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Molecular Pathology Training and Competencies

Anatomic and Clinical Pathology Residency Program

Goals

  • To understand the specimen requirements for molecular testing
  • To understand the clinical applications of molecular testing and the appropriate role of nucleic acid-base testing relative to other methodologies
  • To develop competency in test interpretation
  • To develop a familiarity with the principles and techniques used in the design and validation of molecular tests

Duties and Responsibilities

  • Residents are assigned to the molecular laboratory to actively participate in clinical interpretive services. The resident must respond in a prompt manner. This exposure will provide the direct clinical involvement with the patient that is required and aid the resident in the development of skills necessary for proficiency in proper patient management and problem solving ability
  • The resident participates throughout the year, in the completion of the clinical event form
  • The resident will make available to the section a beeper number and will be called as needed. The Medical Director must be notified of any coverage issues from the assigned schedule so that proper coverage is assured
  • The resident must participate in one research activity during each year. This activity can relate to method evaluation, basic research, or other task delegated and/or as approved by the Medical Director
  • Assessments will be a part of the overall evaluation of the resident and must be completed by the end of the rotation
  • Each resident must participate in the management and direction of the laboratory to include: inspections, safety, quality improvement, and data processing
  • Each resident must participate in the teaching activity as part as the Medical Technology program. The number and frequency of the lectures to be determined at the discretion of the Clinical Pathology Resident Coordinator
  • The resident is responsible for reviewing procedure manuals and all relevant literature regarding the test to be performed
  • The resident will observe and assist the technologist in the performance of the tests
  • The resident is responsible for the completion of the clinical event form when applicable

General Competencies

Purpose

To assure residents the continuum (in their molecular pathology rotation) in learning and evaluating their general competencies necessary to the level expected of a new practitioner as defined by ACGME requirements.

Definition

The trainer is defined as someone who has been specifically selected to perform the training. The trainer is the Attending Pathologist with the help of the Administrative, Technical Specialist, or Senior Technologist (Med Tech II). The trainer will ensure that the general competencies (as defined below) are covered and evaluated during the training period when applicable:

Patient Care: Working under the direction of the pathologist, the resident will be involved in the interpretation of tests, quality control, and process improvement to ensure the provision of patient-focused care. This includes: gathering essential and accurate clinical information when a testing pattern is in question.

  • The resident will utilize medical knowledge with the help of information technology to make informed decisions regarding outcomes, including recommendation for appropriate test follow-up in these cases.
  • The resident will interact with other healthcare professionals to provide compassionate, appropriate and effective patient care for each situation
Method of evaluation:
  • Informed decision-making — oral examination
  • Teamwork — questionnaire completed by superiors, peers, and subordinates
  • Performance of quality control and process improvement reviews — checklist

Medical Knowledge: The resident will be given a working background on critical steps of tasks assigned and be made aware of established procedures. Residents will be expected to demonstrate an investigatory approach and apply analytical thinking to the cases assigned to him.

Method of evaluation:
  • Investigatory and analytical thinking — standardized oral exam
  • Knowledge and application of basic sciences — standardized oral exam

Practice-Based Learning and Improvement: The resident will learn a systematic approach to the investigation and evaluation of clinically relevant testing and how to make appropriate decisions resulting in improved patient care. This means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Method of evaluation:
  • Analyze own practice for needed improvements — MCQ and review of portfolio with mentor
  • Use of evidence from scientific studies — multiple choice questions and
  • Application of research and statistical method — MCQ and global rating
  • Use of information technology — Global rating and portfolio review
  • Facilitates learning of other — Check list and questionnaire filled by superiors, peers, and subordinates

Interpersonal and Communication Skills: The resident will learn how to be effective when exchanging information with other healthcare professionals.

Method of evaluation: 
  • Listening and communications skills — questionnaire filled by superiors, peers, and subordinates

Professionalism: The resident will be expected to show a commitment to ethical principles when carrying out professional responsibilities. He/she will exhibit behavior appropriate to activities of the immunology section.

Method of evaluation:
  • Respectful, altruistic — questionnaire filled by superiors, peers, and subordinates
  • Ethically sound practice — questionnaire filled by superiors, peers, and subordinates

Systems-Based Practice: The resident will be aware of and responsive to the larger context and system of healthcare as it relates to the cases assigned to him.

Method of evaluation:
  • Understanding the interaction of their practice with the larger system — questionnaire filled by superiors, peers, and subordinates
  • Knowledge of practice and delivery system — MCQ
  • Practice cost-effective care — Check list
  • Advocates for the patient within the health system — questionnaire filled by superiors, peers, and subordinates

Curriculum

Molecular medicine is a young branch of medical science. Molecular biology-based investigations of the genome has generated multiple and profound applications to the diagnosis and management of disease. The challenge to the resident is to be able to increase his individual clinical expertise through the interaction with the workings of the section and at the same time gain an in-depth knowledge of the molecular biology sciences.

The following is a list of topics that the resident must understand in order to meet this challenge:

  • Basic Nucleic acid biochemistry
  • Specimen collection and storage
  • DNA quantification
  • Restriction endonuclease Digestion of DNA
  • Restriction Enzymes
  • DNA gel Electrophoresis
  • Blotting
  • DNA Hybridization
  • In vitro nuclei acid amplification
  • DNA sequencing
  • Mechanisms of inheritance
  • Genomic imprinting
  • Types of mutations
  • Current applications
    • Hematology-oncology
    • General oncology
    • Infectious diseases
    • Genetic diseases
    • Histocompatibility

Test methodologies

Infectious Disease:

  • Digene DNA hybrid captures assay
  • HIV PCR quantitative assays
  • Oncology
    • T/B gene rearrangement by PCR
  • Inherited disease
    • Factor V Leiden Mutation
    • Prothrombin gene mutation

Mode of Assessments

The resident will review all results and interpret all results prior to presentation to the pathologist for sign-out. The residents will be evaluated at the end of each monthly rotation as per protocol (see monthly evaluation forms). At the beginning and at the end of the required rotation there will be a "Board" style examination in the above molecular biology topics to enhance the educational experience and to contribution to the resident's portfolio.

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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