1. This is a residency, not a 9-5 job. Make sure your work is done before deciding to leave for the day; don’t dump on your fellow residents. And be grateful you didn’t decide to do surgery or obstetrics.
2. Go to conferences, your absence is noted and recorded.
3. Be on time. If you have to be late, then come in as unobtrusively as possible.
4. Before starting any new rotation, read up on it in the Department of Pathology and Laboratory Medicine Resident Manual so you know what to expect and what is expected of you.
5. Notify the Chiefs, Charla, and your attending ASAP if you have to take unexpected leave.
6. Pager etiquette: There is a reason why you carry a pager, it is so clinicians and other pathologists can reach you when they have a question. So…
Keep your pager on you at work and when on home call.
Change the batteries as needed.
Answer your pages promptly.
7. Turn your cell phone off during conference!
Residents at KU/VA should be on site from 8A-5P at minimum; if they can not be, they need to account for their activities and obtain clearance from their attending. The KU Day 1 Surgical Pathology resident is required to be on site at 7:30 AM; even if there are no early cases scheduled, you must be on hand for any emergent questions. No exceptions! Medical appointments should be cleared through your faculty; sick days must be reported to the Chiefs, Program Coordinator, and attending so that adequate coverage of the service may be provided. Your work day ends when ALL the clinical work is done. And if there is still time in the day, then do some reading, prepare for a slide conference, be productive!
If any issue should arise during the residency, the Chief Residents should ALWAYS be the first line of contact. So, bring all questions and requests regarding any departmental/rotation/equipment etc. issue to them first. They are your liaisons to the faculty and program director and can help you decide the best way to resolve your question. Residency is a hierarchy, and accordingly, the best place to start your request is at the bottom of the ladder, with the people that represent you and your interests (the Chiefs). Often times, more than one resident will bring up similar issues, and Chiefs can coordinate the requests and decide the best place to address the issue. If the issue can not resolved by the Chief Residents or they are in fact a part of the issue, then it must then be brought to the Program Director’s attention. This order (Chiefs → Program Director) should always be used when there is a problem at hand. Residents are discouraged from bypassing this order, such as going straight to the Department Chair, who has very limited time and many other duties.
There are two exams per year that post-sophomore fellows and pathology residents participate in. The RISE (Resident In-Service Exam), a computerized examination for pathology residents, occurs in early May. It is a 2 half-day process of over 300 questions that covers nearly all topics in pathology. Your results are compared to those of residents of your PGY year everywhere as well as all pathology residents. RISE scores have been shown to correlate with Board scores.
In addition, there is an in-house exam in November of each year. This exam is divided into a microscopic and didactic sessions. The microscopic exam takes place within a 15 minute session, where each resident looks at 10 slides with 3-4 faculty members. This portion simulates the slide microscopic portion of the Board Examination. The resident is expected to verbalize as much as possible the following: organ identification, area of pathology, differential diagnoses, and possible confirmatory immunohistochemical or special stains with 90 seconds allowed per slide. The microscopic slides are chosen according to the resident PGY level. The didactic exam is a 100 question multiple choice and matching exam that the faculty writes. Your results are compared to those of your peer.
Vacation Policies (straight from the official manual):
“Allotted time off during monthly rotations – Only one week per month may be taken off (vacation, sick leave, coverage for another resident, or other) on any given rotation. Additional time off will have to be made up during elective time. Until the excess time off has been made up, the resident will not receive credit for that rotation.
Scheduling of vacation is restricted to certain rotations. Vacation times are scheduled by the Chief resident prior to the start of the academic year. Any changes in the vacation schedule after the start of the year must be approved by the Chief Residents and the Program Director.
Full day attendance for off-site rotations (VA and Children’s Mercy Hospital) is required. Exceptions include returning to KU for mandatory conferences and meetings (Core conferences and AP/CP conference). Any other absence must be approved by the VA or Children’s Mercy Hospital Faculty.”
It boils down to:
-15 days of vacation per year
-bonus 5 days off for winter holiday
-no more than 5 days off per rotation (whether it is sick, vacation, professional leave, etc.)
