All residents preview current gyn and non-gyn cases and screen 2 Pap tests per day prior to faculty sign-out. Early during their first cytology rotations, residents may review directly with the attending pathologist while developing an understanding of cytology. As they become more comfortable and the attendings deem it appropriate, they may spend more time previewing the cases prior to sign out. Initially they may formulate a general categorization (such as negative, atypical, suspicious, positive), and ultimately they are expected to perform more independently and accurately. Resident diagnoses are compared to faculty diagnoses (agree/partially agree/disagree) and collated monthly. Senior resident diagnoses should correlate to a high degree with the final diagnosis. In order to properly formulate concise and accurate differential diagnoses, residents:
- Gather essential and accurate clinical information about the patients on whom they review cytopathology specimens.
- Discuss the history with clinical housestaff and/or attending physicians.
- Review reports/slides of previous pathologic specimens and correlate current results with previous specimens.
- Review the online medical record when applicable.
- Residents make informed decisions regarding diagnostic workup of cytology specimens:
- They consider the use of additional studies such as special stains and immunohistochemistry, HPV testing, flow cytometry, microbiological testing, and additional tissue sampling, based on patients’ clinical history, up-to-date scientific evidence gleaned from textbooks, journal articles, internet-based searches, and clinical judgment. More detailed understanding of these studies and their utility is expected with increased experience.
- Residents perform searches via available information technology (hospital and laboratory information systems, internet-based literature searches).
- To perform the workup and diagnosis of cytopathology patient specimens.
- To help educate clinicians by providing relevant literature references.
- Residents work with attendings to generate accurate and clinically useful cytopathology reports and may communicate results to clinicians if deemed appropriate by the attending. . .
- All residents should accompany cytotechnologists to FNAs in the radiology suite and physician office center and observe specimen collection, preparation, and interpretation. With increasing experience, residents may help prepare specimens, review the specimen after the cytotechnologist, and ultimately should be able to interpret FNAs. Senior level residents should also be responsible for timely and effective communication with radiologists, surgeons, endocrinologists, and other clinicians.
- Residents demonstrate competence in the performance of technical procedures considered essential for cytopathology practices. On each rotation, residents should observe, explain the principles, and utilize the variety of cytopathology preparatory techniques such as direct smears, thin-layer, and cell blocks. Residents should also be able to concisely and accurately state gross descriptions of cytopathology cases.
- Residents can independently perform FNAs on a variety of palpable locations, if the opportunity arises. Initially residents should observe FNAs being performed, then may perform a few obvious aspirates, and ultimately should be able to perform more difficult aspirates. All aspirates will be performed under supervision
- Rotation evaluation
- Statistical analysis of a resident portfolio of cases generated by COPATH with concordance of resident vs. attending pathology diagnoses and cases screened (this is reviewed with regard to PGY)
- Global evaluation
- 360o evaluation