Cytology/Fine Needle Aspiration Competencies

Patient Care

Residents gather essential and accurate clinical information about the patients on whom they receive cytology specimens and fine needle aspirations. This will include review of chart, previous pathologic and cytologic specimens, radiologic reports and films. It also includes discussion with attending physician, radiologist performing the procedure and medical or surgical house staff.

Residents make informed decisions regarding diagnostic work up including: selection of specimen (smears) for special stains, immunostains, flow cytometry, and cell block (histology) material.

These decisions are based on the patient's clinical history, differential diagnosis established by the attending physician and the radiologist, knowledge derived from books, relevant and recent journals, Internet-based searches and consultation with attending pathologists.

Residents demonstrate competence in the performance of procedures considered essential for cytology and fine needle aspiration practices. These include:

  • Preparation of smears and fluid base specimens
  • Familiarity with hematoxylin, pap stain and Diff Quick stains
  • Preparation of material for flow cytometry
  • Preparation of material for cell block processing

Residents work with healthcare providers, including those from other disciplines (surgery, medicine, radiology, and ob-gyn) to provide patient-focused care. This may take the form of

  • Generation of accurate and clinically useful cytology reports
  • Report of rapid diagnosis in cases of rush fine needle aspirations
  • Communications to all physicians involved in the patient's care
  • Presentation of findings in different institutional tumor boards

Medical Knowledge

Residents demonstrate an investigatory and analytical thinking approach to clinical situations, including:

  • Development of reasonable and complete differential diagnosis for cytology and fine needle aspiration cases based on available clinical information, microscopic features, and current published information
  • As part of their work up of the cases they suggest appropriate additional testing (special stains, immunostains, flow cytometry), if applicable
  • Formulation of the above differential diagnosis in the final cytology report in a comprehensive, and coherent fashion
  • 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 cytology, including:

  • Demonstration of knowledge of epidemiology of various infectious and neoplastic diseases during discussion of cytology and fine needle aspiration cases, and use of such knowledge to formulate cytologic diagnoses
  • Demonstration of familiarity with the clinical and radiologic manifestations of various diseases during workup of cytology and fine needle aspiration cases, and use of such knowledge to formulate cytologic diagnoses
  • Demonstration of familiarity with basic histochemical and immunologic stains as well as principles of flow cytometry and electron microscopy

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 audits, including review of cytology reports and slides; evaluating reports for diagnostic and typographical errors, assessing the slide quality of slides 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, rush diagnosis discrepancies, cyto-histopathologic correlation and in-house and extradepartmental consultations)

Residents are able to duplicate practice experience and develop diagnostic skills and communication skills with attending pathologist, cytotechnologists, and clinicians, including:

  • Review of interesting cytology cases, some with tissue correlation, in a weekly basis, with further review with pathologist and cytotechnologists
  • Signing out with pathologists in a daily basis
  • Screening of new cases with subsequent review with technical specialist
  • Participation in fine needle aspirations performed in the clinical and the radiology department

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
    ii. Design of their own research studies 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 history and previous pathology information via the hospital's Laboratory Information System (LIS)
    • Performance of Medicine computer searches
    • Maintaining of their own case volume statistics for cytology and fine needle aspirations
    • Accessing web sites pertaining to specific cytologic diagnoses (grading systems for tumors, etc)

Residents actively participate in the teaching of medical students, med tech students, and other healthcare professionals rotating through the cytology section, including:

  • Teaching them during formal rotation through the section
  • Delivering formal lectures
  • Participating in interdepartmental meetings (presentation in Morning Medical Rounds and different tumor boards)

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 the performance or assistance of fine needle aspirations and during sign-out of cases
  • Demonstrating interest in cytology material case during sign-out, by asking relevant questions and responding appropriately to questions from attending pathologists
  • Obtaining relevant clinical information from and providing preliminary diagnostic
    information to clinicians via telephone or in trips to the Radiology Department during the performance or assistance of fine needle aspirations
  • Effectively prepare and deliver cytology case presentations to various intra and extradepartmental audiences
  • During senior years of residence training, serve as an effective teacher for the junior pathology house staff during their cytology rotations
  • Demonstrating effective oral and written communication skills in the presentation and/or publication of cytology material

Residents should work effectively with others as members or leaders of a healthcare team or other professional group, including:

