MCW Pathology & Laboratory Medicine Residency Program - Surgical Pathology Curriculum and Rotations
Surgical pathology refers to the study of tissue samples obtained by various surgical means, including core needle biopsies, skin punch and shave biopsies, open biopsies, video-assisted and laparoscopic biopsies and surgical resection specimens.
Rotation Information
The proper handling, processing and evaluations of surgical samples constitutes the core of the activities rendered by the majority of pathologists in the United States. Our program utilizes a subspecialty-based system for the training of residents in the various sub-disciplines in surgical pathology. Duties in surgical pathology include learning to properly gross and describe specimens, microscopic interpretation and diagnosis, and reporting of findings and proper communication with the clinicians regarding the results. The residents acquire graduated responsibilities as they advance in seniority. A practical slide-based exam is given at the end of each block of rotations to assess the progress and identify areas of weakness.
Description
A two-year rotating lecture series in surgical pathology is given by the faculty. These didactic conferences are well-defined topics that cover the entire gamut of organ systems in surgical pathology. Such sessions take place at a multi-headed microscope or in the department conference room. The objective of this lecture series is to ensure that all residents in the program are exposed to classical examples of all the major entities and conditions in surgical pathology and have had the opportunity to review an actual glass slide of all such conditions by the time they complete their residency.
The department also houses a large teaching slide collection in the resident’s room that is categorized by organ-systems and contains a generous sampling of classical examples of common entities as well as examples of rare entities and unusual cases for the use of the residents. A multi-headed microscope with capacity for ten viewers and with a live video monitor is available in the resident’s room for group review of slides by the residents.
Facilities
The histology lab in surgical pathology counts with four (4) modern grossing stations equipped with automated voice-recognition dictation equipment, computer terminals and digital cameras for macrophotography.
Frozen sections are carried out in our new frozen section suite, which has state-of-the-art equipment, and is conveniently located next to the operating rooms (ORs) and rapid response lab. Communication with the ORs is done through a sophisticated two-way video conferencing system, which allows the pathologist to converse directly with the surgeon via a monitor and to display images from the microscope to explain any problem issues.
Specimen Grossing
All surgical pathology specimens are signed out with faculty. Independence is initially achieved in the gross evaluation of specimens and choice of sections to be submitted for histologic analysis.
Every other week residents are assigned to “grossing” (i.e., description, cutting, sampling) of specimens. Grossing of specimens is based on a “selective grossing” philosophy, whereby residents are assigned specimens based on their level of experience and skill, and the amount and complexity of specimens is gradually increased as the residents advance in their rotations. Residents are expected to have grossed a certain minimum number of cases for all major organ systems by the time they have completed their surgical pathology rotations.
The first year resident is initially guided in the gross evaluation of specimens by surgical pathology faculty, senior pathology residents, dedicated pathology assistants, and the online surgical pathology Grossing Manual, which provides detailed step-by-step instructions for the grossing of all specimens. As experience is gained, the resident is encouraged to complete the gross evaluation and tissue selection independently, with the surgical pathology staff providing a more general supervisory role.
After a specimen has been accessioned and subsequently “grossed” by a resident or pathologist assistant, the resident reviews the paperwork and slides and formulates a preliminary diagnosis, correlating the histologic features with the submitted clinical information, laboratory studies, radiology reports, and additional clinical information provided by the submitting physician and/or resident. This information is combined into a preliminary document that incorporates all relevant elements necessary for a comprehensive surgical pathology report. This preliminary report is then reviewed with the surgical pathology faculty.
Gradually, the resident is also expected to independently initiate the triaging of specimens for special studies (e.g. molecular studies, cytogenetics, electron microscopy, hormone receptor studies, flow cytometry, special stains, etc.) that complete the pathologic evaluation. The final reports are electronically signed out by the surgical pathology attendings, and copies are sent to attending physicians and medical records.
Frozen Sections
Intraoperative consultation by means of frozen section diagnosis is a critical and integral part of the role a pathologist plays in the health care team. Rotating in the frozen section suite is designed to provide the resident with ample exposure to the variety and different levels of complexity of specimens that are processed using this technique.
Residents in the first through fourth years of Anatomic Pathology training participate in intraoperative frozen section consultations. All frozen section intraoperative consultations are the primary responsibility of the frozen section (FS) resident. These are evaluated under the direct supervision of an attending surgical pathologist who is assigned to the Frozen service on a rotational basis. Frozen sections are done by residents in combination with activities during the Surgical Pathology block rotations and is also available as a separate one-block elective rotation.
When specimens arrive for frozen section, residents examine the tissue, perform touch preps if indicated, select tissue to freeze, and orient the specimen for sectioning. Residents review slides with the FS attending, providing relevant history and previous material when available. Residents are responsible for ensuring that all diagnoses are properly recorded and transmitted to the appropriate OR.
Rotations
The rotations in Surgical Pathology expose the resident to various organ systems and emphasize a broad exposure to the technical and basic interpretative aspects of surgical specimens.
Residents are responsible for each case assigned to them and, with supervision by a faculty member, initiate all studies necessary for the completion of a case, including utilization of all available ancillary studies, such as immunohistochemistry, electron microscopy and molecular techniques.
The ultimate goal for this area is to produce experienced, qualified Surgical Pathologists who will have a solid foundation on which to build their careers and who will appreciate the need for consultation.