I. INTRODUCTION AND OVERVIEW
Synopsis of Program
The overall goal of the Pathology residency program is to
train physicians to become competent and skilled in the practice
of pathology (anatomic, clinical or both). Upon completion
of the training program, the resident should be well prepared
to assume the role of a practicing pathologist in a general
hospital setting, an academic medical center, or a research
institute. The resident should, at a minimum, be able to pass
the board examination(s) of the American Board of Pathology.
We accomplish this goal by selecting the best-qualified medical
applicants to our program. Considerable time and effort is
devoted to recruitment and selection of residents. After a
rigorous screening process by our Residency Training Committee,
selected applicants are invited for a full day of interviews
and site visits. The screening process includes a comprehensive
review of Deans’ letters, academic transcripts, letters of
recommendation, USMLE scores, application forms, and the candidates’
written statements of their personal reasons for choosing
pathology as a career. Selected applicants then individually
visit with six to eight staff members, including the Chairman
and several residents, and each is given a complete tour of
our facilities at GWUMC and at the affiliated hospitals. Each
interviewer completes a detailed evaluation form on the applicant.
Upon completion of the application process and interviews,
the candidates are ranked by the department in terms of their
suitability for admission to the program.
An important advisory committee,
the Residency Training Committee (RTC), assists the Program
Director. It currently consists of the Acting Chair of Pathology
and Program Director, Residency Training Committee Chair,
five additional faculty members, and the Pathology Chief Resident.
Anatomic and clinical pathology services at all participating
hospitals are represented. The Chair of the Department of
Pathology selects members of the RTC, and the Committee is
advisory to him/her and to the Program Director. The Committee
is concerned with the selection of residents, evaluation of
residents, structure and content of the curriculum, scheduling
of rotations, evaluation of the program and of the residents,
and all other matters associated with the residency program.
The Committee meets at regular intervals, usually at least
monthly. This form of governance has proved to be highly successful
in maintaining a strong program.
Residents are evaluated at regular
intervals. Upon completion of each rotation or sub-rotation,
a written evaluation form is completed by the physician in
charge of the particular rotation and submitted to the Program
Director and to the Residency Training Committee. The Program
Director meets with each resident every six months to review
his/her evaluations and to discuss each individual’s progress
and future plans. Residents whose performance is unsatisfactory
are advised of the specific deficiencies prior to the completion
of the particular rotation, and the Residency Training Committee
is informed of their situation so that appropriate monitoring
and follow-up may occur. Residents participate in the Residency
In-Service Examination (RISE) sponsored by the American Society
for Clinical Pathology each year to provide them with an opportunity
to compare their level of mastery in each pathology discipline
with that of other pathology residents in accredited programs
in the United
States.
All residents are
assigned to the teaching of sophomore medical students in
pathology. During each year, they spend one afternoon a week
for a period of 15-16 weeks acting as junior instructors (assisting
mainly in laboratory and small-group teaching under supervision
of senior instructors). Selected third- and fourth-year residents,
along with attending faculty, serve as senior instructors.
Residents are also responsible for much of the teaching of
fourth year medical students who enroll in one of the various
senior year electives offered in the Pathology Department.
1. DURATION
AND SCOPE OF TRAINING
§
The graduate medical education program in anatomic and/or
clinical pathology offers and provides for a well-organized
and comprehensive educational experience for qualified physicians
desiring to acquire the basic competence of a pathologist.
Our screening process for accepting desirable candidates into
our program is stringent and requires high credentials, helping
to assure that our trainees are highly qualified and motivated.
§
Our programs are designed to offer residents the opportunity
to acquire a broad understanding of AP and/or CP, and the
routine, as well as newly developed, techniques and methods
of those disciplines. Residents become involved in the day-to-day
consultative role that pathologists must play in patient-care
decision-making. The degree of participation in this role
increases as the resident advances in his/her training.
§
Our program offers an AP/CP-4 program, and AP-3 program,
and a CP-3 program. The majority of our trainees are advised
to enter the AP/CP-4 program. In many years, it is not possible
to enroll in either of the "straight" 3 years programs,
and positions are thus open only for the combined 4-year AP/CP
training under those circumstances.
§
The AP/CP-4 program includes 27 months of formal education
in AP and 19 months of formal education in CP. Two months
of electives complete AP/CP-4 training. The scheduling of
all rotations and the availability of electives are carefully
reviewed in an effort to accommodate residents’ requests and
to take into account evaluations of residents' past accomplishments
and demonstrated abilities.