-vacation generally can not be taken:
June 15 – July 15
KU or VA Surgical Pathology
Children’s Mercy Hospital rotations
Autopsy
Hematopathology
The Process
Vacation requests for the next year are submitted around April of each year. Residents should provide 3 months for their first choice, and 2 alternate months for vacation. The Chief Residents will make out the rotation schedule, allowing for as many residents to obtain their first choices as possible. After the schedule is finalized, if a resident should wish to change their vacation months, they must obtain approval from the Program Director and Chief Residents.
By the 7th of each month, residents who have call requests (SP, Autopsy, or CP) for the next month should have emailed the Chief Residents with specific request dates, if any. Requests will be honored as much as possible, depending on the available number of residents in the call pool. Residents who are on vacation or professional leave may take higher priority over other residents. The call schedule will be sent out approximately the 15th of each month to the residents, faculty members, and ancillary staff.
Any changes to the monthly rotation schedule must be approved by the Chief Residents and Program Director.
If, for any reason, a resident finds that he/she can not fulfill a scheduled call or conference due to a conflict for any reason, it is HIS/HER responsibility to find another resident to switch with. It is NOT the Chief Residents’ responsibility to find another resident to switch with. In addition, the schedule change MUST be approved by the Chief Residents. Finally, it is the resident’s responsibility to notify all faculty members and ancillary staff who are affected by the switch (blood bank, autopsy) and Linda Riley.
These conferences are required at 75% attendance for all residents no matter what rotation they are on. Residents at CMH are still required to attend AP and CP Core and Resident Lunch Meetings.
-Every Tuesday and Wednesday (respectively), at 8:00 AM in Boley-Mantz
-Core lectures cycle over a 2 year period, so that each resident may hear them twice during their residency
-Staffed by faculty and occasionally the Cytology Fellows, when appropriate
-Power Point Lectures will be placed in the shared G drive when available
-Fourth Tuesday of the month, 11:45 AM in Boley-Mantz
-Lunch (with beverage) will be provided for residents and faculty members
A. AP/CP Presentation
12:00 PM: One resident anatomic pathology case presentation (15 minutes)
12:15 PM: One resident clinical pathology case presentation (15 minutes)
Expectations:
Residents that are assigned to present will choose an appropriate topic to discuss. In most cases, a recent personal case should be used. Clearance with the Chief Residents is advised, to prevent too many similar cases in a row. If you do not have a case, (for example: if you’ve never been on a CP rotation, but are scheduled for a CP conference), please ask an appropriate faculty member or the Chiefs for help identifying a good educational case. As a corollary, when you do come across a good case, keep a record so that you may present it later. Presentations will be in power point and will only take up 20 minutes including Q/A session. The faculty evaluates the presentations and the best AP and CP presenters will be awarded a prize (2005-6: $100 additional book money).
Suggested Power Point format:
Brief case history (this is not internal medicine, we like pictures, not blah blah, so keep it pertinent to Pathology)
Significant clinical findings
Pathologic findings
Differential diagnosis
Final Diagnosis with supporting evidence
Brief discussion of topic
Epidemiology and risk factors
Pathologic findings (gross, histology, perhaps cytology)
New findings in recent literature, if appropriate
Differential diagnosis
Ancillary tests to distinguish from the differentials
Treatment and Prognosis
Appropriate patient follow-up.
B. Resident Meeting (12:30 PM)
Faculty members leave, except for Dr. Persons, Dr. McGregor, and Residency Coordinator. Up coming events, changes, and issues will be discussed according to the Agenda. Residents are encouraged to let the Chiefs know if there is something specific that needs to be discussed ahead of time, so that time may be allotted.
-First Monday of the month, 12:00 PM in Wahl West Auditorium
-Faculty (usually guest lecturer) presentation
-Residents and lecturer meet in Svoboda for Q/A at 1:00 PM, lunch is provided
With the exception of the Dermatopathology Conference, residents are expected to have previewed, studied, and formed a differential diagnosis on the cases prior to conference. That being said, not previewing the slides is not an excuse for being left out of the conference. Residents who have not previewed the cases will still be expected to describe and form a differential diagnosis, only on the fly. Therefore, previewing is highly recommended to prevent long uncomfortable silences early in the morning and annoyed throat noises from your fellow residents. 60% attendance is required of all residents on KU AP rotations (Surgical Pathology, Cytology, and Autopsy). Nonetheless, VA and Clinical Pathology residents are highly encouraged to come to these conferences when possible. In general, the VA faculty is very willing to let their residents to come for Hematopathology, Neuropathology, Dermatopathology, and Organ-Specific Conferences.
