Anatomic Pathology Program

Neuropathology Elective

 

Rotation Director:
Charles S. Specht, MD
 

This rotation is designed to provide an in-depth exposure to the pathology of central nervous system (CNS) and neuromuscular diseases. It utilizes a teaching set, active in-house cases, conferences, and reading materials to build the resident's familiarity with this group of diseases.
 

Goals and Objectives:

Patient Care:

Residents must demonstrate a satisfactory level of diagnostic accuracy and the ability to provide appropriate and effective consultation about the pathology of CNS and neuromuscular diseases. Residents are expected to:

  • Recognize and correctly interpret the pathology of common CNS and neuromuscular diseases, including neoplastic and non-neoplastic disorders of the CNS; neurogenic and non-neurogenic disorders of muscle; and lesions of peripheral nerve. As the resident progresses, greater attention will be given to the differential diagnosis of more unusual processes, including less common CNS tumors and interpretation of complex muscle biopsies.
  • Formulate appropriate differential diagnoses based on the histologic findings.
  • Correlate pathologic lesions with clinical and radiographic findings.
  • Appropriately use immunohistochemistry, enzyme histochemistry, electron microscopy and molecular testing for evaluation of CNS and neuromuscular diseases.

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to neuropathology. Residents are expected to:

  • Develop knowledge of the spectrum of neoplastic and non-neoplastic CNS and neuromuscular diseases through reading of textbooks and primary literature
  • Identify specific morphologic changes in tissues, and their significance
  • Understand the relationships between anatomic pathology findings, pathophysiology, patient signs and symptoms, and effects of therapies
  • Understand the utilization of ancillary diagnostic testing ( immunohistochemical and special stains, electron microscopy, molecular testing) in evaluation of CNS and neuromuscular diseases

Practice-based Learning and Improvement:

Residents must be able to demonstrate the ability to evaluate and improve their clinical practices based on new and evolving scientific evidence. Residents are expected to:

  • Apply current medical knowledge and recent literature to current cases
  • Utilize library, web-based, and other educational sources to evaluate cases
  • Prepare clinical cases in an optimal timeframe
  • Utilize performance evaluations to improve practice
  • Acquire skills to engage in "lifelong" learning through appraisal and assimilation of scientific studies related to specific neuropathology problems
  • Facilitate learning of medical students, residents and fellows, and other health care professionals

Systems-based Practice:

Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide optimal pathology services. Residents are expected to:

  • Become involved with management issues related to neuropathology and their effects on other health care professionals, organizations, and society
  • Consider cost-effectiveness in their practice of neuropathology without compromising patient care
  • Understand the pathologist's role and professional practices in relation to other health care professionals
  • Demonstrate ability to access and utilize the resources, providers, and systems necessary to provide optimal care
  • Advocate for quality patient care

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and learning with other health care providers, patients, and patients' families. Residents are expected to:

  • Exhibit effective listening skills and the ability to follow standard operating procedures and verbal instructions
  • Interact with departmental and extradepartmental personnel, including healthcare professionals, administrators, and other staff in an appropriate manner
  • Provide effective and professional consultation to other health care professionals demonstrating care and respect for them, and sustain ethically sound professional relationships with colleagues, staff, patients, and patients' families
  • Present neuropathology material at a conference in an organized, coherent fashion, with well-constructed audiovisual materials
  • Provide accurate communication of pathology information using non-verbal and verbal skills
  • Work effectively as a team with other health care professionals and other staff

Professionalism:

Residents must demonstrate a commitment to fulfilling professional responsibilities and ethical principles and sensitivity to a diverse patient population. Residents are expected to:

  • Demonstrate commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices
  • Demonstrate respect, compassion and integrity in all interactions with patients, their families, faculty, other trainees, technologists, and other staff
  • Demonstrate sensitivity and responsiveness to the ethnicity, diversity, age, gender, sexual orientation, and disabilities of patients, colleagues, and staff
  • Attend all required conferences and actively participate in them to enhance individual and group learning
  • Demonstrate a commitment to excellence and on-going professional development
  • Demonstrate adherence to guidelines and regulations set forth by regulatory and accrediting agencies
  • Demonstrate ability to identify deficiencies in peer performance


Requirements:

  • Level of training: PGY-3 or 4 year, after the resident has gained a grounding in surgical and autopsy pathology


Duration and Timing of the Rotation:

  • 2-8 weeks, depending upon the interests of the resident
  • Resident should contact Dr. Specht regarding timing of the rotation during the year
  • This rotation can be scheduled concurrently with another elective, if desired by the resident. Scheduling of the two rotations should be arranged with the two rotation directors before the start of the rotations.


Teaching Staff:

  • Charles S. Specht, MD
  • Jennifer W. Baccon, MD, PhD


Components:

1.  Background reading (covered independently by resident)

  • Required reading material
    • Gray, De Girolami, and Poirier. Escourolle and Poirier's Manual of Basic Neuropathology, 4th edition. OR
    • Prayson RA. Neuropathology. A volume in the series: Goldblum JR, ed. Foundations in Diagnostic Pathology.
  • Reference Texts:
    • Ellison and Love. Neuropathology, 2nd edition
    • Dubowitz. Muscle Biopsy, 3rd edition
    • Carpenter and Karpati. Pathology of Skeletal Muscle, 2nd edition
    • WHO Classification. Tumors of the Central Nervous System, 2007

2.  Review of CNS pathology teaching set slides

  • This rotation utilizes an extensive collection of teaching cases to provide the resident with an in-depth exposure to the pathology of CNS diseases.
  • In meetings with the faculty, teaching set slides selected by the resident will be reviewed together and discussed to highlight important features and differential diagnoses.

3.  In-house cases

  • Active neuropathology cases will be reviewed independently and then with the faculty member on service.

4.  Conferences

  • The resident will attend all neuropathology conferences during this rotation. These include clinicopathological conferences and didactic lectures provided by the neuropathology service to residents from the anatomic pathology, neurology, and neurosurgery residencies, as well as the adult and pediatric CNS tumor boards.
  • The resident will present a selected case at the Division of Anatomic Pathology Surgical Pathology Conference. Slides to be presented will be reviewed prior to the conference with a faculty member.

5.  Research or educational project (optional)

  • If desired, the resident can work on a small research or educational project.


Method(s) of Evaluation:

  • The resident will be evaluated at the end of the rotation using New Innovations. The evaluations will be based on the resident's daily performance including diagnostic accuracy, and oral "quizzes" throughout the rotation. Performance on the rotation components will be assessed. The resident should choose at least 1 area of concentration within neuropathology to focus on (review of teaching set cases and reading about the entities) each week, and should be able to formulate appropriate differential diagnoses in >90% of cases in this area.
  • Residents will be expected to evaluate faculty and the rotation using New Innovations. These evaluations will be collated and reviewed by the program director and chair and the results will be reported yearly to each faculty member and submitted for review to the Residency Program Committee for feedback.
  • Residents will be evaluated based on direct observation by faculty.
     

Updated:  6/2011 CSS