Section: Neuropathology

Duration: 1 month required rotation

Goals & Objectives

1. The resident will be made familiar with the routine and some of the special procedures utilized in the processing of central and peripheral nervous tissue. This rotation will also provide the opportunity to expand neuroanatomical and neuropathologic concepts, particularly regarding tumors and neuromuscular diseases.
2. In general, autopsy brain evaluations will be completed by the resident during the autopsy rotation while the neuropathology specialty rotation will be dedicated primarily to biopsy material of neurological, rheumatological and neurosurgical interests.
3. The residents are expected to learn the advantages and limitations of the methods employed in neuropathology, including gross inspection (of autopsy brains), traditional H&E stained paraffin sections, special stains including Bielschowsky silver stains and immunocytochemistry, frozen sections, touch/smear preparations, enzyme histochemistry, and electron microscopy.
4. When finished the resident should understand differential diagnosis and evaluation of CNS neoplasm, understand the general concepts and rational for nerve and muscle biopsies, proper handling of these specimens, and general classification of nerve and muscle diseases.
5. By the end of the autopsy rotation the resident should demonstrate an understanding of the proper evaluation of autopsy brain and spinal cord material and should be able to diagnose common congenital, traumatic, and degenerative conditions of the brain. An understanding of appropriate sections to be taken for microscopic analysis, based upon an understanding of the neuroanatomical systems involved in the pathological processes is expected.

Duties & Responsiblities

(with supervision by an attending neuropathologist):
All biopsies and autopsy cases signed-out will be logged.

1. Resident duties will vary with prior training but, in general, will consist of initial evaluation of surgical cases, including muscle and nerve biopsies, literature research regarding current cases, conference preparation, and assistance in conference presentations.
2. Graded responsibility will be assigned as indicated and will include: telephone consultation with referring clinicians for the purpose of acquiring additional history, imaging results and interpretation, clinical impression, laboratory data and additional studies requested.
3. After the initial orientation, the resident is expected to be able to perform frozen sections, formulate differential diagnoses, order appropriate additional tests when necessary, and include a written microscopic description and final diagnosis prior to sign-out with the attending neuropathologist.

Daily Activities

1. Attend all frozen-sections.
2. Sign-out surgical neuropathology cases each day.
3. Sign-out 2 brain autopsies per week.
4. Attend all neuropathology conferences and all brain cutting sessions.
5. Assist in preparation and present cases at conferences each week.

Evaluation:

1. Patient Care: able to distinguish diagnostic materials from non-specific samplings during intraoperative frozen section consultation, to recognize neoplastic from nonneoplastic lesions in surgical biopsies, and to be able to provide appropriate and effective consultations with the neurosurgeons and neuroradiologists; and able to perform autopsy of the brain and spinal cord.
2. Medical Knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and the application of this knowledge to both surgical and autopsy (forensic) neuropathology.
3. Practice-based learning and improvement: able to formulate differential diagnoses and to devise methods of investigation (e.g., special stains, immunocytochemistry) as well as appraise and assimilate additional scientific evidence to improve the patient case practice (i.e. accuracy of the diagnosis).
4. Interpersonal and communication skills: able to discuss effectively with other pathology subspecialists as well as clinicians (e.g., neurologists, neurosurgeons, and neuroradiologists, neuro-oncologists, etc.) to provide the best patient care. In case of brain autopsies - be able to communicate with patient's family with compassion and understanding.
5. Professionalism: demonstrate commitment to carrying out professional responsibilities, adhere to ethical principles, and sensitivities to a diverse patient population.
6. System-based practice: demonstrate awareness and responsiveness to the larger context and system of health care and able to call on system resources to provide optimal pathology services.

Additional information and comments

Overall performance (Excellent, Good, Average, Deficient, Inadequate).

Orientation

I have read and understand what is expected of me as a resident on the Neuropathology rotation at SUNY Upstate Medical University.

Resident Signature: _____________________________________

Date ________________

Completion of Rotation

Signature of faculty completing form: _____________________

Date _____________________

This evaluation was discussed with resident: ____Yes____No

Resident Signature: _____________________________________

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