Autopsy and Surgical Pathology Competencies

Anatomic and Clinical Pathology Residency Program

I. Patient Care

  • Residents gather essential and accurate clinical information about the patients on whom they perform autopsies, including discussion of history with clinical housestaff and/or attendings, detailed hospital chart review, and preparation of autopsy clinical summaries as part of the final autopsy report
  • Residents gather essential and accurate clinical information about the patients on whom they receive surgical specimens, including discussion of history with clinical housestaff and/or attendings, preview of O.R. schedules and reports/slides of previous pathologic specimens, and review of hospital charts and radiologic reports/films when applicable
  • Residents make informed decisions regarding diagnostic workup of autopsy and surgical specimens (special stains, deeper sections, electron microscopy, etc.) based on patients’ clinical history, up-to-date scientific evidence gleaned from textbooks, journal articles, internet-based searches, and clinical judgment
  • Residents use available information technology (hospital and laboratory information systems, Internet-based MEDLINE searches) to support workup and diagnosis of autopsy and surgical pathology patient specimens, and to help educate clinicians by providing relevant literature references
  • Residents demonstrate competence in the performance of procedures considered essential for autopsy and surgical pathology practices, including:
    • Autopsy evisceration and dissection
    • Intraoperative surgical pathology consultation (proper inking, sectioning/dissection, frozen section slide preparation)
    • Dissection and description of surgical pathology specimens
  • Residents work with healthcare providers, including those from other disciplines to provide patient-focused care. This may take the form of:
    • Generation of accurate and clinically useful autopsy and surgical pathology reports and effective communication of results to clinicians
    • Preparation and presentation of joint Medical Mortality Autopsy Conferences with Dept. of Medicine housestaff
    • Active participation in intraoperative consultations, including timely communication of results to surgeons

II. Medical Knowledge

  • Residents demonstrate an investigatory and analytical thinking approach to clinical situations, including:
    • Development of reasonable and complete differential diagnoses for autopsy and surgical pathology cases based on the available clinical information, gross and microscopic features, and current published information
    • As part of their workup of cases, they suggest appropriate additional testing (special stains, electron microscopy, and further clinical testing such as serology, etc.) if applicable
    • Formulation in a comprehensive, cohesive, and coherent fashion the above differential diagnoses and discussion of pathologic findings in the final pathology report
    • Design and carry out at least one research project per academic year, such as clinicopathologic studies, or case reports with literature review
  • Residents know and apply the basic and clinically supportive sciences which are appropriate to the specialty of anatomic pathology, including:
    • Demonstration of knowledge of epidemiology of various infections and neoplastic diseases during discussion of autopsy and surgical pathology cases, and use of such knowledge to formulate pathologic diagnoses
    • Demonstration of familiarity with the clinical presentations and manifestations of various diseases during discussion and workup of autopsy and surgical pathology cases, and use of such knowledge to formulate pathologic diagnoses
    • Demonstration of familiarity with basic histochemical and immunologic stains, including biochemical and immunologic principles, methods, and applications
    • Demonstration of detailed knowledge of human anatomy during dissection and description of autopsy and surgical pathology cases

III. Practice-based Learning and Improvement

  • Residents show the ability to analyze practice experience and perform practice-based improvement activities using a systematic methodology, including:
    • Active participation in weekly surgical pathology case audit, including retrospective review of surgical case reports and slides; evaluating reports for diagnostic and typographical errors, assessing for suboptimal slide quality, and observation of various trends with regard to Quality Improvement monitors
    • As senior residents, actively participate in bimonthly Anatomic Pathology Quality Assurance Committee meetings, learning how to identify and report on a variety of QA monitors (case turnaround time, frozen section discrepancies/deferrals, histology quality monitors, in-house and extradepartmental consultation discrepancies, cytohistologic correlation, etc.)
  • Residents show ability to locate, appraise, and assimilate evidence from scientific studies related to patients’ healthcare problems, including:
    • Use of literature search and review to find relevant scientific references to aid in the workup of autopsy and surgical pathology cases (Index Medicus, Medline computer-based searches).
    • Obtain and use information about their patient population (via SNOMED computer searches and medical records chart review) for clinicopathologic study of selected diseases
  • Residents are able to apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness, including:
    • Active participation in weekly journal club with critical discussion of study designs and statistical methods of presented articles
    • Design their own research studies (clinicopathologic reviews, etc.), as part of their annual requirement for a research project
  • Residents demonstrate competency in the use of information technology to manage information, access on-line medical information, and support their own education, including:
    • Accessing of patient clinical information and previous pathology accessions via the hospital’s Laboratory Information System
    • Performance of Medline computer searches
    • Maintainance of their own case volume statistics for autopsy and surgical pathology
    • Show competence in the use of computer voice-activated transcription technology and digital imaging technology
    • Accessing web sites pertaining to specific pathologic diagnoses (grading systems for tumors, etc.)
  • Residents actively participate in the teaching of medical students and other healthcare professionals rotating through the anatomic pathology section, including:
    • Teaching students and residents from other disciplines during autopsy performance
    • Teaching students and residents from other disciplines during surgical specimen gross description and dissection

