Residency Program in Anatomic Pathology

Program Overview

The Residency Program in Anatomic Pathology (AP)  is a 3-year programme aimed at training medical doctors to become general specialist pathologists with interpretive and diagnostic skills on all pathological tissues obtained from all organ systems of the human body. The Residency Program in Anatomic Pathology is developed based on the Accreditation Council for Graduate Medical Education (ACGME) framework of the United States of America (The ACGME Program Requirements for Graduate Medical Education in Anatomic (AP) and Clinical Pathology (CP)) and its six (6) Core Competencies and their Milestones). The ACGME requirements prescribe a minimum of 36 months of full-time residency training for either AP or CP alone and a minimum of 48 months of full-time residency training for a combined AP/CP program.

Over the 3-year period, residents will have high-quality laboratory-based practical training on specialized benches on a rotational bases including full scale or complete diagnostic (clinical) autopsy, minimally invasive tissue sampling (MITS) autopsy techniques, cytopathology, surgical pathology and intra-operative consultations. This program reflects the NUSOM commitment to the development of physician-scholars and scientists who will advance evidence-based patient care and medical practice by integrating clinical work in hospital pathology laboratories in a clinical setting with research into pathological and molecular mechanisms of disease. This initiative represents a paradigm shift from the traditional non-evidence-based training programs in anatomic pathology currently being offered by other institutions in the country towards the global trends in educating physicians to practice evidence-based and personalized medicine.

Program Structure and Academic Content

Curriculum Organization and Resident’s Experience

The Anatomic Pathology Residency Program of NUSOM has adopted the ACGME competencies and Milestones for training anatomic pathology specialists in NU. As such there will be no rigid compartmentalization of learning activities. Depending on the postgraduate year level (PGY) level, learning activities will occur concurrently. However, a resident must spend a minimum of 24 months of core anatomic pathology education, 6 months of cytopathology and 6 months of research experience. All learning activities and procedures must be documented in the resident’s Case Log and portfolio (Appendix I) similar to the ACGME Case Log System.

PGY-1
A.    SURGICAL PATHOLOGY
(i) Cut-up/Grossing Accurately and comprehensively describes most surgical specimens and

take appropriate blocks;

Recognizes specimens at the time of cut-up which require special procedures or stains;
Recognizes when to seek assistance with unusual specimens from more experienced colleagues.
(ii) Reporting Familiar with the inclusion of relevant important points in reports on surgical specimens, e.g. margins, lymph nodes, grading and staging;

Makes appropriate reference to textbooks or journals;

Apply coding systems to pathology reports appropriately;

Examines and assesses at least 800 surgical pathology specimens from a mix of cases of common pathological conditions and discusses with an attending pathologist;

Participates in grand rounds, tumor boards and mortality meetings (from different clinical specialties like pediatrics, general internal medicine, general surgery, obstetrics and gynecology, and present pathology reports and findings (under supervision) of these cases to other clinicians.

(iii)

 

Special Techniques

 

Awareness of techniques for H & E, Frozen Section and be familiar with the main indications for frozen sections.
(iv) Case Of the Week Participates in a weekly slide sessions/consensus conference where interesting or difficult cases that came up during the week are discussed
B.     AUTOPSY
 

 

Performs at least 20 adult autopsies under supervision including being able to review the history and circumstances of death; external examination of the body; gross dissection and organ evisceration and review of microscopic and laboratory findings appropriate to the case under supervision;

Be aware and observe all safety procedures as dictated by existing protocols;

Attend several brain cuts sessions with experienced pathologists

C.    LABORATORY INFORMATICS AND PATIENT MANAGEMENT SYSTEM
Familiar with applications of information technology in the laboratory including databases, spreadsheets, barcoding and their application in patient management;

Understands the health and safety aspects of the laboratory and mortuary design and operation

D.    LABORATORY MANAGEMENT
Attends national/regional laboratory management courses as relates to anatomic pathology laboratory management;

Acts as resident representative on departmental, national or regional committee for laboratory medicine and pathology;

Understands laboratory expense and revenue calculations and projections, safety regulations, coding and billing compliance

E.     ACADEMIC ACTIVITIES
(i)

 

Journal Club

 

This will be held monthly. Residents will take their turns in critically reviewing a relevant manuscript published in the last 3-6 months in one of the top 10 peer-reviewed journals in the field of anatomic pathology and laboratory medicine.
(ii) Textbook Review Day This will be held monthly. Residents will take their turns in presenting and discussing important highlights from the general pathology chapters of Robbins and Cotran Pathologic Basis of Disease textbook and then transition to a resident-level text. Sternberg’s pathology and Rosai Surgical pathology textbooks are recommended. Only the most current edition of the texts at the time will be consulted.
(iii) Didactic Teaching This will be held weekly. Faculty members or invited experts will deliver a 45-minute lecture on a subspecialty area such as genitourinary

pathology, breast pathology etc. These lectures will cover benign and malignant lesions and will be preceded by an hour-long session of histology slide quiz from that system or organ.

