The Anatomical Manual A Handbook and Guide for Residents

Dr. Carolin J. Teman, MD FCAP FRCPC

Version 2 – published 05 September 2019

2019-2020 TRAINING in Anatomical Pathology ______Table of Contents Section 1: Welcome and Introduction ...... 6 Section 1.1: Overview...... 6 Section 1.2: Blueprint for Success in Anatomical Pathology ...... 7 Section 1.3: Resources ...... 10 Section 1.4: General Structure and Content of the Program ...... 11 PGY 1 (13 blocks): Basic Clinical Training ...... 11 PGY 2 (13 blocks): Anatomical Pathology ...... 11 PGY 3/PGY 4/PGY5 (39 blocks) ...... 11 Section 1.5: Royal College of and of Canada (RCPSC) ...... 13 GENERAL STANDARDS OF ACCREDITATION – A STANDARDS ...... 13 National Standards for Training PRIOR to July 1, 2019 (Traditional Program Stream) ...... 13 National Standards for Training AFTER July 1, 2019 (CBD Program Stream) ...... 13 Section 1.6: Policies and Procedures ...... 14 Anatomical Pathology Residency Program Safety Policy ...... 14 PGME Safety Policy ...... 14 Professional Standards for Faculty Members and Learners ...... 14 Public Laboratories Environmental Health and Safety Manual ...... 14 Alberta Public Laboratories Respectful Workplace Policy ...... 15 Alberta Public Laboratories Human Rights Policy ...... 15 Anatomic Pathology and Manual ...... 15 Program Policy: General Expectations for Residency Training ...... 17 Program Policy & Procedure: Requests for Time-Off ...... 18 Sick/Compassionate/Bereavement/Special Leave ...... 18 Leaves of Absence ...... 18 Vacations ...... 19 Conference/Educational Leave (Article 12 – Resident Physicians Agreement) ...... 20 Exam/Study Leave (Article 13 – Resident Physicians Agreement) ...... 21 Program Policy & Procedure: Out of Province Electives ...... 23 Winter Break (Block 7) ...... 23 CME Funding ...... 25 Mandatory Rounds/Meetings ...... 26 On Call ...... 27 Section 2: Educational Opportunities ...... 35 Section 2.1: Academic Half-day ...... 35 Rounds (a.k.a. Friday Slides or Unknown Slides) ...... 35 Rounds (aka Autopsy Demonstration, or Autopsy Demo) ...... 36 Didactic Curriculum ...... 38 Section 2.2: Other Rounds ...... 42 CPC-IM Rounds ...... 42 CME Rounds ...... 42 CPC-ICU Rounds ...... 42 Weekly GI Teaching Rounds ...... 42 Tom Baker Centre (TBCC) Rounds (Tumor Board) ...... 42 Paul Kneafsey Rounds (PK Sessions) ...... 43 M&M Pathology Teaching Rounds ...... 43 Gross Sessions ...... 43 Journal Club ...... 43 Section 2.3: Associations, Conferences, and Meetings ...... 44 USCAP ...... 44 CAP-ACP ...... 45 The Banff Pathology Course ...... 45

P a g e | 2 v. 2019 RESIDENCY TRAINING in Anatomical Pathology ______International Conference on Residency Education (ICRE) ...... 45 Canadian Anatomic and Conference ...... 46 Section 2.4: PGME Workshops ...... 46 Section 2.5: Non-Medical Expert CanMEDs Roles ...... 47 Elective in QA/QC/Informatics ...... 47 Personal Learning Projects (PLPs) ...... 47 Section 2.6: Other Courses, Workshops, and Meetings ...... 48 didactics ...... 48 Office of Faculty Development (OFD) Teaching Workshops ...... 49 Review Courses ...... 49 Medical Examiner’s Symposium ...... 49 Section 2.7: Residents as Teachers ...... 50 Section 3: Research ...... 51 Section 3.1 Introduction ...... 51 Section 3.2 The Research Coordinator ...... 52 Section 3.3 Research Proposals, Process, and Funding ...... 53 Resident Research Database ...... 53 Research Proposals ...... 53 Research Process ...... 53 Internal Support for Resident/Fellow Research Projects ...... 54 Section 3.4 DPLM Research Day ...... 55 Research Day and Banquet ...... 55 Research Day Awards ...... 56 Paul Kneafsey Memorial Fund and Lecture ...... 56 Section 3.5 Clinical Investigator Program (CIP) ...... 58 Section 4: Evaluation ...... 59 Section 4.1: Traditional Stream ...... 59 ITERS ...... 59 FITER ...... 59 Section 4.2: Competence by Design (CBD) ...... 60 Entrustable Professional Activities for Anatomical Pathology ...... 60 Stage: Transition to Discipline ...... 60 Stage: Foundations of Discipline (aka Foundations) ...... 63 Section 4.3: Examinations ...... 95 In-House Examinations ...... 95 Other ...... 96 Section 4.4: Promotion, Appeals, Remediation, Probation, and Dismissal ...... 98 Evaluation and Promotion ...... 98 Appeals ...... 98 Section 4.5: Residents as Evaluators ...... 98 Section 5: Other/Miscellaneous ...... 100 Section 5.1: Introduction ...... 100 Section 5.2: Social Events ...... 100 Welcome BBQ ...... 100 Outdoor Day/Resident Social ...... 100 Resident’s Retreat ...... 100 Section 5.3: Career Planning, Health and Wellness, Support ...... 101 Career Planning...... 101 Wellness ...... 101 Financial Health ...... 102 Mentorship ...... 102 Ombudsperson ...... 103 Section 5.4: Awards ...... 104

P a g e | 3 v. 2019 RESIDENCY TRAINING in Anatomical Pathology ______Section 6: Residency Training Committee ...... 105 RTC Terms of Reference ...... 105 The Competence Committee – Terms of Reference ...... 108 The Evaluation Subcommittee Terms of Reference – currently inactive ...... 113 The Research Coordinator ...... 114 Section 7: Rotation Goals and Objectives ...... 115 Section 7.1: Introduction ...... 115 Section 7.2: Mandatory Rotations ...... 115 PGY 1: Basic clinical training ...... 115 Pathology 1: Orientation (Block 1) ...... 116 Pathology 2: , Anatomy, and Basic Pathology (Block 11) ...... 118 Internal : ...... 120 : ...... 122 ...... 123 and Gynecology ...... 124 ...... 128 Pediatrics: ...... 129 ...... 131 Diagnostic ...... 133 PGY2: Anatomic Pathology Core ...... 135 Adult Autopsy (FMC) ...... 135 Surgical Pathology ...... 139 PGY3-5 – Rotations ...... 147 Genitourinary Pathology (RGH) ...... 147 Lymph Node Pathology ...... 152 Cytopathology (DSC) ...... 157 (OCME) ...... 166 (ACH) ...... 170 Renal/EM Pathology (FMC) ...... 179 Neuropathology (FMC) ...... 181 Chief Resident (FMC) ...... 189 Bone Marrow Pathology ...... 192 (DSC)...... 198 Molecular Genetic Pathology ...... 202 Molecular Pathology Laboratory ...... 202 Cancer ...... 205 Molecular ...... 206 Section 7.3: Elective Rotations ...... 215 Program Policy: Sub-Specialty Elective Booking ...... 215 Bone and Soft Pathology (FMC) ...... 217 General Hematology & PBS Morphology ...... 219 Hemoglobin Disorders ...... 226 “Rural” Community Surgical Pathology (Red Deer, Alberta) ...... 230 Gynaecologic Pathology ...... 231 Laboratory Informatics ...... 236 Breast Pathology (FMC) ...... 238 Gastrointestinal (GI) Pathology ...... 240 Liver Pathology ...... 243 Cardiovascular Pathology ...... 247 Pulmonary (Thoracic) Pathology ...... 250 Head and Neck Pathology ...... 257 Frozen Section ...... 258 Endocrine Pathology ...... 260

P a g e | 4 v. 2019 RESIDENCY TRAINING in Anatomical Pathology ______PGY5 – Junior Staff - Anatomy/Histology Block 11 ...... 263 Appendix A: Millennium ...... 265 Millennium Tips and Tricks for Dictation ...... 265 Medical Transcription Staff List ...... 267 Millennium Special Characters ...... 268 Appendix B: Sign off Sheet ...... 269 Appendix C: Emergency Contact Information ...... 270 Appendix D: Competence By Design – under construction ...... 271 How to Log in to ePortfolio(for Faculty): ...... 273 How to complete an observation in ePortfolio (for Faculty): ...... 275

P a g e | 5 v. 2019 RESIDENCY TRAINING in Anatomical Pathology ______Section 1: Welcome and Introduction Section 1.1: Overview Welcome to the Anatomical Pathology Residency Training Program at the University of ! We are a 5-year Royal College accredited program. We aim to not only prepare our trainees for Certification in the Specialty of Anatomical Pathology, but to produce exceptional graduates who will become leaders in their field.

Within this manual there is a great deal of detailed information about the structure and content of this residency program. You are strongly encouraged to read this manual in its entirety, ideally during the orientation block of your PGY1 year. This will make you aware of the opportunities available to you, and will help maximize your success as a resident.

We want all of our residents to graduate as well-rounded, highly skilled anatomical pathologists. Just as importantly, we want you to develop a reputation as a hardworking, responsible, and personable colleague. The latter is probably the most important factor that will help you get the fellowship and/or job of your choice.

More specific inquiries can be directed towards the Program Director, Program Administrator, or may be found in related subspecialty manuals.

The program is structured to ensure that trainees obtain more than enough experience necessary to fulfill all the requirements of the Royal College for certification in Anatomical Pathology. We also pride ourselves, however, on having a flexible and unique program that also strives to accommodate the special interests or needs of our residents.

The overall goal of our Program is to provide a fair and challenging environment of integrated service, education and research, in order to produce pathologists who have achieved excellence in all of the core competencies.

We hope that you enjoy and profit from your training at the . Your suggestions and feedback are always welcome.

Program Director: Dr. Carolin Teman (403) 944-8503 [email protected]

Program Administrator: Ms. Cassandra Saubak (403) 944-1692 [email protected]

CBME Lead: Dr. Amy Bromley (403)944-5055 [email protected]

P a g e | 6 v. 2019 RESIDENCY TRAINING in Anatomical Pathology ______Section 1.2: Blueprint for Success in Anatomical Pathology Here is a brief summary of program expectations. If you follow these guidelines, you are on the track toward success. Additional Program Policies can be found later in this document.

1. Pass all of your rotations. - This is a no-brainer.

 When you begin a new rotation, review the rotation objectives in this manual, and meet with the rotation director to discuss expectations.  Work hard.  ‘OTP’: On Time Performance! Arrive on time and stay at least as late as your staff pathologist, unless they kick you out.  Ask for feedback during the rotation. Be open to constructive criticism.  Take ownership of your cases.  Plan on spending at least one hour a day on independent study (both reading and/or slide review) relevant to your rotation. (You will need to do this anyhow as a PGY5 when you are studying for your Royal College exam. It is much easier to study a little bit every day throughout residency, than to cram during the last year of residency.)  Ensure that you have at least 75% attendance for each rotation. This is a PGME requirement. Lower than 75% attendance will result in having to repeat all or part of the rotation, which may in turn delay your promotion/graduation dates.

2. Pass your in-house exams.

 In-house exams are great practice for the Royal College exam. They also provide an objective way for the program to assess your progress, and are an important factor in decisions regarding promotion to the next PGY year, remediation, and probation.  There is more detailed information in the “Examination” section of this manual. However, know that the minimum pass mark on our in-house “Royal College style” exam is 45% for PGY2, 55% for PGY3, 65% for PGY4, and 75% for PGY5. If you fall below this threshold, you will likely need to write a remedial exam at the very least.  Repeated exam failures or severe failures (more than 10% below minimum pass threshold) will lead to consideration of remediation or probation.  For the RISE exam, we expect our residents to obtain at least 50th percentile for their PGY year. (Your peer group for the RISE exam consists predominantly of American AP/CP residents who get only half as much AP experience as you, so you should definitely be in the top 50% overall.)  Please take in-house exams seriously, and study for them. Ideally you should be studying a little bit every day, which is a lot more productive than cramming in the 2-3 weeks ahead of the exam.  There are a ton of study resources available in the residents’ folder on the G drive. Senior residents are also a great source of advice on how to study.

3. Attend all required departmental educational activities.

 This includes academic half day, CPC rounds, departmental CME rounds, and any additional rounds or tumor boards required by your rotation.  Be an active participant.

Page | 7 RESIDENCY TRAINING in Anatomical Pathology ______ Spend plenty of time preparing for unknown slide rounds. We expect a minimum of 80% attendance for required rounds. Failure to meet the 80% attendance threshold is considered a professionalism breach, and may result in a variety of unpleasant consequences including remediation, probation, etc.

4. Participate in at least one research project during residency.

 This is not only a residency requirement, but a Royal College requirement in order to obtain specialist certification in Anatomical Pathology.  Research experience is also a requirement for many fellowships and jobs. There is up to a year of elective time during residency, which includes ample time for research. You should begin a research project no later than your PGY3 year.  We expect all of our residents to present annually at resident research day beginning no later than PGY3.  Ideally you should have at least one first-author publication on your CV by the end of residency.  There is grant money available for resident research through the residency program; more information is available in the research section of this manual.

5. Stay on top of your administrative tasks.

 Ensure that your ITERs are complete, that you have reviewed them (and signed off in one45) in a timely fashion.  Submit vacation (and other time) requests well ahead of time. (Follow the policies and procedures as outlined in this document.)  Know your collective agreement  Check your pay statements. – There have been situations in the past where a resident was on the wrong pay scale for over a year! We want to ensure your remuneration is reflective of your level of training.  Read your emails! Much important information is communicated in this fashion and is learning to manage, respond and prioritize necessary for your success (Like your annual U of C Registration and your Letters of Engagement).  Refer to the weekly schedule regularly or add it to your mobile device. This office has phased out paper schedules: it’s all online. Refer to the website or your mobile schedule for rounds updates and information.

6. Plan to study on your own, outside of work.

 Although your residency lasts five years, there is an immense amount of information that you will need to learn, and you won’t necessarily be exposed to all of this information during your rotations. You will need to fill in the gaps with independent study. Most residents should expect to study for about 5-10 hours per week outside of regular service work.  The best way to go about this is to make a structured reading plan, supplemented with regular slide study. Slide study is often more fun in a group setting, and you are encouraged to form a study group with your peers.  If you make a habit out of consistent and structured study throughout residency, it will pay huge dividends in terms of improved exam performance, improved rotation performance, and a much lower stress level while preparing for the Royal College exam in PGY5.

Page | 8 RESIDENCY TRAINING in Anatomical Pathology ______7. Be a good colleague.

 Again, this is a no-brainer. Reputations are established quickly, and will follow you wherever you go after residency.  The Canadian pathology community is quite small, and a good reputation will go a long way to ensure you get recruited for fellowships and jobs.  Be professional.  Be reliable.  Be kind to others.  Offer to cover for other residents when they are ill or have a family emergency.  Help teach medical students and junior residents.  Be the kind of person that we will want to hire as a staff pathologist once you are done with training. (By the way, we already think that you are this kind of person, otherwise you wouldn’t have been accepted into this residency program! )

8. Don’t be afraid to ask for help.

 Residency is tough: we are here to help.  Nobody gets through residency without periods of feeling stressed out, anxious and/or overwhelmed, although some may hide their stress more than others.  The inherent stress of residency is further compounded by life stressors (both good and bad) including marriage, divorce, kids, personal illness, family illness, financial stressors, etc.  If stress is affecting your performance, seek help before it becomes a major problem.  We have a list of resources (page 9 in this manual) that you can explore, including links to PARA, PFSP (Physician and Family Support), and others.  Many times, speaking with your Program Director or Program Administrator is the first step so that we can help direct you to the resources you need to thrive.

Page | 9 RESIDENCY TRAINING in Anatomical Pathology ______Section 1.3: Resources

AHS Protection Services: ACH 403-955-7600 RGH 403-943-3430 FMC 403-944-1152 SHC 403-956-1000 PLC 403-943-4502

Alberta Health Services: http://www.albertahealthservices.ca  AHS Occupational Health and Safety Office: http://www.calgaryhealthregion.ca/supp/ohs

Alberta Public Laboratories: https://www.albertapubliclabs.ca  APL Occupational Health and Wellness: http://intranet.calgarylabservices.com/Page261.aspx#Home

Alberta Rural Physician Action Plan: http://www.rpap.ab.ca/

AMA Physician and Family Support Program: (PFSP) Hotline: 1-877-767-4637 (toll free 24 hours/day) http://www.albertadoctors.org/bcm/ama/ama- website.nsf/AllDoc/FB63EBAA53FB0B6987256DE3005F370B?OpenDocument

Calendars: Weekly Schedule https://calendar.google.com/calendar/ical/qgdmd6q57r6ks8ie24j6vgugfc%40group.calendar.google.com/priva te-6db6c10c3be69a05d3fd376951fd6608/basic.ics

Orientation and Teaching Calendar (Blocks 1 & 11) for PGY1’s & 2’s https://calendar.google.com/calendar/ical/fvkl1ji59c4c50ccpcibvl126o%40group.calendar.google.com/public/b asic.ics

ePortfolio sign in page: https://rclogin.royalcollege.ca/oamlogin/login.jsp

Nikon Instruments Video Tutorials: https://www.microscope.healthcare.nikon.com/learn/video-tutorials with the following topics available:  Features of an objective  Finding dirt in the Optical System  Cleaning Optics  Maintenance Bulb Replacement; and  Phase, polarization and DIC Microscopy

PARA: 403-236-4841 PARA Collective Agreement https://para-ab.ca/agreement

PGME Residency Training Policies: http://cumming.ucalgary.ca/pgme/current-trainees/residency- training-policies

**Resources for New Residents (an Internal collection) G:\Residents\Resident Resources\Resources for New Residents**

University of Calgary Counseling Services: http://www.ucalgary.ca/counselling/personalcounselling Sexual Harassment Office: Shirley Voyna Wilson 403-220-4086 [email protected] Faculty of Medicine Office of Equity and Teacher Learner Relations: phone: 403-210-6424 email: [email protected] website: http://medicine.ucalgary.ca/equity_teacher-learner Access and Privacy Coordinator: http://www.ucalgary.ca/secretariat/privacy

Page | 10 RESIDENCY TRAINING in Anatomical Pathology ______Section 1.4: General Structure and Content of the Program The Residency Training Program at the University of Calgary is first and foremost designed to meet the training requirements of the Royal College of Physicians and Surgeons of Canada. In addition, other opportunities are available and specifically applicable to the program and system in Calgary. We pride ourselves on having a demanding and comprehensive program that also includes tremendous flexibility and the opportunity to individualize a training plan specific to a resident’s ultimate career goals. The following includes the current rotation requirements for the 5 year training program at the University of Calgary. Note that one “block” equates to four weeks of training (13 blocks per year).

PGY 1 (13 blocks): Basic Clinical Training 2 blocks Anatomical Pathology (1 Orientation + 1 Anatomy/Histology)(FMC) 2 blocks Surgery (1 + 1 Surgical specialty) (RGH) 2 blocks (1 General Internal Medicine (MTU) + 1 ) (RGH) 1 block Obstetrics and Gynecology (RGH) 1 block Pediatrics (ACH) 1 block Medical Oncology (FMC) 1 block Gynecologic Oncology (FMC) 1 block Elective 1 block Emergency Medicine (RGH) 1 block Radiology (RGH)

PGY 2 (13 blocks): Anatomical Pathology 9-10 blocks Surgical Pathology (FMC/PLC/DSC/RGH/SHC) 3-4 blocks (Adult) Autopsy (FMC)

PGY 3/PGY 4/PGY5 (39 blocks) 17 blocks “mandatory” These are the minimum requirements; additional blocks can be taken if desired. Best if completed before PGY5. 1) 4 blocks cytopathology (DSC) – three blocks in PGY3 or 4, one block in PGY5 2) 1 block /electron microscopy (FMC) 3) 2 blocks pediatric pathology (ACH) – any time after PGY3 block 7 4) 2 blocks forensic pathology (OCME) – any time after PGY3 block 7 5) 2 blocks neuropathology (FMC) – any time after PGY3 block 7 6) 2 blocks GU pathology (RGH) (may be split) 7) 1 block lymph node pathology (FMC) 8) 1 block bone marrow pathology (FMC) 9) 1 block molecular genetic pathology (molecular lab and cytogenetics) 10) 1 block dermatopathology (DSC)

12 blocks elective time: Taken any time between PGY 3 and 5 years (recommend that at least 2 blocks be saved for the final 6 months of PGY 5 year) Examples of suitable elective rotations: rural pathology, research, general pathology, or subspecialty focus (eg. breast pathology, pulmonary pathology, GYN pathology etc).

4-6 blocks of other AP rotations (examples given below) Taken any time between PGY 3 and 5 years: May include rotations such as: general surgical pathology (any site), adult autopsy pathology (FMC), other specialty surgical pathology (eg. gyne pathology, breast pathology), etc.

Page | 11 RESIDENCY TRAINING in Anatomical Pathology ______3-5 blocks as Chief Resident (FMC) In general, PGY 4 only. NOT recommended for PGY 5 in final 6 months of training.  Must include regular (~25-50%) participation in the FMC surgical pathology rota (typically in a supervisory role, assisting junior residents).  Must be taken on site at FMC.  May overlap with other electives (eg. autopsy, research, some sub-specialty rotations, etc.), as long as the Chief remains on site at FMC.

* ALL rotations will be evaluated, and must have a preceptor and objectives established prior to commencement.

Page | 12 RESIDENCY TRAINING in Anatomical Pathology ______Section 1.5: Royal College of Physicians and Surgeons of Canada (RCPSC) GENERAL STANDARDS OF ACCREDITATION – A STANDARDS GENERAL STANDARDS OF ACCREDITATION (2012) – B STANDARDS The General Standards of Accreditation apply to all Canadian Residency Training Programs (B Standards) and their Universities and Affiliated Sites (A Standards). They are hyperlinked above for reference

Accreditation of each residency program is based on compliance with meeting these standards. In addition, Specific Standards, Objectives of Training, and Specialty Training Requirements in each Program must be met in order for the Program to maintain Royal College Accreditation status.

Programs are formally reviewed by the College (“External Review”) on a 6 year cycle. Programs also undergo an Internal Review 3 years prior to assist the program with preparation for the RCPSC visit.

Format of the Comprehensive Objective Examination in Anatomical Pathology Examination dates Digital Images Practice Site

National Standards for Training PRIOR to July 1, 2019 (Traditional Program Stream) CanMEDS 2015 Objectives of Training Special Addendum Specialty Training Requirements in Anatomical Pathology (2013; Version 2.0) These training requirements apply to those who begin training on or after July 1, 2013 but before July 1, 2019. Objectives of Training in the Specialty of Anatomical Pathology (2013) This document applies to those who begin training on or after July 1st, 2013 but before July 1, 2019. Specialty Training Requirements Specific Standards of Accreditation for Residency Programs in Anatomical Pathology (2013) The purpose of this document is to provide Program Directors and Surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in anatomical pathology. This document should be used in conjunction with the General Standards of Accreditation, the Objectives of Training and the Specialty Training Requirements in Anatomical Pathology. Editorial revisions – 2013

National Standards for Training AFTER July 1, 2019 (CBD Program Stream) Competencies in Anatomical Pathology Standards of Accreditation for Residency Programs Training Experiences

More on CBD Evaluation at the University of Calgary APPENDIX D: COMPETENCE BY DESIGN

Page | 13 RESIDENCY TRAINING in Anatomical Pathology ______Section 1.6: Policies and Procedures

Anatomical Pathology Residency Program Safety Policy SCOPE: All residents enrolled in the Anatomical Pathology Residency Training Program, University of Calgary.

PURPOSE: To ensure the residents of the Anatomical Pathology Residency Training Program have a safe environment in which to learn and practice.

DISCUSSION: The Anatomical Pathology Program is committed to providing a safe and equitable work/learning environment for its trainees; as such this program abides by the following policies on safety and respectful workplace.

Excellent guidance is available in the University of Calgary Manual ‘Guidelines for Administrators When Acting on Concerns About Conduct’ and the recently approved Faculty of Medicine document ‘Professional Standards For Faculty Members And Learners In The Faculty Of Medicine At The University Of Calgary’. The PGME Office maintains a close relationship with Legal Services, the provincial college, the AHS medical staff office, and the Alberta Medical Association (AMA) and facilitates assistance from these bodies when appropriate.

Trainees are made aware, both verbally and in writing, of two additional pathways to address this problem – ‘PARA help line’ and assistance from the Postgraduate Office of .

The program would defer to the Division Chief or Department Chair regarding professional assistance for the faculty member.

The Office of Sexual Harassment on main campus serves the Faculty of Medicine for all types of harassment complaints. In addition, the Associate Dean for Equity and Teacher Learner Relations in the Faculty of Medicine has an office that provides mediation support as well as policy development, education, research, and oversight. All residents are made aware of these facilities at the beginning of their training.

PGME Safety Policy http://cumming.ucalgary.ca/pgme/files/pgme/uofcpgmeresidentsafetypolicy.pdf Professional Standards for Faculty Members and Learners http://cumming.ucalgary.ca/equity/files/equity/professional-standards.pdf Alberta Public Laboratories Environmental Health and Safety Manual Viewable in SoftTech (log in and password needed to access)  BCERP - Biological and Chemical Exposure Response Plan\03 Handling of Non-Clinical Specimens https://cls.labqms.com/labFrame.asp?DID=10959&FLDVr=1553  General Information https://cls.labqms.com/labframe.asp?MeReLoad=F&DID=13813  Responsibilities https://cls.labqms.com/labFrame.asp?DID=13814&FLDVr=1979  Biohazard Safety Guidelines https://cls.labqms.com/PageDisplay.asp?PID=483&AiXID=  Hazardous Medication PPE Guideline https://cls.labqms.com/labFrame.asp?DID=25311&FLDVr=1983  Ergonomics https://cls.labqms.com/labFrame.asp?DID=13869&FLDVr=1986  Scents in the Workplace https://cls.labqms.com/labFrame.asp?DID=13871&FLDVr=1986  Accident Incident Illness Reporting https://cls.labqms.com/labFrame.asp?DID=13823&FLDVr=1980  Fire Safety https://cls.labqms.com/labFrame.asp?DID=13826&FLDVr=1980  Hand Hygiene https://cls.labqms.com/labFrame.asp?DID=13847&FLDVr=1981

Page | 14 RESIDENCY TRAINING in Anatomical Pathology ______ Hazard Assessments http://intranet.calgarylabservices.com/Page256.aspx

Alberta Public Laboratories Respectful Workplace Policy http://204.244.183.162/labFrame.asp?DID=14104&FLDVr=2030 Alberta Public Laboratories Human Rights Policy http://204.244.183.162/labFrame.asp?DID=14103&FLDVr=2030 Anatomic Pathology and Cytopathology Manual  Quick Reference Table of Contents https://cls.labqms.com/labframe.asp?MeReLoad=F&DID=21356

Reading in Traccess: APL ADMINISTRATION POLICY AND PROCEDURE MANUAL

Policy # Name of Policy Date Table of Contents

III – 2.010 Confidentiality and Access to /Client Personal Information

III – 2.040 Reporting Results by Telephone

VI – 1.010 Professional Staff Responsibilities and Continuity of Care

VI – 2.010 Professional Staff – Signing Out of Reports

OTHER

APL Guide to Services Table of Contents

Brochure APL Privacy & Information Security Guidelines

AP 01B Dissection Manual Procedure #1.03 Safety

AP 01B Dissection Manual Procedure #1.04 Quality Control

AP Form 1019 Autopsy Health & Safety Information

LIST OF ADDITIONAL RESOURCES

HIV -- RG3 in PHAC's safety sheets. But PHAC HIV Biosafety Directive ( http://www.phac- aspc.gc.ca/lab-bio/res/bio-dir-htlv1-eng.php ) says CL2 for handling cultures and nonpropagative activity (, molecular) with some enhanced safety but not CL3 PPE. BMBL (CDC's safety resource) says you can handle researach volumes of culture in CL2 with CL3 precautions.

Local Alberta Public Laboratories BCERP and EH&S manuals AHS Lab Safety (InSite) and Guidelines http://insite.albertahealthservices.ca/7434.asp

Canadian Canadian Biosafety Standards https://www.canada.ca/en/public- health/services/canadian-biosafety-standards-guidelines/second- edition.html

Page | 15 RESIDENCY TRAINING in Anatomical Pathology ______Canadian Biosafety Handbook https://www.canada.ca/en/public-health/services/canadian- biosafety-standards-guidelines/handbook-second-edition.html PHAC Laboratory Biosafety and Biosecurity http://www.phac-aspc.gc.ca/lab-bio/index- eng.php#q8 PHAC’s Pathogen Safety Datasheets http://www.phac-aspc.gc.ca/lab-bio/res/psds- ftss/index-eng.php PHAC Biosafety Directives http://www.phac-aspc.gc.ca/lab-bio/res/advi-avis/index- eng.php HPTA: http://www.phac-aspc.gc.ca/lab-bio/regul/index-eng.php

US & International CDC Biosafety in Microbiological and Biomedical Laboratories 6th Edition: https://www.cdc.gov/biosafety/publications/bmbl5/index.htm Biosafety Competency: http://www.cdc.gov/mmwr/pdf/other/su6002.pdf Biosafety directives for specific organisms (i.e. search by –EVD, MERS-CoV etc ie. https://www.cdc.gov/coronavirus/mers/guidelines-lab-biosafety.html MMWR: Safe Work Practices in Laboratories 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/su6101a1.htm?s_cid=su6101a1_w APLI Biosafety and Lab Acquired M29-A4 and GP17-A3 WHO http://www.who.int/csr/resources/publications/biosafety/Biosafety7.pdf

Page | 16 RESIDENCY TRAINING in Anatomical Pathology ______Program Policy: General Expectations for Residency Training SCOPE: All residents enrolled in the Anatomical Pathology Residency Training Program, University of Calgary.

PURPOSE: To explicitly state the minimum program expectations regarding professional behavior within the training environment.

REQUIREMENTS:  OTP: On Time Performance – you are expected to be on-time for all teaching sessions associated with your training.  Be familiar with the Goals and Objectives before you start the rotation. They are listed in this manual and attached to most of your rotations in One45. If you have questions or concerns with the contents of the G&O document that is related to your rotation, please bring them to the rotation supervisors’ attention as soon as possible.  Adhere to the PGME policy on Professional Ethics https://cumming.ucalgary.ca/pgme/residents/policies-guidelines/code-of-conduct  Follow the “Blueprint for success” guide in Section 1.2 of this document  Read Sections 1 through 5 of this manual and complete the sign off sheet in Appendix B  Complete all administrative tasks in a timely manner.

Page | 17 RESIDENCY TRAINING in Anatomical Pathology ______Program Policy & Procedure: Requests for Time-Off SCOPE: All residents enrolled in the Anatomical Pathology Residency Training Program, University of Calgary.

PURPOSE: For the fair and equitable distribution of resident call and service work requirements within the Residency Training Program for the academic year.

REQUIREMENTS:  In accordance with the Resident Physicians Agreement (previously referred to as the PARA Contract), all requests for time off must be submitted no less than 8 weeks prior to the block in which the leave occurs. The Program Director or designate shall confirm approval or disapproval of the request in writing within two weeks.  The PGME Assessment Policy para 6.10 states: The RPC shall, at its discretion, determine the minimum time required to complete a Rotation, but it cannot be less than 75% of the length of the Rotation. If the maximum allowable days off are exceeded in any one block, then that rotation will be marked as “incomplete”.  All requests shall be submitted on the specified form entitled “AP Resident Leave Form”  It is the resident’s responsibility to follow up on submitted vacation requests. Vacation is not considered approved until the form has been returned to the program administrator with all necessary signatures, and uploaded on One45. No exceptions will be made for residents who do not follow up on their requests.

PROCEDURE: 1. The resident will fill out the specified form with all pertinent details including the name of preceptor and rotation in which the leave occurs and submit the form to the Chief Resident and the program administrator via email. 2. Preliminary information is entered into the Residents One45 and our google calendar 3. If approved, the Chief Resident will sign the request and forward it to the Preceptor for approval and cc the Program Administrator. 4. Once approved by the preceptor of the rotation, the form is then forwarded to the Program Administrator who will obtain final approval from the Program Director. 5. The information is finalized in One45 as well as our google calendar. 6. The signed copy is saved to the network and with the following naming convention: LastName_FirstName_type_Year month dates.pdf (eg. Walker_Simon_Vacation_2015Jun1-5.pdf) 7. A final electronic copy is provided via email to the resident and/or Chief Resident for their files by the Program Administrator. 8. Residents are responsible for keeping track of their vacation requests and following up if approval is not obtained within two weeks. One45 is considered to be the record of approval.

ADDITIONAL INFORMATION: Sick/Compassionate/Bereavement/Special Leave 1. All residents are entitled to the sick (article 14); compassionate (article 15); bereavement (article 16) and special leave (article 14) provisions of the Resident Physicians Collective Agreement

Leaves of Absence 1. For all Leave Of Absence requests (longer than 5 days) a separate PGME form must also be filled in, which requires the Program Director’s signature. This form will be forwarded to PGME and the AHS Medical Affairs Office specifying reason

Page | 18 RESIDENCY TRAINING in Anatomical Pathology ______(maternity/parental, compassionate, sick or educational etc.), type (paid or unpaid) and length (including calendar dates) of the leave. Please refer to the PGME policy and procedure for additional clarification.

2. In contrast to vacation time, a leave of absence (LOA) can be granted at any time, at the discretion of the program director(s). A leave of absence is granted for emergency situations. The preceptor and chief resident shall be notified after approval is obtained. Residents are not required to divulge details regarding emergency situations to anyone other than the program director(s).

3. In the situation where the resident is faced with a dire emergency requiring a leave of absence (serious illness or death of a loved one, for example) the chief resident will assist the affected resident in contacting appropriate staff in the department and in assuring coverage of call. Appropriate support resources will be offered to the resident.

4. For extended leaves of absence due to illness, a physician’s note will be required upon return of the resident, subject to the approval of the PGME Associate Dean, the Medical Affairs Office AHS and the Program Director(s). If there is an extended leave of absence > 3 blocks in length for any reason (excluding maternity leave), it is the resident’s responsibility to inform the Program Administrator, and to have the appropriate forms completed well ahead of the cut-off date. Failure to do so may result in delays in Employment Insurance payments being issued (i.e. the resident will not get paid).

Vacations 1. The training program conforms to the vacation policy as set out by the current Resident Physicians agreement (Article 20).

2. Apart from emergency situations, no vacation/leave shall be granted for PGY1 and PGY2 residents during block 1 as training sessions are very tightly scheduled at this time, and make-up sessions for individuals cannot be accommodated.

3. Vacation requests are also strongly discouraged (and may be denied) during the mandatory 4 week Anatomy/Histology Block (block 11) for PGY1 residents, as preceptors and resources are specifically reserved for the residents at this time, and cannot be re- scheduled.

4. In addition, vacation requests or away electives are likely to be denied for Winter/Spring Examinations, Resident Research Day and/or the Resident Retreat. These special events are organized well ahead of time to address specific components of the Residency Training Programs, and therefore should be taken seriously.

5. Residents must submit requests 8 weeks in advance of the time requested (as per the Resident Physicians Agreement). Under extenuating circumstances, the program might consider a request outside of this rule judged on a case-by-case basis. The resident MUST find coverage for call if (s)he has been scheduled to be on call during requested time off.

Page | 19 RESIDENCY TRAINING in Anatomical Pathology ______Conference/Educational Leave (Article 12 – Resident Physicians Agreement)

1. In addition to the above, residents are excused from service duties to attend the Banff Pathology Course, if they so desire. If a resident chooses not to attend the Banff Pathology Course, however, he/she is expected to remain on service.

2. Resident Ski (Outdoor) Day, Resident Retreat, and Research Day are also excluded from the above definition. Again, if a resident chooses not to participate in these activities, he/she is expected to remain on service.

3. Residents wishing to apply for “short term educational leave” (internally referred to as conference leave) as defined in Article 12.01 shall do so in accordance with the established policy PROGRAM POLICY & PROCEDURE: REQUESTS FOR TIME-OFF above.

Page | 20 RESIDENCY TRAINING in Anatomical Pathology ______Exam/Study Leave (Article 13 – Resident Physicians Agreement) 1. Each request for Exam/Study Leave will be considered in accordance with the article quoted below. 2. Residents wishing to apply for “Exam/study leave” as defined in Article 13 shall do so in accordance with the

Page | 21 RESIDENCY TRAINING in Anatomical Pathology ______3. Program Policy & Procedure: Requests for Time-Off above.

Page | 22 RESIDENCY TRAINING in Anatomical Pathology ______Program Policy & Procedure: Out of Province Electives SCOPE: All residents enrolled in the Anatomical Pathology Residency Training Program, University of Calgary.

PURPOSE: To ensure proper notification of the resident’s out-of-province electives to the PGME office as well as the AHS Medical Education Office and other downstream stakeholders (if necessary).

REQUIREMENTS:  All out of province elective requests shall be submitted on the specified form entitled “AP Resident Leave Form”  It is the resident’s responsibility to follow up on submitted requests. Requests for leave are not considered approved until the form has been returned to the program administrator with all necessary signatures, and information is updated in One45. **No exceptions will be made for residents who do not follow up on their requests. **

PROCEDURE: 1. The resident will fill out the specified form with all pertinent details including the name and email of the preceptor as well as the type of rotation and the location of the rotation. (eg. Dr. Jane Doe, email: jane.doe@ institution .ca, GI Pathology, Toronto, ON (Mt. Sinai ) 2. The form will be submitted by email to the Chief Resident and the program administrator. 3. Preliminary information is entered into the Residents One45 and our google calendar 4. The Chief Resident will sign the request and forward it to the Program Administrator for final processing. 5. The Program Director will review and approve the request (no preceptor signature is required in this instance.) 6. The information is finalized in One45 as well as our google calendar. 7. The signed copy is saved to the programs permanent network files. 8. A final electronic copy is provided via email to the resident and/or Chief Resident for their files by the Program Administrator. 9. The Program Administrator will provide a letter (signed by the Program Director) to the PGME Office as well as the AHS Medical Education Office to advise them of the resident’s intent to engage in an out-of-province elective. 10. The resident is responsible for registering with the appropriate provincial practise register(s) and visiting University and pay any required registrations/fees.

Winter Break (Block 7)

21.03 Winter Break (Block 7)

a) Subject to patient care requirements as determined by the Program Director in consultation with AHS, Resident Physicians will receive six (6) consecutive days off duty with pay between December 20 and January 5 in lieu of Christmas Day, Boxing Day, and New Year’s Day. This provision takes advantage of the seasonal slowdown in health services to afford Resident Physicians with an extended period of rest away from their regular duties.

b) There will be no additional time off in lieu of Christmas Day, Boxing Day, and New Year’s Day for Resident Physicians who work between December 20 and January 5 provided they have received their six (6) consecutive days off as per Article 21.03(a).

The parties recognize that this provision represents a special situation

Page | 23 RESIDENCY TRAINING in Anatomical Pathology ______and that standard, shift-based and on-call duty hours (Article 23) are to be maintained prior to and after the six (6) day block. Duty schedules may be amended to meet the terms of this provision and meet patient care service requirements.

c) Where possible, Resident Physicians shall not be scheduled for on-call service the day preceding the six (6) consecutive days off.

d) Time off in excess of six (6) consecutive days may be granted at the discretion of the Program Director.

1. In accordance with the above quoted article it has been determined by the Anatomical Pathology Program that there will be a specified week in each year in which it is expected that most AP Residents will take the “Winter Break”. The reason for this because the anatomical pathology laboratory is closed on Named Holidays (STATS) (residents will not work unless required to be on-call) normal patient handover or provisions for the clinical setting do not apply to our specialty.

Example: the Winter Break week for anatomic pathology residents is 23 December – 28 December 2017. (This encompasses 1 weekend + 2 stats + 2 weekdays = 6 days consecutive total)

2. Should the resident want additional time off adjacent to the established Winter Break the resident shall request this out of their vacation bank.

3. Requests for exceptions to this week will be dealt with as they arise. Exceptions to this would include: observance of orthodox holidays or other religious observance; not to exceed 6 days consecutive total (including weekends and any stats/named holidays).

In all cases, the terms of the Resident Physicians collective agreement shall be considered the minimum standard.

Page | 24 RESIDENCY TRAINING in Anatomical Pathology ______CME Funding 1) Funding: a) Each resident will be provided with a yearly “Continuing Medical Education” (CME) Fund from the Program Budget. The amount varies for each Fiscal Year based on the residency funds available. For example, in 2018-2019, this amount was $2,500.00/full-time resident. Residents undertaking fractionated training receive a pro-rated amount.

b) Residents can make claims to their CME account during each of their 5 Post Graduate years. All PGY levels can start to claim their CME after July 1 and all claims for this year must be submitted no later than the end of February. One should note that a PGY 5 must claim any eligible CME expenses before the end of February without carry-over. Eligible claims submitted after that time will be deducted from the resident’s following year’s CME fund (with the exception of final year residents, whose funds will expire February 28th of their final year of training and if not submitted by the deadline, funds will be forfeit.) i) In accordance with APL/AHS/U of C Policy, the funds will be made available during each Fiscal year (April 1st – February 28th), and will not be carried over. All expense claims for the fiscal year are therefore to be submitted to the Program Administrator for processing prior to the specified deadline. Note that claims older than 6 months will not be honored. ii) The funds are to be used for educational expenses such as: travel and conference expenses (*see restrictions below), books and software purchases, publication costs, membership and tuition fees, personal educational equipment, etc. If in doubt as to eligibility, the expense should be pre-approved by the Program Director(s) well ahead of the planned purchase (at least 6 weeks). iii) (AHS) oversees the APL Budget, and has put in place certain restrictions on Travel, Hosting, and Hospitality Expenses. For comprehensive information regarding expensing guidelines, please refer to the APL Travel, Hosting, and Hospitality Policy:

The RTC recognizes that travel to conferences and educational events is of extreme importance to our trainees, therefore anyone who plans to travel outside of Alberta for a conference or meeting, and who requires support in addition to what can be provided by CME & PGME (see below), should bring their request forward to the RTC for discussion.

NOTE: If a resident plans to use their CME funding to travel outside of Alberta they shall be required to fill out a Pre-approval form and submit supporting documentation to the Program for approval before travel is booked. (Please see your Program Administrator for the updated form and additional information)

c) The Anatomical Pathology Program will also fund each resident to attend the CAP Review Course ONCE during residency. The expense cap for this travel will be $1,500, anything over and above this amount could be claimed through your regular CME account if you have funds available. Please notify your Program Administrator well in advance which year you may plan to attend (usually PGY5).

d) The Anatomical Pathology Program will also fund each resident in their final year of training up to $1,000 ONCE to help cover the costs to Travel to Ottawa to write the Royal College Exam for our specialty.

e) The Anatomical Pathology Program is also exploring the option of funding resident registration cost only for the CAMP course which occurs annually in Whistler, BC. Details on this course can be found under the section on Educational Opportunities/Conferences

f) Funds may also be available for travel directly from PGME. For example, a resident giving a poster or platform presentation at a

Page | 25 RESIDENCY TRAINING in Anatomical Pathology ______North American conference may be eligible for PGME funding of $2,000.00/meeting providing the following conditions are met:

i) The resident must be the first author (case reports are excluded). ii) The project/study must be original work. iii) The resident is responsible for first applying for PGME funding during the specified call for proposals (quarterly) in advance of the planned trip, and must have PGME approval before they travel (see: https://cumming.ucalgary.ca/sites/default/files/teams/6/finance/travel-grant- expense-claims-pgme-nov18-v2.pdf for additional information). If expenses are anticipated to be over and above $2,000.00, the resident may use his/her CME fund to “top up” the reimbursement. PGME will consider more than one request per year from a given resident. PGME also provides support for a Senior Resident (generally the Chief Resident) to attend the ICRE meeting (check PGME website for details).

g) The APL Resident’s budget will cover costs related to group purchases or activities, such as the Resident Retreat, visiting speakers, Journal Club, working sessions, etc.

h) All of the above guidelines are contingent on available funds.

Mandatory Rounds/Meetings A certain number of regular, established rounds/meetings are considered mandatory for residents not otherwise on vacation or leave. Residents are excused from service duties (including CALL) during these times. Attendance is taken for some of these rounds, and repeated absences without explanation will be noted. (Note that attendance and participation in mandatory educational rounds is also a requirement for successful completion of training, as set out by the Royal College.) A number of other non-mandatory and/or occasional rounds can also be found on the weekly schedule, and these may be attended if the resident has the time, and is excused by his/her preceptor. Rounds/meetings mandatory for ALL residents, regardless of site or PGY year: - Academic Half-Day (every Friday morning, 0800-1200) (Post-call residents are excused, please notify the chief resident and the program administrator by email if you will be post call). - Resident Research Day (Annually, in late spring) - Resident Retreat (Winter, alternating even numbered years) (Outdoor Day optional). Rounds mandatory for PGY 2-5, regardless of site (assuming teleconferencing is available):  CPC Rounds (Tuesdays, 1200-1300) Coombs Theatre, FMC (No rounds in July or August).  CME Rounds (Thursdays, 1630-1730) Coombs Theatre, FMC (No rounds in July or August).

Note: Attendance is taken at all of these sessions and will be tracked.

Page | 26 RESIDENCY TRAINING in Anatomical Pathology ______On Call

Unless otherwise specified this information applies to pathology resident call at the Foothills Medical Centre (FMC) and does not necessarily apply to call in other specialty areas or at other hospital sites.

Helpful On-Call Numbers: Patient Placement (weekend ): 4-1689 – Primary number 4-1484 – Backup numbers 4-1485

Pathology Autopsy Desk (McCaig 7th Floor) 4-4745 Gross Room (McCaig 7th Floor): 4-1227 Morgue Office (Basement): 4-1369 : 4-4765 FMC Main OR Desk (Main building): 4-6200 McCaig OR Desk (McCaig tower, 3rd Floor): 4-4200

Quick summary – what to do if you have a…  Lymph Node – Touch preps, flow cytometry then the rest into formalin  Cytogenetics request: Fatty tumour – Cytogenetics media (if enough tissue available) and no previous FISH ordered; then the rest into formalin  Non-fatty tumour – place specimen in formalin, unless no previous FISH test was ordered.  Renal – Contact renal technologist and pathologist  Pediatric call from ACH – Contact ACH technologist and pathologist on-call  Clinical test – Contact on-call general pathologist/resident  Bone marrow/transfusion – Contact hematopathologist on-call  CNS tumour – Contact neuropathology technologist and pathologist/resident  Peripheral nerve biopsy – Contact neuropathology technologist and pathologist/resident  Muscle biopsy – Contact neuropathology technologist and pathologist/resident  Cardiac Biopsy – Contact on-call cardiac pathologist for instructions  Placenta: Place in fridge until next business day then send for cytogenetics or to ACH for histology OR leave a visible note for the morning staff to send to cytogenetics

**Remember that you can always contact your staff person for advice and help**

1) Time Call is taken from home. Call begins at 1700 on Friday, and ends at 0800 the following Friday. If a resident should be called in to work between the hours of 2400 and 0600, he/she is allowed compensatory time off the following day (post call), until 1200. If there is an attending staff working with the resident on the post-call day, a message should be left with him/her regarding the resident’s absence as well as the program administrator.

Pathology call duties are assigned to PGY2 – 5 residents on a rotating basis. PGY2 residents will not be placed on call until after they have completed at least one block of autopsy and one block of surgical pathology (usually half way through PGY2). The number of call weeks assigned per year depends on how many residents are in the Program, but averages 4-5 times/year.

If at all possible, the resident on call should be on a rotation based at the FMC. If a resident on call is located at an off-site service, they are expected to begin travel to the FMC at 1700 during workdays. This means that the resident may not be available for frozen sections until the time they arrive at the FMC. Fresh specimens received after 1700 can be stored in the fridge until the resident arrives.

Page | 27 RESIDENCY TRAINING in Anatomical Pathology ______

** As of April 1, 2019 any resident physician that is in the hospital for more than 6 hours for a call shift shall be remunerated at the rate for in-house call as per the excerpt from Article 35.05 (d) below:

35.05 d) Switch Call Effective April 1, 2019, a Resident Physician who is scheduled on home call but who is required to work either:

i. more than four (4) hours in hospital during the call period, of which more than one (1) full hour is past 2400 hours and before 0600 hours, or ii. more than six (6) hours in hospital during the call period shall be remunerated at the rate for in-house call.

The rate of compensation will account for pay differentials for weekends, Named Holidays (as set out in Article 21(a)), Christmas Day, Boxing Day, and New Year’s Day. AHS shall have the right to implement reasonable rules to verify that Resident Physicians are entitled to be paid the in-house call rate for that call period. To be eligible for the post- call day the individual would need to work after midnight.

**The resident must notify the Program Administrator of any Switch Call incurred during the call period by email so that the call is correctly submitted to AHS for payment. (This includes weekend autopsies.) Failure to do so WILL result in your stipend being incorrect on your pay remittance.**

2) Duties a) Routine Surgical Pathology: The pathology resident on call is responsible for all fresh Anatomical Pathology and Cytology specimens received at the FMC on the weekend, or weekdays after 5:00 PM and before 8:00AM. Responsibilities include, but may not be limited to, the following: inking, obtaining measurements, opening and fixation, proper storage, notification of other services that may need to be involved, initial sampling, and submission of material in the proper media for ancillary studies. This requires that the resident have a basic knowledge of which media, fixatives and storage protocols are required for the handling of certain specimens and where the appropriate materials and storage facilities are located.

The following fixatives are stored in the refrigerator near the accessioning desk:

 RPMI (for flow cytometry)  Tumor transport medium (for tumor cytogenetics)  Michel’s fixative (for skin biopsy )  Glutaraldehyde (for EM)

The OR should page you if they have a specimen that they want to send to pathology as a fresh specimen after 6pm (usually cancer staging ). You will need to go to the OR to pick up those specimens in person, as the portering system cannot be used to send specimens after 6pm. If the specimen is not in a bucket, ask for a pillowcase to put over the specimen bag, to avoid wandering around the patient areas of the hospital with a bloody bag. (Note: the doors to the FMC main floor OR are often locked at this time, so you may need to arrange for someone to meet you at the door).

Examples: Skin Biopsy for Immunofluorescence requires a portion submitted in

Page | 28 RESIDENCY TRAINING in Anatomical Pathology ______Michel’s fixative.

Lymph Node for Protocol: 1. Record gross description on requisition 2. Decide on tests according to the following priority list: i. Possible frozen section a. Can be useful to decide how to triage the specimen ii. Five air-dried touch preps a. Placed in cytogenetics slide box, together with 2 copies of requisition iii. Formalin-fixed block iv. Flow cytometry (in RPMI) a. Label the RPMI tube with the ’ name and specimen ID b. Drop off the sample at main lab specimen receiving desk, with filled out flow cytometry requisition and a copy of the original requisition c. If STAT specimen, see flow chart on SoftTech to decide if flow pathologist on call needs to be contacted. v. Tumor bank a. Only if there is adequate tissue for the other tests

Soft tissue mass: A. For : 1. If it is a fatty tumor AND there is enough tissue --> put a little piece of tissue in the cytogenetics medium, and the rest goes into formalin. 2. Otherwise, place the entire specimen in formalin.

B. For resection: 1. Ink Margins as appropriate 2. Serially section the specimen in 1-2 cm intervals 3. Photograph the cut surface of the specimen 4. Check the history. Do we have a diagnosis? Has FISH been ordered? If FISH was NOT previously ordered (e.g. on biopsy), or ordered but FAILED --> please submit a piece for cytogenetics regardless of whether the tumor is fatty or not. 5. After hours, label the sample with the patient’s name and specimen label, and store in the fridge. Write a note on the chalkboard to let the lab assistants know that there is a specimen in the fridge that needs to be sent on. 6. If the patient has a diagnosis (e.g. MPNST, Myxoid liposarcoma, etc.), OR FISH was ordered and was positive or negative --> put the whole specimen in formalin.

