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| Anatomic & Clinical Pathology Residency Program |
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RESIDENCY TRAINING PROGRAM IN ANATOMIC PATHOLOGY |
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| 1. INSTRUCTIONAL SITUATION |
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1.1.Title of Program: Residency Training in Anatomic Pathology
1.2 Purpose and Scope: To develop in a duly licensed physician the skills and attitudes in the practice of Anatomic Pathology.
1.3 Resources: |
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1.3.1 Certified staff members with appropriate ratio
1.3.2 Adequate autopsy, surgical and cytology cases
1.3.3 Monthly hospital conferences: clinico-pathologic conferences,
tumor board, intradepartmental and interdepartmental conferences, interhospital conferences
1.3.4 Library resources with adequate Pathology references
1.3.5 Finished and properly filed autopsy, surgical and cytology cases |
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| 2. DUTIES AND RESPONSIBILITIES OF THE RESIDENTS |
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2.1 AUTOPSY DUTIES
The resident is required to do 30 autopsies for the entire 4-year course. Compliance entails the following responsibilities: |
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2.1.1. Screen and check the necessary documents for autopsies including death certificates, consents, and clinical abstracts.
2.1.2. Observe or do the evisceration.
2.1.3. Do dissection of the eviscerated organs.
2.1.4. Accomplish the death certificate.
2.1.5. Document gross findings on photographs.
2.1.6.Save organs of interesting cases for teaching purposes.
2.1.7. Accomplish the autopsy protocol form consisting of the provisional anatomic diagnosis, clinical abstract and gross descriptions.
2.1.8. Schedule gross conferences with the consultant-on-duty.
2.1.9. Present cases to the consultant-on-duty.
2.1.10. Trim specimens for microscopic analysis.
2.1.11. Present all cases during the autopsy conference.
2.1.12. Read finished microscopic slides.
2.1.13. Sign-out microscopic slides with consultant within seven (7) days from release of slides.
2.1.14. Prepare microscopic description, summary and interpretation and final anatomic diagnosis.
2.1.15. Go on duty as dictated by department protocol.
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| 2.2 DOCUMENTATION |
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| 2.2.1 MUSEUM |
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2.2.1.1 Prepare existing gross specimens with formalin.
2.2.1.2 Keep records of specimens.
2.2.1.3 Store interesting cases. |
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| 2.2.2 KODACHROMES/DIGITAL IMAGES |
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2.2.2.1 Document all gross specimens of autopsies.
2.2.2.2 Document microscopic findings of interesting cases for presentation in clinico-pathologic conferences, tumor board conferences, surgical pathology conferences, autopsy conferences, other inter-departmental, intradepartmental and interhospital conferences.
2.2.2.3 Compile all kodachromes/digital images.
2.2.2.4 Maintain a record of existing kodachromes/digital images. |
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| 2.2.3 MICROSCOPIC SLIDES |
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2.2.2.1 Document all gross specimens of autopsies.
2.2.2.2 Document microscopic findings of interesting cases for presentation in clinico-pathologic conferences, tumor board conferences, surgical pathology conferences, autopsy conferences, other inter-departmental, intradepartmental and interhospital conferences.
2.2.2.3 Compile all kodachromes/digital images.
2.2.2.4 Maintain a record of existing kodachromes/digital images. |
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| 2.2.4 AUTOPSY CENSUS RECORDS |
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2.2.4.1 Prepare census reports.
2.2.4.2 Maintain and update the disease datalogue of all autopsies done. |
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| 2.3 SPECIALTY CONFERENCES |
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2.3.1 Present/attend the various subspecialty conferences (intra-department, interdepartment and interhospital conferences).
2.3.2 Prepare materials for presentation in the respective conferences (Kodachromes/digital images, lecture notes)
2.3.3 Prepare clinical abstract and materials (Kodachromes, digital images, review of literature) for the clinico-pathologic and tumor board conferences and to coordinate among the different departments involved. |
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| 2.4 SURGICAL PATHOLOGY DUTIES |
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2.4.1 Cutting, dissecting and describing all specimens in the histopathology section.
2.4.1 Study the cases and review the pertinent literature for accurate diagnoses.
2.4.2 Sign-out the slides and pass-around the difficult cases when necessary.
2.4.3 Submit the final results for typing to the department secretary. Check all typed final results for correction. Release results to laboratory releasing area when necessary.