The AP-3 and CP-3 programs include
24 months of AP or CP education. The remaining 12 months of
training is sometimes a continuation of structured AP or CP
education or is devoted to a specialized facet of pathology.
The resident education occurs
in the Department of Pathology under the direction of the
Program Director with advisory input by the departmental Residency
Training Committee. The Program Director, in conjunction with
the Chairman and the departmental Residency Training Committee,
clearly defines, as part of the program description, the available
opportunities whereby residents may accomplish pathology training.
The Program Director approves all such opportunities and monitors
their progress.
2. INSTITUTIONAL
SUPPORT OF GRADUATE MEDICAL EDUCATION
§
The George Washington University Medical Center is
involved and committed to the GWUMC Graduate Medical Education
Programs. These programs are all approved by the Accreditation
Council for Graduate Medical Education.
§
As an integral part of The George Washington University
Medical Center Graduate Medical Education Programs, house
officers are assigned to selected affiliated hospitals, including
the Veterans’ Affairs Medical Center (Washington, DC) and
the Children’s National Medical Center. Formal affiliation
agreements with each of these hospitals detailing the educational
role of each institution are kept on file in the Office of
the Medical Center Director of Graduate Medical Education
as well as in the Office of the Pathology Department Chair.
§
Other accredited residency training programs of The George
Washington University Medical Center Graduate Medical
Education Programs include Internal Medicine, Obstetrics and
Gynecology, General Surgery, Surgical Subspecialties, and
Radiology.
§
Pathology residents actively participate in rounds and
conferences at all three participating institutions.
3. PROGRAM
DESCRIPTION
§
A program statement is available for review by applicants,
residents, and the Residency Review Committee. It is presented
in the brochure provided by The George Washington University
Hospital Graduate Medical Education Programs.
§
The program statement includes a listing and description
of all required rotations, including their duration, a description
of available elective rotation opportunities for upper level
residents, a description of resident opportunities for teaching
of medical students, and for research in clinical, anatomic,
and experimental pathology. Residents receive close supervision
and guidance in all phases of the training program. The evaluation
system, involving that of residents as well as of attending
staff is clearly explained to all at the yearly departmental
orientation held the first week of July of each year. At this
orientation, all aspects of the program are clearly outlined
and discussed in detail with representatives of all three
affiliated institutions. Residents are given an opportunity
to ask questions and become clear on all aspects of the program.
The program is designed to prepare
residents to assume medical, technical and administrative
responsibilities for AP and CP laboratory services. Residents
receive training and experience in all of the disciplines
needed to acquire basic competence of a pathologist. In addition,
residents receive training and experience in teaching and
in investigative pursuits.
4. CURRICULUM
§
The educational program in AP includes autopsy and surgical
pathology, cytopathology, pediatric pathology, neuropathology,
dermatopathology, forensic pathology, immunopathology, histochemistry,
ultrastructural pathology, and other advanced diagnostic techniques.
§
The educational program in CP includes microbiology (including
bacteriology, mycology, parasitology, and virology), immunology/serology,
blood banking/transfusion medicine, chemical pathology, cytogenetics,
hematology, coagulation, toxicology, medical microscopy (including
urinalyses), molecular diagnostics, flow cytometry, and other
advanced diagnostic techniques.
§
The program provides instruction and experience in the
major aspects of the administration of a clinical laboratory,
including resident participation in interpretations of laboratory
data as part of patient-care decision-making, conferences,
rounds, patient-care consultation, management and direction
of the laboratory, quality assurance, data processing and
medical informatics, teaching, and scholarly activity.
§
The educational experiences detailed above are provided
through specific rotations or experiences at varying times
during each resident’s training cycle. These experiences conform
to the educational goals and objectives of the overall program.
§
The overall curriculum and the curriculum for each rotation
are based on the six major competency areas as defined by
the Accreditation Council for Graduate Medical Education (ACGME).
These are outlined below, with examples of activities and
specific competencies relevant to the practice of anatomic
and clinical pathology.
Six
Major ACGME Competency Areas in the Overall Program and Individual
Rotational Curricula
I. Patient
Care
A.