Cytology - Placement of the specimen in a fridge and if a rush on the weekend notification of the pathologist on call and cytotechnologist. (Note while there is no designated cytopathologist on call usually a cytopathologist will be on call for one of the APL sites and they will generally be contacted)

Dealing with late fresh specimens: you are responsible for preparing any fresh specimens that come up after 5pm. Check in the gross room to see if there is anything to deal with. Before you leave for the day, check with the OR to see if they are expecting any late freshes/frozens.

b) Frozen sections: If you get called for a frozen: Ask who the is (you often get called for neuro or

Page | 29 RESIDENCY TRAINING in Anatomical Pathology ______renal biopsies, which are not your responsibility). Have the “On-call Memo” handy to tell switchboard the name and number of the person they should be paging. Also, ask what the frozen is for—some specimens (e.g., for interstitial lung disease) may be better dealt with as a 24 hour rush. Again, consult your staff pathologist for advice. The OR is to give you at least 30 minutes lead time before weekend/after-hours frozens. During the weekend, there is a tech on-call for frozens (see “On-Call Memo”). During the week, there are no techs on call for frozens. Please see the list of tech home phone numbers on the on call memo for numbers to call.

The pathology resident on call is responsible for attending and participating in all frozen sections received at the FMC on the weekend, or weekdays after 5:00 PM and before 8:00 AM. Residents are responsible for contacting the on call technologist or arranging alternate technologist call back for the procedure and should contact their staff pathologist regarding the frozen section immediately.

The OR is to give at least 30 minutes lead-time before weekend/after-hours frozen section requests. During the weekend, there is a tech on-call for frozens (see “On-Call Memo”). During the week, there are no set techs on call for frozens. In the latter situation, please see the list of tech home phone numbers (posted in the gross room) for whom to contact. Residents are responsible for contacting the on call technologist, or arranging a call back technologist, and should notify their staff pathologist regarding the frozen section immediately. Although a resident should be familiar with how to cut a frozen section, attempting to cut a diagnostic frozen section after hours without the aid of an experienced path tech is strongly discouraged.

Example: A resident is called at 8:00 PM in regards to a frozen section request from the operating room. The resident inquires as to the nature and purpose of the frozen section and obtains the patient name and the operating room contact number. A cardiovascular surgeon has requested a frozen section of the heart in order to assess if there are clear margins around the atrial myxoma they are resecting. The resident contacts their staff pathologist who informs the resident that usually frozen sections are not advocated for such a purpose as myxoid change can be seen in the surrounding normal tissue and this can lead to a high false positive rate. The staff pathologist contacts the operating room and after discussion with the surgeon a joint decision is made to not do a frozen section. This information is conveyed to the resident alleviating the need for them to contact an on-call technologist.

c) Autopsy The Pathology resident on call is responsible for attending and participating in all weekend FMC autopsies with the following provisos: i) Weekend autopsies are usually performed on Saturday. If the subsequent Monday is a statutory holiday, then autopsies are performed on Sunday. Alternative arrangements can be made in advance provided the resident, on call technologist and pathologist(s) are all in agreement. Note: in very rare circumstances, where material is required in a more timely fashion, or as an exceptional courtesy to a special family request, autopsies may be performed earlier than usual. ii) The cut off time for autopsies is noon (12:00) on the day the autopsies are to be performed. The body, chart and signed consent form should all be available at the cut off time. iii) Residents are required to phone patient placement (944- 1689) at 8:05 on the day the autopsies are to be performed. Residents should inquire as to whether there are any cases for the day or any cases pending. A pager number should be left if pending cases are expected. The resident should ask whether there are any autopsy restrictions on the consent

Page | 30 RESIDENCY TRAINING in Anatomical Pathology ______form and if the consent was acquired from the legal next of kin. iv) A maximum of 2 weekend autopsies will be performed. v) No “infectious” cases are performed on the weekend. vi) Autopsies are usually prioritized on a first come first serve basis provided that there are not any exceptional circumstances which may necessitate this order being altered.

Example: an autopsy on a patient who died from a suspected lymphoma which had not been sub-typed may be given priority over an autopsy on a patient who died from a suspected uncomplicated myocardial infarction as the quality of the Flow Cytometric specimen taken from the lymphoma patient may be compromised if delayed)

vii) Residents should discuss in advance with their staff pathologist(s) as to whether the staff person wishes to be notified about any cases before or after the resident has had a chance to review the patient chart and consent form. viii) It is useful to contact the morgue (944-1369) and the autopsy desk (944-4745) at 1500h on the day before the weekend starts to see if there are any cases already scheduled or pending for the weekend. ix) Note that normal turnaround time requirements for issuing a preliminary autopsy report must still be adhered to (2 working days). x) Please ensure the autopsy chart is returned to the autopsy desk before 0830 on Monday morning. This prevents delays in numbering subsequent cases. xi) In situations where a staff pathologist is not in attendance for the autopsy (this is strongly discouraged by the department), arrangements should be made with the staff person to review the retained organs prior to issue of the preliminary autopsy report. Note normal turnaround time requirements must still be adhered to. xii) If a case is pending, and you do not already have 2 autopsies, be proactive in correcting any consent form problems that may be delaying the case. This may require you phoning family members to clarify or acquire proper consent. (Please note you will need a second phone “witness” such as the lab tech in order to take verbal phone consents) or phoning physicians or care homes in order to acquire pertinent history.

Example: On the Friday before the start of a long weekend, (with Monday off) the resident phones the autopsy desk at 3:45 PM. There were five autopsies received that Friday and 2 are left over for the weekend. A third case is pending. The resident, being proactive, reviews the consent forms and supplied charts. Both are signed by the appropriate legal next of kin and both patients died Friday morning. One is restricted to “brain only” and comes with a history of “adrenomyeloneuropathy”. The second is unrestricted and is on a patient who died post- for a mitral valve replacement after a new novel surgical procedure. The resident phones patient placement and determines that the third pending case is on a patient who died on Thursday morning from a suspected lymphoma. The initial consent did not have a completely filled out history section and patient placement is waiting for the attending doctor to complete the form.

The resident discusses the situation with the on call anatomic pathologist and neuropathologist. After discussion the resident and staff pathologist phone the legal next of kin of the patient who died of adrenomyeloneuropathy. They ask the legal next of kin if there was a specific reason why the autopsy was restricted to “brain only”. The legal next of kin states that was what the requesting physician had put down and so they agreed to it. The resident and staff pathologist explain to the legal next of kin that adrenomyeloneuropathy is an extremely rare disease that has diagnostic features in other organs of the body (adrenal gland and testicle) and thus from a diagnostic point of view an unrestricted autopsy would be preferred. The legal next of kin provides a verbal consent for an unrestricted autopsy.

Next, the resident pages the attending physician of the

Page | 31 RESIDENCY TRAINING in Anatomical Pathology ______patient whose consent is pending completion of the history. The attending physician apologizes for not having completed the form yet and provides verbal history and details in lieu of completing the form. The resident documents this history. The resident and staff pathologists agree to perform the autopsies on Saturday instead of the Sunday both for convenience and for the point of acquiring better preserved material for ancillary studies. The adrenomyeloneuropathy case and possible lymphoma case will be performed on the weekend based both on the length of time since death as well as the need for more timely ancillary studies (lymphoma protocol, electron microscopy, tissue bank). Furthermore, the complicated cardiovascular surgery case may be more suited for normal working hours when the cardiovascular surgeon and cardiac pathologists may be able to attend. This decision is relayed to the tech on call who is happy with the change in date. The resident contacts patient placement to inform them that the autopsy consent issues have been cleared with the patient with suspected lymphoma and that autopsies on that patient as well as the patient with adrenomyeloneuropathy will be performed on Saturday with all other cases being left for Tuesday. Patient placement thus, does not have to worry about paging the resident on Sunday and will have the appropriate information about the release of bodies if any inquiries are made of them through the funeral home.

3) On-Call Memo An “On-Call Memo” is distributed via e-mail one or two days before call begins. This memo lists the staff and techs on call at Foothills Hospital and at the other sites, and should be carried with the resident at all times during the call rotation. Please note there is no official pathologist on call for cytopathology. If a pathologist who practices cytopathology is on call for one of the sites then they will usually be paged about on call cytopathology issues. The staff pathologist on-call should be contacted for advice regarding cytology specimens received after hours.

4) Covering Call for someone else Last minute switches in call coverage should be conveyed to the switchboard, the on call staff person and program administrator. As a safety measure the resident should ask the switchboard to forward messages from the pager # of the resident no longer covering call to the pager # of the resident now covering call. Page these numbers to confirm the message forwarding is working and remember to reverse the process later when the original resident is available.

5) Switchboard: It is your responsibility check ROCA (http://iweb6.albertahealthservices.ca/roca/) or call the switchboard at 1700h on Friday to confirm that they have your pager number. Then, page yourself to make sure your pager is functioning.

6) Be Proactive: a) Surgical pathology During weekdays, phone the gross room (944-1227 or 944-4750) at approximately 4:45 PM to see if there are any expected frozen sections or fresh gross specimens pending. The main operating room desk (944-4200) can also be contacted to see if they have any rooms still operating that might send pathology a specimen. This allows one to anticipate any problems and allows time to leave other sites on time or to arrange alternative coverage in advance. b) Autopsy If a case is pending, (and there are not already 2 autopsies), one should be proactive in correcting any consent form problems that may be delaying the case. This may require phoning family members to clarify or acquire proper consent. (Please note you will need a second phone “witness” in order to take verbal phone consents). Alternatively, one may need to contact the attending physician or a care home in order to acquire pertinent history.

Page | 32 RESIDENCY TRAINING in Anatomical Pathology ______

You are responsible for any autopsies that come in prior to 1200 on Saturday (or the middle day of a long weekend). There is a maximum of two autopsies per weekend. No infectious cases are performed. To determine if you have any autopsies: Call Patient Placement (944-1689) at 0805 on Saturday morning (or the middle day of a long weekend) to find out if there are any autopsies. Leave them your pager number. Inform your staff and the neuropathology resident and/or staff if there are any cases to be done. If you already know from Friday that there will be a case, talk to the tech on call and your staff to determine a start time.

**Don’t forget to submit your switch call as per Article 35.05(d)ii**

7) Days in Lieu a) In the Resident Physicians Agreement under article 21.02 “commencing work” on a named holiday includes being scheduled for call.

b) This day shall be requested in the usual away on the AP Resident Leave Form.

8) When in Doubt- Ask for Help. (Staff pathologists, Morgue and Gross room staff, and other Residents are all eager to help you solve a problem now and thus avoid creating more problems for them or others down the road)

P.S. Useful tip #1: Keep the on call list of phone numbers with you at all times. It is not uncommon to get paged erroneously by people looking for other services and having a list of the correct numbers with you can save people time. (Example 1: people trying to find the general pathologist on call in order to acquire permission for lab testing after hours. Example 2: People phoning about the transport of dead bodies unaware that they should contact patient placement and not the pathologist on call)

Page | 33 RESIDENCY TRAINING in Anatomical Pathology ______Useful tip #2: The on call tech is technically on call for only the weekend. While they may come in for weekday after hour frozen sections it is useful to get an up to date home phone number list of techs from the main lab in case you need to contact one for an after-hours frozen section during the weekday

Page | 34 RESIDENCY TRAINING in Anatomical Pathology ______Section 2: Educational Opportunities Introduction Numerous educational opportunities are available for residents in the Anatomical Pathology Program. These include a number of mandatory events (Academic Half-Day, CPC and CME Rounds, some PGME Workshops), as well as a variety of other rounds, meetings, courses, and teaching opportunities. The following section of the Manual serves to highlight some of the most important educational opportunities for residents, but is by no means inclusive. Residents are advised to check the Weekly Schedule for details regarding rounds, and to stay abreast of upcoming specialty meetings and workshops by checking their correspondence and the Departmental bulletin board regularly.

Section 2.1: Academic Half-day Academic Half-Day is a mandatory event in the pathology resident’s calendar, regardless of PGY level (light breakfast is provided). Residents are excused from all clinical duties to attend Academic Half-Day, which typically runs from 0800-1300. Attendance is recorded, and repeated absences without explanation will be noted. Post-call residents may be excused, and are required to inform the Chief resident and Program Administrator.

Surgical Pathology Rounds (a.k.a. Friday Slides or Unknown Slides) Every Friday 0800-0900h (FMC MT7580) Description: Up to Five “unknown” slides accompanied by a brief history are made available at least a week in advance for participants to review. The slides may either be reviewed “on site” at the FMC, or scanned images can be viewed via a link http://digitalmicroscopy.ucalgary.ca/Login.php. Typically, only one H and E slide is provided (no special stains), and the cases may come from any area of pathology (eg. cardiac, breast, pediatric, cytopathology, etc.).

On Friday morning, the cases are presented by the Chief Resident. The staff member or resident responsible for submitting the case leads a brief (i.e. no more than 10 minutes) interactive question, answer, and discussion session, typically starting with a more junior resident and finishing with a senior resident. The one responsible for submitting the case concludes with 2-3 important or interesting teaching points.

Occasionally, a subspecialty “theme” (eg. pediatric pathology, neuropathology, , etc.) is the focus. In the latter situation, if a resident happens to be rotating through that particular service, he/she is expected to lead the rounds and discussion on that date.

The addition of “Rapid Fire” or “Spot Diagnosis” slides – each week there will be a few cases presented which will be for on-the-spot-diagnosis. These slides are not put out for preview or preparation and are to help hone your skills for quick spot diagnosis. It is expected that by your PGY5 year you will be well prepared for both the Royal College exam as well as independent practice.

The Rationale: Friday slides are an ideal opportunity to practice teaching skills. This is a very important skillset for all of us to have, even if it’s not your favorite thing to do. Even if you work in a rural setting you may have residents rotating through, and if you’re at a teaching hospital it’s obviously especially important. Being able to explain something concisely and thoroughly is also essential for interacting/collaborating effectively with other pathologists and clinicians.

Presenting Friday slides (and teaching in general) is also a great way to solidify/reinforce one’s own knowledge.

Page | 35 RESIDENCY TRAINING in Anatomical Pathology ______Preparing to present a Friday slide actually is often not too much more work than preparing to answer questions about someone else’s case (sometimes less work), and you also get the bonus of being “exempt” from difficult questions if you are the one presenting.

Mandatory Slide Submission:  Residents on Surg path and other subspecialty rotations are required to submit one case per week (1 regular or 2 express). PGY2’s start after block 4 but are welcome to start earlier and PGY5’s are exempt from submitting after block 7 in their final year of training.

 The cases you submit don’t have to be your cases on service. They can be teaching slides from the collections, CAP slides or from any staff pathologist you are working with.

 Everyone is of course encouraged to submit any number of cases at any time, this is just a minimum.

 Residents are encouraged to inform their staff if a case they signed out is being presented at the rounds.

 There’s some unclaimed potential Friday slides in the resident room as well, that people have submitted without names. If you need any help finding cases, let the current chief know.

Expectations: 1. Arrive on time. If you are planning to grab breakfast and coffee, arrive early so that rounds can begin at 8:00 sharp.

2. Arrive prepared. “I didn’t have a chance to look at the cases” is not an excuse. Treat the cases like they are tumor board cases, and it’s your job to review them and present at tumor board in front of your colleagues. (Or, if you prefer, treat it like your future Royal College oral exam, because this is basically what these rounds are preparing you for.)

3. Make your descriptions concise and accurate, have a good differential diagnosis, and have a well thought out plan for further workup if applicable. Think ahead about what questions might be asked. I.e. if you are being shown a cerebellar hemangioblastoma, you are very likely going be asked about von Hippel – Lindau disease, etc.

4. Be in charge of your own learning. These rounds will show you cool or interesting cases that you might not see otherwise, reinforce concepts about “bread and butter” classic diagnoses that you need to know about, and prepare you to be comfortable and confident in the setting of oral exam-style public interrogation. The more you read around the cases, the more you will get out of rounds. These rounds are not designed as a way to “learn by osmosis” like a didactic lecture.

Autopsy Rounds (aka Autopsy Demonstration, or Autopsy Demo) Every Friday 1110 – 1210h (FMC Morgue Teaching Suite) Autopsy “demo” involves the presentation of post-mortem cases from the preceding week/weeks. The resident involved in the autopsy typically presents the clinical history, demonstrates the relevant organs and major pathological findings, and leads a discussion around the case, or around a particular pathological entity. Attending staff also add to the discussion. As in the Surgical pathology rounds, occasionally the Autopsy Demo session may focus on a “theme” (eg. pediatric pathology). In these circumstances, the session may take the format of a more formal presentation, and may be held in MT 7580. Any changes to the usual

Page | 36 RESIDENCY TRAINING in Anatomical Pathology ______routine will be posted on the Weekly Schedule. And must be pre-approved.

Page | 37 RESIDENCY TRAINING in Anatomical Pathology ______Didactic Curriculum Every Friday 0900 – 1100h These sessions deal with a wide variety of topics relevant to Anatomical Pathology, including not only traditional surgical and cytopathology topics, but also other relevant themes such as: Ethics, CanMEDs roles, Quality Assurance, Informatics, Biostatistics, etc. Other quarterly events (eg. Journal Club, QA/Lab Administration PLPs, etc) may also be scheduled during this time. A “Blueprint” of topics in the Didactic Curriculum has been created that attempts to assign an appropriate amount of time to each component of the program. The curriculum operates on an every 2.5 year cycle, so that in the 5 year training program, each resident should have the opportunity to be exposed to each topic twice. An outline of the Didactic Blueprint is as follows:

Basic Pathology (up to 14 hours) These lectures may be taught by senior residents if space is available in the didactic schedule. 1) 2) Genetic disorders 3) Immunity 4) Neoplasia I: cell cycle, tumor suppressors, and proto-oncogenes 5) Neoplasia II: invasion, metastasis, angiogenesis, and paraneoplastic syndromes 6) Infectious 7) Environmental pathology Bone and Joint Pathology (6 hours) 1) Non-neoplastic bone pathology (arthritis, osteonecrosis, fracture, metabolic diseases, osteomyelitis, congenital bone disease) 2) Bone tumors I: osseous and cartilaginous tumors 3) Bone tumors II: fibrous/fibro-osseous tumors, giant cell tumors, Ewing sarcoma, of bone Breast Pathology (6 hours) 1) Proliferative breast disease/DCIS 2) Lobular neoplasia 3) Invasive carcinoma and phyllodes tumor 4) Prognostic and predictive factors CanMEDs Roles (4 hours) 1) Bioethics 2) Professionalism 3) Communication and negotiations 4) Leader Role Cardiovascular Pathology (6 hours) 1) Ischemic heart disease and the cardiomyopathies 2) Cardiac neoplasia, pericardial disease, and valvular heart disease 3) Vasculitides 4) Congenital heart disease (pediatrics) 5) ASCVD and hypertensive CVD 6) Pericarditis, myocarditis, and the role of the cardiac biopsy Cytopathology (24 hours) 1) QA in Cytopathology 2) Non-neoplastic respiratory cytology 3) ASCUS 4) Normal gyne cytology 5) Benign cellular changes (Gyne) 6) Salivary gland cytology 7) AGUS and glandular lesions of the cervix 8) Lymph node 9) Fluids: pleural/pericardial/peritoneal

Page | 38 RESIDENCY TRAINING in Anatomical Pathology ______10) Brain and spinal cord 11) Breast cytology 12) Retroperitoneum and soft tissue cytology 13) Neoplastic respiratory cytology 14) Urinary cytology 15) Ampullary/hepatobiliary cytology 16) Thyroid cytology 17) FNA technique/Intra-operative assessment 18) Thymus and mediastinum 19) Administrative issues Cytogenetics (2 hours) Dermatopathology (12 hours) 1) Approach to Dermatopathology 2) Pigmented lesions; benign 3) Malignant melanoma 4) Tumors of cutaneous appendages 5) Tumors of the epidermis, cysts and neuroendocrine carcinoma 6) Selected cutaneous mesenchymal 7) Lichenoid reaction pattern 8) Vesiculobullous reaction pattern 9) The vasculopathic reaction pattern and panniculitis 10) Selected entities of psoriaform, spongiotic, and granulomatous dermatitis 11) Selected cutaneous infections and infestations 12) Cutaneous infiltrates Endocrine pathology (7 hours) 1) Neuroendocrine system and paragangliomas 2) Thyroid gland 3) Parathyroid gland 4) Adrenal gland and endocrine pancreas Forensic pathology (7 hours) 1) Introduction 2) Blunt force injury 3) Sharp force injury 4) Pediatric forensics (SIDS, child abuse, etc) 5) Environmental and asphyxial death 6) Gunshot wounds 7) Alcohol/drug abuse/toxicology Gastrointestinal pathology (10 hours) 1) Esophagus 2) Stomach 3) Neoplastic intestine 4) Non-neoplastic intestine 5) Appendix and anus 6) Liver and biliary system (including pediatrics) Genitourinary pathology (20 hours) 1) Prostate, , bladder and testes Gynecologic Pathology (20 hours) 1) Vagina and cervix: Intraepithelial neoplasia 2) Vagina and cervix: Malignant tumors 3) Vulva, vagina, cervix: Benign lesions 4) Vulva: Intraepithelial neoplasia and malignant tumors

Page | 39 RESIDENCY TRAINING in Anatomical Pathology ______5) Endometrium: and carcinoma 6) Uterus: Benign and malignant mesenchymal tumors 7) Ovary: Tumor classification and common epithelial tumors 8) Ovary: Borderline and atypical proliferating tumors 9) Ovary: Sex cord/stromal, germ cell, and mesenchymal tumors 10) Fallopian Tube: Benign conditions and malignant tumors 11) Gestational trophoblastic disease 12) Female Peritoneum: Benign and malignant lesions Head and neck pathology (10 hours) 1) Ear, nose, and throat 2) Oral and odontogenic pathology 3) Salivary gland Hematolymphoid Pathology (12 hours) 1) Development of B/T lymphocytes/Histology of lymph node and BM 2) Overview of non-lymphoid hematopoietic disorders 3) 4) WHO Classification of Lymphoma/Fluid hematopathology 5) Mature small B-cell NHL 6) Mature aggressive B-cell NHL 7) T/NK Cell neoplasms 8) Ancillary tests and Flow Cytometry Mediastinum (1 hour) 1) Thymus Molecular Pathology (1 hour) – undergoing revision 1) Neuropathology (13 hours) 1) Neuroanatomy for pathologists 2) Strokes and organization of 3) Trauma 4) Vascular disorders 5) Brain tumors: Adult 6) Brain tumors: Pediatric and young adult 7) Nerve and muscle pathology 8) Developmental lesions, malformations, fetal lesions, epilepsy 9) Genetic and inherited disease 10) Inflammation 11) Nervous system infectious disease 12) Neurodegenerative diseases Pediatric Pathology (8 hours) 1) Placental pathology 2) Fetal autopsy 3) IUGR 4) Chromosomal anomalies 5) Congenital anomalies (heart, renal, etc) 6) Kidney tumors 7) Liver disorders 8) Metabolic disorders (Autopsy) 9) GI disorders 10) Small round blue cell tumors 11) Skeletal 12) Early pregnancy loss

Page | 40 RESIDENCY TRAINING in Anatomical Pathology ______Pulmonary Pathology (10 hours) 1) Pulmonary and infections 2) COPD 3) Interstitial lung disease and lung biopsy 4) Lung neoplasia 5) Pleural pathology Renal Pathology (6 hours) 1) Medical renal pathology I 2) Medical renal pathology II Soft Tissue Pathology (4 hours) 1) General approach to soft tissue tumors 2) Spindle cell tumors 3) Pleomorphic tumors 4) Small round blue cell tumors Miscellaneous 1) Ocular pathology 2) Pathology imaging 3) Autopsy consent

Page | 41 RESIDENCY TRAINING in Anatomical Pathology ______Section 2.2: Other Rounds CPC-IM Rounds Tuesdays; 1200-1300 (FMC Coombs Theatre; teleconferenced to PLC/RGH/DSC/SHC) CPC Rounds are mandatory for all PGY 2-5 residents who are on-site at the FMC, or who have access to teleconferencing. Residents are therefore excused from service duties to attend these rounds, unless an exceptional circumstance occurs (in the midst of an infectious autopsy, etc). Attendance is recorded. Clinico-pathological (CPC) Rounds consists of a presentation of an interesting clinical case (Internal Medicine), combined with a review of the surgical pathology or post-mortem findings (Pathology). The cases are chosen jointly by the Internal Medicine and Pathology Residents, and may come from either autopsy or surgical material. One or two teaching points from a clinical, pathological, or combined perspective are also presented by the respective residents, and a question and answer period follows. Pathology residents receive written feedback on their presentations to assist in developing teaching and presentation skills. Usually the resident involved in the case will be asked to present, but cases may be re-distributed to keep the workload fair between residents. Pathology residents should contact the involved Medicine resident 6-8 weeks in advance of the presentation to discuss and plan the teaching points, etc.

CME Rounds Thursdays; 1630-1730 (FMC MT7580; teleconferenced to all APL sites) Continuing Medical Education Rounds are mandatory for all PGY2-5 residents; regardless of site (teleconferencing is available at all sites). Residents are therefore excused from service duties to attend CME Rounds. Attendance is recorded, and repeat absences without explanation will be noted. Occasionally, residents may experience a conflict with CME Rounds and the Oncology Didactics (see Section 3.6: Other Courses, Workshops, and Meetings), in which case they may choose to attend whichever session they feel is more beneficial to their education.

CPC-ICU Rounds The third Thursday of the month; 1200-1300 (FMC ICU Classroom 04140) CPC-ICU Rounds are mandatory for any resident on an Autopsy rotation. Residents are excused from service duties to attend these rounds. Does not run over July & August.

Weekly GI Teaching Rounds Weekly, on Wednesdays from 1630 – 1730h at the FMC Room MT7578 Taught by the GI Special Interest Group and organized by Dr. K. Koro; these are optional teaching rounds for residents, however if you choose to attend the time is protected and you shall be excused from your clinical duties to participate. The weekly schedule will have the most up to date information.

Tom Baker Cancer Centre (TBCC) Rounds (Tumor Board) A variety of TBCC Tumor Board meetings occur with regularity throughout the Academic year. Residents are welcome to attend these optional rounds, if their schedule and interest allows. These subspecialty rounds typically are mandatory for residents rotating through those subspecialty areas (for example, a resident on the bone and soft tissue rotation is expected to attend sarcoma rounds.) Examples of some of the Rounds are given below. Residents are encouraged to check the Weekly Schedule for specific times and locations, as these may vary somewhat, and this list is not meant to be inclusive.

Sarcoma Rounds Time: every Monday; 1630-1730 Location: TBCC, Room CC105

Page | 42 RESIDENCY TRAINING in Anatomical Pathology ______Gyne-Oncology Rounds Time: every Thursday; 0700 – 0800h Location: TBCC Room CCB20

Breast Rounds Time: every Monday; 1200-1300 Location: TBCC Radiology Conference Room (Basement)

Paul Kneafsey Rounds (PK Sessions) For PGY5s: weekly “PK” Rounds were initiated a number of years ago by one of our great staff pathologists and teachers, Dr. Paul Kneafsey. These multi-headed slide sessions were intended to help PGY5s prepare for the Royal College exam, motivating them to adopt a budgeted schedule of preparation during their final year, and providing them with practice in addressing oral questioning.

Tragically, Dr. Kneafsey died unexpectedly in 2001. Subsequently, the staff pathologists at the FMC were asked to continue with these very useful and popular rounds, mainly to continue assisting the senior residents with exam preparation, but also as a legacy to Paul.

These optional sessions are held once a week (usually on Wednesdays, from 1700-1800 but are based on staff availability). The sessions are -based, and therefore involve a variety of staff. The sessions are organized by the PGY5s. A copy of the previous years schedule can be found in “Residents Resources” on the G Drive.

M&M Pathology Teaching Rounds Every Monday afternoon at 1600h review interesting and/or challenging Head & Neck or Gynecologic pathology cases at the multi-headed microscope (FMC). If there are less than 2 participants, the rounds will be cancelled. The weekly schedule will have the most up to date times and information.

Gross Neuropathology Sessions Adult brains are cut every Tuesday at 0900 in the FMC Morgue. Pediatric cases are cut every Thursday at 0900 in the ACH Morgue. The weekly schedule will have the most up to date times.

Journal Club A Journal Club meeting will be held at least quarterly, and will take place during Academic Half-Day throughout the academic year. The goal of journal club is to educate residents in critical appraisal to enable them to accurately interpret the literature.

The papers are predominantly original articles; however review articles may be chosen in special circumstances. A maximum of two articles will be selected from the current literature one month prior to journal club, and a senior resident will be responsible for leading the discussion. A staff person will be designated as a resource for each journal club based on topic or availability. Records of the article chosen, responsible resident and staff, and major discussion points will be kept by the Chief Resident.

Page | 43 RESIDENCY TRAINING in Anatomical Pathology ______Section 2.3: Associations, Conferences, and Meetings USCAP The United States and Canadian Academy of Pathology (USCAP; North American branch of the International Academy of Pathologists, or IAP) is a well-established organization made up of anatomical pathologists, and dedicated to providing the highest standards of pathology education throughout the world. Mission Statement: The USCAP's mission is to provide pathologists with high quality continuing medical education (CME) at the investigative and applied practice level, and to reinforce and update their knowledge of pathology in their area(s) of interest. This mission is accomplished by a broad-based CME program which includes various topics and forums of particular intellectual and professional interest where participants can engage in presentation, discussion and critical evaluation of the application of scientific, technological and methodological advances to matters related to human health and disease. Specifically these include lectures, seminars, symposia, courses with extemporaneous discussion and critical evaluation, question and answer sessions, and the distribution of instructional materials for the purpose of meeting identifiable educational needs. The program is planned to meet the needs of pathologists of various levels of experience from residents and fellows to the well- established and expert investigator and practitioner. The effectiveness in meeting registrant needs is assessed by their satisfaction as evidenced by comparative and annual attendance monitoring and by registrant evaluations as to the improvement of their knowledge and skills relevant to their pathology practice.

General types of services and activities 1) An Annual Meeting, will be held which includes, but is not limited to: proffered papers and poster presentations representing new basic and clinical scientific information presented by meeting attendees; long courses and special courses for in depth review of recent concepts and advances in pathology; specialty conference slide seminars where pathologists can meet acknowledged experts and engage in discussion of specific and important cases; short courses on organ or topic oriented pathology; and, plenary lectures on topics of special interest. 2) The Academy will present an annual pathology practice update course, Diagnostic Pathology, to provide updated practical knowledge in anatomical pathology for residents, surgical pathologists and academicians constituted of lecture presentations accompanied by a bound syllabus and CD of representative images for future reference by attendees. 3) The Academy will present an annual physician oriented Diagnostic Cytopathology course addressing problems and pitfalls in differential diagnoses of perplexing problems commonly encountered by cytopathologists and anatomic pathologists in their day to day practice. 4) The Academy presents an annual Practical Pathology Seminars course which provides updated, pragmatic, problem-solving information for practicing anatomic pathologists. 5) The Academy will support the Biennial Congress of the International Academy of Pathology and other IAP Divisions around the world as resources permit. 6) The Academy will also publish two peer-reviewed journals, Laboratory Investigation and Modern Pathology, to disseminate information on current research and significant advances in the understanding of pathology diagnosis and practice. The Annual Meeting is a week-long meeting generally held in February or March. It regularly attracts thousands of pathologists from the USA and Canada, as well as numerous scientists from abroad. Several awards are available for Pathologists-in-Training, and a “Fellowship Fair” has recently been developed. This meeting is a great opportunity for residents to present their research, gain practice in public speaking, listen to world renowned speakers, meet interesting people, and network for future career planning. Funding from PGME may be available for residents who are first authors on original work (see Travel/Conference Policy in Section 1 of Manual).

Page | 44 RESIDENCY TRAINING in Anatomical Pathology ______For residents who wish to attend but do not have a presentation, he/she may be reimbursed for costs from their CME funds. Residents are encouraged to attend at least one (if not more) of the USCAP meetings during their residency training. Further detail on membership, upcoming meetings, abstract deadlines, courses, awards, etc. is available on the USCAP website: www.uscap.org.

CAP-ACP Mission Statement: The Canadian Association of Pathologists (CAP-ACP) is a voluntary professional organization of laboratory physicians and scientists. The CAP's mission is to provide national leadership in Pathology and Laboratory Medicine through the promotion of excellence in practice, education, and research, and through the fostering of integrity and high standards of ethical behavior. The CAP aims to provide continuing professional development to all subgroups within its membership. The CAP will also advocate for high quality and standards for patient care, promote collegiality, and advocate for the professional interests of laboratory physicians and scientists. Activities: The CAP accomplishes its work through its, Committees and Clubs. The CAP publishes a peer-reviewed Journal, grants awards and organizes an Annual Meeting for its members.

There is a Resident’s Section within the CAP. This section aims to promote the quality of resident training and provides a communication network for Canadian pathology residents.

The five-day Annual Meeting generally takes place in June or July, and is held in various locations across the country. The Annual Meeting includes a meeting of the Resident Section. Several CAP awards are also offered to residents. Travel and registration fees can be applied for through PGME if the resident is presenting. CME Funds may also be used.

The CAP Annual Meeting is another great opportunity to network, attend educational seminars, and present one’s original research. Junior Residents, in particular, are encouraged to attend this valuable meeting.

Further details on the Annual Meeting, Journal, Membership, etc. are available on the CAP-ACP website.

The Banff Pathology Course The Banff Pathology Course is a collaborative effort of the Department of Pathology & Laboratory Medicine, University of Calgary and the Department of Laboratory Medicine & Pathology, University of Alberta to provide a continuing medical education activity for residents in training and practicing pathologists.

This 3-day annual meeting is held every year in late August/early September. The focus changes every year, but overall the intent of the conference is to provide a forum for sharing information on current practice and diagnostic methods, and updating knowledge in emerging areas of pathology. The Banff Conference is typically well-organized and attracts world renowned speakers. The venue for this event is also highly desirable, and opportunities to enjoy the outdoors, share in a banquet with colleagues, and network with others abound. Residents are encouraged to attend this conference, and PGY2-5s are excused from service duties (including call) to do so. Every effort will be made to protect this time for PGY1s as well, although this may not always be possible in some clinical rotations. The Registration fee may be covered by the residency program, in years where the budget allows. Other expenses such as travel and accommodation expenses can be reimbursed through the resident’s CME accounts (For details, see Travel/conference policy in Section 1). For additional information, see: www.ucalgary.ca/pathology/banff- pathology-course.

International Conference on Residency Education (ICRE) The International Conference on Residency Education (ICRE) is a recently developed conference sponsored by the Royal College of

Page | 45 RESIDENCY TRAINING in Anatomical Pathology ______Physicians and Surgeons of Canada. This one-of-a-kind annual meeting (held in rotating cities in Canada) provides workshops, lectures, and scientific presentations that deal entirely with issues related to post-graduate medical education. Special programs/workshops for Program Administrators, Program Directors, and Chief Residents are also offered. PGME is prepared to offer funding to support a Chief or Senior Resident to attend this meeting. For details on funding support, please visit the PGME website. Further details regarding meeting dates, workshops, accommodation, etc. are available on at: rcpsc.medical.org/icre

Canadian Anatomic and Molecular Pathology Conference This conference held annually, the first week of February, in Whistler, BC is recently developed and recommended for both faculty and trainees to attend. Usual registration for Residents & Fellows is $150 - $175 The program will determine annually if the registration fee for our trainees can be reimbursed; the determination will be based on the fiscal climate each year. More course information can be found at www.pathologycamp.ca

Section 2.4: PGME Workshops

The Office of Post-Graduate Medical Education (PGME) offers a number of Workshops throughout the year that address a variety of topics applicable to Residents in all training programs. Some of these workshops are considered mandatory. The schedule and topics may vary somewhat throughout the year, and the most up-to-date information can be found on the PGME website (http://cumming.ucalgary.ca/pgme/workshopsevents). Our Anatomical Pathology Program supports attendance by our residents at any appropriate PGME Sessions. Some examples of the currently available workshops are as follows:

Medical-Legal Module 1: The Legal Aspects of Medical Practice Open to all residents; mandatory for PGY-1 residents This 4 hour module includes informed consent, informed transition of care, capacity, confidentiality, disclosure, and other important legal aspects of verbal and written communication with patients, families, and other health care professionals. Module 1: forms the basis for subsequent modules presented over a 2-year cycle. Module 2: Doctor’s Legal Responsibilities and Relationships Module 3: Risk Management for Doctors Module 4: The Doctor’s Role in Legal Proceedings Module 5: Legal Aspects of Practice Management

Ethics Day This one day workshop on medical bioethics is mandatory for new residents and fellows. This session includes both didactic presentations and small-group discussion of case scenarios. Breakfast and lunch are provided.

Teaching Skills This workshop consists of 3 half-day sessions. Participants must attend all 3 sessions. Attendance is mandatory for all residents whose programs do not offer a teaching skills session in their academic half-day schedule (i.e. Pathology). This workshop includes both didactic and interactive (small group) components. Topics include bedside, small group, large group, and procedural teaching, mentorship, evaluation, etc. To register for any of these workshops please follow: https://intranetqa.ucalgary.ca/medicine/education/pgmeevents/

Page | 46 RESIDENCY TRAINING in Anatomical Pathology ______Section 2.5: Non-Medical Expert CanMEDs Roles The Leader Role Finding comfort with the Leader Role has always been a challenging component of this Program. The program seeks to train residents to develop skills in time management, administration, leadership, informatics, quality assurance/control, etc. in the following ways:  The didactic curriculum includes lectures in the areas of laboratory management and quality assurance. Access to PGME-wide workshops in conflict and communication, financial management, etc. is also provided (see PGME website for details). Additional workshops, retreats, etc. may also address some of these topics (eg. Resident’s Retreat Feb 2014: The afternoon session focused on “Financial Management”). Staff physicians are also encouraged to bring topics in this realm up for discussion in their day-to-day interaction with residents at all levels.  Opportunities to participate in committee work (Residency Training Committee, Safety Committee, AP/Cytology Operations Committee, etc.) are available not only to the Chief Resident, but also to Junior Residents. Residents are invited to attend Business/Laboratory Meetings relevant to their current rotation whenever possible (Cytopathology, Lymphoma Group, etc), and to actively participate when appropriate.  The Chief Resident rotation is mandatory in our Program. This rotation intensely involves a Senior Resident in the management of the department with duties such as: rota assignment, vacation approval, on-call scheduling, didactic session planning, trouble- shooting resident issues, and committee work. (See Section 3 of the Manual for detailed objectives and description of this rotation).  Residents routinely participate in the interviewing of new staff applicants (usually the Chief or other Senior Resident) as well as CARMs candidates (Junior and Senior Residents).

Other specific opportunities in this area are as follows:

Elective in QA/QC/Informatics This elective in Lab Administration has recently been created (Dr. C. Naugler) to provide residents with exposure to a variety of topics not otherwise comprehensively covered in their curriculum. See Section 7 (Laboratory Informatics) of the Manual for detailed description and Objectives of this rotation.

Personal Learning Projects (PLPs) PLPs were introduced as another way to expose residents to a variety of Lab Management issues. A list of relevant topics was created by Dr. M. Trotter, and approved by the RTC. One-two residents are expected to participate in the presentation and discussion of one-two of these topics (on a rotating basis) every 3-4 months. Over the five year training period, each topic should be able to be covered at least once. A detailed list of the questions/topics is as follows:

Quality Assurance 1) What is the ISO 15189 standard for medical laboratories and what are the main components of this standard? 2) Outline the major categories used by the College of Physicians and Surgeons of Alberta (CPSA) in accreditation of an Anatomical Pathology Laboratory. 3) What are the components of a CPSA on-site laboratory accreditation? 4) Describe the essential components of a quality assurance program in surgical pathology. 5) Describe the essential components of a quality assurance program in cytopathology. 6) Describe the essential components of a quality assurance program in autopsy pathology. 7) Describe the essential components of a quality assurance program in tumor cytogenetics.

Page | 47 RESIDENCY TRAINING in Anatomical Pathology ______8) Discuss the components of quality control and quality assurance in a diagnostic laboratory. 9) Discuss the principles of root cause analysis and the role of root cause analysis in investigation of incidents/errors in Anatomical Pathology. 10) Discuss the role of intra- and extra-departmental review of pathology diagnostic material (second opinion). 11) Classify addendum reports and give an example of each type. 12) Discuss the concept of “critical values” in Anatomical Pathology. 13) What are the recommended retention guidelines for specimens and documents in Anatomical Pathology? 14) Discuss the essential components of “safety” in an Anatomical Pathology laboratory. 15) Discuss the role of synoptic reporting as a quality assurance tool.

Laboratory Management 1) Draw an organizational chart for the Division of Anatomical Pathology and Cytopathology. 2) How is workload measured in Anatomical Pathology? 3) What are the components of an annual performance appraisal for pathologist staff? 4) Discuss how you would prepare for and conduct an interview for a laboratory technical employee or supervisor. 5) Discuss how you would handle the following management/human resources issues: a) Complaint from technologist regarding harassment by pathologist b) Concern raised by pathologist regarding diagnostic competency of a colleague c) Complaint from a resident that a pathologist is not answering pager while on call d) Resident concerns that a pathologist is refusing to engage in designated microscope teaching 6) What are the basic concepts underlying Lean production methods, and how can these methods be applied to an Anatomical Pathology laboratory? 7) Prepare a major equipment request (MER) for: a) an automated special stainer (histochemistry) b) a replacement pathologist microscope 8) Write a sample 5-year strategic plan for the Division of Anatomical Pathology and Cytopathology.

Laboratory Informatics 1) Discuss the costs and benefits of pathology informatics to the patient and to society. 2) From the perspective of Anatomical Pathology, discuss the selection criteria for choosing a new laboratory information system. 3) Your laboratory, in concert with the health region, is about to implement electronic reporting of Anatomical Pathology results directly to the patients’ hospital chart and, for outpatients, to /physician electronic medical records (EMRs). What quality assurance processes must be in place prior to the go live date? 4) Discuss the components of digital imaging including image acquisition, manipulation, and storage. 5) Discuss available resources for clinical decision support. 6) Discuss the role of in Anatomical Pathology. 7) Discuss the advantages and disadvantages of voice recognition technology in pathology. 8) What are the advantages of adopting the LOINC coding system for medical terminology? 9) Discuss the role of ICD and SNOMED coding in laboratory informatics?

Section 2.6: Other Courses, Workshops, and Meetings Oncology didactics This series of lectures, designed for Oncology Residents/Fellows, provides didactic sessions on the following topics: Introduction to Oncology, Basic Pathology, Radiology, The Molecular Basis of Cancer, Clinical Research Methods, Ethics and Errors, and Health Care in

Page | 48 RESIDENCY TRAINING in Anatomical Pathology ______Canada: Economics, Law, and Policy. The course is intended for Oncology Residents and Fellows, but Pathology Residents are also welcome and encouraged to attend when possible. The sessions on The Molecular Basis of Cancer, Clinical Research Methods, Ethics and Errors, and Health Care in Canada would be of particular relevance to Pathology residents. The sessions are generally held on Tuesdays and Thursday afternoons from 1600-1700, in the TBCC, but Residents should check the separately distributed schedule for details. It is recognized that the Thursday afternoon sessions may conflict with the Department of Pathology Grand Rounds. If the resident believes the topic in this course to be of greater interest/applicability to his/her education, however, then he/she has the freedom to make that choice.

Office of Faculty Development (OFD) Teaching Workshops The Office of Faculty Development (OFD) at the University of Calgary sponsors a number of Teaching workshops throughout the year that may be interesting and/or relevant to the Trainee in pathology. While intended for Faculty Development, residents can and have attended some of these sessions in the past. Some examples of Workshops offered in the past have included: “Teaching Professionalism”, “Evidence Based Medicine”, “Disclosure Workshop”, etc. For more details on available workshops and registration, see: medicine.ucalgary.ca/facdev

Review Courses In the past, some Senior Residents (PGY4 and 5) have found it helpful to participate in an Anatomical Pathology Review course, to assist with preparation for Board Examinations. Residents may access their CME Funds to pay for these courses.

Examples of Review courses are as follows: 1) Armed Forces Institute of Pathology (AFIP) Annual Anatomical Pathology Course: For details, see: www.afip.org 2) American Society for (ASCP) Resident Review Course: For details, see: www.ascp.org 3) The Osler Institute Pathology Course (geared more towards preparation for the American Board Exams): For details, see: www.osler.org 4) The Canadian Association of Pathologists (CAP/ACP) Resident’s Review course (recommended and up to $1,500 is provided by our program for each resident to attend once during their AP residency). For details, see: http://cap-acp.org/

Medical Examiner’s Symposium This continuing education symposium offers a 2 day weekend program of lectures of interest and relevance to any team member involved in Forensic Investigation. The Symposium is offered once every 2 years (odd years), in March. The meeting is held in an Alberta sites such as the Kananaskis or Edmonton. The Office of Continuing Medical Education at the University of Calgary has provided financial support for residents to attend in the past. Residents may also access their CME funds to attend this course. For information, see: https://justice.alberta.ca/programs_services/fatality/ocme/Pages/Education.aspx

Page | 49 RESIDENCY TRAINING in Anatomical Pathology ______Section 2.7: Residents as Teachers The Royal College encourages all programs to produce good resident teachers, and there is ample opportunity for doing so at the University of Calgary.

Residents at all levels are involved in teaching on a daily basis. This may involve the teaching of support staff, medical students, other residents, and/or other members of the professional health care team. The Chief Resident plays a particularly important role as a teacher.

There are a number of different ways in which a resident may be involved in teaching. These include, for example: teaching via the double-headed microscope, through demonstration of gross techniques and findings, or by being involved in discussions at surgical pathology rounds. More formal opportunities include: leading small group sessions at the , presenting formal rounds to clinicians and other health care groups, or preparing for a platform or poster presentation at a local, national, or international meeting.

Various courses and workshops are available to assist with the development of teaching skills (see preceding section), and residents are encouraged to become involved in these sessions as time and interest permit.

In recognition of our top Resident Educator, an Award for “Outstanding Achievement in Teaching by a Resident” is presented every year. Nominations for the top teachers are put forth by the Residency Training Committee, and all Anatomical Pathology Staff are invited to vote. The Award comes with a Certificate and $500.00 in prize money.

Presentations at rounds are evaluated by the attendees (forms are distributed via One45), and the feedback is given back to the resident as well as documented in their file.

Page | 50 RESIDENCY TRAINING in Anatomical Pathology ______Section 3: Research Section 3.1 Introduction Philosophy The research process is important for developing skills in critical thinking and in the interpretation of the published scientific literature. Involvement in research also serves the purpose of contributing to medical knowledge and in facilitating the career goals of the resident. The Royal College of Physicians and Surgeons General Standards of Accreditation require that the Department of Pathology have an active research program. This is evidenced by activities such as publications in peer-reviewed journals, involvement by staff and residents in current research projects, presentation of scientific work in public forums, etc.

Objectives By the end of the residency program, the resident will be able to: 1) Conduct a thorough literature review using computerized databases. 2) Evaluate an article from a scientific journal using as criteria: a) Relevance of the topic to current practice b) Adequacy of the method of investigation including: i) Clarity of statement of the problem including the hypothesis to be tested ii) Selection of variables most amenable to study iii) Adequacy of method of selecting cases iv) Appropriateness of methods of data analysis and study design v) Validity and reliability of data vi) Precision of measurement vii) Identification of potential sources of bias viii) Adequacy of the discussion ix) Validity and generalizability of the conclusions 3) Design and execute a research project 4) Present original work in a public forum

Types of Research Projects 1) Clinical based project using archival and/or prospective case material 2) Methods development 3) Research designed to address issues of quality assurance 4) Experimental research

Publication of Research Research projects should be sufficiently well designed, novel, etc., such that they have a reasonably high likelihood of acceptance in the peer-reviewed scientific literature. The resident should work with the supervisor to ensure that the research is written up in the format required by scientific journals and submitted for publication.

Page | 51 RESIDENCY TRAINING in Anatomical Pathology ______Section 3.2 The Research Coordinator Resident Research Coordinator: Dr. Martin Hyrcza ([email protected])

General: Reporting to the Anatomical Pathology Residency Training Committee (RTC), the Resident Research Coordinator, a faculty member in the Department of Pathology and Laboratory Medicine, assists and mentors pathology residents in all matters related to resident research. The ultimate goals are to elevate the quality of research, and to increase the level of accountability related to resident research activity.

Specific Roles and Responsibilities: 1) Meet regularly with residents as a group (minimum 2 x per year) to discuss research-related opportunities, topics, concerns etc. 2) Provide one-on-one mentoring to residents regarding research activities, including first- responder for residents having difficulty finding/starting research projects. 3) Maintain updated list of research interests/activities of each faculty member. 4) Maintain updated database of resident research activity, and monitor research outcomes (abstracts, peer reviewed publications, etc). 5) Review/approve (along with the Program Director and/or RTC) written funding requests for resident research projects 6) Provide academic and organizational assistance for resident and graduate student research day. 7) In collaboration with RTC, approve in-house and external research electives and assist RTC with evaluations of these electives. 8) Review the terms of reference on an annual basis. Term: The position is appointed by the RTC, in consultation with the Department Head. The term is three years, and is renewable.

Report: A report (written or verbal) will be presented to the RTC at least twice per year as well as have a standing item on the RTC agenda.

Page | 52 RESIDENCY TRAINING in Anatomical Pathology ______Section 3.3 Research Proposals, Process, and Funding Resident Research Database The Resident Research Database can be found at the following path:

Research Proposals Research proposals are required for all resident projects, and are limited to 5 pages. The proposal should contain the following subheadings: 1) Specific aims These should be concise and in point form. It is reasonable to include the hypothesis to be tested in conjunction with the specific aims. 2) Background and significance This should comprise a concise literature review of the area such that a reviewer could be reassured that the resident is aware of what others have done and can understand the rationale or thinking behind the proposed research. 3) Preliminary data If preliminary data is available, this should be included here. It is probably a good plan to conduct a small pilot project before embarking on a full research proposal. A pilot project should show that the project is technically feasible and that there is a high likelihood of success. 4) Methods This should include an overview of the experimental design and specific protocols corresponding to the specific aims mentioned above. Special attention should be given to the number of cases/experiments required to answer the scientific question(s), controls that will be used and the method(s) for data analysis. Laboratory techniques and procedures can be briefly mentioned unless they are of an innovative nature. 5) Ethical considerations These should be addressed in detail and appropriate ethics review and approval obtained. 6) Budget These items should be developed using the guidelines established by the department.

Research Process SCOPE: All residents (PGY 2 – 5) enrolled in the Anatomical Pathology Residency Training Program, University of Calgary.

PURPOSE: To clarify the role of the resident when starting a research project within the Anatomical Pathology Resident Training Program, Department of Pathology and Laboratory Medicine.

REQUIREMENTS: 1. All requests shall be submitted on the specified form entitled “APL Application for Internally Supported Research RE7118” 2. A prospective budget for the project should be included. 3. May or may not require Ethics approval prior to application

PROCEDURE: 1) A research proposal may be initiated at any time during the year. 2) Identify an area of research that is of interest to you. Contact a staff member with expertise in that area and determine if they are willing to supervise your project. (The Research Coordinator maintains a list of potential preceptors, and is willing to facilitate this process.)

Page | 53 RESIDENCY TRAINING in Anatomical Pathology ______3) The resident will fill out the specified form APL Application for Internally Supported Research (RE7118) with all pertinent details and submit the form to APL AP Research via email ([email protected] ). The project will be assessed for feasibility and ensure the budget is accurate. 4) If approved at stage 3, it will be sent to: the AP Resident Training Committee, the APL AP Divisional Research Committee (the chair is Dr. Martin Koebel) and APL Research Office. The RTC will review for budget approval, provide any comments on scientific merit or methodology, the APL AP Divisional Research Committee will review for scientific merit and methodology, APL Research is included to ensure their awareness of the project and is also welcome to comment on the project. The APL Research Office also provides the internal research letter required for ethics submission 5) Any comments on the project will be sent back to AP Research (Taryn Rutherford) so the resident and supervising staff member aren’t fielding the same question from multiple sources, one set of questions will be put forward to the resident and supervising staff member for answering. 6) Once all issues are resolved (and the budget approved) the project is approved by AP Research, an RS number will be issued and an AP Research Agreement will be sent for review and signing. 7) A copy of the AP Research Agreement will be provided to the Program Administrator to be kept on file. 8) All project invoices will be submitted for payment to the Program Administrator without delay.