-First Monday of the month, at 8:30 AM in Boley-Mantz
-Staffed by Dr. Cunningham
-Cases are placed in Heme sign-out room during the previous week
-Monday, Thursday, and Friday, 8:30 AM in Boley-Mantz (except when substituted by another conference – M&M, specialty slide conference)
-Staffed by Drs. Tawfik, Damjanov, Fan, and Zhang
-Cases are placed in the Resident Work Room (1431)
-Some Cytology cases may be sprinkled in by the Cytology Fellows
-Second Thursday of the month, 8:30 AM in Boley-Mantz
-Cases are picked out by the Cytology Fellows
-Staffed by Drs. Tawfik, Damjanov, Fan, and Zhang
-Cases are placed in the Resident Work Room (1431)
-Third Friday of the month, 8:30 AM in Boley-Mantz
-Staffed by Dr. Newell
-Cases are placed in the Resident Work Room (1431)
-Tuesdays, at 4:00PM in Boley-Mantz
-Staffed by Dr. Fraga (MAWD Pathology)
-No preview of slides available, unless otherwise notified
-Selected Fridays, in place of a General S/P conference, 8:30 AM in Boley-Mantz
-Rare and interesting cases sent from around the world
-Staffed by Dr. Damjanov
-Cases are placed in the Resident Work Room (1431), with an accompanying email designating the case each KU resident is personally responsible for
Expectations for Unknown Slide Conferences:
Residents are expected to have studied the slides and formed at least a differential diagnosis for each case. The most important thing is to work through each case, not necessarily to jump to an answer. Just like math, it is more important to “show your work”, than to be lucky and get the right answer. While we are tested using multiple choice questions for Board purposes, you won’t be that lucky when you start your practice. Bear in mind that most of these cases have been signed out, and staff are aware that these aren’t truly unknown cases. You will be judged on your descriptions, thought process, and differential diagnosis, not just your diagnostic skills. You may also be asked secondary questions related to epidemiology, pathogenesis and treatment, so be prepared and study the cases. It is not enough to come to conference with a list of the diagnoses. To start you off, here is a sample of decisions to be made when looking and describing a slide during conference. We suggest using this general algorithm to work through cases; and you will find yourself being able to verbalize what you see and improve upon your differential diagnosis.
Low Power:
1. What organ is this? Is there normal tissue or is it all abnormal?
2. Is the lesion well-circumscribed, encapsulated, poorly circumscribed, or infiltrative?
Medium Power:
1. Are the cells of one type (monomorphous) or polymorphous?
2. What shape do the cells have: spindle, round, oval, epithelioid, polygonal, etc?
3. Is there specific architecture/structure such as glands, tubules, sheets, nests, nodules, fascicles, bundles, herringbone, etc?
4. Is there a change or response in the stroma: hyalinized, sclerotic, desmoplastic, inflammatory, mucinous, myxoid, increased angiogenesis, etc? Is the stroma in fact lesional?
5. Based on the above, is the lesion reactive, inflammatory, or neoplastic?
High Power:
1. Described the nucleus: small, large, vesicular, hyperchromatic, spindle in shape, central or eccentric in location, intranuclear pseudoinclusion, prominent nucleoli, etc?
2. What quality does the cytoplasm have: abundant, scanty, eosinophilic, basophilic, vacuolated, bubbly, etc?
3. Is there pleomorphism, anaplasia, or atypical mitoses? Does this push for a benign or malignant (or borderline process)?
4. Based on all of the above, which general class of lesions do you favor this lesion to be: hematopoietic, epithelial, mesenchymal, melanocytic, biphasic, etc?
5. Finally, what is your differential diagnosis and ancillary tests/stains you would use to confirm your favored diagnosis?
ONE MORE POINT:
What ever you say, do it with confidence. Don’t, for example, use the words, “I think this is a spindle cell lesion”. It’s easy to do and we are all guilty, but just say it free and clear, “This is a spindle cell lesion”.
