Return to: Medical School : AHC : U of M Home

PrintPrint

Rotation Summaries - Anatomic Pathology

Anatomic (Surgical and Autopsy) Pathology - Veterans' Affairs Medical Center, Minneapolis

The Anatomic Pathology rotation at the VAMC is designed to provide the residents with skills in the areas of tissue description, sectioning, handling, and fixation. The rotation provides exposure to a wide variety of cases to expand their microscopic diagnostic skills, with extra emphasis in the areas of lung, urinary bladder, prostate, and skin pathology.

Core Competencies

These are essential to make residents into better individual physicians and for improvement of general health care. The six competencies are:

Supervisory Guidelines for Patient Care and Specimen Handling

While both junior and senior residents perform similar tasks; senior residents are allowed to work more independently. At all levels of training, the resident's duties are always under the instruction and supervision of a surgical pathology fellow, pathologist assistant, and/or staff pathologist. In the gross room, the pathologist's assistant, the fellow, and/or the Pathology Staff on the frozen section service supervise the residents. Staff Pathologists sign out all Surgical Pathology and Autopsy reports.

Overview of Daily Duties and Responsibilities

Surgical pathology residents cover autopsy service two days a week and use Fridays to follow-up on their autopsy cases. They also take weekend autopsy calls.

Surgical Pathology Service
Autopsy Service
  1. The residents work under the direct supervision of a pathologist assistant and/or staff pathologist.
  2. 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.
  3. In order to consider an autopsy educationally effective, it needs to be completed within 30 days of the patient's death. Therefore, trainees can only count those autopsies that are completed within this time frame toward their graduation requirement.
  4. After receiving a valid permit for an autopsy, the resident completes a review of the pre-mortem clinical condition, including:
    1. Review the medical record,
    2. Discuss the case with the attending physician and house staff, and
    3. Discuss the case with the staff pathologist / pathologist assistant.
  5. A thorough external examination of the body is then performed with all findings described and documented. Pertinent findings should also be photographed.
  6. The resident will then undertake a systematic approach to the postmortem examination, including organ dissection and evaluation of the macroscopic pathology. The dissection will be performed using universal blood and body fluid precautions.
  7. The resident will sample any gross abnormalities for conventional histology and possible histochemistry, immunohistochemistry and electron microscopy.
  8. The resident and staff pathologist will review the microscopic findings.
  9. The resident and staff pathologist then discuss the clinical data, macroscopic and microscopic findings, and write the final autopsy report that includes a brief clinical-pathologic correlation section.
  10. The resident, pathologist assistant and staff pathologist review the pathologic findings with the treating clinical team. The resident should invite the house staff members associated with the patient's care to come to the autopsy or review the gross organs afterwards.
  11. The residents will participate in brain cutting and neuropathology microscopic sign-out with consultant neuropathologists and/or staff pathologists.
  12. The resident on the autopsy service is responsible for presenting the Monday morning gross conference. During this conference, the resident will present the autopsies from the previous week, including a brief clinical summary and pertinent macroscopic and microscopic findings. In addition, the resident will be an active participant in the cardiovascular and neuropathology conferences associated with their autopsies.