Internal Support for Resident/Fellow Research Projects

Definition: Resident research projects must involve the Pathology resident/fellow in a primary investigator or major co-investigator role. The resident/fellow (trainee) must be first or senior author on any abstracts or publications arising from the research project. 1) Alberta Public Laboratories (APL) supports the technical costs of approved (per the above process) resident/fellow research projects including: a) Data retrieval from laboratory information system b) Block/slide retrieval from on-site storage c) Block/slide retrieval from off-site storage (Iron Mountain) to a maximum of 30 cases (pilot project or proof-of-principle) d) Slide cutting and , including special stains available in house e) Immunohistochemistry (IHC) available in house (APL IHC Laboratory) f) Molecular testing available in house 2) Resident research projects may occasionally have associated costs that are not covered by APL, for example: a) Chart retrieval from medical records b) Block/slide retrieval from Iron Mountain in excess of 30 cases c) IHC, including new antibodies and method development for tests not on the APL menu, (Anatomical Pathology Research Laboratory) d) Molecular testing not on APL test menu e) Statistical support f) Database development/support g) Capital equipment costs h) Publication costs 3) To cover costs associated with #2 above, a trainee and his/her staff research supervisor may apply to the Anatomical Pathology Residency Training Committee (RTC) for additional funding support.

Page | 54 RESIDENCY TRAINING in Anatomical Pathology ______a) The maximum additional funding awarded per request is $5,000. b) The total funding available per year is $15,000 (subject to change dependent on annual budget) c) A trainee or a staff supervisor can apply only once per calendar year (April 1 – March 31) d) A copy of the approved Application for Internally Supported Research application (APL Form RE#7118), with attached Research Project Cost Summary, must be submitted to the RTC, with justification for the additional funding request e) The trainee must be intimately involved in the research project and must be first or senior author on any presentations or publications arising from the research work. f) Projects will be funded on a first-come, first-served basis effective April 1, each year. g) If total funds requested are more than available, then funding per project will be decreased accordingly, as decided by the Chair of the AP Research Committee and the RTC. h) Funding decisions made by the RTC are final. There is no appeals process.

Section 3.4 DPLM Research Day The Department of Pathology and Laboratory Medicine at the University of Calgary holds an annual Research Day. All Anatomical Pathology residents beyond the PGY2 year are expected to present. Research Day includes presentations not only by pathology residents, but also by fellows, graduate students, medical students, and even technologists associated with the department.

Research Day, more than just being a competition, provides residents with an opportunity to be trained and evaluated in the scholarly aspects of physician competency. Research Day not only allows the department to internally comment on the design and presentation of a resident’s research, but these projects form the starting point of subsequent educational travel, a highly valuable ancillary educational activity made available to residents doing original research.

The Research Day is currently held in the late spring/summer. Our department takes great pride in our Annual Research Day, which has been a center piece in our program for over twenty years. Funding for Research Day comes from multiple sources including the APL Resident’s Budget, PGME, and from the Paul Kneafsey Memorial Fund. Research Day includes a guest speaker who delivers the Paul Kneafsey Memorial Lecture, and who also acts as the primary adjudicator for the Research Day competition. The Research Day events are thus two days of activities including the visit by the selected guest speaker, various educational and social activities attended by that person, and the Research Day itself.

At the end of Research Day, an Awards Banquet is held to celebrate the achievement of all presenters and to declare the winners of the competition. The Banquet also offers residents and staff an informal and relaxed environment in which to relax, socialize, share ideas, and otherwise get to know one another.

The Research Day Awards include: Outstanding Clinical Research ($500.00), Outstanding Basic Science Research (Dr. Anna Kossakowska Award) ($500.00), and an Honorable Mention Award in both the Clinical and Basic Science categories ($250.00 each). In addition, a $250.00 prize is awarded to the Best Poster presentation (provided 2 or more are entered).

Research Day and Banquet

All Anatomical Pathology Residents at the PGY2 - PGY5 level are expected to participate in Research Day. In addition, Research Day entries are also open to Graduate Students, Fellows, Medical/Laboratory Students, and Technicians from the Department of Pathology and Laboratory Medicine. The work presented must be original, and must be based on work undertaken predominantly in Calgary. The presenter must be a major contributor to the work. While most of the Residents in Anatomical Pathology will be expected to deliver a platform presentation, entry into the poster competition is also

Page | 55 RESIDENCY TRAINING in Anatomical Pathology ______acceptable. Residents may choose to enter a platform presentation AND a poster, if desired.

Abstracts are generally due up to 4 weeks before Research Day, and Abstract Guidelines will be distributed well before-hand. Guidelines must be strictly adhered to in order to warrant consideration for acceptance. All Research Day presentations (poster and platform) are eligible for awards.

Platform presentations are 10 minutes in length, with 5 minutes allowed for questions/discussion. The order of presentations will be randomly selected, although some scheduling allowances may be made for supervisors who are off-site. Posters should be in position well before the Viewing Session begins.

Three Adjudicators participate in the judging of the presentations; two are local Professional Staff, and one is the Visiting Guest Speaker. At the end of the day, the Adjudicators meet and choose the Award Recipients (Award details are given below). In general, presentations are judged based on their content, originality, relevance, science and methodology. Presentation style, background knowledge, and ability to respond to questions are also taken into account.

The Banquet is traditionally held on the evening of Research Day. Attendees enjoy a Banquet meal, followed by the Awards Ceremony.

Research Day Awards

First Prize: Basic Science Category (Anna Kossakowska Award) ($500.00): This Award is given to the most Outstanding Basic Sciences presentation. The Award is named in memory of Dr. Anna Kossakowska, a dedicated Anatomical Pathologist and Basic Science Researcher from the Department of Pathology (1984-2003). Dr. Kossakowska was a cornerstone of the Autopsy and Lymphoma services at the Foothills Medical Centre for many years, and published widely in the field of Hematopathology and Molecular Pathology.

First Prize: Clinical Science Category ($500.00): This Award is given to the most Outstanding Clinical Sciences presentation.

Honourable Mention (One each in the Basic and Clinical Sciences Categories)($250.00): This Award is given to the second most highly ranked presentation, in both the Basic Sciences and Clinical Sciences categories.

Best Poster Award (Any category)($250.00): If two or more poster presentations are entered, an Award for the Best Poster will be given. The Poster Author must be present at the Poster Session, and available to answer questions in order to be considered for this Award.

Paul Kneafsey Memorial Fund and Lecture Dr. Paul Kneafsey represented a central figure in the Department of Pathology at the University of Calgary. He served as an Anatomical Pathologist from 1989 until his untimely death in 2001. Dr. Kneafsey was a role model in all realms of physician competency. He was extremely active in the management of Residency training, and served as Program Director from 1995 to 1999. He was a dedicated mentor to residents, and, in 2006, received posthumously the Mentor of the Year Award from the Royal College of Physicians and Surgeons of Canada. He was a committed and accomplished teacher, and won the “Teacher of the Year” Title on numerous occasions. For many of the years that he served in this department, he essentially ran the Friday morning Surgical Pathology

Page | 56 RESIDENCY TRAINING in Anatomical Pathology ______Rounds. He also established the tradition in our department of providing and reviewing sets of unknown slides for the PGY-5 residents, to help them prepare for the Royal College Examination. These rounds continue today, and are affectionately known to the Senior Residents as “PK Sessions”. He attended a variety of medical rounds on a regular basis, and always managed to convey his opinion along with a healthy sense of humor, which inevitably contributed to a lively discussion.

Following his death, the friends and family of Paul Kneafsey established an Endowment Fund in his name, which was meant to provide for the expenses of the Annual Research Day. The Department of Pathology and Laboratory Medicine gratefully acknowledges the generous support of Dr. Michele O’Sullivan, whose contributions have enabled the Paul Kneafsey Memorial Fund to be a self- sustaining endowment, memorializing the professional record of her brother and our colleague. Contributions to this worthy cause continue to be collected every year.

Each year, a distinguished speaker is invited to deliver the Paul Kneafsey Memorial Lecture, which is given at the Thursday afternoon CME Rounds, prior to Resident Research Day. The visiting speaker also contributes to other educational rounds for the Department, and acts as the Primary Adjudicator for the Research Day Competition.

Past Paul Kneafsey Memorial Lecturers: 2001 Randy Gascoyne 2012 George Netto 2002 John O’Connell 2013 Andrew Churg 2003 Thomas Krausz 2014 Jennifer Hunt 2004 George Mutter 2016 Ming Zhou 2005 Emma Lew 2017 Paul Swanson 2006 Patrick Walker 2018 Henry Tazelaar 2007 Robert Folberg 2019 Robert West 2008 Richard DeMay 2020 Jason Hornick 2009 Petur Nielsen 2021 2011 Mark Sherman 2022

* Due to a change in the timing of Research Day, there was no lecture in 2010 or 2015.

Guest Lecturers prior to 2005: 1990 J. Griffin 1996 Joanne Wright 1991 D. Gnepp 1997 Brian West 1992 Kim Solez 1998 Ruth Katz 1993 Frederick Behm 1999 Cynthia Nast 1994 Bruce McManus 2000 Victor Tron 1995 Louis Dehner

Page | 57 RESIDENCY TRAINING in Anatomical Pathology ______Section 3.5 Clinical Investigator Program (CIP)

What is the Clinician Investigator Program? The University of Calgary’s Clinician Investigator Program (CIP) is a postgraduate medical training program for residents in any specialty or subspecialty who want to develop a strong foundation for a career in clinical research. It provides a tailored combination of research, clinical and coursework experiences that provide the knowledge, attitudes and technical competence graduates need to be successful in clinical and translational research in their chosen field. The CIP is recognized and accredited by the Royal College of Surgeons and Physicians of Canada (RCSPC). If you’re interested in taking your clinical research skills to the next level, then this program is for you! https://cumming.ucalgary.ca/cip/

How do I Complete the Clinician Investigator Program? To complete the program, you must be enrolled in an accredited specialty or subspecialty residency program at the University of Calgary and conduct research for at least 2 years. You must complete all Graduate Studies program requirements including coursework, research proposal and thesis submission, and defense. PhD candidates will also complete a candidacy exam. CIP specific requirements including seminars, coursework and clinical duties must also be completed. Once all program requirements have been fulfilled, you will receive a graduate degree (MSc or PhD) and a certificate of completion from the RCSPC. For more information, see www.ucalgary.ca/cip or the contacts below:

Clinician Investigator Program Office Clinician Investigator Program Office Faculty of Medicine University of Calgary HRIC 1AC62, 3280 Hospital Dr. NW Calgary, AB T2N 4N1 Phone: (403) 220-7318 Fax: (403) 210-9550 e-mail: [email protected]

CIP People Dr. Zelma Kiss MoonMoon Ahmed CIP Director CIP Program Administrator (403) 220 4839 (403) 220-7318 [email protected] [email protected]

Page | 58 RESIDENCY TRAINING in Anatomical Pathology ______Section 4: Evaluation Section 4.1: Traditional Stream The evaluation of residents is a central role of the Residency Training Program. Throughout the five years of the residency, ongoing evaluations help identify strengths and weaknesses, and serve to steer residents to the final goals of excellence in all CanMEDs competencies. Evaluation occurs in a number of different ways: Informal evaluation: feedback occurs on a daily, on-going basis throughout the resident’s service rotations, in the research setting, during teaching and presentation at rounds, etc. Formal evaluations include the ITERs (In Training Evaluation Reports), In-house Examinations, the FITER (Final In Training Evaluation Report), and the Royal College Fellowship Examination.

If a resident is found to be struggling/substandard, discussions and actions regarding remediation, probation, promotion, or dismissal may ensue, as appropriate. An appeals mechanism is also in place. An attempt is always made to work through these issues at the RTC level. The guidelines and policies, however, are written by the PGME Committee, and more involved cases may necessitate involvement at a higher level.

ITERS In-Training Evaluation Reports (ITERS) must be completed at the end of each rotation, as well as midway through any rotation lasting longer than 2 blocks. ITERS are completed through a web- based format through One45. This format is used throughout most Royal College Accredited Residency Programs, and therefore strives in its general design to be uniform across all disciplines. The PGME Office has put in place a generic scale for ITERs. Please take note that there are no “borderline” or “marginal” categories and that there is a clear demarcation between the failing categories and the passing categories. Individual programs may add numeric values and/or definitions to the scale as they wish.

Our program has designed our own (CanMEDs-based) categories for evaluation, which are specific to the particular rotation. Evaluations are generally issued by the preceptor of the rotation, who gathers and summarizes comments from the other staff working with the resident. Preceptors who incorporate the opinion of other faculty into their evaluation should indicate the consulted staff members in the appropriate spot at the end of the evaluation form.

One45 has made evaluations easy to complete, easy to monitor compliance, and easy to create summaries. One45 however, does not ensure the most important component of the formative evaluation system; namely, timely and face-to-face evaluations. Face-to-face evaluations enable a dialogue between the evaluator and the person being evaluated that is not possible on paper or on One45. Often, at the time of face-to-face evaluation, problems that might have been perceived during the rotation might be clarified by some explanation. For the preceptor, this is an excellent opportunity, at the middle or at the end a rotation, to receive feedback about the quality of the rotation. For the resident, on- going face-to-face evaluation provides a truly formative evaluation process rather than an end of rotation scorecard. Of note, if at any time during the rotation the preceptor believes the resident is struggling and may possibly fail the rotation, this must be communicated to the resident, in writing as well as a face to face discussion. This enables the resident to discuss the problem with the preceptor, and gives he/she the opportunity to try and modify his/her performance before the end of the rotation.

FITER The Final In-Training Evaluation Report (FITER) is completed about midway through the PGY5 year. In essence, the FITER is the training program’s assertion that the resident is competent in all areas to practice independently in the specialty of Anatomical Pathology. FITERS are completed by the Program Director(s) and then forwarded to the PGME office and subsequently to the Royal College.

Page | 59 RESIDENCY TRAINING in Anatomical Pathology ______Section 4.2: Competence by Design (CBD) All Anatomical and General Pathology Programs in Canada transitioned to Competence by Design on July 1, 2019. If you are a resident trainee starting on or after July 1, 2019 you will be participating in this education stream. The Competence Committee – Terms of Reference

Definitions  Academic Advisor – a faculty member specifically appointed to individual resident(s) to review the residents’ academic progress during residency.  CBME Lead – Point person to develop and apply the new curriculum to ensure all educational activities deemed by the specialty committee are able to be experienced.  Entrustable Professional Activity (EPA) - a task that you do that defines you as a pathologist that can be entrusted to a trainee to exhibit competence.  Milestone – "the expected ability of a health care professional at a stage of expertise", an observable marker of a person's ability along a developmental continuum.  Stages of Training – Competence By Design (CBD) is broken into a series of integrated stages from the beginning of residency through practise o Transition to Discipline - Orientation to the discipline o Foundations of Discipline - Broad based competencies every trainee must acquire before moving on to more advanced, discipline specific competencies o Core - Essential competencies that constitute the core of a discipline o Transition to Practice - Allows trainees to exhibit readiness for autonomous practice

Entrustable Professional Activities for Anatomical Pathology (taken verbatim from the Royal College of Physicians and Surgeons publication © 2018 The Royal College of Physicians and Surgeons of Canada. All rights reserved.)

Stage: Transition to Discipline EPA #1: Participating in basic specimen handling Key Features: - This EPA includes the use of the basic knowledge covered in the orientation to the laboratory in order to:  Match requisition and container and/or specimen  Systematically verify the adequacy of patient and clinical information (requisition adequacy and completeness such as documentation of ischemic time) to initiate laboratory evaluation of a specimen  Assess and prepare selected simple surgical specimens which are defined as single organ, routine indications and/or routine surgical specimens (e.g., appendix, gallbladder, simple hysterectomy for fibroids/uterine prolapse, colon for diverticulosis, ischemic small bowel) for fixation  Select and recognize the appropriate fixative type (formalin, alcohol) and assess whether the quantity and size of the specimen container is appropriate  Match slides, blocks, and requisition

- The observation of this EPA is divided into two parts: specimen handling; and assessment of knowledge. - The assessment of knowledge will consist of a structured oral or a written multiple-choice quiz, designed and administered by the supervising pathologist, on content related to the topic of specimen handling.

Assessment Plan:

Page | 60 RESIDENCY TRAINING in Anatomical Pathology ______Part A: Specimen handling

Assessment Method: Assessment Form: # Observations: Direct observation or case Form 1 Collect 5 observations of review by pathologist, TTP Collects info on: achievement trainee, histotech, or - Specimen type: appendix; - At least 1 of each specimen pathology assistant gallbladder; simple type hysterectomy for fibroids or prolapse; colon for diverticulosis; ischemic small bowel; other - If “other” please specify specimen type: [free text] - - Fixative: fresh; formalin; alcohol

Part B: Assessment of knowledge

Assessment Method: Assessment Form: # Observations: Evidence of satisfactory - Form 4 Collect 1 observation of completion of a structured achievement oral or written quiz administered by the supervising pathologist

Relevant milestones:

Part A: Specimen handling 1. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry 2. ME 1.3 Apply knowledge of principles of , , genetics, and pathogenic mechanisms, and the changes that occur in disease states 3. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues 4. ME 2.2 Identify basic principles of specimen adequacy as they apply to surgical and cytopathology specimens 5. ME 3.3 Recognize and discuss the importance of the triaging and timing of a procedure or 6. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite, to minimize occupational risk 7. COM 4.1 Organize information in appropriate sections within an electronic or written 8. COL 2.1 Respond to requests and feedback in a respectful and timely manner 9. L 1.2 Demonstrate knowledge of laboratory safety initiatives 10. L 1.4 Describe the data available from health information systems to optimize patient care 11. P 1.1 Demonstrate punctuality 12. P 1.1 Complete assigned responsibilities

Page | 61 RESIDENCY TRAINING in Anatomical Pathology ______EPA #2: Summarizing relevant clinical information for clinicopathologic correlation

Key Features: - This EPA focuses on extracting clinical information, including clinical history and relevant laboratory and imaging results, from a number of different sources (including electronic), interpreting this information in light of the clinical question, and providing a summary. - This EPA may be observed in surgical pathology, cytopathology, or autopsy pathology.

Assessment Plan: Case discussion and/or review of written clinical summary by supervisor (may include pathologist or Core or TTP trainee) Use Form 1. Form collects information on: - Location: surgical pathology; cytopathology; autopsy pathology; other - If “other” specify location: [free text]

Collect 3 observations of achievement - At least 1 autopsy pathology

Relevant Milestones: 1. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry 2. ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states 3. ME 2.2 Obtain a relevant clinical history 4. COM 2.3 Seek and integrate relevant information from other sources 5. ME 2.2 Interpret history and relevant investigations in light of the clinical question 6. ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor 7. HA 1.1 Analyze a given patient’s needs for health services or resources related to the scope of Anatomical Pathology

EPA #3: Demonstrating basic skills in microscopy Key Features: - This EPA focuses on using a microscope correctly and troubleshooting its principal problems. - This includes:  Setting up the microscope (turning it on, adjusting the focus), using a polarizer and micrometer, understanding ergonomic setup  Performing basic microscope maintenance such as changing objectives and bulbs  Viewing the slide

- The observation of this EPA is divided into two parts: microscopy; and assessment of knowledge. - The observation of microscopy is based on the resident driving the double/ multi-headed microscope in the review of slides. - The assessment of knowledge will consist of a structured oral or a written multiple-choice quiz, designed and administered by the supervising pathologist, on content related to the topic of microscopy.

Assessment Plan: Part A: Microscopy Direct observation by supervisor Use Form 2. Collect at least 1 observation of achievement

Part B: Assessment of knowledge

Page | 62 RESIDENCY TRAINING in Anatomical Pathology ______Evidence of satisfactory completion of a structured oral or written quiz administered by the supervising pathologist Use Form 4. Collect 1 observation of achievement Relevant Milestones:

Part A: Microscopy 1. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues 2. ME 1.3 Apply knowledge of how a light microscope works 3. ME 3.4 Use a light microscope to examine microscopic slides 4. ME 3.4 Perform basic microscope maintenance

EPA #4: Creating a personal teaching and learning plan

Key Features: - The observation of this EPA is divided into 2 parts:  creating and maintaining a clinical training portfolio and  presenting a personal learning project, including identifying a topic, identifying and utilizing information sources, presenting the topic to a group and assessing the process (including self-assessment).

Assessment Plan:

Part A: Clinical training portfolio Resident’s submission of teaching and learning plan reviewed by pathologist, or TTP trainee or academic advisor Use Form 4. Collect 1 observation of achievement

Part B: Personal learning project Direct observation by supervisor Use Form 1. Collect 1 observation of achievement

Relevant Milestones: Part A: Clinical training portfolio 1. S 1.2 Use feedback to enhance self-assessment and improve learning 2. S 1.1 Create a learning plan in collaboration with a designated supervisor identifying learning needs related to Anatomical Pathology and career goals 3. S 1.1 Use technology to support learning in medicine

Part B: Personal learning project 1. S 1.2 Identify and record learning needs that arise in daily work, and apply strategies to address those gaps 2. S 3.3 Identify relevant sources of information 3. S 3.3 Determine the validity and risk of bias in a source of evidence 4. S 4.5 Summarize and communicate to peers the findings of a literature search

Stage: Foundations of Discipline (aka Foundations) EPA #1: Performing gross dissection of simple surgical

Page | 63 RESIDENCY TRAINING in Anatomical Pathology ______specimens, from accessioning to submission of blocks

Key Features: - This EPA includes grossing select simple specimens, defined as single organ, routine indications and/or routine surgical specimens. - Examples include: simple hysterectomy for fibroids, skin ellipses, appendix, gallbladder, reduction mastectomy, panniculectomy, colon for diverticulosis, and tissue biopsies. - This EPA also includes adherence to safety and quality assurance protocols, and existing grossing protocols.

Assessment plan: Direct or indirect observation by pathologist, pathology assistant, or Core or TTP trainee Use form 2. Form collects information on: - Observation: direct; indirect - Specimen type: [free text]

Collect 10 observations of achievement - At least 5 direct observations by a pathologist - A variety of cases

Relevant Milestones: 1. ME 5.2 Organize work station to ensure safe practices in the laboratory 2. ME 5.2 Take universal precautionary measures to minimize hazardous exposures including potential infectious and chemical agents 3. ME 5.2 Use personal protective measures, including gowns, goggles, and slash resistance gloves 4. ME 1.3 Apply knowledge of normal anatomy and gross appearances of tissues 5. ME 1.3 Apply knowledge of the principles of tissue fixation, decalcification, processing, and the potential impact of improper handling of fresh tissues 6. ME 2.2 Obtain a relevant clinical history 7. ME 3.4 Perform appropriate dissection, description, and sampling of surgical specimens for routine and ancillary procedures 8. ME 3.4 Work efficiently, ensuring appropriate fixation in a timely manner 9. ME 3.4 Seek assistance as needed 10. COM 4.1 Document using standardized grossing templates and/or descriptions and protocols as much as possible 11. L 4.1 Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

EPA #2: Microscopic reviewing and reporting of simple surgical specimens

Key Features: - This EPA focuses on providing an interpretation of select simple surgical specimens, defined as single organ, routine indications and/or routine surgical specimens. - Examples include: simple hysterectomy for fibroids, skin ellipses, appendix, gallbladder, reduction mastectomy, panniculectomy, colon for diverticulosis and tissue biopsies. - This includes identifying normal and abnormal histology, obtaining additional investigations such as special stains/immunohistochemistry as directed, and using the LIS/EMR to obtain additional clinical information where appropriate. - It also includes preparing a draft pathology report following the case review with attending staff. - The case mix should represent simple biopsies, and routine surgical (benign) specimens as suggested by the grossing guidelines (e.g., L4E

Page | 64 RESIDENCY TRAINING in Anatomical Pathology ______(level 2 or 3) / or CPT codes (88305)).

Assessment plan: Direct observation by General or Anatomical Pathologist, or TTP trainee Use Form 1. Form collects information on: - Organ System: breast; bone & soft tissue; gynecology; gastrointestinal; genito-urinary; head & neck; endocrine; skin; cardio vascular; thoracic; neuropathology; lymph nodes & spleen

Collect 10 observations of achievement - At least 4 organ systems - At least 3 different observers - At least 2 observed by surgical pathologists

Relevant milestones: 1. ME 1.3 Apply knowledge of the principles of tissue fixation, decalcification, processing, and the impact of improper handling of fresh tissues 2. ME 1.3 Apply knowledge of routine histochemical staining 3. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues 4. ME 1.3 Apply knowledge of the principles of and indications for immunohistochemistry and special histochemical stains 5. ME 2.2 Develop a differential diagnosis 6. ME 2.2 Perform a pathological examination that is focused and relevant 7. ME 2.2 Select and/or interpret investigations 8. ME 2.2 Synthesize patient information to determine diagnosis 9. COM 4.1 Document microscopic assessment accurately 10. ME 3.4 Seek assistance as needed 11. COM 4.1 Generate a clear, concise report that enhances patient management 12. COM 4.1 Identify and correct vague or ambiguous documentation 13. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report if applicable 14. COM 4.1 Incorporate the data available from health information systems in the formation of their differential diagnosis and final report 15. L 4.1 Build relationships with mentors and faculty 16. S 1.2 Identify, record, prioritize and address learning needs that arise in daily work using various strategies (e.g., scanning the literature, or attending formal or informal education sessions) 17. S 3.1 Recognize uncertainty and knowledge gaps in clinical and other professional encounters relevant to Anatomical Pathology 18. P 1.1 Complete assigned responsibilities 19. P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

EPA #3: Assessing patients and integrating clinical information in the evaluation of disease processes

Key Features: - This EPA ensures the resident establishes the skills and knowledge of clinical medicine in order to effectively function, in later stages, as a pathology consultant for a wide variety of patients and conditions. - This EPA includes performing clinical assessments, including history and physical exam, selecting and interpreting the results of investigations, and collaborating with clinical colleagues to develop a

Page | 65 RESIDENCY TRAINING in Anatomical Pathology ______differential diagnosis and treatment or management plan. - It also includes communicating with patients and their families to gather clinical information and convey information about the diagnosis and/or management plan. - This EPA will be observed in the ambulatory or inpatient setting, with adult and pediatric patients, in a range of medical and surgical clinical conditions.

Assessment Plan: Direct observation and/or case review by supervisor Use Form 1. Form collects information on - Type of observation (select all that apply): direct observation of history; direct observation of communication with patients; case discussion or chart review - Setting: Medicine; Surgery; Oncology; Pediatrics; other - If “other” please indicate setting: [free text]

Collect at least 10 observations of achievement - At least 2 of each type of observation - At least 2 each for medicine, surgery, oncology, and pediatrics - At least 1 assessment from a staff supervisor in each setting

Relevant Milestones: 1. ME 1.1 Demonstrate compassion for patients 2. COM 2.1 Use patient-centred interviewing skills 3. ME 2.2 Obtain a relevant clinical history 4. ME 2.2 Perform a physical exam that informs the diagnosis 5. ME 2.2 Select and/or interpret investigations 6. ME 2.2 Develop a differential diagnosis 7. ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor 8. ME 2.4 Identify and/or monitor key clinical features in the implementation of a management plan 9. COM 3.1 Convey information to the patient and/or family clearly and compassionately 10. COM 3.1 Verify and validate the patient’s and/or family’s understanding of their care 11. COL 1.2 Work effectively as a member of the clinical team 12. COM 4.1 Document the essential elements of a clinical encounter using a structured approach 13. P 1.1 Complete assigned responsibilities

EPA #4: Performing basic tasks in autopsy pathology

Key Features: - This EPA focuses on the basic tasks of an autopsy including reviewing the consent form, reviewing and summarizing the chart, and performing limited basic procedures. - This includes: opening the pulmonary vasculature; opening the aorta, identifying and dissecting the main arteries; opening the bowel; dissecting the pelvic block; obtaining quality photographs as directed; completing required forms for ancillary tests (e.g., microbiology requisitions, biochemistry requisitions). - The observation of this EPA is divided into two parts: o verification of consent and chart review; o performing basic procedures related to autopsy

- Performing a complete autopsy is a task of the Core stage.

Assessment Plan: Part A: Verification of consent and chart review

Page | 66 RESIDENCY TRAINING in Anatomical Pathology ______Direct observation by pathologist or TTP trainee Use Form 1. Collect 2 observations of achievement Part B: Performing basic tasks related to autopsy Direct observation by pathologist or TTP trainee Use Form 2. Form tracks information on - Task (select all that apply): open the pulmonary vasculature; open the aorta, identify and dissect the main arteries; open the bowel; dissect the pelvic block; obtain quality photographs as directed; complete required forms for ancillary tests (e.g., microbiology requisitions, biochemistry requisitions); other - If ‘other task’ is assessed, please specify: [free text]

Collect 2 observations of achievement - No more than 1 “other” task

Relevant Milestones: Part A: Verification of consent and chart review 1. ME 1.6 Seek assistance in situations that are complex or new 2. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 3. ME 2.2 Obtain a relevant clinical history 4. ME 3.2 Describe the provincial and institutional rules governing consent for autopsy 5. ME 3.2 Identify the features of an appropriate autopsy consent 6. COM 4.1 Identify and correct vague or ambiguous documentation 7. COL 1.3 Communicate with clinical staff regarding issues of consent and clinical questions that need to be addressed 8. ME 4.1 Recognize when a case requires involvement of the medical examiner 9. ME 2.2 Synthesize and organize clinical information for clear and succinct presentation to supervisor 10. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 11. P 3.1 Describe local regulations regarding the reporting of deaths to the medical examiner or coroner Part B: Performing basic tasks related to autopsy 1. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite, to minimize occupational risk 2. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry 3. ME 1.3 Apply basic knowledge of normal gross and light microscopic appearance of tissues 4. ME 1.3 Apply knowledge of the principles of embryologic development and common variations of normal development 5. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 6. ME 2.2 Perform a pathological examination that is focused and relevant 7. ME 3.4 Perform basic procedures in autopsy pathology 8. ME 1.6 Seek assistance in situations that are complex or new 9. ME 3.4 Photograph specimens 10. S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

Stage: CORE EPA #1: Initiating ancillary studies at the time of specimen receipt

Page | 67 RESIDENCY TRAINING in Anatomical Pathology ______Key Features: - This EPA focuses on applying knowledge of ancillary techniques and their contributions to diagnosis in distributing tissue samples between routine pathologic studies (histology/cytology) and ancillary studies to optimize the diagnostic yield of a specimen. - This EPA includes handling specimens and submitting tissues for ancillary studies following institutional SOPs and includes: cytogenetics, molecular pathology, in situ hybridization, immunofluorescence, flow cytometry, and electron microscopy. - This should be observed at the time of specimen receipt, though simulation may be employed for teaching and assessment purposes. - At this stage, this EPA does not include test interpretation. - Training experiences in specialized areas such as neuropathology, pediatric pathology and renal pathology are recommended to achieve this EPA.

Assessment Plan: Direct observation by pathologist, technologist, pathology assistant or TTP trainee Use Form 1. Form collects information on: - Specimen type: [free text] - Ancillary tests required or anticipated (select all that apply): immunohistochemistry; cytogenetics; molecular; in situ hybridization; immunofluorescence; flow cytometry; electron microscopy - If “other” please specify test: [free text] - Lymphoma protocol: yes; no

Collect 5 successful observations - At least 1 sampling for electron microscopy - At least 1 lymphoma protocol - At least 1 example of “flash freezing” fresh tissue - At least 1 pathologist observer

Relevant Milestones: 1. ME 1.4 Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance 2. ME 1.6 Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation 3. ME 3.1 Recognize when a specimen might require ancillary studies 4. ME 3.1 Describe the indications, contraindications, risks, and alternatives for a given test 5. ME 2.2 Assess specimen adequacy for ancillary testing 6. ME 3.3 Prioritize routine and ancillary studies when specimen adequacy is limited 7. ME 3.4 Maintain the integrity required for the specific ancillary study (e.g., nucleic acid integrity for molecular testing, cell membrane for flow cytometry, viable cells for cytogenetics) 8. COL 1.3 Consult with clinical colleagues, when appropriate, to ascertain if ancillary studies would be of value 9. COL 1.1 Receive and appropriately respond to input from other health care professionals (e.g., pathology assistants, technologists) 10. L 2.2 Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

EPA #2: Performing gross dissection of routine surgical specimens

Key Features: - This EPA includes all routine surgical specimens defined as oncologic

Page | 68 RESIDENCY TRAINING in Anatomical Pathology ______and non-oncologic, single-organ systems (may include lymph nodes) and/or routine indications. - This includes: • Breast: lumpectomy, prophylactic mastectomy, gynecomastia • Bone & soft tissue: curetting, non-tumor amputations • Skin: wide local excisions • Gynecologic pathology: hysterectomy for endometrial , prophylactic for Lynch syndrome, ovary resection, cone/LEEP, placenta , prophylactic BSO (SEE FIM) • Gastrointestinal pathology: colectomy for benign/malignant conditions • Genitourinary pathology: prostatectomy, TURP, partial nephrectomy • Endocrine: adrenal simple procedures, thyroidectomy, parathyroidectomy • Head & neck pathology: glossectomy, salivary gland resection • Lymph nodes and spleen: lymph nodes, splenectomy • Neuropathology • Thoracic pathology: lobectomy, wedge resection, pleurectomy, valves - The observation of this EPA may be based on direct or indirect observation. - Direct observation is defined as the supervisor observing all or a component of the grossing of a surgical specimen; this may involve the discussion and elaboration of ‘an approach’ to the surgical specimen between the supervisor and resident, review of surgical specimens at daily grossing rounds, and/or simulations of select gross cases. - Indirect observation includes the review of a ‘gross description’ by a supervisor after completion of grossing, including correlation with gross photography, mapping of sections, and descriptions; re-review of a surgical specimen with the resident following initial grossing (e.g., additional blocks); and/or discussion of specific protocols or approaches (e.g., College of American Pathologists) as they pertain to specific organ systems.

Assessment plan: Direct or indirect observation by staff pathologist with feedback from PA or TTP trainee review of gross description Use Form 2. Form collects information on: - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Specimen type: [free text] - Pediatric: yes; no

Collect at least 50 observations of achievement - A variety of organ systems - A variety of specimens - At least 6 in each of breast, skin, gynecology, gastrointestinal, genitourinary, and head & neck - At least 8 different observers

Relevant Milestones: 1. ME 1.3 Apply knowledge of normal 2. ME 2.2 Perform a pathological examination that is focused and relevant 3. ME 2.2 Review clinical history, imaging and other relevant data as necessary 4. ME 3.4 Perform gross dissection, description and sampling of surgical specimens, applying meticulous attention to block selection and mapping using diagrams and images and demonstrating awareness of downstream synoptic reporting and staging parameters, and the need to save tissue for research, tissue bank and other indications, as necessary 5. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite and autopsy suite to minimize occupational risk

Page | 69 RESIDENCY TRAINING in Anatomical Pathology ______6. L 1.1 Participate in quality management by minimizing cross contamination and using standardized grossing templates and protocols as appropriate 7. ME 3.4 Seek assistance as needed 8. ME 3.4 Take high quality photographs of specimens 9. ME 2.2 Formulate a differential diagnosis based on the pathological examination 10. COM 4.1 Communicate findings in a timely fashion, with appropriate documentation

EPA #3: Performing gross dissection of complex surgical specimens

Key Features: - This EPA includes all complex surgical specimens, defined as oncologic staging surgeries, single organ specimens of complex anatomy, multi organ specimens, specimens for non-routine indications or other unique situations such as those requiring a contextual awareness of the case. - Examples of complex gross examinations include • Whipple resections, low anterior resection, abdominoperineal resection, exenteration, esophagectomy, endoscopic mucosal resection, gallbladder cancer with debulking, Hirschprung (pull through), prophylactic gastrectomy • Neck lymph node dissection, total laryngectomy, oral tumor resections with bone • Vulvectomy, multigestation placenta, radical hysterectomy • Post breast resections • Soft tissue/bone tumor amputations • Post treatment resections in other organ systems • Total cystectomy, radical nephrectomy - The observation of this EPA may be based on direct or indirect observation. - Direct observation is defined as the supervisor observing all or a component of the grossing of a surgical specimen; this may involve the discussion and elaboration of ‘an approach’ to the surgical specimen between the supervisor and resident, review of surgical specimens at daily grossing rounds, and/or simulations of select gross cases. - Indirect observation includes the review of a ‘gross description’ by a supervisor after completion of grossing, including correlation with gross photography, mapping of sections, and descriptions; re-review of a surgical specimen with the resident following initial grossing (e.g., additional blocks); and/or discussion of specific protocols or approaches (e.g., College of American Pathologists) as they pertain to specific organ systems.

Assessment plan: Direct or indirect observation by staff pathologist with feedback from PA or TTP trainee review of gross description Use Form 2. Form collects information on: - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal (including hepatobiliary/pancreas); genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Specimen type: [free text] - Pediatric: yes; no

Collect 100 observations of achievement encompassing a wide breadth of presentations - A variety of systems - A variety of specimens - At least 15 gastrointestinal - At least 10 in each of gynecology, genitourinary, and breast - At least 5 head & neck - At least 5 pediatric - At least 8 different observers

Relevant Milestones: 1. ME 1.3 Apply knowledge of normal gross examination

Page | 70 RESIDENCY TRAINING in Anatomical Pathology ______2. ME 2.2 Perform a pathological examination that is focused and relevant 3. ME 2.2 Review clinical history, imaging and other relevant data as necessary 4. ME 3.4 Perform gross dissection, description and sampling of surgical specimens, applying meticulous attention to block selection and mapping using diagrams and images and demonstrating awareness of downstream synoptic reporting and staging parameters, and the need to save tissue for research, tissue bank and other indications, as necessary 5. COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner 6. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite and autopsy suite to minimize occupational risk 7. L 1.1 Participate in quality management by minimizing cross contamination and using standardized grossing templates and protocols as appropriate 8. ME 3.4 Seek assistance as needed 9. ME 3.4 Take high quality photographs of specimens 10. ME 2.2 Formulate a differential diagnosis based on the pathological examination 11. COM 4.1 Communicate findings in a timely fashion, with appropriate documentation

EPA #4: Generating diagnostically accurate and complete pathology reports for routine surgical pathology cases

Key Features: - This EPA focuses on managing a routine surgical pathology case from receipt of the H&E-stained glass slides, to generation of a report. - A routine case is one with a diagnosis that is common and typically easily rendered, and that has relatively easily assessed reporting elements. Examples of this case type include: routine gastrointestinal, breast core and bladder biopsies, and resection specimens such a simple hysterectomies and breast lumpectomies for benign disease. - This EPA includes matching the specimen with the requisition, ensuring that the correct patient material has been received with appropriate and accurate documentation, and that the processing has rendered the case satisfactory for interpretation (if not, pre-analytical issues that may have arisen should have been brought to the attention of the staff pathologist). - This EPA includes using the laboratory and hospital information systems to gather relevant history, using a microscope (including a polarizer) correctly, reviewing the case in a timely fashion, generating a diagnosis and/or differential diagnosis, selecting and interpreting ancillary studies (special/immunostains, levels, etc.) and providing an accurate report ready for verification and review with staff. - Organization and prioritization of work is an additional feature, and includes appropriate management of urgent cases, critical values and reportable diseases. - This EPA may include communication with clinicians, or other house staff.

Assessment Plan: Direct and indirect observation with review of resident’s submission of report by pathologist or TTP trainee Use Form 1. Form collects information on - Diagnosis: [free text] - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Pediatric: yes; no - Specimen type: biopsy; resection; other

Collect at least 100 observations of achievement encompassing a wide breadth of presentations - At least 10 from each breast, gynecology, gastrointestinal,

Page | 71 RESIDENCY TRAINING in Anatomical Pathology ______genitourinary, and skin - At least 5 from each of the other organ systems - At least 5 pediatric - A variety of specimens and diagnosis, including malignant and non-malignant, biopsies and surgical resection - At least 8 different observers

Relevant Milestones: 1. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 2. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 3. ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant 4. ME 1.6 Seek assistance in situations that are complex or new 5. ME 2.2 Obtain a relevant clinical history 6. ME 2.2 Formulate a differential diagnosis based on the pathological examination 7. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 8. ME 3.4 Use digital microscopy and interpret gross and microscopic digital images, including digitized and scanned slides 9. ME 2.2 Establish a final diagnosis that takes into account clinical correlations 10. ME 5.2 Apply the principles of situational awareness to clinical practice 11. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for surgical pathology 12. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report 13. ME 1.4 Complete pathology reports within appropriate turnaround times 14. COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 15. HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care 16. L 2.1 Develop practice-based and system-based rules for resource allocation 17. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

EPA #5: Generating diagnostically accurate and complete pathology reports for complex surgical pathology cases

Key Features: - This EPA focuses on managing a complex surgical pathology case from receipt of the H&E-stained glass slides, to generation of a report. - A complex case is one with a diagnosis that is uncommon, difficult to render or that has reporting elements with considerable inter-observer variability. Cases in which the differential diagnosis cannot be resolved are included in this category. Examples include: skin biopsies for suspicious melanocytic lesions or inflammatory dermatoses, kidney biopsies, most oncologic resections with synoptic reporting protocols, specimens containing multiple organs where the disease process may involve more than one organ. - This EPA includes matching the specimen with the requisition, ensuring that the correct patient material has been received with appropriate and accurate documentation, and that the processing has rendered the case satisfactory for interpretation (if not, pre-analytical issues that may have arisen should have been brought to the attention of the staff pathologist). - This EPA includes correlation with relevant clinical history, gross

Page | 72 RESIDENCY TRAINING in Anatomical Pathology ______description, diagnostic imaging, laboratory tests, and previous pathology, generation of a diagnosis and/or differential diagnosis, selection and interpretation of ancillary studies (special/immunostains, levels, etc.) and provision of an accurate report, using synoptic reporting as needed, ready for verification and review with staff. - Organization and prioritization of work is an additional feature, and includes appropriate management of urgent cases, critical values and reportable diseases. - This EPA may include communication with clinicians, or other house staff, and consultation with other pathologists.

Assessment plan: Direct and indirect observation with review of resident’s submission of report by pathologist or TTP trainee Use Form 1. Form collects information on: - Diagnosis: [free text] - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Pediatric: yes; no - Specimen type: biopsy; resection; other

Collect at least 100 observations of achievement encompassing a wide breadth of presentations - At least 10 from each gynecology, gastrointestinal, genito-urinary, breast, and skin - At least 5 from each of the other organ systems - At least 5 pediatric - A variety of specimens and diagnosis, including malignant and non-malignant, biopsies and surgical resection - At least 8 observers

Relevant Milestones: 1. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 2. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 3. ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant 4. ME 1.6 Seek assistance in situations that are complex or new 5. ME 2.2 Formulate a differential diagnosis based on the pathological examination 6. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 7. ME 3.4 Use digital microscopy and interpret gross and microscopic digital images, including digitized and scanned slides 8. ME 2.2 Establish a final diagnosis that takes into account clinical correlations 9. ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion 10. ME 1.4 Complete pathology reports within appropriate turnaround times 11. COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 12. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports, for surgical pathology 13. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report 14. COM 4.1 Use synoptic and other standardized reporting formats as appropriate 15. COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner

Page | 73 RESIDENCY TRAINING in Anatomical Pathology ______16. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

EPA #6: Performing medical autopsies and generating complete and diagnostically accurate reports

Key Features: - This EPA focuses on hospital autopsy, from receipt of the chart and consent form, to the generation of an accurate, timely and clinically relevant final report. - This includes performing the external examination, organ evisceration, organ dissection, gross examination including diagnosing any pathology, drafting a preliminary report, ordering ancillary testing when necessary, examining the microscopic slides and drafting the final opinion and report. - This also includes modifying standard autopsy procedures as necessary. - This EPA includes limited autopsies (examples: chest, heart or brain only) but does NOT include pediatric/fetal/perinatal cases. - The observation of this EPA is divided into three parts: initial assessment and preliminary report; organ evisceration; interpretation and final report.

Assessment Plan: Part A: Initial assessment and preliminary report Direct observation by pathologist or TTP trainee Use form 1. Form tracks information on - Case details: full; limited - Provisional/favoured cause of death: cardiac; pulmonary (non-infectious); gastrointestinal; infectious; malignancy; other - If “other” indicate provisional cause of death: [free text]

Collect at least 6 observations of achievement - At least 2 different pathologist observers

Part B: Organ evisceration Direct observation by pathologist, TTP trainee, pathology assistant or autopsy technician Use Form 2. Collect 5 observations of achievement - At least 1 pathologist observer

Part C: Interpretation and final report Case review with pathologist Use Form 1. Form tracks information on: - Case details: full; limited - Final cause of death: cardiac; pulmonary (non-infectious); gastrointestinal; infectious; malignancy; other - If “other” indicate final cause of death: [free text]

Collect 6 observations of achievement - At least 2 different pathologist observers

Relevant Milestones: Part A: Initial assessment and preliminary report 1. ME 3.2 Ensure autopsy consent has been obtained and documented correctly 2. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry 3. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 4. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques

Page | 74 RESIDENCY TRAINING in Anatomical Pathology ______5. ME 1.6 Seek assistance in situations that are complex or new 6. ME 2.2 Obtain a relevant clinical history 7. ME 2.2 Perform a pathological examination that is focused and relevant 8. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 9. ME 3.4 Perform a complete autopsy, with appropriate full description and diagnosis at gross and microscopic levels 10. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite, to minimize occupational risk 11. COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance 12. ME 3.4 Interpret the findings of autopsy in the context of the relevant clinical history 13. ME 3.4 Document procedures accurately 14. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations

Part B: Organ evisceration 1. ME 1.3 Apply knowledge of normal anatomy, physiology, and biochemistry 2. ME 1.6 Seek assistance in situations that are complex or new 3. ME 3.4 Perform organ evisceration 4. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite, to minimize occupational risk 5. COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance 6. COM 3.2 Communicate and document issues arising from a breach in quality or safety of laboratory practice 7. COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner 8. L 1.2 Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations 9. S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

Part C: Investigation, interpretation and final report 1. ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states 2. ME 1.3 Apply knowledge of normal gross, light microscopic, and ultrastructural appearance of tissues 3. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 4. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 5. ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant 6. ME 3.4 Utilize other areas of laboratory medicine, including microbiology, for diagnostic purposes 7. ME 3.4 Interpret the findings of autopsy in the context of the relevant clinical history 8. ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion 9. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations 10. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report

Page | 75 RESIDENCY TRAINING in Anatomical Pathology ______11. COL 1.2 Consult as needed with other health care professionals, including other physicians 12. P 3.1 Fulfil the requirements of the physician’s duty to report 13. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 14. P 3.3 Prepare an autopsy for presentation at M&M rounds or departmental autopsy rounds

EPA #7: Performing routine forensic autopsies and generating complete and diagnostically accurate reports

Key Features: - This EPA focuses on adult and older child cases, with manner of death including non-suspicious injuries, suicide, sudden natural deaths, intoxications, and complications of therapy. - This EPA includes correctly performing pre-autopsy assessments, performing the external examination and gross dissection, recognizing and describing evidence of disease and/or injury, obtaining appropriate samples for ancillary testing, preparing autopsy reports, examining microscopic slides, interpreting ancillary results and drafting a final report including final opinion with the cause of death, and recognition of common forensic artifacts. - This EPA also includes recognizing a case needing forensic autopsy, directing photography and/or taking photographs as appropriate, preparing a forensic autopsy report in the correct format that includes a cause of death statement that may inform determination of the manner of death in routine cases. - The observation of this EPA is divided into 2 parts: pre-autopsy assessment, dissections and examinations; interpretation and final report. - The observation of this EPA does not require that the resident has participated in both aspects (i.e., resident can interpret and report cases for which they were not the original prosector).

Assessment Plan: Part A: Pre-autopsy assessment, dissections and examinations Direct observation by forensic pathologist, pathologist, or forensic pathology subspecialty trainee Use Form 1. Form collects information on - Case type: natural death; multiple trauma; decomposed remains; intoxication; hanging; bodies from uncontrolled environments; post-procedure death; other - If “other” indicate case type: [free text] - Cause of death: [free text] - Manner of death: natural; accident; suicide; undetermined - Special dissections performed: yes; no - If “yes” specify dissection: [free text]

Collect 6 observations of achievement - At least 3 case types - At least 2 different observers

Part B: Interpretation and final report Direct observation by forensic pathologist, pathologist, or forensic pathology subspecialty trainee

Use Form 1. Form collects information on - Case type: natural death; multiple trauma; decomposed remains; intoxication; hanging; bodies from uncontrolled environments; post-procedure death; other - If “other” indicate case type: [free text] - Cause of death: [free text]

Collect 6 observations of achievement - At least 3 case types - At least 2 different observers

Relevant Milestones:

Page | 76 RESIDENCY TRAINING in Anatomical Pathology ______Part A: Assessment, dissections and examinations 1. ME 3.2 Ensure autopsy consent has been obtained and documented correctly 2. ME 2.2 Obtain a relevant clinical history 3. ME 2.2 Perform a pathological examination that is focused and relevant 4. ME 2.2 Recognize common forensic artifacts 5. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 6. ME 3.4 Perform a complete forensic autopsy, including but not limited to toxicological examination and the submission of specimens to the forensic sciences laboratory 7. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 8. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 9. ME 1.6 Seek assistance in situations that are complex or new 10. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 11. ME 3.4 Interpret the findings of autopsy in the context of the relevant clinical history 12. COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance 13. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 14. P 3.1 Demonstrate understanding of the laws and policies relevant to conducting forensic investigations 15. P 3.1 Adhere to requirements related to reportable diseases, including infectious diseases 16. P 3.1 Describe local regulations regarding the reporting of deaths to the medical examiner or coroner

Part B: Interpretation and final report 1. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 2. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 3. ME 2.2 Interpret the findings of autopsy in the context of the relevant clinical history 4. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations 5. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report 6. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 7. P 2.1 Demonstrate a commitment to the promotion of the public good in health care, including stewardship of resources 8. P 3.1 Demonstrate understanding of the laws and policies relevant to conducting forensic investigations 9. P 3.1 Adhere to requirements related to reportable diseases, including infectious diseases

EPA #8: Performing routine pediatric, fetal/perinatal autopsies

Key Features: - This EPA focuses on pediatric, fetal and perinatal autopsies, from receipt of the chart and consent form, to the generation of an accurate, timely, and clinically relevant final report. - This includes performing the external examination, organ evisceration, organ dissection, gross examination including diagnosing any pathology, drafting a preliminary report, ordering ancillary testing when necessary, examining the microscopic slides, and drafting the final opinion and

Page | 77 RESIDENCY TRAINING in Anatomical Pathology ______report. - This also includes modifying standard autopsy procedures as necessary. - This EPA includes using examination and dissection techniques to exclude common congenital abnormalities and applying knowledge of histology associated with normal fetal and childhood development. - This EPA includes incorporating the examination of the placenta in perinatal cases. - This EPA excludes brain only autopsies. - The observation of this EPA is divided into two parts: initial assessment and preliminary report; interpretation and final report.

