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School of
Medicine

Pathology

Surgical Pathology

Surgical Pathology

Surgical Pathology

Goals and Objectives

During the rotations in surgical pathology, each Resident will master the following skills:

Patient Care

  • Show knowledge of proper method for sampling tissues to demonstrate pathologic lesions.
  • Develop excellent diagnostic acumen for pathologic lesions commonly seen in the practice of surgical pathology.

Medical Knowledge

  • Master gross and microscopic photography.
  • Understand basic principles of microscopy
  • Understand the basic chemistry of tissue fixation using the standard fixatives.
  • Understand the basis of common special stains.
  • Become facile with the preparation, utility and interpretation of frozen sections.
  • Understand the diagnostic uses of the electron microscope in anatomic pathology, for the diagnosis of medical kidney disease, neuromuscular disease and certain tumors and infections.
  • Understand interpretation of ancillary modalities for the diagnosis of medical renal disease in biopsy specimens, including immunofluorescent detection of immunoglobulin, complement and fibrinogen, immunohistochemistry, and special histological stains.

Practice-Based Learning and Improvement

  • Develop an appreciation for and familiarity with recent surgical pathology literature.
  • Participate in research studies in cooperation with the members of the surgical pathology faculty.

Interpersonal and Communication Skills

  • Learn proper terminology for gross descriptions of surgical specimens.
  • Learn to assess the needs of a clinician based upon the clinical history and the type of specimen provided.
  • Develop competence in disseminating information about surgical pathology specimens in conferences.
  • Interact appropriately with technical staff and help troubleshoot small problems

Professionalism

  • Develop meticulous habits related to the proper identification, orientation, and documentation of surgical pathology specimens.
  • Understand and exercise proper levels of security for confidential patient information according to current HIPAA standards.

Systems-Based Practice

  • Become an effective teacher of surgical pathology techniques to junior Residents.
  • Provide and request consultative services as needed in a cost-effective fashion. 

Duration

The rotation in surgical pathology is the predominant focus of the anatomic pathology rotation. Residents rotate in surgical pathology approximately seventy percent of the time spent in the anatomic pathology rotation, with the remainder spent on autopsy pathology. The schedule is designed such that whenever possible, a Resident will be able to examine microscopically the specimens that he has examined grossly.

Duties and Responsibilities of Residents by Year

The expectations for Residents training in surgical pathology are divided into four levels of experience.

Level 1

The initial level of experience is commensurate with the first half year of training in surgical pathology. At this level, the following expectations are made:

General Skills

  • Demonstrate habits of punctuality and efficiency in the cutting room.
  • Read and understand the general section of the Surgical Pathology Manual.
  • Learn the location and contents of common sources of information, including the Armed Forces Institute of Pathology fascicles and major pathology textbooks.
  • Develop competence in reporting information to and receiving information from clinicians whether in person or by telephone.
  • Learn how to perform a good frozen section and how to prepare a proper cytologic preparation from selected specimens for rapid cytologic evaluation.
  • Provide evaluation of teaching efforts and skills of attending Faculty.

Gross Room Skills

  • Become competent at gross description of common specimens.
  • Learn to section tissues thinly to allow adequate fixation.
  • Learn to use the gross photography equipment.
  • Learn to select, prepare and if necessary, fix tissues for various specialized laboratories, including immunohistochemistry flow cytometry and molecular diagnostics.

Microscopic Skills

  • Review and master normal histology.
  • Become competent at microscopic description.
  • Learn how to perform microscopic photography.
  • Begin to review the current surgical pathology literature.
  • Understand the use of common special stains, including the Masson trichrome, reticulin, mucin, Grimelius, periodic acid Schiff, and iron stains.
  • Diagnose with relative confidence common surgical pathology case materials including most inflammatory lesions, dating of the endometrium, cervical dysplasia and colonic polyps.
  • Begin to master more complicated specimens including breast carcinomas, prostate carcinomas and lymph node biopsies.
  • Be able to perform most frozen sections and touch preps.

Teaching Skills

  • Participate actively at weekly Scopicon conference.
  • Participate in teaching of medical students as appropriate for level of training.

Research Skills

  • Recognize cases that may contribute to the academic environment or endeavors.

Learning Skills

  • Show evidence of reading at the textbook level.
  • Able to discuss classic cases.

Level 2

In the second half year of training, the following expectations apply:

General Skills

  • Begin to appreciate the limitation of one's developing knowledge in order to focus on areas for improvement, and also to know when to seek advice.
  • Learn to expect the unexpected in diagnostic materials.
  • Be willing to begin to assist more junior Residents in their daily tasks.
  • Begin to take more responsibility for activities in the frozen section lab and in the cutting room; i.e., manage tissue specimens with less reliance on Fellows and Seniors.
  • Provide evaluation of teaching efforts and skills of attending Faculty.

