Department Of Pathology And Laboratory Medicine

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University of Kansas Medical CenterDepartment of Pathology andLaboratory MedicineResident Manual(2012-2013)

Table of ContentsMission, Goals and Philosophy .4Educational Program.5Overall Educational Goals .5Program Structure .10PGY-Specific Goals .12Didactic Sessions and Conferences .17Resident Scholarly Activity .17USMLE Step 3 Policy.18Professionalism .19Eligibility and Selection of Residents .20Evaluations .21Resident Evaluations .21Faculty Evaluations .22Program Evaluations.22Promotion.25Remediation, Probation and Corrective Action .25Grievance Procedure .26Work Environment and Duty Hours .27Work Environment .27Supervision of Residents .29Transfer of Care .33Duty Hours and Call Schedules .34Outside Rotations and Moonlighting .36Fatigue .38Vacations .41Other Policies .41Core Competencies Teaching and Assessment Matrix .43Pathology Resident ManualPage 2

Table of Contents (Continued)Rotation-Specific Goals and Learning Objectives .44Supervision Requirements.44Surgical Pathology – University of Kansas Medical Center .48Surgical Pathology – VA Medical Center .62Pediatric Surgical Pathology – Children’s Mercy Hospital .68Surgical Pathology Trainer.79Cytology .85Autopsy .95Forensic Pathology .107Transfusion Medicine .109Clinical Chemistry.125Hematopathology .148Wet Heme/Flow Cytometry .155Microbiology and Immunology .166Laboratory Management .174Integrated Clinical Pathology – VA Medical Center .186Cytogenetics .194Molecular Pathology .200Dermatopathology/Neuropathology .206Electives .216Anatomic Pathology Elective .216Clinical Pathology Elective .217Research Elective .220Addendum A – Sample Evaluation FormsPathology Resident ManualPage 3

MISSION, GOALS AND PHILOSOPHYThe mission of the Department of Pathology and Laboratory Medicine at the University Of Kansas Schoolof Medicine is to provide excellent teaching, research, patient care, and community service to meet thehealth needs of Kansas and the community at large. Our aim is to provide a supportive work environmentin which each individual can excel and pursue avenues that lead to national and international recognition.We will accomplish this by developing mechanisms that make optimal use of our human and financialresources.Within this context the overall goals of our residency training program are to develop a pathologist with thefollowing characteristics: A pathologist capable of communicating as a medical consultant to other clinicians and to patients,as well as being capable of optimally directing the management of anatomic and clinical laboratoryenterprises. The pathologist understands the science and technology of laboratory medicine andassures the quality, clinical appropriateness, and usefulness of the data produced by that laboratory.The pathologist is a clinician first and foremost.A pathologist who has the skills to recognize, interpret, and communicate pathologic processes inthe clinical practice of anatomic pathology.A pathologist who understands and consults on methods of diagnostic test development, testutilization in the context of both generally applicable as well as patient-specific clinical settings,and assay interpretation in the acute and chronic clinical management of patients. These activitiesinclude the pathologist’s role in the development and implementation of integrated medicalinformatics that optimize patient care.A pathologist who has the skills to consult in these areas at the broader systems level, and in thevarious extant healthcare delivery models.A pathologist who understands the role of research, in its broadest definition, in clinical decisionmaking, test development, knowledge generation, and continuing education.To accomplish these goals, our program offers a flexible but educationally intensive training program inAnatomic Pathology (AP) and Clinical Pathology (CP, Laboratory Medicine) in order to prepare each ofour residents for certification by the American Board of Pathology. A core program provides training thatwill lead to basic competence in general pathology. Elective opportunities are offered to permit thedevelopment of specialty excellence in particular subspecialty fields within Pathology such as SurgicalPathology and Hematopathology. Research activity is encouraged for our residents.Values that we feel are important are that the program will be a balanced one in AP and CP and wewill practice and teach state-of-the-art diagnostic pathology together with a strong foundation inpathogenesis and the molecular basis of disease. We encourage a strong and collegial relationshipbetween faculty residents and all members of the department. We believe when our residents finishthis program they should have outstanding skills and knowledge and we will help them obtain thefellowship, faculty or hospital position that they choose.Pathology Resident ManualPage 4