Assessment Plan: Part A: Initial assessment and preliminary report Direct observation by pathologist Use Form 1. Form collects information on - Type: fetal; neonatal; pediatric

Collect 3 observations of achievement Part B: Interpretation and final report Direct observation by pathologist Use Form 1. Form collects information on - Type: fetal; neonatal; pediatric

Collect 3 observations of achievement

Relevant Milestones: Part A: Initial assessment and preliminary report 1. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 2. ME 2.2 Obtain a relevant clinical history 3. ME 2.2 Perform a pathological examination that is focused and relevant 4. ME 3.4 Perform a complete pediatric autopsy, with appropriate full description and diagnosis at gross and microscopic levels 5. ME 1.3 Apply knowledge of normal gross, light microscopic, and ultrastructural appearance of tissues 6. ME 1.3 Apply knowledge of the principles of embryologic development and common variations of normal development 7. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 8. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 9. ME 1.6 Seek assistance in situations that are complex or new 10. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 11. ME 5.1 Report patient safety incidents to appropriate institutional representatives 12. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations 13. COL 2.1 Delegate tasks and responsibilities in an appropriate and respectful manner 14. HA 1.1 Respond to findings related to inheritable conditions that may be of significance in disease prevention or early detection (e.g., genetic diseases that may affect a sibling) 15. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

Part B: Interpretation and final report

Page | 78 RESIDENCY TRAINING in Anatomical Pathology ______1. ME 1.3 Apply basic knowledge of normal gross, light microscopic, and ultrastructural appearance of tissues 2. ME 1.3 Apply knowledge of the principles of embryologic development and common variations of normal development 3. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 4. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 5. ME 2.2 Perform a gross and microscopic pathological examination that is focused and relevant 6. ME 3.4 Utilize other areas of laboratory medicine, including microbiology, for diagnostic purposes 7. ME 3.4 Interpret the findings of autopsy in the context of the relevant clinical history 8. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for autopsy consultations 9. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report 10. HA 1.2 Alert treating physicians when potentially detectable inherited conditions are encountered (e.g., genetic diseases that may affect a sibling) 11. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 12. P 1.1 Manage complex issues while preserving confidentiality 13. P 3.1 Fulfil the requirements of the physician’s duty to report

EPA #9: Selecting, interpreting, and integrating molecular test results

Key Features: - This EPA focuses on the role of molecular pathology in anatomic pathology practice, and includes in situ hybridization, PCR-based testing, cytogenetics, and next-generation sequencing. - This EPA includes assessing specimen adequacy for molecular testing and suggesting appropriate tests, typically after review of light microscopy, as well as interpreting and integrating the molecular results into the final report. - This EPA does not include the interpretation of complex raw data (e.g., next-generation sequencing).

Assessment Plan: Direct observation (i.e., interpreting select molecular tests) and/or case discussion, report review, and case collection by pathologist Use Form 1. Form collects information on: - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Genetic abnormality type: cytogenetic type; sequence level

- Test type: in-situ hybridization; PCR-based testing; cytogenetics; next-generation sequencing; other - If “other” please specify test: [free text]

Collect 25 observations of achievement - At least 5 cytogenetic-type abnormality investigations - At least 5 DNA sequence-level abnormality investigations

Relevant Milestones:

Page | 79 RESIDENCY TRAINING in Anatomical Pathology ______1. ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states 2. ME 1.3 Apply knowledge of general concepts related to the human genome, human genes, and inheritance of DNA 3. ME 1.3 Apply knowledge of general concepts of inherited and somatic disease 4. ME 1.3 Apply knowledge of the essential elements of adequate analytical validation for genetics-based tests 5. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 6. ME 1.3 Apply knowledge of appropriate sample requirements and handling 7. ME 3.1 Describe the advantages and limitations of molecular testing as an adjunct to cytopathologic evaluation of cellular specimens 8. ME 2.2 Select additional testing based on an appreciation of the diagnostic possibilities, the clinical context and the relevance and capabilities of available technologies 9. L 2.1 Utilize genetic testing resources effectively to balance costs with potential utility of results 10. ME 4.1 Coordinate the use of multiple diagnostic investigations so as to ensure complementarity and efficiency 11. ME 3.3 Prioritize routine and ancillary investigations when specimen adequacy is limited 12. ME 5.1 Recognize sources of analytical error for various molecular tests 13. ME 2.2 Interpret molecular diagnostic test results together with available clinical and histopathological data 14. COM 4.1 Integrate molecular results into the anatomical pathology report 15. HA 1.2 Describe the role of molecular methods used to screen for inherited/familial cancer syndromes 16. S 3.3 Critically assess the current knowledge as related to molecular diagnostics in the practice of AP with special emphasis in oncology and inherited diseases 17. P 1.3 Describe the role and apply knowledge of the ethics of genetic screening in family planning and for hereditary cancers 18. P 3.1 Ensure compliance with privacy regulations as they apply to the use of genetic information 19. P 3.1 Recognize the medicolegal implications in the practice of genetics

EPA #10: Selecting, interpreting and integrating ancillary diagnostic techniques other than molecular pathology

Key Features: - This EPA includes non-molecular ancillary tests including immunohistochemistry, special histochemical stains, flow cytometry, immunofluorescence, electron microscopy. - This EPA includes assessing specimen adequacy and selecting appropriate studies when indicated, typically after review of light microscopy, as well as interpreting the test, and integrating the results into the final diagnosis and report.

Assessment Plan: Direct and indirect observation by pathologist Use Form 1. Form collects information on: - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Specimen type: cytology; other - Test type: immunohistochemistry; special histochemical stains; flow

Page | 80 RESIDENCY TRAINING in Anatomical Pathology ______cytometry; immunofluorescence; electron microscopy; other - If “other” please specify test: [free text]

Collect 45 successful observations of achievement - A variety of organ systems - At least 5 cytology - At least 10 observations of each: immunohistochemistry, special stains, and flow cytometry - At least 5 observations of electron microscopy and/or immunofluorescence - At least 2 different pathologists

Relevant Milestones: 1. ME 1.3 Apply knowledge of principles of cell biology, immunology, genetics, and pathogenic mechanisms, and the changes that occur in disease states 2. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 3. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 4. ME 1.6 Seek assistance in situations that are complex or new 5. ME 1.6 Convey diagnostic uncertainty and recommend additional studies when needed 6. ME 2.2 Select and/or interpret investigations 7. ME 2.2 Assess specimen adequacy for ancillary testing 8. ME 2.2 Select ancillary techniques judiciously in a resource-effective and ethical manner 9. ME 3.4 Recognize patterns of familial cancer syndromes, using or suggesting appropriate ancillary tests to guide genetic counseling 10. COM 4.1 Integrate information from ancillary studies and other sources into the pathology report 11. HA 1.2 Respond to individual patient diagnostic needs and issues as part of patient care 12. L 1.1 Apply quality management principles such as the use of controls (e.g., internal, external, reagent and tissue) to ensure validity of study findings and apply this understanding to troubleshooting test failure 13. L 2.1 Use clinical judgment to minimize wasteful practices 14. S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps

EPA #11: Managing cytopathology specimens within the preparation laboratory

Key Features: - This EPA focuses on the pre-analytic handling of cytopathology specimens. - This includes advising other physicians on optimal management of specimens, accepting or rejecting specimens based on specimen and requisition adequacy criteria, preparing gynecological and non-gynecological specimens, and applying principles of quality assurance to the processed specimen (e.g., stain quality, appropriate specimen labelling). - This may include rapid on site assessment and FNA samples performed by a pathologist. - The observation of this EPA is divided into two parts: specimen adequacy and processing; advising health care professionals. - The observation of advising health care professionals may be a simulated scenario.

Assessment Plan: Part A: Specimen adequacy and processing Direct observation and/or case discussion by technologist or pathologist Use Form 1. Form collects information on - Specimen type: gynecological; fine-needle aspiration (FNA); fluids (pleural, peritoneal, urine, CSF, etc.); endoscopic ultrasound (EUS); endobronchial ultrasound (EBUS); other - If “other” indicate specimen type: [free text]

Page | 81 RESIDENCY TRAINING in Anatomical Pathology ______- Component (select all that apply): adequacy; preparation; assessment of finished product

Collect 10 observations of achievement - At least 5 of each of the 3 components (adequacy, preparation, assessment of finished product) - A variety of specimen types (including gynecological and non-gynecological) - At least 2 different observers

Part B: Advising health care professionals Direct observation by pathologist Use Form 1. Form collects information on: - Scenario: cervical specimen; other exfoliative specimen; FNA cytology; fluids; possible infectious etiology - Simulation: yes; no

Collect 5 observations of achievement - At least 1 for each pre-analytic scenario

Relevant Milestones: Part A: Specimen Adequacy and Processing 1. ME 2.1 Determine if cytopathology specimens and requisitions meet adequacy criteria 2. ME 2.1 Describe reasons for specimen rejection and the process of rejection documentation 3. ME 5.1 Resolve issues related to specimen misidentification 4. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical handling of a cytology case 5. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques in cytopathology 6. ME 3.4 Prepare gynecological and non-gynecological cytopathology specimens, including staining, cover-slipping, triaging and storage 7. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite and autopsy suite to minimize occupational risk 8. COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions 9. L 2.1 Use clinical judgment to minimize wasteful practices 10. L 1.1 Participate in quality control, quality assurance and quality improvement initiatives

Part B: Advising health care professionals 1. ME 2.2 Ascertain the clinical scenario and the information a clinical team requires from a request for cytopathology testing 2. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques in cytopathology 3. COL 1.3 Provide advice to clinical colleagues regarding specimen procurement and handling 4. COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions

EPA #12: Assessing and reporting cytopathology specimens

Key Features: - This EPA focuses on providing a complete cytopathological interpretation including recommendations, as appropriate. - This includes examining cytology slides, determining specimen adequacy for assessment, initiating and interpreting additional investigations (typically immunohistochemical and histochemical stains)

Page | 82 RESIDENCY TRAINING in Anatomical Pathology ______and integrating all case features (including history) to arrive at an accurate interpretation. - This EPA includes adherence to accepted reporting classification schema (e.g., Bethesda System for Reporting Cervical Cytology) as appropriate, and adhering to local procedures regarding turnaround time and critical values in cytopathology.

Assessment Plan: Direct and indirect (i.e., case discussion and review of cases) observation by pathologist Use Form 1. Form collects information on: - Specimen type: pap smear; fine-needle aspiration (FNA); fluid (pleural, peritoneal, urine, CSF, etc.); endoscopic ultrasound (EUS); endobronchial ultrasound (EBUS)

Collect at least 60 observations of achievement - At least 20 pap smears - At least 10 fluids - A mix of FNA, EUS and EBUS (at least 10 in total) - At least 3 different observers

Relevant Milestones: 1. ME 1.3 Apply knowledge of the appearance of normal cells in cytologic preparations 2. ME 1.3 Apply knowledge of cytological appearance of cells in disease states 3. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 4. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 5. ME 2.2 Assess specimen adequacy in surgical and cytopathology specimens 6. ME 2.2 Describe common pitfalls in diagnosis of cytopathological specimens 7. ME 2.2 Identify and interpret epithelial cell abnormalities of squamous and glandular cells 8. ME 4.1 Determine the need and timing of referral to another specialist and/or second opinion 9. COM 4.1 Prepare clear, concise, comprehensive, and timely written reports for cytopathology consultations 10. COM 4.1 Use standardized terminology for reporting results, as relevant 11. COM 4.1 Provide educational notes and recommendations when needed in the report 12. COM 4.1 Use standardized non-diagnostic (e.g., contents) and diagnostic (e.g., unsatisfactory/ benign/ atypical/ suspicious/ malignant) general categories for reporting results (non-Gyne) 13. COM 4.1 Provide descriptive diagnoses that will clearly communicate cellular findings for those anatomic sites where there is no standardized terminology (FNA) 14. COM 4.1 Convey critical values or unexpected results in a timely manner 15. L 2.1 Use clinical judgment to minimize wasteful practices 16. S 1.2 Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance 17. S 3.4 Integrate best evidence and clinical expertise into decision-making

EPA #13: Conducting intraoperative assessments

Key Features: - This EPA focuses on the elements of an intraoperative consultation, from specimen handling to clear and effective communication of results to the clinical team. - This includes gathering the clinical history, handling and triaging the tissue, working effectively with all members of the clinical team

Page | 83 RESIDENCY TRAINING in Anatomical Pathology ______(surgeon, technologists, staff pathologist), analyzing the various preparations (touch-preparation, frozen section, etc.), providing a clinically relevant interpretation, and conveying the results to the clinical team. - Examples of requests relevant to this EPA include intraoperative consultations for tissue adequacy, diagnosis, margins, and lymphoma protocol.

Assessment Plan: Direct or indirect observation by pathologist or TTP pathology trainee Use Form 1. Form collects information on: - Observation: direct; indirect - Organ system: breast; bone & soft tissue; skin; gynecology; gastrointestinal; genitourinary; endocrine; head & neck; lymph nodes & spleen; neuropathology; thoracic - Type of preparation: frozen section; touch prep; both

Collect 15 observations of achievement - At least 8 direct observations - At least 2 neuropathology - At least 3 intraoperative touch preps

Relevant Milestones: 1. ME 1.3 Apply knowledge of indications, contraindications and limitations of frozen sections 2. COL 1.2 Discuss indications for appropriate use of intra-operative and urgent consultations 3. ME 2.2 Obtain a relevant clinical history 4. ME 1.3 Apply knowledge about most appropriate method of intraoperative assessment (gross examination only vs frozen sections vs cytologic examination) 5. ME 2.2 Assess specimen adequacy in surgical and cytopathology specimens 6. ME 3.4 Prepare frozen sections, including imprint cytology specimens when relevant and review for diagnosis 7. COL 1.2 Work effectively with laboratory technologists and pathology assistants, directing their assistance 8. ME 1.3 Apply knowledge of the appearance of normal cells in cytologic preparations 9. ME 1.3 Apply knowledge of gross and microscopic appearances of tissues in disease states 10. ME 1.3 Apply knowledge of cytological appearance of cells in disease states 11. ME 1.3 Apply knowledge of the principles of and indications for ancillary diagnostic techniques 12. ME 2.2 Formulate a differential diagnosis based on the pathological examination 13. ME 2.2 Establish a final diagnosis that takes into account clinical correlations 14. ME 3.4 Establish and implement a plan for post-procedure handling of tissue 15. COL 1.2 Interact effectively with surgeons during intraoperative consultations 16. COL 1.2 Convey diagnostic uncertainty and discuss deferral of diagnosis when needed 17. COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 18. ME 5.2 Apply safe practices in the laboratory, intraoperative consultation suite, and autopsy suite to minimize occupational risk

EPA #14: Teaching health care professionals and colleagues

Key Features: - This EPA focuses on the skills of critical appraisal as well as presentation and teaching skills.

Assessment Plan:

Page | 84 RESIDENCY TRAINING in Anatomical Pathology ______Direct observation by pathologist Use Form 1. Form collects information on - Type of activity: journal club; grand rounds; academic halfday; other didactic sessions

Collect 2 observations of achievement Relevant Milestones: 1. S 2.4 Identify the learning needs and desired learning outcomes of others 2. S 2.4 Develop learning objectives for a teaching activity 3. S 3.3 Critically evaluate the integrity, reliability and applicability of health related research and literature 4. S 3.4 Integrate best evidence and clinical expertise 5. S 2.4 Present the information in an organized manner to facilitate understanding 6. S 2.4 Use audiovisual aids effectively 7. S 2.4 Provide adequate time for questions and discussion

EPA #15: Participating in quality management activities

Key Features: - This EPA focuses on the role of the anatomic pathologist as a participant and leader of quality management in the laboratory. - At this stage, this includes completion of a laboratory management or quality improvement project, as well as responding to individual quality management events and participating in systematic quality management activities. - Individual quality management events include any finding or occurrence that requires action to maintain quality of care or safety. Examples include o Critical values o Breaches in laboratory safety o Failed immunohistochemical stains

- Examples of systematic quality assurance activities include: o Cytology-histology correlation rounds o Case consensus conferences o Process improvement initiatives o Validating new tests/methodologies

- The observation of this EPA is divided into two parts: completion of a project; participation in quality management.

Assessment Plan: Part A: Laboratory management or quality improvement project Review of completed project by supervisor Use Form 4 Collect 1 observation of achievement Part B: Quality management participation Direct observation or case discussion/presentation) by supervisor Use Form 1. Form collects information on - Clinical area: surgical pathology; autopsy; cytopathology; molecular pathology; other - If “other” identify clinical activity: [free text] - Quality management activity: responding to a finding or occurrence; participating in a systematic quality assurance activity

Collect 5 observations of achievement - At least 2 responses to a finding or occurrence that requires action to maintain quality of care or safety - At least 2 participation in systematic quality assurance activities

Page | 85 RESIDENCY TRAINING in Anatomical Pathology ______- At least 2 assessors

Relevant Milestones: Part B: Quality management participation 1. ME 1.3 Define a critical result (critical diagnosis), and describe how it is documented and handled 2. ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 3. ME 5.1 Recognize near-misses in real time and respond to correct them 4. COM 3.2 Communicate and document issues arising from a breach in quality or safety of laboratory practice 5. COM 4.1 Convey critical values or unexpected results in a timely manner 6. COL 1.1 Anticipate, identify, and respond to patient safety issues related to the function of a lab or clinical team 7. COL 1.3 Communicate effectively with physicians and other colleagues in the health care professions 8. L 1.1 Describe the metrics and measurement systems (e.g., statistical benchmarking and dashboard construction) used by the laboratory to track lab activities and current practice patterns 9. L 1.4 Identify variation/gaps between actual and targeted performance using thresholds 10. L 1.1 Understand the various process improvement methodologies (PDSA, six-sigma, DMAIC, Lean) and their strengths and weaknesses 11. L 1.3 Manage a suspected specimen mix-up 12. L 1.3 Resolve and analyze diagnostic discrepancies 13. L 1.1 Identify problems, formulate and carry out a plan of action, and reassess the results in the context of quality improvement 14. L 1.2 Actively encourage all involved in health care, regardless of their role, to report and respond to unsafe situations 15. L 1.1 Participate in quality control, quality assurance and quality improvement initiatives 16. S 3.4 Apply evidence-based medicine and best practice guidelines 17. S 3.4 Identify new evidence appropriate to their scope of professional practice through quality-appraised evidence-alerting services 18. P 2.1 Demonstrate a commitment to maintaining and enhancing competence 19. P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment

EPA #16: Conducting scholarly work

Key Features: - This EPA includes active participation in more than one key aspect of performing scholarly work: identification of a question for investigation, literature review, data gathering, data analysis, and reflective critique. - It must include presentation or dissemination of the scholarly work locally or nationally. - This may include scholarly research, quality assurance, or educational projects. - The assessment of this EPA is based on the submission of a completed scholarly project, and may also include observation of the presentation of the scholarly work.

Assessment Plan: Direct and/or indirect observation by supervisor Use Form 1

Page | 86 RESIDENCY TRAINING in Anatomical Pathology ______Collect 1 observation of achievement Relevant Milestones: 1. L 4.1 Organize work to manage clinical, scholarly and other responsibilities 2. S 4.4 Identify, consult and collaborate with content experts and others in the conduct of scholarly work 3. S 4.4 Generate focused questions for scholarly investigation 4. S 3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature 5. S 4.5 Summarize the findings of a literature review 6. S 4.4 Select appropriate methods of addressing a given scholarly question 7. S 4.2 Identify ethical principles in research 8. S 4.4 Collect data for a scholarly project 9. S 4.4 Perform data analysis 10. S 4.4 Integrate existing literature and findings of data collection 11. S 4.4 Identify areas for further investigation

EPA #17: Maintaining personal learning and career plans

Key Features: - This EPA focuses on the update of the trainee’s personal learning plan to reflect their progression in their training/career. - This EPA includes maintaining an accurate logbook and portfolio.

Assessment Plan: Maintenance and regular review of a log book, portfolio and learning/career plan by supervisor or academic advisor with validation by the program director Use Form 4 Collect at least 6 observations of achievement Relevant Milestones 1 L 4.1 Set priorities and manage time to integrate practice and personal life 2 L 4.2 Examine personal interests and seek career mentorship and counselling 3 L 4.2 Reconcile expectations for practice with job opportunities and workforce needs 4 L 4.3 Improve personal practice by evaluating a problem, setting priorities, executing a plan, and analyzing the results 5 S 1.1 Create a learning plan in collaboration with a designated supervisor identifying learning needs related to Anatomical Pathology and career goals 6 S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources

EPA #18: Participating in direct patient care activities that highlight clinicopathological correlation

Key Features: - This EPA focuses on the key role of pathology expertise in patient care. - This includes working with patients and clinicians to understand the clinical question and identifying how pathology investigation can further the diagnostic and/or therapeutic management plan. - This may include advising physicians, at the point of care, on approaches to specimen procurement and handling, and on test selection and sequencing, and conveying the results of pathology investigations at the bedside as well as in team meetings such as tumour boards. - This EPA will be observed in clinical settings such as outpatient ,

Page | 87 RESIDENCY TRAINING in Anatomical Pathology ______the OR, genetics counselling sessions, cancer clinics, endoscopy clinics, and/or colposcopy clinics, and in clinical–pathological conferences (CPC). - The observation of this EPA is divided into two parts: clinical settings; CPC conferences.

Assessment Plan: Part A: Clinical setting Direct observation and/or case discussion by supervisor, this may include clinicians, pathologists, or senior trainees (TTP residents, fellows) in clinical or pathology disciplines Use form 1. Form collects information on: - Setting: cancer clinic; colposcopy clinic; endoscopy clinic; clinic; genetics counselling; other [free text]

Collect 3 observations of achievement - At least 2 different clinical settings

Part B: CPC conferences Direct observation by supervisor, with input from other CPC conference attendees Use Form 1. Form collects information on: - Organ system: breast; bone & soft tissue; skin; endocrine; gynecology; gastrointestinal; genitourinary; head & neck; lymph nodes & spleen; neuropathology; thoracic

Collect 3 observations of achievement - At least 3 different organ systems

Relevant Milestones: Part A: Clinical setting 1 ME 1.3 Apply a broad base and depth of knowledge in the clinical and biomedical sciences to perform a pathology consultation 2 ME 2.2 Gather and synthesize patient information to establish the clinical question 3 ME 2.2 Develop a differential diagnosis 4 ME 2.2 Select and recommend pathology investigations, including molecular pathology 5 COM 3.1 Convey information to patients and families about pathology tests results clearly and compassionately 6 ME 3.4 Recognize patterns of familial cancer syndromes, using or suggesting appropriate ancillary tests to guide genetic counselling 7 COL 1.1 Establish positive relationships with other members of the health care team 8 COL 1.3 Provide advice to clinical colleagues regarding specimen procurement and handling 9 COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 10 COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate 11 HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care 12 ME 1.6 Demonstrate insight into their own limits of expertise

Part B: CPC conferences 1 ME 1.4 Synthesize cases for discussion at multidisciplinary rounds 2 ME 2.2 Apply tumor staging thresholds and other important prognostic parameters in synoptic reporting in order to position patients in treatment algorithms 3 COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 4 S 3.4 Integrate best evidence and clinical expertise into decision- making 5 COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate 6 HA 1.1 Respond to individual patient diagnostic needs and issues as part of patient care 7 P 1.1 Exhibit appropriate professional behaviours

Page | 88 RESIDENCY TRAINING in Anatomical Pathology ______8 ME 1.6 Demonstrate insight into their own limits of expertise

STAGE: Transition to Practice EPA #1: Managing the daily workload of an anatomical pathologist including surgical pathology, intraoperative consultations, cytopathology and autopsy

Key Features: - This EPA focuses on managing the workload of an anatomical pathologist: preparing cases for sign out, performing autopsy and intraoperative consultation, teaching junior residents and medical students, preparing, presenting and leading multidisciplinary activities. - This includes working effectively with clinicians, laboratory staff, interprofessional staff, and administrators, and communication with patients. - At this stage, the resident will prepare pathology reports that are ready for verification by staff, with no or minimal modification. - This EPA includes attaining a certain concordance with peer review, complying with institutional turnaround time (TAT), consulting with colleagues appropriately, and adhering to institutional performance indicators. - The observation of this EPA is based on a day’s work.

Assessment Plan: Direct and indirect observation of a day’s work by pathologist, with input from other health care professionals and junior trainees Use Form 1 Collect 10 observations of achievement - At least different 5 observers

Relevant Milestones: 1 ME 1.5 Set priorities, triage and manage the workload within accepted turnaround times 2 L 4.2 Describe the principles of workload measurement within the laboratory 3 ME 1.5 Carry out professional duties in the face of multiple, competing demands 4 ME 1.6 Demonstrate insight into their own limits of expertise 5 COM 3.2 Communicate and document issues arising from a breach in quality or safety of laboratory practice 6 COM 4.1 Prepare clear, concise, comprehensive and timely written reports for surgical pathology, cytopathology, and autopsy consultations 7 COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhance patient management 8 L 3.1 Demonstrate knowledge of the principles of laboratory management, including resource allocation and collaboration with technical managers, and hospital and laboratory administration 9 S 3.4 Integrate best evidence and clinical expertise into decision-making 10 L 1.1 Demonstrate an awareness of current practice guidelines 11 P 1.1 Exhibit appropriate professional behaviours 12 P 3.1 Describe the relevant codes, policies, standards, and laws governing physicians and the profession including standard-setting and disciplinary and credentialing procedures 13 P 4.3 Provide mentorship to residents and colleagues

EPA #2: Supervising, teaching and assessing junior learners

Key Features: - This EPA focuses on the informal teaching that occurs as part of usual laboratory activities, and includes teaching, providing support and feedback, and ensuring quality laboratory practices and reports. - This EPA may be observed in daily laboratory activities such as grossing, performing an autopsy, intra-operative consultation or case

Page | 89 RESIDENCY TRAINING in Anatomical Pathology ______sign-out.

Assessment Plan: Direct and/or indirect observation by supervisor, with input from junior learners Use Form 1. Collect 4 observations of achievement

Relevant Milestones 1 S 2.1 Recognize the influence of role-modelling and the impact of the formal, informal, and hidden curriculum on learners 2 S 2.2 Ensure a safe learning environment for all members of the team 3 S 2.3 Supervise learners to ensure they work within their limits, seeking guidance and supervision when needed 4 S 2.4 Provide teaching and/or other informal learning activities 5 S 2.5 Provide feedback to enhance learning and performance 6 S 2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner 7 P 1.1 Intervene when behaviours toward learners undermine a respectful environment 8 P 3.3 Participate in the assessment of junior learners

EPA #3: Participating in laboratory management activities, in the role of junior staff

Key Features: - This EPA focuses on the role of the anatomical pathologist as a participant in and leader of quality management in the laboratory. - This EPA builds on the knowledge and skills of Core to add increased responsibility for quality management activities at the individual and system level. - This includes managing critical incidents, such as breaches in laboratory safety or mislabeling of specimens, and leading quality management activities such as o Chairing quality assurance rounds, such as cytology-histology correlation, case consensus rounds, or other pathology quality related rounds o Leading a process improvement initiative o Leading the validation of a new test or methodology o Participating as a member of a hospital committee responsible for the oversight of multiple quality assurance activities o Participating in laboratory accreditation activities

- The observation of this EPA is divided into two parts: leading quality management activities; and managing a critical incident. - The critical incident may be real or simulated.

Assessment Plan: Part A: Leadership in quality management activities Direct and indirect observation by supervisor Use Form 1. Form collects information on: - Activity: [free text]

Collect 1 observation of achievement Part B: Management of critical incident(s) Direct observation and/or incident review by supervisor Use Form 1. Form collects information on: - Type of critical incident: [free text] - Nature of critical incident: real; simulation

Collect 1 observation of achievement

Page | 90 RESIDENCY TRAINING in Anatomical Pathology ______Relevant Milestones: Part A: Leadership in quality management activities 1 ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 2 ME 5.1 Identify potential improvement opportunities arising from harmful patient safety incidents and near misses 3 COM 3.2 Plan and document follow-up to a harmful patient safety incident 4 HA 2.2 Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities 5 L 1.1 Apply the science of quality improvement to contribute to improving systems of patient care 6 L 1.2 Contribute to a culture that promotes patient safety 7 L 1.4 Use to improve the quality of patient care and optimize patient safety 8 L 1.1 Participate in quality control, quality assurance and quality improvement initiatives 9 L 3.1 Demonstrate knowledge of the principles of laboratory management, including resource allocation and collaboration with technical managers, and hospital and laboratory administration 10 P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice environment 11 P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice 12 P 3.3 Explain the role of intra- and extra-departmental review of diagnostic material

Part B: Management of critical incident(s) 1 ME 5.1 Recognize and respond to a breach in quality or safety of laboratory practices 2 ME 5.1 Resolve issues related to specimen misidentification and diagnostic or other errors 3 ME 5.1 Take appropriate actions to address a breach in quality or safety 4 COM 3.2 Document actions taken to address a breach in quality or safety

EPA #4: Developing and implementing a personal learning plan geared to setting of future practice

Key Features: - This EPA may include a variety of scenarios. Examples include: a plan to act on the performance gaps identified in another EPA; a plan to prepare for fellowship training; a plan to prepare for practice in a specific setting (i.e., community) and/or a setting requiring distinct skills. - Achievement of this EPA includes providing a) the rationale for a learning plan, b) self-reflection, c) personal needs assessment, d) time management and e) identification of the methods to achieve the personal learning plan such as literature review, clinical training, conference attendance and/or rounds attendance.

Assessment Plan: Supervisor review of resident’s submission of a personal learning plan Use Form 1. Collect one observation of achievement

Relevant Milestones: 1 ME 1.1 Demonstrate an awareness of what is required to practice safely and effectively in the setting of future practice 2 S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement 3 L 4.2 Examine personal interests and career goals 4 S 1.1 Define learning needs related to personal practice and/or career goals 5 S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps 6 S 1.1 Create a learning plan that is feasible, includes clear

Page | 91 RESIDENCY TRAINING in Anatomical Pathology ______deliverables and a plan for monitoring ongoing achievement 7 S 1.1 Identify resources required to implement a personal learning plan 8 L 4.2 Adjust educational experiences to gain competencies necessary for future practice 9 P 2.1 Demonstrate a commitment to maintaining and enhancing competence

EPA #5: Liaising with clinical services regarding the diagnostic, prognostic and predictive implications of molecular pathology test results

Key Features: - This focus of this EPA is the role of the anatomical pathologist as a consultant regarding investigation of clinical questions using molecular pathology. - This includes gathering the needed clinical information about the case, discussing the implications of the molecular test results and, as relevant, making recommendations for further testing and/or patient management. - This EPA includes direct communication with clinician(s) as well as integration of molecular pathology test results into the pathology report. - This EPA does not include the interpretation of complex raw data (e.g., next-generation sequencing). - This EPA may be observed in a case discussion with clinicians, or at tumour boards or other multidisciplinary rounds.

Assessment Plan: Direct observation and/or case review by staff pathologist Use Form 1. Form collects information on: - Organ system: [free text] - Setting: multidisciplinary rounds; direct communication with clinician; family conference; other - Test type(s): in situ hybridization; PCR-based testing; cytogenetics; next-generation sequencing

Collect at least 2 observations of achievement - Various tests and system/sites as defined by competence committee

Relevant Milestones: 1 ME 2.2 Interpret the diagnostic, prognostic and treatment implications of molecular pathology test results 2 COL 1.3 Convey information to clinical colleagues in a manner that enhances patient management 3 ME 2.4 Recommend additional genetic/non-genetic testing if required 4 L 2.1 Utilize genetic testing resources effectively to balance costs with potential utility of results 5 ME 1.3 Apply knowledge of appropriate sample requirements and handling 6 ME 1.3 Apply knowledge of turnaround time and its importance for various genetic tests 7 ME 2.2 Select additional testing based on an appreciation of the diagnostic possibilities, the clinical context and the relevance and capabilities of available technologies 8 ME 4.1 Coordinate the use of multiple diagnostic investigations so as to ensure complementarity and efficiency 9 COM 4.1 Incorporate the diagnostic, prognostic or predictive implications of molecular pathology tests into an integrated pathology report 10 COM 4.1 Include the recommended reporting elements, when integrating molecular results into an anatomic pathologic report 11 S 3.4 Integrate best evidence and clinical expertise into decision making

EPA #6: Representing Anatomical Pathology in multidisciplinary teams

Key Features: - This EPA focuses on the role of the anatomical pathologist in

Page | 92 RESIDENCY TRAINING in Anatomical Pathology ______contributing expertise to shared clinical decision making for individual patients, as well as to administrative aspects of practice that contribute to improving care delivery within the department, hospital and/or community. - This EPA includes contributions as the lead pathologist in o tumour boards or other multidisciplinary case conferences o intradepartmental committees (e.g., workplace safety, quality assurance, university committee or hospital committee)

- This EPA includes advocating for the profession, which may require being an advocate for additional resources, workload management, quality assurance, or promoting the role of the pathologist in patient care. - The resident is expected to be involved in these activities on a longitudinal basis during the Transition to Practice stage. - The observation of this EPA is divided into two parts: tumour boards/multidisciplinary case conferences; other committee work.

Assessment Plan: Part A: Tumour boards / Multidisciplinary case conferences Multiple observers provide feedback individually, which is then collated to one report Use Form 3. Form collects information on: - Observer role: pathologist; clinician; resident; other

Collect feedback from at least 2 observers on two occasions - At least one pathologist and one clinician for each observation

Part B: Other committee work Direct observation by senior committee member (ideally committee chair) Use Form 4 Collect 1 observation of achievement

Relevant Milestones:

Part A: Tumour boards / Multidisciplinary case conferences 1 ME 1.4 Present and discuss pathology cases effectively at clinical rounds, in the role of a consultant in pathology 2 COL 1.1 Establish positive relationships with other members of the health care team 3 COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management 4 S 3.4 Integrate best evidence and clinical expertise into decision-making 5 COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate 6 COL 2.2 Achieve consensus when there are differences in recommendations provided by other health care professionals 7 ME 1.6 Convey diagnostic uncertainty and recommend additional studies when needed 8 P 1.1 Exhibit appropriate professional behaviours

Part B: Other committee work 1 P 2.1 Demonstrate a commitment to active participation in the activities of the profession 2 ME 1.5 Carry out professional duties in the face of multiple, competing demands 3 ME 1.6 Demonstrate insight into their own limits of expertise 4 L 1.1 Apply the science of quality improvement to contribute to improving systems of patient care 5 L 3.1 Demonstrate knowledge of the principles of laboratory management, including resource allocation and collaboration with technical managers, and hospital and laboratory administration 6 L 3.1 Demonstrate leadership skills to enhance health care 7 L 4.1 Set priorities and manage time to integrate practice and

Page | 93 RESIDENCY TRAINING in Anatomical Pathology ______personal life 8 S 3.4 Integrate best evidence and clinical expertise into decision-making 9 COL 1.1 Receive and respond appropriately to input from others 10 COL 1.3 Work effectively with physicians and other colleagues 11 P 1.1 Exhibit appropriate professional behaviors

Page | 94 RESIDENCY TRAINING in Anatomical Pathology ______Section 4.3: Examinations In-House Examinations Winter Exam This annual In-House Exam is held in late November, and is fashioned directly after the format of the Royal College Fellowship Exam. It is mandatory for all PGY2-5 residents.

This Exam takes place over two days, typically on a Thursday and Friday. One day is spent completing the written and practical components (short answer questions, digital slide exam, and digital photos). The Oral Examination is held on the other day.

The short answer section includes 28 questions (typically with 3-4 parts each), and a 3 hour time limit is provided (approximately 6 minutes per question). Topics include basic pathology processes (eg. inflammation) and specific disease entities (eg. ductal carcinoma of the breast), as well as questions related to specific fields (eg. molecular pathology), or laboratory practices (eg. QA/lab management, CanMEDs roles). Answers should be provided in point form to maximize efficiency. Each question is marked out of 10, and the overall score is converted to a percentage.

The digital slide section includes 48 slides accompanied by a brief history, such as age, gender, and site. The cases represent all subspecialties of surgical pathology (including autopsy and neuropathology), but do not include cytopathology. Residents are asked to provide their best diagnosis; only the first answer will be marked. Each question is out of 5 marks; this allows for part marks to be given if the answer is incompletely or partially correct. The overall score is converted to a percentage.

The digital photo section is administered as a Power point file. Each resident is provided with a computer and given the location of the examination file on the network and he/she works at his/her individual computer to complete the answer sheet within a time limit of 90 minutes (60 cases). Topics tested in this section include: Gross Pathology (20 cases), Forensic Pathology (20 cases), and Cytopathology (20 cases). The overall score is converted to a percentage.

The percentages for each of the three sections above are then averaged to give a final exam score.

Oral Exam: The Junior residents (PGY 2/3) study 3 designated cases (i.e. slides with brief histories) at a quiet microscope for ½ hour, and are then examined for 30 minutes by two Examiners. The Senior residents (PGY 4/5) see 5 cases for 1 hour; then are examined for 60 minutes.

The Oral Examiners take notes during the exam to assist in grading, and to provide residents with feedback following the exam. A percentage will be given for the Oral component.

Results: Results are collected on a spread sheet. While a passing mark is expected in all components of the Exam, the overall score ultimately determines the Resident’s final status. The pass marks vary depending on the training level of the resident, and are as follows: PGY-2 45% PGY-3 55% PGY-4 65% PGY-5 75%

Every attempt will be made to provide results to the residents prior to the holiday break. Answer sheets will be returned, and feedback on the individual sections of the Exam will be provided on an ad hoc basis. The results will also be reviewed at the following RTC meeting en camera. Residents will have the opportunity to discuss their results individually with the Program Director at their semi-annual meeting (“Fireside Chat”).

For residents that have difficulty on the Exam, an individual approach has been adopted. This approach is discussed with the Program Director where a formal or informal individual learning plan may be created, and

Page | 95 RESIDENCY TRAINING in Anatomical Pathology ______mutually agreed upon at the RTC level.

Examples of approaches used may include: to repeat a failed part of the exam (oral, short answer, glass slides, practical) in 3-6 months, to incorporate an elective block in an area of weakness, a personalized learning plan, or, in some cases, to formal remediation.

In January of 2017, the RTC passed a motion: “Failing one or more in-house exams is considered grounds for non-promotion in the academic year” – What this means for you as a resident is that in-house exams are to be taken seriously as they can have an impact on your academic standing within the program.

Spring Exam (and RISE) The second In-House Examination is administered in the spring, usually in late March, on a day of the Program’s choosing (the RISE within a window specified by the ASCP). It extends over a 2 day period, and includes a Written and an Oral Component as well as the RISE.

RISE component: This is a 300 question multiple-choice exam provided by the American Society of Clinical Pathologists (RISE Exam: Resident In-service Examination). http://www.ascp.org/MainMenu/residents/PathologyResidentInServiceExaminationRISE.aspx.

The RISE is administered to almost all of the American and Canadian residents in pathology. It is modeled after the American Board Exam, and therefore some components may not be entirely applicable to residents at the University of Calgary AP Program, but it is still a worthwhile exercise. Results are computer generated in spreadsheet form. It is possible not only for a resident to see the breakdown of his/her scores in individual areas of pathology, but he/she can also compare grades with those of peers at the same PGY level. Our program uses the results of this exam as a benchmark comparison to other trainees across Canada and the US.

Oral Component: This component has been added to the Spring Exam in order to give the Residents extra practice. The Spring Oral Exam is identical in format to that given in the winter (see above).

Written Component: is the same in format as the Winter Exam (see above)

The Spring Exam is mandatory for all PGY2-4 residents. It is optional for PGY5 residents with previous good exam performance, but mandatory for PGY5 residents who scored less than 50th percentile in their PGY4 RISE exam.

Other

Mock Oral Exams In 2009, the PGME Office initiated a new program, offering standardized mock oral examinations in the non-medical expert CanMEDS competencies. The ideal targets for these examinations are PGY- 4 residents, who are close to their fellowship examination, but not too close. These optional examinations should provide valuable feedback to residents about the type of questions they might encounter on the oral examination of the Royal College exam, while also providing feedback to the training programs about their progress in teaching in these areas.

The American Board Examination Some residents elect to write the US Board Examination as well. This Examination is administered by the American Board of Pathology, and takes place in the spring (April-June). Details are available at www.abpath.org. Residents interested in registering for the American Board Exam should contact the Program Director at least several months before the intended Examination date in order to have their name and training details registered.

Page | 96 RESIDENCY TRAINING in Anatomical Pathology ______

Page | 97 RESIDENCY TRAINING in Anatomical Pathology ______Section 4.4: Promotion, Appeals, Remediation, Probation, and Dismissal The Residency Training Program in Anatomical Pathology at the University of Calgary follows the policies of the Postgraduate Medical Education Office in the Faculty of Medicine. Those policies are available at the following web sites:

Evaluation and Promotion https://cumming.ucalgary.ca/pgme/residents/policies-guidelines/assessment-promotion

In addition to the above referenced PGME policy, the Anatomical Pathology Program stipulates that in order to be successfully promoted the resident will have to fulfil the following criteria: 1. Have acceptable attendance levels at all mandatory rounds and teaching sessions 2. Be up to date on One45 forms and ITER review 3. Have passed (all) rotations in the academic year

Appeals https://cumming.ucalgary.ca/pgme/residents/policies-guidelines/appeals

Section 4.5: Residents as Evaluators Evaluation of Staff as Teachers using One45: In all teaching environments there is an acknowledged inequality of power between teacher and learner. Given this power differential, the evaluation of staff by residents is conducted anonymously, via the One45 system. Since ours is a smaller program, and in order to preserve anonymity, the evaluation of individual preceptors is collected semi-annually by creating a summary report that provides the cumulative evaluation of all residents who have taken a rotation under that supervisor. The report is not released to the preceptor unless there is more than 5 responses in the report. This cumulative summary is sent to the Head of the Department, to the Program Director and to the individual preceptor.

**Every effort is made by the program to maintain anonymity with this reporting which is why in rotations of low attendance or form completion, a report may not be generated and released to faculty in some instances.**

Evaluation of Lectures/Didactics Other directed teaching (didactics, CME rounds, etc) given by individuals may also be evaluated, using a form similar to what is pictured below:

Comments:

Page | 98 RESIDENCY TRAINING in Anatomical Pathology ______

These forms are distributed on One45 and are anonymous. The results are pooled and reported at regular intervals to the preceptor (currently quarterly). A report will not be generated unless there are more than 5 responses, in order to retain anonymity.

Evaluation of Specific Rotations The RTC has instituted a system of regular “rotation reviews” of all mandatory rotations in the program. At every RTC meeting, a mandatory rotation will be reviewed and discussed. This serves as an opportunity for residents (and staff) to critically review and express their opinions on the duration, content, structure, preceptors, objectives, evaluation, and support materials of the rotation. Updates or revisions will be made to the rotations as deemed necessary by the RTC. These reviews occur over a 2 year rotating cycle. In addition, a “Rotation Evaluation” form is available for residents to complete at the end of specific rotations.

This form is anonymous and residents should complete one for each rotation completed. If there is a problem with a specific rotation, it is expected that the resident discuss these issues directly with the Program Director(s) and do not site specific examples within the form submission as this can compromise the residents’ anonymity.

Page | 99 RESIDENCY TRAINING in Anatomical Pathology ______Section 5: Other/Miscellaneous Section 5.1: Introduction This section contains information not easily categorized in other parts of the Manual. It includes a wide range of information including: career planning, physician health and wellness, financial planning, social activities, and mentoring.

Section 5.2: Social Events Welcome BBQ New residents arrive July 1st of each year. The welcome party for new residents (and staff, if appropriate) typically occurs in July, and, weather permitting, includes an outdoor BBQ and informal activities for the new residents and staff and their families. The get together serves to introduce the new residents and staff to the department, and to provide all with an opportunity to socialize with their families outside the usual milieu of the hospital.

Outdoor Day/Resident Social This optional day of outdoor recreational activity can be scheduled at any time during the year. The activity (and location) is selected and organized by the resident’s group (spearheaded by the Chief), and funded by the Program Budget. Although this event is traditionally been known as “Outdoor Day”, the activity chosen might be cross-country skiing, snowshoeing, downhill skiing, or even a simple mountain hike. Outdoor Day is typically planned for a Friday, and those residents attending the activity are relieved of their educational and service commitments (including call). Those choosing not to take advantage of this day are expected to attend to their usual service commitments. The event is normally concluded with an informal dinner either hosted by a staff person, or held in a restaurant. On alternating years, the Outdoor Day is combined with the Resident’s Retreat (see below)

Resident’s Retreat A resident retreat in Banff is planned on alternating, even numbered years (2010, 2012, etc.). The retreat has historically been combined with the Outdoor Day, making for a 2-3 day all-inclusive event. Topics for the Retreat have varied over the years, and have included things as diverse as “Research”, “The ”, “All things Professional” and “Career Planning”. Accommodations, travel (mileage and park entry fee), meals, and costs related to the Outdoor Day (lift tickets, equipment rentals, etc.) are provided for the Friday and Saturday that the residents are in Banff. Family members are welcome to attend the social activities, but family costs (apart from the banquet) must be covered by the resident or staff member in attendance. Residents attending the retreat are excused from call during the time they are in Banff.

Page | 100 RESIDENCY TRAINING in Anatomical Pathology ______Section 5.3: Career Planning, Health and Wellness, Support Career Planning Career planning is an ongoing process, and begins even in the PGY-1 year. Here, residents begin to explore different area of pathology, recognize their strengths, weaknesses, likes, and dislikes, and start to formulate ideas regarding their ultimate choice for a career in pathology.

Staff pathologists are sensitive to the resident’s interests, and may make suggestions or encourage a resident to pursue his/her interests through elective rotations, research projects, etc. Future plans are always a topic for discussion with the Program Director at the semi-annual resident’s meetings (aka Fire-side chats). There are also a number of good resources in our department who have experience working in, and connections with, other institutions throughout Canada and the US. These individuals may be able to make recommendations to the residents as the appropriate opportunities present.

Employment advertisements are circulated and posted on the Information Board outside the resident’s room as they are sent to us, though recently these have been circulated by email communication. In addition, colleagues who practice outside of Calgary often provide “insider” information about upcoming positions before they are posted. We have been fortunate in recent years to have been able to recruit several of our own trainees as well.

Many pathology meetings (the USCAP, for example), host a Resident’s Forum, which includes discussion of career opportunities. Recently, pathology residents in Calgary have been funded to take part in a series of webinars from the Pathology Residents Education Program (PREP) of the Dark Report. This US-based series provides information on job hunting, contract negotiations, etc. Residents not only gain information from the sessions, they are also able to interact with other residents through a Q and A format that allows one to get immediate answers to important questions.

Ultimately, the responsibility of investigating and choosing the most appropriate career path lies with the individual resident. Our Program, however, ensures that the most up-to-date information and solid support is routinely provided to all of our trainees.

Physician Wellness Residents are encouraged to maintain a healthy balance between work and personal life. The Program attempts to be as supportive and flexible as possible in this regard by providing opportunities for socialization in the workplace, granting leave when appropriate, and maintaining a willingness to entertain modifications to the Training Program if the integrity of the program is not otherwise compromised.

If a resident is facing challenges with managing personal life issues, there are a number of support mechanisms available. Residents meet formally with the Program Director twice a year, but are encouraged to discuss time management or other problems with the Program Director or other Staff Member at any time. A Mentorship Program and the Program Ombudsperson are also available for residents to utilize, if desired (see Section 6.4).

In Alberta, we are also fortunate to have the ready services of the Physician and Family Support Program (offered by the AMA) at our disposal (Hotline: 1-877-767-4637: toll free 24 hours/day), or http://www.albertadoctors.org/bcm/ama/ama- website.nsf/AllDoc/FB63EBAA53FB0B6987256DE3005F370B?OpenDocument

The University of Calgary additionally offers counseling and other support services, as follows: Counseling Services: http://www.ucalgary.ca/counselling/personalcounselling

Sexual Harassment Office: Shirley Voyna Wilson 403-220-4086

Page | 101 RESIDENCY TRAINING in Anatomical Pathology [email protected]

Faculty of Medicine Office of Equity and Teacher Learner Relations: 403-210-6424

Financial Health Financial health and well-being are also critical for success, no matter what career path is ultimately chosen. Residents are encouraged to have a working knowledge of topics such as insurance, taxation, budgeting, investing, estate planning, and debt management, to name a few.

For those trainees who are not familiar with the topics listed above, or who do not have access to a financial advisor or accountant, MD Management might be a useful resource to consider. PGME offers a 3 hour general workshop on Financial Management, provided by MD Management (see PGME website for details: http://medicine/ucalgary.ca/postgrad).

In addition, a consultant could be invited to speak at the Academic Half Day on topics specifically relevant to the discipline of Pathology. A resident may also choose to arrange a one-on-one meeting with a Financial Consultant from MD Management to discuss individual needs (md.cma.ca)

Mentorship Mentorship Guidelines Definition A mentor is a person who accepts facilitating an individual’s learning by assisting, supporting, and guiding him or her. The mentor carries out activities as requested by the learner.

Who is eligible to be a mentor? Principally, all pathologists (GFT/Non-GFT) are eligible to be mentors for one or more pathology residents.

How is the mentor selected? The resident chooses a mentor from a list of pathologists that have agreed to function as such for residents when she or he feels that support is needed. Selecting a mentor at any time is not mandatory. The pairing of a mentor and resident is by mutual consent.

Mentorship Role The mentor may act as a teacher, advocate, and friend of the resident. The mentor may suggest informal meetings/contact in regular or irregular intervals in order to “touch base” as well as approach the resident when help may be needed for the duration of the mentorship. However, overall, the mentor should seek a passive role and leave it to the resident to determine the extent of the contact. There is no obligation for the resident to involve his or her mentor in professional or personal issues. Conversely, the resident must respect the mentor’s other work commitments and his or her privacy. The mentor should establish a welcoming, not intimidating atmosphere and encourage open communication The mentor should listen, support and motivate the resident in his or her goals and provide guidance, advice and suggestions if asked for. The mentor cannot be held responsible if the resident is not successful in examinations, in completing the program or in any other tasks.

Termination of Mentorship The mentorship lasts for as long as the resident feels she or he requires the support of the mentor. A resident may have more than one mentor at one time (for example, one to address issues regarding research, and another one regarding personal issues). However, involving more than one mentor for the same issue at the same time is not sensible, unless these mentors are aware of

Page | 102 RESIDENCY TRAINING in Anatomical Pathology ______each other and work as a team to support the resident. The staff member can also terminate the mentorship. He or she should be encouraged to give reasons when doing so.

Assessment of the Mentor The mentor should be assessed in a similar fashion as preceptors of rotations are evaluated.

List of Available Mentors in the Department Dr. Karl Anders (SHC) Dr. Iwona Auer (Hematopathology: FMC) Dr. Hallgrimur Benediktsson (FMC) Dr. Noureddine Berka (Histocompatability & Immunogenetics; DSC) Dr. Tarek Bismar (RGH) Dr. Marie-Anne Brundler (ACH) Dr. Maire Duggan (FMC) Dr. Vincent Falck (FMC) Dr. Jim Gough (FMC) Dr. Charlene Hunter (DSC) Dr. Margaret Kelly (FMC) Dr. Fariborz Kolvear (Cytogenetics, DSC) Dr. Christopher Naugler (DSC) Dr. Denise Ng (FMC) Dr. Travis Ogilvie (FMC) Dr. Lothar Resch (FMC) Dr. Kiril Trpkov (RGH) Dr. James Wright Jr. (ACH) Dr. Hua Yang (FMC) Dr. Asli Yilmaz (RGH)

Ombudsperson The University of Calgary ombudsperson (“ombuds”) program was self-initiated by a number of clinician-educators, and is considered a strength of our residency programs. Ombuds are physicians involved in resident training and education, and have a particular interest in resident well-being. They have strengths in communication and collaboration. An ombuds can be within or outside of a Department. The ombuds is linked with the Office of Associate Dean, Equity and Professionalism.

Typical issues an ombuds might address include: 1) Evaluations and appeals of failures, making themselves available to be the support person at appeal committees when requested to do so by the resident 2) Workload concerns 3) Job threat: advise re: appropriate avenues to follow 4) Interpersonal conflicts

The Ombudsperson for Anatomical, General, and Neuropathology is Dr. Sandra Lee. Residents are encouraged to contact Dr. Lee directly with concerns or questions. Her telephone number is: 403-956-1380; email [email protected].

Page | 103 RESIDENCY TRAINING in Anatomical Pathology ______Section 5.4: Awards A number of other important Awards are distributed to members of the Department, typically at the end of the Academic year (June). These include the following:

Outstanding Achievement in Teaching by a Resident ($500.00) Nominees for the most Outstanding Resident Teacher are put forward by the Residency Training Committee and the resident population. Ballots are then circulated to all Staff Pathologists and Residents, who vote on the winner.

Black Crow Award: This award was active until 2016 and was given to the Resident accruing the most Autopsy cases in the academic year. The Black Crow has no monetary value, but it carries with it a certain status! The winner’s name is engraved on a plaque. This award has been retired and replaced with the Kristy Ells Memorial Award.

