Anatomical Pathology

Goals and Objectives

Anatomical Patholoigy

Medical Expert Role
  • The resident will be placed on the daily resident schedule/ and will participate in the usual rotations: surgical pathology sign-out, frozen sections and grossing, as well as one week in cytology
  • For daily sign-out in general surgical pathology, the resident is responsible to review all the slides the day before (at the discretion of the staff, only a portion of the slides may be required), read around the cases, and review pertinent clinical histories and ancillary information
  • The resident must be able to present the cases to the staff in a clear, concise, manner and come up with reasonable differential diagnoses
  • For frozen section, the resident will shadow the senior residents and staff, and observe carefully the technique of grossing the specimen, selecting the appropriate section for frozen section, the technique of freezing, cutting in the cryostat, and staining of the slides
  • In the grossing lab, the PGY1 resident will observe the pathology assistants and senior residents in grossing the specimens- photographing, measuring, inking, and taking appropriate sections
  • By the end of the rotation, they should be able to independently gross small specimens
  • 2 days of the cytology week will be spent signing out the cases with the staff
  • Since the cytology cases come out the same day as the sign-out, as soon as they are screened by the cytology technicians, they don’t need to be reviewed prior to sign out
Communicator Role
  • Understand Surgical Pathology critical values and the need to report these to the appropriate person
  • Formulate comprehensive and clinically meaningful pathology reports, prioritizing the features of importance.
  • Demonstrate awareness of the importance of timeliness, clarity and accuracy in all verbal and written communications
  • Act as consultants to clinical colleagues on the interpretation and relevance of pathology findings
Collaborator Role
  • Shadow and assist a PGY2-5 resident as they prepare multidisciplinary rounds (MDR). Attend an MDR each week with a PGY2-5 resident or staff pathologist.
  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to interdisciplinary team activities.
  • Understand the importance of contributing to educational/or research endeavors of clinical and laboratory colleagues.
  • Be aware of the strong interface between the laboratory and clinical disciplines.
Scholar Role
  • Explain the principles of evidence based medicine and its relevance to clinical decision making
  • Record personal learning objectives during the rotation and take responsibility for self-managing your own learning objectives documental at the beginning of the rotation
  • Seek ongoing feedback from teachers and modify learning objectives as necessary
Leader Role
  • Utilize resources of the laboratory effectively to achieve an accurate diagnosis.
  • Understand principles of quality assurance and patient safety.
  • Allocate finite health care resources wisely
  • Utilize information technology to optimize patient care, life-long learning and other activities.
  • Work effectively and efficiently in a health care organization.
Professional Role
  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practice medicine ethically consistent with obligations of a physician.
  • Adhering to hospital rules and accepted standards of dress while working
  • Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to anatomical pathology.
  • Show up on time and attend all appropriate learning sessions and rounds
  • Complete all necessary evaluations on time

 

BASIC HISTOLOGY ROTATION (PGY-1/TTD)

The basic histology rotation will consist of a one-week rotation through the histology laboratory core facility at the University of Ottawa (Roger Guindon Hall) as part of the PGY1 surgical and cytopathology block. Through a combination of structured teaching, hands-on experience, and supplemental self-study, by the end of the rotation, the PGY1 resident is expected to:

Medical Expert
  1. Describe the steps through which tissue progresses from the gross room through to the pathologist's desk (processing, embedding, cutting, staining, etc.).
  2. In a stepwise fashion, describe the procedures in the performance of the following ancillary diagnostic techniques: 
    1. Immunohistochemistry,
    2. Special histochemical stains.
  3. Compare and contrast frozen sections and formalin-fixed, paraffin-embedded permanent sections, including the advantages and limitations of each.
  4. Perform embedding, cutting, and H&E staining of frozen section slides with adequate level of competence such that if a histotechnologist was not available for frozen section (eg. at a future institution where the resident is completing his/her fellowship), the resident would be able to perform the frozen section independently.
  5. Demonstrate the basic functioning of a fluorescence microscope.
  6. Understand the qualities of different tissue types and how they vary in the processing and cutting (eg. Fatty vs. fibrous vs. bone).
  7. Understand the difference between en face and perpendicular margins and embed them appropriately.
Leader
  1. Describe quality control procedures in the histology and immunohistochemistry laboratories.
  2. Understand the principles of choosing control tissues for immunohistochemistry.
    1. Describe the difference between on-slide and batch controls.
Professional
  1. Demonstrate attention to laboratory safety:
    1.  Take universal precautionary measures to minimize hazardous exposures including potential infectious and chemical agents.
    2. Use personal protective measures (lab coats, goggles, gloves, etc.) as appropriate.
Communicator
  1. Communicate effectively with histotechnologists and ancillary laboratory personnel.
Collaborator
  1. Describe the role of histotechnologists within the healthcare team.
  2. Recognize the unique knowledge of and work collaboratively with histotechnologists and other laboratory personnel.
Health Advocate
  1. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures.
Scholar
  1. Develop a personal learning plan to fill in knowledge gaps as appropriate.
  2. Through reading and self-study, develop a basic understanding of and role of the following immunohistochemical stains:
    1. Cytokeratins, in particular CK7 and CK20
    2. CD45, CD3, CD20, CD68/CD163, CD138
    3. Vimentin
    4. S100.
References:

Lester SC. Manual of Surgical Pathology. Elsevier Health Sciences; 2010 Jul 27.

Bahrami A, Truong LD, Ro JY. Undifferentiated tumor: true identity by immunohistochemistry. Archives of pathology & laboratory medicine. 2008 Mar;132(3):326-48.

Rotation Contents:

Tech assigned

Topic

 

Grossing and processing

  1. Dissection
  2. Fixation
  1. Size of sample and duration of fixation
  2. type of fixative depending on application
  1. Selection of programs according to type of tissue
  2. Orientation aids (dye, agar, rolls, pads)

 

Paraffin sectioning

  1. Sectioning – different thickness
  2. Angle blocks, always same orientation on slide
  3. Localization of structures

 

IHC

  1. Core versus Hospital operations (procedures and selection of antibodies)
  2. Theory and protocol
  3. Equipment
  4. Antibody selection and titration
  5. Use of controls (Core versus hospital; on slide/additional slide); challenges of in slide for the Core
  6. Troubleshooting (slide analysis)
  7. Common artifacts

 

Special Stains

  1. Examples of staining and application
  2. Hands on training (Masson Trichrome, LFB)
  1. Principles of the staining
  2. Solutions (reuse, fresh, stock, etc.)
  3. Differentiation
  1. Controls and troubleshooting (examples of past issues)

 

Frozen

  1. Freeze fresh tissues (with and without isopentane)
  2. Cryoprotection of fixed samples
  3. Safety
  4. Sectioning, temperature depending on type of samples
  5. Staining (H&E)
  6. Comparison of sections, identification of artifacts

Updated April, 2020
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