Goals: To provide introductory training in AP with an emphasis on basic grossing skills. To provide an introduction to the function of histology lab, the gross room and frozen section room. To review basic histology. Objectives: MK PC Prof PBL IP/CS SBP PGY-1 PGY-2 PGY-3 PGY-4 Show basic proficiency in gross techniques, initial handling of specimens, understand and demonstrate gross exam; resident will be given graduated reponsibility so that by the last week of the rotation she/he will begin grossing independantly under a a a a a a Be able to orient specimens, describe and measure lesions and take appropriate sections for microscopy a a a a a a Demonstrate ability to take high quality photographs of gross specimens a a a Show proficiency in handling and submission of small biopsies for histologic processing a a a a a Describe the reasons for tissue fixation in preparation of sections for light, IF and electron microscopy examination a a Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a Show knowledge of different fixatives, pros and cons, used in surgical path, the function of different solutions a a Explain the different sections of the surgpath report, using correct terminology a a a a a Review basic histology: Skin, Breast, Bone and Soft Tissue, Lung, GI, GU, Lymph Node, Bone Marrow, Uterus, Ovary, Thyroid a a a Read assigned chapters in Robbins and Lester (see below) a a a Evaluation tools: Direct observation and feedback MK: medical knowledge Faculty evaluation PC: patient care End of Rotation Multiple Choice Exam Prof: professionalism PBL: practice-based learning and improvement IP/CS: interpersonal and communication skills SBP: systems-based practice Recommended Reading: Pathologic Basis of Disease. Robbins and Cotran 8th Ed. Chapters 1-4, 6-8 Manual of Surgical Pathology. Lester. 2nd ed. Chapters 1-10 AP Introductory Pathology Rotation Competency Involved Level Acquired Competency Key:
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Transcript
Goals:
To provide introductory training in AP with an emphasis on basic grossing skills. To provide an introduction to the function of
histology lab, the gross room and frozen section room. To review basic histology.
Observe and understand IS issues for BB Write Apheresis Orders - Attending Co-sign Session 2: AABB Chaps 24, 28
Week 6
LIJMC Assist BB Mgr in managing lab staff regarding medical issues Session 1: AABB Chaps 25, 29
Session 2: AABB Chaps 26
Week 7
LIJMC Assist BB QA Mgr in QA activity and projects Session 1: AABB Chaps 1, 3
Session 2: RISE Topics Review
Week 8
LIJMC In-service to BB Staff Session 1: RISE Topics Review
Assist BB QA Mgr in QA activity and projects Written and Oral Examination
Final Exam 1) Written and 2) Oral
Week 9
NUMC and Mobile Blood Collection, component production, Trace life of whole blood collection to patient transfusion AABB Chap 5, 6, 9 and PG Chaps 1, 2
NYBC (3 days) donor recruitment, testing, and logistics
NSUH Review laboratory routine and special procedures Refresh clinical skills acquired in 1st two months Session 1: PG 3,4,5
Objectives:MK PC Prof PBL IP/CS SBP PGY-1PGY-2PGY-3PGY-4
Be familiar with clinical laboratory regulations & standards; know how they are applied & what constitutes compliance a a a a a
Knows requirements for Standard Operating Procedures (SOP) & reviews these along with other laboratory documents a a a a
Interpretets & applies statistical Quality Control analysis in relation to accuracy & precision requirements for specific tests a a a a a
Know how to establish, verify and evaluate reference ranges for laboratory tests a a a a a
Review, interpret & evaluate Proficiency Test results, calibration verification & linearity studies a a a a a a
Demonstrates knowledge in qualitative & quantitative methods/instrumentation & participates in selecting & validating new methods a a a a a a
Understands & can evaluate specimen variables, interferences & lab errors in all phases of testing a a a a a
Participates in the lab Performance Improvement & Safety processes & PI, operational & methods committee meetings a a a a a a a
Participates in lab management processes including personnel policies, staff development, performance & competency assessment & budget preparation a a a a a a a
Understands the role of Information Technology/computers in providing lab information/results can utilize this technology in problem solving a a a a a a
Understands the importance of critical values & the critical value notification process & can interpret these results in a clinical context a a a a a a
Provides clinical consultations based on lab results, patient history & current evidence based medicine reports a a a a a a
Takes regular rotations being on-call for chemistry & clinical pathology & demonstrating problem solving, consultative skills and presenting problems/cases at the CP on-call conference a a a a a a
Provides continuing education to the lab technical staff by presenting case studies or technical reviews a a a a a a a
Signs out lab reports including SPEP, IFE, Western Blot analysis and interpretation of autoantibody test results a a a a a a a
Participates in basic & clinical research as appropriate a a a a a a
Understands the unique role of the Medical Director and can solve problems & make decisions in that role a a a a a a
Review and evaluate preventive maintenance processes & logs and participate in trouble shooting activities a a a a a a a
Understands the principles & applications of all analytical techniques including ISE, FPIA, EIA, chromatography, nephelometry/turbidimetry, spectrophotometric, mass spectroscopy & atomic absorptiona a a a
Demonstrates competence in interpreting test results to assess disease processes and understanding the limitations of methodology/instrumentation utillized in the following areas:
