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Rotation Summaries - Anatomic Pathology

Anatomic (Surgical and Autopsy) Pathology, University of Minnesota Medical Center, Fairview, Riverside Campus

The anatomic pathology rotation at University of Minnesota Medical Center, Fairview, Riverside Campus, is designed to instruct physicians-in-training in anatomic pathology in the community practice setting. The rotation encompasses primarily surgical and some autopsy pathology. Physicians-in-training are instructed in the gross and microscopic evaluation of specimens from inpatient surgery, outpatient surgery, physician offices and specimens sent from rural hospitals.

Supervisory Guidelines for Patient Care and Specimen Handling

Physicians-in-training discuss biopsies as necessary and all resection specimen with the supervising faculty member prior to its dissection. This discussion includes a review of the relevant prognostic and staging information, approaching the specimen's dissection, and as necessary, procurement of tissues in special fixatives or freezing.

With the assistance of the supervising faculty, residents review the microscopic findings of each specimen they gross, except when performing autopsy duties. Under the guidance of the teaching faculty, residents are responsible for deciding if and what additional ancillary studies are necessary for each case.

Due to the lower number of autopsies performed at this institution, autopsies are integrated into the rotation over the course of the three months. When an autopsy occurs, the teaching faculty assume responsibility for the grossing and signing out of surgical cases, while the physician-in-training completes the autopsy. The physician-in-training is responsible for reviewing the patient's clinical history and discussing the case with relevant clinical care teams. The autopsy is then thoroughly discussed with the responsible teaching faculty member and a plan for approaching the post-mortem examination developed. Under the faculty member's supervision, the physicians-in-training completes the external examination and gross dissection. After reviewing these findings with the staff pathologist, the physician-in-training dictates the clinical history, gross anatomic findings, and provisional autopsy diagnoses (PAD). Subsequently, the physician-in-training will review the histologic findings and prepare an outline for the summary and interpretation. The physician-in-training presents the microscopic findings and summary to the responsible faculty member. After discussing the case with the faculty member, the physician-in-training completes the final autopsy report.

Faculty Supervision and Availability

The teaching faculty members are continuously available during standard operating hours either by phone or pager. At all times, a faculty member is on-call for evening and weekend questions.

Overview of Daily Duties and Responsibilities

Based on their level of training, residents are provided increasing autonomy with close faculty supervision. Due to the lower number of autopsies available at this site, the residents alternate gross and microscopic surgical evaluations for the entire three-month period. Each week, the resident will gross two days, review histology two days, and have the fifth day to finish cases, catch up on autopsy work, and study/read current pathology topics.

When autopsy cases are available, the teaching faculty will complete the gross and microscopic evaluations during the period in time in which the resident is performing the autopsy. In this fashion, resident participation in both surgical and autopsy pathology is maximized. Residents are expected to be fully involved in all aspects of the post-mortem examination, including but not limited to review of the medical record, summation of the circumstances of death, external examination of the body, evisceration, dissection of the organs, preparation of the written autopsy report, preparation of the preliminary anatomic diagnosis, review of microscopic findings, review of all ancillary testing, and determination of the cause and manner of death. The above level of involvement is expected for both individual and shared autopsies. Depending on the case, the resident is expected to cut the brain fresh or after fixation and directly review the neuropathology with the staff and/or neuropathologist. In order to consider an autopsy educationally effective, it needs to be completed within 30 days of the patients death. Therefore, trainees can only count those autopsies that are completed within this time frame toward their graduation requirement.

During the rotation, the resident will be responsibility for the processing of a reasonable number of the gross specimens, which come into the laboratory on their designated day. The residents will, on the subsequent day, participate in the histologic evaluation and ordering of ancillary studies as necessary. Residents are expected to review as many of their cases as possible prior to signing them out with a staff pathologist. All cases grossed by a resident will be reviewed together with a staff pathologist at the time of sign-out. The residents will also be responsible for preparing the original draft of the interpretive surgical pathology reports. During the rotation, the resident will be responsible for presenting a didactic lecture on a surgical pathology topic to the University of Minnesota Medical Center, Fairview, Riverside Campus faculty, technologists, and related healthcare professionals.

Goals and Objectives

Problems in accomplishing any specific objective should be discussed with Dr. Dexter.

Surgical Pathology:
Autopsy Pathology

Resident Opportunities to Function as Consultant to Other Physicians

During this rotation, the residents have the responsibility, under faculty supervision, of discussing the interpretive consultative reports on surgical and autopsy cases with the members of the clinical team. Through their discussions with the clinical team, the residents have the opportunity to directly impact the patient's care.

