Cytopathology Rotation Objectives:

Skill Level I 

Learning of those skills necessary to move from novice to advanced beginner; from basic acquaintance with cytopathology to readiness to commence independent learning of cytopathology.

Gynecologic Cytopathology:

The resident should demonstrate the ability to:

  • Explain the differences among conventional smear and liquid-based preparations in gynecologic cytopathology.
  • Examine any gynecologic cytopathology specimen, either a conventional smear or a liquid-based preparation, and properly classify it by The Bethesda System 2001.
  • List the common inflammatory etiologies and identify their presentation in gynecologic cytopathology specimens.
  • List the various microbiological, immunocytochemical, and molecular diagnostic techniques for confirmation of human papilloma virus and other infectious agents common in gynecologic cytopathology specimens, and appropriately recommend their cost-effective use.
  • List and demonstrate the proper application of The Bethesda System 2001 quality indicators and criteria for unsatisfactory gynecologic cytopathology specimens, and communicate their significance and rationale to clinicians in a concise and collegial manner.
  • Communicate the proper methods of gynecologic cytopathology specimen collection for both conventional smear and liquid-based preparations to clinicians in a concise and collegial manner.

Non-Gynecologic Cytopathology:

The resident should demonstrate the ability to:

  • Examine and properly classify using the current laboratory system (such as negative, inflammatory/reactive, atypical/suspicious, neoplastic or malignant) both fine needle aspiration (FNA) biopsies and exfoliative non-gynecologic cytopathology specimens from the various commonly sampled body sites.
  • List the common inflammatory etiologies and identify their presentation in non-gynecologic cytopathology specimens from the various commonly sampled body sites.
  • List the various microbiological, immunocytochemical, and molecular diagnostic techniques for confirmation of infectious agents usually found in non-gynecologic cytopathology specimens from the various commonly sampled body sites, and appropriately recommend their cost-effective use.
  • List the criteria for limited and unsatisfactory non-gynecologic cytopathology specimens from the various commonly sampled body sites, and communicate these criteria including their significance and rationale to clinicians in a concise and collegial manner.
  • Communicate the proper techniques for exfoliative cytopathology specimen collection to clinicians in a concise and collegial manner.

Cytopathology Rotation Objectives:

Skill Level II 

Learning of those skills necessary to move from advanced beginner to competent practitioner; from independent learning of cytopathology to readiness to commence safe practice of cytopathology.

FNA Procedural Cytopathology:

The resident should demonstrate the ability to:

  • Communicate the proper techniques for FNA biopsy specimen collection to clinicians in a concise and collegial manner.
  • Communicate the various potential FNA biopsy procedural complications to patients in a concise and professional manner.
  • Appropriately evaluate suitability for, correctly obtain consent from, and then competently demonstrate the performance of diagnostic superficial FNA biopsy on patients.
  • Explain and demonstrate the proper management of potential complications of FNA biopsy including fainting, arterial bleeding, pneumothorax, and needle-stick injury.

Advanced General Cytopathology:

The resident should demonstrate the ability to:

  • Explain and demonstrate the proper composition of a clear, concise, and complete cytopathology report for gynecologic cytopathology specimens based upon their final The Bethesda System 2001 classification, and recommend appropriate clinical follow-up.
  • Explain and demonstrate the proper composition of a clear, concise, and complete cytopathology report for non-gynecologic cytopathology specimens from the various commonly sampled body sites based upon the final diagnostic findings, and recommend appropriate clinical follow-up.
  • Explain and demonstrate the proper interpretation and triage of cytopathology specimens during rapid (intra-procedural) evaluation, including determination of specimen adequacy and necessary ancillary techniques, and the appropriate collection of supplementary diagnostic materials for such techniques.
  • List and explain the various potential causes of specimen identification errors in both gynecologic and non-gynecologic cytopathology.
  • List and identify the causes of common preparatory artifacts and explain how to confirm these causes and to manage such problems for quality assurance and diagnostic purposes.
  • List and identify the causes for common specimen contaminants and explain how to confirm these causes and to manage such problems for quality assurance and diagnostic purposes.
  • Explain and demonstrate the proper application of continuous quality assurance and regulatory compliance methods including correct procedural and diagnostic coding both for a gynecologic and for a non-gynecologic cytopathology service.
  • Explain the importance of correlation of prior and subsequent histopathology with cytopathology cases for both quality assurance and diagnostic purposes.
  • Explain and demonstrate the proper prioritization of workflow so that the most urgent cases are processed and examined first.

General Areas of Competency for Resident Training:

The Accreditation Council for Graduate Medical Education (ACGME) requires assessment of each resident’s competency in six major areas, exemplified below for anatomic pathology with criteria characteristic of the extremes of unsatisfactory and outstanding performance; the performance of most residents will be between these two extremes.