Kristy Ells Memorial Award ($250.00) 2017 was the first year this was given. Kristy Ells was the sole Pathology Technician in the FMC morgue for 20+ years and was instrumental in many of our alumni’s autopsy training. She embodied technical proficiency and outstanding skill in her work. Therefore, this award will be given in her memory to the resident demonstrating the highest proficiency in the Adult Autopsy Service in the academic year. Faculty of the Autopsy group will nominate recipients for this award each year and the recipient’s name will be engraved on a plaque to be displayed in the hallway near the Residents’ Room at FMC.

(Faculty) Teacher of the Year: This highly competitive and prestigious award is given annually to the staff pathologist voted to be the top Teacher of the Year by the resident’s group. The winner’s name is engraved on a plaque. Staff Teacher of the Year Award To recognize Outstanding Teaching by a Staff Member, the resident group votes for the recipient of an Award for “Teacher of the Year”. The winner is chosen at the end of the Academic Year, and his/her name is engraved on a plaque.

Resident Appreciation Award (Outstanding Support Staff) ($250.00): This Award is presented by the Residents to the Support Staff voted to have contributed the most to residency education and general well-being in the previous year.

Sandra Skrober Collegiality Award This award was created in 2016 as a memorial to honor our long time Program Administrator Mrs. Sandra Skrober (1949-2016). She proudly provided outstanding administrative support to the AP Resident group from 2001 to 2015. She is the first recipient of this award as she demonstrated the embodiment of collegiality towards residents and staff alike. This award will be given annually to the staff pathologist/resident/technical or clerical individual who most demonstrates the qualities of which she is remembered fondly. This award is voted by the resident’s group and the winner’s name is engraved on a plaque displayed in the department.

Note: A list of past winners in all of the above categories is available as a separate document to anyone interested.

Page | 104 RESIDENCY TRAINING in Anatomical Pathology ______Section 6: Residency Training Committee RTC Terms of Reference 1) Purpose To continuously monitor and improve the residency training program, to recruit and select new residents, to maximize the individual educational experience for each resident, to oversee the service component provided by residents to the department, and to mentor and train residents with the final goal of independent practice of the specialty at a level of excellence in all CanMEDS competencies. 2) Membership a) Chair (Program Director(s)) b) AP Resident Research Coordinator c) AP CBME Lead d) Molecular Pathology Representative e) At least two members from the Foothills Medical Centre f) At least one member from each affiliated site: i) Alberta Children’s Hospital ii) Diagnostic and Scientific Centre iii) Office of the Chief Medical Examiner iv) v) Rockyview General Hospital vi) g) Three Resident representatives (AP Chief Resident + 1 Junior AP resident + GP Chief Resident) h) Recording secretary (Program Administrator) i) Ex-officio members i) Department Head of Pathology and Laboratory Medicine ii) Program Director for PGY1 Program iii) Program Director General Pathology (GP) Program or designate iv) Program Director Neuropathology (NP) Program or designate 3) Quorum a) Quorum consists of half +1 of the total membership from 2a-g as listed above.

4) Selection and Term a) Program Director(s) - Selection of a candidate for Program Director will be by the Pathology and Laboratory Medicine Department Head with recommendation from the Anatomical Pathology RTC and the departmental membership. Subsequent to the agreement of the Associate Dean (PGME) and finally agreement of the Dean that the nomination is appropriate, the formal appointment is made. The Associate Dean PGME notifies the Clinical Section Chief, the nominee, the PGME committee, and the appropriate national accrediting body (Royal College of Physicians and Surgeons of Canada) of the appointment. Appointments are normally for a term of 5 years, renewable once, assuming continued satisfactory performance by the incumbent and the continued support of the Department Head.

b) Site Representatives – Selection for this role is by: i) nomination from an existing member of the RTC ii) written expression of interest to the RTC Chair(s) There is no term restriction on this role.

c) Member-at-large – Selection for this role is by: i) nomination from an existing member of the RTC ii) Written expression of interest to the RTC Chair(s). There is no term restriction on this role.

Page | 105 RESIDENCY TRAINING in Anatomical Pathology ______d) AP Research Coordinator – Selection is by the RTC with the support of the Department Head of Pathology and Laboratory Medicine. Term is 3 years and is renewable. e) Resident Representatives – shall consist of the Chief Resident (Senior Resident Representative) and a Junior Representative. The junior representative position will be shared between interested PGY’2s, each attending no less than one meeting per year.

5) Responsibilities a) To the residents i) Review resident experience during the PGY1 year. ii) Oversee the mandatory and elective rotations of residents in the PGY2-5 years, ensuring that residents meet all requirements of the Royal College and the Royal College Specialty Committee in Anatomical Pathology. iii) Provide for the orientation of new residents including the orientation and probationary period for AIMG residents. iv) Oversee the mentoring and counseling of residents, and promote access to all resources available to residents through the Post Graduate Medical Education Office, the University of Calgary, the Royal College of Physicians and Surgeons of Canada, and the Alberta College of Physicians and Surgeons. v) Administer an evaluation process for and by residents, provide timely feedback to residents and staff, and continuously improve the formative and summative qualities of evaluations, including the monitoring of progress in all CanMEDs competencies. vi) Continuously monitor the program’s didactic curriculum vii) Participate in CaRMS match activities for the selection of candidates for admission to the program viii) Maintain an appeal mechanism. The Residency Training Committee will receive and review appeals from residents and, where appropriate, refer the matter to the Postgraduate Medical Education Office. ix) Assist the Program Director in the writing, administration, and marking of semi-annual in-house examinations

b) To the Royal College i) Ensure that the training program meets or exceeds the requirements of the Royal College of Physicians and Surgeons of Canada: (1) GENERAL STANDARDS OF ACCREDITATION – A STANDARDS (2) National Standards for Training PRIOR to July 1, 2019 (Traditional Program Stream) (3) National Standards for Training AFTER July 1, 2019 (CBD Program Stream) ii) Review and approve the recommendations of the Program Director(s) regarding promotions, Certificate of Completion of Training (CCT), and Final In-training Evaluation Report (FITER) for each resident. iii) Prepare for Internal (PGME) and External (RCPSC) Reviews of the program.

c) To the Department i) Recruit and select new residents. ii) Assist the AP Research Coordinator as necessary to initiate, promote, and supervise research activity by residents in the department. iii) Oversee the operating budget for the Residency Training Committee, and whenever possible, apply for any available funding to provide for residency training; review expenditures as reported annually by the Program. iv) Review and approve as necessary the policies and procedures that govern resident activities in the department. v) Oversee the working relationships between residents, faculty, laboratory and support staff.

Page | 106 RESIDENCY TRAINING in Anatomical Pathology ______d) To the University of Calgary i) Implement all policies set out by the Post Graduate Medical Education Office. ii) Receive, review, and refer, as necessary, appeals from residents. iii) Comply with all Professional Standards for Faculty Members and Learners in the Faculty of Medicine at the University of Calgary. 6) Meetings i) Meetings of the RTC shall take place regularly, generally on the first Tuesday of each of the following months (July (second Tuesday), September, November, January, March, & May). ii) There will be a minimum of 6 meetings/year (an extra meeting may be scheduled in February to deal with CaRMS applications and ranking). iii) Meetings begin at 3 pm and are to last one hour. Whenever possible, unfinished items on the agenda are to be tabled or discussed and resolved outside of formal meetings (email or phone). iv) Emergency or ad-hoc meetings may be called at the discretion of the Program Director(s).

7) Accountability The Committee will report activities and outcomes to the Head, Department of Pathology and Laboratory Medicine.

8) Terms of Reference The Committee will review the terms of reference every year.

9) Resources  Administrative support provided by the Program Administrator  Advisory and financial support provided by the PGME Committee, University of Calgary  Financial support is provided by Alberta Public Laboratories  Advisory and financial support is provided by the Alberta International Medical Graduate Program

10) Subcommittees Evaluation Subcommittee – currently inactive Anatomical Pathology Research Committee Anatomical Pathology Competence Committee

Page | 107 RESIDENCY TRAINING in Anatomical Pathology ______The Competence Committee – Terms of Reference General Considerations As part of Competence by Design, specialist education is broken down into a series of integrated stages. Promotion or advancement from one stage to the next is determined outside of the individual teacher-learner interaction at a group decision-making process of the Competence Committee. In this way, a Competence Committee is a critical component of Competence by Design (CBD) because it supports the regular, systematic and transparent review of a resident’s progress towards competence. The Competence Committee’s goal is to ensure that all learners achieve the requirements of the discipline. The Committee achieves this goal through the synthesis and review of qualitative and quantitative assessment data at each stage of training to determine and guide the resident’s progress.

Key Competencies and Characteristics The Competence Committee will be composed of individuals with interest, experience and expertise in assessment and medical education relevant to the discipline. The Competence Committee members must be able to interpret multiple sources of qualitative and quantitative observation data to achieve consensus, where possible, in order to make judgments on outcomes.

Definitions  Academic Advisor – a faculty member specifically appointed to individual resident(s) to review the residents’ academic progress during residency.  CBME Lead – Point person to develop and apply the new curriculum to ensure all educational activities deemed by the specialty committee are able to be experienced.  Entrustable Professional Activity (EPA) - a task that you do that defines you as a pathologist that can be entrusted to a trainee to exhibit competence.  Milestone – "the expected ability of a health care professional at a stage of expertise", an observable marker of a person's ability along a developmental continuum.  Stages of Training – Competence By Design (CBD) is broken into a series of integrated stages from the beginning of residency through practise o Transition to Discipline - Orientation to the discipline o Foundations of Discipline - Broad based competencies every trainee must acquire before moving on to more advanced, discipline specific competencies o Core - Essential competencies that constitute the core of a discipline o Transition to Practice - Allows trainees to exhibit readiness for autonomous practice

Guiding Principles The roles, responsibilities and activities of the Competence Committee are guided by the following principles: 1. The Competence Committee is a sub-committee of the Residency Training Committee (RTC) 2. The Competence Committee allows for an informed group decision-making process where patterns of performance can be collated to reveal a broad picture of a resident’s progression toward competence. 3. The Competence Committee has authority to make decisions on individual EPA achievement. The CC presents status change determinations as recommendations to the RTC. The RTC ratifies these status recommendations with input from the Post Graduate Dean (when required). 4. Committee work is guided by the national specialty competency framework, including specialty-specific milestones and EPAs by stage, as established by the specialty committee as well as the relevant university and Royal College assessment policies. 5. The Competence Committee is expected to exercise judgement in making EPA decisions and status recommendations: i.e. They

Page | 108 RESIDENCY TRAINING in Anatomical Pathology ______will use Specialty defined EPAs and the expected number of observations as a guideline, but they are not bound to a specific number, context or type of assessments. The key is that the committee must feel it has adequate information on the EPAs to make holistic judgements on the progress of the resident. The wisdom of the Competence Committee is considered the gold standard for EPA decisions and learner status recommendations. 6. In addition to utilizing milestones and EPAs, Committee discussions will be based on all of the assessment tools and relevant evidence from the program as uploaded in ePortfolio. 7. All committee discussions are strictly confidential and only shared on a professional need- to-know basis. This principle is equivalent to patient confidentiality in clinical medicine. 8. Committee decisions must be based on the evidence available in the trainee’s ePortfolio at the time of the committee meeting. Individual committee member experience can only be introduced with appropriate documentation within ePortfolio. Committee members must make every attempt to avoid the introduction of hearsay into deliberations. Discussions are informed only by the evidence available in the program’s ePortfolio system. 9. The functioning of the Competence Committee, including its decision making processes, will be a focus of accreditation surveys in the future. 10. Individual trainees, or their Faculty Advisors, may be invited to discuss their progress with the members of the Competence Committee. 11. Committee work must be timely in order to ensure fairness and appropriate sequencing of training experiences. 12. The Competence Committee operates with a growth mindset. This means that Committee work is done in a spirit of supporting each trainee to achieve their own individual progression of competence. 13. The Competence Committee has the responsibility to make decisions in the spirit of protecting patients from harm, including weighing a trainee’s progress in terms of what they can safely be entrusted to perform with indirect supervision. Some Committee discussions must be shared to provide focused support and guidance for residents. This principle is equivalent to patient handover in clinical medicine. 14. The Competence Committee, on an exceptional basis, has the option to identify trainees who are eligible for an accelerated learning pathway provided that all requirements are met. 15. The Competence Committee, on an exceptional basis, and after due process, has the responsibility to identify trainees who have met the predefined category of “failure to progress” and who should be requested to leave the program as per the Post Graduate Office Policies of the Cumming School of Medicine, University of Calgary. 16. Competence Committee decisions/recommendations and their associated rationales must be documented within the program’s ePortfolio system.

Role A competence committee allows for an informed group decision-making process where patterns of performance can be collated to reveal a broad picture of a resident’s progression toward competence. The Competence Committee mandate is to review and discuss learner portfolios in order to:  advise/guide resident learning and growth;  modify a resident’s learning plan;  make decisions on a learner’s achievement of EPAs;  recommend learner status changes to the Residency Program Committee;  ensure there is a report back mechanism so that the resident is aware of their status following a review.

Page | 109 RESIDENCY TRAINING in Anatomical Pathology ______Responsibility and Authority The Competence Committee reports to the Residency Training Committee via the Program Director or delegate and will be responsible for:  Monitoring and making decisions on the progress of each resident in demonstrating achievement of the EPAs or independent milestones within each stage of a competency- based residency training program.  Synthesizing the results from multiple assessments and observations to make recommendations to the RPC related to: • The promotion of residents to the next stage of training; • The review and approval of individual learning plans developed to address areas for improvement; • Determining readiness to challenge the Royal College examinations; • Determining readiness to enter independent practice on completion of the transition to practice stage; • Determining that a trainee is failing to progress within the program; • Monitoring the outcome of any learning or improvement plan established for an individual resident. • Maintaining confidentiality and promoting trust by sharing information only with individuals directly involved in the development or implementation of learning or improvement plans.

Composition The Competence Committee will be comprised of the following individuals: 1. Anatomical Pathology Competence Committee Chair (CBME Lead) 2. Anatomical Pathology Program Director 3. Faculty Advisors: 1 for each of the following Stages of Training: a. Transition to Discipline b. Foundations of Discipline c. Core d. Transition to Practice (can be combined with the program director) 4. General Pathology Program Director or designate 5. Anatomical Pathology Program Administrator

Process and Procedures 1. Meetings: The number of Competence Committee meetings is to be no less than 6 per year. Meetings may be either virtual, face to face or some combination of the two.

2. Agenda Development: Trainees are selected for the agenda of a planned Competence Committee meeting by the Chair of the Committee, and/or the Program Director (or their delegate). This shall be done in advance of the Committee meeting to provide reviewers adequate time to prepare.

3. Frequency of Trainee Review: Every trainee in the program must be discussed a minimum of twice per year, unless that trainee is on a maternity/paternity or other approved extended leave of absence.

4. Quorum: There should be at least 50% attendance from the membership of the Competence Committee to achieve quorum, with an absolute minimum of 3 clinical supervisors, and the program director present for all discussions.

Page | 110 RESIDENCY TRAINING in Anatomical Pathology ______5. Selection: Trainees may be selected for Competence Committee review based on any one of the following criteria: a. Regularly timed review b. A concern has been flagged on one or more completed assessments c. Completion of stage requirements and eligible for promotion or completion of training d. Requirement to determine readiness for the Royal College exam e. Where there appears to be a significant delay in the trainee’s progress or academic performance; or f. Where there appears to be a significant acceleration in the trainee’s progress.

6. Primary Reviewer: Each trainee scheduled for review at a Competence Committee meeting is assigned to a designated primary reviewer. The primary reviewer is responsible for completing a detailed review of the progress of the assigned trainee(s) based on evidence from the completed observations and other assessments or reflections included within ePortfolio. The primary reviewer considers the trainee’s recent progress, identifies patterns of performance from the observations, including numerical data and comments, as well as any other valid sources of data (e.g. in-training exam performance). At the meeting, the primary reviewer provides a succinct synthesis and impression of the trainee’s progress to the other Competence Committee members. After discussion, the primary reviewer proposes a formal motion on that trainee’s status going forward.

7. Secondary Reviewer(s): All other committee members are responsible for reviewing all trainees on the agenda as secondary reviewers. All secondary reviewers are required to come prepared to discuss all trainees’ progress.

8. Royal College recommended Committee Procedures: a. The Chair welcomes members and orients all present to the agenda and the decisions to be made. b. The Chair reminds members regarding the confidentiality of the proceedings. c. Each trainee is considered in turn, with the primary reviewer presenting their synthesis, displaying relevant reports from ePortfolio, and sharing important quotes from any observational comments about the trainee. The primary reviewer concludes by proposing a status for the trainee going forward in the program. d. If seconded by another committee member, all members are invited to discuss the motion. e. The Chair will call a vote on the proposed recommendation of the primary reviewer. f. If the recommendation of the primary reviewer is not seconded or the motion does not achieve a majority of votes, the Chair will then request another motion regarding the trainee. g. This will continue until a majority of the Competence Committee members supports a status motion. The rationale for the recommendation must be documented in the program’s ePortfolio system. h. Status recommendations can only be deferred if additional information is required. However, this deferred recommendation must be revisited within 4 weeks. i. A status recommendation is recorded in the trainee’s ePortfolio and is communicated to the RTC for ratification.

Page | 111 RESIDENCY TRAINING in Anatomical Pathology ______j. Once ratified by the RTC, a status decision is communicated to the trainee and recorded in the committee’s archives. k. Competence Committees should flag EPAs or milestones which are inconsistently being met at a defined stage for a cohort of residents to the Program Director. The Program Director, in turn, and in conjunction with the RTC, should alert the Specialty Committee for a discussion of the appropriateness and expected time of completion of those EPAs

9. Post Competence Committee meetings: a. As soon as possible after the committee decision and ratification by the RTC, the Program Director, or other appropriate delegate, communicates the decision of the Competence Committee in writing within 2 weeks. b. Changes to the trainee’s learning plan, assessments, or rotation schedule will be developed with the resident and implemented as soon as feasible in a face-to-face meeting if the status for the trainee is set to anything other than “progressing as expected” c. All relevant stakeholders of the RTC are on the Competence Committee and therefore are able to access key information if need be.

10. Appeal Process: a. Any appeals to stage of training decisions made by the Competence Committee and ratified by the RTC will follow the established process set out by the Post Graduate Medical Education Office of the University of Calgary and the decision at the University level is final.

Reporting The Competence Committee will report outcomes of discussions and make recommendations to the Residency Program Committee for ratification.

Term of Office The selection of members of the Competence Committee will be based on established University policies. Ordinarily, members should be appointed by the Program Director to serve a defined term with an appropriate process for renewals.

Page | 112 RESIDENCY TRAINING in Anatomical Pathology ______The Evaluation Subcommittee Terms of Reference – currently inactive 1) General This committee assists the Residency Training Committee in matters related to the evaluation and promotion of residents. As the many aspects of this task are more than the committee members could be expected to do alone, this group will engage the assistance of other faculty members as necessary.

2) Roles and Responsibilities a) Assist with completion of FITERS for approval by the RTC (and signature of the Program Director(s)). b) Make recommendations to the RTC regarding annual promotions. c) Prepare, administer, and provide a summary of the results of the Winter examination. d) Arrange and administer the annual spring RISE examination (MCQ) and Oral Examination. e) Participate in the construction and evaluation of remedial and probationary rotations. f) Review the terms of reference as needed. 3) Membership Three members, all three of which should be standing members of the RTC. Members should serve for five years, on a staggered basis.

4) Chair The chair is selected by the members of the committee.

5) Quorum As this is an ad hoc committee, most of its business will be conducted during irregular meetings including meetings by email. Meetings need not be minuted, but all meetings should result in either a written or a verbal report to the RTC. As the outputs of this committee are recommendations to the RTC (albeit extremely important recommendations) rather than decisions, recommendations do not have to be unanimous, but all recommendations to the RTC should indicate the degree of consensus.

6) Frequency of Meetings The committee will by necessity be meeting several times a year.

Page | 113 RESIDENCY TRAINING in Anatomical Pathology ______The Research Coordinator 1) General Reporting to the Anatomical Pathology Residency Training Committee (RTC), the Resident Research Coordinator, a faculty member in the Department of Pathology and Laboratory Medicine, assists and mentors pathology residents in all matters related to resident research. The ultimate goals are to elevate the quality of resident’s research, and to increase the level of accountability related to resident research activity.

2) Specific Roles and Responsibilities a) Meets regularly with residents as a group (1-2 x per year) to discuss research-related opportunities, topics, concerns etc. b) Is available to provide one-on-one mentoring to residents regarding research activities; acts as a first-responder for residents having difficulty finding/starting research projects. c) Maintains an updated list of research interests/activities of each faculty member. d) Maintains an updated database of resident research activity, and monitors research outcomes (abstracts, peer reviewed publications, etc). e) Reviews/approves (along with Program Director and/or RTC) written funding requests for Resident Research Funds ($5,000.00 each) f) Provides academic and organizational assistance for resident and graduate student research day. g) Reviews the terms of reference on an annual basis

3) Appointment The position is appointed by the RTC, in consultation with the Department Head. The term is three years, and is renewable.

4) Reporting A report (written or verbal) will be presented to the RTC once per year

Page | 114 RESIDENCY TRAINING in Anatomical Pathology ______Section 7: Rotation Goals and Objectives Section 7.1: Introduction A specific number of rotations are considered “mandatory” by the Royal College of Physicians and Surgeons of Canada, as well as by the Anatomical Pathology Training Program in Calgary (see Section 1.2 and 1.3). In addition, a number of other elective rotations are available for residents to choose from, depending on individual interests/career plans. This section of the manual provides basic information regarding the goals, objectives, pre-requisites, and supervisors of the various rotations. More detailed, day-to-day information will be made available upon commencement of the rotation (where applicable).

Note: A variety of other electives in less commonly pursued areas (eg. cancer cytogenetics), off- site settings, or non-standardized situations (eg. research) may also be taken for credit. Details regarding these electives may be available in separate “mini-manuals”, might be established by the individual resident, or could be provided by an off-site program supervising the resident. Nevertheless, all electives MUST have a supervisor/preceptor, must have objectives established prior to commencement, and must have an evaluation completed at the end of the rotation (optimally within 4 weeks).

Section 7.2: Mandatory Rotations PGY 1: Basic clinical training Goals: The goals of the PGY1 year are to provide a broad background in clinical medicine, to provide exposure to most of the medical and surgical services that rely heavily on the pathology laboratory, and to prepare the trainee for Medical Council of Canada Qualifying Examination. Rotations: Anatomical Pathology 8 weeks (4 weeks Orientation + 4 weeks Anatomy/Histology) Internal medicine 8 weeks General surgery 4 weeks Surgical specialties 4 weeks Emergency Medicine 4 weeks Pediatrics 4 weeks Obstetrics and Gynecology 4 weeks Gynecologic Oncology 4 weeks Medical oncology 4 weeks Radiology 4 weeks Elective 4 weeks

General Objectives: At the completion of the PGY 1 year, trainee is expected to demonstrate: 1) The ability to diagnose and manage in a hospital and ambulatory setting, adult and pediatric patients with common medical, surgical, and gynecological disease. 2) The ability to manage an uncomplicated pregnancy, a normal vaginal delivery, and common obstetrical complications. 3) The ability to triage the critically ill and to set priorities in management. 4) The ability to manage the initial stabilization of the patient with multisystem failure due to disease or trauma. 5) The ability to manage common problems arising in the pre and post-operative periods. 6) The ability to appropriately request an autopsy. 7) The ability to dissect some common surgical pathology specimens. 8) The ability to appropriately order laboratory tests. 9) The ability to effectively use personnel, equipment and other resources. 10) The ability to explain and justify operative procedures to patients. 11) The ability to appropriately refer patients to specialty consultants and community service. 12) The ability to provide emotional support for patients and their families. 13) The ability to elicit active participation of patients and their families in the patient care, where appropriate.

Page | 115 RESIDENCY TRAINING in Anatomical Pathology ______Pathology 1: Orientation (Block 1) General Description: This 4 week orientation block serves to introduce (PGY1) and re-familiarize (PGY2) residents with the basic operations of the Anatomical Pathology service at Alberta Public Laboratories. The orientation includes introductions to key personnel, an overview of surgical and autopsy pathology at the Foothills Medical Centre (FMC), an explanation of the relationship between the University of Calgary and Alberta Public Laboratories, a tour of the facilities, a review of general safety procedures, distribution of paperwork from the Program Administrator, and an introduction to our clerical services and Laboratory Information System.

After the first day of “common” orientation, the residents split into their respective PGY1 and PGY2 groups. All residents attend the Academic Half-Day on Friday mornings.

The PGY2s will receive a more in-depth, week-long orientation to the major laboratory areas, including the Main Lab, Gross Room, LIS, and the Morgue. They will spend the remainder of Block 1 rotating through the surgical pathology and autopsy services at the FMC, under the supervision of senior residents and/or Attending Staff Pathologists.

The PGY1s will spend the remaining 3 weeks of their rotation observing on the Surgical Pathology and Autopsy services. They will be closely supervised at all times by either: a Senior Resident, a Senior Path Tech/Assistant, or a Staff Pathologist. Toward the end of the block, they will begin to gross simple surgical specimens, write histological descriptions, and assist with straightforward autopsy cases. In the afternoons, a series of multi-headed microscope sessions will be offered to the residents by various pathologists as an introduction to common pathological processes in different organ systems.

Specific Objectives and Activities: Medical Expert: 1) the resident will be familiar with normal histology and anatomy of common organs (such as skin, breast, gastrointestinal tract, liver and gallbladder, lung, thyroid, parathyroid, and adrenal) 2) the resident will describe the gross and microscopic appearance of general pathological processes (inflammation, healing and repair, necrosis, thrombosis, neoplasia) 3) the resident will prepare fresh specimens as appropriate, including: taking a clear, well- centered gross photograph, “painting” cancerous specimens with ink, assisting with preparation of large specimens for fixation (bowel, breast, uterus), and assisting with submission of tissue for special studies (touch preps, flow cytometry, cytogenetics, tissue bank) 4) the resident will recognize the importance of correct specimen identification (assigning a “unique identifier”/accession number to each specimen), the value of an adequate clinical history on the requisition, and that certain specimens are best received in the lab fresh, so that specialized tests may be carried out 5) the resident will observe and participate in at least one complete autopsy (including evisceration and organ dissection), and at least one autopsy demonstration round 6) the resident will be able to identify: the purpose and value of an autopsy (hospital and forensic), the differences between a hospital and forensic autopsy, circumstances that require contacting the Medical Examiner’s office, and the limitations of an autopsy 7) (PGY2) the resident will be aware of the following principles as they relate to frozen sections: uses, limitations, and approximate rates of diagnostic accuracy, false positives and false negatives 8) (PGY2) the resident will be able to: prepare and freeze tissue in a cryostat, perform cryotomy technique to produce an acceptable section, perform an adequate H and E stain, and cover-slip the slide 9) (PGY 2) the resident will be able to: describe the uses of fixatives (in particular, formalin), understand the principles of paraffin

Page | 116 RESIDENCY TRAINING in Anatomical Pathology ______tissue processing, recognize the significance of correctly processed and oriented blocks, describe the use of the microtome, and perform microtomy technique 10) (PGY 2) the resident will understand the basic reagents and staining principles used in H and E staining, and recognize that “special stains” can be used to demonstrate tissue components and structures (eg. Gram stain, Congo Red, etc.) 11) (PGY 2) the resident will be able to describe, dissect, and submit appropriate tissue sections from the following types of specimens: G/I: small bowel, large bowel, vermiform appendix and gall bladder; breast: biopsies, mastectomies; gyne: ovary, fallopian tubes, uterus, POC; lung and/or thyroid Communicator: 1) the resident will communicate clearly and consistently with all staff with regards to meeting times, expectations, and/or questions and answers. This may be done verbally or via handwritten notes and/or emails. 2) the resident will recognize: a properly completed autopsy consent form, appropriate reasons for refusal to perform an autopsy, and the confidentiality of the autopsy findings and report 3) (PGY2) the resident will begin to document gross descriptions and histological findings by dictating or handwriting gross findings, diagnoses, microscopic descriptions, and preliminary autopsy reports. Leader: 1) the resident will become familiar with the basic organizational structure of Alberta Public Laboratories 2) the resident will prioritize his/her time efficiently during this rotation so that the goals and objectives are met 3) (PGY2) the resident will gain a basic knowledge of the LIS (how to log in to the system, how to review a report, how to do a search for previous pathology reports, etc) Health Advocate: 1) the resident will, when appropriate, reinforce to the public and the profession the essential contribution of laboratory medicine to health 2) the resident will begin to identify the important determinants of health affecting patients 3) the resident will demonstrate a sound knowledge of safety procedures and policies in the laboratory (eg. use of appropriate protective clothing/equipment, refraining from eating and drinking in designated areas, disposing of sharps, biohazardous waste, and chemicals in appropriate areas, recognizing where the eyewash station, shower, and fire extinguisher are located, and identifying which infections may require modified handling in the gross room or morgue) Collaborator: 1) the resident will disseminate patient information/diagnoses to clinicians in a timely manner, and as appropriate, to facilitate optimal patient care Professional: 1) the resident will adhere to the Guidelines for Professional Conduct, as outlined in the University of Calgary document Scholar: 1) the resident will utilize appropriate self-assessment strategies to identify potential areas for self-improvement 2) the resident will attend and participate in the weekly Academic half-day, as scheduled Evaluation: The ITER will be completed on-line at the end of the rotation by the Program Director or delegate (with input from staff pathologists, other residents, technical and clerical staff). A face-to-face meeting and discussion with each resident will be held at the end of the block.

Page | 117 RESIDENCY TRAINING in Anatomical Pathology ______Pathology 2: Histology, Anatomy, and Basic Pathology (Block 11) General Description: This block is commonly referred to as Anatomy/Histology Block. The primary goal of this component of the program is to teach/review basic histology, and to strengthen the foundation for understanding pathology. Secondary goals include review of selected basic histopathologic and gross pathologic entities, review of basic topics relevant to pathology (such as immunohistochemistry and special stains), review of anatomy, and prosection practice where available. It will also be an opportunity for skill development in medical education techniques, and inter-professional education as this practicum is taught in conjunction with the first year Anatomical Pathology, General pathology, and Neuropathology residents, as well as students in the Pathologists’ Assistant program. This is a seminar-type practicum, where students research an area of histology, and then present their findings back to the peers.

Specific Objectives: Medical Expert: 1) the resident will develop/refine a thorough knowledge and understanding of the normal histology of all the major organ systems: gastrointestinal system, salivary gland and hepatobiliary/pancreatic systems, skin, breast, cardiovascular system, oral cavity, respiratory tract, endocrine system, urinary system, male and female reproductive systems, central nervous system, immune system, bone and soft tissue. (A specific list of objectives for each body system will be circulated at the beginning of the course). 2) the resident will compare and contrast the histologic features of various tissues to determine site, and develop an approach to identifying an unknown site. 3) the resident will develop his/her knowledge of several basic pathology entities in each body system, including features to recognize them (and distinguish from normal histology), appropriate differential diagnoses, and criteria for diagnosis. 4) the resident will develop his/her knowledge of findings and diagnoses that can be made on gross examination, in surgical specimens and autopsies. 5) the resident will develop/refine a knowledge of the anatomy of individual organs and their relationships to other organs, especially as they relate to the hospital autopsy dissection (and to grossing of pathology specimens). 6) the resident will become familiar with core microscopy techniques including measurement, Kohler illumination, polarization, and how to acquire good quality images. 7) the resident will develop their knowledge of core aspects of pathology including a general hierarchical approach to pathology, immunohistochemistry and special stains (how they work, relevant issues including sensitivity, specificity, and costs, strategies for selecting tests in common situations, and how to interpret results), a basic approach to processing fresh and formalin fixed specimens, and a basic approach to handling an autopsy including evaluation of the consent form. 8) the resident will attend gross pathology rounds, and continue to attend other mandatory rounds including academic half days, clinicopathological correlation rounds, and continuing medical education rounds. Communicator: 1) the resident will actively listen during other students’ presentations, and engage in interactive learning. 2) the resident will give respectful, constructive criticism of other students’ presentations. 3) the resident will develop skills in accurately and clearly explaining topics in histology and basic pathology. Leader: 1) the resident will prioritize his/her time efficiently during this rotation so that the goals and objectives are met 2) the resident will provide constructive feedback about the course with regards to what aspects were useful, and how it can be improved for future residents.

Page | 118 RESIDENCY TRAINING in Anatomical Pathology ______Health Advocate: 1) the resident will be aware of “critical values” in surgical pathology, and be able to list and recognize situations where this applies and the importance of prompt communication 2) the resident will, when appropriate, reinforce to the public and the profession the essential contribution of laboratory medicine to health 3) the resident will begin to identify the important determinants of health affecting patients Collaborator: 1) the resident will develop rapport and respect for other students in the group. 2) the resident will share knowledge and information they find with other members of the group, for example if they found an answer to an unresolved question during a presentation. Professional: 1) the resident will strive for excellence in their mastery of basic histology and anatomy, especially as they pertain to pathology. 2) the resident will be prepared and punctual for every scheduled session. 3) the resident will be respectful of their colleagues in the same or different residency programs, and students in the Pathologists’ Assistant program, during presentations. Scholar: 1) the resident will become familiar with resources to effectively resolve questions related to histology and anatomy. 2) the resident will develop their presentation and teaching skills by teaching histology and basic pathology entities in one or more organ systems. 3) the resident will develop their skills in creating questions for quizzes, and taking tests. 4) the resident will recognize potential areas for self-improvement (either by reflection or seeking external feedback) in their knowledge of histology and anatomy, and their presentation skills. Evaluation: Residents will be evaluated based on their performance by weekly quizzes, as well as the quality of their presentations. The presentations will be evaluated based on completeness (covering all objectives), organization, and adherence to medical education techniques. Self-send forms for resident presentation are available on One45 to collect data, the ITER will be completed at the end of the block by the course coordinator, who will provide feedback and constructive criticism.

Page | 119 RESIDENCY TRAINING in Anatomical Pathology ______Internal Medicine: The trainee is expected to demonstrate appropriate recognition and management of patient with symptoms and signs of diseases in the following sub-specialties of internal medicine: 1) , Immunology, and 6) 2) 7) 3) 8) Respiratory Diseases 4) 9) Medical Oncology 5) Hematology

Objectives: Medical Expert 1) As applied to illnesses on the inpatient medical service (MTU) when working in direct contact with the admitting internist in addition to the role of the consultant on the GIM consults, GIM outpatient clinics, urgent assessment clinics, and preoperative clinics. Communicator 1) Learners will be communicating with their patients, attending staff, colleagues, allied health services, consultants, families, and emergency room physicians. Collaborator 1) Learners will be working with ancillary health services, other residents, students, and consultants whether on the MTU or other GIM services. Leader 1) Learners will be working in different inpatient and outpatient settings with exposure to Leaderial skills needed for such practices as discussed with unit managers and attending staff. Health Advocate 1) Competencies as per GIM but particularly applied to the Urban community hospital setting and patient population. Scholar 1) Learners will be discussing their patient care with attending staff and consultants with emphasis on providing evidence based care which brings to the surface opportunity for research ideas and gaps in knowledge dissemination. Professional 1) Learners will be demonstrating a commitment to patients, staff and society through ethical practice. Procedures: The trainee is expected to satisfactorily perform and interpret if necessary the following procedures: 1) Venipuncture 2) Arterial puncture 3) E.C.G 4) Central venous access 5) Basic and advanced life support 6) Thoracocentesis 7) Paracentesis 8) Fine needle aspiration of superficial lumps and bumps 9) Punch biopsies 10) Lumbar puncture 11) Chest tube insertion Evaluation Learner and Faculty evaluations shall conform with PGME and RTC

Page | 120 RESIDENCY TRAINING in Anatomical Pathology ______Policies. A system analogous to that used at FMC and PLC will be available at RGH in order to facilitate the integration of mid-rotation evaluations with final in-training evaluations. The evaluation process is a responsibility that is shared by learner and educator.

Page | 121 RESIDENCY TRAINING in Anatomical Pathology ______Pediatrics: The trainee is expected to demonstrate appropriate recognition and management of pediatric patient with symptoms and signs of diseases in the following sub-specialties of internal medicine:

Objectives: Medical Expert 1) As applied to illnesses on the pediatric service when working in direct contact with the admitting internist in addition to the role of the consultant on the GIM consults, GIM outpatient clinics, urgent assessment clinics, and preoperative clinics. Communicator 1) Learners will be communicating with their patients, attending staff, colleagues, allied health services, consultants, families, and emergency room physicians. Collaborator 1) Learners will be working with ancillary health services, other residents, students, and consultants whether on the MTU or other GIM services. Leader 1) Learners will be working in different inpatient and outpatient settings with exposure to Leaderial skills needed for such practices as discussed with unit managers and attending staff. Health Advocate 1) Competencies as per GIM but particularly applied to the Urban community hospital setting and patient population. Scholar 1) Learners will be discussing their patient care with attending staff and consultants with emphasis on providing evidence based care which brings to the surface opportunity for research ideas and gaps in knowledge dissemination. Professional 1) Learners will be demonstrating a commitment to patients, staff and society through ethical practice. Procedures: The trainee is expected to satisfactorily perform and interpret if necessary the following procedures: 1) Venipuncture 2) Arterial puncture 3) E.C.G 4) Central venous access 5) Basic and advanced life support 6) Thoracocentesis 7) Paracentesis 8) Fine needle aspiration of superficial lumps and bumps 9) Punch biopsies 10) Lumbar puncture 11) Chest tube insertion Evaluation Learner and Faculty evaluations shall conform with PGME and RTC Policies. A system analogous to that used at FMC and PLC will be available at RGH in order to facilitate the integration of mid-rotation evaluations with final in-training evaluations. The evaluation process is a responsibility that is shared by learner and educator.

Page | 122 RESIDENCY TRAINING in Anatomical Pathology ______Surgery Pre-amble: The Resident is expected to develop a competent clinical approach to the surgical patient and manage the patient appropriately. The Resident will learn to educate and give support to the surgical patient and their family.

General Objectives 1) At the completion of the rotation, the Resident should demonstrate the following: 2) the ability to diagnose and manage acute and chronic problems in the office, emergency room and hospital 3) effective utilization of consultants knowledge of pre and postoperative management 4) the ability to explain and justify operative procedure to patient 5) the ability to treat common problems arising during, pre and postoperative period (eg. diabetes, , fluid and electrolyte imbalance, nutrition etc.) 6) the ability to assist during major surgery and to be able to perform certain minor surgical procedures. Specific Objectives The Resident should be able to demonstrate an effective approach to the patient presenting with the following clinical conditions: 1) acute abdomen: including perforation, abscess, , appendicitis, cholecystitis bowel obstruction, and diverticulitis 2) hernia (hiatus, inguinal, incisional and umbilical) 3) chronic disease complicating an acute abdomen (Anticoagulation, COPD, CAD, DM) 4) malignant and benign tumors (breast, bowel, skin, stomach), 5) Biliary tract disease (gallstones, infection, jaundice) 6) anal and rectal problems (hemorrhoids, fissures, abscess) 7) Inflammatory bowel disease and its complications (obstruction, perforation, fistula) 8) Fluid and Electrolyte imbalance 9) Sepsis 10) Nutrition in the surgical patient Procedures The Resident should demonstrate skills in the following: 1) incision and drainage of abscesses 2) aspiration of cysts 3) excision of benign skin lesions 4) simple suturing and wound closure 5) assistance during surgical procedures

Page | 123 RESIDENCY TRAINING in Anatomical Pathology ______Obstetrics and Gynecology General Objectives: 1) Diagnostic & therapeutic skills for effective and ethical patient care 2) An ability to assess and apply relevant information to clinical practice in consultation with attending staff. 3) Recognition of personal limitations of expertise Obstetrics Specific Objectives: Medical Expert: The PGY1 resident will gain a working level of knowledge of the following clinical conditions or problems encountered commonly in the practice of Obstetrics. 1) Antepartum care: a) Maternal and fetal physiology b) Fetal development c) Management of normal pregnancy: d) Diagnosis e) Dating f) Assessment of gestational size g) Assessment of fetal growth h) Assessment of fetal well-being i) Understand principles of genetic counseling j) Recognition of fetal anomalies k) Understand and apply principles of pregnancy risk assessment l) Outline management plan for Rh negative obstetrical patient. m) Knowledge of routine laboratory screening n) Understand relationship between general medical disease and pregnancy o) Nutritional management (recommendations: iron / folic acid) p) Potential complications associated with smoking, alcohol and drug use (maternal and neonatal) 2) Intrapartum care: a) diagnose labor b) anatomy, physiology and mechanisms of normal labour c) assessment of labor progress d) indications, methods, and complications of labor augmentation. e) intrapartum assessment of maternal and fetal health. f) use of analgesia and anaesthesia in labor. g) indications and methods of labor inductions. h) indications for operative intervention. i) risks and benefits of VBAC. j) active management of 3rd stage of labor. k) indications for episiotomy l) apgar scoring 3) Normal puerperium / postpartum care: a) counsel re: breast-feeding b) counsel re: family planning c) recognize risk factors for postpartum depression 4) Obstetric complications: a) Diagnosis & Management of: i) hyperemesis gravidarum ii) 2nd trimester pregnancy loss iii) threatened preterm labor iv) spontaneous rupture of membranes (term & preterm) v) antepartum hemorrhage

Page | 124 RESIDENCY TRAINING in Anatomical Pathology ______vi) gestational diabetes vii) gestational hypertension viii) fetal growth restriction ix) post dates x) fetal demise 5) Delivery Complications: a) shoulder dystocia b) breech c) cord prolapse

rd 6) Complications of 3 Stage: a) retained placenta b) early and delayed postpartum hemorrhage (PPH) 7) Complications of puerperium: a) delayed PPH sepsis Technical Skills: With assistance/supervision: 1) conduct prenatal exam including bimanual assessment of uterine size 2) conduct a complete antenatal assessment 3) Leopold’s maneuvers 4) sterile speculum exam to assess status of membranes 5) ARM 6) application of scalp electrode 7) assessment of cervical dilatation in labor 8) normal vaginal delivery 9) repair episiotomy 10) recognize and repair 1st & 2nd degree lacerations 11) establish I.V. access 12) first assist at cesarean section Diagnostic Procedures and Techniques: The PGY1 resident will demonstrate an understanding of the indications, risks, benefits, and limitations of the following investigative techniques specific to the practice of Obstetrics: 1) Cervical culture and serology for sexually transmitted diseases including HIV and Hepatitis B screening. 2) Documentation of immunity to varicella and rubella. 3) Determination of blood group and type with maternal antibody screening. 4) Cervical cytology. 5) Maternal serum screening 6) Screening for gestational diabetes 7) Screening for Group B streptococcus in pregnancy. 8) Torch screening to identify possible congenital viral infections 9) Current recommendations for ultrasound screening in normal pregnancy. 10) Fetal assessment - interpretation in non-stress test and biophysical profile. 11) Interpretation of fetal heart rate tracing in the laboring patient.

Page | 125 RESIDENCY TRAINING in Anatomical Pathology ______Gynecology: The PGY1 resident should acquire knowledge of the principles of reproductive anatomy, physiology and applied endocrinology sufficient for diagnosis, investigation, and management of gynecologic conditions. He/she should be aware of the relationship of structure and function of the reproductive system to the patients total body function and also the variations which occur in structure and function with each stage of the reproductive life, namely childhood, puberty, pregnancy, and menopause senescence. The PGY1 resident should acquire sufficient knowledge to include in the general history and examination of the female information and findings relevant to age and gender. He/she should be aware of the principles of prevention at various life stages and be able to incorporate these into his/her assessment and management of the patient. The PGY1 resident will need to have demonstrated an ability to obtain information, carry out examinations including pelvic examinations, evaluate and investigate disorders, make diagnosis, and carry out treatment.

Specific Objectives Medical Expert: The PGY1 resident in Gynecology will acquire knowledge of the following clinical conditions or problems encountered commonly in the practice of gynecology: A working level of knowledge is required for the following: 1) Principles of well-woman exam, methods of screening 2) Principles of management of genital tract neoplasia, understand the role of regular cervical cytology and the prevention of invasive disease, understand the specificity and sensitivity of the Papanicolau test and factors leading to a false positive or negative test. 3) Diagnosis and management of infections of the female reproductive tract and urinary system including sexually transmitted infections. 4) Principles and management of disorders of menstruation, ie. oligomenorrhea, menorrhagia, polymenorrhea, dysmenorrhea, and premenstrual tension syndrome. 5) Identification and principles of Management of Complications of early pregnancy, ie. abortion, ectopic pregnancy, gestational trophoblastic disease 6) Diagnosis and Management of acute and chronic pelvic pain. 7) Diagnosis and management of pelvic masses. 8) Provision of contraceptive advice and an understanding of the role of abortion and sterilization procedures 9) Physiology and management of menopause 10) Human sexuality - recognition of sexual dysfunction, knowledge of principles of sexual counseling 11) Principles of a sexual assault evaluation Technical Skills: The PGY 1 resident will acquire a variety of technical skills in the practice of gynecology. The following is a list of required technical skills: 1) Conduct a gynecologic examination including placement of a speculum within the vagina with minimal patient discomfort. 2) Acquire competence in performing a bi-manual assessment of the pelvis including a recto- vaginal examination. 3) Competence in obtaining cervical cytology (pap). 4) Competence in obtaining cervical cultures for sexually transmitted diseases. 5) Preparing and interpreting wet mounts of vaginal discharge. 6) A competent intra-operative assistant. Diagnostic Procedures & Techniques: The PGY1 gynecology resident will demonstrate an understanding of the indications, risks and benefits, limitations and role of the following investigative techniques specific to the practice of gynecology and will be competent in their interpretation: 1) Interpretation of cervical culture results. 2) Interpretation of cervical cytology results.

Page | 126 RESIDENCY TRAINING in Anatomical Pathology ______3) An understanding of the use and interpretation of serial quantitative beta HCG determinations in the diagnosis and management of early pregnancy failure or ectopic pregnancy. 4) Tumor markers including CA125, LDH, Beta HCG, and AFP. 5) Imaging - The appropriate selection of imaging modalities including: Ultrasound - transvaginal/abdominal, CT scanning, MRI scanning, and hystersalpingography. 6) The resident should also have an opportunity to observe an endometrial biopsy. 7) The resident should have an opportunity to observe the placement and removal of IUCD’s. 8) The resident should be provided with an opportunity to manage early complications of pregnancy with assistance and supervision, ie. First trimester bleeding, ectopic pregnancy. 9) The resident should also be involved in the management of post-operative patients recognizing and have the ability to recognize and initially manage any complications, ie. Wound infection, pulmonary embolus, etc. Communicator 1) The PGY1 resident must be able to establish relationships with patients and their families characterized by understanding, trust, empathy, and confidentiality; obtain and synthesize relative histories from patient’s families and/or community; discuss appropriate information with patient or family and other healthcare providers that facilitate optimal health care. This also implies the ability to maintain clear, accurate, timely, and appropriate records. Collaborator 1) The PGY1 resident must be able to consult effectively with other physicians, consult effectively with other healthcare providers, and contribute effectively to a multidisciplinary health care team. Leader 1) The PGY1 resident must be able to balance patient care, learning needs, and outside activities, must work effectively and efficiently in a healthcare organization, and must utilize information technology to optimize patient care and lifelong learning. Health Advocate 1) The PGY1 resident will identify the important determinants of health affecting patients, contribute effectively to improved health of patients and communities, recognize and respond to those issues where advocacy is appropriate. Scholar 1) The PGY1 resident must develop, implement, and monitor a personal continuing education strategy, be able to critically appraise sources of medical information or appropriately integrate new information into clinical practice, identify gaps in personal knowledge and skill and develop strategies to correct them by self-directed reading, discussion with colleagues, and on-going procedural experience. The resident must also be comfortable teaching medical students in both formal and informal settings. Professional 1) The PGY1 resident must deliver the highest quality of medical care with integrity, honesty, compassion and respect, exhibit appropriate personal and interpersonal professional behaviors, and practice medicine in a way that is consistent with the ethical obligations of the physician.

Page | 127 RESIDENCY TRAINING in Anatomical Pathology ______Emergency Medicine General 1) Recognize threats to life and limb, understand the concept of triage. Recognize sick or unstable patients and act appropriately. 2) Develop an orderly and systematic approach to the investigation and management of ER patients. Order diagnostic tests appropriately. Formulate differential diagnosis. 3) Perform a complete and appropriate assessment of an Emergency patient. 4) Become proficient at discussing patient problems and treatment plans with the preceptors, consultants, staff, patients and families. 5) Become comfortable with disposition of ER patients to the community, provide adequate out- patient follow up and referral. 6) Understand the concept of pre- hospital care, and demonstrate knowledge of the local system 7) Recognize which patients require hospital admission and which patients can be managed as outpatients. 8) Demonstrate the skills to support and stabilize the acutely ill patient and arrange appropriate management, referral, and transfer. 9) Demonstrate wise stewardship of resources within the health care system and consider the needs of the individual, hospital, and community. Procedural Skills: The resident shall perform or be able to demonstrate knowledge of the following: 1) airway maintenance 2) spinal precautions 3) vascular access - including central lines, intraosseous 4) chest tube placement of pneumothorax 5) CPR and ACLS skills 6) lumbar puncture 7) local anesthetic use and suturing techniques 8) splinting/casting techniques, and simple fracture reduction skills 9) management of epistaxis 10) approach to removal of foreign bodies 11) Foley catheter placement

Page | 128 RESIDENCY TRAINING in Anatomical Pathology ______Pediatrics: The trainee is expected to demonstrate an effective approach of the following: 1) Normal growth and development 2) Failure to thrive 3) Feeding problems 4) Prematurely 5) Chromosomal disorders 6) Genetic counseling 7) Cyanosis 8) Jaundice 9) Communicable disease 10) Immunization schedules 11) Skin rashes 12) Management of handicapped children 13) Abnormal sex maturation 14) Enuresis 15) Obesity 16) Scoliosis 17) Child abuse 18) Diarrhea and constipation 19) HIV in children 20) Sudden infant death syndrome 21) Metabolic inborn errors of disease Procedures: The trainee is expected to demonstrate effective skills in the following: 1) Venous access 2) Lumbar puncture 3) Chest and abdominal x-ray interpretation

Medical Expert  Learn to obtain a concise and relevant history from the patient or their caregivers  Perform an age‐appropriate examination and appreciate how such an examination differs from that in adults  Generate age‐appropriate differential diagnoses, based on the history and examination  Suggest testing that would narrow the diagnosis and suggest treatments appropriate for those diseases  Learn and be able to assess developmental milestones  Learn the general categories of major pediatric diseases (e.g. infectious diseases of infants, inherited metabolic diseases, child abuse, neoplasia), their clinical manifestations, and their sequelae

Communicator  Accurately, concisely, and perspicuously report results of the history and physical examination  Appropriately communicate with pediatric patients and their caregivers, realizing that these relationships change throughout childhood

Page | 129 RESIDENCY TRAINING in Anatomical Pathology ______Collaborator  Work effectively with the group of individuals caring for the pediatric patient, including health care professionals and the primary caregivers  Learn how pathology impacts the practice of pediatrics  Determine the types of information pediatricians want to learn from an autopsy report

Manager  Understand limitations in resources available for testing and treatment of pediatric diseases

Health Advocate  Appropriately advocate for pediatric patients, especially in preventative medicine (e.g. immunizations, adequate nutrition, obesity)  Understand the medicolegal aspects of infant abuse, including the importance of accurate and complete documentation and the interactions with child protection agencies and the criminal justice system

Scholar  Perform, critically evaluate, and communicate appropriate or focused literature searches relevant to patient care  Discuss with the health care team the pathology and of specific pediatric diseases

Professional  Be punctual for shifts and educational events  Show enthusiasm for learning  Follow through on assigned tasks and transfer of patient care; inform supervisor of errors or concerns  Deliver the highest quality care with integrity, honesty and compassion with sensitivity to racial, cultural and societal issues

Page | 130 RESIDENCY TRAINING in Anatomical Pathology ______Gynecologic Oncology General Objectives: The rotation of gynecologic oncology is coordinated to provide the resident with a working knowledge of the principles of diagnosis, investigation, and management of both premalignant and malignant diseases of the female genital tract. Specific Objectives: Medical Expert The resident will have a scheduled weekly teaching session during which time a designated topic will be reviewed. It is anticipated that these topics will cover some of the basic knowledge in gynecologic oncology, as listed below: 1) Academic knowledge: 2) 3) Pelvic Anatomy 4) Fluid/electrolyte balance 5) Vaginal neoplasia 6) Principles of chemotherapy 7) Vulvar dystrophy and neoplasia 8) Principles of 9) Cervical neoplasia 10) Endometrial neoplasia 11) Uterine sarcomas 12) Ovarian neoplasms 13) DES exposure 14) Trophoblastic disease 15) and pain control Technical Knowledge: 1) Recognize ovarian cancer and co-ordinate appropriate surgical therapy 2) Conduct appropriate investigation, treatment and follow-up of a patient with a hydatidiform mole 3) Attend vulvar, cervical, and endometrial tissue sampling in an setting. 4) Place appropriate central venous lines for the purpose of hemodynamic monitoring and/or TPN. Scholar 1) Residents with a designated research project will be allocated time on the oncology rotation (up to one-half day per week) per the guidelines of the Research Committee by prior arrangement with the preceptors. Each resident will be expected to select a topic to review in depth including a critical review of the current literature, the topic to be assigned in the first 1-2 weeks on the rotation. Communicator 1) Formal presentation of the review at a designated Gynecologic Tumour Board will be required, as well as a 2-3 page written summary which will be submitted to the rotation preceptor. Frequently, medical students are part of the oncology team and the oncology resident will be expected to supervise the students on ward rounds, as well as teach around clinical cases on a day-to-day basis. These teaching and communication skills will be assessed as part of the formal evaluation of the oncology rotation. Collaborator 1) The oncology service will be responsible for the gynecology rounds once every month. Case presentations and topic reviews will be undertaken jointly by the attending gynecologic oncology staff and the resident. Health Advocate 1) The resident is responsible for:

Page | 131 RESIDENCY TRAINING in Anatomical Pathology ______a) Comprehensive inpatient care for those patients admitted to the gynecologic oncology service including daily ward rounds, review of diagnostic imaging tests, review of laboratory tests. b) Attendance in the operating room c) Attendance in outpatient clinics d) Care of patients attending the emergency room who are being managed in the gynecologic oncology service e) Assessment of inpatient consultations when requested Leader 1) The resident is expected to: a) Discharge summaries of all inpatients for which they were responsible b) A review of all orders of junior trainees attending such patients on service c) Teaching sessions, when appropriate, for the medical students. Professional 1) The resident is expected to relate in an appropriate manner to the other members of the gynecologic team, including nurses, dieticians, enterostomal therapists, psychosocial consultants, pathologists and radiation oncologists. He/she is expected to provide instruction to junior house staff members when they are directly participating in patient care. 2) It is expected that the resident present her/himself in a respectable manner to all patients, both in-house and ambulatory. During the day, OR attire is reserved for the operating room. 3) The resident on the gynecologic oncology service is present in order to attain an education experience. It is not the responsibility of the resident to act as a “consultant” independently to other practitioners except with direct instruction from members of the gynecologic oncology staff. Evaluation: There is an evaluation after 4 weeks given to the resident in a verbal and written form. There is an In-Training Evaluation Form completed and reviewed with each resident upon completion of the rotation.