2.4.4 Go on frozen section duties |
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2.4.4.1 Be available from 7:00-5:00 p.m. on weekdays and weekends or when indicated, for schedule and unscheduled pay and charity frozen section specimens. Inform consultant-on-duty for any schedule of frozen section.
2.4.4.2 Receive specimen: analyze, smear and cut lesion.
2.4.4.3 Orient lesion on microtome platform.
2.4.4.4 Screen quality of prepared slides.
2.4.4.5 Study and diagnose lesion.
2.4.4.6 Refer to the consultant-on-duty for final frozen section diagnosis.
2.4.4.7 Cut, dissect and describe definitive frozen section diagnosis.
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| 2.4.5 Oversee all surgical pathology cases. |
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| 2.5 CYTOLOGY ROTATION |
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2.5.1 Inform consultant of any scheduled express fine needle aspiration.
2.5.2 Facilitate performance of express fine needle aspiration at the ultrasound or CT-scan sections.
2.5.3 Aspirate referrals from the various subspecialty clinics, if indicated.
2.5.4 Interpret smears, cell blocks and certain cytospin specimens.
2.5.5 Sign-out cases with the consultant-on-duty. |
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| 2.6 RESEARCHES |
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2.6.1 Conduct retrospective studies and case studies.
2.6.2 Prepare papers for presentation to the staff, hospital and Philippine Society of Pathologists.
2.6.3 Formalize papers for possible publication. |
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| 3. EVALUATION OF RESIDENT PERFORMANCE |
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| 3.1 Terminal Competencies for Post-Mortem Examinations |
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3.1.1.1 Explain to the relatives of the deceased why an autopsy is necessary, and in layman’s terms, how the procedure is to be performed.
3.1.1.2 Verify legal requirements before performing the autopsy.
3.1.1.3 Review clinical history if available. |
3.1.1.3.1 List down clinical problems.
3.1.1.3.2 Anticipate tissues to be taken.
3.1.1.3.3 Formulate own clinical diagnosis.
3.1.1.4 Perform technically acceptable autopsy depending on the existing legal constraints with proper dissection of the different organs giving emphasis on the organs that might provide answers to the problem. |
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3.1.1.4.1 Take proper specimen for toxicologic and/or microbiologic studies when needed.
3.1.1.4.2 Take appropriate sections for histopathologic processing.
3.1.1.4.3 Prepare the appropriate specimen for proper gross documentation and histopathologic processing. |
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| 3.1.1.5 Make a problem oriented provisional anatomic diagnosis with adequate gross description of organs and gross clinico-pathologic correlation. |
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| 3.1.1.5.1 Classify the different gross lesions encountered, giving differential diagnosis and its basis. |
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| 3.1.1.6 Present the case in an organized manner during gross conference. |
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3.1.1.6.1 Present clinical history, problem list, gross specimen.
3.1.1.6.2 Discuss initial clinico-pathologic correlation.
3.1.1.6.3 Give initial gross diagnosis. |
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| 3.1.1.7 Make technically acceptable microscopic slides. |
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3.1.1.7.1 Demonstrate the operation of the autotechnicon machine.
3.1.1.7.2 State the principles involved of the different reagents used in the processing of tissues.
3.1.1.7.3 Operate the microtome.
3.1.1.7.4 Stain the slides and state the principles involved in the staining procedures. |
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| 3.1.1.8 Interpret the microscopic lesions and correlate with the gross. |
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3.1.1.8.1 Classify lesion according to basic process.
3.1.1.8.2 Give differential diagnosis. |
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3.1.1.9 Determine the appropriate special stains that can be utilized to aid in the interpretation of the lesion.
3.1.1.10 Synthesize all the data gathered and make a final problem oriented clinico-pathologic correlation of the case following the approved departmental format.
3.1.1.11 Take technically acceptable pictures of gross and microscopic lesions. |
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| 3.2 Terminal Competencies for Surgical Pathology |
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| 3.2.1 When given a surgical pathology specimen the resident after 2 years in anatomic pathology will be able to: |
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3.2.1.1 Verify if the request form is properly accomplished including clinical history and pertinent laboratory data, operation performed and specimen taken.
3.2.1.2 Process the gross specimen. |
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3.2.1.2.1 Verify if the specimen is appropriate to the operation performed.
