STAGE: TRANSITION TO DISCIPLINE (TTD) (PGY1)

Anatomical Pathology: Transition to Discipline

EPA # 1 - Participating in basic specimen handling

Key Features:

- This EPA includes the use of the basic knowledge covered in the orientation to the laboratory in order to:

• Match requisition and container and/or specimen
• Systematically verify the adequacy of patient and clinical information (requisition adequacy and completeness such as documentation of ischemic time) to initiate laboratory evaluation of a specimen
• Assess and prepare selected simple surgical specimens which are defined as single organ, routine indications and/or routine surgical specimens (e.g. appendix, gallbladder, simple hysterectomy for fibroids/uterine prolapse, colon for diverticulosis, ischemic small bowel etc.) for fixation
• Select and recognize the appropriate fixative type (formalin, alcohol) and assess whether the quantity and size of the specimen container is appropriate
• Match slides, blocks, and requisition

- The observation of this EPA is divided into two parts: specimen handling; and assessment of knowledge.
- The assessment of knowledge will consist of a structured oral or a written multiple- choice quiz, designed and administered   by the supervising pathologist, on content related to the topic of specimen handling

Assessment Plan:

Part A: Specimen handling
Direct observation or case review by pathologist, TTP trainee, histotech, or pathology assistant

Use form 1. Form collects info on:

Part B: Assessment of knowledge

Evidence of satisfactory completion of a structured oral or written quiz administered by the supervising pathologist

Use Form 4

Collect 1 observation of achievement

Relevant milestones:

Part A: Specimen handling

1. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry
2. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues
3. ME 2.2 Identify basic principles of specimen adequacy as they apply to surgical and cytopathology specimens
4. ME 3.3 Recognize and discuss the importance of the triaging and timing of a procedure or therapy
5. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite, to minimize occupational risk

Evaluation type:

Clinical scenario:

Type of rotation:

EPA # 2

Summarizing relevant clinical information for clinicopathologic correlation

Key Features:

Assessment Plan:

Case discussion and/or review of written clinical summary by supervisor (may include pathologist or Core or TTP trainee)

Use Form 1. Form collects information on:

- Location: surgical pathology; cytology; autopsy pathology; other
- If “other” specify location: [free text]

Collect 3 observations of achievement
- At least 1 autopsy pathology

Relevant Milestones:

1. ME 2.2 Obtain a relevant clinical history
2. ME 2.2 Interpret history and relevant investigations in light of the clinical question
3. ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor
4. HA 1.1 Analyze a given patient’s needs for health services or resources related to the scope of Anatomical Pathology

Evaluation type: 

- Observations/case discussion by pathologist while resident presents a case (after synthesizing relevant info from various sources) before autopsy, sign out, and/or MDR

Clinical scenario:

Type of rotation: 

EPA # 3

Demonstrating basic skills in microscopy

Key Features:

- This EPA focuses on using a microscope correctly and troubleshooting its principal problems

- This includes:

• Setting up the microscope (turning it on, adjusting the focus), using a polarizer and micrometer, understanding ergonomic setup
• Performing basic microscope maintenance such as changing objectives and bulbs
• Viewing the slide

- The observation of this EPA is divided into two parts: microscopy; and assessment of knowledge
- The observation of microscopy is based on the resident driving the double/ multiheaded microscope in the review of slides
- The assessment of knowledge will consist of a structured oral or a written multiple- choice quiz, designed and administered   by the supervising pathologist, on content related to the topic of microscopy

Assessment Plan:

Part A: Microscopy
Direct observation by supervisor Use form 2.

Collect at least 1 observation of achievement

Part B: Assessment of knowledge
Evidence of satisfactory completion of a structured oral or written quiz administered by the supervising pathologist

Use Form 4

Collect 1 observation of achievement

Relevant Milestones:

Part A: Microscopy

1. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues
2. ME 1.3 Apply knowledge of how a light microscope works
3. ME 3.4 Use a light microscope to examine microscopic slides
4. ME 3.4 Perform basic microscope maintenance

Evaluation type:

• Direct observation by supervisor
• Structured oral or written quiz administered by the supervising pathologist

Clinical scenarios:

• Surgical pathology rotation/signout
• Possibly basic histology rotation

Milestones satisfactorily met through rotation:

1. Apply basic knowledge of normal gross and light microscopic appearance of tissues
2. Use a light microscope to examine microscopic slides

Recommendations for milestones requiring formal attention:

• Apply knowledge of how a light microscope works
  • Formal online module required + reading Molavi chapter 1.
• Perform basic microscope maintenance
  • Direct observation on day 1 by a coresident/staff of adjusting a microscope to create an image.

EPA # 4

Creating a personal teaching and learning plan

Key Features:

- The observation of this EPA is divided into 2 parts:

• creating and maintaining a clinical training portfolio and
• presenting a personal learning project, including identifying a topic, identifying and utilizing information sources, presenting the topic to a group and assessing the process (including self-assessment).

Assessment Plan:

Part A: Clinical training portfolio
Resident’s submission of teaching and learning plan reviewed by pathologist, or TTP trainee or academic advisor

Use form 4

Collect 1 observation of achievement

Part B: Personal learning project Direct observation by supervisor

Use form 1

Collect 1 observation of achievement

Relevant Milestones:

Part A: Clinical training portfolio

1. S 1.2 Use feedback to enhance self-assessment and improve learning
2. S 1.1 Create a learning plan in collaboration with a designated supervisor identifying learning needs related to Anatomical Pathology and career goals
3. S 1.1 Use technology to support learning in medicine

Part B: Personal learning project

1. S 1.2 Identify and record learning needs that arise in daily work, and apply strategies to address those gaps
2. S 3.3 Identify relevant sources of information
3. S 3.3 Determine the validity and risk of bias in a source of evidence
4. S 4.5 Summarize and communicate to peers the findings of a literature search

Evaluation type

· This would be direct observation of the personal learning project, perhaps a 10 minute presentation to an off-service oncologic staff or senior resident about the pathology/cancer with its relevant information. This could also be presented to the group of residents/staff during the academic day of their particular service

· Part A seems to ask for a learning plan, so this could be as simple as identifying a topic with the staff ahead of time and discussing which areas will be covered, like epidemiology, etiology, genetics, treatment etc of the pathology/cancer; also could be reviewed with academic advisor

· Part B is the observation which could be done by the off service staff or senior resident during the presentation

Clinical Scenario

· This could be done during or after clinic in an off-service rotation, or could be done as a presentation during the academic day or morning rounds for the off-service

Specific rotation

· Could be done a total of 3 times during year 1 for any of the off-service oncologic blocks, such as gyne onc, med onc, rad onc, gen surg