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Surgical Pathology Curriculum*

The basic learning objectives of the rotations in surgical pathology are encompassed in the six competencies outlined below as well as the two skill levels that follow.

PATIENT CARE

Analyze clinical data and other relevant information

Communicate with clinicians to obtain and transmit pertinent patient information

Effectively communicate pathologic findings to colleagues and provide consultative information regarding patient management

Complete work in timely manner in the interest of patient care and management and reduced turn-around time

MEDICAL KNOWLEDGE

Demonstrate familiarity with normal histology

Gain knowledge and technical skills to recognize, interpret, and explain pathologic processes in the clinical practice of surgical pathology

Develop an understanding of basic pathologic processes

Develop a basic knowledge of surgical pathology.

Become familiar with common microscopic stains, indications for their use, and expected results

PRACTICE-BASED LEARNING AND IMPROVEMENT

Understand necessary components of surgical pathology report

Evaluate adequacy of clinical information provided on surgical pathology forms

Describe gross surgical specimens and obtain adequate tissue sections

Dissect tissues as appropriate to preserve important pathological features or anatomic landmarks

Demonstrates technical ability, timeliness, and appropriate communication when performing frozen sections

Suggests and interprets appropriate additional studies, e.g. Immunohistochemistry, electron microscopy, etc.

Investigate cases using texts, journal articles, and internet sources

Integrate clinical and laboratory data to arrive at diagnosis

Understands principles of quality control, e.g. detection of errors in slides or specimen labeling, poor staining, inadequate controls, lost specimens, etc.

Takes suitable gross and microscopic photographs to demonstrate important positive or negative findings

Understands operation of histology laboratory, equipment, organization, and procedures, e.g. tissue processing, embedding specimen orientation, and slide preparation

Effectively utilizes local computer network

Recognizes need for expedited specimens

Knowledge of precautions to be taken against infections and other hazards in the handling of fresh tissue during intraoperative consultations.

Demonstrates knowledge of the appropriate storage and disposal of tissues and fixatives.

Demonstrates knowledge of the common pathogens that can be transmitted to laboratory personnel in pathology, as well as basic safety precautions to be taken in the anatomic pathology laboratory, including universal precautions for infectious agents.

INTERPERSONAL AND COMMUNICATION SKILLS

Communicates effectively with clinicians and other health care providers to obtain information and provide consultations

Effectively teaches other physicians, students, and health care workers

Interacts effectively with administrative, secretarial, clerical, and technical staff

Demonstrates willingness to present cases at departmental and multidisciplinary conferences

Demonstrates effective communication skills in case presentations and other meetings

Appropriately uses and responds to e-mail and other communications


PROFESSIONALISM

Prepares and organizes for slide sign-out and, if necessary, reviews previous surgical or cytopathology material

Follows up by completing unfinished cases and collecting needed information

Adheres to ethical principles, accepts responsibility for actions, admits mistakes, recognizes and addresses ethical dilemmas, maintains patient confidentiality

Recognizes limits of abilities and need to consult with others

Works effectively with members of the health care team, demonstrating courtesy and responsiveness to views of others

Is sensitive to diversity of coworkers and patients

Engages in ongoing learning; shows initiative in seeking new information; asks knowledgeable and well-informed questions

Implements improvement activities; changes behavior in response to feedback

Understands and complies with HIPAA and other regulations regarding patient confidentiality and handling of tissues for diagnosis and research

Accepts responsibility and follow through on tasks

Maintains log of surgical pathology and frozen sections cases

Is punctual, arriving on time for sign-out sessions and conferences

SYSTEMS-BASED PRACTICE

Participates in institutional conferences dealing with management, quality assurance, graduate medical education, and other medical center and hospital functions

Understands the importance of cost conscious medical care; avoids unnecessary procedures but does not compromise quality of care

Attends interdisciplinary conferences

Skill Levels
Skill Level I denotes items for which training will begin immediately upon entering the AP education track; Skill Level II denotes material that is typically covered at a more advanced level of training in the residency program.

Skill Level I

-Demonstrate proficiency in basic anatomic pathology skills

-Demonstrate knowledge of the standards (JCAHO, CAP) required for submitting surgical pathology specimens

-Demonstrate knowledge of the common and basic elements of the surgical pathology report, including:

-Identifiers (patient and institution)
-Input from the responsible pathologist
-Input from the responsible clinician
-Necessary dates and times that must be in the report
-Necessary clinical information
-Documentation of the specimens that were submitted
-Thorough and accurate gross description

-Ability to determine when a microscopic description and/or interpretation is necessary, and provide such information.

-Demonstrate competency in selecting representative tissue samples for intraoperative frozen sections, preparing the same, and staining the sections.

-Be able to evaluate margins of tumor resection specimens using frozen sections and touch preparations.

-Know the procedures for the reporting of untoward incidents in the laboratory.

-Demonstrate knowledge of the basic recommendations/requirements (JCAHO, CAP, regional legal requirements) pertaining to retention of pathology specimens and records.

-Demonstrate knowledge of the basic principles of informatics in anatomic pathology, and ability to effectively utilize the local computer network.

-Demonstrate knowledge of web-based or organization (CAP, ASCP, USCAP, etc.) related learning and CME tools in anatomic pathology.


Skill Level II

-Demonstrate knowledge of the common situations requiring expedited processing of a pathology specimen, and those that do not.

-Demonstrate knowledge of the common indications for an intraoperative consultation.

-Demonstrate proficiency in interpreting & reporting frozen sections within 15 minutes of receiving a specimen for that purpose in the pathology laboratory.

-Demonstrate the ability to effectively construct a complex surgical pathology report.

-Demonstrate knowledge of the common grading and staging systems applied to malignant neoplasms.

-Be able to properly prepare synoptic surgical pathology reports for common malignancies.

-Demonstrate the ability to dictate necessary amendments and/or addenda for surgical pathology reports.

-Demonstrate knowledge of how and when to obtain external consultations in anatomic pathology and document the results appropriately.

-Demonstrate the steps for preparation of consultation reports on outside slides and/or paraffin blocks, and transmittal of those reports to responsible clinicians and/or referring pathologists.

-Demonstrate the techniques for preparing intraoperative cytology smears.

-Enumerate the indications and the limitations pertaining to intraoperative frozen section examinations.

-Demonstrate an ability to manage workflow in the gross room, assist junior residents with gross dissection, provide accurate gross descriptions of routine and complex specimens, use the local anatomic pathology laboratory information system, and practice safety in the pathology laboratory.

-Demonstrate knowledge of available procedures for locating a missing specimen and resolving questions of specimen identity.

-Be able to independently report the histopathologic aspects of routine and complex cases, including cases prepared by junior residents and/or pathology assistants, with attention to organization of diagnostic format, development of differential diagnosis, and ordering of necessary special stains and other ancillary techniques.

-Demonstrate knowledge of quality control pertaining to histologic sections and special stains, including trouble-shooting of mistakes in accessioning, labeling, & misidentification of specimens.

-Demonstrate proficiency in digital imaging techniques.

-Review consultation slides on referral cases with attention to pertinent clinical information, requests for additional slides or blocks if needed, and formatting of the final consultative report.

-Demonstrate an ability to organize, perform, and analyze a quality control review project in surgical pathology for presentation to faculty.

 

*Adapted from ADASP Working Group. Curriculum content and evaluation of resident competency in anatomic pathology, 2003.