3.2.1.2.2 Fix fresh specimen in the appropriate fixative.
3.2.1.2.3 Label and dissect the specimen properly.
3.2.1.2.4 Take the proper sections with adequate dimensions in relation to the clinical history on what is observed and on what information is expected. Note: Ackerman’s dissection technique is recommended.
3.2.1.2.5 Compose an organized or systematic, concise gross description and give gross diagnosis if possible. |
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| 3.2.1.3 Diagnose the microscopic findings |
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| 3.2.1.3.1 Correlate the microscopic with the gross findings and clinical data. |
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3.2.1.3..1.1 Describe all the microscopic features of the lesions, their relationship and give differential diagnosis and basis.
3.2.1.3.1..2 Give the most probable diagnosis and its more distinct features.
3.2.1.3.1.3 Discuss the latest concepts on the pathogenesis of the lesion.
3.2.1.3.1.4 Suggest special stains for problematic cases to verify probable diagnosis.
3.2.1.3.1.5 Compose an adequate report stating all necessary information expected by the clinicians.
3.2.1.3.1..6 If malignant, state the prognosis by giving the pathologic grade, and stage, following TMN (UICC).
3.2.1.3.1..7 If metastatic, discuss the probable sites of origin and the manner of spread.
3.2.1.3.1.8 If malignant, state the usual response of the tumor to different therapeutic measures available. |
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| 3.3 Terminal Competencies for Cytopathology |
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| 3.3.1 When given a cytology request, the resident will be able to: |
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3.3.1.1 State the collection procedure of fine needle aspiration biopsy, cervico-vaginal smears and other cytologic specimen.
3.3.1.2 Verify request, taking note of the patient’s clinical data, indication, clinical history, pertinent physical examination and other ancillary procedures.
3.3.1.3 Decide whether the specimen/smear is appropriate for cytologic study and is representative of the site under study.
3.3.1.4 Process cytologic specimen. |
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| 3.3.1.4.1 Fix and label specimen. |
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3.3.1.4.1.1 Instruct medical technologist the appropriate cytologic procedure to be done.
3.3.1.4.1.2 State the different stains used and its principles. |
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3.3.1.5 Classify cells as normal or abnormal, benign, dysplastic or malignant, giving the cytologic bases and probable origin.
3.3.1.6 If malignant cells are present, correlate with expected tissue lesions.
3.3.1.7 Make an adequate, concise cytologic report. For cervico-vaginal smears, use the standard Bethesda method for reporting. |
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| 3.4 Terminal Competencies for Frozen Section |
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| 3.4.1 When given a request for frozen section, the resident will be able to: |
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3.4.1.1 Verify if the request is properly filled up containing the necessary information: patient’s clinical data, pre-operative diagnosis, clinical history, pertinent physical examination, ancillary procedures and indication of the frozen section.
3.4.1.2 Render a pre-operative diagnosis for the lesion based on personal evaluation of the clinical history and examination.
3.4.1.3 Determine the exact needs of the requesting physician for the frozen section.
3.4.1.4 After adequate examination of the gross specimen, render a preliminary gross diagnosis.
3.4.1.5 Prepare a technically acceptable frozen section microscopic slide using the cryostat or CO2 apparatus.
a. State the staining procedure and its principle.
3.4.1.6 Decide whether a definite diagnosis can be made or should one defer the diagnosis.
3.4.1.7 Confer with the clinicians if a problem arises during the frozen section.
3.4.1.8 Communicate the diagnosis properly to the clinicians.
3.4.1.9 Follow-up the paraffin sections and correlate with the frozen section diagnosis. |
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| 3.5 Terminal Competencies for a Research Study |
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| 3.5.1 When given a problem or issue for resolution, the resident will be able to: |
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3.5.1.2 Make a research proposal.
3.5.1.3 Undertake the research, if approved.
3.5.1.4 Write the research paper (requirements in anatomic pathology in relation to clinical pathology). |
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3.5.1.4.1 One case report per year (2 anatomic pathology and 2 clinical pathology cases)
3.5.1.4.2 One retroperspective study
3.5.1.4.3 One prospective study |
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| 3.6 Evaluation scheme |
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| 3.6.1 Evaluation of each resident is done through: |
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3.6.1.1 Assessment of the consultant based on the objectives of the program.