60% attendance required from all KU AP/CP residents.
-Second Tuesday of most months, 12:00 PM in Autopsy Conference Room
-Paid for by Pathology department for your education
-Important topics in pathology, such as CPT coding
-Second Tuesday of the month, 12:00 PM in Boley-Mantz, unless there is a CAP Teleconference → moves to Third Tuesday
-Staffed by Dr. Fan
-One 1st year and up resident assigned to present an AP article
-Second 1st year and up resident assigned to present a CP article
-While a CP attending may help you find a good CP article, all articles must be approved by Dr. Fan
-Review articles may not be used; it must be an original article. It must also have been published within the last year
-Titles of journals need to sent to Chiefs at least 1 week prior to conference
-Copies should be distributed in Surg Path (for residents) and to all faculty mailboxes (in Clin Lab as well as Surg Path) at least one week prior to conference
Expectations:
20-30 minutes per article presentation and Q/A session. This is not a Power Point presentation, but rather “sit down at the table” discussion of the article. You should not be reading the article verbatim, but hitting the highlights, important points made by the authors, and specifically how the results advances what we already know and changes how we currently practice. This is also a critical review; it is important to point out potential weaknesses of the study.
-Fourth Monday of the month, 12:00 PM in Autopsy Conference Room
-Staffed by Dr. Damjanov
-1-3 cases presented by 1st year and up residents
-Cases will be chosen by Chiefs and Dr. Damjanov
Expectations:
20-30 minutes per Power Point presentation and Q/A session per case. When doing an autopsy, the pictures the better. You’ll get experience taking pictures, and you’ll have more to show at conference.
Suggested Power Point format:
Case history
External exam
Internal exam
Gross images
Microscopic images
Final Anatomic Diagnoses
Brief discussion of pertinent pathology (i.e. epidemiology, risk factors, etc…)
60% attendance required from all KU residents. VA residents can observe these conferences via broadcast to the 11th floor VA conference room.
-Second Monday, 12:00 PM in Sudler Auditorium (3rd floor)
-Attended by Internal Medicine and Pathology residents and faculty
-Case is selected by Internal Medicine and Pathology Chiefs
-Format:
Clinical information presented by IM resident
Differential diagnosis discussion by IM faculty
Pathology presented and topic discussed by Pathology faculty
-Fourth Monday of the month, 8:00 AM in Sudler Auditorium (3rd floor)
-Attended by Internal Medicine and Pathology residents/faculty
-Case is selected by Internal Medicine and Pathology Chiefs
-Format:
Clinical information presented by IM resident
Discussion by IM faculty
Pathology presented by Pathology resident (1st year and up) who performed the case
Suggested Power Point format: this is very similar to Autopsy Conference
External exam
Internal exam
Gross images
Microscopic images
Cause of Death and Final Anatomic Diagnoses
-60% attendance is required of all residents on KU AP rotations (Surgical Pathology, Cytology, and Autopsy).
-Fridays, 7:30 AM in Sudler Auditorium (3rd floor)
-Attended by Surgery, Oncology, Radiation Oncology, Pathology, and Radiology
-Staffed by Dr. Damjanov
-Case list is sent out by Wednesday morning to Valerie and Chiefs
- 2nd year or higher resident assigned to present the pertinent pathology
Expectations:
Resident should be familiar with all pathology available for patients. TIP: you don’t have to show everything you’ve got on a patient, but you should be aware of it if the clinicians ask. If a case does not appear to have any pathology, resident should contact the presenting attending ASAP to check that they are aware of this. Sometimes outsides slides are in the process of being accessioned, and should be rushed so that at least a preliminary report can be given at Tumor Board. Recommended Power Point format:
Patient Initials (ex: S.Y.), no specific identifying information
Dates of procedures with tissue sites
Pertinent low power and high power H&E or Diff-Quik/Pap (Cytology)
Pertinent immunohistochemistry (IHC) images (I put 3 (+) and 1 (-) in 1 page), there is no need to show all immunohistochemistry as “all brown stains look alike”
Summary of IHC and special stains
Final Diagnosis (include staging if appropriate)
** Make sure to include anything significant in tumor checklists (ex: lymph nods status) and ancillary confirmatory tests (ex: flow cytometry for lymphoma). Make it short, sweet, and clear! There are often cases that can be described as “sticky”, where it is the presentation of our opinion that matters the most. This skill is learned by experience, but suffice it to say, you should always only say what you are absolutely sure, but when you say it, do it with absolute confidence. Finally, show the presentation/slides to Dr. Damjanov by Thursday afternoon to obtain his approval.
