Surgical Pathology Senior Elective

Overview

This elective is designed to familiarize students with the discipline of surgical pathology and to encourage the development of basic skills in gross pathology and histopathological interpretation.

The Laboratory of Surgical Pathology at Barnes-Jewish Hospital receives a broad range of medical biopsy material in addition to specimens derived from the busy surgical subspecialty practices. As a result, this elective is beneficial not only for students considering a career in pathology, but also for students planning careers in internal medicine, surgery, obstetrics-gynecology, pediatrics, radiology, radiation oncology and dermatology.

Students on this elective will:

  1. Learn how patient specimens are received and processed
  2. Acquire skills in the gross examination and microscopic diagnosis of disease through active participation
  3. Learn the role of the pathologist in the preoperative, intraoperative, and postoperative care and management of patients

Students will function as junior housestaff managing their own cases with supervision from residents, fellows and attending pathologists. Students may also wish to participate in ongoing research projects within the Department as time and interest allow.

The daily schedule for students begins at 8:00 a.m. with morning conference. In general, the student will be able to complete all gross examination and sign-out activities by 4:30 p.m. Students are welcome to stay beyond 4:30 p.m. to participate in any of the academic or other working activities of the Division.

In order to permit maximum interaction with the surgical pathology staff and house staff, the elective is limited to four students (third and fourth year students combined) per 4-week block.

Goals and Objectives

  • Familiarize the student with the organization and clinical activity of the Division of Surgical Pathology
  • Reinforce the student’s knowledge of anatomy, histology and basic pathology
  • Introduce the student to the principles and methodologies of diagnosis in histologic and cytologic specimens
  • Learn the role of the pathologist in the preoperative, intraoperative, and postoperative management of patients through active participation in handling pathologic specimens

By the end of the rotation the student will be able to:

  • Understand the process of specimen handling in the histology laboratory
  • Recognize and describe common gross surgical pathology lesions
  • Perform and dictate a microscopic examination suitable for inclusion into the patients record
  • Formulate a rational approach to the differential diagnosis of common surgical pathology specimens including the use of ancillary techniques when appropriate
  • Integrate the pathologic features with the clinical history to establish a diagnosis for common specimens

Structure of elective

Students choosing this elective will be assigned on the first day to a resident and attending pathologist responsible for managing a general surgical pathology service. This experience includes evaluating a wide array of specimens including neoplastic and non-neoplastic disease from the various medical and surgical specialties (head and neck, thoracic, gastrointestinal, pancreatobiliary, endocrine, breast, genitourinary and pediatric) which will provide a good general overview of the role of the surgical pathologist in a busy academic medical center. Because we recognize that some of our students have special interest in a specific field of study, we offer the option of choosing to spend part of their rotation on one of the sub-specialty’s of pathology listed below.

  • Hematopathology
  • Dermatopathology
  • Neuropathology
  • Gynecologic pathology
  • Cytology/fine needle aspirate

Student Responsibilities

Surgical pathology training

Gross room specimens will be assigned to the student daily by his/her attending pathologist, pathology assistants and gross room fellows and will increase in complexity as technical skills and experience is accrued over the 4 week rotation. Students will start with simple specimens (gallbladders, appendicitis, diverticular disease) and work up to more complicated specimens (inflammatory bowel disease, colon cancer, prostate cancer, etc. …).

Students will be allowed to perform the gross examination and dissection of assigned specimens with resident/fellow/attending pathologist supervision.

Students will be allowed to individually review their gross descriptions and microscopic sections on assigned specimens prior to review of the case with the attending pathologist.

Students will then review and discuss their cases on a one-on-one basis with the attending pathologist after which the student will dictate the report.

At all times students must adhere to all safety policies and follow universal precautions.

Conference attendance and participation

Students will be expected to attend the daily 8:00 a.m. surgical pathology or autopsy conference, Tuesday noon pathobiology conference (see conference schedule) and 1 multidisciplinary working conference each week.

Case presentation

Students will select an interesting case from their assigned specimens and prepare a 10-20 minute discussion for presentation to the Anatomic Pathology residents, fellows and staff during the final week of the rotation. The case is chosen by the student based on his/her interests. Pathology residents and attending pathologists will be available for assistance in taking photomicrographs, suggesting references and practicing (if so desired). This presentation provides an opportunity for the student to show his/her mastery of how to describe morphologic features (accumulated over the previous weeks) and understanding of the pathogenesis of the disease process.

Work hours

The daily schedule for students begins at 8:00 a.m. with morning conference. In general the student will be able to complete all gross examination and sign-out activities by 4:30 p.m. Students are welcome to stay beyond 4:30 p.m. to participate in any of the academic or other working activities of the Division.

Professional expectations

Appropriate attire and closed-toe shoes are required. Students may change into scrubs for gross room examination if desired.

Students are given supervised patient care responsibilities on a daily basis. As a result, excused absences from the rotation must be discussed with and approved by the clerkship coursemaster in advance.

Evaluation of students

Our goal is to evaluate students fairly and promptly. The final grade assigned will primarily reflect the accumulation of skills obtained by handling pathologic specimens over the course of the rotation. The end-of-rotation case presentation represents a small contribution to the overall evaluation. The evaluation is performed by the Attending Pathologist with whom the student worked most extensively. This pathologist will receive input from residents and other staff with whom the student worked.

Students are expected to gain some mastery of the following skills:

  • Obtains appropriate clinical information from a variety of sources
  • Performs gross examination independently with an accurate description
  • Shows vigilance when handling specimens with respect to patient identification, block labeling, etc
  • Shows improvement in microscopic examination skills over the 4-week period
  • Formulates differential diagnoses
  • Dictates efficiently and accurately

Characteristics of students who receive a grade of PASS

By the end of the rotation the student has mastered the objectives stated above including being able to communicate gross and microscopic descriptions both verbally and in written form and develop a rational approach to surgical pathologic diagnosis. The student also demonstrates vigilance in patient identification and specimen handling. Finally, we expect students to attend all daily sign-out activities and morning conferences.

Characteristics of students who receive a grade of HIGH PASS

In addition to the above requirements, students who receive High Pass typically function at the level of a beginning junior housestaff in his/her degree of independence, knowledge and dedication to detail. The High Pass student also shows enthusiasm for the specialty as demonstrated by work ethic, reading about cases received and participation.

Characteristics of students who receive a grade of HONORS

In addition to the above, the Honors student sets himself/herself apart showing outstanding initiative and commitment to learning exceeding expectations of the pathology faculty. This may include but is not limited to one or more of the following: excellence in the approach to the gross room or review of microscopic slides, routine follow-up of interesting cases with literature review and/or participation in Divisional research activities.

Characteristics of students who receive a grade of INCOMPLETE/FAIL

Students who have more than 3 days of excused absences from the rotation that prevent the student from mastering the stated objectives will receive an incomplete. Students in danger of receiving an incomplete will be notified in advance and will be given the opportunity to participate in additional activities to ensure that objectives are met. Students who fail to participate in Divisional activities, have unexcused absences, or have incomplete status and fail to complete additional assigned activities will receive a failing grade for the rotation.

Feedback

Students can expect to receive feedback on his/her gross examination, gross description and morphologic interpretation skills on a daily basis from his/her assigned resident/attending pathologist.

At the end of the rotation the student will meet with the Coursemaster to discuss the student’s performance and grade (if grade is available at that time). Students will also have the opportunity to provide direct feedback about his/her experience during the end-of-rotation meeting.

Students will be asked to fill out an elective evaluation for the medical school as well as a smaller intradepartmental evaluation form designed to obtain information to improve the experience for students in surgical pathology.