Page | 132 RESIDENCY TRAINING in Anatomical Pathology ______Diagnostic Radiology General Objectives: This rotation will serve as a practical introduction to major areas in Diagnostic Radiology. The goal is to acquire a comprehensive understanding of the scope and complexity of diagnostic imaging. By the end of this rotation, the resident should have a basic understanding of the indications and contraindications of each different imaging technique and its relationship to other modalities, and should be able to weigh the risks of common procedures against the need for information and the patient’s best interest.

Specific Objectives: Medical Expert Demonstrate diagnostic and therapeutic skills for ethical and effective patient care including: 1) A basic understanding of the nature of different types of radiographic images, including physician and technical aspects, patient positioning, contrast media. 2) Knowledge of the theoretical and practical aspects of radiation protection. 3) A basic knowledge of adult human anatomy. 4) Knowledge of appropriate application of imaging to patients, importance of informed consent, complications such as contrast media reactions, and factors affecting interpretation and differential diagnosis. Communicator 1) Establish an appropriate relationship with patients, families, colleagues, supervisors, and support staff. 2) Listen effectively. 3) Understand the importance of communication with referring physicians, including an understanding of when the results of an investigation or procedure should be urgently communicated. Collaborator 1) Consult effectively with other physicians and health care professionals. Leader 1) Utilize information technology to optimize patient care, life-long learning and other activities. Health Advocate 1) Understand the benefits and risks of radiological investigation and treatment. 2) Recognize when radiologic investigation or treatment would be detrimental to the health of a patient. Scholar 1) Critically appraise sources of medical information as appropriate to the rotation. Professional 1) Deliver highest quality care with integrity, honesty and compassion. 2) Exhibit appropriate personal and interpersonal professional behaviours. 3) Practice medicine ethically consistent with the obligations of a physician. Outline: There will be four one-week segments in: 1) Gastrointestinal, Genitourinary and 2) Musculoskeletal & Cardiopulmonary 3) Vascular & US 4) CT, CNS, MRI Rather than pursuing identification of , stress should be placed on: 1) indications and contraindications of procedures,

Page | 133 RESIDENCY TRAINING in Anatomical Pathology ______2) alternative investigations available and their appropriate use, 3) studying normal anatomy with the different imaging techniques, 4) the practical aspects of the imaging process 5) understanding the quality assurance process

Additional information regarding PGY 1 Clinical year: 1) Call Back to the Anatomical Pathology Program The trainee is required to attend the following educational conferences in the Department of Pathology and Laboratory Medicine at the Foothills Hospital McCaig Tower: Friday 0800 to 1230: Academic Half Day 2) Evaluations The trainee performance after each rotation will be completed by the designated supervisor and forwarded to the program director. The trainee will complete evaluations of the rotation(s) and preceptor(s) following each rotation, ands these will be forwarded to the program director. Unsatisfactory evaluations of rotations are communicated to the PGY1 Multidisciplinary Education Committee. 3) Other In general, regardless of the rotation, the trainee is expected to make every attempt to review with the attending pathologist, any biopsies pertaining to their patients, and to be present when an autopsy is being performed on any of their patients.

Updated: April, 2010

Page | 134 RESIDENCY TRAINING in Anatomical Pathology ______PGY2: Anatomic Pathology Core Adult Autopsy (FMC) Supervisor: Dr. Amy Bromley (Group Leader: Autopsy) email: [email protected] Preceptors: Drs. Amy Bromley, Travis Ogilvie, Martin Koebel, Angela Franko, Francis Green, Hua Yang Length: 4 blocks minimum Prerequisites: Familiarity with basic anatomy and knowledge of morgue safety procedures

General Objectives The primary objective of this component of the program is to train residents to conduct a high quality, problem-oriented autopsy. The training has a graduated level of responsibility. At the end of training the resident should be able to conduct a comprehensive autopsy, prepare a well-written report on the findings, demonstrate the findings to a medical audience, and correlate these findings with the clinical features of the case. The resident pathologist should be familiar with the medico- legal aspects of the autopsy including matters concerning the legality of consent and requirements for medico-legal autopsies. The resident should have demonstrated due concern and relevant knowledge regarding infectious hazards associated with the autopsy. The resident should have demonstrated technical skills in all areas of routine autopsies as well as be able to carry out specialist autopsy techniques that may be orientated towards specific organ systems, or certain types of clinical cases (for example, pediatric, forensic, cardiac and neuropathology cases). The residents should be able to prepare/dissect and photograph appropriate gross autopsy specimens with a view for presentation at clinico-pathological case rounds (CPC rounds). The resident must be able to act as consultant to clinical colleagues on interpretation of the autopsy findings and their relevance to the clinical setting.

Specific Objectives Medical Expert 1) Residents must have detailed knowledge of the legal requirements pertaining to valid informed autopsy consent, safety training requirements and of the regulations relating to retention of autopsy tissue specimens for research and teaching. 2) Residents must have detailed knowledge of the responsibilities and relationships of the medical examiner, police and the hospital pathologist including: legal requirements for classifying a death as a medical examiner case, reporting of findings to the medical examiner, reporting cases to officials with respect to notifiable infectious disease and the legal requirements of Alberta Workers Compensation Programs. 3) Residents must demonstrate that they can conduct an autopsy and ancillary autopsy procedures with maximum safety to themselves and others. Residents should be familiar with classifications of infectious disease as they pertain to health regulations and with the modes and vectors of transmission of infectious agents during autopsy procedures 4) Residents must be able to extract relevant information from the clinical chart and electronic databases of APL and Alberta Health Services and consult with attending physicians if necessary. They must be able to summarize this information orally and in writing and use this information appropriately to plan the autopsy. 5) Residents must demonstrate an ability to perform a full autopsy in a systematic manner. Initially they must be proficient in en-bloc organ removal and dissection. By completion of their training they must demonstrate skills in organ system removal. 6) Conduct appropriate dissections of organ systems tailored to specific clinical questions and/or autopsy limitations. Prepare dissections in suitable form for subsequent demonstration and preparation of permanent teaching specimens for undergraduate medical students. 7) Take organ, blood and and/or culture when appropriate.

Page | 135 RESIDENCY TRAINING in Anatomical Pathology ______8) Demonstrate an ability to identify, describe and document diseased organs and tissues. Cut and block samples in a manner that is appropriate to the clinical, radiological, laboratory and other data. 9) Describe in writing the gross findings of specimens. 10) Photograph gross specimens. 11) Interpret microscopic slides with the help of the attending pathologist or consultant and identify and diagnose pathologic and post mortem autolytic changes. 12) Recognize morphological changes induced by conventional and novel modes of therapy including new surgical techniques, chemotherapy, radiotherapy, and adverse drug reactions. Communicator 1) Demonstrate an ability to produce an autopsy report with an interpretation appropriate to the clinical setting. For this he/she should be able to: a) Provide pathologic diagnoses. b) Correlate these findings with the known clinical, radiological, laboratory and other data. c) Discuss the pathophysiology of the disease process in the patient being reviewed. d) Generate an autopsy report, which includes accurate patient demographics, clinical information, gross description, microscopic description, diagnosis, and a summary of the most relevant summary interpreting the findings and making clinical-pathologic correlations. e) Synthesize all the available clinical and pathologic information to formulate a meaningful differential diagnosis regarding the patient’s clinical progress and cause of death. f) Effectively communicate the pathologic findings and conclusions to professional colleagues in pathology as well as attending physicians and surgeons (and families of the deceased, when appropriate). 2) Recognize reporting deficiencies and take appropriate corrective action. 3) Residents will also present select cases at Friday rounds and Tuesday CPC rounds. 4) Residents are expected to meet professional deadlines in a timely manner (e.g. provisional diagnoses should be signed out in 48 hours; final diagnosis in 60 working days) Collaborator 1) The resident must demonstrate a commitment to medical ethics, sensitivity to diverse patient populations, and professional responsibilities. Completing reports in a timely manner, being sensitive to religious concerns of families and recognizing the importance of confidentiality in medical practice are essential. 2) The resident must demonstrate a satisfactory level of diagnostic competence and the ability to provide effective pathologic consultation under appropriate circumstances. The autopsy examination is a consultation requested of the pathologist by the attending physician and/or family. Its primary purpose is the identification of disease, its extent and the effects of medical intervention. Questions asked on the autopsy consultation form need to be addressed in a concise and respectful manner. 3) The resident must demonstrate knowledge about established and evolving diagnostic scientific practice by developing proper diagnoses and by documenting application of new knowledge in the autopsy report. In this regard, the final diagnoses rendered by the resident will be judged on accuracy. Application of new knowledge will be judged by the inclusion of literature references (when appropriate) in the report. The clinical-pathologic correlation in the report will also be used to ascertain the level of resident expertise. 4) The resident must demonstrate the ability to investigate complex cases, provide a diagnostic and consultative service and assimilate scientific evidence into their practice for the continual improvement of patient care. This includes detailed work up of cases for publication. Leader 1) Learn the basics on how to manage an autopsy service, including morgue design, safety concerns, recruiting, and training, ordering of

Page | 136 RESIDENCY TRAINING in Anatomical Pathology ______supplies, public health requirements and communicating with funeral homes, security services, police and the office of the chief medical examiner. Health Advocate 1) Respond to the needs of the family of the deceased, whether these be about the diagnosis, the deceased’s medical care, insurance issues etc. 2) Be willing to explain the findings of the autopsy in appropriate (lay) language and participate in postmortem meetings with the attending physicians, relatives and pathologists. 3) Acquire appropriate QA/QC knowledge to ensure patient safety and accuracy of medical reports. Scholar 1) Develop an individualized case-by-case approach to the conduct of an autopsy, based upon answering relevant questions that the clinical history and circumstances of the death raise. 2) Maintain and enhance professional activities through ongoing learning. 3) Critically evaluate information and its sources, and apply this appropriately to practice decisions. 4) Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate. 5) Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices. 6) Teach proper prosection and grossing techniques to more junior residents starting autopsy service. 7) Prepare and present cases at continuing medical education rounds 8) Assist more junior residents in interpreting microscopic findings and correlating them into a final cause of death. Professional 1) Show respect for the deceased at all times, through a willingness to contact families of deceased before and after the autopsy. 2) The resident will demonstrate effective, respectful and professional communication with staff, physicians and families. This will be evaluated by faculty observation of resident performance on individual cases. Graded Responsibility During the first block of training on the autopsy service, the new trainee is assisted and/or supervised by either a more senior resident or by the attending staff pathologist. The number of cases performed by the resident each day is limited to one (1) in the first block, and two (2) thereafter.

During the first 1-2 blocks on the autopsy service, the resident learns how to review a chart quickly and efficiently, double-check the validity of the consent, perform basic dissection techniques, review microscopic slides, and prepare preliminary and final autopsy reports (including gross and microscopic descriptions).

For all trainees, the preliminary autopsy report must be completed within 48 hours of the autopsy, and the final report is expected to be completed within 60 days.

As the junior resident acquires more experience (3rd - 4th block), they are expected to review the clinical findings of each case with the supervising pathologist prior to initiating the autopsy, but may then proceed with the case independently. Depending on the skill level of the resident, and the complexity of the case, a supervisory pathologist may elect to review the dissection of the organs at the completion of the autopsy (but before the body is released). Some residents will require greater supervision during this period. The resident is expected to review the microscopic slides when available, and prepare a microscopic report, which is then reviewed with the staff pathologist using a multi-headed microscope at a mutually agreeable time. New trainees may present their cases at Autopsy Demo, but are not expected to present at CPC rounds until after their first 2 blocks are

Page | 137 RESIDENCY TRAINING in Anatomical Pathology ______completed (depending on experience). In the subsequent blocks, the resident is expected to conduct an autopsy and prepare a preliminary report after consultation with the staff pathologist.

Third and fourth year residents have considerable responsibility for assisting with training of junior residents, supervision of elective students and assisting with undergraduate teaching. The degree of supervision of fourth year residents (senior and chief) will vary with the capabilities and often the initiative of the resident and will be at the discretion of the supervising pathologist. It is anticipated that the senior residents will be able to conduct all aspects of the autopsy with minimal supervision.

Revised: April, 2013

Page | 138 RESIDENCY TRAINING in Anatomical Pathology ______Surgical Pathology Various Site Contacts for Surgical Pathology DSC Dr. Charlene Hunter [email protected] FMC Dr. Mara Caragea emails for time off go to Cass SHC Dr. Sandra Lee [email protected] PLC Dr. Jenika Howell [email protected] RGH Dr.

General Objectives: During the course of the training program, the resident will develop the knowledge and skills necessary to function as a surgical pathologist. The resident will acquire a broad and deep knowledge of surgical pathology as an academic and practical subject with a sense of how surgical pathology relates to the patient, his problems and their treatment. The resident will also acquire a thorough knowledge of all the procedures performed in the surgical pathology laboratory, from the proper fixation and submission of specimens to the lab, to gross dissection, to the preparation slides and other diagnostic material, to the production and distribution of complete and accurate medical reports and finally the maintenance and operation of Quality Assurance and Quality control programs

Specific Objectives: Medical Expert: 1) Demonstrate the ability to accurately describe and sample gross pathology specimens. a) Describe the gross findings orally b) Describe the gross findings in writing. c) Appropriately cut and sample surgical specimens depending on the clinical, radiological, laboratory and other data obtained. d) Be proficient in the making of smears and touch preparations e) Be proficient in the embedding of fresh tissue and the cutting and staining of frozen sections f) Appropriately sample surgical specimens for rush diagnosis g) Effectively communicate the rush diagnosis to the operating surgeon h) Apply universal precautions for dealing with surgical specimens and special precautions when dealing with established or suspected infectious etiologies. i) Be proficient with the principles and techniques of harvesting tissue for electron microscopy, cytogenetics, molecular biology, flow cytometry and research protocols. 2) Demonstrate adequate knowledge and understanding of the methods of tissue fixation and processing in surgical pathology. a) Know the principles of fixation, the types of fixatives used and their indications in the practice of surgical pathology, for both light and electron microscopy. b) Know the principles of tissue processing including, dehydration, paraffin embedding, paraffin sectioning, osmication and plastic embedding. 3) Demonstrate knowledge of the principles of histology staining and the use of these stains in the surgical pathology examination of diseases. For this the resident will be able to: a) Understand the basis of the routine stains and special stains used in surgical pathology b) Understand the basis of immunohistochemical and immunofluorescence staining techniques. c) Understand the utility of special staining techniques (immunohistochemical and immunofluorescence) d) Understand the basis of molecular biology procedures. e) Understand the utility of molecular biological procedures used in surgical pathology f) Select the appropriate immunohistochemical stains and molecular biological procedures relevant to the problem based on the gross, histologic, clinical, radiologic, laboratory and other data available. g) Interpret the normal, abnormal and artifactual findings demonstrated by each of these stains in tissue sections.

Page | 139 RESIDENCY TRAINING in Anatomical Pathology ______h) Interpret the normal, abnormal and artifactual findings demonstrated by use of molecular biological procedures in tissue specimens. i) Understands the basis of morphometry. j) Be familiar with the principles of tissue culture, karyotype preparation, chromosome banding and interface nuclear sexing techniques which are employed in cytogenetic investigations. 4) Demonstrate the ability to adequately describe and record microscopic findings. a) Operate and maintain a light microscope, and apply polarized optics and immunofluorescent techniques b) Adequately describe microscopic findings orally c) Adequately describe microscopic findings in the surgical pathology report. d) Take photomicrographs 5) Demonstrate an ability to produce a surgical pathology report with an interpretation appropriate to the clinical setting. a) Accurately and succinctly describe the gross and microscopic findings b) Correlate these findings with the known clinical, radiological, laboratory and other data. c) Provide pathologic diagnosis d) Discuss the pathophysiology of the disease process as it applies to that particular patient. e) Recommend any further investigations that may be helpful, based on the biopsy findings 6) Access and apply relevant information to the practice of Anatomical Pathology. a) Demonstrate a thorough knowledge of the normal organs of the body. The resident should be able to: i) Have a superior knowledge of normal gross anatomy of the body. ii) Have a superior knowledge of the histology of the body organs iii) Have a superior knowledge of the physiology of the individual body organs. b) Demonstrate a thorough knowledge of (including molecular genetics, molecular biology, etiology, pathophysiology, gross and microscopic pathology, and clinical pathology correlations) general pathologic reactions of the organs of the body (general pathology). For this, the resident will acquire a superior knowledge of: i) Mechanisms of cellular injury and repair. ii) Mechanisms of inflammation iii) Disorders of immunity and immune mediated diseases. iv) Disorders of genetics and the molecular basis of cell function and dysfunction v) Mechanisms of the process of neoplasia. vi) Nutritional and metabolic disorders. vii) The influences of environmental and toxic factors on the body. viii) Infectious diseases (bacterial, fungal, viral, rickettsial and parasitic) and their effects on the body. ix) Disorders affecting the fetus, infant, and child, including a thorough knowledge of embryological development and its relationship to malformations, and the molecular biology and genetics associated with malformations. x) How specific derangement’s, focal or general, in tissue structure and/or function leads to specific clinical, physiologic, and radiological and laboratory abnormalities. 7) Demonstrate a superior knowledge of the pathology and pathophysiology (including molecular genetics, molecular biology, etiology, pathophysiology, gross and microscopic pathology, and clinical pathological correlation’s) of disorders of the organs systems (systemic pathology). a) Disorders affecting the heart and blood vessels. b) Disorders affecting the hematopoietic system, lymph nodes and the mechanisms of coagulation, thrombosis and fibrinolysis. c) Disorders affecting the . d) Disorders affecting the head and neck e) Disorders affecting gastrointestinal tract, liver, biliary tract and pancreas. f) Disorders affecting kidneys and genitourinary tract g) Disorders affecting breast

Page | 140 RESIDENCY TRAINING in Anatomical Pathology ______h) Disorders affecting endocrine system i) Disorders affecting integument j) Disorders affecting skeletal system and connective tissues k) Disorders affecting nervous system Communicator: 1) Residents will demonstrate an ability to establish a relationship of trust and respect with clinical and non-clinical colleagues, patients, their family, and the community. 2) Communicate effectively with technical and clinical colleagues informally, through formal verbal presentations (presentation at rounds, meetings), and in the form of surgical pathology reports. 3) Demonstrate ability to answer questions on etiology, , and pathology of disease without preparation and be able to openly admit circumscribed ignorance without loss of face. 4) Obtain and synthesize information from clinical and other colleagues and listen carefully. 5) Discuss information freely with clinicians and, if necessary, patients and their families. a) Communicate effectively (verbally and in writing) the results of pathology investigations in a timely fashion to colleagues, so that patient care is not delayed or jeopardized. b) Be willing to discuss results with family, as they become available and provide a time-line for the final diagnosis. c) Assist in the continuing education of physicians and other members of the hospital staff by participating effectively in interdisciplinary rounds and meetings (including presentation at rounds). Collaborator: 1) The resident will become part of the clinical team through interaction with clinical colleagues directly and at rounds. 2) Demonstrate the ability to advise clinical colleagues on the appropriateness of obtaining histology specimens and follow up examinations of these, and to advise on further appropriate investigations. 3) Understand the role of intra- and extra-departmental review of diagnostic material 4) Contribute effectively to other interdisciplinary team activities a) recognize the expertise of other health team members b) respect the role and opinions of other health team members c) Understand the principles of tissue acquisition for research. Leader: 1) Effectively utilize information technology to optimize patient care, as well as to facilitate continual self-learning a) Use a word processing program b) Use patient related clinical and laboratory database programs. c) Use graphics and presentation programs. d) Be familiar with the application of computers in laboratory medicine in general and Anatomical Pathology in particular. e) Be an effective time manager f) Plan self-learning and self-assessment learning goals and objectives. g) Maintain a Continuing Medical Education (CME) log book of the rounds, lectures and other CME activities they have attended. 2) Demonstrate an ability to run a quality control program in surgical pathology. For this the resident should be able to: a) Run a conference with colleagues in the discussion of routine, interesting, and difficult cases. b) Be familiar with quality control programs for tissue processing and staining.

Page | 141 RESIDENCY TRAINING in Anatomical Pathology ______c) Be familiar with quality control for frozen section diagnosis – final diagnosis comparison for surgical pathology specimens. d) Understand mechanisms used to ensure accurate and rapid preparation and distribution of all surgical pathology reports e) Understand methods of effective indexing and storage of specimens and reports and methods for efficient data retrieval. f) Understand the legal obligations for tissue paraffin block and glass slide storage. g) Understand the financing of the anatomical pathology laboratory and how to set about acquiring additional funding or achieving improved economy. 3) Work effectively and efficiently in a health care organization. For this the resident will: a) understand the roles and responsibilities of a surgical pathologist b) understand principles of laboratory management and administration c) understand methods of quality control and quality assurance in surgical pathology d) understand the organization and function of the Canadian health care system e) understand the principles of workload measurement within the laboratory f) demonstrate a knowledge of laboratory safety g) Understand finite health care resources and use discretion in utilization of resources without unnecessary waste. h) Utilize time and resources effectively to balance patient care, learning needs and outside activities. Health Advocate The resident will be competent to: 1) Recognize and respond to those issues, circumstances, or situations in which advocacy on behalf of patients or community is appropriate. The resident will be competent to: a) Identify population at risk for specific disease entities b) Recognize the fundamental role of epidemiological research in understanding the pathophysiology and etiology of disorders. c) Understand the importance of promoting and reinforcing to the public and profession the essential contribution of laboratory medicine in health. d) Demonstrate the ability to recognize those situations, especially regarding infectious or communicable diseases, that require consultation or notification of the Department of Health. e) Understand procedures for disposal of chemical and biological waste. f) Demonstrate understanding and compliance with safety guidelines of the laboratory. They should have a thorough grasp of measures taken to avoid biohazards in the laboratory and to avoid chemical spills. g) Understand how public policy is developed with regard to health and disease.

Scholar: The resident will be able to: 1. Develop, implement and document a personal continuing education strategy. The resident will a) Accept the responsibility for self-learning and self-evaluation b) Demonstrate the ability to identify gaps in knowledge and expertise. c) Access personal learning needs d) Choose an appropriate learning method and subject matter(s) e) Evaluate the outcome of the self-learning experience. 2. Apply the principles of critical appraisal to sources of medical information. For this the resident will: a) Incorporate an attitude of scientific inquiry and the use of evidence into the process of making pathologic diagnoses. b) Select appropriate questions to be answered. c) Research the literature for answering the questions. d) Keep current with evidence based literature pertinent to the practice of surgical pathology.

Page | 142 RESIDENCY TRAINING in Anatomical Pathology ______3. Facilitate the learning of patients, students, residents and other health professionals. For this the resident will: a) Demonstrate an ability to utilize surgical cases for teaching of undergraduates, residents and clinical colleagues b) Assist in continuing medical education of physicians and other members of the hospital staff. c) Demonstrate skills in taking photographs of gross specimens as well as microphotographs for the purpose of teaching and communication d) Teach pathological principles at rounds, conferences and other forums. 4. Contribute to the development of new knowledge. For this the resident will: a) Demonstrate the ability to pose a research question, to formulate a plan that attempts to answer the question, and to carry out the research according to program requirements. b) Conduct a literature search relevant to the question c) Identify, consult and collaborate with the experts with the expertise in the area of the research. d) Propose a methodological approach to answer the question. e) Carry out the research proposal f) Defend and disseminate the results of the research g) Identify areas for further research which arise from the results h) Acquire skills in the development of guidelines relevant to the practice of surgical pathology Professional: 1. Deliver the highest quality practice of surgical pathology with integrity, honesty and compassion. The resident will be competent to: a) Demonstrate effective consultation, as an anatomical pathologist, with respect to patient care, education and legal opinion. b) Recognize personal limits of expertise. The resident must be able to: 1) Recognize when he/she should seek consultation from another pathologist. 2) Recognize when he/she should seek consultation from a specialist other than a pathologist. 2. Exhibit appropriate personal and interpersonal behaviors. For this the resident will: a) Demonstrate appropriate interpersonal relationships with peers, supervisors, support and clinical staff, showing concern, respect for others, and sensitivity to gender/ethnic and other social issues b) Respond appropriately to criticism c) Act as an appropriate role model for students and others. d) Address interpersonal differences in professional relations. e) Maintain an appropriate balance between personal and professional roles f) Be accountable for his/her personal actions g) Have a high degree of self-awareness h) Be reliable and conscientious in the discharge of his/her professional responsibilities. 3. Practice surgical pathology in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. The resident will: a) Demonstrate an ethical approach to the performance of duties within the laboratory b) Know and understand the professional, legal and ethical codes to which physicians are bound c) Understand and apply relevant legislation relating to the health care system in order to guide him/her in the practice of surgical pathology. d) Recognize, analyze and know how to deal with unprofessional behavior in the practice of medicine, including but not exclusive to health problems such as psychiatric illness or substance abuse, taking into account local and provincial regulations.

The resident will fulfill these objectives by:

Page | 143 RESIDENCY TRAINING in Anatomical Pathology ______1) Integrating into a busy tertiary care surgical pathology service to obtain intensive hands-on experience. 2) Assume graded responsibility commensurate with experience and seniority. (see appendix for further details) 3) In depth and systematic study of surgical pathology through participation in education as well as patient-service oriented rounds. 4) Regular attendance at academic half-day and specialty rounds 5) Diligent preparation of cases prior to signing them out with a staff pathologist on a doubled- headed microscope. 6) Attending the didactic teaching program that cover core knowledge of pathology and Can Meds competencies as pertaining to surgical pathology 7) Participation in continuing Medical Education sessions. 8) Participation in resident research day starting in PGY2 9) Participation in teaching medical students, junior residents, technical staff, etc. 10) Regular assessment of their performance at rounds and sign-out sessions with staff pathologist 11) Biannual formal evaluation examinations 12) Using current journals and surgical pathology texts as well as Internet resources. 13) Obtaining experience in laboratory organization and quality assurance. 14) Applying safety principles with regard to hazards associated with the laboratory. 15) Discussion of ethical problems related to the practice of pathology with peers and teaching staff. Graded responsibility Graded responsibility is the process by which a resident, during the course of their 5 years of training, not only obtains the knowledge and skills, but also the attitudes necessary to function as a competent specialist in anatomical pathology. While the requirements of different career paths may vary, this program seeks to ensure a core level of competence for all residents at the completion of their training in their capacities as 1) diagnosticians, 2) educators, 3) administrators, and 4) researchers.

Gradation of resident responsibility is commensurate with advancing levels of seniority in the surgical pathology rotations. Realistically, the short time frame devoted to the other rotations limits such expectations.

The training program is designed to initially equip residents with basic skills (eg: gross dissection) and later to expose them to more difficult and complex pathology through elective and advanced surgical pathology rotations. A gradation of responsibility based on the faculty’s evaluation and expectation of the residents’ performance is thus effected.

It is critical that serious errors in diagnosis should not occur and hospital by-laws require that all pathology reports be signed by a staff pathologist. Thus the implementation of graded responsibility is not always successful, since the moral, ethical, and legal obligations of the staff pathologists must be accommodated.

Graded responsibility may include, but is not limited to: 1) Coverage of Anatomical Pathology on call service beginning in the PGY-2 year after completion of Autopsy and Surgical Pathology block training. (See Resident On Call duties for specific details) With increasing expertise the resident will be allowed to perform more duties without direct supervision to the point where they may be allowed to handle and sign out non- complicated surgical pathology cases by themselves. 2) A resident should have grossed and signed out the following types of cases by the end of the stated PGY year:

Page | 144 RESIDENCY TRAINING in Anatomical Pathology ______PGY-1: Simple bowel resection/colectomy, hysterectomy, breast biopsy and mastectomy PGY-2: Thyroidectomy, parathyroidectomy, salpingo-oophorectomy, lobectomy (lung), esophagogastrectomy, soft tissue tumor resection, “cone” biopsy of the cervix, TME PGY-3: Resection of: liver & biliary tract, prostate, urinary bladder, kidney, testis, salivary gland PGY-4: Resection/Removal of: pancreas, bone, larynx and complex oropharyngeal specimens, transplanted organs (including Donor organs), placenta PGY-5: Cardiac conduction system

3) Residents will gradually assume more responsibility for the unsupervised handling of uncomplicated specimens followed by progressively more complicated cases. Near the completion of their training residents may be given the opportunity to function in a junior staff type capacity where they may sign out unsupervised cases that are cosigned by willing staff members. PGY2: Gross Dissection: Throughout the course of the year, it is expected that the resident will become proficient at gross dissection and will eventually acquire sufficient proficiency to require guidance primarily in the setting of difficult and complicate cases. The gross descriptions should ultimately require little to no editing and should be clear, concise and use appropriate terminology. A manual outlining the optimal method of gross dissections of specialized specimens is available for reference. Pathology assistants, staff pathologists and senior residents are always on hand to provide assistance when necessary. Before starting to gross, the staff pathologist and resident on duty must meet to review and assign specimens to the resident. The assigned specimens should provide educational experience. The resident is responsible for proof reading the gross descriptions and making appropriate revisions of the cases assigned to him/her.

Microscopy: In the first months reporting is focused on the large specimens grossed by the residents and biopsies relating to common pathological entities. At this time, the resident is not expected to review all trays of slides. As the year advances and the resident progresses the caseload will be increased. It is recommended that the caseload increase reflect a mutual agreement between the staff pathologist and the resident. The residents are encouraged to inform the Program Director if they feel that service work is impacting on their education.

The cases are examined by the resident, who is asked to record his/her opinion (in writing or via dictation). The work is then reviewed by both resident and staff together and the pathologist will finalize the case. Under certain circumstances the trainee will be expected to communicate with clinicians in order to obtain further information and/or to convey, orally, results of pathological studies. With time, the resident is expected to initiate the order of special stains ancillary studies.

Frozen Sections: The resident and the pathologist will attend a frozen section together and gross examination dissection and microscopy review will be conducted in unison. The objective at this point is to provide the resident with exposure to (i) the appropriate gross and microscopic approach to specimens commonly submitted for frozen section, (ii) the limitations of the procedure and (iii) the mode of clinicopathologic correlation on those settings. They are expected to competently carry out the technical component of a frozen section. The amount of supervision diminishes with time such that residents can do all parts of the frozen section unsupervised except issuing the final report.

Page | 145 RESIDENCY TRAINING in Anatomical Pathology ______PGY3: Medical Expert/Clinical Service: During this year the resident completes the core rotation in Autopsy and Surgical Pathology and rotates through sub-specialty areas in Anatomical Pathology i.e.: Cytopathology, Forensic Pathology, Pediatric Pathology, electron microscopy. The brief amount of time spent in these rotations requires that each be primarily a learning experience, thus the potential for graded responsibility is limited. Nevertheless, as the resident becomes familiar with the area, he/she is increasingly entrusted with more responsibility and clinical involvement and teaching (as presentations at specialty conferences, etc.).

PGY4 – PGY5: During the last two years of training, the resident spent time in elective rotations related to his/her career goals. It is expected that residents at this level of training have a comprehensive approach to the interpretation of complicated cases, participate actively with educational activities directed at junior residents, medical students, clinical or surgical residents rotating in Pathology as well as involvement in administrative processes.

Medical Expert/Clinical Service Gross Dissection: Residents at this level will be capable of handling the gross dissections of the vast majority of cases and will require only minimal assistance. As the resident becomes more experienced with the gross room he/she is increasingly entrusted with more responsibility. It is expected that residents at this level teach junior residents, medical students and clinical residents the fundamentals basis of gross dissection and the significance of sampling specimens. In preparation for the RCPSC exams the PGY5 residents are relieved of most of the gross duties, which are assumed by the staff pathologist and the Pathology assistant on duty.

Microscopy: Progressively, it is expected that senior residents generate comprehensive pathology reports of high quality on a routine basis. Autonomous ancillary test ordering is required and the final diagnosis should be correct in almost all cases. The reports should require little revision. Independent sign-out may take place, but this is very much dependent on the individual Pathologist. Residents at this level are exposed to consultation and referral cases by the Pathologist.

Frozen Sections: Residents at this level are expected to dissect the frozen specimens and submit the appropriate sample for microscopic review. When diagnostic difficulty is encountered the resident at this level should (1) recognize the fact, (2) know when to consult with the clinician or colleagues as appropriate (3) be capable of procuring appropriate tissue samples for special studies as indicated and (4) be aware of when to defer a case. The final year resident is expected to make a diagnosis, communicate the diagnosis and give appropriate further direction to the clinician if needed. The staff Pathologist on duty supervises the resident and co-signs the report (as dictated by hospital by-laws) prior to its release.

Revised: September, 2012

Page | 146 RESIDENCY TRAINING in Anatomical Pathology ______PGY3-5 – Subspecialty Rotations Genitourinary Pathology (RGH)

Introduction Anatomical Pathology at the Rockyview General Hospital (RGH) is an integral part of the Department of Anatomical Pathology at the University of Calgary and Alberta Public Laboratories. It is a regional centre for urological pathology for the whole . All prostate biopsies (approximately 1500 per year) performed in the region are processed through Anatomical Pathology at RGH. On an annual basis, urological pathology volume additionally consists of approximately 300 radical prostatectomies, 100 partial or total nephrectomies, 70 orchiectomies and 30 cystectomies. Anatomical Pathology at the RGH also receives consult material in urologic pathology and provides consult services for the whole region and the . Anatomical Pathology at RGH also provides an in-hospital service in general surgical pathology in multiple disciplines and this service is reflective of a busy general/community hospital environment.

Duration of Rotation: 8 weeks 1) May be split into two, 4 week blocks (one as a junior (PGY3), and one as a senior (PGY4 or 5)) 2) 8 weeks is a minimum; a resident may choose to spend additional elective time at the RGH if desired 3) Residents in their PGY3 or higher years of training will function with a high degree of autonomy, but will be supervised by a designated staff pathologist during the RGH rotation. Specific Duties and Responsibilities During the Rotation: 1) Participate in the daily surgical pathology rotation that will ensure exposure to grossing of urological pathology specimens (fresh or fixed), dictating the gross description, microscopic/synoptic report and final diagnosis and signing-out surgical specimens with supervising staff. 2) Participate in surgical pathology frozen section consultations under staff supervision. 3) Increased responsibility and ability of the resident to perform independently without assistance is expected at the PGY4 and PGY5 levels. 4) Attend and participate in the regular bi-monthly surgical pathology half-day rounds at RGH that will usually include: general surgical pathology/unknown slides (8:00 a.m.), gross surgical pathology (9:00 a.m.), topic-oriented urological pathology (10:00 a.m. to 12:00). 5) Attend and participate in Intradepartmental Rounds, every Tuesday at 13:00-14:00. 6) Use the appropriate dissection manuals (such as Manual of Surgical Pathology by Lester S.) to acquire basic information pertaining to tissue handling in urological and other surgical pathology. Residents are encouraged to go over the specimen with the supervising staff pathologist or experienced Path technicians about their plan to gross the specimen. Residents are strongly encouraged to closely involve supervising staff pathologists in their workup of complex cases at the earliest stage of the dissection. 7) Participate in the photography of gross specimens and select the appropriate specimens for photography and select possible teaching specimens. 8) Develop knowledge and experience in the appropriate use of available laboratory methods for diagnostic workup in urological pathology including: special stains, immunohistochemistry, electron microscopy, molecular/genetic studies. 9) In addition to final examinations, residents will be informally evaluated on a daily basis, as they perform their daily routines. A formal evaluation will be done at the end of their rotation. 10) Residents will use a urological pathology teaching glass slide database in the department to increase their exposure to less common entities in urologic pathology.

Page | 147 RESIDENCY TRAINING in Anatomical Pathology ______

Specific Objectives: Medical Expert 1) To gain the ability to accurately describe and sample urological and other gross pathology specimens. 2) To develop and demonstrate the skill and ability to function effectively at intra-operative consultation (including the ability to sample, cut and stain frozen sections). 3) To develop the ability to organize case material, perform additional studies as necessary such as special stains, deeper sections, immunohistochemistry, electron microscopy and molecular cytogenetic studies in a timely fashion. 4) Attain the ability to make correct microscopic diagnosis, including diagnosis made during intra- operative consultations, reaching a level appropriate for a junior staff pathologist. 5) Establish the ability to accurately, concisely and comprehensively report final diagnosis and to provide a high quality written report. 6) Develop the ability to act effectively as intradepartmental consultant and to understand, judge and justify the circumstances for extra-departmental consultation. 7) To access, seek and apply relevant clinical information to surgical pathology practice. 8) To demonstrate knowledge of normal anatomy, physiology and biochemistry of the prostate, kidney, bladder and testicle. 9) To understand the principles of embryologic development of the genitourinary system. 10) To demonstrate knowledge of the normal gross, microscopic and ultrastructural appearances of genitourinary organs and tissues. 11) To demonstrate knowledge of the accepted classifications of the neoplasms of the genitourinary system. 12) To demonstrate ability to take satisfactory gross and microscopic photographs of genitourinary organs and tissues. Communicator 1) Provides clear and thorough explanations of diagnosis, investigation and management. 2) Establishes good working relationships with peers and other health professionals. Effectively provides and receives information. Handles conflict situations well. 3) Prepares documentation that is accurate and timely. 4) Functions as an effective member of the laboratory team. 5) Communicates effectively with technical and other support staff in the laboratory. 6) Communicates effectively with surgeons at intra-operative consultations. 7) Participates effectively in interdisciplinary rounds and meetings (including presentation at rounds). The resident will fulfill these CanMEDs competencies by: 1) Acting as consultants to clinical colleagues on the interpretation of the relevance of pathological findings, with emphasis on their significance in clinical patient management. 2) Assisting in continuing education of physicians and other members of the hospital staff. 3) Understanding the information pathologists should provide in a given clinical situation and developing the ability to communicate effectively in an oral and written form.

Page | 148 RESIDENCY TRAINING in Anatomical Pathology ______Collaborator 1) Interacts effectively with health professionals by recognizing and acknowledging their roles and expertise. 2) Consults with and delegates tasks effectively to support clinical and administrative staff. 3) Collaborates effectively and in a constructive manner with other members of the health care team. 4) Understands the role of the anatomical pathologist as a member of the health care team. 5) Understands the role of the anatomical pathologist in providing timely, high quality service to patients and clinicians. 6) Understands the role of intra- and extra-departmental review of diagnostic material. 7) Contributes effectively to other interdisciplinary team activities. 8) Understands the principles relating to tissue acquisition for research purposes. The resident will fulfill these CanMEDs competencies by: 1) Having experience in clinical medicine and pathology sufficient to achieve a sound understanding of the effects of disease and the role of pathology in its management. 2) Demonstrates the ability to advise on the appropriateness of obtaining histologic and cytologic specimens, and, following examination of these specimens, to advise on further appropriate investigations. Leader 1) Understands the role of an anatomical pathologist as an effective Leader in a laboratory setting. 2) Utilizes resources effectively based on sound judgment. 3) Understands and makes effective use of information technology, including methods for searching medical databases. 4) Sets realistic priorities and uses time effectively in order to optimize individual professional performance. 5) Understands the principles of practice management. 6) Develops familiarity with laboratory management structures. 7) Understands the principles of workload measurements within the laboratory. 8) Demonstrates knowledge of laboratory safety. 9) Understands and applies the principles of quality assurance as they pertain to the anatomical pathology laboratory. The resident will fulfill these CanMEDs competencies by: 1) Demonstrating knowledge of the principles of laboratory management and administration. 2) Demonstrating knowledge of the methods of professional quality assurance and quality control as it applies to anatomical pathology. 3) Demonstrating competence in basic computer skills with emphasis on automatic electronic reporting, electronic communication and search strategies. Health Advocate 1) Understand the anatomical pathologist’s role to intervene on behalf of patients with respect to social, economic and biologic factors that may impact on their health. 2) Understand the anatomical pathologist’s role to intervene on behalf of the community with respect to the social, economic and biologic factors that may impact on community health.

Page | 149 RESIDENCY TRAINING in Anatomical Pathology ______3) Recognizes and responds appropriately in advocacy situations. 4) Understands the importance of promoting and reinforcing to the public and the profession the essential contribution of laboratory medicine to health care. 5) Understands the role of the laboratory in providing accurate information pertaining to public health issues. The resident will fulfill these CanMEDs competencies by: 1) Applying laboratory practices and regularly evaluating quality assurance/quality control practice to determine if they meet the needs of the interdisciplinary community of professionals responsible for individual and population health care. 2) Reinforcing to the public and to the profession the essential contribution of laboratory medicine to health. 3) Utilizing the opportunities to effectively educate, communicate, and present the role of laboratory medicine in health care. Scholar 1) To demonstrate and understand the ongoing commitment to the need for continuous learning, and to develop and implement an ongoing and effective personal learning strategy. 2) To demonstrate the ability for critical appraisal of medical information, and to successfully integrate information from various sources. 3) To interact and participate within various learning activities by providing guidance, teaching, and by giving constructive feedback. 4) To develop capability of self-directed study using appropriate resources. 5) To demonstrate the ability to identify limitations and gaps in knowledge and expertise. 6) To develop an ability to pose a research question, to formulate a plan that attempts to answer the question, and to carry out the research according to the plan. 7) To develop an ability to effectively communicate with and teach health professionals, including students and colleagues. The resident will fulfill these CanMEDs competencies by: 1) Proposing a research question relevant to anatomical pathology/urological pathology. 2) Developing a proposal to solve the research question, including: a) Conducting an appropriate literature search based on the research question; b) Proposing a methodological approach to solve the question. 3) Consulting, identifying and collaborating with appropriate experts to perform the research. 4) Carrying out the research outlined in the proposal. 5) Presenting and defending the results of the research. 6) Identifying areas for further research that stem from the research project. 7) Becoming familiar with the prostate cancer database created at Rockyview Hospital. Professional 1) Demonstrates integrity, honesty, compassion and respect for diversity. 2) Fulfills medical, legal and professional obligations as an anatomical pathologist specialist. 3) Meets deadlines and is punctual; provides follow up. 4) Demonstrates and understands the principles of ethics and applies them in clinical situations. 5) Demonstrates an awareness of own limitations, seeking advice when necessary.

Page | 150 RESIDENCY TRAINING in Anatomical Pathology ______6) Negotiates interpersonal relationships including concern and respect for others and sensitivity to gender/ethnic and other social issues that pertain to peers, supervisors, clinical and other support staff. 7) Demonstrates an ethical approach to the performance of duties within the anatomical pathology laboratory. 8) Responds to criticism and acts in a collegial manner. The resident will fulfill these CanMEDs competencies by: 1) Acting as an appropriate role model for peers, students and others. 2) Demonstrating a professional attitude to colleagues, as well as to other laboratory staff. 3) Developing an appreciation of the role of the anatomical pathologist in providing quality patient care in a timely and efficient manner. 4) Demonstrating sound judgment of individual professional limitations and the necessity of seeking an appropriate second opinion. Recommended Reading: 1) Diagnostic Surgical Pathology (Sternberg S. et al, 1999). (Chapters on the developmental abnormalities of the kidney, adult renal tumors, urothelial tract, prostate and seminal vesicles, non-neoplastic diseases of the testes, testicular and paratesticular tumors, and the penis). 2) Urological Surgical Pathology (Bostwick D and Eble J, 1997). 3) Tumors of the Kidney, Bladder, and Related Urinary Structures (Murphy, Beckwith, and Farrow AFIP Fascicle 1994). 4) Tumors of the Testis, Adnexa, Spermatic Cord and Scrotum (Ulbright, Amin and Young. AFIP Fascicle 1999). 5) Tumors of the Prostate Gland, Seminal Vesicles, Male Urethra, and Penis (Young, Srigley, Amin, Ulbright and Cubilla, AFIP Fascicle 2000). 6) Urological Pathology Update – Syllabus from The Banff Pathology Course 2002. 7) WHO Classification: Tumors of the Urinary System and Male Genital organs. 4th Edition 2016.

Last Revised: 29 April 2016 by Drs. Kiril Trpkov and Asli Yilmaz

Page | 151 RESIDENCY TRAINING in Anatomical Pathology ______Lymph Node Pathology

Supervisor/Preceptor:

Dr. Iwona Auer-Grzesiak, MD, FRCPC Hematopathologist and Director of Flow Cytometry Laboratory Room 7508, FMC McCaig Tower 7th Floor 1403 – 29th Street NW, Calgary, AB T2N 2T9 Ph: (403) 944-8225 [email protected]

Preceptors: Meer-Taher Shabani-Rad, MD, FRCPC Xiu Yan Jiang, MD, Msc., FRCPC Hematopathologist/Clinical Section Chief Hematopathologist, Hematology and Diagnostic and Scientific Centre Room 7526, FMC McCaig Tower 1E-411 9-3535 Research Rd NW 1403 – 29th Street NW, Calgary, AB T2N2T9 Calgary, Alberta, Canada, T2L2K8 Ph: (403) 944-4754 Ph: (403) 770-3548 [email protected] [email protected]

Adnan Mansoor, MD, FCPS, FRCPC, FCAP Carolin J. Teman, M.D., M.S., FRCPC, FCAP Hematopathologist Surgical Pathologist and Hematopathologist Hematology and Transfusion Medicine Room 7557, FMC McCaig Tower Room 7522, FMC McCaig Tower 1403-29th Street NW, Calgary, AB, T2N 2T9 1403 – 29th Street NW, Calgary, AB T2N2T9 Ph: (403) 944 8503 Ph: (403) 944-4232 [email protected] [email protected] Etienne Mahe, MD, FRCPC, FCAP Hematopathologist Room 7523, FMC McCaig Tower 1403 – 29th Street NW, Calgary, AB T2N2T9 Ph: (403) 944-5290 [email protected] Last Revised: 29 April 2016

GENERAL OBJECTIVES: The four week long Lymph Node module is designed to familiarize the trainee with the process of the lymph node/hematolymphoid mass biopsy, processing, evaluation and diagnostic assessment at the level of both primary and consultative/expert pathology practice, which comprehensively covers all aspects of patients care including: expert, education and legal matters.

At the completion of the rotation the clinical trainee is expected to be familiar with:  indications for the LN biopsy  distinction between the FNA, core biopsy and excisional biopsy  distinct portions of the lymphoma protocol  will be able to describe and interpret microscopic findings at the level appropriate for his/her training (graduate responsibility)  value of ancillary techniques with respect to the final diagnosis/sub-classification.

At the Medical Expert level the trainee will be able to:  Differentiate the reactive, atypical and neoplastic hematolymphoid proliferations  Subclassify hematolymphoid neoplasms into 2016 WHO categories  Provide differential diagnoses at the level appropriate for his/her

Page | 152 RESIDENCY TRAINING in Anatomical Pathology ______training appropriately utilize and interpret ancillary technique data  Research/review papers relevant to investigated cases  Independently pose own investigative questions/projects  Be familiarized with expert, educational and legal aspects of the consultative pathology practice

It is expected that this four week long exposure limited to LN pathology will result in an adequate expertise to independently handle 75% of service lymphoma cases and appropriately differentiate/triage top 25% complex cases. It is expected that the latter cases be handled at the level of a “pathology consultant” following appropriate consultative/referral practice/letters.

General expectations:  Daily evaluation of cases and designated rounds attendance.  Record/log of reviewed pathology cases with own and final diagnoses and choice of ancillary techniques.  Pager availability for daily lymphoma protocol cases at FMC and after hours/weekend cases at other Calgary Region (arrange with techs/pathologists on call).  Preparation of at least two formal presentations at Clinical Haematology Tumour Rounds at TBCC.  Self-schedule two day long Molecular Pathology exposure with Bob Winkfein, MPL Laboratory Scientist at 403.220.8667. Group scheduling with other residents rotating thru HP with you is encouraged  Self study; regular daily review of teaching slides sets, CD ROM talks/lectures, relevant papers, etc.  Independently select clinically interesting/relevant cases for a review with the pathologist, in order to enhance one’s specialty (paediatric/CNS etc) experience  Writing end-of-rotation test, which will include two short answer questions and two pathology cases evaluation/differential diagnosis discussion (last Friday of the rotation).  Participate in module/preceptor evaluation.  Maximum one week long vacation/absences, which must be pre-approved by the hematopathology training co-ordinator prior to the start of the elective

SPECIFIC OBJECTIVES: At the completion of each training week, the trainee will be familiar and will acquire understanding of the following competencies:

Medical Expert competencies include: By Week #1  Demonstrate understanding of a role of consultative practice in surgical pathology.  Demonstrate understanding of all parts of a lymphoma protocol.  Effective selection and utilization of immunohistochemical markers.  Understands the principles of screening immunohistochemical panels.  Comprehends value of ancillary techniques/data and their utility in the diagnosis of malignant lymphoma  Demonstrates knowledge of histology of a normal lymph node and developmental pathways of hematopoetic cells.  Understands the concept and distinct morphologic features of various reactive lymphadenopathies.

For Aperio access, contact Tom Kryton to set up an account for you: Thomas Kryton Digital Imaging Specialist, Virtual Microscopy Lab 403-220-8322 [email protected]

Talks/lectures available on G drive:

Page | 153 RESIDENCY TRAINING in Anatomical Pathology ______1. Development of B/T lymphocytes. 2. Histology of a normal lymph node. 3. Reactive lymphadenopathies. 4. Lymphoma protocol and ancillary techniques in the diagnosis of non-Hodgkin lymphoma 5. Flow cytometry: Applications in neoplastic hematopathology.

