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SUNY Downstate Medical Center/Kings County Hospital Center
Pathology Residency Training Program
Neuropathology Rotation

Resident duties during the rotation:

1. Attend all conferences in the neuropathology division during the rotation including the tumor board conferences.

2. Be present at all weekly brain cutting conferences and dissect at least three brains during the rotation. Sign out those cases with the attending with proper gross and microscopic description and a formulated diagnosis.

3. Study all the incoming surgical and autopsy cases including consultation cases and discuss with neuropathology fellow or attending.

4. Utilize the archival material and atlases for self study.

Goals:
To expose pathology residents to various aspects (including immunohistochemistry, molecular genetics and electron microscopy) of neuropathology and to teach them clinicopathological aspects of spectrum of neuropathological diseases through didactic sessions, incoming and archival materials and unknown slide conferences. Self study using atlases, textbooks, slide sets and websites is also encouraged.

Objectives:
At the end of the rotation:

1. Residents will be able to comfortably remove the brain, spinal cord and pituitary gland in an autopsy case.

2. Residents will be able to describe, dissect and take appropriate sections of brain and spinal cord; all in the light of knowledge of clinical aspects of the case and basic neuroanatomy. They will be able to write a microscopic description and arrive at a diagnosis on common cases. They will be able to make a clinicopathological correlation and communicate it effectively to peers and colleagues and in lay language to technicians, secretaries and patients’ families

3. Residents will be able to prepare and make a diagnosis of frozen sections from common neurosurgical entities.

4. Residents will be familiar with methods of processing different types of neuropathological specimens (tumors, infectious lesions, temporal arteries, muscle and nerve). They will be aware of special precautions necessary in processing a variety of specimens such as brain biopsy from a patient with dementia suspected of having Creutzfeldt-Jakob’s disease.

5. Residents will be able to make a diagnosis of most neurosurgical specimens (interpreting the special stains including immunohistochemistry) and infectious lesions and will be comfortable in discussing the diagnosis with clinicians, peers and families.

6. Residents will have a basic understanding of muscle and nerve diseases and will develop the ability to make a diagnosis of common neuromuscular diseases and interpreting the histochemical stains.

7. Residents will be reasonably prepared to answer in-service (RISE) and board-type neuropathology questions and pass the neuropathology test at the end of the rotation.

The Six Competencies
The resident’s performance will be evaluated on the basis of achieving the above goals and objectives of the program in the context of the following six competencies:

PATIENT CARE
The resident is expected to demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective neuropathology consultation, to communicate effectively with other physicians, medical students and family members; to gather appropriate information about the patient from all available sources; to make informed decisions based on current scientific evidence and sound judgment; to use information technology to support patient diagnostic decisions and education of health care workers; to perform the brain autopsy, spinal cord removal, and handling of neurosurgical and neuromuscular specimens in a manner appropriate for effective diagnosis; to work with the health care team, e.g. neurologists and neurosurgeons, to support patient diagnosis and management.

MEDICAL KNOWLEDGE
The resident is expected to have knowledge of basic neuroanatomy and neuropathology and common histological and other methods used in neuropathology; have the ability to integrate and analyze clinical information and general autopsy information to put together clinical-pathological correlative assessment; participate in scholarly activities such as poster or platform presentations at national meetings or publications in peer review journals.

PRACTICE-BASED LEARNING AND IMPROVEMENT
The resident is expected to present concise and complete clinical summary to neuropathologist supervising the autopsy or signing out the microscopic aspects of case; to learn to remove brain, spinal cord and pituitary and to describe dissect, and take appropriate histologic sections of brain and spinal cord. The resident should be able to write a microscopic description and arrive at a diagnosis of common neuropathological conditions; He or she should learn the methods of processing different types of neuropathology specimens, e.g. tumors, temporal arteries, muscle and nerve; The resident must be aware of special precautions warranted for processing specimens from patients with dementia suspected of having Creutzfeldt-Jakob disease.


INTERPERSONAL AND COMMUNICATION SKILLS
The resident should demonstrate skills that result in effective information exchange and team building with patients, patients’ families, and professional associates; express ideas and positions clearly both orally and in writing; ensure that reports are complete and up to date; keep thorough and accurate records; be objective, frank, and concise; listen to others and work effectively with other members of the health care team including technologists, dieners, neurosurgeons, neurologists, medical students, nurses, etc; gives clearly defined orders and administrative directives. The resident should contact physicians who wish to attend neuropathology conferences, e.g. brain cutting. He or she should demonstrate effective verbal and written communication skills in case presentations, descriptions and be an effective teacher of fellow residents and other physicians, medical students, technologists, and others..

PROFESSIONALISM
The resident should demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient populations; he/she should carry out duties with dispatch and thoroughness; be prompt and well-prepared for conferences and teaching assignments; assume delegated responsibility; demonstrates stability in critical situations; demonstrate respect, compassion and integrity; be responsive to patient care needs and society at a level that supercedes self-interest; be committed to excellence and on-going professional development; understand and comply with HIPAA and other regulations regarding patient confidentiality and handling of tissues for research and diagnosis.

SYSTEMS BASED PRACTICE
The resident should be aware of the role of neuropathology in large medical systems and public health, e.g. the importance of dementia or Alzheimer’s disease in our aging society; be able to call on system resources to provide pathology services that are of optimal value; understand the reciprocal interaction of neuropathology practice with that of other health care; understands the importance of cost containment without compromise of quality care.

Recommended Reading:

1. Gray, DeGirolami and Poirier. Esoeourolle and Poirier Manual of Basic Neuropathology, 4th Edition, 2004. Butterworth.
2. Kleihues and Cavenee. Pathology and Genetics of tumors of the Nervous System, 2000. IARC Press.
3. Ellison, Love, Chimelli, Harding, Lowe, Roberts and Vinters. Neuropathology, 2004. Mosby
4. Prayson: Neuropathology, 2005. Elsevier.