General Objectives
By the end of this 4 week rotation, the PGY1 Anatomical Pathology (AP) resident is expected to develop an understanding of:
- The AP resident role in the frozen section suite
- Principles of specimen opening in the gross room (EPA: TTD#1):
- Ischemic time in tumours
- Scout section(s) to mitigate over-fixation
- Orientation to the gross room with respect to various fixatives and handling of unique specimens ie. Lymphoma protocol
- Principles of cytology with respect to types of procedures, fixatives and on-site evaluation
- Adequacy
- Formalin fixed sample for any case that may require ancillary studies
- The autopsy process:
- Valid autopsy consent
- Personal protective equipment
- Orientation to the morgue
- The handling of tissue blocks in histology and immunohistochemistry lab (EPA: TTD#1)
The four week block will be divided as follows:
- One week of frozen section
- One week of opening bench/gross room
- One week autopsy suite
- 2 days – histology lab and immunohistochemistry lab
- 2 days – cytology (on-site evaluation)
Scheduling:
- If you anticipate that you will require vacation or CME time during this block, please advise the PD so that this block may be rescheduled to the next available slot.
- If this is not possible or there is an unexpected absence, it will not be possible to reschedule components of this block at a later time.
For specific goals and objectives please refer to the specific rotation goals and objectives, under the PGY2-PGY5 headings, particularly Autopsy, Cytopathology and the major (core) surgical pathology subspecialty rotations.
Medical Expert Role
- The resident will be placed on the daily resident schedule for frozen section and autopsy.
- The chief resident will coordinate and schedule the appropriate days for histology and immunohistochemistry lab, opening bench/gross room and cytology (on-site evaluation)
- For frozen section, the resident will be assigned with a senior resident and staff, and will learn the following (EPA: TTD#1, C#13):
- Compare and contrast frozen sections and formalin-fixed, paraffin-embedded permanent sections, including the advantages and limitations of each.
- 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.
- In the grossing lab, the PGY1 resident will observe the pathology assistants at the opening bench primarily and learn the following: orientation, margin identification, margin sampling, tumour/specimen exposure to formalin and selecting scout sections if appropriate (EPA: TTD#1, C#1).
- The PGY1 resident may also observe the pathologist assistant and senior residents grossing large specimens and, depending on skill acquisition, may attempt to gross simple/routine specimens (EPA: C#2).
- Understand the difference between en face and perpendicular margins and embed them appropriately.
- 2 days of cytology will be spent primarily with the cytotechs for onsite evaluation and learning about types of specimens/procedures and fixatives (EPA: C#11A).
- 3 days in the histology and immunohistochemistry lab to learn basic principles of tissue processing:
- Describe the steps through which tissue progresses from the gross room through to the pathologist's desk (processing, embedding, cutting, staining, etc.).
- In a stepwise fashion, describe the procedures in the performance of the following ancillary diagnostic techniques (EPA: C#1):
- Immunohistochemistry
- Special histochemical stains
- Understand the qualities of different tissue types and how they vary in the processing and cutting (eg. Fatty vs. fibrous vs. bone)
- Understand the principles of choosing control tissues for immunohistochemistry
- Describe the difference between on-slide and batch controls
- Demonstrate the basic functioning of a microscope (TTD#3).
- Demonstrate an understanding of a valid medical autopsy consent (EPA: C#6)
- Demonstrate an understanding of the differences between a coroner (forensic) autopsy and a medical (hospital) autopsy (EPA: C#6, C#7).
Communicator Role
- Understand rush specimens and how to handle these specimens in the gross room
- Independently learn about surgical pathology critical values and the need to report these to the appropriate person
- Be able to communicate with OR personnel (surgeons, OR nurses, residents and fellows) with respect to intra-operative consultation (frozen section) results and also to clarify the indication/need of the frozen section
- Demonstrate and understanding of the need for on-site evaluation for cytology specimens
- Demonstrate awareness of the importance of timeliness, clarity and accuracy in all verbal and written communications
- Problem solve an incomplete/invalid hospital consent (EPA: C#6)
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
- Describe the role of Pathologist Assistants within the healthcare team
- Describe the role of histotechnologists within the healthcare team
- Describe the role of the cytotechnologists within the healthcare team
- Describe the role of the morgue technologists within the healthcare team
- Recognize the unique knowledge of and work collaboratively with histotechnologists and other laboratory personnel
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
- Through reading and self-study, develop a basic understanding of and role of the following immunohistochemical and histochemical stains:
- Immunohistochemistry:
- Cytokeratins, in particular CK7 and CK20
- CD45, CD3, CD20, CD68/CD163, CD138
- S100
- Approach to an undifferentiated tumour
- Approach to carcinoma of unknown primary
- Histochemical stains:
- Special stains for microorganisms
- Stains for pigment: hemosiderin, melanin
- Special stains for tissue elements (Ie. Masson Trichroma, etc)
- Immunohistochemistry:
- Seek ongoing feedback from teachers and modify learning objectives as necessary
Leader Role
- 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
- Demonstrate attention to laboratory safety:
- Take universal precautionary measures to minimize hazardous exposures including potential infectious and chemical agents
- Use personal protective measures (lab coats, goggles, gloves, etc.) as appropriate
- 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
- Adhere 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
Rotation Checklist:
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Date |
Topic |
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Grossing and processing:
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Paraffin sectioning
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Immunohistochemistry:
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Histochemical (Special) Stains:
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Frozen Section:
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Autopsy Suite:
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Cytopathology:
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Updated April, 2022