Both the College of American Pathologists (CAP) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredit the Laboratory of Pathology (LP). LP is certified pursuant to the Clinical Laboratory Improvement Amendments (CLIA) by the Department of Health and Human Services Health Care Financing Administration.

The residents participate as representatives on the Quality Improvement Committee, and CAP inspection readiness committees. Residents formally participate in the preparation of reports and standard operating procedures for JCAHO and CAP inspection, play an important role in mock inspections, and receive mandatory training in laboratory safety, biohazard waste disposal and radiation training. Residents are assigned to the CAP readiness committee, and conduct inspections in conjunction with senior technical or professional staff. Residents participate in the inspections.

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• The services are covered by four residents rotating every month or every 2 months (one on In-House Surgical Pathology, one on Submitted Surgical Pathology, one on the Autopsy Service, and one on Cytology).
• A third-year Surgical Pathology Fellow also participates in the In-House service. Four senior staff members supervise the residents (one on In-House Surgicals, one on Submitted Surgicals, one on the Autopsy Service, and one on Cytopathology).
• The senior staff rotates weekly. At a given point in time two residents are on elective.
• Sign-out sessions and/or conferences start every morning at 8:30a.m.
• All residents are expected to participate in the departmental conferences (see Appendix A1).
• Attendance at the twice-weekly pathology teaching conferences (Tuesday and Thursday, 1:00 p.m.), and the autopsy gross conference (Monday, 8:30 a.m.) is required for all residents.
• Residents formally participate as members in Quality Improvement Committee, ASCP meetings, and the United States and Canadian Academy of Pathology.
• Residents make formal presentations at these meetings. Each year a resident is nominated to serve on the ASCP National Resident Physician Liaison network.
• Residents serve on both the LP Fellows Committee and the NIH Fellows Committee, making recommendations to the staff and the institution regarding departmental and institutional programs.
• Senior residents oversee junior residents performing gross specimen examination and cutting, as well as supervise junior residents on autopsy. Senior residents also assist during resident orientation of new residents, teaching conferences intra and inter departmental. All senior residents are assigned as mentors to a junior resident during the orientation month of new incoming residents. While the NIH is not affiliated with a medical school, medical students may take electives at the NIH. Rotating medical students are assigned to anatomic pathology service areas (e.g. surgical pathology, cytopathology, autopsy) under the supervision of a resident, who provides instruction, guidance, and mentoring. However, the senior staff takes ultimate responsibility for all cases assigned to medical students.
• Residents participate in specific test/instrument evaluation procedures; for example, the residents have participated in the review of new automated immunostaining devices introduced into the Immunohistochemistry Lab, i.e. the Dako, Ventana immunostainers. As part of their instruction in immunohistochemistry, residents screen immunohistochemical preparations and controls, and evaluate them for technical adequacy, sensitivity, and specificity. Residents may be assigned to test and evaluate a new monoclonal antibody for clinical usage. Residents played a role in the evaluation of the new automatic H&E stainer in the Histology Laboratory.
• Residents interact daily with Clinical Fellows in other ACGME accredited fellowships in other clinical departments. Residents discuss cases from their service with them. They present at clinicopathological conferences, where the clinical history is presented by the Clinical Fellow, the resident presents the pathological findings, and the case is then discussed by all participants. Residents have direct responsibility for teaching research fellows, rotating medical students and predoctoral students. Rotating medical students are assigned to a clinical service rotation (e.g. surgical pathology, cytopathology, autopsy) with a resident. The resident serves as a mentor and teacher, although the staff takes ultimate responsibility for all cases assigned to medical students.
• One resident is appointed to serve on the LP Safety Committee and attends quarterly meetings each year. The resident serving on this committee represents residents and fellows of LP.
• Each resident must review and understand the following procedure manuals:
  • LP Safety Manual
  • Clinical Services General Policy Manual
  • Autopsy Manual
  • Grossing Manual
  • Request for Human Biological Materials
  • Other manuals must be reviewed in each section as required by each Clinical Chief.

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The residents and staff on service carry pagers so they can be promptly located when necessary during normal working hours. It is the responsibility of the on-call resident and staff person to check in with the paging operator (496-1211), leaving the appropriate signal page number and home number. The operator should also test the long distance signal pager to make certain it is working.

