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Rotation Summaries - Anatomic Pathology

Neuropathology at University of Minnesota Medical Center, Fairview

The major purpose of the neuropathology rotation is to impart in the residents a working familiarity with the gross and microscopic anatomy of the nervous system and to acquire elementary dissection and diagnostic skills using both autopsy and surgical material. Although the residents' role in the rotation is not primarily to provide a service function to the Division, residents are expected to take part in gross dissection and directed learning coupled with didactic and Socratic teaching conferences that allow the residents to concentrate primarily on increasing their knowledge of neuropathology rather than service-related concerns.

Consultation visits to the Minneapolis Veterans' Affairs Medical Center, Hennepin County Medical Center, and Hennepin County Medical Examiner's Office are incorporated into the rotation to enhance the mixture of neuropathological cases seen and substantially broaden the practical experience of the residents on the rotation.

Supervisory Guidelines for Patient Care and Specimen Handling:

As specimen handling is not a specified part of the rotation, specimen handling in the Neuropathology Laboratory is the direct responsibility of the laboratory personnel and the teaching faculty. Resident decision making in the laboratory is under the direct supervision of the teaching faculty. The on service teaching faculty members are physically present during standard operating hours; faculty members not physically present are rapidly available by phone or pager. No diagnosis is communicated to the clinicians before a faculty member has evaluated the case.

Overview of Daily Duties and Responsibilities:

The focus of this rotation is not on providing a service function for the Division of Neuropathology. The major goal of the rotation is to have the residents gain familiarity with neuropatholigic problems and to develop the necessary tools to perform a competent postmortem examination of the central nervous system.

  1. Participate with the attending neuropathologist in the two weekly conferences at the University Medical Center on gross and microscopic neuropathology for the residents in pathology, neurology and neurosurgery.
  2. Assist the attending neuropathologist at the brain-cutting conference held at the University of Minnesota Medical Center, Hennepin County Medical Center, Hennepin County Medical Examiner's Office, and Minneapolis Veterans' Affairs Medical Center. These activities include gross dissection and description of the autopsy brains, blocking tissues for microscopy, photography of specimens.
  3. Attendance at sign-out of neurosurgical specimens with the attending neuropathologist and the residents on the surgical pathology service who are responsible for dictating the cases.
  4. Participate with the attending neuropathologist in all frozen sections of neurosurgical material.
  5. Review all neurosurgical consultation cases with the attending neuropathologist.
  6. Fulfill explicit requests of the attending neuropathologist to review cases of special neuropathological interest from the autopsy, surgical or consult services.

Goals and Objectives:

  1. Develop a systematic approach to the pathological analysis of the nervous system, including gross examination and dissection with selection of appropriate sections for microscopic examination.
  2. Be able to describe the gross and microscopic anatomy and pathology of the nervous system with appropriate terminology and conclusion.
  3. Be able to recognize and diagnose the basic neoplastic processes that affect the nervous system. This includes understanding the clinical settings in which these diseases arise and the prognostic implications of the diagnoses.
  4. Become familiar with the interpretation of intraoperative diagnostic techniques, e.g., frozen sections, touch preparations and cytological smear preparations, for lesions of the nervous system.

Opportunities to Function as Consultant to Other Physicians:

Due to the brevity of the rotation, the lack of experience of the rotating residents and the specialized requirements of the Physicians requesting consultations, there is limited opportunity for the residents to function in the capacity of a consultant while on this rotation. The residents are responsible for presenting their autopsy brains to the University of Minnesota Medical Center Neurology Service at a weekly conference. In some circumstances residents will make presentations at conferences involving clinical services.

On-call Duties:

The resident is expected to be available to laboratory personnel, either in person or by pager, throughout the working day. In an urgent situation, the resident should contact either the supervisor or a faculty member. No on-call duties outside of regular laboratory working hours are assigned to the resident.