Technical
Skills
The resident will master the technical skills relevant
for the practice of pathology. Some examples of these technical
skills are dissection, gross and/or microscopic morphologic
evaluation, interpretation of special stains, performance
of aspiration procedures, interpretation of electrophoretic
studies, interpretation of immunohematologic workups, extraction
of relevant clinical information from a patient’s medical
record, evaluation of quality control data, etc.
B.
Clinical
Consultation
The resident will learn to provide appropriate and
effective consultation to clinicians and other health care
providers. Consultation may include providing a diagnosis,
discussing the implications of a diagnosis in the management
of a patient, providing advice regarding ordering of lab tests
or blood products, assisting in the interpretation of test
results, etc.
II. Medical
Knowledge
A.
Fund
of Medical Knowledge
The resident will develop a fund of general medical
knowledge and focused pathology knowledge relevant to the
practice of pathology. This will include an understanding
of basic concepts of disease; the pathophysiology of common
disorders; the epidemiologic, clinical, morphologic, biochemical,
and/or molecular genetic features of common disorders; the
prognostic and general therapeutic implications of common
disease states; and the societal impact and preventative aspects
of common diseases.
B.
Application
of Medical Knowledge in the Practice of Pathology
The resident will learn to effectively apply his/her
general and focused medical knowledge in the day-to-day practice
of pathology. The resident must be able to apply her/his
knowledge of the diagnostic, prognostic, and general therapeutic
features of common disease states to analyze clinical situations,
construct a reasonable differential diagnosis, establish a
definite diagnosis, and discuss the prognostic and general
therapeutic implications of a disease state with clinicians.
III.
Practice-Based Learning and Improvement
A.
Evidence-Based
Practice
The resident will learn to make effective use of conferences,
lectures, and reading of the medical literature (texts, journals,
and other medical databases) to inform her/his day-to-day
practice of pathology. The resident must develop the ability
to critically evaluate the quality of research studies and
to be discriminating in the selection of information sources
used to support medical decision making.
B.
Use
of Information Technology
The resident will learn to use a variety of information
technologies to inform and improve his/her day-to-day practice
of pathology. Examples of information technologies that must
be mastered include electronic medical literature databases,
Web-based information sources, and computer-based resources
(CDs and other media).
IV. Interpersonal
and Communication Skills
A.
Communication
Skills
The resident will learn to communicate effectively
and courteously with health care providers, laboratory staff
members, administrators, patients, and other individuals in
the course of her/his practice. These communications will
include verbal (face-to-face and telephone conversations)
and written (written reports, notes, e-mail messages, etc.)
formats. The resident must strive to communicate in a clear,
concise, accurate, and appropriately focused manner. Regarding
the production of written reports, the ultimate goal is for
the resident to produce essentially letter-perfect reports
that require minimal or no modification by the attending pathologist.
B.
Teamwork
The resident will learn to work as an effective member
of the health care team in the course of his/her daily practice.
The resident must strive to perform her/his tasks in a responsible
and timely fashion, facilitate the tasks of other team members,
and be cooperative in his/her interactions with team members.
[Note: Other team members may include technologists, transcriptionists,
other residents, fellows, attending pathologists, clinicians,
administrators, and others.]
V. Professionalism
A.
Courtesy
and Collegiality
The resident must learn to treat health care providers
(including clinicians, nurses, other pathologists, technologists,
transcriptionists, etc.), administrators, patients, and others
courteously and respectfully. The resident must learn to
be collegial in all interactions with other members of the
health care team.
B.
Professional
Responsibility
The resident must learn to take his/her professional
responsibilities seriously and act accordingly. The resident’s
professional responsibilities may include clinical service,
teaching, administrative tasks, research, institutional tasks,
and work with professional organizations. The resident should
strive to approach each of these responsibilities with enthusiasm
and complete all tasks and assignments effectively and in
a timely fashion.
VI. Systems-Based
Practice
A.
The
Health Care System and the Role of Pathology
The resident must acquire knowledge of practice and
health care delivery systems and an awareness of the role
of pathology in the context of the greater health care system.
The resident will develop a working knowledge of different
inpatient and outpatient delivery systems and the general
regulatory and financial aspects of health care delivery.
The resident must learn the importance of providing effective
and timely consultation to clinicians, advising health care
providers in the provision of cost-effective care, and providing
statistical and other data in support of quality care.
B.