IV. Interpersonal and Communication Skills

  • Residents demonstrate effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. This includes:
    • Following instructions from attending pathologists during performance of intraoperative consultations, autopsy and surgical specimen dissection and gross description, and during sign-out of cases
    • Demonstrating interest in pathology case material during case sign-out by asking relevant questions, and responding articulately to questions from attending pathologists
    • Eliciting relevant clinical information from and providing preliminary diagnostic information to clinicians via telephone conversations or trips to the operating room for intraoperative consultations
    • Generating concise, accurate, and complete dictated gross descriptions and written microscopic description/diagnoses of autopsy and surgical cases in preparation for case sign out with attending pathologists
    • Effectively prepare and deliver oral autopsy and surgical pathology case presentations to various intra- and extradepartmental audiences
    • During senior years of residency training, serve as an effective teacher for the junior pathology housestaff during their autopsy and surgical pathology rotations
    • Demonstrating effective oral and written communication skills in the presentation (and/or publication) of autopsy or surgical case reports and research projects
  • Residents should work effectively with others as a member or leader of the healthcare team or other professional group, including:
    • Preparation and presentation of autopsy cases with medical residents during weekly Medical Mortality conferences
    • Participation with other members of the Department of Pathology and other departments on various hospital committees

V. Professionalism

  • Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population, including:
    • Showing respect, compassion, and integrity during performance of autopsies on patients, including gentle, respectful handling of the body and maintenance of modesty for the deceased
    • Showing responsiveness and accountability to the needs of patients and their families and clinicians that supersedes self-interest, including contribution to the timely completion of autopsy and surgical pathology reports, and discussion of results with clinicians
    • Demonstrating commitment to excellence and ongoing professional development, such as completing directed and independent reading from pathology textbooks and journal articles during anatomic pathology rotations, designing and completing at least one research project per year, undertaking literature searches on various pathology topics, and attending in-house and off-site pathology lectures and conferences
    • Demonstrating a commitment to ethical principles pertaining to confidentiality of patient information acquired during handling of autopsy and surgical pathology cases
    • Demonstrating commitment to ethical principles pertaining to business practices, including helping to ensure accurate billing for histology technical procedures incurred during specimen gross description and slide preparation

VI. Systems-based Practice

  • Residents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. This includes:
    • Understanding how their handling of autopsy and surgical specimens affects other healthcare professionals, the healthcare organization and the larger society, including making accurate diagnoses with efficient use of routine and special stains and other testing, achieving rapid turnaround time for pathology reports, timely communication of results to clinicians in order to expedite patient discharge from the hospital, and establishing accurate diagnoses of epidemiologically important infectious diseases or genetic diseases
    • Knowing the differences between various medical practice and healthcare delivery systems (fee-for-service, discounted fee-for-service, capitated systems, etc.), and how they affect the practice of anatomic pathology
    • Demonstrating knowledge of methods for controlling healthcare costs and allocation of resources, including understanding the hospital capital budget process as it pertains to the laboratory, and understanding of monthly anatomic pathology budget reports
    • Practicing cost-effective healthcare and resource allocation that does not compromise equality of care, including judicious, cost-conscious ordering of histology special stains and ancillary lab studies for autopsy and surgical pathology cases
    • Demonstrating knowledge of how to partner with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare, and knowledge of how these activities can affect system performance. This includes participation of senior pathology residents at the bimonthly Anatomic Pathology Quality Assessment/Improvement Committee meetings, attendance at various weekly interdisciplinary tumor boards, and attendance at hospital administrative lecture series

Autopsy and Surgical Pathology Competencies Assessment Tools

Name of Resident: _________________
Date of Evaluation:________

I. Patient Care

Method of assessment: Checklist evaluation
Frequency: Every three months 1 2 3 4 5

Autopsy Pathology

  • Detailed clinical chart review, preparation of thorough, accurate clinical summaries
  • Proper autopsy evisceration, dissection, and demonstration of normal anatomy
  • Submission of sections for histology
  • Microscopic description
  • Gross and microscopic diagnoses
  • Ordering recuts, special stains, additional sections, if necessary for diagnosis
  • Formulation of accurate, clinically useful autopsy reports, including final summary of case
  • Effective communication of autopsy results to clinicians
  • Preparation of high-quality gross and microscopic kodachromes for conferences
  • Preparation and presentation of cases for Medical Mortality conference.
  • Proper use of available information technology to support workup and diagnoses of cases

