CYTOPATHOLOGY ROTATIONS

Supervisor:

Terry Morgan, MD, PhD

Location:

OHSU Cytopathology

Duration:

1 month per rotation, total of 3 months

GOALS AND OBJECTIVES:

Patient Care
Be able to perform fine needle aspiration biopsies (FNA) of lesions and perform adequacies under ultrasound or CT-scan guidance.

Medical Knowledge
Know the main laboratory preparatory techniques/procedures relating to processing and staining GYN and non-GYN specimens.

Understand the use of special stains in cytopathology, including immunostains.

Know the spectrum of normal and dysplastic cervical cytology.

Know the signs of inflammation and infection in cytologic specimens.

Know the spectrum of normal, reactive and neoplastic changes in body fluids.

Know the spectrum of normal, reactive and neoplastic cytology in FNA.

Practice-Based Learning and Improvement

Understand the process and significance of cyto-histologic correlation for GYN and non-GYN specimens.

Understand and learn from QA/QC procedures (screening negatives, resolving technical problems).

Interpersonal and Communication Skills

Be able to clearly convey assessment of specimen adequacy at the time of fine needle aspiration biopsy.

Be able to clearly convey cytologic interpretations in writing and verbally.

Professionalism

Professional interaction with all the cytopathology staff and clinicians is demanded.

Comply with HIPAA standards with regard to confidential patient information.

Systems-Based Practice

Know the administrative structure of the Cytopathology Department, and the role of each member, including the clerical staff, the laboratory staff, the cytotechnologists, and the laboratory supervisor.

Participate in consultative services performing fine needle aspirations, attending Tumor Boards to promote integrated healthcare delivery.

Description of Responsibilities by Rotation:

1st Rotation:
Goals:

Acquire basic understanding of laboratory procedures as well as the rules and regulations related to the cytopathology laboratory.

Begin to acquire screening and cytodiagnostic skills.

Introduction to the role of the FNA service.

Learning the role of the cytopathologist in optimizing patient care with specimen assessment and triage.

Encourage the importance of current cytopathology literature review to reinforce the concept of life-longlearning.

Objectives:
Note: The first month of cytopathology is primarily dedicated to reading, study sets, and pap smears with an unknown examination administered at the end of the month (SurePath pap test). Residents are responsible to review 3-5 unknown pap smears per day and attend all FNAs and all possibly adequacy assessments. They are also required to attend daily sign-out.

1st Week:
Learn about acceptance, accessioning and preparation of specimens for processing.

Processing and staining of specimens with the Papanicolaou stain.

Preparation of specimens for screening.

Screening of specimens and assignment of cytotechnologist's provisional interpretation.

Residents are to screen at least 3 cervical-vaginal smears per day before the cytotechnologist and the have those slides re-screened by cytotechnologist.

Read the following chapters, book and articles:

Manual of Cytotechnology (ASCP Press) - PART 2: Gynecologic cytology, recommended chapters 5-6,10-13
The Bethesda Book - read in entirety
The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology
JAMA, April 24, 2002- Vol 287, No. 16. (Reprint can be obtained from the library web site).
Demay's Cytopathology - good reference for interesting cases.

2nd Week:
Continue daily pap smear screening.

Examination:

• Patient Care
• Medical Knowledge
• Interpersonal and Communication Skills
• Practice-Based Learning and Environment
• Professionalism
• Systems-Based Practice