General
Laboratory Administration
The resident will develop an understanding of the
general administrative aspects of pathology practice. The
resident will learn to understand and apply the principles
of quality control, quality assurance, and continuous quality
improvement. The resident will develop a working knowledge
of laboratory staffing, laboratory instrumentation, workflow,
turnaround time management, safety, customer service, regulatory
accreditation, budget, and billing practices.
5. PERSONNEL
Program
Director
The
Program Director is a physician licensed to practice medicine
in the District
of Columbia. He is currently certified by the American Board of Pathology
in AP, CP, and Hematopathology and is in good standing with
the medical staff at the GWU Hospital.
The
Program Director is responsible for and has the authority
to conduct the entire program. He is assisted by an advisory
committee, the departmental Residency Training Committee,
which advises him on the operational aspects of the program.
He devotes much time to fulfill the responsibilities inherent
in meeting the educational goals of the program. He screens
all applications to the program and interviews all applicants
invited for interviews. He reviews all evaluations of residents
and the annual evaluations of the attending staff and rotations
in general. Resident performance is reviewed at the Residency
Training Committee meetings, monthly Departmental Executive
Committee meetings and frequently at the monthly Departmental
General Faculty meetings and quarterly Clinical Pathology
Combined Faculty meetings. The Program Director interviews
each resident individually every six months about his/her
progress in the program. This enables him to evaluate individually
the annual progress of each resident.
Teaching
Staff
§
The members of the teaching staff are fully qualified in
the areas and branches of pathology for which they have educational
responsibilities. All have appropriate academic faculty appointments
in the Department of Pathology and have appropriate staff
appointments and privileges at their own hospitals. Each person
is an active participant in the instruction and supervision
of residents, and is involved through their chiefs and representatives
(AP and CP) in the selection and evaluation of residents.
§
There
is a sufficient number of teaching staff so that members are
readily available to residents during specific rotations and
assignments, and yet at the same time are able to meet
effectively their patient care, educational, and research
responsibilities.
§
Members of the teaching staff demonstrate a vital interest
in teaching, and devote the time and effort necessary to support
the educational program (clearly evaluated by residents annually).
They are engaged in continuing scholarly activity, participate
in local and/or national scientific societies (paper presentations,
course organization and teaching, committee membership and
leadership), participate in their own continuing medical education,
demonstrate an active interest in research (clinical and/or
basic) as it pertains to pathology, and produce numerous scientific
presentations, often with residents as co-authors.
Number
of Residents
§
The number of resident positions offered (15) is compatible
with the educational resources available in the program.
§
Any anticipated change in the need for residents in training
will be implemented only after prior written approval of the
Residency Review Committee of the ACGME.
§
Usual enrollment in the program consists of three to four
residents in each year of the program.
Appointment
of Fellows
§
Fellows are appointed for special training or education.
Opportunities for fellowship currently exist in the following
areas: surgical pathology, cytopathology, and in research
in pathology. Fellows have specific assigned responsibilities
that do not dilute or detract from the educational opportunities
of the regularly appointed residents.
§
The Program Director approves and appoints all fellows
and designates their specific areas of training and/or research
for the prescribed duration of the fellowship.
Other
Personnel
§
The hospital laboratories providing patient care services
are all accredited by appropriate accrediting organizations
or agencies, including the College of American Pathologists
(CAP) and local regulatory authorities. Qualified physicians
who are licensed to practice medicine and are members of the
medical staff serve as directors and clinical faculty.
§
The number and qualifications of medical technologists
and other support personnel are adequate for the volume of
work in the laboratory and the educational activities of each
institution.
6. PROGRAM
FACILITIES
§
Adequate space and equipment are available for the conduct
of the program, including equipment for the performance of
all the functions described above, meeting rooms, classrooms,
and office and research space for staff.
§
Some common areas of office and laboratory space are provided
for the residents for both patient care work and participation
in scholarly activities.
§
Patient materials of the department are indexed and computerized,
such that appropriate retrieval is permitted.
§
Institutional, departmental and sectional libraries are
available which contain standard journals and texts of pathology
and other fields of medicine. Rapid access to national databases
in medicine is readily available for literature review through
the University and Medical Center libraries,
including full access to the Internet and National Library
of Medicine (NLM) databases.
§
Audiovisual resources are available for educational purposes
at departmental and institutional levels.