EDUCATIONAL PROGRAMOVERALL EDUCATIONAL GOALSCompetencies that are common to all rotations are outlined below. Competencies that are specific toindividual rotations are included with each sub-discipline. Residents will be given graduated responsibilitiesand will be evaluated at two general skill levels. Specific goals and learning objectives (Skill Levels) aredescribed under each sub-discipline.Legend for Learning Activities for ResidentsDidactic lectureFaculty sign-outJournal clubDirectly supervised procedureRole modelingLab inspectionsInterdisciplinary conferenceOnline toolsUnknown slide conferencesProjectDLFSOJCDSPRMLIICOTUSCPLegend for Evaluation Methods for ResidentsReport reviewRRDirect observationDOChecklistCLGlobal rating/faculty evaluationGR/FEStandardized examSEPractical slide examPSEIn-house written examIWE360 multisource rating360PortfoliosPFProcedures and case logsPCLCORE COMPETENCY: PATIENT CAREGoal:Residents must demonstrate a satisfactory level of diagnostic competence and the ability to provideappropriate and effective consultation in the context of pathology ivitiesGather essential and accurate information about patients using all FSO, DSP,RR, DO, CL,RM,ICGR/FE, PFrelevant available modalities.Pathology Resident ManualPage 5

Act as a skilled consultant to other clinicians to develop a diagnosticplan based on specific clinical questions and relevant clinical andpathologic information. This should be accomplished both in thepatient-specific setting and the broader context of developingappropriate clinical pathway algorithms for diagnosis.Gain knowledge and technical skills to recognize, interpret, and explainpathologic processes in the clinical practice of anatomic and clinicalpathology.DL, FSO,DSP, RM, ICRR, DO,GR/FE, SE,IWEDL, FSO, JC,DSP, RM,OT, USCConsult as part of a multidisciplinary healthcare team in developing atherapeutic plan that includes laboratory monitoring of efficacy andtoxicity. Where clinically appropriate, consult on the use of laboratorybased therapeutics such as blood transfusion and other forms of cellulartherapy.Provide expert consultation on the interpretation and follow-up ofunusual or unexpected test results.DL, FSO, JC,DSP, RM, IC,OTRR, DO, CL,GR/FE, SE,PSE, IWE,PF, PCLRR, DO,GR/FE, SE,IWE, PF, PCLDL, FSO, JC, DO, GR/FE,DSP, RM, IC, SE, IWE, PCLOTConsult as a clinical expert in laboratory medicine at multidisciplinary DL, FSO, JC, DO, GR/FE,RM, IC, OTPCLconferences.Note: The American Board of Pathology requires the following for board eligibility: a minimum of 50autopsies, 2,000 surgical specimens, 1,500 cytology specimens and 200 intraoperative consultations.CORE COMPETENCY: MEDICAL KNOWLEDGEGoal:Demonstrate knowledge about established and evolving biomedical, clinical and cognitive (e.g.epidemiological and social-behavioral) sciences and the application of this knowledge to tivitiesBe able to use all relevant information resources to acquire and DL, FSO, JC, RR, DO, CL,evaluate evidence-based information. Demonstrate proficiency in DSP, RM, IC, GR/FE, SE,PSE, IWEevaluating and presenting findings from appropriate peer-reviewed OT, USC, Pjournals.Develop and maintain a knowledge base in the basic and clinical DL, FSO, JC, RR, DO, CL,DSP, IC, OT,GR/FE, SE,sciences necessary for effective consultation in laboratory medicine.USCPSE, IWE,PF, PCLDemonstrate sufficient knowledge to determine clinically optimal yet DL, FSO, JC, RR, DO,GR/FE, SE,cost-effective testing and laboratory-based therapeutic strategies, RM, IC, OTIWE, PCLincluding issues of turnaround time, test menu construction, and inhouse referral diagnostic testing.Employ mathematics and statistics as appropriate to laboratory testing; DL, JC, RM,DO, CL,GR/FE, SE,understand and implement quality control (QC) and quality assurance LI, OT, PIWE, 360procedures as required.Recognize the unique aspects of laboratory medicine practice as DL, FSO, JC, RR, DO,modified by patient age and other patient population characteristics, DSP, RM, IC, GR/FE, SE,OT, USCIWE, PF, PCLespecially aspects of pediatric and geriatric practice.Pathology Resident ManualPage 6

