Pathology

Course #: 885J

Title:  Hematopathology/Flow Cytometry/Cytogenetics and Molecular Pathology

Selective Director(s):  John Lazarchick, M.D., Sally Self, M.D., Daynna Wolff, M.D., and Denise Quigley, M.D.

Maximum Number of students per block: 1

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Learn to use a multidisciplinary approach to the diagnosis of hematologic malignancies utilizing morphology, immunophenotyping, cytogenetics and molecular analysis including Fluorescent In-Situ Hybridization (FISH) and Polymerase Chain Reaction (PCR)
2. Distinguish between acute and chronic leukemias and determine cell lineage and any associated chromosomal abnormalities based on morphology, immunophenotyping and genetic analyses.
3. Distinguish between benign and malignant plasma cell hyperplasias utilizing clinical correlation, classical immunoelectrophoresis and immunofixation techniques in chemistry, bone marrow analysis and cytogenetics.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Analysis of CBC data, peripheral smear interpretation and examination of bone marrow aspirate and biopsy material and the correlation of such with the patient’s clinical history and ancillary laboratory data.
2. Review of principles of flow cytometry to immunophenotype hematopoietic cells and to become familiar with lineage-specific CD markers to distinguish myeloid, lymphoid, erythroid and megakaryocytic markers. Results on patients will be reviewed with the student by the attending physician and resident staff on service.
3. Review of methodology involved with karyotyping marrow or node hematopoietic cells and review of patient results with the attending staff and laboratory supervisor.4. Review of the principles involved in FISH analysis and PCR to analyze for specific chromosomal abnormalities associated with acute and chronic leukemia of myeloid or lymphoid origin and lymphomas. The attending staff and laboratory personnel will review all pertinent cases with the student.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. Observe and/or participate in obtaining at least one bone marrow aspirate/biopsy on a patient who is suspected or known to have a hematologic malignancy.
2. Present clinical history, physical findings, ancillary laboratory data, morphologic assessment, flow cytometric interpretation, cytogentic analysis and molecular study results on a patient with either a myeloproliferative or myelodysplastic disorder.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Observation of clinical skills and knowledge on the Hematopathology rotation by the attending.
2. Observation of clinical skills and knowledge on the Flow cytometry rotation by the attending.
3. Observation of clinical skills and knowledge on the Cytogenetics/Molecular Pathology rotation by the attendings.

Please outline when and how the learners will receive feedback on their performance:
The student will be working closely with the faculty members participating in this elective and will receive daily feedback from them. A formal 30-60 minute review will be held at the end of each week of the three week rotation with the primary faculty member responsible for that week.

Course #: 886J

Title:  Surgical and Cytopathology

Selective Director(s):  David Lewin, M.D., Mary Richardson, M.D., and Rana Hoda, M.D.

Maximum Number of students per block: 1

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Understand the process by what a pathologic (histopathologic or cytpathogic) specimen is processed in the laboratory before it is available for examination by the pathologist.
2. Understand the role of intraoperative frozen section consultation in operative patient care.
3. Understand the role and utility of fine needle aspiration in workup and diagnosis of mass lesions.
4. Understand the relative utility of histologic and cytologic diagnostic techniques in the management of patient care.
5. Recognize the role of the pathologist in overall patient care through interactions with clinical colleagues

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Participation in surgical pathology for two weeks, including gross examination of specimens, evaluation of frozen sections and microscopic evaluation of biopsy and resection specimens.
2. Participation in cytopathology for one week, including general cytology signout (pap smears and fluid analysis) and performance and evaluation of fine needle aspirations specimens.
3. Attendance at a variety of tumor boards to see the interaction of pathologist with their clinical colleagues.
4. Attendance at general pathology lectures.
5. Identification of a particular topic of interest and presentation of a 10 to 15 minute oral presentation with review of the pertinent literature

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. At least 5 frozen section intraoperative consultations
2. Work up 2 major oncology resections and follow them through to appropriate tumor board discussions.
3. 10 surgical biopsy specimens.
4. At least 5 gynecological pap smears (normal and abnormal) and 5 non-gynecological cytology specimens
5. At least 2 fine needle aspirations and 2 adequecy assessments of mass lesions.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Evaluation by attending physician on surgical and cytology pathology signout
2. Observation and evaluation of skills in the frozen section room and during fine needle aspiration by appropriate attending or resident pathologist.
3. Quality of oral presentation by selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback while on the rotation. Formal feedback will be provided by the rotation director during a meeting at the end of the rotation to discuss performance, as well as written evaluation.