1. Liver & pancreatic function tests a a a a a
2. Cardiac enzymes & markers of cardiac injury & risk stratification a a a a a a
3. SPEP & the major serum proteins a a a a a
4. Renal function tests a a a a a
5. Toxicology, Therapeutic Drug Monitoring and Trace Element Analysis a a a a a
6. Dyslipoproteinemias a a a a a
7. Diabetes, HgbA1c and carbohydrates a a a a a
8. Endocrinology of thyroid, adrenals & pituitary a a a a a
9. Markers of bone resorption and formation a a a a a
10. Vitamins, iron and porphyrins a a a a a
11. Tumor markers a a a a a
12. Pregnancy evaluation including maternal serum screening & fetal lung maturity testing a a a a a
13. Disorders of inborn errors of metabolism (biochemical genetics) a a a a a
14. Autoantibody testing including ANA, ANCA & other IFA tests a a a a a
15. Automated EIA Serology tests for viral diseases a a a a a
16. Manual Serology tests including dsDNA, Lyme Western Blot & heterophile antibodies a a a a a
17. Allergy testing (ImmunoCap) a a a a a
18. Manual & automated urinalysis with microscopy a a a a a
19. Point of Care Testing a a a a a
20. Cystic Fibrosis & Sweat Chloride testing a a a a a
21. Parathyroidectomy and Intraoperative PTH testing a a a a a
Pathology Board exam review and knowledge-base assessment a a a a a a
Perform mock CAP inspection and/or participate in a real Cap inspection if possible a a a a a a
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation Prof: professionalism
RISE examination PBL: practice-based learning and improvement
IP/CS: interpersonal and communication skills
SBP: systems-based practice
Competency Required Level Aquired
NS-LIJ CLINICAL CHEMISTRY ROTATION
Competency Key:
The clinical chemistry resident rotation is a four and a half month rotation comprised of a two month sequence followed by two separate one month periods wherein one week of this time is spent in forensic toxicology at the Medical Examiners Lab. There is an
additional two week rotation in serology/immunology at the Core Lab usually in the 3rd or 4th year. The goal of these rotations is to provide a comprehensive overview of subjects relating to pathology and clinical laboratory practice. This will provide a basis for
residents to be successful on the CP section of the board exam, as well as develop into clinicians who are able to evaluate, provide clinical consultation to others, promote laboratory improvement, and assist in the implementation of new laboratory testing. The
Clinical Chemistry rotation is designed to provide training and competency in various aspects of the field, including understanding the pathophysiology of various disease states and the diagnostic utility of tests used to evaluate these disease states. An additional
focus is to provide the opportunity for residents to become acquainted with the research process and scientific presentation of research. This rotation encompasses the clinical chemistry, immunology/serology, clinical & forensic toxicology, urinalysis and point of
care testing areas.
Goals:
The resident on rotation is to gain an understanding of daily laboratory function with focus on
medical lab management from the perspective of a medical lab director. The rotation includes
specific opportunities for learning about the management side of the resident’s specific career
Begin rotation in the accession area and follow all specimen types from set up to sign out a a a a
Know the specimen requirements for cytogenetic and molecular cytogenetic testing a a a a
Determine the reason for referral and obtain clinical information on patients referred for cytogenetic testing as needed a a a
Determine appropriate testing methodology based on clinical indication provided; cytogenetics only or cytogenetics and
FISH for initial diagnosis, FISH for follow up visits, etc.a a a a
Learn about culture specifications for different specimen types, limits of testing, and additional testing needs a a a a
Initiate a culture of their own peripheral blood, harvest, and G-band the metaphases. a a a a
Perform microscopic analysis and karyotype metaphase cells using an image analysis system under direct supervision a a a a a
Use the International System for Cytogenetic Nomenclature (ISCN) to describe both normal and abnormal karyotypes a a a a
Learn the common numerical and structural chromosomal abnormalities associated with genetic diseases a a a
Correlate karyotypic abnormalities in constitutional disorders with phenotype, risks, family history, and prognosis. a a a a
Learn the major recurrent karyotypic abnormalities associated with leukemias, lymphomas and solid tumors, and their
utilization in the subclassification of diseases, therapy planning and prognosticationa a a a
Correlate karyotypic abnormalities in hematopoietic neoplasms and solid tumors with response to treatment and disease
prognosis.a a a a a
Understand the principles of FISH, the various types of probes currently used, their validation and use in various
specimen types including archival tissuea a a a
List the commonly used FISH probes used in prenatal diagnosis and the diagnosis of constitutional disorders a a a
List the FISH probes used individually and in Panels in the detection of chromosomal abnormalities in hematopoietic
malignanciesa a a a
Learn to interpret cytogenetic and molecular cytogenetic results in relation to morphologic, clinical and pathological
findingsa a a a a a a
Describe potential problems in the interpretation of cytogenetic and FISH data for hematopathological specimens. a a a a a a
Understand the use of cytogenetic and molecular cytogenetic testing in the diagnosis and management of disease and
the relationship/overlap between this testing and other laboratory tests including microarrays, molecular, flow cytometry,
hematopathology, histopathology, etc.