(iv) Seminars/Research training courses An annual attendance at research seminars, research conferences or research methodology courses is required
PGY-2
  A.       SURGICAL PATHOLOGY
(i) Cut-up/Grossing Competently handles specimens of subspecialties e.g renal, nervous tissue and muscle biopsies.
(ii) Reporting Examines and assesses at least 600 surgical pathology specimens from an adequate mix of cases of both common and uncommon pathological conditions;

Formulate a microscopic diagnosis for most cases examined grossly;

Previews cases prior to sign-out with an attending pathologist;

Participates in regular, formal, clinicopathological conferences, grand rounds and tumor board meetings;

Reliably identifies cases requiring a specialist opinion

(iii) Special Techniques Aware of techniques for immunohistochemistry and can reliably request appropriate special stains or immunohistochemistry on common diagnostic problems;

Reliably interprets immunohistochemistry staining results on common surgical specimens including skin immunofluorescence;

Understands the basic methodology of some molecular biology techniques like In-Situ hybridization, Southern blotting, PCR and Flow Cytometry, being aware of their uses and limitations in augmenting pathological diagnosis.

(iv) Frozen section Performs at least 50 intra-operative consultations and sign-out under supervision of an attending pathologist.
(v) Case Of the Week Continue to participate in weekly slide consensus conferences as in PGY-1
    B.     CYTOPATHOLOGY
    Examines at least 800 cytologic specimens including a variety of both exfoliative and aspiration cytology specimens;

Familiar with the clinical management implications of different cytological diagnosis;

Attends and performs aspiration procedures and slides preparation;

Recognizes the main types of malignancy and reactive changes in FNACs, brushings and body fluids

    C.    AUTOPSY
    Performs a further 15 autopsies including stillborn, perinatal and pediatric autopsies;

Prepares written description of gross and microscopic findings;

Recognizes when ancillary testing is required and takes appropriate samples e.g for toxicology and microbiology;

Being able to develop  an opinion on cause of death;

Discusses clinicopathological correlation as appropriate to the case;

Review of the autopsy report with a faculty member

    D.    LABORATORY MANAGEMENT
    Participates in laboratory inspections; methods validation; understands principles of human resource management;  proficiency testing; public health reporting;  quality control and quality assurance;  risk management; safety standards and compliance;  and the use of hospital and laboratory management systems;

Attends regional or national courses on laboratory management

    E.     ACADEMIC ACTIVITIES
    All the academic activities described in PGY-1 will continue longitudinally in PGY-2 and PGY-3
PGY-3
    A.     SURGICAL PATHOLOGY
(i) Grossing/cut-ups Completely handles rare specimens e.g. laryngectomy, neck dissections, major resection for bones and soft tissues;

Efficiently takes blocks from specimens, which are comprehensive and adequate but not excessive.

(ii) Reporting Examines and assesses a further 600 surgical pathology specimens from and adequate mix of pathological conditions;

Independently reports most common pathological conditions but preview with an attending pathologist before sign-out;

Recognizes and refers difficult and/or rare cases to specialists when appropriate.

(iii) Special Techniques Accurately interprets immunohistochemistry (IHC), immunofluorescence and electron microscopy of renal biopsies;

Uses PCR, IHC, FISH and flow cytometry to supplement routine histopathology and formulating a pathological diagnosis where appropriate;

(iv) Frozen sections Reliably diagnoses routine frozen sections and gives appropriate advice to clinicians.
(v) Case Of the Week Continue to participate in weekly slide consensus conferences as in PGY-2
    B.     CYTOPATHOLOGY
Examines a further 700 cytology specimens from a mix of aspiration and exfoliative cytology specimens;

Understands the organization and administration of cervical and breast screening programs;

Understands the role of immunocytochemistry in cytopathology and apply the technique in cytological diagnosis;

Gains experience in independently reporting gynecological and non-gynecological cytology, seeking appropriate specialist opinion when necessary;

Takes part in gynecological cytology proficiency testing (EQA);

Examines and recognizes examples of potential false/positive and false/negative cervical smears;

Regularly examines doubtful and equivocal cervical smears, screened by MLSO/cytology screeners;

Attends fine needle aspiration procedures and perform aspirates & slides preparation

    C.    AUTOPSY
  Continues to perform another 15 autopsies with the addition of at least 5 perinatal/pediatric autopsies

Able to appropriately dissect the heart for assessment of relative ventricular sizes

Able to dissect the cardiac conducting system.

Able to remove spinal cord and examines middle ear

    D.    LABORATORY MANAGEMENT
    Continue to participate in laboratory inspections or mock inspections, method validation, review of proficiency testing results, quality control and quality assurance activities as prescribed by approved laboratory protocols and SOPs and the use of hospital and laboratory information systems.
    E.     ACADEMIC ACTIVITIES
    Academic activities in PGY-2 will continue longitudinally;

Participate and conduct pathology practical laboratory sessions for the MD students and deliver lectures as may be approved by the Departmental Chair