Pediatric Pathology

Goals and Objectives

Pediatric pathology is a subspecialty of anatomic pathology. The main goal of the 2- month rotation is for the residents, to become familiar with the basics of pediatric and perinatal pathology. At the end of the rotation, the resident should be able to recognize specimens that belong to the field of pediatric and perinatal pathology and be able to handle them appropriately when practicing in a pathology department of any size, and request consultation as warranted.

The resident should be able to assume responsibility for organizing the service. The resident should have mastery of the information contained in standard texts and be prompt in using the literature to solve specific problems. The resident should begin to understand the role of the practitioner in an integrated health care delivery system and to be aware of the issues in health care management facing patients and physicians.

Program Requirements

General Objectives

  • To be able to address issues specific to pediatric pathology that can occur in a general hospital setting (such as gross receipt of pediatric tumors)
  • Considering the above: to understand issues of time sensitive tissue procurement distinctive to pediatric pathology (cytogenetics, metabolic testing, molecular genetics, flow cytometry, tumour biological studies)
  • To appreciate how a working knowledge of developmental biology informs pediatric pathology
  • To have a working sense of the distinctive spectrum of pathology in the pediatric age group
  • To become competent in signing out maternal-fetal specimens that are relevant to general anatomical pathology: placentas
  • To have a working approach to stillbirth autopsies
  • To have sufficient exposure to be able to consider a career in pediatric pathology (and consider further training)

Specific Objectives

At the completion of the rotation, the resident will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker

General Requirements

  • Demonstrate diagnostic skills for accurate and timely diagnosis of pediatric pathology specimens from a variety of sites.
  • Known when to refer out more complex/complicated cases for consultation.
  • Know how to approach a freshly received pediatric specimen including special procurement considerations
  • Become competent in placental sign out

Specific Requirements

  • Know how to gross major pediatric specimens including major pediatric tumors (Wilms Tumour, Neuroblastoma, Osteosarcoma) and non-neoplastic specimens (pull through specimen for Hirschsprung’s disease)
  • Know how to utilize ancillary cytogenetic and molecular studies effectively for pediatric specimens
  • Understand the different spectra of pediatric tumors that pertain to different age groups: infant, child, adolescent and young adult (AYA)
  • Become familiar with histological recognition of characteristic pediatric entities (small round blue cell tumors (SRBCT), developmental lesions, histiocytic lesions, pediatric lymphoid lesions,
  • Have an approach to use of ancillary studies for the work-up of a SRBCT
  • Be able to conduct gross dissection and description of a placenta
  • Be ready for placental sign out at the level of a new junior staff
  • Recognize the role of placental pathology in supporting obstetrics and maternal and fetal care (and thus have an insight into correlations for major conditions such as IUGR, preeclampsia and infections)
  • Recognize the spectra of pediatric autopsy practice (stillbirth, dysmorphology, metabolic cases, neonatal cases, pediatric cases)
  • Be able – with assistance- to conduct aspects of the pediatric autopsy (such as pediatric cardiac and lung exam)
  • Have an approach to the investigation of fetal loss
  • Have an approach to the autopsy investigations relating to major fields in perinatal medicine (IUGR, unexpected fetal demise, hydrops fetalis, oligo- and polyhydramnios, complications of extreme prematurity)
  • Recognize the spectrum of routine pediatric GI pathology (Eosinophilic Esophagitis, celiac and IBD) plus know something about other more rare conditions such as tufting enteropathy, microvillous inclusion disease, etc.)
  • Know about the uses of EM/ Ultrastructure in pediatric pathology (immotile cilia syndrome, tumours)

Communicator

General Requirements

  • Discuss cases with other pediatric pathologists and members of the health care team in terms of diagnosis and prognosis.