-60% attendance from KU CP residents (except Heme resident)
-Staffed by Dr. Patel
-Mondays, at 2:00 PM in Boley-Mantz
-Review of all CP calls from previous week with CP attending
-Presentation of interesting cases or issues from previous week (clinical chemistry, microbiology, blood bank etc.)
Generally, 3rd year and higher residents and Cytology Fellows divide up these conferences. We are expected to read the reports of the cases to be discussed carefully before both conferences so that we understand the report, and feel confident that there are no ambiguities, or sources of confusion in them. Hopefully this can be done with enough anticipation so that, if needed, we can get the slides and review them with the attending who signed out the case, or the “conference advisor” (Dr. Tawfik for ENT, Dr. Fan for breast). It is an excellent idea to go and see another resident/fellow do the ENT and Breast dog and pony show before it is your turn.
ENT conference:
Breast conference:
Attendance requirement of conferences may appear to be a complicated affair. But keep this in mind, residents are encouraged to attend 100% of conferences whenever possible. The 60% and 75% attendance requirement takes into account the rotation you are on (AP vs. CP vs. offsite) and potential vacation/sick leave. When doing an offsite rotation (CMH/CBB), you are still required to attend the AP/CP core and Resident Meetings. Your attendance record is reviewed by the Chiefs, Program Director, and REC; continued poor attendance may lead to loss of the yearly Book Fund. Even if a conference is not required for your rotation, you are encouraged to attend if it does not interfere with your rotation obligations.
KU AP |
KU CP |
VA |
|
AP and CP Core |
75% |
75% |
75% |
AP/CP Resident Meeting |
75% |
75% |
75% |
Grand Rounds |
75% |
75% |
75% |
Hematopathology |
60% |
Not Required, but Encouraged |
Not Required, but Encouraged |
General Surgical Pathology |
60% |
Not Required, but Encouraged |
Not Required |
Organ-specific Surgical Pathology |
60% |
Not Required, but Encouraged |
Not Required, but Encouraged |
Neuropathology |
60% |
Not Required, but Encouraged |
Not Required, but Encouraged |
Dermatopathology |
60% |
Not Required, but Encouraged |
Not Required, but Encouraged |
Histopathology Club |
60% |
Not Required, but Encouraged |
Not Required |
Tumor Board |
60% |
Not Required, but Encouraged |
Not Required |
CAP Teleconference |
60% |
60% |
Not Required |
Journal Club |
60% |
60% |
Not Required |
Autopsy |
60% |
60% |
Not Required |
CPC |
60% |
60% |
Attend at VA Conference Room |
Morbidity and Mortality |
60% |
60% |
Attend at VA Conference Room |
CP Call Rounds |
Not Required |
60% |
Not Required |
Breast / ENT |
Not Required |
Not Required |
Not Required |
INFORMATION NEEDED FROM RESIDENTS WHEN THEY SUBMIT AUTOPSY, FNA OR BONE MARROW DATA:
1) Resident Role: Either Primary or Secondary.
Primary – if you have the substantial responsibility during the procedure
Secondary – if you had a primarily assisting role
2) Procedure Date
3) CPT Code*
*CPT CODES AVAILABLE FOR PATHOLOGY
88020 Necropsy (autopsy), gross and microscopic; without
CNS
88027 Necropsy (autopsy), gross and microscopic; with
brain and spinal cord
88028 Necropsy (autopsy), gross and microscopic; infant
with brain
88029 Necropsy (autopsy), gross and microscopic; stillborn
or newborn with brain
88040 Necropsy (autopsy); forensic examination
Give the appropriate code for non-forensic or forensic autopsy when you were actively involved (in either primary or secondary role) in each of the following components of a complete autopsy. Give
Note: You may give a code for autopsies in which you were not involved in all seven of the above components using the appropriate code for gross examination only or limited autopsy.