3.6.1.2 Intradepartmental in-service examinations (practical and theoretical) to be held every 3 to 6 months.
3.6.1.3 In-service examination given once a year by the PSP. |
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4. Schedule of activities in Anatomic Pathology |
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WEEKLY SCHEDULE FOR ANATOMIC PATHOLOGY
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TUES |
WED. |
THURS. |
FRI. |
SAT. |
SUN. |
(AM) |
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CUTTING OF SPECIMENS |
3rd journal club (AP & CP) |
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Hospital wide |
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LCP conferences (by invitation) |
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conferences: |
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1. CPC |
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2. Tumor board conference |
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3. Nephropath conference |
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4. Research conference |
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(PM) |
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READING OF SLIDES / SIGN-OUT WITH CONSULTANT / CUTTING OF SPECIMENS |
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1st - Renal hour |
PSP activities |
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2nd - Reporting/Lecture |
(scheduled): |
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3rd - Lab. consultant's |
1. Interhospital slide |
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meeting |
conference |
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4th - Surgical pathology/ |
2. Lectures |
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Weekly AP exam |
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Autopsy conference |
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| RESIDENCY TRAINING PROGRAM IN CLINICAL PATHOLOGY |
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The extent of knowledge and skills expected at the end of training in Clinical Pathology are enumerated to serve as guidelines for the trainee to know what he expects to learn and to check his progress. |
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| 1. INSTRUCTIONAL SITUATION |
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1.1. Title of Program: Residency Training in Clinical Pathology
1.2. Purpose and Scope: To develop in a duly licensed physician the skills and attitudes in the practice of Clinical Pathology
1.3 Resources: |
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1.3.1 Certified staff members with appropriate ratio
1.3.2 adequate laboratory procedures
1.3.3 Conferences: intradepartmental, interdepartmental, and interhospital conferences and other specialty conferences and conventions
1.3.4 Library resources with adequate Pathology references with journals and Internet accessibility
1.3.5 Finished and properly filed Clinical pathology rotation checklists and researches
1.3.6 other hospitals for networking purposes |
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| 2. PRE-REQUISITES: |
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2.1 A degree of Doctor of Medicine from a recognized medical institution
2.2 A postgraduate internship in an accredited hospital
2.3 A licensed to practice medicine issued by the Board of Medicine, Professional Regulation Commission |
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| 3. GENERAL OBJECTIVES: |
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3.1 To give the physician sufficient skill and experience to practice the science and art of Clinical Pathology independently, with the competence necessary to tackle the common problems and situations encountered in the country.
3.2 To provide excellent patient care through constant improvement in systems in line with the mission-vision of the Institute
3.3 To acquire the necessary knowledge, skills and perspective in the practice of Clinical Pathology
3.4 To keep abreast with the current trends and concepts in the practice of Clinical Pathology by reading, experience and research
3.5 To develop desirable attitudes of professionalism, social consciousness and civic mindedness
3.6 To inculcate the ethical practice of Clinical Pathology |
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| 4. SPECIFIC OBJECTIVES |
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4.1 To perform laboratory procedures in all sections of the Clinical Pathology efficiently.
4.2 To know the technical and clinical data about each procedure to allow sufficient understanding, selection and interpretation.
4.3 To know appropriate specimen collection and preservation
4.4 To understand the limitations and sources of errors on each procedure including interfering substances
4.5 To know all principles of equipment and instruments as well as reagents and standards
4.6 To know how to resolve technical problems as they arise by knowing the cause among several factors
4.7 To have the ability to respond appropriately and adequately to requests for consultation by clinicians for specific tests, interpretations and correlation of laboratory results
4.8 To have the appropriate skills and attitudes in the proper management of the laboratory |
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| 5. TRAINING PROGRAM |
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| The Clinical Pathology program encompasses 18 months in the 4 years of the Combined Clinical and Anatomic Pathology program of closely supervised work with gradually increasing responsibilities. |
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| 5.1 Instructional Objectives |
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| 5.1.1 Administrative Phase |
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5.1.1.1 Preparation of the patient and the collection of the specimen for each procedure
5.1.1.2 Flow of specimens to and within the laboratory and its reporting and distribution of results.
5.1.1.3 Knowing the work load, limitations of procedures and other features affecting personnel and interdepartmental relationships
5.1.1.4 Responsibilities of the pathologist, medical technologist and other personnel
5.1.1.5 Routine and special procedures in the section
5.1.1.6 Economics of handling the section
5.1.1.7 All problems arising in the section will be referred to the resident assigned to the section and later with the consultant in charge
5.1.1.8 Confronted with a laboratory emergency request, the resident must be able to: |
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5.1.1.8.1 Prioritize examinations to be done.