Gross Room Skills

  • Take additional responsibility for the completeness of the information brought to signout including adequacy of histologic sampling, selection of special studies, gathering of clinical information from computer databases and clinicians, and formulation of a working diagnosis.
  • Be able concisely to describe and perform the technique for cutting in most major specimens as described in the Surgical Pathology Manual.

Microscopic Skills

  • Competently formulate the microscopic description of most lesions.
  • Able to analyze findings in even difficult cases to produce a differential diagnosis.
  • Demonstrate ability to use the literature to solve diagnostic problems.
  • Develop diagnostic skill with more difficult specimens including unusual variants of cystic breast disease and their differentiation from carcinomas, morphological hallmarks of various forms of inflammatory bowel disease, common forms of bone lesions, ovarian tumors, sarcomas, and the ability to begin to categorize lymphomas and lymphoproliferative diseases.

Teaching Skills

  • Review current literature for current cases.
  • Participate actively in conferences.

Research Skills

  • Able to identify areas in need of investigation.
  • Able to formulate methods that might be used to solve a research question.
  • Outline a proposal to perform a research project under the supervision of the faculty.

Learning Skills

  • Able to discuss most topics at the textbook level.

Level 3

In the third half year of training, the following expectations apply:

General Skills

  • To oversee the performance of all other Residents and students on service.
  • To be liaison between Residents and faculty in case of problems/conflicts.
  • To be in charge of scheduling duties, including assignment of daily difficult specimens.
  • To solve problems that arise.
  • To improve the diagnostic acumen to a high level of competence.
  • Provide evaluation of teaching efforts and skills of attending Faculty.

Gross Room Skills

  • Able to gross in large specimens with little direct supervision.
  • Able to help supervise junior Residents.

Microscopic Skills

  • Able to diagnose most cases and is becoming aware of his or her limitations
  • Progressively able to dictate cases.
  • Able to select appropriate areas to freeze and can correctly interpret many frozen sections and is also able to screen and interpret accurately many cytologic preparations of selected specimens sent to frozen section lab for rapid evaluation.
  • Discuss diagnostic workup of renal biopsy cases with attending after reviewing paraffin slides.
  • Review immunofluorescence studies and understand their significance for diagnosis in renal biopsy.
  • Examine thick sections to select appropriate blocks for thin sectioning for electron microscopy of renal biopsy cases.
  • Demonstrate proper technique for the operation of a transmission electron microscope, including film loading, unloading and development in the darkroom.

Teaching Skills

  • To teach junior Residents both gross and microscopic pathology
  • Become involved in interdepartmental conference preparations.
  • Begin to offer to prepare and presentation cases at Tumor Boards

Research Skills

  • To become directly involved in studies with senior faculty members.
  • Review Publication Policy for Residents and fellows.

Learning Skills

  • Aware of controversies in diagnostic pathology and newer information which is not yet in texts.

Level 4

In the fourth six month period of training, and in subsequent periods, the following expectations apply:

General Skills

  • Function essentially as a junior colleague of the faculty.

Gross Room Skills

  • Able to gross virtually any specimen with little supervision and knows when to ask for help.
  • Able to effectively supervise other Residents in their gross room activities, i.e., act as "Chief Resident" in the gross room.
  • Provide evaluation of teaching efforts and skills of attending Faculty.

Microscopic Skills

  • Able to dictate almost all cases well with limited supervision.
  • Able to supervise frozen sections and interpret majority of frozen sections and cytologic specimens prepared in frozen section lab for rapid evaluation.
  • Knows his or her limitations and when to ask for help.
  • Able to interact professionally and authoritatively with Surgical Staff members in frozen section lab.

Teaching Skills

  • Functions as a resource for junior Residents

Research Skills

  • Present original work at local and national meetings.

Learning Skills

  • Shows evidence of extensive reading and knowledge with regard to most subjects in surgical pathology.

Administrative Skills

  • Able to help junior Residents to organize work and can troubleshoot for junior Residents to help avoid delays in sign-out.

Supervision and Evaluation

Surgical pathology cases are signed out by the Resident with a member of the faculty. Faculty are ultimately responsible for the accuracy of final diagnoses, but Residents shall have assumed progressively more input into the case material as the Residency progresses.

Each pathologist completes a monthly evaluation for each Resident addressing the six Core Competencies. The progress of the Resident in meeting the goals listed above are addressed. Evaluations are forwarded to the Program Director for summary, where they are available for review.