38220 Bone marrow; aspiration only
38221 Bone marrow, biopsy, needle or trocar
Enter the appropriate code when you perform a bone marrow aspiration or a bone marrow biopsy.
Note: You may give a code for the interpretation of a biopsy or aspirate, even if you did not perform the procedure.
10021 Fine needle aspiration; without imaging guidance
Give the appropriate code when you perform a fine needle aspiration.
OTHER CODES:
You may give any valid CPT code. For example, you may keep track of consultations, clinical pathology tests, identification of microorganisms, special stains, or surgical specimens examined. Tracking your experience in these areas, however, is not required.
Entering Procedure Instructions:
1) Go to www.acgme.org
2) Enter your username (first initial and last name) and "test" for password. You can change your password by clicking on the Change Password BEFORE you log in. If anyone ever forgets their password, Charla can easily assign another one for them. Be sure to save if you change password. If you have a problem with your username, it's probably because Charla had to include your middle initial so that no duplication of usernames exists in the system. So, if you have a problem, enter your first initial, middle initial and then your last name. Call Charla if you still can't get logged in.
3) The next screen allows you to enter procedures by clicking on "Case Entry" which is listed across the top of the page.
4) After clicking Case Entry, the "Procedure Menu" appears.
To ADD new procedures, click on Add.
To change, delete or view procedures, click on Search/Update.
5) In order for your new procedure to be entered, be sure to fill in the "required fields": Resident, Institution, Resident Year, Resident Role (primary, secondary, etc), Procedure Date and CPT Code.
BE SURE TO SAVE EACH PROCEDURE. ALSO, THE INSTITUTION, YEAR IN PROGRAM AND PROCEDURE DATE WILL REMAIN UNCHANGED FROM YOUR PREVIOUS ENTRY, so you can enter many procedures and then save it; so that you don't have to duplicate information when you have many procedures with the same date.
50 complete autopsies (full participation) with complete report are required. Average of 30 KU/VA/Dr. Handler hospital cases per resident will be required. The remaining may be forensic (maximum of 20). Dr. Handler non-forensic hospital cases require full participation:
Review of history, external exam, gross dissection, and development of an
opinion regarding the cause of death
Review microscopic and laboratory finding
Prepare written description (using Dr. Handler's template)
Submit to Dr. Handler for review
Final report must be approved and signed by Dr. Handler
Submit copy of final report to Charla Tunget (residents keep a copy as well)
It is the individual resident's responsibility to choose which cases to write-up with Dr. Handler and the resident's responsibility to have completed a total of 50 autopsies at the end of three months of autopsy service. If during the three months, less than 30 KU/VA/Dr. Handler hospital cases are performed, the resident must report this to the Chief Residents and the Program Director to arrange for an additional rotation or weekend call to reach the 30 hospital cases. You will absolutely need to participate with Dr. Handler on his non-forensic hospital cases, so that your board requirement may be assured. Jump in as much as possible!
ACGME GOLDEN RULE = No resident will be on call for more than 6 days in a row. “Residents must be provided with 1 day (24 continuous hours) in 7 free from all educational and clinical responsibilities, averaged over a 4 week period.”
Weekday, after hours, and weekend at home call is taken by those residents rotating through Surgical Pathology at KU. Frequency of call is typically Q3 (every 3 days) when only residents are on rotation. When there is a PSF on rotation, the frequency of call is Q4 (every 4 days). Weekday call begins at 7:30 AM, which means the Day1 resident is expected on site at 7:30 AM, no exceptions. After hours call begins after 5 PM for the Day 1 resident. This resident is responsible for all frozen sections, STAT Cytology specimens, and other Anatomic Pathology issues/questions occurring until 8 AM the next morning.
Resident Responsibilities (Q3 schedule)
DAY 1:
• Gross all big and small specimens all day (PAs gross biopsies).
• Perform all frozen sections (with assistance from PA and faculty) and the big specimens following the frozen sections (whether they come the same day or the next day).
• New cases accessioned after 4:30 PM is assigned to the resident who is Day 1 on the next day.
