Surgical Pathology
Duration: Nine to 12 months, Initial: One to two months
Rotation Director(s): Jiang Wang, MD, PhD
Faculty/ Instructor(s):
Amy Frey, DO
Matthew Hagen, MD, PhD
Ady Kendler, MD, PhD
Shagufta Khan, MD
Julie Qualtieri, MD
Fred Lucas, MD
Description of Rotation
The goal of resident training in the surgical pathology rotation is to develop the skills needed to function as an independent surgical pathologist. To achieve this goal, the resident will need to develop a systematic approach to specimen processing, microscopic examination, use of laboratory resources and differential diagnosis and to develop and maintain familiarity with the literature. The resident will also need to develop an appreciation for the impact of a given diagnosis on clinical decision-making and patient care.
Level of Training
By the end of Year 1 (two to four months experience)
Gross Dissection and Description
- able to handle biopsies and simple dissections alone
- able to handle complicated dissections with supervision
Microscopic Examination and Diagnosis
- knows normal histology
- able to recognize abnormal tissue
- able to make simple diagnoses
Frozen Section
- able to cut and stain most cases in a timely manner
- able to make touch preps
Organizational and Administrative Skills
- able to organize slides and correct draft reports prior to sign out
Evidence of Study
- familiar with gross dissection procedures
- reads about cases at textbook level
Conference Presentations
- able to give an intradepartmental 15-minute case presentation with discussion of diagnostic features
By the end of Year 2 (four to six months experience)
Gross Dissection and Description
- able to handle complicated dissections with limited supervision
Microscopic Examination and Diagnosis
- able to diagnose most simple and some difficult cases
- understands grading and staging and is able to determine TNM classification for malignant neoplastic cases
Frozen Section
- able to cut and stain all cases in a timely manner
- able to select appropriate areas for sections
- able to diagnose easy cases
Organizational and Administrative Skills
- able to organize and correct draft reports and review slides prior to sign out
- able to effectively interact with clerical and laboratory staff
Evidence of Study
- able to discuss most cases at textbook level
- uses journal articles to supplement study of interesting or unusual cases
Conference Presentations
- able to give an intradepartmental 15-minute case presentation with discussion of differential diagnosis and clinical implications
By the end of Year 3 (six to nine months experience)
Gross Dissection and Description
- able to handle all specimens with little or no supervision
- able to assist junior residents
Microscopic Examination and Diagnosis
- able to diagnose most cases
- develops good differential diagnosis
- able to dictate most cases
Frozen Section
- able to decide whether or not to defer microscopic examination
- able to diagnose all easy and some difficult cases
Organizational and Administrative Skills
- able to organize work and handle most problems
- able to effectively interact with clinical staff
Evidence of Study
- able to search and discuss journal literature in regard to difficult or unusual cases
Conference Presentations
- able to give a 20-30 minute case presentation with review of recent literature
- makes a presentation at the local, state or national level
By the end of Years 4 and 5 (after 12 or more months experience)
Gross Dissection and Description
- able to handle almost all specimens with no supervision
- able to supervise pathologists assistants and junior residents
Microscopic Examination and Diagnosis
- able to diagnose and dictate almost all cases well
- knows limits and when to seek help
Frozen Section
- able to decide most cases
- able to supervise pathologists assistants and junior residents
- knows limits and when to seek help
Organizational and Administrative Skills
- able to manage almost all cases from start to finish with minimal supervision
- able to supervise junior residents
Evidence of Study
- shows evidence of regular reading of major diagnostic pathology journals
Conference Presentations
- able to give a 30-minute subject review with citation of recent literature
- presents a paper or poster at a state or national meeting
Responsibilities
The resident(s) assigned to surgical pathology will rotate through a three-day schedule. He/she will process surgical specimens including cutting frozen sections in the morning on the first day, preview and sign out surgical cases with the attending pathologist on the second day and sign out biopsy cases with the attending pathologist including cutting frozen sections in the afternoon on the third day. The resident is expected to be on duty from 7:30 a.m. until at least 6 p.m., remaining later to gross or dictate if the workload warrants.
Progressive Responsibilities
Residents will be supervised closely during their early rotations. With increasing experience, the resident will be expected to perform more of the complicated gross dissections without assistance and to supervise junior residents. The resident will be given increasing opportunity to review slides and dictate diagnoses on their own, along with the option of selecting those cases they want to review one-on-one with the attending surgical pathologist. The degree of autonomy will be established between the resident and each attending on the basis of level of training, past performance and mutual trust.
Daily Responsibilities
- Examine, process, and dictate the gross description of specimens according to the instructions and policies in the procedure manual and other gross dissection texts available in the Gross Room and the Surgical Pathology Library.
- Examine specimens submitted for frozen section, selecting areas for examination and preparing sections under the guidance of an attending surgical pathologist.
- Work in a cooperative manner with the pathologist’s assistants.
- Photograph resection specimens or unusual lesions.
- Harvest tissue for the tumor bank as per the protocol.
- Help to maintain order and cleanliness in the Gross Room and Sign-Out Areas.
- Seek assistance from a senior resident, surgical pathology fellow, pathologist’s assistant or attending pathologist before cutting an unfamiliar specimen.
- Proofread and correct draft reports.
- Consult clinicians and review patient records to obtain information necessary for interpretation of specimens.
- Preview microscopic sections prior to sign-out with the attending surgical pathologist to the extent that time allows.
- Review microscopic sections with assigned attending surgical pathologist and establish diagnoses for specimens. Dictate the diagnosis and, if appropriate, note sections of the reports under the guidance of the attending surgical pathologist.
- Dictate the diagnosis and, if appropriate, note sections of the reports under guidance of the attending surgical pathologist.
- Order recuts and special stains as necessary with appropriate staff guidance.
- Present cases at conferences when requested by an attending surgical pathologist.
Evaluation
Performances in the following areas are judged by the attending surgical pathologists as part of the daily one on one interaction with the resident:
- gross skills
- diagnostic skills
- frozen section skills
- organization
- attention to detail
- general knowledge
- evidence of study
- quality assurance documentation
- conference performance
- reliability and punctuality
- interpersonal skills with attending staff, clinician, others residents, clerical staff and laboratory staff
- attitude