Goals and Objectives

Surgical Pathology
  1. Basic understanding of the approach to surgical and biopsy specimens, including dissection, photographic illustration, sampling, and fixation.
  2. Basic understanding of gross pathology and lesion descriptions that include prognostic information.
  3. Basic understanding of the appropriate methods for submitting tissue for histologic evaluation, including the safe use of different fixatives.
  4. Learn sampling and fixation of specimens for electron microscopy. Develop a basic understanding for the interpretation of electron microscopy on surgical pathology specimens.
  5. Participation in operating room consultations (frozen sections), including appropriate sampling, processing, and interpretation, as well as interactions with clinicians. Develop a basic understanding of the common indications and contraindications for frozen section evaluation of tissue.
  6. Understanding the use of intraoperative consultation for clinical decision-making.
  7. Demonstrate the ability to work calmly under pressure.
  8. Have a basic understanding of the microscopic approach to histologic sections.
  9. Become familiar with the elements of the surgical pathology report and have the ability to generate high-quality microscopic descriptions.
  10. Have a basic understanding of special stains, as they apply to histologic interpretation.
  11. Learn how and when to utilize immunohistochemistry and electron microscopy in the development of a final surgical pathology diagnosis.
  12. Demonstrate sufficient knowledge and scholarly insight to adequately describe and interpret unusual cases.
  13. Be proficient in the performance of literature searches.
  14. Gain familiarity of one's ability and limitations and know when and how to consult with surgical pathology colleagues.
Autopsy Pathology
  1. Ability to efficiently collect clinical information from the patient's chart and correlate the clinical data with gross and microscopic pathologic findings.
  2. Proficiency in the techniques of post-mortem examination.
  3. Learn to observe, describe and sample gross pathologic abnormalities.
  4. Learn the histologic manifestations of the major types of diseases.
  5. Learn to translate all findings into an autopsy report: clinical, macroscopic and microscopic.
  6. Be familiar with infection control policies and procedures.

Resident Opportunities to Function as Consultant to Other Physicians

Residents generate a number of consultative reports, including the surgical/autopsy pathology reports, the intraoperative consultation reports, and special studies reports. The residents participate in direct patient care by communicating surgical pathology diagnoses and their implications to the clinical residents and staff on the wards. Residents interact with other training programs on a peer basis, including internal medicine, radiology, and otolaryngology. Frequently, the residents are requested to present their surgical/autopsy cases at the clinical service rounds of other departments. During the rotation, residents are expected to participate in the correlation studies between biopsies, pap smears, and fine needle aspirations.

On Call Duties

During this rotation the residents will on average have one out of every seven days free of hospital duties. The residents have no surgical pathology on-call duties during this rotation.

While on the surgical and autopsy services, the residents are expected to participate in weekend call for the performance of autopsies. The rotation director assigns autopsy duties approximately every other weekend. When on call, the resident is responsible for calling hospital to see if any autopsies arrive before 2:00 p.m. each day. Prior to the initiation of an autopsy, the resident is expected to call and discuss the case with the staff pathologist. Autopsies will not be started after 2:00 p.m. except under unusual circumstances. If a resident on the autopsy service is called on both weekend days, an in-lieu day may be awarded after consultation with the rotation director.

Prompt and Reliable Communication with On-duty Faculty

During general working hours, the on service supervising teaching faculty is available in person with other faculty members available by scheduled appointment, by phone, and by pager. During the on-call hours, the teaching faculty is continuously available either at home by phone or by 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 meetings as they relate to laboratory management. As opportunity provides, residents will be allowed to participate in CAP laboratory accreditation, including self-inspections and inspection of other institutions.

Required Conference/Seminars

Optional Conferences

Scholarly Activities and Research During Rotation

Residents are provided with continuous access to literature searching programs. The expectation is that residents will utilize the medical literature to find up-to-date information on their cases. It is further expected that residents will utilize the medical literature to help provide our colleagues with up-to-date knowledge related to the cases they complete. During sign-out of cases, the residents and teaching faculty discuss each case, both from a histologic and scholarly perspective. In discussing the latter, the resident and faculty discuss both normal and abnormal physiology and the mechanisms potentially responsible for creating the morphologic findings observed. It is hoped that these discussions will foster an interest in research and the development of new knowledge.

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 is another component of the evaluation. Residents on probation receive a written mid-rotation evaluation. On-line evaluations are completed using e-value system, for all rotating residents and fellows at the completion of their rotations.

Educational Resources Available

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

In addition, the Veterans' Hospital has an on-site full service medical library with multiple pathology textbooks and journals. Residents have 24-hour access to this library via the Admission's Desk at night. Further, residents have access to the University of Minnesota Medical School Library (Diehl Hall), which is one the University of Minnesota Campus.

Computer Information Systems for Resident Education and Service Duties

Residents have continuous access to the laboratory information systems, which relate to patient care on the Veterans Affairs Medical Center Campus. The residents also have access to on-line literature searching in the residents' room.