  • Preparation and presentation of cytology material to the morning medical rounds and different tumor boards
  • Participation with other members of the Dept. of Pathology and Laboratory Medicine and other departments on various hospital committees
  • Participation in all Cytology Section meetings, interacting with Technical Specialist, Cytotechnologists, and Technicians
  • Participation in departmental safety inspections coordinated with Section Director, Technical Specialist, and safety officer

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

  • Showing respect, compassion, and integrity to patients undergoing fine needle aspirations
  • Showing responsiveness and accountability to the needs of patients, their families, and the clinicians that supersedes self interest, including a professional attitude while performing or assisting fine needle aspirations, respecting patient confidentiality at all moments and rendering a timely report and discussion with the clinician
  • Demonstrating a commitment to excellence and ongoing professional development, such as completing directed and independent reading from cytology textbooks and journals, undertaking literature searches on various cytopathology topics, attending in-house and off-site pathology lectures and conference, and designing and completing at least one research project per year
  • Demonstrating a commitment to ethical principles pertaining to confidentiality of patient information acquired during the performance or assistance to fine needle aspirations
  • Demonstrating commitment to ethical principles pertaining to business practices, including helping to ensure accurate billing for all technical and professional procedures incurred during the performance or assistance to fine needle aspirations

Systems-Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effective call on system resources to provide care that is of optimal value. This includes:

  • Understanding how their handling of cytology and fine needle aspiration material 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 cytology reports, timely communication of results to clinicians to expedite implementation of adequate therapy or discharge from hospital, and establishing accurate diagnoses epidemiologically important infectious diseases
  • Understanding the clinical value and social impact of new cytologic techniques (i.e., fluid-based specimens, digene, and new automated screening techniques) and the importance of applying them toward delivery of better patient care
  • Knowing the difference 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 cytology
  • Demonstrating knowledge of methods for controlling healt care costs and allocation of resources, including understanding the hospital capital budget process as it pertains to the laboratory, and understanding monthly cytology budget reports
  • Practicing cost-effective healthcare and resource allocation that does not compromise the quality of care, including judicious, cost-conscious ordering of cytology special stains and ancillary lab tests during the performance of fine needle aspirations
  • Demonstrating knowledge of how to prepare 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 Assurance Committee meetings, attendance at various weekly interdisciplinary tumor boards, and attendance at hospital administrative lectures

Assessment of ACGME Competencies: Cytology/Fine Needle Aspiration

Patient Care

Method of assessment: Checklist evaluation 
1 2 3 4 5

  • Appropriate and accurate clinical information about patient, including previous pathology and radiology reports
  • Appropriate decision regarding all diagnostic work up: Selection of smears, order of special stains and preparation of material for immunologic studies, flow cytometry and cell block preparation
  • Preliminary diagnosis in cases of rush specimens (fna or otherwise) and discussion with the attending pathologist
    Communications of results to the attending physicians involved in the case
  • Generation of an accurate and clinically useful final cytology report
  • Presentation of cytologic diagnosis in different tumor boards and inter and intradepartmental conferences with review of the pertinent literature

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

I. Patient Care Competency

Method of assessment: 360 degrees global rating.
1 2 3 4 5

  • Communications 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 situations
  • Organizational skills
  • Promptness

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

II. Medical Knowledge Competency

Analytical thinking and application of medical knowledge to arrive to a final diagnosis or meaningful differential diagnosis.

Method of assessment:
Review of 10 unknown cytology cases: 4 GYN, 3 NON GYN and 3 FNAs.

Available material: Relevant clinical information, previous cytologic and pathologic diagnoses and clinical impression from the submitting physician.
Case 1 2 3 4 5 6 7 8 9 10

Scoring for each case:
1 = Incorrect diagnosis (benign vs malignant)
2 = Partially correct diagnosis (atypical vs malignant
3 = Acceptable diagnosis (suspicious vs malignant)
4 = Correct diagnosis (benign or malignant)
Best possible score: 40 Resident's score: _____ = %______

Method of assessment: Written examinations
Two cytology examinations including glass slides, kodachromes and digital images with 50 multiple choice questions each. One with only gyn material and the other with non gyn and fna material.

Method of assessment: Review of Performance Improvement Programs (CAP) of GYN and NON GYN sets (4 sets of each annually), with individual evaluation of diagnoses rendered.
Method of assessment: Screening of unknown GYN cases (2 daily) to be reviewed by cytotechs or pathologist.

Method of assessment: Daily sign out with pathologist during the rotation.
Method of assessment: Performance of touch prints during frozen section and evaluation of cytologic diagnosis against tissue diagnosis.

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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