| SURGICAL PATHOLOGY AT OHSU Supervisor: Christopher Corless, MD, PhD Duration: Minimum of 6 months, usually in 1 or 2 month blocks Location: Surgical Pathology, OHSU Goals & Objectives: The main goals of this rotation are to train residents in the proper methods of gross evaluation, sectioning, microscopic examination and reporting of surgical pathology specimens. At the end of their training, residents are expected to be able to prepare and interpret frozen sections from a variety of organs, to generate complete and accurate descriptions of complex resection specimens, to be thoroughly knowledgeable in the application of special stains (including immunohistochemical stains), and to exhibit good judgment in the differential diagnosis of pathologic findings identified during the examination of microscopic sections. Specific objectives are organized around the core competencies listed below. 1. Patient Care Residents are expected to demonstrate progressively improving skills in the following areas:
2. Medical Knowledge Residents are expected to master the following topics as they relate to routine surgical pathology:
The emphasis of the rotation is on case-based, experiential training in surgical pathology. Residents are expected to make use of local resources in gathering clinical and radiologic data relevant to their assigned cases. In addition, residents will refer to textbooks, syllabi and internet resources to gather information relevant to the differential diagnosis of their cases. Residents will participate in laboratory self-inspections as mandated by the College of American Pathologists (CAP), and be in attendance when outside inspectors visit the surgical pathology division. 4. Interpersonal And Communication Skills Residents are expected to be able to prepare clear and concise gross descriptions and final diagnoses on surgical pathology reports. In addition, residents must be able to communicate effectively with clinicians. Residents must also show that they can work closely with histotechnologists, physician assistants, transcriptionists and other support personnel in the surgical pathology division, even under stressful conditions. 5. Professionalism Residents are expected to be dedicated to the completion of all cases and other assigned tasks while they are on the service. Furthermore, residents must be cooperative, courteous, and dependable. They are expected to adhere to hospital regulations regarding patient confidentiality. 6. Systems-Based Practice Residents must learn about cost-effective approaches to the practice of surgical pathology. They are also expected to learn about laboratory costs, professional billing, and other issues of laboratory management. Duties & Responsibilities: 1. Residents are assigned duties based on a three-day cycle, beginning with gross examination and dictation of specimens on day one, review of microscopic sections and report preparation on day two, and sign-out of cases with the staff on day three. Half-day coverage of intraoperative consultations is included on days one and two. Residents are excused from their duties while attending the Laboratory Medicine Call rounds and AP & CP didactic lectures on Wednesday mornings, but are otherwise expected to be dedicated to their obligations on the service. 2. Residents must cooperate with the Physician Assistants in the specimen grossing area, and are expected to complete the examination and sectioning of all cases assigned to them by the supervising PA. After their first two months of training, residents will be preferentially assigned the larger and more complex specimens that are received from the operating rooms. 3. Residents are expected to review their gross dictations and to correct typographical errors or other omissions. Residents will also review the microscopic sections of all assigned cases, including outside consultations, and make an attempt to identify and interpret any pathologic findings. Special stains and immunohistochemical stains should be ordered immediately if warranted in the work up of a case. In addition, the resident should gather in necessary clinical and/or radiologic data that are important to rendering a diagnosis on an assigned case. 4. Unless excused for a conference or other assignment, residents are expected to sit with the staff while cases are reviewed and diagnoses rendered. Graduated Responsibility: First two months of training: During this period the resident learns the basics of gross examination, sectioning and dictation. Oversight for this training is shared by the Physician Assistants, senior residents, surgical pathology fellow, and sometimes the Chief Resident. Faculty are always available for consultation on how to process a specimen. Also during this period residents learn to prepare cryostat sections and are introduced to the use of special stains in the microscopic evaluation of case material. Later months of training: As they advance, residents are expected to exhibit increasing independence in all aspects of specimen handling, from gross dictation to final diagnosis. They should have no difficulty making routine diagnoses (e.g. basal cell carcinoma, acute appendicitis), and begin to develop skills in interpreting more challenging cases (e.g. differential diagnosis of pediatric sarcomas). Senior residents: Residents in their third and fourth years of training are expected to complete and dictate the final diagnoses of all routine surgical pathology cases, including cancer resection specimens (e.g. breast, lung, colon) with appropriate TNM staging. By the end of their training, they should have no difficulty making diagnoses across the full spectrum of adult and pediatric surgical pathology specimens, with the exception of rare entities and unusual morphologic variations. Most importantly, the resident must demonstrate good judgment in specimen diagnosis and know when it is appropriate to seek an expert opinion. Evaluation: Residents are evaluated at the end of each rotation block (usually one or two months) with regard to the following core competencies: 1. Patient care - does the resident 2. Medical knowledge 3. Practice-based learning and improvement 4. Interpersonal and communication skills 5. Professionalism 6. Systems-based practice |