a a a a a
Review cases with the Director(s) as they interpret and sign out cases a a a a a a
Learn to read the Cytogenetic report and discuss the findings with referring physicians a a a a a
Learn to interact effectively and appropriately with technologists and other laboratory personnel a a a
Perform literature searches with regard to difficult/unusual cases and discuss the findings with the Director and Staff a a a a a
Explain the cost effective utilization of cytogenetics/FISH in the diagnosis of hematopoietic neoplasms. a a a a a
Understand the Certification, QA, QC, and QI requirements of a cytogenetics laboratory a a a a
Know the basic Cytogenetics standards of various certifying agencies, CAP, NYS DOH, CLIA, and Proficiency testing a a a a a a
Give a 30 minute presentation to technologists on a related topic selected in consultation with the Directors for CME a a a a
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
Presentation Prof: professionalism
Examination PBL: practice-based learning and improvement
IP/CS: interpersonal and communication skills
SBP: systems-based practice
Cytogenetics Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To acquire and refine the knowledge of cytopathology as necessary for the up-to-date practice of pathology.
To demonstrate diagnostic competency in cytopathology.
To develop the skills to oversee cytopathology operations in a pathology laboratory.
To demonstrate responsibility and high ethical standards in providing patient focused care.
Objectives: MK PC Prof PBL IP/CS SBP PGY-1 PGY-2PGY-3PGY-4
Define & list 2001 Bethesda terminology in reporting GYN Cytology √ √Recognize benign process, infectious agents, LSIL, HSIL, and malignant cell changes in gynecological cytology √ √Recognize & describe normal cytomorphology of all body sites √ √Recognize & describe benign proliferative, inflammatory, pre-malignant, and malignant cell changes in all body systems √ √Describe cytologic patterns associated with infections, various infectious agents, chemotherapy agents, and radiation √ √Acquire appropriate knowledge in interpretation of Non-gynecological specimens (i.e.-effusions, urines, csf, & bronchial specimens) √ √Acquire appropriate knowledge in interpretation of FNA specimens √ √Define & recall cytopathology preparatory techniques, and appropriate submission of various samples √ √Define & list NCI guidelines of standardized thyroid FNA terminology √ √Recognize the role of special diagnostic techniques, including immunocytochemistry, flow cytometry and molecular analysis in the work- √ √Acquire proficiency in FNA procedures recognizing its use & limitations √ √Function independently to assess adequacy, communicates clearly with clinicians, and demonstrates appropriate level of confidence √ √Obtain pertinent clinical & radiologic data, prepare smears, & triage cytologic material during FNA procedures √ √Comprehend regulatory issues relevant to a cytopathology service, including retention of slides & reports √ √Outline QA & QC procedures in cytopathology (i.e.- cyto/histo correlations, retro-review, etc) √ √Participate in cytopathology quality assurance program & interdepartmental conferences √ √Acquire and correlate information on selected and complex cases, such as cases for presentation at conferences √ √Comprehend importance of verifying accuracy of information provided on requisition, slide labels and reconciling discrepancies √ √Assume responsibility for screening, documenting interpretation , and signing out cases with Cytopathologist √ √Demonstrate understanding of how Cytopathology diagnosis affects health care decisions for clinicians & patients √ √Demonstrate ability to use literature search to aid in learning & workup of cases √ √Demonstrate ability to investigate & evaluate cases & assimilate scientific evidence (i.e.- journal club) √ √Present prepared & completed project as Cytopathology Conference at the end of rotation √ √Operate laboratory information system for searching of previous pathology reports, editing of reports, & correlating with current histology √ √Attend weekly cytopathology conferences √ √Demonstrate understanding of limitations of cytopathology & when cytopathology is beneficial & cost effective decision for patient and √ √Operate & apply proper use of ancillary testing (i.e.- immunocytochemistry, flow cytometry, genetic studies) √ √Comprehend departmental performance improvement, quality assurance, & quality control procedures √ √Demonstrate awareness and responsiveness to the larger context and system of health care and the ability to call on system resources √ √List & differentiate federal CLIA' 88, JCAHO, CAP, & NY state regulations √ √Demonstrate caring and respectful behaviors when interacting with physicians, patients, and patient families √ √Display ability to clearly explain FNA procedure & obtain consent & time out procedures with an appropriate level of confidence √ √Gather & record essential & accurate information from physicians & patients √ √Display ability to advise other physicians in the appropriate technique for obtaining an adequate specimen √ √Compile all pertinent information (i.e.- clinical history, radiologic findings, surgical reports) on cases examined √ √Work with health care professionals to provide patient-focused care √ √Demonstrate knowledge of psychosocial & cultural factors influencing technical & clinical staff, as well as patients √ √Accept criticism & follow advice √ √Interact well with other health care professionals, technical, lab assistants and clerical staff √ √Demonstrate initiative and independence in performing duties √ √Demonstrate responsibility in completing tasks within a timely manner √ √Conduct patient care activities with high ethical standards & accepts responsibility √ √