• Before leaving on Day 1, the resident is expected to check with the OR (x82880) that no more frozen sections are expected.
• On call for after hours frozen section specimens and STAT Cytology specimens.
DAY 2:
• Read slides for big specimens for sign-out and order all necessary special stains after consulting the assigned faculty.
• Sign out big specimens.
• Finish cutting in additional specimen parts that are from cases logged during Day 1.
DAY 3:
• Sign-out biopsy specimens (grossed in on Day 2 by PA) with biopsy attending after reviewing the slides.
• Work-up and sign out all remaining cases.
• Emergency backup for frozen sections.
Resident Responsibilities (Q4 schedule)
Same as above, except on Day 4, the resident has a chance to read and catch up sign-out on any left over cases. Also, the resident is responsible for helping the Day 1 resident if needed.
Faculty Rotation
Typically, two faculty members will work together in pairs in surgical pathology in 1-week blocks. One attending is responsible for all biopsy; the other is responsible for frozen section and surgical specimens.
At Home Weekend Call is split between the residents on Day 1 on Friday before and Monday after the weekend.
Saturday
Resident on Day 1 on Friday is responsible for this day of call. Responsibilities include:
1. Gross all specimens (biopsies and surgical specimens) from OR and Clinical Laboratory drop box. Surgical specimens belong to this resident; biopsies belong to the resident who is on Day 3 on Monday.
2. Sign-out biopsies (grossed in Friday) with the biopsy attending. If there are any cases with new diagnosis of malignancy, call clinician, notify, and document in CoPath.
3. Cover all frozen sections, STAT Cytology specimens, and other Anatomic Pathology issues/questions occurring until 8 AM Sunday.
Sunday
Resident on Day 1 on Monday is responsible for this day of call. Responsibilities include all frozen sections, STAT Cytology specimens, and other Anatomic Pathology issues/questions occurring until 8 AM Monday.
Post Sophomore Fellows
While we know that our PSFs are the cream of their class and eager to please, it is also known that they do not have the benefit of clinical experience or a practicing license. For accountability and more importantly, patient care, the PSFs will always have on call back-up, in addition to the faculty on call. As much as possible, there will be a total of 4 people when a PSF is rotating through, resulting in a 4 person rotation. During the rotation a senior resident will be designated as the PSF’s go-to-person during the work day for questions and concerns. When the PSF is on call, a Cytology Fellow will be designated as the PSF’s back-up person. If there is an after hours or weekend call, the Cytology Fellow will come in with the PSF to assist in the gross processing of the specimen. The faculty member on call will still come in to sign out the frozen section case.
April 2006 Surg Path |
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Key: 1= ON-CALL |
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KU Surgical Pathology Transition
Example:
June 30 → July 1
Chris (Day 3) → Lisa (Day 1) → meet 6/30 afternoon
Jamie (Day 1) → Sharane (Day 2) → meet 7/1 morning
Vynette (Day 2) → Ken (Day 3) → meet 6/30 afternoon
1. Departing and arriving residents MUST meet face to face by the above time period to discuss incomplete cases and what each case needs to be signed out.
2. The leaving Day 1 resident (Jamie) MUST correct the gross description on all cases prior to the hand over.
3. The status of each incomplete case MUST be indicated on the paperwork for the case (ex: awaiting immunos or special stains, needs Q/A, need to obtain more history, etc).
4. Day 2 and 3 leaving residents: All incomplete cases MUST have corrected gross descriptions, topography, final diagnosis, and tumor checklists entered as much as HUMANLY possible. Don’t slack and dump it on the hapless resident coming in after you. Going off service is not an excused to be lazy; stay as late as you need to finish your work.
5. The departing residents are to make themselves available for questions as needed during the first week of the next month. If they are at KU and on a light rotation, they are HIGHLY encouraged to finish up their incomplete cases themselves. Remember, no one knows the case as well as you!
VA Surgical Pathology
At the VA, there is no after hours or weekend call. Whoo hoo! There are 2 residents on service and thus the rotation is 2 days.
DAY 1:
• Gross all specimens (biopsies and bigs).
• Perform all frozen sections (with assistance from PA and faculty).