Residents are on call by phone or long-range pagers. Residents are not required to be present at the institution during periods of on call. Residents' on call responsibilities include coverage of surgical pathology, post-mortem pathology and cytology services. In addition, the resident on call may be asked to perform initial processing of specimen for other diagnostic services in Anatomic Pathology (i.e, hematopathology, flow cytometry, cytogenetics, electron microscopy, etc.)

Faculty supervision for the resident on call is two-tiered. At the first level is the on call attending who is the primary resource for the resident when there is an autopsy, surgical specimen or frozen section to be processed and diagnosis rendered after hours or on weekends. The second tier of faculty support consists of surgical pathology, post mortem pathology and cytology attending staff who have specifically requested to be notified in case of difficulties regarding these services.

The resident on call discusses clinical activities with the attending pathologist on call. Immediate feedback is provided to the resident from the on call attending. The on-call attending may enlist the consultation of other staff pathologists, if indicated, or requested by the clinical staff or resident staff.

NEVER HESITATE TO CALL THE STAFF ON DUTY FOR ADVICE AND INSTRUCTIONS. NEUROPATHOLOGY STAFF & OTHER SUBSPECIALTY STAFF ARE ALWAYS AVAILABLE.

The resident operates with increasing levels of responsibility and autonomy as he/she progresses through the program. However, it is the responsibility of the resident on call to operate within his/her abilities and request help from attending on call when necessary. It is the responsibility of both the resident and on call attending to assure that the highest level of patient care is maintained. A first year resident is closely supervised, and the staff pathologist is generally on-site with the resident during all activities. For example, the staff pathologist would assist a first year resident during the autopsy examination. A second year resident is considered qualified to complete the autopsy examination independently, consulting with the senior staff prior to beginning the case regarding the diagnostic questions and any special procedures to be performed. At the conclusion of the case, the second-year resident will again consult with the senior staff regarding the Provisional Anatomic Diagnosis based on gross examination. A third-year resident assumes still greater responsibility, assisting in the supervision of junior residents, and instructing them in procedures of gross and microscopic examination. For emergency diagnostic cases (surgical pathology, cytopathology), diagnoses are always reviewed by a senior staff, prior to reporting of the diagnosis by a first or second year resident. In some instances, the senior staff may authorize a third-year resident to provide preliminary diagnostic information.

On Call: Residents take weekend and evening calls, with the stipulation that all residents must have at least 1 full 24 hr day off in 7, as averaged over a four week period. A single resident covers all clinical services: surgical pathology, autopsy, and cytology. A separate attending staff pathologist is designated for each service.

Residents take call from home and are not required to stay in the hospital. They carry a beeper with a radius range of 50 miles, giving them the flexibility to pursue personal activities during their call responsibilities. During the first two years of experience, the resident serves a total of seventeen and one-third weeks on call. Most of this call time is served in the first year of residency. Third year residents are relieved of call responsibilities, but are available to advise and mentor junior residents. In addition, to insure that no resident carries an excessive burden, a back-up resident is available for coverage if a resident receives more than 2 autopsies to perform on any call day.

The duty hour standards and requirements of ACGME are fully met. Residents never sleep over at the hospital. A duty hour starts only when the resident comes in to handle a specimen or conduct an autopsy. Actual duty hours worked on call for any week that the resident carries the beeper ranges only 2-6 hours and frequently the resident is not called in at all.

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E. Leave & Back-up coverage

Vacations should be taken during an autopsy or cytology rotation or elective. If vacation is taken during autopsy rotation, back-up coverage must be arranged, and the Chief of the Autopsy Service notified. If vacation is taken during a cytology rotation, a make-up rotation should be scheduled with the Chief of the Cytopathology Section. Try not to take vacation during the month of July. Complete request for Administrative/Annual Leave (see Appendix A8).

Attendance at scientific meetings or courses will be covered by Administrative Leave. As with Annual Leave, back-up coverage by another resident should be arranged. Request form (see Appendix A8) should be completed prior to the initiation of Travel Orders.

"Emergency" use of annual or sick leave will be defined as any leave not scheduled in advance. If the resident taking emergency leave is on the autopsy service, the resident on cytology rotation will cover.

If two or more autopsies occur, then the resident on elective rotation will step in. If the resident taking emergency leave is on the in-house surgical service, then a second-year resident on elective will cover. If the resident taking emergency leave is on the submitted service, then the third-year fellow on elective will cover.