Key of Rating Scale
1 = never performs satisfactorily
2 = almost never performs satisfactorily
3 = sometimes performs satisfactorily
4 = performs satisfactorily most of the time
5 = always performs satisfactorily

Surgical Pathology

1 2 3 4 5

  • Gathers essential and accurate clinical information for patients
  • Consistent preview of O.R. schedule and reports/slides of prior pathology specimens, relevant x-ray reports
  • Proper dissection and gross description of surgical specimens, demonstration of normal anatomy
  • Dictation of gross descriptions using voice-activated transcription software
  • Submission of histologic sections, generation of key of sections in path reports
  • Proper workup of surgical pathology cases based on independent review of microscopic slides, including recommending additional sections, recuts, special stains, and generating differential diagnoses
  • Generation of concise, accurate, and clinically useful microscopic descriptions, when indicated
  • Generation of accurate diagnoses or differential diagnoses based on independent review of cases
  • Effective communication of preliminary results to clinicians, and obtaining clinical information when indicated
  • Preparation of high-quality gross and microscopic photos for potential conferences, when indicated
  • Proper use of available information technology to support workup and diagnoses of cases (medline searches, etc.)
  • Active participation in intraoperative consultations, including orientation and inking, sectioning, frozen section slide separation, generation of diagnoses, and timely communication of results to surgeon

Key of Rating Scale
1 = never performs satisfactorily
2 = almost never performs satisfactorily
3 = sometimes performs satisfactorily
4 = almost always performs satisfactorily
5 = always performs satisfactorily

Method of assessment: 360 degree global rating
Frequency: Every six months

Autopsy and Surgical Pathology

1 2 3 4 5

  • Communication with other staff
  • Ability to relate to other staff
  • Respectful towards others
  • Works well as member of healthcare team
  • Ability to learn
  • Attempts to improve
  • Initiative
  • Quality of work
  • Interest/enthusiasm for work
  • Industriousness
  • Resourcefulness
  • Judgment
  • Ability to handle stressful conditions
  • Organizational skills
  • Promptness

Key of Rating Scale
1 = never 2 = almost never 3 = sometimes 4 = almost always 5 = always

II. Medical Knowledge Competency

A. Investigatory and analytic thinking

Method of Assessment: Oral examination (4 unknown autopsy cases, 6 unknown surgical pathology cases)
Frequency: One exam per year
Case # A1 A2 A3 A4 S1 S2 S3 S4 S5 S6

  • Based on available clinical information, stated gross findings, and review of microscopic slides
  • Generate concise, accurate oral microscopic description
  • Generate accurate, comprehensive diagnosis or differential diagnosis
  • Generate appropriate case workup based on differential diagnosis, incl. special stains, recuts, other clinical or pathologic studies, if applicable

Scoring for Each Case
1 = incorrect
2 = only partially correct/complete (~25%)
3 = approximately 50% correct/complete
4 = mostly correct/complete (~75%)
5 = completely correct
Total possible score: 150 Resident’s score: ___ = ___ %
Date of Exam: ___________

B. Knowledge and application of basic sciences

Method of assessment: Written examinations

  • Normal Histology exam: 100 questions based on Kodachrome slides, administered 3 months after start of PGY1 year.
    Date of Exam: _____ Score (out of 100%) ____
  • Surgical Pathology exam: 100 questions based on glass slides, administered over the period of one year (every year).
    Date of Exam: _____ Score (out of 100%) ____
  • Surgical Pathology exam: 100 questions based on digital images, administered over the period of one year (every year).
    Date of Exam: _____ Score (out of 100%) ____
  • Immunohistochemistry exam: 50 questions based on Kodachrome slides, administered over the period of one year (every year).
    Date of Exam: _____ Score (out of 100%) ____

III. Practice-based Learning and Improvement Competency

Method of assessment: Portfolio
(To be completed over the course of the two years of AP training)

A. Analyze own practice experience and perform performance improvement activities using a systematic methodology

  • Generate a log of cases which the resident personally reviewed in the weekly surgical pathology audit during the evaluation period, including retrospective review of surgical case reports and slides, evaluation of reports for errors, and assessment of slide quality
    Date of satisfactory completion: __________
  • Generate a log of cases reviewed in the monthly frozen section case conference (review of frozen section slides, frozen section diagnosis, permanent section slides, and final diagnosis)
    Date of satisfactory completion: __________
  • Prepare a written summary of quality assurance trends in Anatomic Pathology for at least two different volume or quality monitors contained within a selected bimonthly departmental QA report
    Date of satisfactory completion: __________

