  • Maintain a log of current cases and experiences to assure documentation that he/she has seen at least 1500 cytologic specimens (including a variety of both exfoliative and aspiration specimens) and have performed at least 15 fine needle aspirations. These FNAs should be documented on the ACGME website along with autopsies and bone marrows.
  • Be responsive to faculty and staff suggestions for improvement

Systems-based Practice

At the conclusion of training in Cytopathology, the pathology resident should

  • Understand the principles of quality improvement relating to cytopathology
  • Be aware of potential causes of specimen identification errors and problem solving approaches
  • Be aware of and participate as appropriate in laboratory and hospital-wide quality improvement programs
  • Be familiar with regional or national proficiency standards for cytopathologists and cytotechnologists
  • Be knowledgeable about use of information systems and other means used to document and disseminate Cytopathology results, manage patients, and assure continuous quality improvement
  • Be familiar with federal/state compliance regulations

 

B. FINE NEEDLE ASPIRATION (FNA)

Patient Care

At the conclusion of training in Cytopathology, the pathology resident should be able to

  • Recognize the indications for fine needle aspiration (FNA)
  • Obtain pertinent clinical information using all appropriate sources (chart examination, consultation with clinicians, etc.)
  • Clinically assess the lesion(s) to be aspirated by physical examination
  • Follow appropriate procedures for accurate patient identification as well as identification of accurate procedure site/laterality prior to initiating procedure
  • Explain the procedure as well as its benefits and potential complications to patients in a clear, concise, and professional manner in order to obtain informed consent
  • Perform the FNA biopsy procedure with proficiency under attending supervision
  • Assess the adequacy of specimen using appropriate staining technique and microscopic interpretation
  • Provide provisional diagnosis to patient and attending physicians under the supervision of cytopathology attending
  • Provide adequate after-care to patients. This includes attending to FNA biopsy site, responding to questions or concerns, providing reassurance as needed, and advising follow-up with referring clinicians.

 

Medical Knowledge

At the conclusion of training in fine needle aspiration, the pathology resident should

  • Be able to correctly interpret and diagnose FNA-derived materials including smears and cell blocks using conventional stains as well as additional techniques as appropriate.
  • Correlate FNA findings with available histopathological material

Practice-based Learning and Improvement

The resident should

  • Screen FNA cases prior to review with the cytopathologist
  • Read relevant cytopathology textbooks and journal articles pertaining to cases

At the conclusion of training in FNA, the pathology resident should

  • Be familiar with instruments and materials needed to perform FNA
  • Be able to perform procedures for handling the aspirate/specimen including slide preparation, fixation, and retrieval of sample for cell block, flow cytometry, immunohistochemistry or other appropriate procedures.
  • Have performed 15 diagnostic superficial FNA biopsies under the supervision of an attending cytopathologist

Interpersonal and Communication Skills

The resident should be able to

  • Communicate effectively with patients and family members providing necessary information in clear, concise and professional manner.
  • Provide reassurance to patients and family members as appropriate
  • Communicate effectively with health-care professionals including physicians, nurses, technologists, and others

Professionalism

The resident should

  • Comply with all HIPAA, other regulatory, and hospital guidelines for privacy, safety, and patient care
  • Exhibit a professional demeanor in terms of appearance, conduct, attitude, and communication
  • Maintains the ACGME log site entering all FNAs performed to demonstrate compliance with suggested number of 15 over training period

Systems-based Practice

  • Understands the role of FNA biopsies in the overall evaluation, diagnosis, and management plan of patients
  • Is aware of and participates as appropriate in laboratory and hospital-wide quality improvement programs
  • Is familiar with regional or national proficiency standards for cytopathology technologists and pathologists
  • Is knowledgeable about use of information systems and other means used to document and disseminate cytopathology results

 

 

 

 

 

 

*Adapted, in part, from curricular materials provided by JJ Steinberg at AECOM.

Rev. June 2007