Service coverage for all leave scheduled in advance will be arranged among the residents on an individual basis. The resident scheduling the leave is totally responsible for arranging for the coverage.

Coverage of emergency leave will be coordinated by the Chief Resident, in consultation with the Program Directors and Chiefs of the services involved.

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F. Extramural Rotations

To satisfy criteria for licensure in anatomic pathology, the residents are required to complete a rotation in forensic pathology.

Outside elective rotations must be approved in advance by one of the Program Directors. The outside rotation approval form must be submitted at least 1 month in advance (Appendix A2). This form must also be completed prior to institution of required outside rotations so that appropriate notification and liability coverage can be maintained.

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G. Statistical concepts:

·Residents receive formal training in statistical concepts as part of the organized course in clinical research and informatics offered by the NIH Clinical Center.

During the data club sessions held in the research sections of the Laboratory of Pathology, residents receive weekly exposure to statistical analysis methods

During immunohistochemistry rotations they learn the principles of sensitivity and specificity testing as applied to monoclonal antibodies.

Courses in statistics are offered to residents through the NIH Foundation for Advanced Education in the Sciences (FAES). Such courses include:

• Experimental Statistics
• Epidemiology
• Methodology in Clinical Trials
• Regression and Correlation Methods
• Statistics for Biomedical Scientists
• Categorical Data Analysis
• Nonparametric and Robust Methods
• Survival Data Analysis
• Introduction to Mathematical Modeling With Application to Quantitative Analysis of Binding Data.

The NIH/FAES are accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

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H. Tissue distribution for research purposes:

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Orientation includes introduction to library search services. Personal resources available to all residents include personal computers with network access to online literature services. Staff instruct residents in how to conduct effective and targeted literature searches. This is performed as part of the evaluation of interesting surgical or post-mortem cases. In addition, all residents are expected to complete at least one manuscript for publication during the course of the residency. The senior staff mentor residents regarding the preparation of a research paper, including an effective review of the literature.

Residents have access to a departmental library and a large complete medical library in the same building. In addition, the National Library of Medicine is on the NIH campus. Each resident is provided with desktop computer, word processing, database and Internet access software. In preparation for case review or conferences the residents are required to conduct literature searches using online software through the National Library of Medicine. Residents conduct computer searches to compile data from the medical literature for case studies, and as part of the process of generating a diagnostic pathology report.

As part of a new Grand Rounds series, all NIH residents and fellows, should attend a lecture "Separating Wheat from Chaff" on critical evaluation of the literature.

The CCR Fellows Editorial Board is service available to NCI fellows. The Fellows Editorial Board is a way for you to have your manuscripts (grants, papers, etc.) reviewed by your peers for editorial content. The Board will not judge the scientific merit of the manuscript/grant. All submissions will remain confidential! If you are interested in taking advantage of this new service, contact Isaac Rodriguez-Chavez at chavezi@mail.nih.gov

• Submit an electronic document or 5 hard copies of your manuscript or grant application (in the form of a complete draft) to the CCR Office of the Director, Building 31A, Room 3A11, Attn: NCI, CCR Fellows Editorial Board.
• Within 10 days, the Board will edit your document for form, clarity and content. They will not, however, evaluate its scientific merit.
• Authors will be able to meet one-on-one with a Board member to discuss any suggested editorial changes.
• Multiple submissions are encouraged until a final product is optimally developed.

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J. Mental or emotional conditions inhibiting performance or learning and drug- or alcohol-related dysfunctions:

Residents are encouraged to attend a lecture by State of Maryland on physician impairment as part of Grand Round Series, The scope of Physician Impairment.

Residents meet with the Program Directors on a one-on-one basis every six months. At these meetings, they are interviewed about their satisfaction with the program, and any personal concerns that they may have about their professional circumstances, or demands from their personal lives.

Counseling, Medical, Psychological support services are available through the Employee Assistance Program. The EAP provides counseling and support to all employees for issues related to stress and drug or alcohol related dysfunction.
Medical services for work-related injuries are available from the Occupational Medical Service.

The policy on physician impairment and substance abuse is available upon request.

All residents receive and sign a Memorandum of Understanding or "Contract" that outlines access to counseling, medical and psychological support services, policies on physician impairment, conditions of reappointment, and other institutional policies.

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Last Updated 1/12/2009 2:43:08 PM