7. EDUCATIONAL
PROGRAM
Resources
for Anatomic Pathology
§
The volume and variety of material available in the AP
educational program at the GWUH and at the affiliated institutions
are sufficient to ensure that residents have a broad exposure
to both common conditions and unusual entities, develop proficiency
in diagnosis and problem-solving, and develop the necessary
technical skills to perform the functions of an anatomic pathologist.
§
There is sufficient volume and variety of material available
for educational purposes to ensure the opportunity for:
o
Performance of at least 50 autopsies per resident during
the program, including forensic and stillborn autopsies.
o
Examination and signing out of at least 2,000 surgical
pathology specimens per resident during the program. The available
material from the three hospitals provides an adequate mix
of cases for exposure to both common and uncommon conditions.
o
Examination of at least 1,500 cytologic specimens per resident
during the program. The material includes both exfoliative
and aspiration specimens.
o
Performance of at least 200 operating room consultations
(frozen sections and/or cytologic touch preparations) per
resident during the program.
Resources
for Clinical Pathology
§
The volume and variety of material available in the program
for training in CP is sufficient to ensure that residents
have a broad exposure to both common conditions and unusual
entities, develop proficiency in diagnosis and problem-solving,
and develop the necessary technical skills to perform the
functions of a clinical pathologist. Emphasis is placed on
training residents to function as an effective consultant
regarding patient care decisions.
§
The number and variety of tests performed in the laboratories
utilized in the program are sufficient to give residents experience
in the range of tests typically in a general hospital. Seminar
and course materials and laboratory indices of unusual cases
are available.
§
The program currently has a laboratory workload of 2.4
million billable tests. Material includes an adequate variety
of clinical pathology procedures.
§
An adequate number of supervisory personnel and medical
technologists, as well as modern equipment, are available
in each of the laboratories utilized in this program.
Seminars, Conferences,
and Rounds
§
A variety of regularly scheduled seminars and conferences
is devoted to the basic and applied medical sciences and clinical
correlation conferences.
§
Regularly scheduled mortality conferences are held in conjunction
with other clinical services.
§
Departmental conferences in AP and CP are held for review
and discussion of difficult and unusual cases. Both faculty
and residents attend these conferences.
§
Residents participate in regular, formal clinical and teaching
rounds corresponding to the assigned laboratory services.
Consultation
§
Residents, along with faculty, are regularly involved in
consultative activities, which are important not only for
the services provided to the patients and physicians in the
Center but also as an educational activity for preparing the
resident in roles that they will assume upon completion of
their training and certification.
§
Patient-care consultations are both intra- and interdepartmental.
Teaching
§
All residents participate in the education of second year
medical students in their course in pathology. Junior residents
act as junior instructors in laboratory and small-group discussion
sessions, usually one afternoon per week during the teaching
year. Senior residents are selected to act as senior instructors,
similar to faculty, conducting small group (20-25 students)
discussion teaching one afternoon per week for 14-16 weeks.
§
The students evaluate resident teaching of medical students
each year. Also, the Program Director and teaching staff review
resident teaching of medical students. Each year the Frank
Miller Award is given to the senior resident who has excelled
in the teaching of medical students.
8. EVALUATION
§
There is a regular, formal, written evaluation of each
resident by the teaching staff after each rotation or sub-rotation
(every 1-4 months) at each of the affiliated institutions.
The written evaluations are based on and organized according
to the six major competency areas as defined by the ACGME
(outlined in detail in the Curriculum section above). Evaluations
are discussed with the residents by the supervisor after each
rotation. Also, the Program Director completes a formal written
evaluation provided by the Graduate Medical Education Office
and discusses both the specific rotational and the general
GME Office evaluations with each resident individually every
six months. The departmental Residency Training Committee
also reviews evaluations.
§
Residents provide a confidential and anonymous written
evaluation of each rotation and a detailed annual evaluation
of the program and teaching staff. Summaries of these evaluations
are reviewed by the Program Director and the Departmental
Residency Training Committee.
9. RESIDENT
RESEARCH
§
At orientation in July of each year, the Program Director
and his/her staff discuss the research opportunities for incoming
residents. Residents are oriented about research conducted
by the staff and are encouraged to collaborate with attending
pathologists and other investigators. All residents are required
to produce at least one published or publication-quality paper
during their training period. Some of our past residents
have received prizes for their presentations at local and
national society meetings. Departmental Research Seminars
are conducted on a regular basis, and residents may present
their research at these seminars.
