mgh:cyto-rotation

• Introduction to Cytopathology

• Clinical Rotations

Anatomic Pathology residents spend four weeks on the cytology service during AP1 (rotation-1), and six weeks during AP2 (rotation-2). Each week that you are on the cytology service, you will be assigned to work a faculty member who is on-service, and you will have an opportunity to review and diagnose current cytology cases. Additionally, there are structured learning modules for rotation-1 and rotation-2.

• Cytology Policies and Procedures

Rotation 1 (4 weeks) Rotation-1 curriculum is intended to be completed during four weeks of AP1.

• Week 1

• 1-1 Introduction to Cytology
• 1-2 Cytomorphology Basics
• 1-3 GYN Cytology Basics
• 1-3 GYN Cytomorphology- Squamous
• 1-3 GYN Cytomorphology- Glandular (Quiz for 1-3)
• 1-4 Body Cavity Fluids
• 1-5 Cerebrospinal Fluid
  
  

• Week 2

• 1-6 Urine Cytology
• 1-7 Respiratory Cytology
• 1-8 Thyroid and Parathyroid Cytology
• 1-9 Salivary Gland and Head/Neck Cytology
  
  

• Week 3

• 1-10 Liver Cytology
• 1-11 Pancreas Cytology
• 1-12 Kidney Cytology
• 1-13 Adrenal Gland Cytology
  
  

• Week 4

• 1-14 Breast Cytology
• 1-15 Basic Lymph Node Cytology
• 1-16 Bone/Soft Tissue Cytology
• 1-17 Fine Needle Aspiration Biopsy Service
  
  

Rotation 2 (2 weeks) Rotation-2 curriculum is advanced, and intended to be completed during two weeks of AP-2. {{collapsed|

• Week 1|

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• Week 2

• 2-6 Pancreas - cysts, molecular testing
• 2-7 Respiratory Cytology - ancillary testing
• 2-8 Thyroid - molecular testing
• 2-9 Lymphoid lesions
• 2-10 Thymus and mediastinum
  
  

Learning Objectives

• Learning Objectives

Patient Care

• Understand the cytological screening process of a Pap Test
• Be familiar with the cytology requisition form(s) available for cytology specimens
• Demonstrate familiarity with collection techniques for all specimen types
• Understand how to use the image-guided screener
• Learn the CoPath System for cytology sign out
• Learn the processing procedures for the various types of cytology specimens
• Witness the HPV processing procedure of the Roche Cobas system
• Watch the DVD of the FNA technique and practice the FNA technique and smearing skills on phantoms
• Be familiar with the ultrasound machine knobology and how to handle the transducer

Medical Knowledge

• Understand the cytological criteria for the routine cytological diagnoses
• Demonstrate knowledge of the Bethesda System for reporting gynecologic and thyroid cytology
• Demonstrate knowledge of specimen adequacy and the basic reporting system for cytopathology
• Demonstrate an investigatory and analytical thinking approach to clinical situations, including the development of a reasonable differential diagnosis based on available clinical information, microscopic features, and current published information
• Understand the utility and limitations of the diagnostic work up of cytology specimens including: selection of special stains, immunocytochemistry, flow cytometry, and molecular studies.
• Demonstrate familiarity with the clinical and radiologic manifestations of various diseases during workup of cytology and fine needle aspiration cases, and use such knowledge to formulate cytologic diagnoses
• Review the basic concepts of ultrasound characteristics that support benign and malignant masses

Practice Based Learning and Improvement

• Actively participate in morning cytology conference
• Review cytology study sets
• Write up interesting cases for the cytology study sets and review with an attending
• Participate in cytology multidisciplinary conferences and meetings if available during the 4 week block
• Participate in the QA review process of the cytological-histological correlation process for both GYN and Non-GYN cytology samples

Interpersonal and Communication Skills

• Demonstrate effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills
• Demonstrate an interest in cytology material during teaching sessions asking relevant questions and responding appropriately to questions from attending pathologists

Professionalism

• Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Demonstrate a commitment to excellence and ongoing professional development by completing directed and independent reading from cytology textbooks and journals, undertaking literature searches on various cytopathology topics when appropriate
• Demonstrate a commitment to ethical principles pertaining to confidentiality of patient information

Systems-Based Practice

• Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
• Understand how the handling of cytology and fine needle aspiration material affects other healthcare professionals in the overall care of the patient including: making accurate diagnoses with efficient use of routine and special stains and other testing including epidemiologically important infectious diseases; achieving rapid turnaround time for cytology reports; and timely communication of results to clinicians to expedite implementation of adequate therapy or discharge from hospital
• Understand the difference between various medical practices and healthcare delivery systems (fee for service, discounted fee for service, capitated systems, ACO) and how they affect the practice of cytology
• Demonstrate knowledge of methods for controlling health care costs and allocation of resources, including understanding the hospital capital budget process as it pertains to the laboratory, and understanding monthly cytology budget reports
• Practice cost-effective healthcare and resource allocation that does not compromise the quality of care, including judicious, cost-conscious ordering of cytology special stains and ancillary lab tests during the performance of fine needle aspiration biopsies
• Demonstrate knowledge of how to coordinate patient care with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare, and knowledge of how these activities can affect system
  
  

Welcome to Cytology

Cytopathology is considered a subspecialty of anatomic pathology but in reality the discipline touches on all areas of anatomic pathology, albeit from the vantage point of the individual cell rather than tissue. The cytopathology laboratory functions separately but in parallel with the other anatomic pathology and clinical pathology labs. Correlation of cytopathology findings with test results obtained on concurrent tissue samples and other ancillary tests (biochemical and molecular) helps to improve diagnostic accuracy. Correlation with clinical and radiologic findings is also important. Residency training in cytopathology trains residents to be competent using a stepwise process for each organ system:

Indications for cytological examination How to procure the specimen Specimen processing Test platforms used Reporting terminology Cytomorphology of normal cells and pathologically altered cells The learning goals are in tune with the pathology milestones. The resident is expected to be at level 1 at the start of residency. Therefore the learning objectives are divided into the levels 2, 3 and 4 to correlate with the milestones. Residents may advance at a more or less accelerated pace through these levels.