Communication with On-Duty Faculty:

The residents have office space in the Division of Neuropathology and are expected to spend the majority of time within the Division. Teaching faculty members on service are physically present during standard operating hours (8:00 am - 5:00pm); specific faculty members when not physically present in the laboratory are available by phone or pager. At all times, a supervising faculty member is on call for evening and week-end questions. No diagnosis is communicated to clinicians before a faculty member has evaluated the case.

Structured Education and Management of the Surgical Pathology Laboratory:

Residents may be involved on an ad hoc basis when issues of laboratory management arise. Due to the brevity of the rotation, no formal arrangement for such activities can be guaranteed.

Required Conference/Seminars:

Optional Conference/Seminars:

Scholarly Activities and Research During Rotation:

Research within the Division of Neuropathology is an option that our residents may choose for research elective activities. Incorporation of residents into experimental neuropathological work ongoing in the Division or selection of projects in clinically related research, e.g., immunohistochemistry of tumors are possible avenues of pursuit.

Basis and Method of Resident Evaluation:

The residents will be expected to perform autopsy brain dissections and descriptions in a competent manner such that appropriate materials are submitted for microscopic examination and an accurate diagnosis can be rendered by the attending neuropathologist. Residents who put forth an honest effort to develop neuropathological skills will be evaluated favorably. Residents who fail to attend the required functions or who fail to progress in the development of neuropathological dissection techniques or in their understanding of neuropathological processes will be evaluated unfavorably.

The residents are provided with continuous feedback on their performance during the rotation. In general, only deficiencies are noted in writing. 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, and their gross and microscopic diagnostic, technical and observational skills. Their understanding of the necessity for special testing (immunohistochemistry, special stains, ISH) for individual cases also will be ascertained. Residents will be evaluated on their interpersonal skills, professional attitudes, reliability, and ethics with members of the teaching faculty, peers, laboratory staff, and clinicians. They are further evaluated on their initiative in fostering quality patient care and use of the medical literature, 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.

Educational Resources Available:

The residents on the rotation have an office in the Division of Neuropathology that is shared with residents from other services (Neurology and Neurosurgery) who also rotate in Neuropathology. This office is equipped with a multihead-microscope and numerous individual microscopes. The interaction among the residents from different services complements the educational experiences of each group of residents and creates an environment requiring strong interpersonal communication. The office also includes a library with textbooks of neuropathology and neurology. There are microscopic teaching sets, consisting of microscopic slides with a self-directing syllabus. There also is a large collection of gross neurological specimens that can be used both for self-directed study and serve as the basis for the weekly gross neuropathology conference. The neuropathology microscopic slides and reports from the past 40 years also are housed in the Division and the residents have access to them via indexed diagnosis files. Files of gross Ektachrome slides also are available for many cases of neuropathological interest. Included in these files are over 400 detailed CPC cases with clinical protocols.

The Division of Neuropathology is located in Diehl Hall, one floor below the University of Minnesota's Biomedical Library, where the residents have access to computers for literature searches as well as to the entire library collection of journals and books.

Books that are available and recommended for use by the residents include the following:

  1. Manual of Basic Neuropathology by Gray, De Girolami, and Poirier, 4th Edition, Butterworth-Heinemann, 2004.
  2. Surgical Pathology of the Nervous System and its Coverings. Burger, Scheithauer and Vogel, 4th Edition, Churchill Livingstone, 2002.
  3. Principles and Practice of Neuropathology. Nelson, Parisi and Schochet. Mosby, 2003.
  4. Tumors of the Central Nervous System. Burger and Scheithauer. AFIP Fascicle, 1994.
  5. Greenfield's Neuropathology. Graham and Lantos, 7th Edition, Arnold, 2002 (with CD-ROM).
  6. Neuropathology CD-ROM. Ellison and Love. Mosby, 1998.

Computer Information Systems for Resident Education and Service Duties:

A CoPath-based PC is available in the Divisional Office to access diagnostic reports and cases in progress. There is no dedicated computer for residents' educational use in the Division but the Biomedical Library Computer Center is located one floor above the Divisional Offices in the same building. Wireless access to the internet is available in Diehl Hall for use by residents with laptop computers. The residents also have continuous access to computers in the Resident's Room located in the adjacent Mayo Building