5.1.1.8.2 Maximize manpower.
5.1.1.8.3 Institute remedial measures for deficiencies that may arise. |
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| 5.1.1.9 When assigned to a laboratory section, the resident must be able to: |
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.5.1.1.9.1 Assist in the periodic evaluation of laboratory staff and personnel.
5.1.1.9.2 Report observations to the pathologist-in-charge and give suggestions for the improvement of the section. Apply efficiently the workflow chart in the laboratory.
5.1.1.9.3 Institute quality control measures.
5.1.1.9.4 Guide personnel in the proper disposal of infective and toxic waste.
5.1.1.9.5 Institute preventive and protective measures against health hazards in the performance of laboratory tasks. |
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| 5.1.2 Technical Phase |
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5..1.2.1 Proper collection and handling of specimens for work-up, its precautions and principles
5.1.2.2 Performance of the different technical procedures available in the section under the supervision of the medical technologist in charge and consultant
5.1.2.3 Familiarization with the instruments used and the principles involved
5.1.2.4 Preparation of reagents, working solutions and calibration curves
5.1.2.5 Quality control
5.1.2.6 Given a request, the resident must be able to: |
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5.1.2.6.1 Collect specimens properly if the clinician is not available.
5.1.2.6.2 State principles of laboratory procedures and instruments used.
5.1.2.6.3 Name reagents and standards used for each test.
5.1.2.6.4 Guide personnel in the preparation of reagents, standards and calibration curves.
5.1.2.6.5 Perform quality control measures.
5.1.2.6.6 State the limitations and sources of error of different tests.
5.1.2.6.7 Inform patients on the limitations and necessity of laboratory tests. |
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5.1.3 Interpretive Phase
Each procedure must be studied with the following in mind: |
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5.1.3.1 Indications for requesting the procedure
5.1.3.2 Limitations of the method
5.1.3.3 Range of normal values and significant differences of values
5.1.3.4 Pathophysiologic mechanisms resulting in abnormal values
5.1.3.5 Disease states that result in abnormal values
5.1.3.6 Presented with a laboratory result, the resident must be able to correlate them clinically and: |
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5.1.3.6.1 Explain the indications for doing certain procedures.
5.1.3.6.2 Enumerate the range of reference values of important tests.
5.1.3.6.3 Differentiate values which are technically significant.
5.1.3.6.4 Describe diseases and their pathophysiologic mechanisms which give rise to abnormal laboratory results.
5.1.3.6.5 When necessary, interview and examine specific patients for correlation with laboratory results.
5.1.3.6.6 If results show discrepancies to: |
5.1.3.6.6.1 Investigate and identify possible sources of error.
5.1.3.6.6.2 Institute corrective and preventive measures. |
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| 5.1.4 Consultative Phase |
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5.1.4.1 All abnormal results should be correlated with the patient’s clinical condition by consultation with the clinical resident, by looking up the chart or by examining the patient.
5.1.4.2 Interesting and problematic cases should be studied with some depth, with reading of appropriate literature; and correlation of the laboratory data with the clinical findings must be attempted.
5.1.4.3 Consultations and problems brought to the laboratory by clinical residents will be handled by the resident in the section, which will be discussed later with the consultants.
5.1.4.4 When consulted by clinicians regarding laboratory requests and results, the resident must be able to: |
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5.1.4.4.1 Provide satisfactory medical opinion based on proper pathologic correlations.
5.1.4.4.2 Suggest alternative examinations for better patient care.
5.1.4.4.3 Provide information for references. |
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| 5.2 Regular Tour of Duty |
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5.2.1 Work hours: starts at 8 am and ends at 5pm each day, Monday to Friday.
5.2.2 Rotation: residents shall provide coverage for duties after office hours, at a rotation schedule of one resident each. The coverage of duties after office hours shall be on-call basis provided the resident on-duty shall be within the hospital premises until 10 pm.
5.2.3 The same rotation schedule shall be followed on weekend/holiday rotations. |
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