Pediatric Pathology
Duration: Three months
Rotation Director(s): Lili Miles, MD
Faculty/ Instructor(s):
Jun Mo, MD
Todd Boyd, DO
Anita Gupta, MD
Richard McMasters, MD
Rachel Sheridan, MD
Jerzy Stanek, MD
Description of Rotation
The pediatric pathology rotation is an introduction to pediatric pathology for the resident in pathology. The rotation develops a foundation for understanding the etiology and pathogenesis of disorders affecting development of the fetus, newborn infant and child. This learning experience includes genetic disorders, developmental anomalies, infections and neoplasm’s peculiar to childhood. The resident develops skills necessary for competent examination and evaluation of conditions commonly observed at autopsy of fetuses, infants and children, including during autopsy rotations at UC. The resident also develops skills necessary for competent examination and reporting of surgical specimens derived from conditions mainly observed during infancy and childhood. In addition to rotating on the autopsy and surgical diagnostic services, the resident attends and participates in all regularly scheduled clinical correlation and mortality conferences with the various pediatric subspecialties during the course of the rotation.
Rotation Objective
- Evaluate and report diagnoses on accessioned surgical specimens (approximately 750 during the three-month rotation).
- Present in a satisfactory fashion all assigned surgical and autopsy cases in selected intra- and interdepartmental conferences.
- Become familiar with the phenotype and genotype of major cytogenetic disorders and the associated karyotype abnormalities.
- Become familiar with the ultrastructural aspects of important pediatric diseases including renal pathology, tumor diagnosis and metabolic storage disorders.
- Learn the basics of perinatal pathology through perinatal pathology material provided at CCHMC, as an observer of perinatal autopsies performed at CCHMC and in perinatal conferences.
- Become familiar with the common chromosomal abnormality syndromes and recognize the characteristic anatomical features associated with them.
- Understand placental physiology and pathology and relate these to fetal pathological conditions.
- Become familiar with the common forms of congenital heart malformations and have a basic understanding of the associated pathophysiology.
- Present article(s) of choice at journal club.
- Perform assigned autopsies with direct staff supervision of all phases including gross dissection, photography, preparation of gross description, proper use of normal weights and measures, sampling technique, microscopic evaluation and description, final analysis, face sheet preparation and conference presentation.
Overall Responsibilities
The resident rotation in the division of pathology at Cincinnati Children’s Hospital Medical Center is based on continuous exposure to all facets of surgical and autopsy pathology through assignments, consultations and conferences. The rotation requires the resident to assimilate scientific data concerning diseases of embryo, fetus, infant, child and adolescent, to improve the resident’s patient care practice. During the rotation, the resident typically rotates one week on surgical pathology, followed by two consecutive weeks on GI biopsies, Hemepath or other biopsies (kidney, cardiac, small bowel transplant etc.) with the rotating staff pathologists. During the course of the rotation, the resident presents at least once at journal club, using articles of interest to the resident, that preferably but not necessarily relate to pediatric pathology.
Daily Responsibilities
The resident is based at Cincinnati Children’s Hospital Medical Center, division of pathology, for the entire rotation. During the weeks that the resident is on the surgical pathology service rotation, the resident is responsible for dictating the surgical pathology specimen gross descriptions, selecting and trimming specimen tissue samples for paraffin processing and loading all of the daily surgical specimens on the tissue processor machine at the end of each work day.
In a timely manner, the resident reviews all the slides of surgical samples submitted on the previous day and formulates a diagnostic impression to be presented to the attending staff pathologist at the designated sign-out time when all the slides are reviewed by both the attending and the resident. The resident is also responsible for generating the microscopic description for the final surgical pathology report, dictating the microscopic description and final diagnosis in a timely fashion.
Additional responsibilities on the surgical service include ordering appropriate ancillary studies, including immunohistochemical stains, participating in all intraoperative consultations, consulting with clinicians and being on call during the entire week of surgical rotation.
The resident is responsible for obtaining additional clinical information when necessary for the diagnostic interpretation of the biopsy samples, using the extensive medical informatics system at CCHMC. Daily, the resident provides a written evaluation of the quality of slides, reports labeling errors etc. to the lab manager using a form that is provided with the surgical pathology slides. During the weeks on ER rotations (GI biopsies etc.), the resident reviews the slides independently, then with the assigned attending, and dictates the microscopic description and diagnosis in a timely fashion.
The resident also performs autopsies under staff supervision that are assigned by CCHMC faculty to the resident during the course of the pediatric pathology rotation. The resident is responsible for reviewing the clinical chart, performing the gross dissection, trimming the appropriate tissue samples for paraffin processing, reviewing the microscopic sections, and formulating a diagnostic interpretation of both the gross and microscopic findings for presentation to the attending staff pathologist at the time of the autopsy review. The resident then generates the entire autopsy report, including the preliminary and final autopsy findings, clinical synopsis, gross description, microscopic description, and summary and discussion. The residents should not be the backup person for UC autopsy cases during their CCHMC rotation.
Evaluation
The resident is expected to adequately perform and carry his/her responsibilities related to his/her rotations on both the autopsy and surgical pathology services. The resident is evaluated for understanding of the reading material and daily work based on oral discussions with individual faculty members, as well as the quality of presentation at the departmental conferences. A written evaluation by all faculties who worked with the resident is provided to the resident after the rotation using MedHub. The resident is also asked to evaluate the pediatric pathology rotation and faculties at the end of the rotation using MedHub.