< h3 > Medical Knowledge

Unsatisfactory = Limited knowledge of basic and clinical sciences; poor understanding of diagnostic criteria and of relevant patterns and mechanisms of disease; minimal interest in learning
Outstanding = Exceptional knowledge of basic and clinical sciences; comprehensive understanding of diagnostic criteria and of relevant patterns and mechanisms of disease; highly resourceful in development of knowledge

< h3 > Patient Care

Unsatisfactory = Incomplete or inaccurate gross descriptions, microscopic diagnoses, and reviews of clinical data; incomplete or incompetent application of diagnostic criteria and performance of gross dissections and other procedural services; fails to analyze clinical data and consider patient implications when making medical decisions
Outstanding = Superb, accurate, comprehensive gross descriptions, microscopic diagnoses, reviews of clinical data, and procedural skills; always makes medical decisions using sound judgment, considering patient implications and available evidence

< h3 > Interpersonal and Communication Skills

Unsatisfactory = Does not establish even minimally effective medical relationships with co-workers and clinical colleagues; does not demonstrate ability to build relationships through listening, narrative, or nonverbal skills; does not provide education or advice to co-workers and clinical colleagues
Outstanding = Establishes highly effective medical relationships with co-workers and clinical colleagues; demonstrates excellent relationship building through listening, narrative, and nonverbal skills; excellent education and counseling of co-workers and clinical colleagues, always “interpersonally” engaged

< h3 > Professionalism

Unsatisfactory = Lacks respect, compassion, integrity, honesty; disregards need for self-assessment; fails to acknowledge errors; does not consider needs of patients, families, co-workers, and clinical colleagues; does not display responsible behavior
Outstanding = Always demonstrates respect, compassion, integrity, honesty; teaches/role models responsible behavior; totally committed to self-assessment; willingly acknowledges errors; always considers needs of patients, families, co-workers, and clinical colleagues

< h3 > Practice-Based Learning and Improvement

Unsatisfactory = Fails to perform self-evaluation; lacks insight, initiative; resists or ignores feedback; fails to use available resources to enhance patient care or pursue self-improvement
Outstanding = Constantly evaluates own performance, incorporates feedback into improvement activities; effectively accesses and utilizes resources to manage information for patient care and self-improvement

< h3 > Systems-Based Practice

Unsatisfactory = Unable to access/mobilize outside resources; actively resists efforts to improve systems of care; does not use systematic approaches to reduce error and improve patient care
Outstanding = Effectively accesses/utilizes outside resources; effectively uses systematic approaches to reduce errors and improve patient care; enthusiastically assists in development of system improvements

Objective Evaluations in Cytopathology:

Demonstration of a resident’s achievement of the specific individual competencies itemized in the rotation objectives above should be documented. This may be in the form of checklists. Such checklists should promptly be completed by each supervising faculty member. Timely personal discussion with the resident of his or her performance by the faculty is optimal.

Of a twenty-specimen glass slide quiz on gynecologic cytopathology, at least 90% of the specimens should be classified within one grade of the proper classification by The Bethesda System 2001 (as per the College of American Pathologists’ glass slide review system).

Of a twenty-specimen glass slide quiz on non-gynecologic cytopathology, at least 80% of the specimens should be properly classified using the current laboratory system (such as negative, inflammatory/reactive, atypical/suspicious, neoplastic or malignant).

On a question short answer or a multiple-choice examination (such as the cytopathology component of the American Society for Clinical Pathology Resident In-Service Examination), a resident should perform appropriately for his or her level of training.

 

Subjective Evaluations in Cytopathology:

Each supervising faculty member should promptly complete a standard written resident evaluation form addressing all of the ACGME required competencies at the end of every resident’s rotation in cytopathology. Timely personal discussion with the resident of each written evaluation by the faculty is optimal.

The cytopathology laboratory staff and the clinical staff with whom he or she has worked in the performance of FNA biopsies should similarly perform a written evaluation of each resident (360 degree evaluation) at least annually.

If a resident’s performance is perceived as unsatisfactory at any time during the rotation, this should be discussed immediately with the resident and/or the residency training program director for remedial action.

Assessment of Competency in Cytopathology:

Assessment of each resident’s competency in cytopathology should be based on his or her satisfactory achievement of all the objective performance standards described above as well as the subjective but equally important competency standards as assessed by the faculty standard written evaluations and by the staff 360 degree evaluations.

The assignment of additional training and experience in cytopathology to assist the resident in achieving satisfactory performance should be an option available to the residency training program director.