Goals and Objectives for Pathology Residents

General Program Philosophy

The program educates residents in both anatomic pathology and laboratory medicine. The anatomic pathology program focuses on skills and methodologies associated with diagnostic surgical pathology, cytopathology, and autopsy pathology. The laboratory medicine program focuses on skills and methodologies associated with chemistry, microbiology, immunology, hematology, coagulation, and blood banking. Both programs encourage residents to take part in ongoing teaching and research activities.

Residents must be capable of assimilating a large amount of basic information. This includes an understanding of basic human biology, i.e., an understanding of normal and abnormal human structure - function interactions at all levels of biologic organization during all stages of life, including information considered to be basic to the general practice of medicine.

Residents must be capable of practical problem solving. This involves the thoughtful use of general information in evaluating the significance of specific observations made on specific patients and/or patient specimens. It also involves recognition of the uncertainty that abounds in medicine and the intellectual honesty to admit, "I do not know what this observation means," as an important step in an individual's educational process.

First and Second Year Autopsy Goal

Provide training that will enable residents to perform an autopsy on a deceased patient (adult, child, infant and fetus) and elucidate the disease process/processes responsible for clinical deterioration and death.

Autopsy Objectives

• Know how to examine autopsy request forms to determine whether appropriate permission for the procedure has been obtained before beginning a case.
• Learn how to extract pertinent information from existing medical records in order to reconstruct, as accurately as possible, the deceased patient's medical history and learn when to request information in addition to that found in existing records from the patient's clinical physician(s).
• Learn how to summarize patient information in a clear and concise manner for oral and written presentations and how to distill the essential parts of the medical history into estimates of the likely accute mechanisms and underlying cause of death.
• Know when extracted medical information suggests or requires a medical examiner consultation before proceeding with the autopsy and how to interact with the medical examiner.
• Learn how to conduct the systematic anatomic evaluation of a deceased person, including a thorough external examination, various eviceration procedures (e.g. removal of thoracic, abdominal, and pelvic organs, removal of brain, removal of spinal cord), and dissections of the various enviscerated organ block(s).
• Know when, from the results of medical history and/or the actual autopsy procedure, additional special examinations (e.g. bones, sinus cavities, and other organ/tissues not routinely evaluated, forensic techniques) are needed and when to ask pathology staff members for help with these special procedures.
• Know how, using existing medical history and/or anatomic observations, to select apppropriate samples of normal and diseased tissues for microscopic studies that are likely to further elucidate the natures of the disease processes affecting the autopsied patient.
• Learn how to effectively use a microscope for evaluating the various selected histology samples.
• Learn how to write and dictate accurate, concise, and effective descriptions of the important gross and microscopic observations.
• Learn how to organize the disparate data gathered from various evaluations of medical records, gross anatomy, and microscopic observations.
• Learn how to weigh and consider the signficance of the various observations made during autopsy procedures, how to correlate and explain specific clinical and pathologic observations, and how to reach a final understanding of the disease process(es) responsible for the clinical deterioration and death of the autopsied patient.
• Learn how to write a final report based on the understanding noted above and to do so in a thoughtful, honest, clear, concise, and timely manner.
• Learn how to use available photographic equipment to document specific anatomic observations.
• Learn how to present any of the data gathered from the autopsy study in one or more educational conferences.
• Learn how to communicate with clinicians before and after the autopsy about preliminary and final findings, and when to refer calls to an attending pathologist.
• Learn effective safety procedures for prosector and others in autopsy room.
• Know when and how to utilize specialized laboratory techniques (e.g. bacterial, viral and tissue culture; cytogenetics; biochemical and molecular biologic).
• Be familiar with the CAP autopsy requirements.

First and Second Year Cytopathology Goal

Provide training that will enable residents to evaluate cytology samples taken from various tissue sites by a variety of methods and make diagnostic assessments that will be used to guide the subsequent care of patients, as the outcome of the following objectives.

Cytopathology Objectives

• Learn the usual methods of obtaining cytology specimens from the various tissue sites (e.g. pap smears, body fluid smears, leson brush smears, fine needle aspirate smears), the usual methods for preparing samples for microscopic study (e.g. direct smears, cytospin smears, fixation, cell block sections, stains), and the common uses of ancillary studies (e.g. immunocytochemistry, flow cytometry).
• Learn to recognize typical or usual cellular apperances (e.g. usual epithelial, stromal, defensive, neural, and/or circulatory cell types) on the various samples derived from the various body sites and processed in the various ways.
• Learn to recognize atypical or unusual cellular apperances associated wityh various clinically significant non-neoplastic diseases (e.g. inflammation-induced reactive cellular changes, microbiologic pathogen identifications) on the various samples derived from the various body sites and processed in the various ways.
• Learn to recognize atypical or unusual cellular apperances associated with various clinically significant neoplastic diseases (e.g. benign, possibly malignant, and in-situ/invasive malignant) derived from the various cell populations (e.g. epithelial, stromal, defensive, neural, and/or circulatory) on the various samples derived from the various body sites and processed in the various ways.
• Know how to write final interpretive reports that are honest, clear, concise, and timely, using conventionally accepted terminology and diagnostic schemes (e.g. Bethesda method of reporting pap smear results), and when to provide additional information and/or recommendations to patient care physicians.
• Gain familiarity with medical legal issues and consequences of cytologic evaluations.
• Be familiar with the CAP and CLIA cytology requirements.