Course #: 887J

Title:  Introduction to Diagnostic Pathology and Its Role in Patient Care

Selective Director(s):  David Lewin, M.D. and Michael Caplan, M.D.

Maximum Number of students per block: 2

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Identify the principles, main objectives, and methodologies of the medical and forensic autopsy.
2. Understand the process by which a pathologic (histopathologic or cytopathologic) specimen is processed in the Laboratory before it is available for examination by the pathologist.
3. Understand the role that intraoperative and frozen section consultation plays in patient diagnosis.
4. Understand the differences between anatomic and clinical pathology with regard to nature of specimens, processing, pathologist input, and temporal sequence before a result is reported.
5. Gain insight into the role of the pathologist in overall patient care through interactions with clinical colleagues.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. One week of observation and participation under supervision in the Autopsy Room to gain exposure to practices, methodologies, and techniques of hospital (medical) and forensic (mediocolegal) autopsies.
2. One week of observation and participation under supervision spent on Anatomic Pathology Rotations, to include Surgical Pathology and Cytopathology to gain exposure to those aspects of diagnostic pathology that feature a formal sign-out involving residents, fellows, and faculty.
3. One week of observation and participation under supervision spent concentrating in an area of Clinical Pathology (e.g., Blood banking and Transfusion Medicine, Microbiology, Hematopathology, Molecular Pathology, and Clinical Chemistry).
4. Completion of a 15 to 30-minute oral presentation with a review of the pertinent literature on a particular topic of interest.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 2 patients (decedents) with causes of death attributable to either disease processes or injuries or a combination of both.
2. 10 adult patient biopsies or surgical resections for disease processes.
3. 3 pediatric patient biopsies or surgical resections for disease processes.
4. 10 patient biopsies for clinical pathology parameters.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Participation on the Medical and Forensic Autopsy Service by the autopsy attending.
2. Participation on the Surgical Pathology Service by the attending(s).
3. Completion of oral presentation and its quality as evaluated by the selective director.

Please outline when and how the learners will receive feedback on their performance:
There will be a meeting with the student at the end of the rotation discussing performance, as well as a written evaluation.

Course #: 888J

Title:  Forensic Pathology

Selective Director(s):  
Kim Collins, M.D., Erin Presnell, M.D., Michael Caplan, M.D. and Cynthia Schandl, M.D., Ph.D.

Maximum Number of students per block: 2

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Identify factors that define a forensic or medicolegal case.
2. Perform external examinations prior to autopsy in order to properly document identifying characteristics and injuries.
3. Prepare paperwork specific to forensic pathology including evidence transfer, clothing documentation, toxicology request forms, data sheets, etc.
4. Perform autopsy procedures and protocols including sexual assault examination, sample procurement, and basic dissection and evisceration technique.
5. Perform uncomplicated autopsy organ dissection.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Attendance at bi-weekly forensic seminar series.
2. Participation in video tape and written lesson review.
3. Pre-case and post-case discussions with attending and fellow pathologists.
4. Active participation in autopsy case-work.
5. Presentation of a 15 minute forensic topic.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. One accidental death
2. Once homicidal death
3. One suicidal death
4. One natural death
5. One pediatric death

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Attending physician will review extent of participation weekly.
2. Attending physician will proof read a dictated autopsy report, with handwritten and verbal comments.
3. Attending physicians, forensic fellow, and pathology resident will critique the 15 minute presentation.

Please outline when and how the learners will receive feedback on their performance:
1. Weekly, verbally or written by attending physician on
a. Participation in autopsy procedure
b. Dictation of an autopsy case