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation Prof: professionalism
RISE examination PBL: practice-based learning and improvement
Daily interactions/question and answer during sign-out IP/CS: interpersonal and communication skills
End-of-rotation evaluation SBP: systems-based practice
Weekly case presentations
Cytopathology Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To train residents to be able to 1) interpret biopsies of common skin diseases; 2) gross skin specimens; 3) understand histological
preparation and commonly used special procedures and their uses in diagnostic dermatopathology.
Show proficiency in gross techniques, initial handling of specimens, understand and demonstrate gross exam a a a a a a
Be able to orient specimens, describe and measure lesions and take appropriate sections for microscopy a a a a a a
Demonstrate ability to take high quality photographs of gross specimens a a a
Describe the reasons for tissue fixation in preparation of sections for light, IF and electron microscopy examination a a
Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a
Show knowledge of different fixatives, pros and cons, used in surgical path, the function of different solutions a a
Enumerate potential areas of specimen contamination along processing, discuss ways of troubleshooting for errors a a a a
Distinquish between special stains, enzyme histochemistry and immunohistochemistry, be able to list all stains a a
Know special stains used for diagnosis of various infectious organisms (fungal, mycobacterial, bacterial, etc.) a a a
Demonstrate ability to generate meaningful antibody panels that are appropriate for diagnosis a a a
Be able to accurately describe light microscopic features of neoplasms and other disease entities a a a a
Be able to generate meaningful differential diagnoses in tumor diagnoses a a a a
Generate appropriate surgpath report, using correct terminology, including necessary parameters to stage tumor a a a a a
Be able to classify disease processes and neoplasms of the Head and Neck region a a a a
Know and be able to identify the common head and neck and oral tumors a a a a
Classify and enumerate the diagnostic features of benign and malignant salivary gland tumors a a a a
Classify and discuss the microscopic features of sino-nasal polyps, benign and malignant tumors a a a a
Gross & Signout Schedule: Monday and Wednesday Gross at LIJ (Start at Noon); Signout Everyday
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation Prof: professionalism
RISE examination PBL: practice-based learning and improvement
IP/CS: interpersonal and communication skills
SBP: systems-based practice
Head and Neck Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To develop expertise in the methodological, diagnostic and management aspects of the clinical hematology laboratory
Objectives: MK PC Prof PBL IP/CS SBP PGY-1/2 PGY-2/3 Assessment
Observe and understand:
Manual methods in hematology lab: ESR, retic count, manual cells counts (WBC, plt, fluids), cytospin a a a a
Principles of automated cell analysis a a a a
Robotics and middle ware use a a a a
Interpretation of:
Peripheral blood a a a a
CSF and body fluid a a a a
Hemoglobin electrophoresis, HPLC, IEF, solubility a a a a
Understand use of QC and QA in the hematology laboratory a a a a
Observe and understand principles and interpretation of:
PT, PTT, fibrinogen, thrombin time, Ddimer, mixing studies a a a a
Factor assays a a a a
Lupus anticoagulant testing a a a a
Platelet aggregation a a a a
Thrombosis evaluation a a a a
Develop skills in interpretation of:
Bone marrow aspirate and biopsy, iron stores, cytochemistry a a a a
Flow cytometry principles and interpretation of PB, fluids, bone marrow, tissues, FNA a a a a
Performance of flow panel a a a a
Perform mock CAP inspection with understanding of questions a a a a a a a
Understand proficiency testing a a a a
Present continuing education conference to technologists a a a a a a
Independent reading in Henry, Foucar, Coagulation a a a
Attend laboratory PI and Hematology Method Committee meetings a a a a a
Present 30 minute case discussion to fellow residents on laboratory topic (to be saved on HP shared drive) a a a a
Professionalism demonstrated by:
Ethical behavior a a
Respects all clients and client information (HIPPA compliant) a a
Commitment to excellence a a
Professional dress and behavior a a
Demonstrates Interpersonal and Communication skills:
Presentations to residents, attendings, and laboratory staff
On call communication and conference presentations a a
Uses computer to obtain clinical information for diagnosis a a a a
Interact effectively and appropriately with medical technologists and other laboratory personnel a a a a a
Attend and participate in Check Sample, Checkpath, microscopy ;and hematology teaching conferences a a a a
a a a a a a
Evaluation tools:
Direct observation and feedback
Faculty evaluation MK: medical knowledge
RISE examination PC: patient care
360° evaluation Prof: professionalism
PBL: practice-based learning and improvement
IP/CS: interpersonal and communication skills
SBP: systems-based practice
Clinical Hematology/Hematopathology Rotation
Level Aquired Competency Involved
Competency Key:
Name Clinical Hematology/Hematopathology Rotation 1
Lab objectives Clinical Reading (All mandatory; bold even more than)Week 1 Manual methods in hematology lab: Peripheral blood/fluid study set Intro to Hematopoiesis
NS ESR, retic count, manual cell counts, Bone marrow study set Foucar: Ch1,2
(WBC, plt, fluids), cytospin Review current slides: PB, Hematopoiesis
Normal and abnormal PB fluids, bone marrow cases Bone marrow exam
CAP: Color Atlas of Body Fluids
CAP: Color Atlas of Hematology
WHO Classification of Tumours
ASCP: 6415 Non-neoplastic BM: Rdrive
Week 2 Principles of automated cell analysis Review current slides: PB, Henry: Basic Methodology automated methods
LIJ Robotics and middle ware use fluids, bone marrow cases Henry: Anemia, RBC membrane, metabolism,
Hemoglobin electrophoresis, HPLC Sign out hemoglobin electrophoresis globin synthesis and hemoglobinopathies/
2. Grossing of hematopathology specimens: lymph node, spleen
3. Flow cytometry review
Goals:
To train residents to identify medical important bacteria, fungi, and parasites; recommend appropriate specimens and tests; competently examine, interpret
and report gram stain findings and results of stains for acid-fast bacilli; interpret and report antimicrobial susceptibility test results
Review the clinical presentation, pathogenesis, and treatment of common infectious diseases caused by bacteria, mycobacteria, fungi, and parasites a a a a a a
Provide clinical advice to physicians and nurses, graduated with experience, for appropriate tests and specimen collection a a a a a a a
Interpret and communicate to physicians, graduated with experience, the clinical significance of organisms isolated from various body sites a a a a a a a
Learn proper method of handling infectious agents/chemicals, biosafety levels, waste disposal, and overall lab safety a a a a a
Learn the appropriate specimen collection and transport conditions for common pathogens a a a a
Understand the procedure and work flow for each bench (blood culture, respiratory, wounds, respiratory, etc) a a a a a
Learn the quality control requirements for testing in all areas of the microbiology laboratory a a a a a
Learn different types of media and incubation conditions for bacteria including fastidious organisms a a a a
Become proficient in preparing and interpreting Gram stains of clinical specimens a a a a
Describe typical Gram stain appearance, colony morphology, and hemolysis patterns for commonly isolated gram-positive and gram-negative pathogens. a a a a
Recognize important biochemical reactions used to identify common bacterial pathogens a a a a
Describe characteristics of pathogens that could be used as agents of bioterrorism a a a
Discuss non-culture-based testing methods including antigen tests, serology, and molecular that are available for diagnosis of major bacterial pathogens a a a a a
Review antimicrobials, their mechanisms of action, and become familiar with the CLSI guidelines a a a a a
Compare antimicrobial susceptibility testing (AST) methods, including broth dilution methods, disk diffusion testing, agar dilution testing, and the Etest. a a a a a
Explain the principles and work flow of the BACTEC blood culture system and the automated Microscan ID/AST system a a a a a
Describe when and how the phenotypic tests for inducible clindamycin resistance (D-test) and ESBL are performed a a a a
Describe mechanisms and special detection methods for important resistant organisms: MRSA, VRE, penicillin-resistant S. pneumoniae, ESBL producing
enterobacteriaceae, and KPC enterobacteriaceae
a a a a a a
Describe the compilation and use of an antibiogram a a a
Describe the processing, media, growth conditions, and incubation time of medically important mycobacteria a a a a
Read and interpret fluorochrome- and carbolfuchsin-stained smears in mycobacteria part of rotation a a a a
Define rapid grower, scotochromogen, photochromogen, and nonchromogen and provide examples of mycobacteria in each category a a a a
Compare and contrast the Mantoux skin test and interferon gamma release assays for detection of latent tuberculosis a a a a
Explain the specimen collection, transport, and special media for yeasts and molds from different body sites a a a a
Describe common pathogenic yeast species, identifying features, and resistance to anti-fungals a a a a a
Describe common pathogenic hyaline and dematiaceous molds, morphological features, and clinical associations a a a a a
Define thermal dimorphic fungus and give examples a a a
Identify medically important fungi based on colony morphology, microscopic appearance, phenotypic tests, and their appearance in tissue. a a a a
Describe the route of infection and life cycles of important intestinal, tissue, and blood parasites a a a a
Discuss proper specimen collection, transport, and testing methods for diagnosis of parasite infections a a a a a a
Identify pathogenic and non-pathogenic intestinal protozoa by direct microscopy and interpret non-microscopic test results a a a a
