The residency program has been and continues to be a major priority of The Ohio State University Pathology Department. The major goal is to train residents to




НазваниеThe residency program has been and continues to be a major priority of The Ohio State University Pathology Department. The major goal is to train residents to
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PATHOLOGY RESIDENCY


A. Philosophy and Goals


The residency program has been and continues to be a major priority of The Ohio State University Pathology Department. The major goal is to train residents to become competent diagnosticians and clinical consultants who will contribute to maintain the high standards of the specialty. Therefore, we are committed to training our residents to develop their skills in the six areas of competencies mandated by the ACGME to the level expected of a new practitioner. Goals, objectives and assessment measures are in place to ensure mastery of these competencies: 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism and 6) systems-based practice. A thorough understanding of pathology is essential for the resident to become a competent consultant who can function optimally in a patient care situation. Participation in scholarly activities and teaching are also considered components of resident training. Our goal is to develop a spirit of inquiry that will allow the practitioner to participate in the generation of new knowledge, learn to critically evaluate research findings, and provide the tools to continue to expand their knowledge upon completion of their training. Exposure of the resident to the administrative, fiscal, ethical, legal and sociopolitical aspects of pathology practice are also a major importance.


B. Curriculum


  1. The basic curriculum is combined AP/CP program that consists of 108 weeks of anatomic pathology, 76 weeks of clinical pathology and 24 weeks of additional AP/CP electives. A 3-year program in either straight anatomic or straight clinical pathology is also offered.




  1. Combined Anatomic and Clinical Pathology Program – 4 years




    1. The 4-year curriculum is arranged as follows: year 1 – anatomic pathology; year 2 – clinical pathology and one elective; year 3 and 4 – anatomic and clinical pathology and AP/CP electives. The rotations are listed below:




PGY-1

AP

LENGTH

(weeks)




Introduction to AP

4




Surgical Pathology (includes 4 wks of Cytopathology)

36




Autopsy Pathology

12

PGY-2

CP







Hematopathology

14




Medical Microbiology

8




Clinical Chemistry

4




Transfusion Medicine

8




Molecular Pathology

4




Cytogenetics

4




Flow Cytometry

2




Electives

8

PGY-3 & PGY-4

AP & CP







Surgical Pathology

16




Gross Room Rotation

4




Cytology Block

8




Forensic Pathology

4




Neuropathology

4




Renals/Transplant

4




Dermatopathology

8




Pediatric Anatomic Pathology

4




AP Subspecialty

(choice of Gyn, Head & Neck, Gastrointestinal, Breast/GU)

4




Hematopathology

8




Transfusion Medicine

8




Pediatric Clinical Pathology

4




Chemistry/Toxicology

4




Chemistry

4




Medical Microbiology

2




Flow Cytometry

2




AP/CP Electives or Research (approval of Program Director)

12




  1. Straight Anatomic or Clinical Pathology – 3 years




    1. A 2-year core curriculum is offered in AP and CP.




AP

LENGTH

(weeks)

Introduction to AP

4

Surgical Pathology

32

Autopsy Pathology

12

Cytopathology

4

CP

LENGTH

(weeks)

Chemistry

4

Hematopathology

14

Transfusion Medicine

8

Medical Microbiology

8

Cytogenetics

4

Molecular Pathology

4

Flow Cytometry

2

Electives

8




    1. The third year for AP consists of 32 weeks in AP rotations in the following areas: surgical pathology including a gross room rotation, cytology, neuropathology, pediatric pathology, forensic pathology, transplant/renal pathology, hematopathology, dermatopathology and up to 20 weeks in non-AP rotations. The non-AP rotations can include any area in pathology and are subject to approval by the program director.




    1. The third year for CP is tailored to the individual’s interest and previous experience. Individual curriculum must be approved by program director.


C. General Competencies


  1. Patient Care


Residents must demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services.


    1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with physicians, laboratory personnel, patients and clerical staff.

    2. Gather essential and accurate information about their patients and/or patient specimens.

    3. Educate staff, students and other physicians.

    4. Use information technology to support diagnostic decisions.

    5. Perform competently the medical and invasive procedures considered essential for pathology.

    6. Work with health care professionals, including those from other disciplines, to provide patient-focused care.




  1. Medical Knowledge


Residents must demonstrate knowledge about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to pathology.


    1. Demonstrate an investigatory and analytic thinking approach to clinical situations.

    2. Know and apply the basic and clinically supportive sciences which are appropriate to pathology.




  1. Practice-Based Learning and Improvement


Residents must be able to demonstrate the ability to investigate and evaluate their diagnostic and consultative practices, appraise and assimilate scientific evidence and improve their patient care practices.


    1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.

    2. Locate, appraise, and assimilate evidence from scientific studies related to patient specimens.

    3. Obtain and use information about their population of patients and the larger population from which their patients are drawn.

    4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic effectiveness.

    5. Use information technology to manage information, access on-line medical information; and support their education.

    6. Facilitate the learning of students and other health care professionals.




  1. Interpersonal and Communication Skills


Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with other health care providers, patients’ and patients’ families.


    1. Create and sustain a therapeutic and ethically sound relationship with physicians, laboratory personnel, clerical staff and students.

    2. Use effective listening skills and elicit and provide information using effective verbal, nonverbal, explanatory, questioning, and writing skills.

    3. Work effectively with others as a member or leader of a health care team or other professional group.




  1. Professionalism


Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.


    1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.

    2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.




  1. Systems-Based Practice


Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide pathology services that are of optimal value.


    1. Understands how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.

    2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.

    3. Practice cost-effective health care and resource allocation that does not compromise quality of care.

    4. Advocate for quality patient care and assist others in dealing with system complexities.

    5. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.