By Week #2  Demonstrates understanding of basis of WHO classification of tumours of hematopoietic and lymphoid tissues.  Understands clinical and morphologic basis of Hodgkin lymphoma diagnosis  Understands principles of diagnostic criteria and subclassification of Hodgkin Lymphoma  Understands differential diagnosis and mimickers of Hodgkin Lymphoma. For Aperio access, contact Tom Kryton to set up an account for you.

Formal talks/lectures available on G drive: 1. Hodgkin lymphoma; diagnosis, subclassification and differential diagnosis. 2. WHO classification of tumours of hematolymphoid and lymphoid tissues. Dr. X. Jiang

By Week #3  Demonstrate knowledge of spectrum of mature clonal B-cell neoplasms.  Understand the principles of morphologic/immunohistochemical and cytogenetics principles of subclassification of mature clonal B-cell neoplasms, as per WHO classification.  Demonstrate knowledge of spectrum of mature aggressive B-cell non-Hodgkin .  Understand the principles of morphologic/immunohistochemical and cytogenetic principles of subclassification of aggressive B cell neoplasms, as per WHO classification.

Formal CD ROM talks/lectures available: 1. Mature small cell B-cell non-Hodgkin lymphomas 2. Diffuse Large B cell lymphoma

By Week #4  Demonstrate knowledge of spectrum of mature clonal T-cell neoplasms.  Understand the principles of morphologic/immunohistochemical and cytogenetics principles of subclassification of mature clonal T-cell neoplasms, as per WHO classification.  Understand the principles of morphologic/immunohistochemical and cytogenetic principles of subclassification of clinico-pathologically specific T/NK cell lymphomas, as per WHO classification.  Demonstrate general understanding of other hematopoietic disorders including: precursor B/T neoplasms, chronic myeloproliferative/myelodysplastic disorders, and acute myeloid / myeloid sarcoma.

Formal CD ROM talks/lectures: T-cell and NK-cell neoplasms An overview of haematopoietic disorders

Communicator General Requirements:  Establish effective working relationships with consulting hematologists/ oncologists/ pathologists and surgeons/ interventional radiologists  Obtain and synthesize relevant clinical history from physicians, electronic and written health records.  Listen and respond effectively.  Convey and discuss in timely fashion laboratory data with the appropriate members of the patient’s health care team.

Specific Requirements:  Understand the role of a primary pathologist and consultant

Page | 154 RESIDENCY TRAINING in Anatomical Pathology ______pathologist  Act as a consultant to both pathology/clinical peers on the interpretation and relevance of pathological findings, with particular regard to their significance in the management of the patient.  Understand the role pathologic findings could provide in a given clinical situation; be able to communicate it effectively and in a timely fashion in an oral and written form with designated members of the patient’s health team.  Assist in the continuing education of clinicians/pathologists/trainees and other members of the health care team.

Collaborator General Requirements  Consult effectively with laboratory personnel and other pathologists/clinicians and health care professionals.  Contribute effectively to interdisciplinary team activities  Contribute to formal and informal research and innovation initiatives of the laboratory and clinical teams

Specific Requirements:  Must have experience in neoplastic hematopathology sufficient to achieve a sound understanding of the effects of disease and the role of pathology in clinical management.  Demonstrate the ability to advise on the appropriateness of obtaining histologic/ancillary techniques specimens and following examination of these, to advise on further appropriate investigations and management  Demonstrate the ability to advise on formal and informal research and innovation initiatives of the laboratory and clinical teams

Leadership (former Manager Role) General Requirements:  Utilize resources effectively to balance patient care, turnaround time, and educational/research needs.  Allocate finite health care resources wisely.  Work effectively and efficiently in a health care organization.  Utilize information technology to optimize and personalize patient care/prognosis, life-long learning and other activities. Specific Requirements  Demonstrate knowledge of the principles of laboratory management and administration.  Demonstrate knowledge of the methods of quality control in the field of neoplastic hematopathology.  Demonstrate knowledge of the methods for laboratory and professional quality assurance as applied to neoplastic hematopathology  Demonstrate competence in basic computer skills with emphasis on automated electronic reporting, electronic communication and search strategies.

Health Advocate General Requirements:  Contribute effectively to improved health of patients and communities.  Recognize and respond to those issues where advocacy is appropriate.  Understand the role of primary and consultative pathology service in patient’s care

Specific Requirements:  As members of an interdisciplinary team of professionals responsible for individual and population health care, the hematopathologist will endeavour to ensure that laboratory practices and test selection are regularly evaluated to determine that they meet these community needs.  Reinforce to the public and to the medical profession the

Page | 155 RESIDENCY TRAINING in Anatomical Pathology ______essential contribution of laboratory medicine to the overall health care system.

Scholar General Requirements:  Develop, implement and monitor personal continuing education strategy/progress.  Critically appraise sources of medical information.  Facilitate learning of patients, laboratory personnel, medical students, post-graduate trainees and other health professionals.  Contribute to development of new knowledge thru involvement in formal and informal research/innovation initiatives.

Specific Requirements:  Able to search and appraise literature relevant to difficult pathology cases  Be able to propose a research question relevant to lymph node pathology.

Professional General Requirement:  Deliver highest quality patient care.  Exhibit appropriate personal and interpersonal professional behaviours.  Practise medicine ethnically consistent with obligations of a physician.  Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent in practice of hematopathology.

Specific Requirements  Act as an appropriate role model for trainees and others.  Demonstrate a professional attitude to colleagues and other laboratory staff.  Have an appreciation of the crucial role of the pathologist in providing quality patient care.  Knowledge of an individual professional limitations and the necessity of seeking appropriate second opinions.

Page | 156 RESIDENCY TRAINING in Anatomical Pathology ______Cytopathology (DSC) Site: Diagnostic Scientific Centre Rotation Supervisors: Dr. Marie Dvorakova and Dr. Nicole Bures Length of Rotation: 12 weeks (PGY3 or 4) + 4 weeks (PGY5) Prerequisites: Successfully completed PGY2 Last Modified: Marie Dvorakova (May 2016)

Contact phone numbers: Marie Dvorakova, Group Leader, Cytopathology 403-770-3823 Cytotechnologists 403-770-3272

Definition Anatomical Pathology is that branch of laboratory medicine concerned with the study of the morphologic aspects of disease. Cytopathology as a subdomain of Anatomical Pathology focuses on evaluation of cellular morphology.

Background The University of Calgary Residency Training in Cytopathology takes place at the Diagnostic & Scientific Centre (DSC), the core laboratory facility of Alberta Public Laboratories (APL) located in the University Research Park at 3535 Research Road NW, Calgary. All gynecological and the vast majority of non-gynecological cytology is Liquid-based Cytology (LBC) processed using ThinPrep Cytyc (Hologic) technology with ThinPrep Imaging system for pre-screening of gynecological cytology slides. The APL Fine Needle Aspiration Clinic at the Peter Lougheed Hospital runs every other Friday. Residents who wish to obtain additional training can make arrangements in consultation with staff to attend FNA clinics or at an institution outside Calgary.

Rotation Requirements Successful completion of the core 12-week rotation in Cytopathology will require the following: 1) Pass mark on the post rotation exam (cytology images and short answer questions to simulate the Royal College Exam)

2) Active participation in sign-out and feedback from Cytopathologists and Cytotechnologists

3) 30 – 45 min presentation of a topic relevant to practice of Cytopathology

4) Acceptable performance at the glass slide quizzes administered by the Cytotechnologists

5) Attendance

Rotation Structure At the beginning of the 12 week rotation, the trainees meet with the Cytopathology Group Leader or designate to discuss rotation goals and objectives. A short pre-test and an orientation to the Cytopathology laboratory will follow. The residents are expected to attend daily teaching sessions by the Cytotechnologists and participate in sign-out with the pathologist on service (with the exception of mandatory Educational Half Day). Trainees are required to attend any staff or guest lecture presentations pertaining to Cytopathology; attendance at the Cytopathology CME sessions, teleconferences and Quality Committee is encouraged. Cytotechnologist teaching is structured as follows:

Page | 157 RESIDENCY TRAINING in Anatomical Pathology ______

WEEK 1 WEEK 2 WEEK 3 WEEK 4

Normal smear patters Benign Cell changes Squamous lesions Glandular lesions

Joanne/Vivian Joanne/Vivian Joanne/Vivian Joanne/Vivian

WEEK 5 WEEK 6 WEEK 7 WEEK 8

Respiratory Cytology Resp/ Head and Neck Salivary Gland/Lymph Node Bone and Soft Tissue

Beata Beata Beata Beata

WEEK 9 WEEK 10 WEEK 11 WEEK 12

Gastric Cytology Thyroid/CSF Urine/Kidney/Adrenal Effusions/Breast Beata/Gerri Rosemin Rosemin Rosemin/Gerri

The one block cytology rotation in the last year of training is devoted to teaching slide review, cytology research projects, and other activities relevant to Cytopathology that have to be approved by the Rotation Supervisor.

Objectives (CanMeds Roles) Cytopathology is a subdomain of Anatomical Pathology and the general CanMeds Roles apply.

Medical Expert Definition: As Medical Experts, Anatomical Pathologists integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient- centred care. Medical Expert is the central physician Role in the CanMEDS framework. Key and Enabling Competencies: Anatomical Pathologists are able to: 1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care 1.1. Perform a pathology consultation, including the preparation of a complete report and recommendations in response to a request from another health care professional or a medico-legal authority 1.2. Demonstrate use of all CanMEDS competencies relevant to Anatomical Pathology/Cytopathology 1.3. Identify and appropriately respond to relevant ethical issues arising in patient care and medical decision-making 1.4. Demonstrate the ability to prioritize professional duties when faced with multiple cases and problems 1.5. Demonstrate compassionate and patient-centered care 1.6. Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed 2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Anatomical Pathology/Cytopathology 2.1. Apply knowledge of the clinical and fundamental biomedical sciences relevant to Anatomical Pathology/Cytopathology, including: 2.1.1. Normal anatomy, physiology, and biochemistry

Page | 158 RESIDENCY TRAINING in Anatomical Pathology ______2.1.2. General principles of embryologic development and common variations of normal development 2.1.3. Basic principles of cell biology, immunology and pathogenesis, and the changes that occur in disease states 2.1.4. Normal gross, light microscopic, and ultrastructural appearance of tissues 2.1.5. Appearance of normal cells in cytologic preparations 2.1.6. Principles of tissue fixation, decalcification, processing, and routine histochemical staining 2.1.7. Gross and microscopic appearances of tissues in disease states 2.1.8. Cytological appearance of cells in disease states, in both non-gynecologic and gynecologic preparations 2.1.9. Principles of and indications for ancillary diagnostic techniques: 2.1.9.1. Immunofluorescent microscopy 2.1.9.2. Immunohistochemistry and in-situ hybridization (ISH), including fluorescent in-situ hybridization (FISH) 2.1.9.3. Cytogenetics 2.1.9.4. Molecular pathology 2.1.9.5. Flow cytometry 2.1.9.6. Special histochemical stains 2.1.9.7. Transmission electron microscopy 2.1.9.8. Digital microscopy 2.2. Describe the CanMEDS framework of competencies relevant to Anatomical Pathology/Cytopathology 2.3. Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up to-date, and enhance areas of professional competence 2.4. Contribute to the enhancement of quality care and patient safety in Anatomical Pathology, integrating the available best evidence and best practices 3. Perform a complete and appropriate assessment of a case 3.1. Obtain a relevant clinical history 3.2. Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case 3.3. Assess specimen adequacy in surgical and cytopathology specimens 3.4. Perform a pathological examination that is focused and relevant 3.5. Formulate a differential diagnosis based on the pathological examination 3.6. Select ancillary techniques judiciously in a resource-effective and ethical manner 3.7. Establish a final diagnosis that takes into account clinical correlations 3.8. Generate a clear, concise report that enhances patient management 3.9. Communicate the findings in a timely fashion, with appropriate documentation 4. Demonstrate proficient and appropriate use of diagnostic and procedural skills 4.1. Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to Anatomical Pathology 4.1.1. Take high quality microscopic photographs of specimens 4.1.2. Demonstrate safe practices in the laboratory, frozen section room, and autopsy suite, to minimize occupational risk 4.2. Ensure appropriate informed consent has been obtained for autopsies, genetic testing, research, or other tests as required 4.3. Ensure adequate follow-up is arranged when a pathologist performs a diagnostic procedure 4.4. Use diagnostic and preventative interventions appropriately 5. 4.4.1. Utilize appropriate ancillary techniques, including but not limited to molecular cytogenetics, for family counseling and screening 6. 4.4.2. Recognize patterns of familial cancer syndromes, using appropriate ancillary tests to guide genetic counseling 7. 4.4.3. Utilize other areas of laboratory medicine, including but not limited to microbiology, for diagnosis and preventative interventions 7.1. Demonstrate effective use of digital microscopy and interpretation of gross and microscopic digital images, including

Page | 159 RESIDENCY TRAINING in Anatomical Pathology ______digitized and scanned slides 8. 4.5.1. Demonstrate knowledge of the principles of telepathology 9. Seek appropriate consultation, recognizing the limits of their own expertise 9.1. Demonstrate insight into their own limits of expertise 9.2. Demonstrate effective, appropriate, and timely consultation of another pathologist as needed for optimal patient care 9.3. Recognize situations where there is a need to consult other health professionals 9.4. Recommend relevant follow-up services for a patient and/or the patient’s family

Communicator Definition: As Communicators, the primary role of Anatomical Pathologists is to effectively transmit diagnostic information to clinicians in both verbal and written form.

Key and Enabling Competencies: Anatomical Pathologists are able to: 1. Convey effective oral and written information about a case 1.1. Prepare clear, concise, comprehensive, and timely written reports for surgical pathology, cytopathology, and autopsy consultations 1.1.1. Use synoptic and other standardized reporting formats as appropriate 1.1.2. Integrate information from ancillary studies and other sources into the pathology report 1.1.3. Convey diagnostic uncertainty and recommend additional studies when needed 1.1.4. Communicate critical values or unexpected results in a timely manner 1.2. Interact effectively with surgeons during intra-operative consultations 1.2.1. Convey diagnostic uncertainty and discuss deferral of diagnosis when needed 1.3. Present and discuss pathology cases effectively at clinical rounds 1.4. Maintain clear, accurate, and appropriate written or electronic documentation 1.5. Present medical information effectively to the public or media about a medical issue 2. Develop rapport, trust, ethical and professional relationships with clinical colleagues 2.1. Recognize that being a good communicator is a core clinical skill for pathologists, and that effective communication can foster patient satisfaction, physician satisfaction and improved clinical outcome 2.2. Establish positive professional relationships with clinical colleagues that are characterized by understanding, trust, respect and honesty 2.3. Respect patient confidentiality and privacy 2.4. Listen effectively and be aware of and responsive to nonverbal cues 3. Accurately elicit and synthesize relevant clinical and pathological information and perspectives of patients and families, colleagues, and other professionals 3.1. Gather information about a disease and about a patient’s beliefs, concerns, and expectations 3.2. Seek out and synthesize relevant information from other sources as appropriate 4. Accurately convey relevant information and explanations to colleagues and other professionals, as well as patients and families when appropriate 4.1. Deliver information to a patient and family, colleagues and other professionals in a humane manner and in such a way that it is understandable and encourages discussion and participation in decision-making 5. Develop a common understanding on issues, problems, and plans with patients, families, and other professionals 5.1. Respect diversity and difference, including but not limited to the impact of gender, religion, and cultural beliefs on decision-making 5.1.1. Ensure appropriate communication with patient and/or family members with respect to the handling of surgical and post-mortem procedures in the context of a multi-cultural society 5.2. Encourage discussion, questions, and interaction relevant to the case

Page | 160 RESIDENCY TRAINING in Anatomical Pathology ______5.3. Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, disclosing errors and addressing anger, confusion and misunderstanding 5.3.1. Communicate and document issues arising from adverse incidents appropriately

Collaborator Definition: As Collaborators, Anatomical Pathologists effectively work within a health care team to achieve optimal patient care. Key and Enabling Competencies: Anatomical Pathologists are able to:

1. Participate effectively and appropriately in an interprofessional health care team 1.1. Describe the pathologist’s roles and responsibilities to other professionals 1.2. Describe the roles and responsibilities of other professionals within the health care team, including but not limited to administrators and support staff 1.3. Recognize and respect the diversity of roles, responsibilities and competences of other professionals in relation to their own 1.4. Work with others to assess, plan, provide and integrate care for individuals and groups of patients 1.4.1. Collaborate with clinical colleagues to help with the development and implementation of a management plan when appropriate 1.5. Work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities 1.6. Participate effectively in interprofessional team meetings 1.7. Explain the role of intra- and extra-departmental review of diagnostic material 1.8. Enter into interdependent relationships with other professions for the provision of quality care 1.8.1. Provide advice to clinical colleagues regarding histologic and cytologic specimen collection and handling 1.8.2. Discuss indications for appropriate use of intra-operative and urgent consultations 1.9. Respect team ethics, including confidentiality, resource allocation, and professionalism 1.10. Demonstrate leadership in a health care team, as appropriate 2. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict 2.1. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team 2.2. Work with other professionals to prevent conflicts 2.3. Employ collaborative negotiation to resolve conflicts 2.4. Respect differences and address misunderstandings and limitations in other professionals 2.5. Recognize one’s own differences, misunderstandings and limitations that may contribute to interprofessional tension 2.6. Reflect on interprofessional team function

Leader Definition: As Leaders, Anatomical Pathologists are integral participants in health care organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the health care system. Anatomical Pathologists are central to quality management within the laboratory and, by extension, to the quality of health care.

Key and Enabling Competencies: Anatomical Pathologists are able to: 1. Participate in activities that contribute to the effectiveness of their health care organizations and systems 1.1. Work collaboratively with others in their organizations 1.2. Describe the structure and function of the health care system as it relates to Anatomical Pathology, including the roles of pathologists and other physicians

Page | 161 RESIDENCY TRAINING in Anatomical Pathology ______1.3. Describe principles of health care financing, including physician remuneration, budgeting and organizational funding 1.4. Explain the principles of and participate in quality control, quality assurance and quality improvement 1.4.1. Identify and explore issues to be addressed in the pre-analytic, analytic and post- analytic stage of specimen handling 1.4.2. Demonstrate expertise in laboratory safety initiatives 2. Manage their practice and career effectively 2.1. Set priorities and manage time to balance clinical workload, practice requirements, outside activities and personal life 2.1.1. Describe the principles of workload measurement within the laboratory 2.2. Demonstrate an understanding of the principles of laboratory management, including but not limited to collaboration with technical managers, and hospital and laboratory administration 2.3. Implement processes to ensure personal practice improvement 2.4. Employ information technology appropriately 3. Allocate finite health care resources appropriately 3.1. Recognize the importance of just allocation of health care resources, balancing effectiveness, efficiency and access with optimal patient care 3.2. Apply evidence and management processes for cost-appropriate care 4. Serve in administration and leadership roles, as appropriate 4.1. Chair or participate effectively in committees and meetings 4.2. Le ad or implement change in health care as appropriate 4.3. Plan relevant elements of health care delivery (e.g., work schedules)

Health Advocate Definition: As Health Advocates, Anatomical Pathologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. 1. Key and Enabling Competencies: Anatomical Pathologists are able to:Respond to individual patient diagnostic needs and issues as part of patient care 1.1. Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care 2. Respond to the health needs of the communities that they serve 2.1. Describe the practice communities that they serve 2.2. Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately 3. Identify the determinants of health for the populations that they serve 3.1. Identify the determinants of health of the populations, including barriers to access to care and resources 3.1.1. Evaluate laboratory practices and test selection regularly to ensure they meet community needs 3.2. Identify vulnerable or marginalized populations within those served and respond appropriately 4. Promote the health of individual patients, communities, and populations 4.1. Describe an approach to implementing a change in a determinant of health of the populations they serve 4.2. Describe the importance of screening in the early detection and treatment of certain cancers, including but not limited to gynecological cancer 4.3. Describe the role of molecular methods used to screen for familial cancer syndromes 4.4. Describe how public policy impacts on the health of the populations served 4.5. Describe the role and demonstrate an understanding of the ethics of genetic screening in family planning and for hereditary cancers 4.6. Identify points of influence in the health care system and its structure

Page | 162 RESIDENCY TRAINING in Anatomical Pathology ______4.6.1. Reinforce to the public and to the profession the essential contribution of laboratory medicine to health 4.7. Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism 4.8. Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager or gatekeeper 4.9. Describe the role of the medical profession in advocating collectively for health and patient safety 4.10. Demonstrate the ability to recognize instances of child abuse and elder abuse in pathology practice

Scholar Definition: As Scholars, Anatomical Pathologists demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application, and translation of medical knowledge

Key and Enabling Competencies: Anatomical Pathologists are able to:

1. Maintain and enhance professional activities through ongoing learning 1.1. Describe the principles of maintenance of competence 1.2. Describe the principles and strategies for implementing a personal knowledge management system 1.3. Recognize and reflect on learning issues in practice 1.4. Conduct personal practice audits 1.5. Pose an appropriate learning question 1.6. Access and interpret the relevant evidence 1.7. Integrate new learning into practice 1.8. Evaluate the impact of any change in practice 1.9. Document the learning process 2. Critically evaluate medical information and its sources, and apply this appropriately to practice decisions 2.1. Describe the principles of critical appraisal 2.2. Critically appraise retrieved evidence in order to address a clinical or laboratory question 2.3. Integrate critical appraisal conclusions into practice 3. Facilitate the learning of other health professionals, residents, students, patients, families, the public, and others, as appropriate 3.1. Describe principles of learning relevant to medical education 3.2. Identify collaboratively the learning needs and desired learning outcomes of others 3.3. Select effective teaching strategies and content to facilitate others’ learning 3.4. Deliver an effective lecture or presentation 3.5. Assess and reflect on a teaching encounter 3.6. Provide effective and constructive feedback 3.7. Describe the principles of ethics with respect to teaching 4. Contribute to the development, dissemination, and translation of new knowledge and practices 4.1. Describe the principles of research and scholarly inquiry 4.2. Describe the principles of research ethics 4.3. Describe the principles of tissue acquisition for research 4.4. Pose a scholarly question, and formulate a plan to answer the question 4.5. Conduct a systematic search for evidence 4.6. Select and apply appropriate methods to address the question 4.7. Disseminate the findings of a study 4.8 Complete a scholarly project

Professional Definition: As Professionals, Anatomical Pathologists are committed to the health and well-being of individuals and society through ethical practice,

Page | 163 RESIDENCY TRAINING in Anatomical Pathology ______profession-led regulation, and high personal standards of behavior. Key and Enabling Competencies: Anatomical Pathologists are able to: 1. Demonstrate a commitment to their patients, profession, and society through ethical practice 1.1. Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism 1.2. Demonstrate a commitment to delivering the highest quality care and maintenance of competence 1.3. Recognize and appropriately respond to ethical issues encountered in practice 1.4. Recognize and manage conflicts of interest 1.5. Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law 1.6. Maintain appropriate boundaries with colleagues, other health professionals, laboratory staff, students and patients 2. Demonstrate a commitment to their profession, clinical colleagues, patients, and society through participation in profession-led regulation 2.1. Demonstrate knowledge and understanding of the professional, legal, and ethical codes of practice, including but not limited to: 2.1.1. Local regulations regarding the reporting of deaths to the medical examiner or coroner 2.1.2. Conducting forensic investigations 2.1.3. Principles and practice of presenting pathologic evidence in a court of law 2.2. Fulfil the regulatory and legal obligations required of current practice, including but not limited to timely reporting of cases and of critical values 2.2.1. Demonstrate knowledge of the policies on reportable diseases, including but not limited to infectious diseases 2.3. Demonstrate accountability to professional regulatory bodies 2.4. Demonstrate awareness of professional and institutional codes of conduct and respond appropriately to breaches in these codes 2.5. Participate in peer review 3. Demonstrate a commitment to physician health and sustainable practice 3.1. Balance personal and professional priorities to ensure personal health and a sustainable practice 3.2. Strive to heighten personal and professional awareness and insight 3.3. Recognize other professionals in need and respond appropriately

Cytopathology medical staff Dr. Nicole Bures Dr. Margaret Gorecki Dr. Tatjana Terzic Dr. Máire Duggan Dr. Steve Gorombey Dr. Ranjit Waghray Dr. Marie Dvorakova Dr. Moosa Khalil Dr. Yinong Wang Dr. Chen Gao Dr. Walid Mourad

Required Reading and References Required texts are denoted with an *. Additional helpful reference atlas denoted with **.

Online (Refer to G:\Residents\Resident Resources\Resident Library\Online Resident Books.xlsx for the most up-to-date list and links to the online texts) **Diagnostic Cytopathology (Gray and Kocjan, 3rd edition) Cytopathology of Neuroendocrine Neoplasia: Color Atlas and Text , Sudha R. Kini Diagnostic Pathology: Cytopathology *The Bethesda System for Reporting Cervical Cytology, Ritu Nayar, David C. Wilbur (2015) *The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology *The Bethesda System for Reporting Thyroid Cytopathology

Access to various Journals via the University of Calgary Library

Page | 164 RESIDENCY TRAINING in Anatomical Pathology ______

Hardcopy 1) **Comprehensive Cytopathology Marluce Bibbo, 2nd Edition 1997, WB Saunders, Philadelphia, Pennsylvania, USA. 2) **The Art and Science of Cytopathology Richard DeMay, 2012, American Society of Clinical Pathologists, press, Chicago, Illinois, USA. 3) **The , Richard DeMay ASCP Press 2005. 4) *Cytology, Diagnostic principles and clinical correlated. E. Cibas, B. Ducatman 3rd Ed 2008. 5) Atlas of Diagnostic Cytopathology, B. Atkinson Saunders 2004. 2nd Ed. 6) Guide to clinical aspiration biopsy thyroid. Sudha Kini. 2nd Ed. 1996. 7) Color atlas of differential diagnosis in exfoliative and aspiration cytopathology. Sudha Kini. 1999. 8) *The Bethesda System for Reporting Thyroid Cytopathology. 2010 9) *The Bethesda System for Reporting Cervical Cytology, Ritu Nayar, David C. Wilbur 3rd. Ed. 10) *Practical Principles of cytopathology. Richard Demay. 1999 11) Guide to clinical aspiration biopsy breast. Tilde S Kline. 2nd Ed. 1999. 12) Fine needle aspiration cytology. Mary Sidawy. Foundation series.2007. 13) Fine needle aspiration cytology of superficial organs and body sites. Kim Geisinger. 1999. 14) Aspiration biopsy cytologic interpretation and histologic bases. Leopold Koss. 2nd Ed. 1992. 15) Diagnostic cytopathology. Winifred Gray 2nd Ed. 2003. 16) Fine needle aspiration cytology. Svante Orell. 4th Ed. 2005. 17) Cytopathology of the breast. S. Masood. ASCP 1996. 18) Cytopathology of the head and neck. L Layfield. ASCP. 1996. 19) Cytopathology of the lower female genital tract. Gerard Nuovo. 1994. 20) Diagnostic cytology and its histopathologic basis. Leopold Koss. 4th Ed. 1992. 21) Atlas of Cerebrospinal Fluid Cells. Hans Wolfgang Kolmel. 1976. 22) Exfoliative Cytopathology. Zuher Naib. 3rd ed. 1985. 23) Practical Cytopathology. Robert Astarita. 1996.

Websites http://www.cytologystuff.com/ http://www.cytopathology.org/ (American Society of Cytopathology)

P a g e | 165 RESIDENCY TRAINING in Anatomical Pathology ______Forensic Pathology (OCME) Site: Office of the Chief Medical Examiner, 4070 Bowness Road NW Preceptor: Dr. Eric Bol ([email protected] ) Length of Rotation: 8 weeks (May be extended to 12 weeks if desired) Prerequisites: PGY 3, Neuropathology rotation highly recommended Last Modified: May 17, 2016 Dr. Bamidele Adeagbo

Definition Forensic pathology is a subspecialty of anatomic and general pathology which focuses on the interpretation of diseases of and injuries to the . The role of a forensic pathologist incorporates the formulation of an opinion as to the cause and manner of death taking into consideration the history, circumstances and autopsy findings as a whole. The work undertaken may have medical – legal significance requiring testimony as an expert witness.

Background The Office of the Chief Medical Examiner (OCME) is a branch within the Justice Services Division of the Ministry of Justice & Attorney General, Government of Alberta. Its area of jurisdiction is the province of Alberta with a population of approximately 3.8 million. The OCME is responsible for the investigation and certification of all deaths in Alberta caused by violence, as well as all unexplained and some unattended natural deaths in accordance with the Fatality Inquiries Act. It is managed from two regional offices - one located in Edmonton and the other in Calgary. The Chief Medical Examiner is based in Edmonton but regularly attends in Calgary. The Edmonton office administers all investigations in the northern part of the province while the Calgary office administers the geographic area south of a line extending from Jasper to Hobbema and down to Provost. Within both offices are 3 - 4 Assistant Chief Medical Examiners. In Edmonton approximately 1700 deaths are examined in a year and in Calgary approximately 1500 deaths are examined a year. Approximately half of these examinations are external examinations. Homicide numbers vary year to year: 53-63 in Edmonton (2008-2010) and 24-53 in Calgary (2008-2010). A histology laboratory is located in Calgary and a toxicology laboratory is located in Edmonton. Two PhD chemists direct the toxicology laboratory. The office staffs comprise medical investigators (MIs), histology and toxicology technologists, mortuary technicians, administrators and administrative support personnel.

Specific Objectives Medical Expert 1. Familiarization with the role and operation of the OCME in sudden death investigation 2. Understand similarities and differences between hospital and forensic autopsies 3. Introduction to the differing laws and regulations in Canada in relation to death investigation between provinces 4. Familiarization with the Fatality Inquiries Act and the Fatality Inquiries Regulations for the Province of Alberta 5. Understand the value, techniques and theory of death scene investigation as it applies to forensic pathology 6. Introduction to the challenges of identification of human remains with particular reference to the use of fingerprinting, odontology, radiology and anthropology 7. Perform a complete and appropriate assessment of a deceased individual both adult and pediatric 8. Learn dissection techniques in the autopsy room in both adult and pediatric autopsies including when to order appropriate ancillary studies such as histology, microbiology, toxicology, neuropathology, radiology, genetic studies, virology etc. 9. Familiarization with autopsy findings in a variety of sudden natural and violent deaths 10. Familiarization with autopsy histology

P a g e | 166 RESIDENCY TRAINING in Anatomical Pathology ______11. Understand proper techniques and theory for collection and handling of toxicology specimens 12. Understand proper techniques and theory for collection and handling of trace evidence in the course of a suspicious death autopsy 13. Introduction to the concepts of forensic science relevant to forensic pathology e.g. tool mark analysis, blood stain analysis, entomology, forensic biology, forensic photography etc. 14. Introduction to the concept of external examination 15. Understand how to properly certify cause and manner of death 16. Understand mechanisms of death 17. Introduction to the limits of a forensic autopsy i.e. questions that cannot be answered despite full autopsy 18. Familiarization with the principles of physical violence and the effects this can have on a human body: including sharp force, blunt force, crush, asphyxia, firearms, blast, electrocution, heat, cold, toxin related, fire and water related injuries 19. Introduction to court room proceedings and presentation of evidence as an expert witness Forensic Pathologist 20. Adequate preparation for the Forensic Pathology component of Canadian AP/GP Examinations

Communicator 1. Develop rapport, trust and professional relationships with staff at the OCME, allied professionals and any members of the public such as relatives/friends of the deceased who are encountered during this elective 2. Demonstrate an understanding of the importance of timeliness, clarity and accuracy in all communications 3. Convey effective oral and written information with regards case investigations in which you have the responsibility of producing an official autopsy report 4. Introduction to the concept of ‘lay language reports’ when conveying complex scientific information 5. Collaborator 6. Participate effectively and appropriately within the multidisciplinary team setting of medico- legal death investigation 7. Understand the role of the OCME in working with a diverse population with a multitude of religious, ethnic, cultural and personal beliefs surrounding death, the body of the dead, autopsy and the afterlife. In particular how these different beliefs may affect every stage of the death investigation 8. Understand how different autopsy techniques may impact the later preparation of a body by a funeral home and subsequent viewing by relatives and friends of the deceased

Leader 1. Introduction to the concept of team leadership by the forensic pathologist in the setting of a homicide investigation and team dynamics 2. Understand and demonstrate the principles of quality assurance, quality control and quality improvement as it applies to forensic pathology 3. Demonstrate effective personal time management with regards maximizing educational opportunities whilst at the OCME 4. Manage workload appropriately to ensure timely completion of work

Health Advocate 1. Understand and demonstrate an understanding of all necessary safety precautions in the autopsy room, laboratory and at death scenes with emphasis on both day to day casework and high risk autopsies 2. Understand the role of the pathologist in ensuring the safety of all morgue staff and observers at autopsy 3. Understand the concepts of public health as it applies to the work conducted at the OCME e.g. responding appropriately to the likes of

P a g e | 167 RESIDENCY TRAINING in Anatomical Pathology ______infectious disease diagnoses, potential hereditary disease diagnoses, potential unsafe environments (e.g. carbon monoxide leaks, work related fatalities, product design flaws, bioterrorism), death trends that may pose an immediate or emerging threat to the health of a population (e.g. adulterants to illicit drugs) and mass fatality events 4. Understand how forensic pathology can promote the health of communities and populations through the study of mechanisms, causes and manners of death e.g. deaths in infancy, maternal deaths, deaths from epilepsy

Scholar 1. Demonstrate continual learning through e.g. the process of reflective learning, the conduct of personal practice audits, the posing of appropriate learning questions, accessing journal articles relevant to work undertaken or witnessed, integrating new learning into practice, documenting and sharing this learning. 2. Understand critical evaluation of information from its source and apply this appropriately in the workplace 3. Actively participate in opportunities for learning by attending: 4. OCME Alberta Forensic Pathology Rounds: Wednesday afternoons 1500 – 1600 hrs. in both Edmonton and Calgary by videoconference 5. Morning case conference/round: Monday to Friday, 8:15 am 6. Request appropriate personal professional feedback and provide effective feedback during the elective

Professional 1. Assist in the provision of the highest quality of service that the OCME can provide to all Albertans with competency, integrity, honesty and respect 2. Respect confidentially and privacy with regards any conversation about case work seen or conducted in the OCME particularly when outside the office and after the elective 3. Recognition of professional limits and actively seeks advice and assistance from senior staff members. 4. A resident will never be made to conduct any procedures on any individuals that are felt to be out of their scope of experience, competence or comfort level.

Requirements 1. Residents are advised to bring in appropriate ‘morgue footwear’. Scrubs, surgical gowns, plastic aprons, hair nets, eye shields and face masks are provided as well as cut-proof gloves, latex and latex free gloves are all provided in house. 2. Residents are advised to ensure that all appropriate vaccinations are up to date prior to attending at the OCME for their elective. 3. Residents should aim to complete in the region of 20 full autopsy cases (non homicides) and will only ever be invited to undertake an examination on a decomposed individual. 4. Residents are expected to complete the communication notes in the OCME database MEDIC when they complete their autopsies in a timely fashion (preferably immediately after autopsy) 5. Residents are expected to discuss the cause and manner of death immediately after autopsy with the supervising medical examiner although the certificate will be signed by the supervising medical examiner 6. Residents are responsible for writing up the official autopsy report for their cases into the OCME database MEDIC with guidance from the supervising medical examiner and on the agreed departmental template in a timely fashion (preferably within a day or two after autopsy) 7. Residents are expected to follow through and review and discuss toxicology, histology and other ancillary investigation results as they pertain to the case they completed whilst still at the OCME. 8. Residents should request to attend court trial where the Chief or an Assistant Chief Medical Examiner is providing testimony 9. Residents should request to spend at least an hour with the Chief

P a g e | 168 RESIDENCY TRAINING in Anatomical Pathology ______or an Assistant Chief Medical Examiner to discuss the proper method for completing a death certificate 10. Residents are asked to hold their building access card with the appropriate level of responsibility and care as would be expected of a rotating resident and return the aforementioned access card at the end of the elective. 11. Residents are requested that they do not remove any data (paper, digital, microscope slide or other) from the department. 12. Residents are reminded in particular not to discuss the circumstantial or autopsy information learnt regarding homicide cases outside of the department as this may be critical privileged information relevant to criminal proceedings. Evaluation Evaluation of progress through the elective will include: 1. On-going day to day evaluation 2. An informal mid –way point one to one with the elective preceptor (This should allow for adequate time during the elective to address any perceived exposure/training deficits or deficiencies in performance) 3. End of elective PowerPoint presentation on a topic to be decided in-rotation with preceptor. 4. End of elective formal evaluation through One45 in the form of an ITER (In-Training- Evaluation-Report) Suggested Reading Spitz W U et al. Spitz and Fisher’s Medicolegal Investigation of Death 4th Edition. 2006. Charles C Thomas Publisher.

Further Reading 1. Saukko P, Knight B. Knight’s Forensic Pathology 3rd Edition. 2004. Arnold Publishing 2. Di Maio VJ, Di Maio D. Forensic Pathology 2nd Edition. 2001. CRC Press 3. Froede RC. Handbook of Forensic Pathology 2nd Edition. 2003. College of American Pathologists. 4. Basic Competencies in Forensic Pathology. A Forensic Pathology Primer. 2006. College of American Pathologists. 5. Dolinak D et al. Forensic Pathology: Principles & Practice. 2005. Academic Press 6. Ludwig J. Handbook of Autopsy Practice 3rd Edition. 2002. Humana Press 7. Burton E C et al. Religions and the autopsy. Medscape Reference Article [http://emedicine.medscape.com/article/1705993-overview] 8. Di Maio VJM. Gunshot Wounds 2nd Edition. 1999. CRC Press. 9. Saferstein R. Criminalistics: An Introduction to Forensic Science 9th Edition. 2006. Prentice Hall. 10. Payne-James J et al. Forensic Medicine. Clinical and Pathological Aspects. 2003. Greenwich Medical Media. 11. Pounder D.J. Lecture Notes in Forensic Medicine. Accessible online [http://www.dundee.ac.uk/forensicmedicine/notes/notes.html] 12. Cummings PM et al. Atlas of Forensic . 2011. Cambridge University Press. 13. Oehmichen M et al. Forensic Neuropathology and Associated Neurology. 2009. Springer- Verlag 14. Karch SB. Karch’s Pathology of Drug Abuse. 2009. CRC Press. 15. Busuttil A & Keeling JW. Paediatric Forensic Medicine & Pathology. 2009. Edward Arnold. 16. Kim A. Collins & Roger W. Byard. Forensic Pathology of Infancy and Childhood. 17. Thali, Viner & Brogdon. Forensic Radiology.

P a g e | 169 RESIDENCY TRAINING in Anatomical Pathology ______Pediatric Pathology (ACH) Supervisor: Dr. Kyle Kurek email: [email protected] Length: 2 blocks (8 weeks) Prerequisites: Halfway through PGY3 Revised: July, 2016 (Drs Marie-Anne Brundler and Kyle Kurek) Description Alberta Children's Hospital (ACH), a tertiary care centre that serves southern Alberta, offers a full range of pediatric medical and surgical subspecialty services. Pediatric pathology is a recognized subspecialty of Anatomical Pathology, and within APL. The pediatric pathologists are located at the APL site at Alberta Children’s Hospital and provide a comprehensive service in pediatric pathology for this site. We also provide expertise in fetal, perinatal and placental pathology for the acute care hospitals in the Calgary Zone. Therefore, placentas and perinatal autopsy cases are transferred to the pathology laboratory at ACH for examination. In addition, we perform perinatal and pediatric autopsies for other hospitals in the South zone. Moreover, we receive specialist consultations from other sites, and specialist pediatric and perinatal case referrals and consultations from other laboratories in Alberta, and out of Province. This creates a high volume service, which is key for teaching pediatric, fetal, and placental pathology.

The Department of Pathology and Laboratory Medicine at ACH provides pediatric pathology rotations for Anatomical Pathology residents in the University of Calgary program. Our residents participate in the evaluation of a wide range of pediatric biopsy and surgical specimens, covering a broad spectrum of pediatric and placental pathology, and including highly complex perinatal, pediatric, surgical, oncological and post transplant cases. During their rotation, the residents also undertake pediatric, perinatal, and fetal autopsies (approximately 200 cases are performed at ACH each year). Because many pediatric tumours and other pediatric lesions are rare, AP residents rotating for 8 weeks would normally not have an opportunity to encounter the entire spectrum of pediatric pathology on sign out. Therefore, the Department provides to residents an extensive archival collection of teaching cases organized by organ system and/or pathology for self-directed learning. The pediatric pathologists actively participate in a number of clinical and rounds at ACH, but also in conjunction with perinatal, neonatal and MFM services at other sites, namely FMC. This provides the residents with addition educational opportunities.

General Objectives The primary objective for this rotation is for residents to gain specific knowledge and experience so that they can safely and competently handle pediatric, perinatal and placental pathology cases, including cases that will require specialist pediatric pathology or possibly other subspecialist consultation.

Medical Expert By the end of the rotation, the trainee will: 1) Be able to perform a complete perinatal or pediatric autopsy 2) Be familiar with standard approach for pediatric and perinatal autopsies 3) Be familiar with specialized autopsy protocols, including metabolic and skeletal protocols 4) Be able to perform competent gross and microscopic examination of pediatric surgical specimens and placentas 5) Demonstrate safe and appropriate handling of surgical and autopsy materials 6) Be able to appropriately triage biopsy specimens for required ancillary testing 7) Be familiar with specific pediatric tumour protocols

Communicator By the end of the rotation, the trainee will:

P a g e | 170 RESIDENCY TRAINING in Anatomical Pathology ______1) Be able to write complete, clear, concise and accurate surgical and autopsy reports, which include relevant clinic-pathologic correlations 2) Be able to present selected cases at departmental and subspecialty rounds 3) Be able to communicate effectively with the surgeons during intra-operative consultations 4) Be able to effectively discuss case findings or pursue case inquiries with clinicians

Collaborator During the rotation, the trainee will: 1) Work effectively as a member of the health care team 2) Become familiar with the role of other health care professionals, especially social workers, in the pediatric/perinatal care after death process

Leader During the rotation, the trainee will: 1) Utilize resources effectively to balance patient care and learning needs 2) Utilize information technology to optimize patient care and facilitate life-long learning understand the quality indicators used in the laboratory

Scholar During the rotation, the trainee will: 1) Develop and implement a personal continuing education strategy 2) Be able to provide a critical appraisal of medical information, including literature reviews, standard references, text books and periodicals 3) Review archival teaching cases and self-study modules to enhance their learning experience

Professional During the rotation, the trainee will: 1) Display work attitudes and practices appropriate for a pathologist-in-training 2) Exhibit appropriate personal and interpersonal behaviour 3) Practice ethical medicine consistent with the obligations of a physician 4) Recognise his/her own limitations and appropriately seek for assistance from the attending or other staff

Rotation-Specific Objectives Surgical Pathology 1) Perform competent gross examination and description of surgical specimens 2) Participate in intraoperative consultations and understand their role in diagnosis and specimen workup. 3) Be able to appropriately triage biopsy specimens (r/o tumour, metabolic, infectious, etc.) for required ancillary testing 4) Be familiar with various pediatric tumour protocols. 5) Recognize classic examples of typical pediatric lesions, either through exposure during the rotation or by reviewing the teaching sets (for a detailed list see separate Appendix, part A). Placental Pathology 1) Perform complete gross examination and description of singleton and multiple pregnancy placentas. 2) Understand basic placental anatomy and histology.

P a g e | 171 RESIDENCY TRAINING in Anatomical Pathology ______3) Recognize and understand common pathologies (for a detailed list see separate Appendix, part B):

P a g e | 172 RESIDENCY TRAINING in Anatomical Pathology ______Fetal, Perinatal and Pediatric Autopsy 1) Perform review of pertinent health records, including (maternal) prenatal records in perinatal and fetal cases. 2) Review autopsy consent form, identify and address deficiencies, and undertake autopsy in accordance with consent. 3) Demonstrate competent autopsy technique. Know: a) Normal developmental anatomy and histology b) How to approach a macerated/stillborn fetus c) How to approach a fragmented fetus d) How to perform a metabolic , skeletal dysplasia autopsy e) How (and based upon what indications) to collect tissues/specimens for cytogenetic, molecular and metabolic studies, and infectious studies. 4) Understand and be able to identify (for a detailed list see separate Appendix part C): a) Common malformations, deformations, disruptions, sequences, and associations. b) Common genetic and non-genetic syndromes presenting in the fetal and perinatal period c) Common congenital infections

Duties and Responsibilities of Rotating Residents: Residents are expected to be “on service” at ACH during regular working hours on weekdays – except Friday mornings which are dedicated to the Academic Half-day Didactic sessions. Other absences require the approval of the supervising pathologist.

Surgical/Placental Pathology Perform gross examination of surgical and placenta specimens, including description, dissection and sampling for microscopy, and where appropriate also ancillary studies. This is to be done in accordance with assigned activities as per 4 weekly rota. Participate in intra-operative consultations and triage of specimens received fresh.

Review histologic preparations and prepare a report before review/discussion with staff pathologists. Identify and review previous slides relevant to the current case, and obtain pertinent additional information from attending clinicians as appropriate. Plan further workup (levels, special stains, IHC, other) where required.

Following review with attending, and where applicable of ancillary tests, finalise the diagnostic report within an appropriate time frame. Recognise urgent or unexpected critical findings, and communicate and document them as guided by the attending pathologist. Become familiar with the common “Quality Indicators” used in Anatomical Pathology, including the following:  Report turnaround time  Frozen section/final diagnosis correlation  Occurrences/Non-conforming events (accessioning, technical, medical)  Safety concerns  Critical in Anatomical Pathology

Autopsy Pathology Prior to beginning an autopsy, the resident should review the consent form, review and summarise pertinent health records, and discuss clinical issues relevant to the case with the attending pathologist and as advised, the clinician.

The resident should become familiar with standard protocols for pediatric and perinatal autopsies, including additional requirements for suspected , arthrogryposis or skeletal dysplasia.

P a g e | 173 RESIDENCY TRAINING in Anatomical Pathology ______The resident should undertake the autopsy including external examination and internal examination with dissection of organs, photographic documentation of pertinent gross findings, tissue sampling for microscopic examination, and ordering of ancillary laboratory tests as appropriate.

Following the autopsy the resident should document autopsy findings in writing, including fetal measurements, and compose the Preliminary Autopsy report comprising preliminary diagnosis, clinical summary, and preliminary autopsy diagnosis in a timely fashion.

Upon receipt of microscopic sections the resident should review the findings, formulate microscopic descriptions, and aim to provide an interpretation of findings and clinico-pathological correlation. In discussion with the attending pathologist responsible for the case, the preliminary autopsy diagnosis should be amended to include as applicable ancillary test results (such as babygram, cytogenetics, or bacterial or viral cultures) and neuropathology. Autopsy findings and their clinical relevance should be discussed in the amended autopsy summary, in a language that can be understood by a generalist. References should be provided as appropriate.

The final autopsy report should be completed before the end of the rotation. Preliminary and final autopsy reports follow a standard format; examples are provided to residents. The resident should if possible be exposed to different case scenarios, namely stillbirth, fetal anomalies, and fragmented fetuses/POCs, and understand the approach used.

Clinical and educational rounds Pediatric Pathology Rounds: Review of interesting or challenging pediatric surgical and placenta cases. Tuesday 4-5 pm, multiheader microscope ACH (Staff AP, residents, fellows)

Pediatric Autopsy Rounds: Review of interesting or challenging pediatric or perinatal autopsy cases, including neuropathology. 1st Thursday of month, 8-9 am multiheader microscope ACH (Staff AP, NP, residents, fellows)

Pediatric Brain-Cutting: Thursdays, 9-11 am: ACH autopsy suite. Neuropathologist/NP fellowsperform gross brain examinations

MFM pathology outcome rounds: 3rd Thursday of month, 7.30-8.30 am; EFW Radiologymultidisciplinary review of perinatal and neonatal cases encompassing clinical history, prenatal diagnostic imaging, prognosis, management, and pathological correlation

Pediatric GI Pathology Rounds: fourth Friday of the month. 12.15-13.45 pm: Review of Pediatric GI and liver cases (staff, residents and fellows)

Pediatric Tumor board: Wednesdays, 4 -5 pm (held in Diagnostic Imaging at ACH): a multidisciplinary review of current oncology cases. Pathologists and/or residents frequently present the pathologic findings.

Pediatric Grand Rounds: Wednesdays, 8.30-9.30 am, ACH Auditorium

Review of archival material Glass slides, organized by organ systems or pathology are available for review at the resident desk. Collection of congenital heart malformations: a wide variety of wet specimens is available for residents to review with staff pathologists.

Evaluation Case related feedback will be provided by the attending pathologists the resident works with throughout the rotation. The supervisor will discuss rotation objectives and organization with the resident at the start of the rotation. Progress will be discussed half way through the rotation, and where required adjustments will be made to allow the resident to best

P a g e | 174 RESIDENCY TRAINING in Anatomical Pathology ______achieve the goals. The resident’s ITER will be based upon feedback obtained from all the pathologists interacting with the resident throughout the rotation. The resident will also do a written exam at the beginning and end of the rotation to assess progress.