Identify blood parasites and where applicable, determine parasitemia in blood smears a a a a a
Identify medically important arthropods such as lice and ticks a a a a
Recognize artifacts that resemble parasites in patient samples a a a a a
Recognize medically important parasites in stool ova and parasite preparations, in blood smears, and in tissue. a a a a
Understand CLIA, New York State and CAP requirments for microbiology testing and reporting a a a a a a
Participate in quality improvement and quality assurance activities a a a a a a a
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
Evaluation by technologists, supervisors, and managers (360° evaluation) Prof: professionalism
Post Rotation Exam PBL: practice-based learning and improvement
RISE examination IP/CS: interpersonal and communication skills
SBP: systems-based practice
Competency Involved Level Aquired
General Microbiology
Competency Key:
Goals:
To understand the basic principles of molecular diagnostics and competently interpret molecular diagnostic assays;
To consult with clinicians on the appropiate applications of molecular diagnostic assays
To learn the appropriate precautions necessary for laboratory safety and prevention of assay contamination and overall quality control of
laboratory testing.
To interact appropriately and professionally with physicians and technologists and other relevant persons and agencies.
Objectives: MK PC Prof PBL IP/CSSBP PGY-1 PGY-2 PGY-3 PGY-4
Know which molecular infectious disease assays are performed at the North Shore-LIJ Core laboratory including which tests are FDA
approveda a a a
Develop skills and knowledge to address clinical issues through cost effective and evidence based use of Health System and other
available resourcesa a a a a a
Provide clinical consultation to physicians and nurses on proper use of clinical laboratory resources a a a a a a a
Understand FDA, CLIA, NY state and CAP regulations regarding molecular laboratory tests and reporting a a a a
Know New York State Department of Health regulations on HIV and other reportable diseases a a a a a
Learn methods of evaluating, selecting, validating, and verifying molecular assays a a a a a
Understand basic principles of bacterial and viral genetics a a
Explain the principles of the polymerase chain reaction (PCR) including reverse-transcriptase, multiplex and quantitative PCR and
diagram the steps in these reactionsa a a
Explain the principles of nucleic acid sequence-based amplification (NASBA) and diagram the steps in NASBA. a aExplain the principles of the hybrid capture (Digene) reaction and interpretation of the Human Papilloma Virus High Risk (HPV-HR)
assay a a a a a
Explain the principles of transcription mediated amplification (TMA) and diagram the steps in TMA. a a
Explain the advantages and disadvantages of different nucleic acid amplification tests (NAAT) such as PCR, NASBA, bDNA, hybrid
capture, and TMA.a a a a
Explain the different methods used for detection of amplified targets a a
Learn about basic laboratory safety equipment and precautions a a a a
Explain the design and work flow of a molecular laboratory a a a a a
Explain methods to detect and avoid contamination in molecular testing a a a a a
Learn common causes of inhibition in nucleic acid amplification tests and ways to avoid inhibition a a a a a
Explain and describe methods for manual and automated nucleic acid purification. a a
Perform a manual DNA and RNA extraction from a sample specimen. a a a
Explain the use of positive, negative, and internal controls in molecular testing a aa a
Explain preventive maintenance and quality control of instruments and reagents a a a a a a
Understand the appropiate application of molecular infectious disease assays for different diseases such as HIV viral load, Amplified
MTD, and Digene Hybrid Capture HPV testing a a a a a
Competently perform a manual molecular assay and interpret the results a a a a a
Analyze and interpret molecular diagnostic data including appropriate reporting and medical significance of positive and negative test
results.a a a a a a
Interpret virals load results assays for HIV, hepatitis B, and hepatitis C and when it is appropriate to order a a a a a
Analyze and interpret results for HIV genotyping and hepatitis C genotyping a a a a a
Perform a literature search on an assigned clinical test and present a verbal summary to the rotation director and laboratory staff. a a a a a a
Plan and conduct a research project related to clinical molecular testing a a a a
Attend and participate in departmental activities and conferences a a a a a a
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Post-rotation examinations PC: patient care
Faculty evaluation Prof: professionalism
Evaluation by technologists, supervisors, and managers (360° evaluation) PBL: practice-based learning and improvement
RISE examination IP/CS: interpersonal and communication skills
SBP: systems-based practice
Molecular Diagnostics for Infectious Diseases
Level acquiredCompetency Involved
Competency Key:
Goals:
To train residents to competently perform and interpret molecular diagnostic assays; to correlate such findings with
the clinical picture; to interact appropriately and professionally with physicians and other relevant persons and agencies.