Specific Requirements

  • Assist in clarifying and transmitting clinical pathological correlation by participating in educational rounds/clinical review forums such as pediatric surgical pathology rounds and pediatric oncology tumour boards, perinatal and neonatal M and M, etc.
  • Act as a consultant to clinical colleagues on the interpretation and relevance of pathologic findings, with particular regard to their significance in the management of the pediatric patient.
  • Understand the information a pathology report should provide in each clinical situation and be able to communicate it effectively in an oral or written form.
  • Appreciate sensitive issues that arise in pediatric pathology such as communicating causes of fetal or pediatric loss with clinical teams, facilitating autopsies that empower cultural considerations, special confidentiality issues surrounding genetic testing

Collaborator

General Requirements

  • Consult effectively with other physicians and health care professionals
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements

  • Have sufficient fluency in pediatric conditions to communicate effectively with pediatric medical and surgical care providers
  • Attend multidisciplinary working groups such as surg-path rounds, GI-path, etc.
  • Attend and present at pediatric tumor boards; understand the roles of the various members of the interdisciplinary teams

Manager

General Requirement

  • Gain insight into resource management issues in pediatric subspecialty care
  • Be aware of resource management issues in regional maternal-fetal medicine lab support
  • Demonstrate participation in quality management

Specific Requirements

  • Demonstrate knowledge of the methods of quality control in the histopathology and immunohistochemistry laboratory.

Health Advocate

General Requirements

  • Identify the important determinants of health affecting pediatric patients including screening for genetic and metabolic disease.
  • Learn about determinants of maternal and fetal health
  • Understand rudimentary perinatal epidemiological concepts
  • Consider how sociological determinants impact maternal and fetal health
  • Consider determinants of fetal and maternal outcomes in global health

Specific Requirements

  • Define (and understand problems with definitions of): stillbirth, miscarriage, perinatal mortality, antenatal mortality, infant mortality
  • Relate these epidemiological terms with determinants of care (maternal health, maternal care, fetal care, access to care, maternal nutrition, infant nutrition)

Scholar

General Requirements

  • Demonstrate the ability to acquire new knowledge related to pediatric pathology conditions
  • Demonstrate the ability to evaluate the quality of evidence and decide if and how to change practice
  • Identify areas of active translational research in pediatric lab medicine

Specific Requirements

  • Demonstrate self-learning (reading, etc.) around a single complex autopsy case
  • Demonstrate self-learning around a complex surgical case
  • Participate in teaching of elective medical students (if available) [optional].

Professional

General Requirement

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviors.
  • Practice pediatric pathology ethically consistent with obligations of a physician.
  • Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to pediatric pathology.

Specific Requirements

  • Act as an appropriate role model for students and others.
  • Demonstrate a professional attitude toward colleagues, as well as other laboratory staff.
  • Have an appreciation of the crucial role of the pediatric pathologist in providing quality patient care. This will include knowledge of individual professional limitations and the necessity of seeking appropriate second opinions.

Instructional Tools and Responsibilities

The residents on Pediatric Pathology rotation is expected to perform the following:

  • Familiar with handling, grossing and microscopic findings of small blue round cell tumors, pediatric renal tumours, Hirschsprung’s disease, and placentas.
  • Review the slides before sign-out, check prior history, request to pull previous slides if necessary.
  • The clinical work is the most important teaching tool of the rotation. The workload assigned to each resident will be defined by the staff pathologist, who will take into account the level of training and the individual competence of the resident in different areas/roles. The resident is expected to keep track of his/her clinical work and to keep a logbook of the cases he or she was involved with and will be asked to show at mid rotation assessment so as to ensure to cover topics that were not seen through rotation by teaching slides. An alternative is to track involvement through the LIS. A pro-active and mature attitude is expected from the resident when performing the clinical work. The level of independence will depend on the competency demonstrated throughout the rotation.
  • Attending is mandatory for the GI, kidney, surgical pathology, brain cutting and tumor board rounds. The main goal of these rounds is to teach pathological aspects of pediatric/perinatal diseases within clinical context.
  • Able to approach fetal/perinatal autopsies with mandatory fulfilment of at least 2 autopsies with full reporting. The number of autopsies will be recorded at the end of the rotation and incorporated in the final evaluation.
  • At the end of the rotation a final evaluation will be provided by each pathologist who participated in the training of the resident.
  • A brief slide quiz and written quiz will be given at the end of the rotation.

 

Updated April, 2020

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