During the rotation, the residents will be exposed to laboratory correlation studies. These will include, but not limited to, the following:

  1. Correlation of fine needle aspiration studies with subsequent surgical pathology specimens.
  2. Correlation of cervical PAP smear findings with cervical biopsies.
  3. Correlation of ancillary studies with histology in the work-up of lymphomas and hematologic disorders.

On Call Duties

On call duties during this rotation, the residents will on average have one out of every seven days free of hospital duties. Due to the at-home nature of the call and the limited number of emergencies, the call duties are constructed in the following fashion. The residents will be on at-home pager call every third week. The on-call period will last from 7:00 a.m. Monday morning through the following weekend, ending at 7:00 a.m. on Monday of the subsequent week. During their call, the residents will be supervised by a member of the University of Minnesota Medical Center, Fairview, Riverside Campus teaching faculty, who will be available at all times, either via their office phone, pager, or home phone. On call activities are reviewed with the residents on an on-going basis, as evening and weekend calls are received.

Prompt and Reliable Communication with On-duty Faculty

During general working hours, the supervising teaching faculty members are available either in person, by scheduled appointment, by phone, and in emergencies by pager. During the on call hours, the teaching faculty is continuously available either by at home phone or pager.

Structured Education and Management of the Surgical Pathology Laboratory

During this rotation, the residents will attend scheduled quality assurance, laboratory safety, and other appropriate staff meetings, as they relate to laboratory management. As opportunity provides, residents will be allowed to participate in CAP laboratory inspections.

Required Conference/Seminars

Optional Conferences:

There a large number of additional high-quality conferences on the University Campus that involve pathology correlation. Residents are encouraged to attend these conferences when ever possible as time permits.

Additional Pathology Related Conferences on the University Campus

Name of Conference Day Held Time Frequency
Adult Kidney Monday 4:00 Monthly
Pediatric Renal Last Monday of month 11:00 Monthly
Neuro-oncology Monday 1:00 Weekly
Neuropathology Tuesday 10:00 Weekly
Gastrointestinal Tuesday 12:00 Weekly
Colorectal Tumor Tuesday 3:30 Rare
ENT (head & neck) Wednesday 12:30 Weekly
Pediatric Brain Tumor Wednesday 1:30 3rd week of month
Orthopedics Thursday 7:00 Weekly
Pulmonary/Thoracic Thursday 12:00 Weekly
Neurology-Path Thursday 1:00 Weekly
Surgery/Radiology Thursday 4:00 Weekly
Breast Friday 7:00 Weekly
Medicine/Pathology Friday Noon Weekly, Sept-June
Heart Transplant Friday 2:00 Every other month
Urologic Pathology 1st Wednesday 5:00 Monthly

Scholarly Activities and Research During the Rotation

Residents are provided with continuous access to on-line literature searching programs. The residents are expected to use the medical literature to find up-to-date information on their cases and to provide clinical colleagues with up-to-date knowledge related to their case.

During case sign-out, the residents and teaching faculty discuss each case, both from a histologic perspective and a scholarly perspective. In discussing the latter, both normal and abnormal physiology and the mechanisms possibly responsible for creating the morphologic findings observed are reviewed. By providing the residents with increasing responsibilities and duties, as their level of training increases, the teaching faculty hope to instill within the resident the skills and tools necessary for developing a life-long method of continued professional development.

Basis and Method of Resident Evaluation

The residents are provided with continuous feedback on their performance during their rotation. In general, only deficiencies are noted in writing during the rotation. Residents are evaluated on their demonstrated ability to provide informative consultation to the clinical service teams, their medical knowledge, their application of this knowledge to efficient/quality patient care, their diagnostic, technical and observational skills both in the gross room and at the microscope, and their interpersonal skills, professional attitudes, reliability, and ethics with members of the teaching faculty, peers, laboratory staff, and clinicians. They are also evaluated on their initiative in completing and fostering quality patient care, their use of the medical literature and other resources, as it relates to their assigned cases. Their timely completion of assigned interpretive reports, including autopsy protocols, is another component of the evaluation.

Educational Resources Available

Residents are provided with access to multiple general and specialty surgical pathology textbooks including:

Journals:

In addition, the personal libraries of the teaching staff are available, as necessary for temporary use by the residents. In addition to the on-site intradepartmental pathology library and private reference book collections of the teaching faculty, residents have access to the University of Minnesota Medical School Library (Diehl Hall) which is on the University Campus via a 5-minute shuttle ride.

Computer Information Systems for Resident Education and Service Duties

Residents have continuous access to the laboratory information systems (AOAC), which relate to patient care on the University of Minnesota Medical Center, Fairview, Riverside Campus. The residents also have access to on-line literature searching.