Perform gross examination and intraoperative consultations under the supervision of Neuropathologist. a a a
Preview microscopic slides and prepare for sign-out of cases with neuropathology faculty. Read the cases and search relevant literature, as appropriate. a a a a
Demonstrate diagnostic knowledge of the common CNS and peripheral nerve tumors. Define the peaks of occurrence, locations, clinical presentations, histologic and
cytologic characteristics of common primary CNS tumors (meningioma and other dura-based lesion, astrocytoma, oligodendroglioma, ependymal tumors,
medulloblastoma, pituitary adenoma, choroid plexus tumors, pineal region tumors, mixed glio-neuronal tumors, CNS cystic lesions, schwannoma, neurofibroma and
MPNST). Recognize the histologic differences among primary CNS tumors, metastatic tumors, lymphomas and pseudotumors. Become familiar with the current WHO
classification for tumors of CNS.
a a a
Demonstrate understanding of the common neurodegenerative diseases (Alzheimer's disease, Pick's disease, Parkinson's disease, Lewy body dementia, Amyotrophic
lateral sclerosis, progressive supranuclear palsy, and corticobasal degeneration and multiple system atrophy).a a a
Demonstrate diagnostic knowledge of common CNS infections (bacterial, fungal, viral, parasitic and prion infections) a a a
Demonstrate understanding of malformations (Arnold–Chiari malformation, neural tube defects, agenesis of the corpus callosum, holoprosencephaly, Dandy-Walker
Syndrome, polymicrogyria, lissencephaly and heterotopia) a a a
Demonstrate understanding of demyelinating diseases, perinatal disorders, metabolic, nutritional and toxic diseases. a a a
Demonstrate knowledge of basic muscle pathology (neurogenic atrophy, inflammatory myositis, and common congenital myopathies) and nerve pathology and common
enzyme histochemical stains used in muscle biopsy interpretation.a a a
Demonstrate knowledge of the common special stains, immunostains and molecular studies used in neuropathology a a a
Become comfortable removing brain and spinal cord in autopsies. Become familiar with basic anatomy of the brain and spinal cord, basic gross description of the normal
brain, the routine sections to be taken for microscopic examination of the brain and spinal cord.a a a
Supervise junior autopsy resident on service in regards to neuropathologic autopsies. a a
Review teaching sets and discuss major topics with faculty. a a
Attend CNS lectures for tumors and non-tumors, and neuropathology microscopic review sessions. a a a a
Review the cases for and attend CNS Tumor Board. a a a a
Attend pre-test, post-test and glass slide test. a a
Become familiar with on-line and printed neuropathology resources a a a
Identify the national and international centers and resources to consult in special situations, such as CJD. a a a
Develop a basic understanding of various components of neuropathology operations, and related billing and consultation-related issues. a a a a
Communicate with clinical faculty, residents and staff to communicate results or obtain information. a a a
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation as part of general pathology evaluation Prof: professionalism
RISE examination as part of general pathology evaluation PBL: practice-based learning and improvement
End of Rotation Slide Exam IP/CS: interpersonal and communication skills
End of Rotation Written Exam SBP: systems-based practice
Recommended Reading:
1. Louis, DN, Ohgaki, H, Wiestler, OD, Cavenee, WK. WHO Classification of Tumours of the Central Nervous System, Fourth Edition, 2007
2. Fuller, GN and Goodman, JC. Practical Review of Neuropathology , Lippincott Williams & Wilkins, Philadelphia, 2001
3. Prayson R: Neuropathology Review , Second Edition, Humana Press, Wotawa, NJ, 2008.
4. Burger PC, Scheithauer BW, Vogel FS: Surgical Pathology of the Nervous System and Its Coverings, Edition 4, WB Saunders, Philadelphia, 2002.
Neuropathology Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To train residents to competently perform gross tissue examination, interpret and report gross and microscopic findings of
biopsy and surgical specimens from the oral and maxillofacial regions, including the salivary glands.
