NEUROPATHOLOGY
OHSU Resident Rotation

Supervisors:
Marjorie Grafe, MD, PhD (Division Director)
S. Humayun Gultekin, MD
Randy Woltjer, MD, PhD

Location:
OHSU Neuropathology

Duration:
1 month minimum
Some objectives will be met while the residents are assigned to Surgical Pathology or Autopsy.

Goals and Objectives:

The primary goal of this rotation is for the resident to obtain a basic foundation of knowledge in both autopsy and surgical neuropathology, including neuromuscular pathology. Specific objectives are organized around the core competencies listed below.

1. Patient Care

The resident will demonstrate the ability to:

• Obtain and summarize clinical history and imaging findings for autopsy and surgical cases.
• Use the clinical history to appropriately plan the neuropathology evaluation.
• Remove the brain and spinal cord at autopsy, and evaluate the skull.
• Perform an appropriate gross examination of the brain, including dissection and sampling for microscopic analysis.
• Evaluate autopsy and surgical neuropathology microscopic sections, plan special stains as appropriate,, and generate accurate and appropriate diagnoses.
• Perform neuropathology intra-operative consultations and communicate the appropriate diagnosis with the surgeon.
• Generate accurate, concise, and organized autopsy and surgical neuropathology reports that include gross and microscopic findings.

2. Medical Knowledge

The resident will demonstrate:

• A basic understanding of the principles and pathogenesis of neurological disease.
• A basic understanding of the clinicopathological correlations of diseases of the nervous system.
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• Appropriate use of specialized terminology in neuropathology.
• Knowledge of the gross and microscopic features of the normal brain and spinal cord.
• Knowledge of the basic gross and microscopic features of the abnormal brain.
• Knowledge of how muscle and nerve biopsies and performed, and the appropriate methods of tissue preservation for these tissues.
• A basic understanding of muscle enzyme histochemistry and specialized immunostains.
• A basic understanding of the major neurodegenerative diseases.
• A basic understanding of the major developmental abnormalities of the nervous system.
• A basic understanding of the major infectious diseases of the nervous system.
• The ability to formulate an appropriate differential diagnosis for CNS neoplasms, and to develop a plan (special stains, other techniques) to refine the diagnosis.

3. Practice-Based Learning and Improvement

The resident will demonstrate:

• Development of a personal strategy to maintain and update medical knowledge.
• The ability to critically analyze microscopic findings and review the pertinent literature.
• The ability to apply the principles of quality control and quality assurance.
• Recognition of professional limitations and when to seek appropriate consultations with literature and peers.

4. Interpersonal and Communication Skills

The resident will demonstrate:

• The ability to generate clear and concise gross and microscopic descriptions and final diagnoses.
• Effective communication with technical, office, and other support personnel.
• Clear and effective communication with patient care teams.
• The ability to prepare and deliver effective presentations.

Professionalism

5. The resident will demonstrate:

• Effective and respectful relationships with patients, medical and allied professionals and support staff.
• Punctual attendance to patient care responsibilities; completion of case work-ups and reports in a timely fashion.
• Full integration and contribution to the health care team.
• Maintenance of confidentiality of patient information.

6. Systems-Based Practice

The resident will demonstrate:

• The ability to use local (hospital) resources to gather clinical and imaging data relevant to cases.
• The ability to prepare for, and participate in, interdisciplinary conferences.
• The ability to handle minor issues regarding specimen processing and handling.
• Understanding of how frozen section diagnoses impact the surgical management of a patient.
• Understanding of the treatment/clinical management implications of certain diagnoses and special studies.

Duties and Responsibilities:

1. Participate in brain cutting, including selection and submission of tissue blocks for microscopic analysis. Dictate and review gross description.
2. Review autopsy brain slides with NP fellow and attending; dictate microscopic findings and final diagnoses.
3. Participate in neuropathology frozen sections when assigned to Surgical Pathology and when assigned to the Neuropathology rotation.
4. Review all current surgical specimens, including brain, muscle and nerve biopsies with the NP fellow and attending.
5. Review the NP study set slides. Contribute appropriate new cases to the study sets.
6. Participate in all Neuropathology division and interdisciplinary conferences (see schedule below).

Graduated Responsibility:

Expectations parallel those for the appropriate level of training in Surgical Pathology and Autopsy. Residents in their third and fourth years of training are expected to formulate accurate diagnoses of basic neuropathology processes, and appropriate differential diagnoses of more complex neuropathology processes.

Residents on the neuropathology rotation have no special call responsibilities, but are expected to be available for frozen sections during regular daytime working hours.

Supervision:

The neuropathology fellow is the first line of supervision. A member of the neuropathology attending staff is always available for consultation and will supervise review of all autopsy brains, autopsy and surgical microscopic slides, final reports, and conference presentations.

Evaluation:

Residents are evaluated formally at the end of the neuropathology rotation using the Verinform system, addressing each of the core competencies.

Residents must complete the formative competencies listed below by the end of their training. Generally these competencies will be complete by the end of their neuropathology rotation.

Neuropathology Conference Schedule

Monday
7:30             Muscle biopsy conference (1st Monday)                        BSc resident room
8:30             Muscle signout                                                               Dillehunt multiheaded scope
12                Neuro-oncology (Neurology)  (2nd & 4th)                    Hatfield 14

Tuesday
7                  Neurosurgery-Path-Rad correlations (2nd & 4th)  Hatfield 12
8                  Neuropath QI                                                                 BSc resident room

Wednesday
8:00             Neurosciences Grand Rounds                                         UHS 8B-60
11:00           Pathology Grand Rounds                                                Old Library

Thursday
7                 Neurosurgery didactic  (1st & 3rd)                                    Hatfield 14
7                 Legacy Tumor Board   (2nd & 4th)                                  Good Sam Cancer Ctr, 219
9                 Autopsy conference                                                          BSc 2324
11               Brain cutting                                                                     Morgue
3:30            Muscle sign out                                                                 Dillehunt multiheaded scope

Friday
7                 Neurosurgery tumor board                                               Hatfield 14
8:30            Sign out autopsy brains                                                    BSC resident room

Reviewed and updated 3/20/06, MRG.