Welcome to Anatomic Pathology. We hope to work with you to make the next 4 weeks an enjoyable and worthwhile part of your undergraduate medical education. This elective is tailored to best serve each student's individual goals. For instance, you may: be considering a career in pathology; desire a review of the pathology of human disease; or you may have chosen a residency already, and want to improve your understanding of the related pathology. You will meet with the clerkship supervisor on the first day to discuss your goals and determine an appropriate plan for your time here.
Although the types of specimens you see may vary, the following general objectives will apply to all students:
- You will learn why medical and surgical specimens are submitted for pathologic exam and (for selected specimens) identify what questions are to be resolved by the pathologic examination, devise a plan for answering these questions, carry out this plan, and communicate this information to the submitting clinician through the formulation of a final report.
- You will learn about basic and specialized ways of processing and examining tissues, when special examinations are useful or necessary, and about any specific procedures that must be followed in the collection or submission of a specimen if special examinations are anticipated.
- (For selected specimens) you will correlate clinical findings (symptoms, signs, course of disease, treatment) with gross and microscopic alterations in the affected tissue(s).
- You will learn the role of the pathologist as part of the patient care team.
- You will learn the importance of communication among all members of the patient care team in optimizing health care delivery.
- You will learn the various responsibilities of and contributions by all members of the patient care team in arriving at a diagnosis as promptly as possible.
- You will progress along a scale of graded responsibility, from close supervision at the beginning of the rotation to near independence at the end.
Responsibility for your education is shared among the resident with whom you are working (particularly for gross pathology), the attending staff (selection of appropriate cases, gross dissection of complex cases, microscopic interpretation and general concepts), and yourself (attendance, initiative, reading).
You will work closely with several pathology residents and attending staff during your elective and generally follow their schedule. On any given day, you will be assisting with dissecting specimens, reviewing biopsies, reviewing large cases, reading about your cases, and attending conferences. You will have an opportunity to see the busier services of GI, GYN, GU, ENT Pathology as well as other subspecialty areas (Pediatric, MSK, Cytopathology, Dermatopathology, and Neuropathology).
The residents work on one or two subspecialty services so you will get a concentrated exposure to those areas.
Specimens are dissected, processed, and reviewed every weekday. Because of technical considerations, each case may take several days. For any given patient case received in the surgical pathology gross room, there are a series of steps for examination and processing of the specimen:
- Specimens from operating rooms, procedure rooms, and clinics received, accessioned, described, and sections taken for microscopic examination. Includes OR consultations and frozen section diagnosis.
- Early morning: Slides for "early" cases (diagnostic biopsies, rapid turnaround time required) become available for review. Slides are put together with typed dictations.
- Afternoon/evening: Late case (large excisions) slides become available.
As cases are assigned to you by your resident, look at slides, do necessary reading, write microscopic description and preliminary diagnosis.
At pre-arranged time (between resident and attending) sign-out cases with attending staff. (i.e. sit at microscope with attending/resident to generate a pathology report). Each subspecialty service has its designated signout time. Please check with your assigned resident for the schedule.
- Daily Schedule - Responsibilities begin at 8:00 a.m. Expect to be here until 5-5:30 p.m. on sign-out days. You may need to be here later if you have many "late" cases, or earlier (7 a.m.) if there is a conference to attend. You will have no weekend, holiday or on-call duties (although if you are interested in observing a post-mortem examination these may be the best opportunities).
- Case Load - You will be responsible for 3-4 surgical specimens per day (this is roughly one-third the load of a pathology resident). Early on, the resident with whom you are working or one of the Pathology Assistants will do most of the gross cutting of your cases; you will do progressively more as you get more comfortable with grossing procedures. You will be expected to have reviewed your slides, done the appropriate reading, made some notes on the microscopic findings, and formulated a preliminary diagnosis by the time of sign-out.
Texts - Reference texts are available in the Pathology Library. There are both general Path textbooks and books in specific subspecialties, e.g. Liver Pathology. There are also clinical texts available and manuals to help with surgical dissection and staging of neoplasms.
Case Presentation - Each student will present at least one case at the Surgical Pathology Unknowns Conference before the completion of the rotation. Typically done during the last week. Conference is usually Tuesday at noon in C7702 (Path conf room).
Attendance - You may, if necessary, be excused for up to 3 days for illness or interviews. If you will need more time than this off, you may consider taking this elective on a not-for-credit basis.
- Conferences - Attendance is required at the Surgical Microscopic (Tuesday, noon) and Gross (Thursday, noon) conferences and at the special Tuesday 2 pm, special didactic microscope session for students provided by Susan Fluck, CT. You are welcome to attend any other conference of interest to you. You will be provided a copy of the week's conferences. (See Conference Schedule).
- Cytopathology - You should observe sign-out of cytologic specimens at least 3 times during this elective. This sign-out is in the afternoon, but check with the attending assigned to that day. Reading on the basics of cytologic interpretation (Keebler's Manual of Cytotechnology, available in Cytology Laboratory) would be useful preparation but is not required.
- Autopsy - If an autopsy become available, you would be free to observe this, as your schedule permits. Check with your resident.
- Clinical Pathology - Although this is an Anatomic Pathology rotation, we do encourage you to learn something about other areas in Pathology. You would have an opportunity to attend some conferences (Rounds at 11 am HG115) and visit the Clinical labs during your AP rotation. Again, check with your resident.
Some suggested sign-out times (may change on occasion) to guide your schedule:
|8:00 - 10:30||FNA immediate assessment (Mon. endoscopy clinic in UPC, Tues and Thur Rads Ground floor CT procedure suite)|
|11:00 - 12:00||Clinpath rounds - in CP residents room HG115 (ground floor in Clin Labs x5166)|
|10:30 - 12:00||Dermpath signout in C7714A|
|2:00 - 3:30||Hemepath signout - (6th floor hallway adjacent to LR D)|
|3:30 - 5:00||FNA/cytology signout in AP 7th floor C7635|
The clerkship supervisor will assign you a grade based on your overall performance, your case presentation, evaluation by the residents with whom you work, and input from other attending staff.
The evaluation is based on both
- Performance on rotation: numbers and complexity of cases, thoroughness of work-ups, quality of interactions with resident and attending
- Presentation: (content, level of difficulty, presentation style, ability to discuss)
Pass = doing the minimum
High Pass = more in-depth effort, doing the extra workups
Honors = working on the level of a junior Path resident (consider the student's year - i.e. MS III vs. MS IV)