Explain the basic methodologies involved in renal pathology (light, IF and EM). a a a a a a
Demonstrate the skills to systemically evaluate compartments in renal biopsy. a a a a a a
Demonstrate the knowledge the common medical kidney diseases and clinical syndromes. a a a
Demonstrate the knowledge of renal allograft pathology. a a a a a
Identify the basic patterns of glomerular injury in light, IF and EM examination. a a a a a a
Demonstrate the ability to integrate light, IF and EM findings and formulate diagnosis. a a a a a a
Rotation Structure
The rotation will be a combination of case self-study, mini-lectures and sign out sessions. Each day, the resident will be
assigned topics. Slides will also be provided along with the topics. The resident will study these cases and then sign out with
renal pathologist. EM and IF photos will be reviewed at the sign out session. During the rotation, the resident will also
preview current cases and sign out with pathologist. The rotation also includes a mandatory half day EM technique session.
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation Prof: professionalism
RISE examination (Formative Evaluation) PBL: practice-based learning and improvement
End of Rotation Virtual Slide Exam (Summative Evaluation) IP/CS: interpersonal and communication skills
BiMonthly AP Board Review Exam (Formative Evaluation) SBP: systems-based practice
Recommended Reading:
Kumar et al: Robbins and Cotran Pathologic Basis of Disease, Chapter 20, the Kidney
Fogo et al: Diagnostic Atlas of Renal Pathology, Elsevier Saunders 2005
Weening et al: The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. 2004 Feb;15(2):241-50.
Racusen LC et al: The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999 Feb;55(2):713-23.
Sis B et all Banff '09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups.Am J Transplant. 2010 Mar;10(3):464-71.
Renal Pathology Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To train residents to competently perform gross exams, interpret and report gross and microscopic findings of adult surgical specimens in neoplastic and non neoplastic pulmonary and mediastinal disease in a
timely manner; to interact appropriately and professionally with physicians,and other relevant persons and agencies
Show proficiency in gross techniques, initial handling of specimens, understand and demonstrate gross exam a a a a a a
Be able to orient specimens, describe and measure lesions and take appropriate sections for microscopy a a a a a a
Demonstrate ability to take high quality photographs of gross specimens a a a
Describe the reasons for tissue fixation in preparation of sections for light, IF and electron microscopy examination a a
Describe sequence of specimen processing including fixation, embedding, sectioning and staining a a
Show knowledge of different fixatives, pros and cons, used in surgical path, the function of different solutions a a
Enumerate potential areas of specimen contamination along processing, discuss ways of troubleshooting for errors a a a a
Distinquish between special stains, enzyme histochemistry and immunohistochemistry, be able to list all stains a a
Know special stains used for diagnosis of various infectious organisms (fungal, mycobacterial, bacterial, etc.) a a a
Demonstrate ability to generate meaningful antibody panels that are appropriate for diagnosis a a a
Be able to accurately describe light microscopic features of neoplasms and other disease entities a a a a
Be able to generate meaningful differential diagnoses in tumor diagnoses a a a a
Generate appropriate surgpath report, using correct terminology, including necessary parameters to stage tumor a a a a a
Be able to classify disease processes and neoplasms of the Lung and Mediastinum a a a a
Be able diagnose common benign and malignant tumors of trachea, lungs, pleura microscopically a a a a
Enumerate and discuss the neoplasms of mediastinum, especially the histologic subtyping of thymomas a a a a
Describe the clinico-pathologic features of the pulmonary vasculitides, especially Wegener's granulomatosis, Churg Strauss Syndrome and Microscopic Polyangiitis
Discribe the pathologic and radiologic findings in chronic hypersensitivity pneumonitis
Discribe the pathologic findings of interstitial lung disease in collagen vascular disease (SLE, Rheumatoid, etc) a a a a
Describe the TNM staging of lung cancer
Describe the use of molecular diagnostics and targeted therapy in lung cancer
Compare and contrast UIP, NSIP, BOOP and LIP
Compare and contrast the diffuse alveolar hemorrhage syndromes of the lung
Describe the changes in the new proposed classification of lung adenocarcinoma (AIS, MIA, Pure lepidic growth adenocarcinoma, etc.)
Describe the clinico-pathologic features of pulmonary sarcoidosis including the necrotizing variant
Gross and Signout Schedule: Residents gross everday at 3 PM (NS 1 week/LIJ 1 week); Complex thoracic specimens only; Signout every day
Evaluation tools:
Direct observation and feedback MK: medical knowledge
Faculty evaluation PC: patient care
360° evaluation Prof: professionalism
RISE examination PBL: practice-based learning and improvement
IP/CS: interpersonal and communication skills
SBP: systems-based practice
Thoracic Pathology Rotation
Competency Involved Level Acquired
Competency Key:
Goals:
To train residents to competently perform gross exams, interpret and report gross and microscopic findings of urologic
surgical specimens in a timely manner; to interact appropriately and professionally with physicians,and other relevant
persons and agencies, and develop an ability to critically analyze the current knowledge base in urologic pathology, as well
as contribute to evidence based medicine.
Residents will be expected to gross specimens, review slides, and prepare for signout daily.