§
Residents become involved in research that is related to
methods development, clinical or basic research, or literature
surveys. The Department provides an appropriate environment
to encourage and promote research and scholarly activities
by residents.
10. RESIDENT
RESPONSIBILITIES
§
Residents are considered to be integral members of the
staff of the Department of Pathology. They or their representative
are involved and participate in discussion of matters related
to management of the Department. The Chief Resident is a member
of the departmental Residency Training Committee and is invited
to attend monthly departmental staff meetings.
§
Under appropriate supervision, senior residents are often
involved in decision-making in the laboratory. This is often
their assigned and direct responsibility.
§
Duty hours and night and weekend call for residents are
dependent upon the needs of specific service rotations. Backup
support is provided for residents when their responsibilities
are especially difficult or prolonged. The Program Director
monitors these assignments.
II. ANATOMIC PATHOLOGY
ROTATIONS
ROTATION: AUTOPSY– GWUMC
Facility:
GWUMC
Duration:
One 2-month introductory rotation.
One
1-month rotation with shared Electron Microscopy responsibilities
One
1-month senior rotation with shared Cytopathology responsibilities.
Teaching
Staff: PatriciaLatham, M.D. (Chief), Jan Orenstein, M.D.
PhD, Robert Jones, M.D. (Neuropathology)
Goals and Objectives:
Objectives for resident training
on the Autopsy Service are to prepare pathologists who will
be knowledgeable about the value and limitations of the autopsy.
At completion of training, the resident should understand
the proper safety and medico-legal requirements. He/She should
know what is required to perform an autopsy, what organs and
tissues are examined, how to dissect tissues to reveal and
demonstrate pathology, how to photograph pathologic findings,
and how to block tissues and process specimens. He/She should
know how to interpret most routine gross and microscopic autopsy
findings. He/She should be able to communicate clearly pathology
findings and to instruct medical staff and students, and he/she
should be able to prepare written reports that are informative
and legally useful.
Duties and Responsibilities:
The resident pathologist assumes
responsibility for obtaining necessary medical information,
ensuring safety, ensuring the observance of appropriate medico-legal
protocol, supervising the performance of the pathologist assistant
and diener, dissecting the organs for interpretation and presentation,
cutting and blocking autopsy brains with Dr. Jones after adequate
fixation, reviewing microscopic sections of systemic organs
and central nervous system, preparing reports, communicating
the findings to medical staff and others, and presenting the
findings at conferences. Second rotation autopsy residents
are expected to demonstrate advanced competence.
Supervision and Evaluation:
By attending with departmental
evaluation form and interview.
ROTATION:
AUTOPSY – VAMC
Facility: VAMC
Duration:
4-months (with shared cytopathology & frozen section responsibilities)
Teaching Staff: Min-Ling Liu, M.D., Ph.D., Shimareet Kumar,
M.D., Suman Chauhan, M.D., Katy Rezaei, M.D.
(for Cytopathology: Suman Chauhan, M.D.; Katy
Rezaei, M.D.)
Goals and Objectives:
Autopsy Service –
The Objectives for resident
training on the Autopsy Service are to prepare pathologists
who will be knowledgeable about the value and limitations
of the autopsy. At completion of training, the resident should
understand the proper safety and medico-legal requirements.
He/She should know what is required to perform an autopsy,
what organs and tissues are examined, how to dissect tissues
to reveal and demonstrate pathology, how to photograph pathologic
findings, and how to block tissues and process specimens.
He/She should know how to interpret most routine gross and
microscopic autopsy findings. He/She should be able to communicate
clearly pathology findings and to instruct medical staff and
students, and he/she should be able to prepare written reports
that are informative and legally useful.
Cytopathology Service –
The overall goal of the Cytopathology
part of the rotation is to help residents build a strong base
in the discipline of cytopathology and get them acquainted
with most technical and diagnostic aspects of cytopathology.
The rotation is designed to build confidence by graduated
increases in responsibility.
Duties and Responsibilities
Autopsy Service –
The resident is responsible
for performing autopsies, obtaining necessary medical information,
ensuring safety, ensuring the observance of appropriate medico-legal
protocol, supervising the performance of the assistant, dissection
of the organs for interpretation and presentation, preparation
of reports, communication of the findings to medical staff
and others, and presentation of the findings at conferences.