Demonstrate awareness and understanding of general and test-specificstandards for method development and evaluation, such as thosepromulgated by the Clinical Laboratory Standards Institute (CLSI;formerly NCCLS), CAP, and similar organizations.Demonstrate awareness and understanding of proficiency programs,such as those provided by CAP and similar organizations.Demonstrate knowledge of the principles of clinical research design,implementation, and interpretation. Understand the various levels ofevidence in medicine and their translation into evidence-based practice.Be able to design a study that can be used to validate methodologiesand parameters of clinical utility for the implementation and continuinguse of new evidence-based analytes in the local setting.DL, RM, LI,OT, PDO, GR/FE,SE, IWE, 360DL, RM, LI,OTDO, GR/FE,SE, IWEJC, DSP, RM,PDO, GR/FE,SE, IWEDL, JC, DSP,RM, LI, PDO, GR/FE,SE, IWE, 360CORE COMPETENCY: PRACTICE-BASED LEARNING & IMPROVEMENTGoal:Demonstrate the ability to investigate and evaluate their diagnostic and consultative practices, appraiseand assimilate scientific evidence and improve their patient care ctivitiesDemonstrate the ability to critically assess the scientific literature.JC, RM, OT,DO, GR/FEPDemonstrate knowledge of evidence-based medicine and apply its FSO, JC, RM, DO, CL,OT, PGR/FEprinciples in practice.Use multiple sources, including information technology, to optimize JC, RM, OTlifelong learning and support patient care decisions.Develop personally effective strategies for the identification and DSP, RM,remediation of gaps in medical knowledge needed for effective USCpractice.Use laboratory problems and clinical inquiries to identify process FSO, RM, ICimprovements to increase patient safety.Demonstrate knowledge of how to establish continuing competency FSO, RM, LIassessment for pathologists as well as for laboratory personnel.Use proficiency programs to improve laboratory practices.RM, LI, OT,PDO, GR/FERR, DO,GR/FE, SE,PSE, IWE,360DO, GR/FE,360, PFDO, GR/FE,360DO, GR/FE,360CORE COMPETENCY: INTERPERSONAL & COMMUNICATION SKILLSGoal:Demonstrate interpersonal and communication skills that result in effective information exchange andteaming with other health care providers, patients and patients' tivitiesDemonstrate the ability to write articulate, legible, and comprehensive FSO, DSP,RR, DO, CL,RMGR/FE, PFyet concise reports and consultation notes. Provide a clear andinformative report, including a precise diagnosis whenever possible, adifferential diagnosis when appropriate, and recommended follow-up orPathology Resident ManualPage 7

additional studies as appropriate.Demonstrate the ability to provide direct communication to thereferring physician or appropriate clinical personnel wheninterpretation of a laboratory assay reveals an urgent, critical, orunexpected finding and document this communication in an appropriatefashion.Conduct both individual consultations and presentations atmultidisciplinary conferences that are focused, clear, and concise.Demonstrate the ability to communicate the vision of the anatomicpathology and clinical pathology service role to other clinicians as wellas to other healthcare personnel and administrators to develop clinicallyadvantageous and cost-effective strategies.Choose effective modes of communication (listening, nonverbal,explanatory, questioning) and mechanisms of communication (face-toface, telephone, e-mail, written), as appropriate.Demonstrate skills in obtaining informed consent, including effectivecommunication to patients about procedures, alternative approaches,and possible complications of laboratory-based patient care diagnosticand therapeutic activities, such as those related to transfusion medicine.Demonstrate skills in educating colleagues and other healthcareprofessionals: (1) demonstrate the ability to help other residents obtainproficiency in laboratory medicine; (2) demonstrate the ability to workwell with technologists and to present laboratory medicine concepts tothem effectively in continuing education settings and in the day-to-daylaboratory environment; (3) demonstrate the ability to educate nonpathology clinicians and other healthcare workers, includingpharmacists, nurses, residents, medical students, and others, abouttopics such as the fundamental principles of pathophysiologyunderlying test design/ interpretation and the approach to choosing andinterpreting laboratory tests; (4) demonstrate an understanding of theprinciples one must follow when educating other practicingpathologists through publications or seminars on new testing andtherapeutic strategies, research discoveries, and other cutting-edgeprofessional knowledge.FSO, DSP,RMRR, DO,GR/FE, 360RM, IC, USCDO, GR/FE,PSEFSO, RM, ICDO, GR/FE,PSE, 360FSO, RM, IC,USCRR, DO,GR/FE, PSE,360DSP, RMDO, GR/FEFSO, JC, RM,IC, USCDO, GR/FE,PSE, 360CORE COMPETENCY: PROFESSIONALISMGoal:Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principlesand sensitivity to a diverse patient ActivitiesDemonstrate compassion: be understanding and respectful of patients, FSO, DSP,DO, GR/FE,RM,IC360their families, and the staff and physicians caring for them.Interact with others without discriminating on the basis of religious, FSO, DSP,DO, GR/FE,RM, IC360ethnic, sexual, or educational differences.Demonstrate positive work habits, including punc

Anatomic Pathology (AP) and Clinical Pathology (CP, Laboratory Medicine) in order to prepare each of our residents for certification by the American Board of Pathology. A core program provides training that will lead to basic competence in general pathology. Elective opportunities are offered to permit the

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