C. Research Opportunities


  1. Research is strongly encouraged with the results published in a manuscript and presented at an annual meeting.

  2. Clinically-oriented research is available with faculty or fellows in all of the rotations.

  3. More basic research opportunities are also available, especially in the following areas:

    1. Cancer immunobiology

    2. Membrane biochemistry and signal transduction regulation

    3. Transplantation immunology

    4. Hemostasis

    5. Molecular biology and cytogenetics

    6. Laboratory-related outcomes research


D. Teaching Opportunities


  1. During required and elective rotations, residents are expected to teach medical technologists, medical students, rotators, and other pathology residents.

  2. Formal teaching by the residents is expected in the following courses:

    1. Presentations at conferences

      1. Intradepartmental conferences

      2. Interdepartmental conferences and tumor boards


E. Duty Hours, Work Environment and Supervision of Residents


Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.



  1. Duty hours are determined by the director of service and clearly communicated to the residents on a given service. Residents will always be provided appropriate back-up support consisting of either another resident, fellow or attending physician to ensure that patient care is not jeopardized. It is the responsibility of the Program Director and faculty to ensure that duty hours correspond to the appropriate program requirements so that residents are not required to perform excessively difficult or prolonged duties on a regular basis. The educational goals of the program and learning objectives of residents must not be compromised by excessive reliance on residents to fulfill institutional service obligations.




    1. On select months, residents log work hours on E*Value.

    2. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.

    3. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call activities.

    4. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.

    5. Scheduled or expected duty hour periods should be separated by 10 hours. If there are inevitable and unpredictable circumstances that occur in which a resident’s duty hours are prolonged, they must still have a minimum of eight hours free from duty before the next scheduled duty period begins.




  1. On-call Activities




    1. PGY-1 residents are limited to a 16-hour shift and are not allowed to take at-home call.

    2. In-house call must occur no more frequently than every third night, averaged over a four-week period.

    3. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.

    4. No new patient may be accepted after 24 hours of continuous duty.

      1. A new patient is defined as any patient for whom the resident has not previously provided care.

    5. At-home call (or pager call)

      1. The frequency of at-home call is not subject to the every-third night, or 24+6 limitation. However at home-call must not be so frequent as to preclude rest and reasonable personal time for each resident.

      2. Residents taking at-home call must be provided with one day in seven completely free from all educational and clinical responsibilities, averaged over a four-week period.

      3. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.

      4. The Program Director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.




  1. Sleeping Quarters and Meal Allowance




    1. Residents on duty in the hospital are provided with a meal allowance, sleeping quarters and lounge areas.

    2. Appropriate security and personal safety measures are provided to residents in all locations including parking facilities and sleeping quarters.




  1. Logging of Duty Hours




    1. Residents and fellows are required to log duty hours on E*Value once a year for a 3 month period (January – March) to assure that we are in compliance with ACGME requirements.

    2. After that period, only residents who have not complied with duty hour requirements will be asked to state why they were not in compliance. This will allow the program to determine whether the resident should continue to log hours. This will assist the department and the institution in keeping compliant and addressing any issues of concern. If a trainee does not comply with this policy, the program director may take disciplinary action.




  1. Moonlighting




    1. Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program.

    2. Internal moonlighting must be considered part of the 80-hour weekly limit on duty hours.




  1. Supervision

    1. Each PGY-1 resident must be directly supervised during performance of, at least, his or her three initial procedures in the following areas: autopsies (complete or limited), gross dissection of surgical pathology specimens by organ system, frozen sections, apheresis, and fine needle aspirations and interpretation of the aspirate.

    2. They will have direct or indirect with direct supervision immediately available provided by faculty, PGY-3 & 4 residents, fellows, and pathologists’ assistants.

    3. Blood Banking/Transfusion Medicine fellows, PGY-3 or PGY-4 residents, or attending pathologists may directly supervise apheresis.

    4. PGY-2 residents are considered to be at the intermediate level.

    5. Residents in the final two years of the program (PGY-3 and PGY-4) are considered to be in the final years of education.

    6. The resident’s responsibilities for patient care decisions, supervision of other residents/students/technologists, and administration are progressively increased according to ability and level of training. Faculty back-up is readily available at all times, and faculty must sign and take the ultimate responsibility for all consultative reports.


F. Conferences


There are many departmental conferences and interdisciplinary conferences within the medical center that residents have the opportunity to participate in.


Conferences in anatomic pathology are held approximately twice a week from 7:30-8:30 am to include didactic sessions, unknown slide conference and journal club.


Conferences in clinical pathology are held approximately twice a week from 7:30-8:30 am to include didactic sessions, unknown slide conference, journal club, and a review of on-call cases.


There is also a regular two year cycle of Business and Laboratory Management lectures covering legal, economic, research design, statistics, ethical, and social issues related to laboratory management.


Interdisciplinary conferences are held in various disciplines throughout the week in the areas of autopsy, dermatopathology, gynecologic pathology, bone and soft tissue, gastrointestinal and liver, as well as a general Tumor Board Conference.


Pathology Grand Rounds is held the 2nd and 4th Tuesday’s from noon-1:00 pm between September through June. This conference provides the opportunity to listen to research efforts among the faculty within and outside of the department.


Chief Residents provide the Pathology Education Office with attendance sheets for logging of attendance on E*Value for required conferences.

The majority of conferences require mandatory attendance.


The resident is to notify Program Director when requesting to be excused from conference. Travel at meetings, vacation and ill days are automatically excused.


Semi-annually, resident attendance will be calculated. If conference attendance falls below 80%, the resident will need to discuss the reasons for absences with Program Director or Associate Program Director. If attendance falls below 70% a letter will be placed in resident’s file as well as possible disciplinary action depending on the recommendation of the Resident Advisory Committee.

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