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Rotation Summaries - Anatomic Pathology Electives

Immunohistochemistry at University of Minnesota Medical Center, Fairview

The immunohistochemistry rotation at University of Minnesota Medical Center, Fairview, Riverside Campus, is designed to instruct physicians-in-training in methodology, new antibody evaluation, troubleshooting and quality assurance/control in the area of immunohistochemistry.

Supervisory Guidelines for Patient Care and Specimen Handling:

Physicians-in-training perform the daily quality assurance/control of the immunohistochemical stains with the teaching faculty responsible for the technical direction and quality assurance/control of the immunohistochemistry laboratory. If an immunohistochemical stain has questionable features, the physician-in-training will immediately bring this to the attention of the teaching faculty member and subsequently, the ordering pathologist.

Faculty Supervision and Availability:

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

Overview of Daily Duties and Responsibilities:

Based on their level of training, residents are provided with increasing autonomy with close faculty supervision. During the rotation, the physician-in-training will have the responsibility for quality assurance/control evaluation of all of the pathologist-ordered immunohistochemical stains, under faculty supervision and prior to the distribution of the slides to the ordering pathologist. During the first part of the rotation, the physician-in-training will spend a brief period of time in the immunohistochemistry laboratory with the lead technologist, who will discuss the operation of the automated immunohistochemistry instruments and the daily workflow in the immunohistochemistry laboratory.

The physician-in-training will also have the following responsibilities:

  1. Participation in daily laboratory quality assurance/control, including slide checks, dilution checks, paraffin block checks with documentation of appropriate quality assurance/control parameters
  2. Participation in the evaluation of a new antibody including literature review, selection of vendor, appropriate antibody pretreatment with enzyme digestion or antigen retrieval, selection of antibody titer and incubation time and evaluation of reactivity of antibody with a variety of tumors
  3. Development of a selective "sausage tissue control block"
  4. Researching and presenting a weekly didactic lecture on an antibody of his (her) choice to the University of Minnesota Medical Center, Fairview, Riverside campus faculty, technologists and related healthcare professionals
  5. Prepare a concise written interpretative summary page on one of the new antibodies under evaluation in the laboratory to be placed in the Immunohistochemistry Antibody Guidebook

Goals and Objectives:

  1. Problems in accomplishing any specific objective should be discussed with the teaching faculty.
  2. Develop a technical understanding of the methods used in the immunohistochemistry laboratory.
  3. Understand the impact of fixation, methods of antibody pretreatment including enzyme digestion and antigen retrieval, antibody titer selection and others.
  4. Understanding of the differences between an immunohistochemistry laboratory for an academic center and a community based hospital.
  5. Develop a familiarity with the management issues involved in the operation of a community hospital immunohistochemistry laboratory.
  6. Learn CPT coding as it relates to immunohistochemistry
  7. Be able to recommend appropriate and properly interpret immunohistochemical staining panels for the different differential diagnoses
  8. Be thoroughly familiar with immunohistochemical panels for common diagnostic problems (e.g. small blue cell tumors, carcinoma versus mesothelioma, carcinoma versus sarcoma, differential diagnosis of spindle cell tumors, differential diagnosis of melanoma, immunostains for infectious organisms)
  9. Be thoroughly familiar with immunostains for prognostic markers (e.g. p53, BerH2, PCNA, etc.)
  10. Be thoroughly familiar with immunostains for the detection of infectious organisms, including viruses
  11. Be thoroughly familiar with laboratory safety and chemical hazard guidelines
  12. Be able to abstract and analyze critically information from an article, and put it in context with the literature available

Opportunities to Function as Consultant to Other Physicians:

During this rotation the physician-in-training will have the responsibility, under faculty supervision, of overseeing the quality assurance/control of all of the immunohistochemical stains and informing the ordering pathologist of quality assurance/control problems and resolutions. The physician-in-training will have the opportunity to provide inquiring pathologists with information regarding characteristics and uses of an antibody and appropriate selection of antibodies. Through their discussions, the residents will have the opportunity to directly impact the patient's care.

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. No diagnosis is communicated to clinicians before a faculty member has evaluated the case.

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:

Anatomic Pathology Conferences on the University Campus that are strongly encouraged as time permits

Scholarly Activities and Research During the Rotation:

Residents are provided with continuous access to on-line literature searching programs. The expectations are that residents will utilize the medical literature to find up-to-date information related to immunohistochemistry. During immunohistochemical stain reviews with the teaching faculty, the residents and faculty discuss the stains both from an immunohistochemistry perspective and a scholarly perspective. 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 service teams, their medical knowledge, their application of this knowledge to efficient/quality patient care, their diagnostic, technical and observational skills both in the laboratory 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. They are also evaluated on their preparation and presentation of a weekly didactic presentation to the laboratory staff, the quality of their tissue sausage block and on the concise and comprehensive nature of their antibody write-up.

Educational Resources Available:

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

    1.Sternberg, et al. Diagnostic Surgical Pathology 2.Silverberg, et al. Principles and Practice of Surgical Pathology and Cytopathology 3.Rosai, Ackerman's Surgical Pathology 4.Enzinger, Soft Tissue Tumors 5.AFIP Tumor Fascicles. 6.Leong A, Wick M, Swanson P, Immunohistopathology and Electron Microscopy of Anaplastic and Pleomorphic Tumors. Cambridge University Press, 1997. 7.An up-to-date file of immunohistochemical articles is available in the Fairview Riverside Department of Pathology.

In addition, the personal libraries of the teaching staff are available, as necessary for temporary use by the residents.

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 University of Minnesota Medical Center, Fairview, Riverside Campus. The residents also have access to on-line literature searching. In addition to the private reference book collections of the teaching faculty, a limited hospital library is available for resident use on the Riverside Campus. In addition, residents have ready access to the University of Minnesota Medical School Library (Diehl Hall) via a 5-minute shuttle ride over to the University campus.