DAY 2:
• Read all slides and sign out with assigned faculty.
• Finish cutting in any left over specimens.
The resident on Autopsy is responsible for all cases occurring during the week, and is also on call one day per weekend. Once, during the month, the resident will have a weekend off call, if scheduling permits. If there are two residents on Autopsy, the call is alternated between them. If possible, each resident will have 1 weekend off call per month. The remainder of the weekend call days will be split among Clinical Pathology residents. Those CP residents who have adequate case numbers to fulfill board requirements may still be assigned Autopsy call. If there are not enough Clinical Pathology residents to cover all the weekend call days, call may also be assigned to VACP, Cytology, and Hematopathology residents.
During the weekend call, the resident should call the Autopsy Assistant at 588-7272 around 7:30-8:00 AM to find out if there are any cases scheduled for the day. Dissection of KU or VA hospital cases must be coordinated with the Pathology staff, as it is during the week. Participation in Dr. Handler cases may be optional, depending on the type of case. Those residents who still need case numbers should participate with Dr. Handler as much as possible. Also, any unusual cases, such as homicides, should have resident involvement.
CP call is assigned to residents on Clinical Pathology rotations at KU, who have experienced Blood Bank before. The vast majority of CP call is taken up with questions from the Blood Bank; however there may be calls regarding other clinical pathology departments (such as microbiology). When there is a resident assigned to KU Blood Bank, he/she will take all CP call from 8A-5P during the week. After hours and weekend call will be taken by the resident assigned according to the schedule. If, however, there is not a Blood Bank resident, then the assigned resident will take call from 8A-8A. Blood Bank calls must be documented by the resident using the proper form. On most Mondays at 10AM, all CP residents will attend CP Call Rounds with Dr. Patel in Boley-Mantz to discuss call from the previous week, as well as any other interesting CP topics.
Some advice for call:
1. Know what the situation is. Gather as much information as possible before calling the clinician. Ask your Blood Bank tech for all the pertinent labs, not just what they tell you.
2. Make sure you know who you are talking to (resident or attending). In most cases, you should be talking to the resident, unless there is not one assigned to the patient.
3. Be as helpful as you can be. Sometimes interactions with clinicians may feel antagonistic. Do your best to dissolve the tension by telling them that you need more clinical information to justify the product release. Find out what end point (lab number) they are trying to reach with their request.
4. Let the clinician know if another product would serve the patient better and why. A part of your job is to help educate your colleagues because this is your areas of expertise. And if no blood product is justified at this time, again tell the clinician why this is so (clinical trials).
5. If you and the clinical resident can not come to a resolution, call your attending for back-up. Very often, the resident is just “doing what they are told to do by the attending or fellow”; this situation is better resolved by an attending to attending interaction.
6. Document, document, document!
APRIL 2006 CP/Autopsy Call Schedule |
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CP= Clinical Pathology; A= Autopsy |
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Surgical Pathology Resident Work Room and Histology: ______________________
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1. Differential Diagnosis in Surgical Pathology (Haber)*
2. Surgical Pathology Dissection: An Illustrated Guide, 2nd ed (Westra) or Manual of Surgical Pathology (Lester) *
3. Robbins Pathologic Basis of Disease*
4. WHO – Tumors of Breast and Female Genital Organs (USCAP members get a deal, some people recommending getting all of them eventually)
5. Rosai and Ackerman’s Surgical Pathology
6. Surgical Pathology of GI Tract, Liver, Biliary Tract, and Pancreas (Odze)
7. Head and Neck Surgical Pathology (Pilch)
8. Practical Principles of Cytopathology (DeMay)
9. Atlas of Diagnostic Cytopathology (Atkinson)
10. Surgical Pathology of the Nervous System and Its Covering. (Burger, Scheithauer)
11. Practical Dermatopathology (Rapini)
12. Enzinger and Weiss’s Soft Tissue Tumors
1. Quick Compendium of Clinical Pathology (Mais)*
2. WHO – Tumors of Hematopoietic and Lymphoid Tissues*
3. Teitz Fundamentals of Clinical Chemistry, fifth edition, 2001
4. Clinical Laboratory Medicine by McClatchey, 2002
* Recommended for PGY1
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