Implementation in the Anatomical Pathology Residency Program (Covid-19)
Lung gross (April 22, 2020)
Dr. Mark Desjardins has advised that we need to be using a Class 2 Bio-safety cabinet for Fresh lungs and LNs. He will perform a risk assessment of the small BSC and the grossing stations for us once he has time.
In the mean time we will have to use the Class 2 BSC that is located up in the frozen section room. Janet is arranging with the OR nurse manager to have AP called when they have a lung and the PA will go down and open and perfuse the lung there.
The Residents can use the BSC in the frozen section room as well.
They will be setting up the supplies in the room to be able to do the work necessary in the FS room.
The BSC in the gross room at the civic campus is a class 2 and can be used for these activities.
On-Call opening/frozen at Civic (April 20, 2020)
In follow-up to the Civic situation with COVID positive staff in the Pathology building, if you are on call and are asked for a frozen or opening of a specimen please open it in the frozen section room beside the OR and NOT in the gross room at the Civic. If you travel to that building during the outbreak (which is still ongoing) you will not be able to travel back to the General. For the juniors, if you do not know where the frozen room is at the civic please ask one of the seniors.
The Autopsy Guideline we have implemented for COVID-19 in addition we have modified our FS coverage my residents and have implemented redeployment strategies for our residents, please, see below.
Frozen Section (April 7, 2020)
Effective immediately, the following change will take place regarding Frozen Section (FS) responsibilities for residents till further notice:
1. Resident will be scheduled as before for FS.
2. No other learners (off-service residents/medical students) will be scheduled for FS.
3. On the day of FS, the resident will get in touch with the staff to discuss cases if need be.
4. Resident will be paged by histology for FS, but is not required to go down to do the FS room. The resident may be called upon by the staff pathologist for other reasons.
5. Resident will follow-up the case with Gross room/Histology to review the slides and discuss with the staff. Resident must keep a log of this activity.
6. The program will send a Daily Encounter Card via One45 to the supervising staff to document in the "Comment section" if any FS was done and whether or not it was reviewed by the resident. The staff may choose to evaluate the resident for intrinsic CanMEDS roles if such activities are done during that time.
7. On-call resident will be responsible for organizing the FS in consultation with the on-call pathologist as before. For this, the resident may have to come to the hospital if need be, but is not required to perform the FS.
8. Under extenuating circumstances, if the resident is required to do an FS, the resident must wear PPE with N95 fitted mask for all cases.
Redeployment strategies for Residents within Anatomical Pathology (April 7, 2020)
1. Assisting with forensic autopsies (Senior residents who have completed their PGY4 forensic rotation)
2. Help with frozen sections (performing chart review on OR cases, pulling previous pathology for review, facilitating second opinion by staff on cases etc) (PGY 2+)
3. Assisting in grossing of all specimens especially large complex cancer cases for timely diagnosis and staging. This would allow clinicians to start patients on treatment without delay. This would especially be important if there is a reduction of pathology assistants due to COVID and subsequent hospital stay or mandatory 14 day self isolation (PGY 2+)
4. Filling in for PA float bench for opening specimens if there is a shortage of PAs for COVID related reasons (PGY 2+)
5. Processing of more specialized specimens such as Cardiac valves, lymphoma protocol (PGY 2+)
6. Continue to be the 1st call for PAs if there is any issue with grossing being triaged to staff (PGY3+)
7. Residents can pull/scan/photograph cases for MDRs (PGY2 and up). PGY5 likely able to prepare and present MDR independently (potentially PGY4 also depending on rotations completed).
8. If surgical pathology cases were to get backlogged due to staff illness, senior residents also could be used to expedite cases (getting IHC ordered), dictating reports, etc. (PGY3+, maybe PGY2 for less complex cases)
9. Covering call weeks due to resident’s being away due to positive COVID tests and self-isolation. We are already stretched thing with our reduced number of residents so we might need other residents to step in
Resident educational activities (March 28, 2020)
1. Residents can self-study on Monday Academic day (AHD) till 12 pm (residents may study from home or work and keep a log of their activities) and then join their respective services.
2. Double scoping is not recommended at this time till further notice. Residents will touch base with their staff and make a plan for signing out cases. One suggestion would be to have the residents review and dictate cases and once done leave cases in staff mailbox to provide feedback via email.
3. For MCC rounds, residents are advised to touch base with staff and help getting the cases ready with printed reports if need be with focused review of cases for residents to take pictures etc.
4. At this time, residents are not required to attend Consensus Rounds.
Monday Academic Day (March 17, 2020)
For Resident Academic days on Monday, if you are scheduled to do unknown round/lecture, please, assign residents tasks such as assigning an article or review to read and summarize and submit to you and as feed you can ask some questions on the topic or give them any other assignments that you may think is appropriate. This is time for us to be a little more innovative in teaching our residents online.
Osama, will continue to do the scheduling for AHD and ask the responsible staff to assign you tasks online which you will log and submit to the program as you have done with me.