Section: Cytopathology

Duration: 2 months. Elective rotation in Cytopathology is also available

Goals & Objectives

To familiarize each resident with the standard text readings in cytopathology, to provide exposure to the routine screening of gynecologic specimens, and to introduce the resident to methods of obtaining, processing, and interpreting cytologic material from various sites. In addition, the resident will become familiar with administrative and operational issues of a cytopathology laboratory, including policies and procedures, regulations, quality assurance, and quality improvement.

The resident should be familiar/competent with the following items:

Screening of routine PAP smears, diagnosis and classification of abnormal PAP smears, systems of reporting (Bethesda and others).
Non-gyn specimens, including body fluids, brush cytology, fine needle aspirations, etc.
Collection and preparation of specimens for cytology evaluation including attendance in radiology suite to observe FNA's and attendance in cytology preparation room. In addition, residents will interact with surgery to perform FNA's in the clinic. The resident must document this experience in their file.
Preview and obtain a clinical history, previous material on all cases to be signed out by the pathologist. Be prepared to support and discuss diagnoses by appropriate research/reading.
Review study sets in both gyn and non-gyn materials (e.g. departmental, ASCP, Checkpath). Review unknowns with a supervisor.
Participation in quality control and quality assurance.
Administrative and management issues and subsequent activities pertaining to cytopathology lab.
The resident will develop the necessary skills to become competent in making clinical/pathologic correlation.
The resident will prepare for sign out with the attending pathologist by having analyzed the materials to the best of her/his ability and a diagnosis written on the requisition sheet. The resident should be prepared to discuss and support their diagnoses with supporting documentation from texts and the literature.

The requirements and expectations as well as opportunities will be reviewed with each resident during their first few days. Self-study is a significant component of the rotation and will be followed up by staff. The University Hospital requires residents to be credentialed for fine needle aspiration biopsies (FNAB's). For residents, these have been set at 5 superficial FNABs. Obtaining these credentials by no means indicates expertise in this technique! A resident will be credited per case if they are actively involved and perform as directed; a resident will be credentialed after 5 documented cases and the approval of the Medical Director. Cytopathology Conferences will be given at least 2-3 times per month. Attendance is required and participation is expected.

Teleconferences, guest speakers and informal discussions are optional but encouraged. 1-month rotation is mandatory. Elective rotation for 2 additional months is also allowed. Greater than three month increments need prior approval of the Director of Cytopathology. Due to the fellowship program, only 1 resident position is available per month; exceptions must be cleared through the Director of Cytopathology. The amount of time allowed off service for vacation/comp time is dependent on the length of the rotation as indicated below. Consideration will be given to residents participating in meetings.

Duties & Responsiblities:

Increment - 1 month The resident will be responsible for attending daily sign-out and, after the first week, will be responsible for Previewing cases in graduated increments. Residents may attend for observation only the weekly Cytopath FNAB Clinic in room 4800 University Hospital. Residents will spend at least two sessions in the preparatory area learning techniques. There will be reading and study packets assigned by topic with follow up by staff. The first 1-month increment will emphasize gynecologic cytopathology. Note: Vacation/comp days must be approved by the Director and will be limited to 2 days under normal circumstances.

Increment - 2 month The resident will be responsible for attending daily sign out and, after the first week, will be responsible for previewing cases in graduated increments. The resident will then begin to work up non-gyn cases for sign out. Preparatory sessions (2) will be assigned during the first month. The resident may be given the opportunity to learn the technique of FNAB. This may occur within the first month at the discretion of the Director; if not, then during the second month. If the resident performs adequately following instruction then he/she will be allowed to continue with interaction in the interventional services. The resident will also attend several radiologic guided procedures with the Cytopathology fellow or Cytotechnologists. If performance and progress is satisfactory then the resident will be allowed to perform independent of staff following residents being credentialed. There will be reading and study packets assigned by topics will follow-up by staff. The emphasis will be mixed, both gyn and non-gyn throughout the two-month cycle. The resident will be expected to present 2 cytopathology conferences (1 didactic/1 unknown) - topics of their choice. Note: Vacation/comp days must be approved by the Director and will be limited to no more than 1 week (5 working days) under normal circumstances.

Increment - 3 month - rotation can be tailored for senior residents with specific requests. The resident will be responsible for attending daily sign out and after the first week will be responsible for previewing cases in graduated increments, including the responsibility for writing up non-gyn (FNAB) cases. The resident may be given the opportunity to learn the technique of FNAB. This may occur within the first month at the discretion of the Director; if not, then during the second month. If the resident performs adequately following instruction then he/she will be allowed to continue with interaction in the interventional services. The resident will also attend several radiologic guided procedures with the Cytopathology fellow or Cytotechnologists. If performance and progress is satisfactory the resident will be given the opportunity for independent assessment of cases prior to final sign-out by the attending. There will be reading and study packets assigned by topics will follow-up by staff. The emphasis will be mixed, both gyn and non-gyn throughout the three-month cycle. The resident will present 3 cytopathology conferences -they can choose topic and style. Note: Vacation/comp days must be approved by the Director and will be limited to no more than 2 weeks (10 working days) under normal circumstances.

1st-4th year residents: If residents participate in primary screening of cytology cases, these cases will be rescreened by the cytopathology fellow, a cytotechnologist, or a pathologist prior to reporting.

5th year (fellow): The cytopathology fellow is required to document his/her workload regarding primary screening of all cytology cases, including FNAs, non-gyn and PAP smears. This includes the total number of slides whereby he/she conducts the initial screening and evaluation. The fellow will also record the total number of hours-spent screening within each 24-hour period.

Evaluation:

Residents must develop competencies in the six areas below to the level expected of a new practitioner.

Patient Care: Residents must demonstrate a satisfactory level of cytologic diagnostic competence and the ability to provide appropriate and effective consultation in the context of cytopathology services.
Medical Knowledge: Residents knowledge will be assessed based on his/her work-up of cases for sign out. Ability to establish clinicopathologic correlation based on cytologic diagnosis will be assessed. Participation in cytopathology conferences will be evaluated by program director and attending staff.
Practice-based learning and improvement: Resident must be able to perform literature search, collect appropriate background information and read text material pertaining to a cytology case that they are working up.
Interpersonal and communication skills: Will be assessed based on residents interaction with the attending staff, cytotechnology staff, peers and physicians from other departments. Ability to communicate cytologic diagnosis and to address the concern of attending physicians about individual cases will be assessed.
Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Systems based practice: Familiarization with system of Health Cazre and ability to call on system resources as needed to provide pathology services of optimal value will be assessed.