B. Use of evidence from scientific studies

  • Select two recent cases (one autopsy, one surgical) with an unusual pathologic diagnosis, and perform and document a medline literature search of these topics; include relevant scientific references
    Date of satisfactory completion: ___________
  • Select one surgical pathology diagnosis and perform a SNOMED computer search using the laboratory’s CERNER lab information system for a selected patient population over a preselected time interval
    Date of satisfactory completion: ____________

C. Application of research and statistical methods

  • Copy at least two peer-generated conference summaries of the resident’s own journal club presentations (includes conference attendance, presented journal articles, critique of presentations)
    Date of satisfactory completion: ____________
  • Copy all abstracts and publications of research studies that the resident designed, executed, wrote up, and/or presented; include annual hospital research day projects
    Date of satisfactory completion: ____________

D. Use of information technology

  • Select two recent surgical pathology cases, and perform and print previous diagnosis inquiries for those patients using the lab information system
    Date of satisfactory completion: _____________
  • Maintain up-to-date autopsy and surgical pathology case volume logs for resident’s own cases.
    Date of satisfactory completion: ______________
  • Access at least one web-site pertaining to a specific pathologic diagnosis (e.g., grading of prostatic carcinomas), and document printout
    Date of satisfactory completion: _______________
  • Print out at least two gross descriptions of surgical pathology cases that the resident has dictated using voice-activated transcription software
    Date of satisfactory completion: ________________
  • Generate high-quality digital images of five different cases using current software, and print out hard copies of images with figure captions
    Date of satisfactory completion: _________________

E. Facilitate learning of others

Method of evaluation: Checklist Frequency: every six months
1 2 3 4 5

  • Teaching medical students and/or non-pathology residents during autopsy performance
  • Teaching medical students and/or non-pathology residents during review of autopsy microscopic sections
  • Teaching during autopsy M & M conference
  • Teaching during gross description/dissection of surgical specimens
  • Teaching medical technology students during presentation of Check Samples

Key of Rating Scale
1 = never 2 = almost never 3 = sometimes 4 = almost always 5 = always

IV. Interpersonal and Communication Skills Competency

Method of assessment: Checklist evaluation
Frequency: every year
1 2 3 4 5

  • Follows instructions
  • Demonstrates interest and asks relevant questions
  • Communication with clinicians
  • Effective written communication
  • Effective oral case presentation
  • Effective teaching
  • Works effectively with others as a member of the healthcare team

V. Professionalism Competency

Method of assessment: 360 degree global rating
Frequency: every 6 months
1 2 3 4 5

  • Respectful to patients during performance of autopsy and handling of surgical specimens
  • Responsive and accountable to needs of patients, families, and clinicians by timely completion of pathology reports
  • Committed to excellence and ongoing professional development:
  • Independent reading
  • Design and completion of research
  • Conducts literature searches
  • Lecture/conference attendance
  • Committed to ethical principles:
  • Maintains patient confidentiality
  • Helps to ensure accurate billing for technical procedures

Key of Rating Scale
1 = never 2 = almost never 3 = sometimes 4 = almost always 5 = always

VI. Systems-based Practice Competency

Method of assessment: Checklist evaluation
Frequency: every 6 months

A. Understands interaction of practice with the larger system
1 2 3 4 5

  • Makes accurate autopsy and surgical pathology diagnoses
  • Contributes to rapid turnaround time of reports
  • Understands impact of diagnosing epidemiologically
  • important infections and genetic diseases

B. Knowledge of methods for controlling health care costs and allocation of resources.
1 2 3 4 5

  • Practices cost-effective pathology (judicious ordering of special studies, stains, etc.)
  • Understands the hospital capital budget process as it pertains to the anatomic pathology lab
  • Understands monthly anatomic pathology budget reports
  • Attends and participates in monthly histology operational meetings

C. Knowledge of how to partner with health care managers and providers to assess, coordinate, and improve healthcare
1 2 3 4 5

  • Participates in bimonthly anatomic pathology quality assurance committee meetings
  • Attends various multidisciplinary tumor boards
  • Attends hospital administrative lecture series

Key of Rating Scale
1 = never 2 = almost never 3 = sometimes 4 = almost always 5 = always

Method of assessment: Portfolio (to be completed over course of two-year AP training period)

D. Knowledge of practice and delivery systems.

  • Provide in writing examples of various medical practice and healthcare delivery systems and discuss how each affects the practice of anatomic pathology. Include:
  • Fee-for-service
  • Discounted fee-for-service
  • Capitated system

Date of satisfactory completion: ____________

For More Information

Please contact us if you have questions about the Anatomic and Clinical Pathology Residency Program at Danbury Hospital, or would like more information.




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