The attending staff will be available at all times to supervise,
depending on the experience and training level of the resident.
Residents are expected to complete provisional autopsy diagnoses
within 24 hours of the autopsy, and final reports within
30 days. Residents on first autopsy rotation should
seek help from senior residents on Surgical Pathology, followed
by residents on Clinical Pathology. Resident on the Autopsy
rotation is expected to provide cross-coverage for the Surgical
Pathology Service. When the resident is not actually performing
an autopsy, he/she is responsible for frozen sections, and
is also expected to review the cytology slides and sign these
out with the attending staff (see “Cytopathology Service”
below). The resident is responsible for preparing and presenting
the ENT Tumor Board conference (alternate Tuesdays at noon), GU
Tumor Board (last Monday of the month 12:00 – 1:00 pm) and
the Life Conference which is held on occasional Fridays (12:00
– 1:00 pm, upon request). He/she is expected to attend the scheduled
surgical pathology, cytopathology, autopsy and clinical pathology
resident teaching conferences (as detailed in the General
outline).
Cytopathology Service–
The residents' responsibilities
include signing out cases, performing fine needle aspirations,
and participating in the bi-weekly Cytopathology Conference.
The trainees are exposed to
a variety of cytologic material. Fundamental issues relating
to attention to details, evaluation of the technical quality
of the cytologic preparations, elimination of discrepancies,
sense of responsibility, and the need to compose readable
and relevant reports are emphasized. Written comments must
be relevant and oriented as a guide to the clinicians. Residents
have ready access to textbooks, journals and other publications.
Resident's
daily assignment:
The
residents review gynecologic, medical, and fine needle aspiration
material and render their opinions in writing. The gynecologic
cases at VAMC are all liquid-based preparation (ThinPrepÒ) and presently include all
submitted smears (not pre-screened), as well as all negative
smears from patients with a newly diagnosed high grade lesion
or carcinoma. All cases are signed-out with the attending
pathologist during daily sign-out sessions over a multiheaded
microscope.
Role
of residents as consultants:
The
residents interact with clinicians and learn to demonstrate
the right degree of comfort when discussing aspects of cases.
The residents communicate and discuss the results of all malignant,
infectious, suspicious and interesting diagnoses with the
clinical staff. They also act as consultants to the clinical
staff; and they frequently discuss and review the cytologic
material with clinicians, residents, and medical students.
The Pathology attending staff members are available for back-up
or further discussion as necessary.
Role
of residents in fine needle aspirations:
The
residents learn the technique of fine needle aspiration and
are encouraged to perform the procedure with appropriate supervision
by the staff pathologists. The importance of localizing the
lesion and getting adequate material is stressed as being
an integral part of reaching a correct diagnosis. Lymph nodes,
salivary glands, and palpable soft tissue lesions are the
most commonly aspirated sites in our department. Fine needle
aspiration of internal organs and nonpalpable deep-seated
lesions are performed by the radiologists under CT or ultrasonic
guidance. Transbronchial Wang needle aspiration, a relatively
common procedure at our department is performed by the pulmonologists.
The residents have ample opportunity to attend these procedures
and at times under direct supervision by the attending cytopathologist
are asked to evaluate the adequacy of aspirated material.
Cytohistologic
correlation:
Cytopathology
and Surgical Pathology Services interact very closely since
all staff members involved in Cytopathology are also involved
in Surgical Pathology. Our cytology working draft automatically
shows if the patient has any current or previous surgical
pathology specimens. As part of the quality assurance program,
cytohistologic correlation is obtained on all suspicious,
malignant, premalignant, and interesting cases. All cases
showing discrepancy are reviewed and discussed during our
quality assurance conference.
Supervision and Evaluation:
Supervision of performance is
provided by the respective attending(s). The residents are
evaluated as to their progress by the service director orally
and in writing at the end of the rotation.
ROTATION:
SURGICAL PATHOLOGY – GWUMC
Facility:
GWUMC
Duration:
3-4 rotations with 11 months total training
Teaching Staff: Sana Tabbara,
M.D., (Service Chief), Mary Sidawy, M.D., Arnold Schwartz,
M.D., Ph.D.,
Robert Jones, M.D., Katherine Berezowski, M.D.,
Jan Orenstein, M.D., Ph.D., Patricia Latham, M.D. (Liver Pathology),
David Kardon, M.D. (Renal Pathology)
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