First and Second Year Surgical Pathology Goal

Provide training that will enable residents to evaluate tissue samples removed from living patients and make diagnostic assessments that will be used to guide the subsequent care of such patients, as the outcome of the following objectives.

Surgical Pathology Objectives

• Learn how to examine the various types of patient specimens received in the anatomic pathology lab, including:
  • Appropriate safety measures and techniques.
  • How to carefully evaluate grossly evident external features.
  • How to dissect to best view existing pathologic alterations.
  • When to ask for help from staff pathologist before proceeding with potentially destructive dissections.
  • How to take appropriate samples for routine histology study and when and how to take additional samples for special study methods (e.g. immediate diagnostic frozen section analyses, electron microscopy, biochemical analyses, gene analyses, mineral analyses).
• Learn the conduct of immediate frozen section examination including when such studies are warranted, how to select and prepare specific samples, how to interpret the histology observations and when to report diagnoses vs. when to defer to permanent histologic interpretations.
• Learn how to write/dictate accurate, concise, and effective descriptions of the diagnostically important gross anatomic observations, including details about specimen handling and sampling.
• Learn how to effectively use a microscope for evaluating histology samples, including:
  • When to ask for assistance from staff pathologists or consultants.
  • Appropriate and cost effective use of ancillary procedures (e.g. special staining, ICC, EM, RT-PCR, etc.) for elucidating relevant diagnostic details.
• Learn how to write/dictate accurate, concise, and effective descriptions of microscopic observations.
• Learn how to weigh and consider the significance of the various observations made from gross and histology studies, how to use the results to solve specific patient problems.
• Learn how and when to communicate with clinicians to obtain additional information, and how to effectively communicate with various attending pathologists and clinicians about specific issues arising while evaluating specific cases.
• Learn how to write/dictate final diagnostic reports that are honest, clear, concise, and timely and have some reasonable awareness of the affects these reports have on clinician understanding and selection of patient treatment regimens.

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Essential Requirements for Pathology Residents

The program educates residents in both Anatomic Pathology and Laboratory Medicine. The Anatomic Pathology program focuses on skills and methodologies associated with diagnostic surgical pathology, cytopathology, and autopsy pathology. The Laboratory Medicine program focuses on skills and methodologies associated with chemistry, microbiology, immunology, hematology, coagulation, and blood banking. Both programs encourage residents to take part in ongoing teaching and research activities.

The following are specific requirements for training in Anatomic Pathology:

Motor

• Residents must have the physical stamina and manual dexterity to perform gross anatomic examinations and dissections of autopsy and surgical specimens. This will involve some lifting and moving of moderately heavy objects.
• Residents must be capable of using a microscope and other laboratory equipment over prolonged periods.

Sensory

• Residents must be able to use their various senses in order to gather necessary information during examinations outlined above. Exceptionally important is the sense of sight.
• Residents will be exposed to various laboratory chemicals, especially to formalin, and should not have chemical hypersensitivities.

Communication

• Residents must be able to accurately communicate the results of their various observations and related considerations, with verbal and written methods; with and without electronic equipment.
• Residents must have a good command of the English language.

Intellectual Abilities

• Residents must be capable of assimilating a large amount of basic information. This includes an understanding of basic human biology, i.e., an understanding of normal and abnormal human structure – function interactions at all levels of biologic organization during all stages of life, including information considered to be basic to the general practice of medicine.
• Residents must be capable of practical problem solving. This involves the thoughtful use of general information in evaluating the significance of the specific observations made on specific patients and/or patient specimens.

Behavioral, Social and Professional Abilities

• Residents must have the emotional maturity and mental stability to function effectively under the natural stresses inherent in medicine. They must be punctual and perform work in a timely manner.
• Their professional actions must always reflect an understanding of the importance of the work they do relative to patient care.
• Residents must be able to interact productively, cooperatively, and in a collegial manner with individuals of differing personalities and backgrounds.
• Residents must continue to work hard to improve their professional skills. This includes not only the ability to identify and solve problems, but also the ability to set priorities and apportion time effectively.

Residency Webpage Editor: Michelle Rickard, Residency Manager