Suggested Reading List 1) Stocker and Dehner: Pediatric Pathology, 3nd Ed., Lippincott, Williams and Wilkins, 2011. 2) Gilbert-Barness: Potter’s Pathology of the Fetus and Infant, Mosby, 2nd Ed., 2007. 3) Gilbert-Barness and Debich-Spicer: Handbook of Pediatric Autopsy Pathology, Humana, 2005. 4) Valdes-Dapena and Huff: Perinatal Autopsy Manual, AFIP, 1983. 5) Jones: Smith’s Recognizable Patterns of Human Malformation, 6th Ed., Elsevier Saunders, 2006. 6) Kraus, Redline, Gersell, Nelson and Dicke: Placental Pathology, AFIP, 2004. 7) Cohen & Scheimberg. Essentials in of Surgical Pediatric Pathology. Cambridge University Press 2015 8) Cohen & Scheimberg. The pediatric and perinatal autopsy manual. Cambridge University Press, 2015

APPENDIX part A - PEDIATRIC SURGICAL PATHOLOGY Bone: Osteosarcoma Osteochondroma Ewing’s sarcoma/PNET Langerhans cell histiocytosis (eosinophilic granuloma) Bone cysts, including aneurysmal bone cysts Fibrous dysplasia

CNS and Eye: Pilocytic astrocytoma Medulloblastoma Ependymoma Craniopharyngioma Retinoblastoma

GI: Eosinophilic Esophagitis, Eosinophilic Colitis Celiac disease Inflammatory bowel disease (Crohn, Ulcerative Colitis) GVHD Meckel’s diverticulum (with or without heterotopias) Duplications, Bowel atresias Intussusception, Volvulus Necrotising enterocolitis Cystic fibrosis Hirschsprung’s disease Polyps and Familial polyposis syndromes

GU: Wilms’ tumour, Nephroblastomatosis Mesoblastic nephroma Clear cell sarcoma Rhabdoid tumour Cystic kidney diseases Renal dysplasia

P a g e | 175 RESIDENCY TRAINING in Anatomical Pathology ______Head and neck: Juvenile Angiofibroma Neck cysts (Branchial, thyreoglossal) Laryngeal papillomatosis

Liver: Neonatal (giant) cell hepatitis Metabolic/storage disorders, including Alpha-1 antitrypsin deficiency, Glycogen storage disease, Galactosemia, Gaucher’s disease, Niemann-Pick disease Familial cholestatic syndromes (progressive familial intrahepatic cholestasis/PFIC) Extrahepatic biliary atresia Choledochal cyst Paucity of intrahepatic bile ducts, syndromic (Alagille) and non-syndromic Congenital hepatic fibrosis (Fibrocystic ) Autoimmune hepatitis Primary sclerosing cholangitis and steatohepatitis

Liver tumours, including Hepatoblastoma, Embryonal sarcoma, Fibrolamellar hepatocellular carcinoma, Mesenchymal hamartoma, Hepatic adenoma

Lymph nodes: Hodgkin’s lymphoma (include subtypes) Non-Hodgkin’s lymphoma; Burkitt, Lymphoblastic, Anaplastic large cell, Diffuse large cell lymphoma Langerhans cell histiocytosis Cat scratch disease Kikuchi disease Kimura disease

Muscle: Duchenne//Becker muscular dystrophy Congenital myopathy

Respiratory: Bronchogenic cysts Congenital lung malformations (CCAM/CPAM) Interstitial lung disease in infancy, including surfactant disorders GVHD

Skin: Melanocytic nevi, including Congenital and Spitz nevus Epidermal and Sebaceous Nevus Pilomatricoma Juvenile xanthogranuloma Langerhans cell histiocytosis Granuloma annulare

P a g e | 176 RESIDENCY TRAINING in Anatomical Pathology ______Soft tissue: Ewing’s sarcoma/PNET , ganglioneuroblastoma, ganglioneuroma Rhabdomyosarcoma Infantile fibrosarcoma Inflammatory myofibroblastic tumour Infantile myofibroma/myofibromatosis Fibrous hamartoma of infancy Nodular fasciitis Lipoblastoma and lipoma Teratoma and other germ cell tumours Vascular tumours (hemangioma) and vascular malformations

APPENDIX part B - PLACENTAL PATHOLOGY Chorioamnionitis / chorionic vasculitis / funisitis Meconium laden macrophages

Patterns of cord insertion Accessory lobes

Single umbilical artery (two vessel cord) Umbilical cord embryonic remnants

Villous edema/hydrops Hemorrhages and hematomas (types) Infarction Placental abruption

Villitis/intervillositis

Common placental findings in maternal diabetes Common placental findings in maternal hypertension

Monochorionic twin placenta (including twin-twin transfusion) Dichorionic twin placenta Post-mortem changes

Tumours (including chorangioma, umbilical cord hemangioma, partial and complete hydatidiform moles)

APPENDIX part C - AUTOPSY PATHOLOGY Intrauterine growth retardation Amniotic band syndrome/amniotic disruption sequence Hydrops fetalis, Oligohydramnios (Potter’s sequence)

Congenital cardiac malformations (VSD, ASD, Tetralogy of Fallot, Hypoplastic left heart syndrome, DORV, AVSD, Transposition) Tracheoesophageal fistula Common sequelae of prematurity; hyaline membrane disease, Bronchopulmonary dysplasia/chronic lung disease of prematurity; intraventricular hemorrhage

Abdominal wall defects (omphalocele/gastroschisis)

P a g e | 177 RESIDENCY TRAINING in Anatomical Pathology ______Diaphragmatic hernia Gastrointestinal atresia Necrotizing enterocolitis Meconium peritonitis Cystic kidney diseases, renal dysplasia Neural tube defects

Common congenital infections (CMV, herpes, parvovirus)

P a g e | 178 RESIDENCY TRAINING in Anatomical Pathology ______Renal/EM Pathology (FMC) Supervisor: Dr. H. Benediktsson email: [email protected] Length: 1 block (4 weeks) Prerequisites: PGY2 Revised: November, 2013 (Dr. H. Benediktsson)

Definition Renal Pathology is that branch of anatomical pathology concerned with the study of the morphologic aspects of diseases of the kidney. It includes gross, histological, immunohistological and electron microscopic evaluation of tissue specimens, primarily from needle biopsies. The majority of cases deal with medical renal disease or renal transplantation.

General Objectives The anatomical pathology resident usually does a four week rotation in renal pathology in conjunction with electron microscopy (usually in the PGY3 year). On completion of the educational program, the graduate physician will be competent to function as an anatomical pathologist in terms of renal and renal transplantation pathology. Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to renal and renal transplant pathology.

Specific Objectives At the completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert / Clinical Decision-Maker 1) Demonstrate knowledge appropriate for a pathologist of normal anatomy and physiology of the kidney appropriate for a pathologist 2) Demonstrate knowledge of the normal ultrastructural appearance of tissues of the kidney 3) Understand the basic principles of cell biology, immunology and pathogenesis of native renal disease, as well as changes occurring in the renal transplant, including primary and secondary graft dysfunction 4) Understand the principles of tissue processing and the use of different fixatives in the laboratory including special fixatives used for electron microscopy 5) Demonstrate the ability to handle a renal biopsy appropriately to ensure proper sampling for all needed modalities of examination 6) Understand the principles of immunohistochemical stains in native renal disease as well as in transplanted kidneys 7) Understand the role of ultrastructural examination of the kidney 8) Understand and be able to describe the principles of electron microscopy 9) Demonstrate knowledge of the use of and indications for special staining, and the technical principles underlying these – especially PASM, trichrome, Congo Red and PAS stains 10) Demonstrate ability to take satisfactory microscopic and electron microscopic photographs of renal biopsies Communicator 1) Establish effective relationships with consulting physicians and surgeons 2) Obtain and synthesize relevant history from physicians, electronic health records and written health records 3) Listen effectively 4) Discuss appropriate information with the health care team 5) Assist in the continuing education of physicians and other members of the hospital staff

P a g e | 179 RESIDENCY TRAINING in Anatomical Pathology ______6) Act as consultant to clinical colleagues on the interpretation and relevance of pathological findings, with particular regard to their significance in the management of the patient 7) Understand the information pathology should provide in a given clinical situation and be able to communicate it effectively in an oral and written form Collaborator 1) Consult effectively with other physicians and health care professionals 2) Contribute effectively to other interdisciplinary team activities 3) Must have sufficient background knowledge in clinical medicine and nephrology to achieve a sound understanding of the effects of disease and the role of pathology in its management 4) Demonstrate the ability to advise on the appropriateness of obtaining histologic and EM specimens and following examination of these, to advise on further appropriate investigations

Leader 1) Utilize resources effectively to balance patient care, learning needs, and outside activities 2) Utilize information technology to optimize patient care, life-long learning and other activities 3) Demonstrate knowledge of the principles of laboratory management and administration as they pertain to renal pathology 4) Demonstrate knowledge of the methods of quality control in renal pathology 5) Demonstrate knowledge of the methods for professional quality assurance as applied to anatomical pathology 6) Demonstrate competence in basic computer skills with emphasis on automated electronic reporting, electronic communication and search strategies

Health Advocate 1) Reinforce to the public and to the profession the essential contribution of laboratory medicine to health Scholar 1) Develop, implement and monitor a personal continuing education strategy 2) Critically appraise sources of medical information 3) Facilitate learning of patients, house staff / students and other health professionals 4) On completion of the rotation, the resident will be able to propose a research question relevant to renal pathology

Professional 1) Deliver highest quality care with integrity, honesty and compassion 2) Exhibit appropriate personal and interpersonal professional behaviours 3) Practice medicine ethically consistent with obligations of a physician 4) Act as an appropriate role model for students and others 5) Demonstrate a professional attitude to colleagues, as well as to other laboratory staff 6) Have an appreciation of the crucial role of the renal pathologist in providing quality patient care. This will include knowledge of individual professional limitations and the necessity of seeking appropriate second opinions

Reading: 1) Heptinstall’s Pathology of the Kidney, Eds: Jenette, Olson, Schwartz and Silva, Sixth Edition, 2007. This is a reference textbook, and should be a source for all specific reading around cases. 2) Fogo A, Kasjgarian M: Diagnostic Atlas of Renal Pathology, Elsevier Saunders 2005 3) Fogo A, Ed. Fundamentals of Renal Pathology, Springer 2008

P a g e | 180 RESIDENCY TRAINING in Anatomical Pathology ______Neuropathology (FMC) Supervisor: Dr. D. Ng email: [email protected] Length: 2 blocks (8 weeks) Prerequisites: Successful completion of this rotation is tied to a strong foundation in general anatomical pathology. Unless there are extenuating circumstances, successful completion of at least 1.5 years of core anatomical pathology training is required prior to completion of the neuropathology rotation i.e. for most residents, this means scheduling of this rotation no earlier than block 7 of the PGY-3 year. Revised: October 2017 by L. Hamilton

Expectations from Neuropathology: Note: Following an initial period of observation of the neurosurgical and neuro-autopsy services, anatomic pathology residents will be placed on the service schedule (typically alternating weeks on the neuropathology surgical and autopsy service) and will work under the supervision of the neuropathologist +/- neuropathology resident on service. Resident responsibilities will be graded based on level of training and performance.

General Expectations Please also see below for specific expectations when assigned to the surgical and autopsy service. Maintain a log of all cases encountered during rotation; include the data in a larger portfolio and review this with staff o Include: case data (age, sex, presentation, duration, location, imaging), materials examined, describe relevant neuroanatomy and whether the pathological changes correlate with the clinical presentation, provide descriptions of materials with details appropriate for training o Record any questions that arose from your observations or study, to act as guides for further study o Discuss or outline some relevant didactic or learning points o Examine any relevant literature on select or interesting cases

Attend all frozen sections, when available.

Attend daily signout with the neuropathologist on service.

Assist in select cases: descriptions, write-ups, obtaining relevant history and imaging Attend didactic sessions given by neuropathology staff when feasible. If unknown cases provided in advance of a didactic session, preview the cases.

Present at select conferences: Clinical case conferences (e.g. TBCC, ACH) - present slides, as appropriate DCNS Friday morning clinical case presentations - as appropriate

Attend neuropathology conferences or conferences involving neuropathologists, when feasible (not to the exclusion of other heuristically useful experiences). Link to the Neuropathology Google Calendar: https://www.google.com/calendar/ical/uofc.neuropathology%40gmail.com/private- 4657f05c41de39d5930caa26bd35c7f3/basic.ics

A summative table is below:

P a g e | 181 RESIDENCY TRAINING in Anatomical Pathology ______Day Time Description Monday 8:00 – 9:00 Developmental Neuroscience Grand Rounds 9:30 - 1030 Neuropathology Interesting cases & QA conference Tuesday AM FMC adult brain dissection 4:00 – 5:00 ACH Neuro-Oncology Tumour Board conference (sporadic) Wednesday 7:30- 8:30 Muscle Biopsy rounds (1st Wed of each month) 3:00 – 4:00 TBCC Neuro-Oncology Tumour Board conference 3:00 – 4:00 Dementia PET Imaging rounds Thursday 8:00 – 900 [Pediatric Autopsy Rounds – occasionally neuropathology-related] 8:00 – 9:00 Maternal Fetal Medicine Pathology Correlation Rounds (3rd week of each month) AM ACH perinatal/pediatric brain dissection PM [Neurology and Neuropathology Academic Half Day] Friday 8:00 – 9:00 [DCNS Clinical Case presentations] 8:00 – 9:00 [Anatomic Pathology unknown slide conference - occasionally neuropathology-related] 9:15 - 1015 [DCNS Grand Rounds] 11:00-12:00 [Anatomic Pathology Autopsy Rounds – occasionally neuropathology-related]

Prepare at least one case for the Neuropathology Resident Teaching Case File. This is an educational resource for rotating residents to review common entities encountered in Neuropathology through the preparation and review of cases with “classical” pathology, and the correlation of clinical, radiology and pathology findings. 1. Select good teaching cases, either surgical or autopsy, that have at least one histology slide with the “classical” findings for that pathological entity (or more, if necessary, including special stains) 2. Prepare a relevant and succinct clinical history, including clinical examination information and results of any pertinent studies (serology, electrophysiology) 3. Obtain relevant neuroimaging 4. Obtain gross images of the case, if available. 5. Compile all information into one coherent case as a powerpoint file; submit glass slide(s) for scanning - remaining information will be uploaded into the same educational website

Prepare a series of unknown surgical cases (with the assistance of neuropathology staff and residents) for presentation at Unknown Slide Rounds at the Anatomic Pathology half-day, as well as a neuro-autopsy case for presentation at Autopsy Rounds. At the start of your rotation, please arrange with the neuropathology staff and residents, as well as the Anatomic Pathology Chief Resident to choose a half-day towards the end of your rotation for this presentation. Read one entire book on basic neuropathology during rotation, such as Escourolle and Poirier's Manual of Basic Neuropathology 5th ed, by Francoise Gray, Umberto De Girolami, Jacques Poirier

Additional recommended textbook resources: 1. Hilton and Shivane. Neuropathology Simplified: A Guide for Clinicians and Neuroscientists.

P a g e | 182 RESIDENCY TRAINING in Anatomical Pathology ______2. Dubowitz, Sewry and Oldfors. Muscle Biopsy: A Practical Approach. 4th ed. 3. Dolinak, Matshes and Lew. Forensic Pathology Principles and Practice. 4. Ellison and Love. Neuropathology: A Reference Text of CNS Pathology. 3rd ed 5. Hilton and Shivane. Neuropathology Simplified. A Guide for Clinicians and Neuroscientists. 6. Louis, Ohgaki, Wiestler and Cavenee. WHO Classification of Tumours of the Central Nervous System. 4th ed. 7. Perry and Brat. Practical Surgical Neuropathology: A Diagnostic Approach

All rotators on neuropathology have several general topics or categories of knowledge they should strive to obtain: 1. Obviously, the core knowledge of the pathology and pathophysiology of select nervous system diseases is critical and important for any future practice. However, know that what we consider “core knowledge” today may not be so in the future. 2. Rotators should learn the methods of neuropathology and their limitations. These would include such topics as how tissue is processed and the times involved in their preparation, the purpose and duration of fixation, what select stains highlight or elucidate, the principles and use of antibodies and immunostaining, and some of the many artifacts induced by clinical interventions (e.g. cautery effects) and pathology processing. 3. Rotators should appreciate both the power and limitations of observation. They should understand how some aspects of pathology represent pattern recognition, while others require generation of hypotheses (e.g. differential diagnoses, mechanisms of disease) and then testing these hypotheses with special pathology techniques. 4. Rotators should understand the various and perhaps uncommon techniques and tools that can be applied to answer a question or test a hypothesis. 5. Rotators should also learn to appreciate some of the limits of neuropathology, including its requirement for structural or neuroanatomic changes, its many gray areas (e.g. tumor grading and diagnostics), and some of the unsubstantiated lore that gets passed from generation to generation.

In addition to the expectations for the rotator, the rotators should also expect assistance from the neuropathology staff. These might or should include: 1. “Didactic sessions” - sessions covering topics not directly related to active cases 2. Sign-out: review of active cases with residents 3. Attendance at frozen sections, with brief explanations of events and findings; neuropathology staff or residents alerts rotators (directly or indirectly) about frozen sections 4. Attendance at autopsies; demonstration of brain removal and dissection of brain after fixation; discuss relevant teaching points from autopsy brain dissections 5. Alert rotators about educational or useful events, such as special conferences or sessions, medical examiner brain dissections, etc. 6. Critique rotator write-ups; assist in how to create a pathology report 7. Provide feedback on rotation, including presentations, log book, professional interactions, and demeanour, observations, knowledge base, readings and literature reviews.

Specific Expectations Autopsy Service  Observe and assist (when appropriate) at least one brain and spinal cord removal at autopsy per month  Attend adult and pediatric brain dissection sessions  Observe and subsequently perform, with the assistance of the neuropathology staff and residents, the dissection of brains.  Provide gross descriptions and microscopic sections code (blocking sheets).  Review histologic slides and prepare microscopic descriptions of the

P a g e | 183 RESIDENCY TRAINING in Anatomical Pathology ______findings.  Correlate the gross and microscopic findings with the clinical history, radiology and systemic autopsy findings to develop a final diagnosis and/or differential diagnosis.  Reviews autopsy slides and report with staff; stage degenerative diseases, when appropriate  Prepare two or more reports per month (more in later months of rotation), dependent on case availability.

Surgical Service  Observe and subsequently assist in the processing of neurosurgical specimens, including the creation of a gross description and the triage and handling of tissue for ancillary testing and tissue banking/research  Attend intraoperative consultations to observe and perform (when appropriate) the preparations of smears and frozen sections, and participate in the process of the formulation of an intra-operative consultative diagnosis. Understand the rationale for the wording of intraoperative consultations.  Attend daily signout rounds at the multihead microscope.  For assigned cases, review the microscopic slides and create a provisional diagnosis / differential diagnosis based on the histological findings in the context of the clinical history and imaging. Suggest appropriate stains, if any, on surgical specimens. Following review of the slides with staff, write up complete surgical pathology reports on two or more cases per month; including synoptic reports when appropriate.

OBJECTIVES: Medical Expert 1. Describe the anatomy and histology of the nervous system with an understanding of its underlying physiology, biochemistry and embryology a. Identify normal gross neuroanatomical structures and describe their general function. b. Identify the anatomy and cellular composition of nervous system tissues in light microscopic sections. c. Describe the topology of the nervous system, including major barriers and surfaces. d. Discuss important aspects of nervous system physiology, including neural transmission, the structure and function of myelin, information encoding in the nervous system, and the concept of labeled lines and nervous system function. e. Identify the major neurotransmitters in the nervous system and the location of the cells that utilize them f. Describe the biological basis for the blood-brain, blood-cerebrospinal fluid, and blood-nerve barriers, and their clinical importance in health and disease. g. Describe the basic embryology of the nervous system and relate neuroembryologic information to the structure of the nervous system.

2. Recognize basic pathological reactions and their significance on gross and microscopic examination a. Recognize basic cellular reactions b. Describe the pattern of necrosis within the brain and its organization c. Describe different types and causes of edema d. Identify types, causes and consequences of different types of herniation e. Identify types and causes of hydrocephalus f. Recognize neoplasia of the various cell types within the nervous system

P a g e | 184 RESIDENCY TRAINING in Anatomical Pathology ______g. Recognize major malformations of the brain and describe how select congenital anomalies relate to failures of nervous system development.

3. Describe and recognize the pathological features of major neurological disorders and the mechanisms by which they are produced a. Vascular diseases, including ischemia, infarction, vasculopathies, hemorrhagic cerebrovascular disease, and vascular malformations b. Neoplasia of the central and peripheral nervous system and its coverings and adjoining structures, including classification, grading, molecular features c. Paraneoplastic syndromes d. Infectious diseases (major viruses, bacteria, fungi and protozoa) e. Prion diseases f. Demyelinating and inflammatory diseases g. Epilepsy h. Neurodegenerative diseases i. Movement disorders j. Cerebellar and spinocerebellar disorders k. Neuromuscular diseases (peripheral nerve, muscle) l. Acquired systemic and metabolic disorders m. Neurological disorders due to drugs, toxins, iatrogenic effects i.e. radiation n. Trauma (blunt head trauma, missile injuries, diffuse axonal injury) o. Inborn errors of metabolism p. Developmental abnormalities q. Acquired prenatal and perinatal diseases r. Neurogenetic disorders, including phacomatoses

4. Understand the major neuropathological techniques used in the processing of surgical and autopsy specimens. Demonstrate effective use of these techniques to address neuropathological diagnostic problems. a. Preparation of intra-operative consultations, and the formulation of an intra- operative consultative opinion b. Processing and triage of surgical neuropathology specimens, including tissue handling for ancillary techniques and tissue banking/research c. Understand the basics of histologic processing of tissues for histologic examination d. Understand the basics of histochemistry and be familiar with the routine special stains (including muscle histochemical stains) used in neuropathology e. Understand the basics of immunohistochemistry and be familiar with the routine immunohistochemical stains in neuropathology f. Observe electron microscopic and understand when and how this technique is useful. g. Be familiar with the techniques of brain and spinal cord removal at autopsy h. Be familiar with the approach to dissecting adult (and pediatric) brains, and routine sampling of tissue blocks for microscopic examination

5. Appreciate the significance of various normal and abnormal neuropathological findings relative to the clinical context a. Demonstrate good judgment from logical reasoning b. Perform radiologic-pathologic correlation of surgical and autopsy cases c. Interpret all available clinical and pathologic data to generate differential diagnoses from the information, and when necessary order additional testing to narrow the differential diagnoses or confirm a diagnosis d. Recognize the genetic implications of select nervous system disorders; and describe the basic principles of clinical genetics e. Know the clinical epidemiology of major nervous system

P a g e | 185 RESIDENCY TRAINING in Anatomical Pathology ______disorders

Communicator 1. Participate in surgical and autopsy neuropathology sessions and signout a. Appropriately engage in case discussions with the group b. Discuss pertinent and succinct clinical histories, laboratory studies ad imaging relevant to the pathologic examination of the tissues c. Maintain clear, accurate, and appropriate records (e.g. written or electronic portfolio) of diagnostic examinations and results.

2. Convey effective oral and written information about a pathologic examination a. Prepare timely, concise, clear, and accurate neuropathological autopsy and surgical reports that provide all relevant information b. Provide synoptic reports for cancer diagnoses and understand the rationale for synoptic reporting c. Provide appropriate grading or staging of various diseases, such as neoplasia and neurodegenerative diseases

3. Participate and present at neuropathology-related clinical-pathology rounds and conferences

Collaborator 1. Demonstrate respectful attitudes and participate effectively and appropriately in an inter- professional healthcare team

2. Detail the roles and responsibilities of the pathologists, technical staff and other learners on the neuropathology service, and interact with them in an appropriate and professional manner

3. Understand their own roles and their own limitations on the team

4. Identify the professionals providing surgical tissues (including nurses, residents, and surgeons), describe their specific roles, and interact and communicate with them in a professional manner.

5. Use their own knowledge and expertise to further the care provided by and knowledge of the other members of the neuropathology team

6. Effectively work with other healthcare team members to prevent, negotiate and resolve interprofessional conflict

Leader 1. Regularly attend neuropathology-related mandated rounds and service activities in a punctual and organized manner

2. Review the literature to understand contemporary neuropathology practice.

3. Participate in quality assurance case review sessions.

4. Participate in neuropathology consultations and formal reviews.

5. Complete surgical and autopsy cases or other assigned tasks in a timely manner.

6. Consider the allocation of health care resources in the neuropathology setting. Select appropriate neuropathological investigative methods in a resource-effective manner.

P a g e | 186 RESIDENCY TRAINING in Anatomical Pathology ______

Health Advocate 1. Take appropriate precautions to protect self and other lab personnel against the transmission of infectious agents.

2. Develop an understanding, based on the neuropathology findings in a patient’s tissues, of the most appropriate therapeutic options for a patient.

3. Prepare surgical reports that include discussions of diagnostic criteria and gray zones in neuropathology, which might impact or influence patient care or prognosis.

4. Prepare autopsy reports that are sensitive to both medical and legal issues.

Scholar

1. Use neuropathology cases as a branch point to learn relevant information. Identify key elements that are unexplained, poorly defined, ambiguous, or require further investigation, then review published literature, including the performance of pertinent literature searches.

2. Document new information in a written or electronic portfolio and retain it for future use.

3. Participate in clinical rounds; identify and record questions that arise from those encounters and seek out answers.

4. Critically evaluate medical information and its sources, and apply this appropriately to practice decisions a. Critically appraise new information, including personally acquired information and published literature, and examine it for its veracity, depth, consistency, and usefulness b. Critically appraise published literature, oral presentations, and other retrieved evidence in order to address a pathological or clinical question c. Integrate conclusions from critical appraisal into pathology reports and clinical care

5. Educate and otherwise facilitate the learning of students, residents, physicians, and other health care professionals (medical audience) a. Develop and select effective teaching strategies and content relevant to the medical audience b. Using various techniques and targeting the level of teaching, effectively communicate with the specific medical audience c. Effectively present neuropathology findings in didactic or clinical meetings d. Listen and provide effective feedback to a medical professional or medical audience e. Assess a teaching encounter (lecture, mentoring, individual) to evaluate its effectiveness, and suggest how it may have been improved

Professional

1. Demonstrate a concern and commitment to their patients; describe the potential impact of pathological diagnoses to the treatment and welfare of patients a. Exhibit appropriate professional behaviours in practice, including honesty, integrity, commitment, compassion, respect, and ethical treatment of patients b. Demonstrate a commitment to delivering the highest quality care and maintenance of competence c. Recognize and appropriately respond to ethical issues encountered in practice d. Recognize and appropriately manage conflicts of interest

P a g e | 187 RESIDENCY TRAINING in Anatomical Pathology ______e. Adhere to the principles and limits of patient confidentiality as defined by professional practice standards and the law; recognize that gray zones exist and determines how to confront or manage these when they conflict with patient care

2. Complete assigned tasks and share the workload with the healthcare team.

3. Recognize own limitations and seek assistance when required, and seek and incorporate feedback into their practice.

4. Show appropriate respect for human organs and tissues.

5. Demonstrate a commitment to physician health and sustainable practice. Balance personal and professional priorities to ensure personal health and a sustainable practice

Evaluation The primary preceptor for the rotating residents will collect feedback on the resident’s performance from the staff neuropathologists on service during the resident’s rotation. This data will be compiled to produce an overall end-of-rotation evaluation. In addition, the primary preceptor meets with the resident at the midpoint of the rotation to address any successes and/or concerns related to the resident’s performance, as well as to address any concerns the resident may have in regards to completing their objectives for the rotation.

In addition to preparing a case for the Resident Teaching Case Files and presentation of neuropathology-related cases at the Anatomic Pathology Academic Half-day unknown slide rounds and autopsy rounds (see above for details), successful completion of the rotation also requires completion of an end-of-rotation quiz. The quiz is comprised of a series of power point images and glass slides of neuropathological entities that fall within the expected realm of knowledge for anatomic pathology training.

P a g e | 188 RESIDENCY TRAINING in Anatomical Pathology ______Chief Resident (FMC) Reviewed: December, 2012 Revised: April 2017

Introduction Although the medical expert category is the central competency in CanMEDs, much of the knowledge base essential to this specialty is acquired during other rotations. The chief residency rotation, in contrast, is the best period of time to train and assess several of the other six CanMEDs competencies, especially the Leader role. This document reflects an emphasis on the non-medical expert competencies.

The Chief Resident is expected to be on site at the FMC for the duration of his/her rotation as Chief Resident. The Chief may elect to concurrently participate in another rotation during his/her time as Chief Resident, as long as it is on site (FMC), and does not interfere with his/her ability to perform the Chief Resident duties.

The Chief Resident rotation is mandatory, and the duration is variable (3-6 blocks), depending on the number of residents in the Program. The resident will be evaluated by the Program Director(s), with input from other Faculty.

Objectives Medical Expert The Chief Resident… 1) Is expected to have a good working knowledge of surgical and autopsy pathology, allowing him/her to supervise junior residents and elective students in surgical and autopsy pathology. 2) Will participate in the FMC service schedule on a regular basis (25-50%, unless concurrently pursuing another elective). 3) Will be involved in leading gross pathology rounds with the junior residents on a regular basis. 4) Will organize and project the slides for the weekly CME-Accredited Surgical Pathology rounds. 5) Optionally, will hold a review session after rounds to re-discuss the unknown slides and address any remaining questions, depending on resident interest. Communicator The Chief Resident… 1) Will help to resolve the concerns and issues of the support administrative, and/or medical professional staff, should they involve residents. 2) Will present resident concerns regarding the anatomical pathology program for discussion at the regularly scheduled RTC meetings. 3) Will distribute important announcements, memos, reminders etc. to the residents.

Collaborator The Chief Resident… 1) Should be available to junior residents to answer questions about surgical pathology and autopsy cases 2) Has the option of attending subspecialty rounds at the multi-headed microscope, and participating in the discussion. 3) Works closely with the RTC to make improvements to the program, and ensures that resident issues are followed up appropriately. Leader The Chief Resident…

P a g e | 189 RESIDENCY TRAINING in Anatomical Pathology ______1) Serves a central role in the orientation of new residents and elective students with regards to departmental structure, policies and procedures, and the use of manuals. 2) Schedules resident’s vacation. 3) Attends to the LIS (laboratory information system) related issues of the residents’ room. 4) Prepares the monthly surgical pathology and autopsy duty ROTA (FMC) and call schedule for the residents. 5) Organizes teaching rounds (academic half-day, CPC rounds, gross teaching rounds, etc) and journal club. 6) Records resident attendance at mandatory rounds (Academic Half Day, Surgical Pathology & CPC Rounds 7) Liaises with the Program Director regarding resident issues. 8) Participates in QA meetings as appropriate. 9) Participates in the organization and planning of events such as Resident Research Day, In house Exams (Winter and Spring) and/or the Resident Retreat, as necessary. 10) Assists with the coordination of resident social activities (Outdoor Day, Welcome BBQ, etc.) 11) Notifies the Program Director or RTC of specific program needs (eg. books, equipment, etc.) 12) Keeps an updated database of resident textbooks, as well as the website, username and password for books with online access 13) Assist with preparations for Royal College accreditation and internal review, when they occur

Health Advocate The Chief Resident… 1) Practices and reinforces confidentiality policies and safety procedures in the laboratory as they relate to residents. 2) Promotes a collegial work environment. 3) Helps monitor peers for signs of stress/illness, and offers access to appropriate resources or seeks assistance as required.

Scholar The Chief Resident… 1) Engages in the teaching and assessment of elective students at the FMC. 2) Participates in undergraduate teaching sessions. 3) Follows up teaching sessions by providing additional information or reference material, as necessary.

Professional The Chief Resident… 1) Acts as the Senior Resident Representative on the Residency Training Committee. 2) Represents the residents and Anatomical Pathology Program at Departmental meetings as required. 3) Acts as a resource person for residents (eg. fields questions regarding upcoming exams, departmental policies, support programs, etc.)

P a g e | 190 RESIDENCY TRAINING in Anatomical Pathology ______4) Manages work related conflicts between residents, and reports to program director if necessary. 5) Assists with interviews and the selection process of new residents (CaRMS) and staff.

P a g e | 191 RESIDENCY TRAINING in Anatomical Pathology ______Bone Marrow Pathology Supervisor: Dr. A. Mansoor ([email protected]) Length: 1 block (4 weeks) BM Faculty: Dr. I. Auer Greziak; Dr. T. Rad; Dr. X. Jiang; Dr. C. Teman; Dr. E. Mahe; Dr. T. Fourie; Dr. P. Minoo; Dr. T. Roshan; Dr. A. Shameli and M. Lareau Prerequisites: Successful completion of PGY2 Revised:

Goals & Objectives At the completion of the rotation the clinical trainee is expected to be familiar with the indications for BM biopsy, will understand the methodology regarding slide preparation (push vs. squash), will comprehend the value of additional clinical and laboratory data in the final diagnosis provided to the clinicians, will be able to describe the microscopic findings and appreciate the value of ancillary techniques to the final diagnosis/sub-classification and will be able to suggest additional studies if required to facilitate the interpretation of BM biopsy material.

In addition, the pathology resident will be familiarized with expert, educational and legal aspects of the BM pathology practice. He/she will be able to differentiate various cellular elements of BM microenvironment. It is expected that this four to eight weeks long exposure limited to BM pathology will result in an adequate expertise to independently handle 75% of BM pathology service and appropriately differentiate/triage top 25% complex cases.

In addition, both clinical and pathology trainees will be able to appropriately interpret and utilize data extracted from case relevant research/review papers and will be encouraged to independently pose their own investigative questions/projects.

General expectations: 1. Daily evaluation of cases and designated rounds attendance. 2. Record/log of reviewed BM pathology cases with own and final diagnoses. 3. Residents are required to make formal presentations at Clinical Hematology Tumor Rounds at TBCC. 4. Self-study; regular daily review of teaching slides sets, CD ROM talks/lectures, relevant papers, etc available in the department. 5. Independently select clinically interesting/relevant cases for a review with the pathologist, in order to enhance one’s specialty (Non- malignant pediatric cases / post-transplant BM biopsies, infectious diseases etc) experience. 6. Writing end-of-rotation test, which will include short answer questions and pathology cases evaluation/differential diagnosis discussion (last Friday of the rotation). 7. Participate in module/preceptor evaluation. 8. Maximum one week long vacation/absences, which must be pre-approved by the hematopathology training co-ordinator prior to the start of the elective 9. Residents and Hematopathology Fellow will participate in “on-call” during their rotation for the Hematopathology service 10. Optimal performance on the end of rotation exam.

Specific objectives: Medical Expert/Clinical decision-Maker competencies include: By Week #1: 1. Demonstrates understanding of normal morphology of cells associated with BM microenvironment 2. Understands effective selection of representative slides for review.

P a g e | 192 RESIDENCY TRAINING in Anatomical Pathology ______3. Demonstrates knowledge of histology of a normal bone marrow structure, morphology and hematopoiesis. 4. Understand the clinical indications for a BM aspiration and biopsy procedure. 5. Understand risks associated with BM aspiration and biopsy procedure; possible sites of collection, preparation and handling of BM specimens

6. Understand pre-analytical, analytical and post-analytical factors that can contribute to the quality of BM sample. 7. Understand advantages and limitations of various ancillary studies performed on the BM samples. 8. For Aperio access, contact Tom Kryton to set up an account for you: Thomas Kryton Digital Imaging Specialist, Virtual Microscopy Lab 403-220-8322 [email protected]

Talks/lectures available on G drive: G:\Hemepath Teaching Program\Teaching materials for residents\Bone Marrow\Lectures on PP 1. Normal Histology of BM trephine 2. Diagnostic approaches to BM diagnosis

By Week #2 1. Comprehends value of ancillary techniques/data in interpretation of BM Biopsy 2. Understands the concept and distinct morphologic features of , white cell disorders, platelet disorders, infectious diseases, and ancillary studies used in BM pathology. 3. Understands clinical and morphologic basis of a staging BM 4. Understands principles of diagnostic criteria to differentiate between reactive and neoplastic lymphoid aggregates. 5. Understands differential diagnosis of a ganulomatosis lesion in BM biopsy. 6. Demonstrates skills for an accurate BM differential counts utilizing clinical case

Formal talks/lectures available on G drive: G:\Hemepath Teaching Program\Teaching materials for residents\Bone Marrow\Lectures on PP 1. Ancillary techniques in lymphoma and leukemia. 2. Transformation and molecular basis of cancer 3. Disorder of WBC. 4. Myeloproliferative Disorder (2008 WHO classification)

By Week #3 1. Demonstrate knowledge of spectrum of acute leukemia 2. Understand the principles of morphologic/immunohistochemical and cytogenetics principles of subclassification of acute leukemia, as per WHO classification. 3. Demonstrate knowledge of spectrum of application of ancillary techniques in the diagnostic subclassification of acute leukemia. 4. Understand the principles of morphologic/immunohistochemical and cytogenetic principles of factors in acute lymphoblastic leukemia and acute myeloid leukemia.

P a g e | 193 RESIDENCY TRAINING in Anatomical Pathology ______By Week #4 1. Demonstrate knowledge of spectrum of myelodysplasia 2. Understand the principles of morphologic/immunohistochemical and cytogenetics principles of subclassification of myelodysplasia, as per WHO classification. 3. Understand the differential features among various types of MDS. 4. Demonstrate general understanding of international prognostic indication of MDS and various treatment modalities available for each subtype of MDS. 5. Understand the principles of morphologic/molecular and cytogenetics principles of sub- classification of myeloproliferative neoplasms, as per WHO classification.

Formal talks are available: G:\Hemepath Teaching Program\Teaching materials for residents\Bone Marrow\Lectures on PP a. Diagnosis and classifications of AML, AML, myelodysplastic syndromes and myeloproliferative neoplasms. b. Flow Cytometry, cytogenetic and cytochemical studies in the diagnosis of acute leukemia and other myeloid neoplasms. c. Myeloproliferative disorders: past, present and future.

Communicator General Requirements: 1) Establish effective working relationships with consulting haematologists, oncologists, pathologists and surgeons. 2) Obtain and synthesize relevant clinical history from physicians, electronic and written health records. 3) Listen and respond effectively. 4) Discuss in a timely fashion appropriate information with the health care team. Specific Requirements: 1) Understand the role of a pathology consultant 2) Act as a consultant to clinical colleagues on the interpretation and relevance of pathological findings, with particular regard to their significance in the management of the patient. 3) Understand the role pathologic findings should provide in a given clinical situation and be able to communicate it effectively and in a timely fashion in an oral and written form. 4) Assist in the continuing education of clinicians/pathologists and other members of the health care team. Collaborator General Requirements 1) Consult effectively with other pathologists/clinicians and health care professionals. 2) Contribute effectively to other interdisciplinary team activities. Specific Requirements: 1) Must have experience in neoplastic hematopathology sufficient to achieve a sound understanding of the effects of disease and the role of pathology in clinical management. 2) Demonstrate the ability to advise on the appropriateness of obtaining histologic/ancillary techniques specimens and following examination of these, to advise on further appropriate investigations and management

P a g e | 194 RESIDENCY TRAINING in Anatomical Pathology ______Leader General Requirements: 1) Utilize resources effectively to balance patient care, turn-around-time, and educational/research needs. 2) Allocate finite health care resources wisely. 3) Work effectively and efficiently in a health care organization. 4) Utilize information technology to optimize patient care, life-long learning and other activities. Specific Requirements 1) Demonstrate knowledge of the principles of laboratory management and administration. 2) Demonstrate knowledge of the methods of quality control in the field of neoplastic hematopathology. 3) Demonstrate knowledge of the methods for professional quality assurance as applied to other subspecialty laboratories like flow cytometry, molecular hematology and cytogenetics. 4) Demonstrate competence in basic computer skills with emphasis on automated electronic reporting, electronic communication and search strategies.

Health Advocate General Requirements: 1) Contribute effectively to improved health of patients and communities. 2) Recognize and respond to those issues where advocacy is appropriate. 3) Understand the role of consult pathology in patient’s care Specific Requirements: 1) As members of an interdisciplinary team of professionals responsible for individual and population health care, the consult pathologist will endeavour to ensure that laboratory practices and test selection are regularly evaluated to determine that they meet these community needs. 2) Reinforce to the public and to the profession the essential contribution of laboratory medicine health.

Scholar General Requirements: 1) Develop, implement and monitor a personal continuing education strategy. 2) Critically appraise sources of medical information. 3) Facilitate learning of patients, house staff/students and other health professionals. 4) Contribute to development of new knowledge. Specific Requirements: 1) On completion of the rotation, the resident will be able to: 2) Propose a research question relevant to lymph node pathology. Professional General Requirements: 1) Deliver highest quality patient care. 2) Exhibit appropriate personal and interpersonal professional behaviors. 3) Practice medicine ethnically consistent with obligations of a physician. 4) Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to anatomical pathology.

P a g e | 195 RESIDENCY TRAINING in Anatomical Pathology ______Specific Requirements 1) Act as an appropriate role model for students and others. 2) Demonstrate a professional attitude to colleagues and other laboratory staff. 3) Have an appreciation of the crucial role of the pathologist in providing quality patient care. This will include knowledge of an individual professional limitations and the necessity of seeking appropriate second opinions.

Educational Materials Available: 1. PowerPoint Presentations on the G:/Drive: G:\Hemepath Teaching Program\Teaching materials for residents\Bone Marrow\Lectures on PP a. Presentations available: i. Ancillary Techniques in Lymphoma & Leukemia ii. Biological & Clinical Heterogeneity in CLL iii. BM involvement by NHL iv. Chronic Myeloproliferative – Dr. Mansoor v. Diagnostic approach to BM trephine biopsy vi. MacDonald – Chronic myeloproliferative disorders vii. Myeloproliferative disorder – Dr. Jiang viii. Normal Trephine BM Morphology – Dr. Mansoor ix. Overview of MDS – Dr. Jiang x. Transformation – Basic Information xi. Use of ancillary techniques in the diagnosis and management of Hematolymphoid malignancies xii. WBC Disorders xiii. WHO Classification - myeloproliferative

2. Aperio – Bone Marrow Teaching Set

A wide variety of digitized bone marrow slides are available for residents to review during the rotation.

Digital slides can be accessed as follows: a. Go to http://digitalmicroscopy.ucalgary.ca/ and log in using your user name and password. If you require a user name and password, please contact Thomas Kryton ([email protected]). b. Select courses. c. Select Adult Bone Marrow Teaching Set and select a case of interest to view. d. Additional clinical, laboratory and diagnostic information is available for each case and has been compiled in a spreadsheet (“Adult Bone Marrow Teaching Cases.xls”) which has been emailed to you and can also be found online in the course attachment section of the course in Aperio. Embedded within the first page of the spreadsheet are instructions for how to use the spreadsheet.

End of Rotation Exam The end of rotation exam will consist of the review and reporting of 3 unknown cases. The resident will be provided with digital slides, as well as the clinical history and CBC and will be expected to comment on the morphological features or the case, and provide a diagnosis/differential diagnosis and answer questions pertaining to the case. Instructions for accessing the exam slides will be provided at the time of the exam.

*Note – If you are away on the last day, please arrange an alternate day and time to complete your exam with Laurel.

P a g e | 196 RESIDENCY TRAINING in Anatomical Pathology ______3. Folder with glass slides in Special Hematology Lab

Optional Clinical Training in Bone Marrow aspiration and Biopsy Procedure: Goal: To gain skills; experience and competence in the clinical procedure of performing Bone Marrow aspiration and biopsy at the bedside for the diagnosis of Hematological disorders.

Supervisors: Dr. Karen Valentine; Director of Clinical Hematology fellowship program; will be the overall supervisor for this clinical training. Dr. Adnan Mansoor will assist with all the administrative issues and coordination. Clinical Hematology Faculty with University of Calgary and Calgary Health Region will be the preceptors. Objectives: Observe, learn and obtain “informed consent” from patient for the clinical procedure of Bone marrow aspiration and biopsy. 1) To observe, learn and skillfully apply various techniques used for local for bone marrow aspiration/biopsy procedure. 2) To observe, learn and develop competency (independent or indirect supervision) in performing the bone marrow aspiration and biopsy procedure. 3) To understand and effectively execute the process of “triage” of various samples, required for submission of bone marrow sample for ancillary techniques. Procedure: 1) Resident will coordinate with Hematology technologist at APL laboratory (7th Floor McCaig Tower FMC) to obtain the list of patients scheduled for the procedure. 2) Resident will accompany the Hematology technologist to the specific patient’s bedside and will introduce him/her to physician responsible for the procedure. 3) Resident will observe the entire procedure quietly and attentively. 4) Resident will maintain a log sheet of the patients attended for acquiring the competency for this procedure (including observed; assisted, performed). Please use an extra patient sticker for this log sheet. Resident will also document the name and obtain signatures of the physician responsible for the specific procedure. 5) Minimum of 5-10 procedures are required as “observed”; minimum of 5-10 as “assisted” and at least 5 as independently performed to be considered as competent in performing this invasive procedure. Director of Clinical Hematology fellowship program (Dr. Karen Valentine) will determine the final competency through input from clinical colleagues and will communicate this to Dr. Auer/Dr. Mansoor.

P a g e | 197 RESIDENCY TRAINING in Anatomical Pathology ______Dermatopathology (DSC) Supervisor: Dr. C. Hunter email: [email protected] Length: 1 block (4 weeks) Prerequisites: At least half way through PGY3 training Revised:

General Objectives Medical Expert/Clinical Decision-Maker 1) The resident should demonstrate a basic understanding of… 2) Normal skin anatomy, physiology, biochemistry, and molecular biology 3) Genetic basis for skin disease 4) Normal microscopic appearance of skin at different anatomic sites and patient ages 5) Basic skin ultrastructure: keratinocytes, melanocytes, Langerhans cells, Merkel cells 6) Immunology of the skin 7) Gross dissection of skin specimens 8) Microscopic appearance and pathobiology of common skin disorders 9) Use of immunohistochemistry and immunofluorescence 10) Use of molecular diagnostics 11) Use of special stains

Communicator 1) Listen, and communicate questions and ideas effectively 2) Communicate effectively with laboratory staff 3) Communicate effectively in written form, specifically in pathology reports

Collaborator 1) Contribute effectively to interdisciplinary team activities (communication with dermatologists, attendance at monthly dermatology rounds) Leader 1) Understand important aspects of quality control and quality assurance in dermatopathology

Health Advocate 1) No specific objectives

Scholar 1) Develop a personal continuing education strategy in dermatopathology 2) Propose a research question relevant to dermatopathology, and develop a simple proposal to solve the research question (see specific objectives)

Professional 1) Exhibit appropriate personal and interpersonal professional behavior 2) Act as an appropriate role model to colleagues and laboratory staff 3) Understand the importance of consultation and seeking of appropriate second opinions

Specific Objectives 1) Participate in sign-out of routine dermatopathology cases (senior residents will be given responsibility for dictating reports) 2) Review Consult and Rush cases 3) Participate in review of immunofluorescence cases 4) Regularly participate in afternoon multiheaded microscope rounds 5) Attend monthly Dermatology rounds 6) Review Dermatopathology Course notes and teaching slides

P a g e | 198 RESIDENCY TRAINING in Anatomical Pathology ______7) Prepare a minimum of two personal learning projects on a dermatopathology subject 8) Identify a question, idea, innovation, tip, or pearl from dermatopathology practice 9) Critically appraise the information through a review of the literature and/or discussion with colleagues 10) Assess the application of the learning derived from step 2 to your practice of dermatopathology 11) Propose a research question relevant to dermatopathology, and develop a simple proposal to solve the research question 12) Review pathologists’ personal teaching sets 13) Read and review dermatopathology textbooks and literature to obtain an understanding of common skin inflammatory and neoplastic conditions (see Recommended Areas of Concentration)

Evaluation: The resident will be assessed by each dermatopathologist, and by technical and clerical staff. The Resident Evaluation will be completed by a committee of all dermatopathologists.

Evaluation Methods: Medical Expert Basic science knowledge, diagnostic skills, clinical judgment assessed during sign-out and teaching sessions Slide exam, 15 cases, at end of rotation Communicator, Collaborator, Leader, Professional Assessed during sign-out and teaching sessions and by discussion with other laboratory staff at end of rotation Scholar Assessed by review of Personal Learning Projects and of Research Proposal Recommended areas of concentration during a 4-8 week Dermatopathology rotation Basic tissue reaction patterns 1) Lichenoid 2) Dermatitis herpetiformis 3) Lichen planus 4) Bullous pemphigoid 5) Lichenoid drug reactions 6) Pemphigus 7) Erythema multiforme 8) Granulomatous 9) Lupus erythematosus 10) Granuloma annulare 11) Psoriasiform 12) Sarcoidosis 13) Psoriasis 14) Infectious granulomas 15) Spongiotic 16) Vasculopathic 17) Eczema 18) Leukocytoclastic vasculitis 19) Vesiculobullous Connective tissue disorders 1) Morphea 2) Lichen sclerosus

P a g e | 199 RESIDENCY TRAINING in Anatomical Pathology ______Cutaneous cysts 1) Epidermoid and trichilemmal cysts 2) Steatocystoma 3) Hidrocystoma Panniculitis 1) Erythema nodosum Cutaneous infections/infestations 1) Dermatophyte infection 2) Molluscum contagiosum 3) Herpes virus infection 4) Insect bite reaction 5) Viral warts 6) Scabies Epidermal tumours 1) Seborrheic keratosis 2) Squamous cell carcinoma 3) Lichenoid keratsis 4) Basal cell carcinoma 5) Actinic keratosis 6) Merkel cell carcinoma Melanocytic lesions 1) Lentigo simplex 2) Recurrent nevus 3) Melanocytic nevus 4) Spitz nevus 5) Dysplastic nevus 6) Pigmented spindle cell nevus 7) Halo nevus 8) Blue nevus 9) Malignant melanoma Adnexal tumours 1) Trichoepithelioma 2) Trichofolliculoma 3) Tricholemmoma 4) Pilomatricoma 5) Syringoma 6) Cylindroma 7) Benign mixed tumour 8) Spiradenoma 9) Poroma 10) Hidradenoma 11) Nevus sebaceus Mesenchymal lesions 1) Fibroepithelial polyp 2) Dermatofibroma 3) DFSP 4) Atypical fibroxanthoma 5) Lipoma/angiolipoma 6) Leiomyoma 7) Neurofibroma 8) Hemangiomas 9) Pyogenic granuloma 10) Glomus tumour

P a g e | 200 RESIDENCY TRAINING in Anatomical Pathology ______11) Kaposi’s sarcoma 12) Angiosarcoma Cutaneous infiltrates 1) Metastases to skin 2) Xanthogranuloma 3) Xanthelasma 4) Urticaria pigmentosa 5) Langerhans cell histiocytosis 6) Cutaneous lymphoid hyperplasia 7) B-cell lymphoma 8) Mycosis fungoides

P a g e | 201 RESIDENCY TRAINING in Anatomical Pathology ______Molecular Genetic Pathology Preamble This is a 4 week block consisting of a two week rotation in both Cytogenetics and Molecular Pathology Laboratory. It is the responsibility of the resident to contact the preceptors of each section and inform the program administrator so that the schedule is appropriately updated.

As molecular diagnostic services are distributed between numerous laboratories within APL, the Molecular Pathology elective is short, and focuses solely on tests performed within the Molecular Pathology laboratory. The resident is encouraged to contact the ACH Molecular Genetics, APL Molecular Hematology, APL Cancer Cytogenomics, APL Molecular Microbiology and APL Tissue Typing laboratories for other experiences within the field of molecular diagnostics.

Molecular Pathology Laboratory Site: Molecular Pathology Laboratory (HMRB B23, University of Calgary) Preceptors: Dr. Adrian Box; Robert Winkfein (Lab Scientist) Additional Staff: Dr. D. Itani and Dr. D. J. Demetrick (Lab Director) Length of Rotation: 2 weeks Prerequisites: Successful completion of PGY3 Last Modified: May 2016

General Objectives: During the Molecular Pathology elective, the resident will learn the indications and principles of some of most widely used diagnostic molecular tests including T-cell and B-cell gene rearrangement studies for the diagnosis of lymphoproliferative disorders, detection of specific mutations in key genes in solid neoplasms, detection of gain or loss of genomic material in cancer specimens, genetic comparison of specimens to establish specimen identity and detection of genomic sequences from microbial and/or viral pathogens. The resident will become familiar with a variety of different techniques in performing these studies, and will understand their advantages and limitations. The resident will review all results generated daily from the laboratory with the technologists, and/or laboratory scientist or sign-out pathologist. He/she will obtain experience in performing a polymerase chain reaction (PCR) assay. The resident also will learn the principles and techniques used to prevent contamination within a diagnostic molecular laboratory.

At the completion of training, the resident will have acquired the following competencies and will function effectively in the following CanMEDS roles: 1) Understand the basic principles, advantages, and limitations of various molecular diagnostic techniques commonly used in diagnostic molecular pathology laboratory including: a) Nucleic acid isolation and purification from blood/fluids/tissue. b) Polymerase chain reaction (PCR)-based assays. c) Specialized detection methods for PCR products. d) Principles of nucleic acid sequencing. 2) Be familiar with the common clinical applications of these techniques: a) Diagnosis (One or more of establishment of clonality in lymphoid cells, sub-classification of lymphoma by translocation analysis, prediction of clinical response to drugs thorough the identification of specific genomic biomarkers, evaluation of potential specimen tissue contamination or misidentification, evaluation of pathogen genomic markers). b) Quality control/assurance in molecular pathology 3) Be familiar with how reports are generated in a timely and accurate fashion for optimal patient management/treatment 4) Learn the need to obtain appropriate specimens for molecular studies. 5) Participate effectively and appropriately in an interprofessional health care team 6) Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict.

Specific Objectives:

P a g e | 202 RESIDENCY TRAINING in Anatomical Pathology ______Medical expert 1) Understand human and the expression of genetic information to functional molecules, including proteins and regulatory RNA molecules 2) Understand the principles of nucleic acid testing. 3) Understand the concepts of nucleic acid hybridization, amplification and dideoxy nucleotide sequencing (Sanger) 4) Understand the principles, advantages and limitations of polymerase chain reaction (PCR) assays a) Be familiar with methods for the performance of PCR reactions b) Be familiar with the common clinical applications of PCR based assays including mutation and polymorphism testing. c) Be familiar with the latest technologies in detecting and/or quantifying PCR products, and their clinical applications 5) Understand the issue of contamination in a molecular diagnostic laboratory, and measures taken to minimize contamination 6) Understand the design considerations of a molecular diagnostic laboratory 7) Understand the current and potential role of molecular diagnosis in maintaining wellness, disease detection, accurate and early diagnosis, predicting progression and predicting clinical response to treatment

Communicator 1) Communicate effectively and demonstrate caring and respectful behavior when interacting with medical colleagues, and technical staff 2) Obtain and discuss appropriate information with staff pathologists and clinicians in difficult cases 3) Accurately convey relevant information and explanations to colleagues and other professionals

Collaborator 1) Work as a part of a multidisciplinary team in the management and treatment of patients 2) Demonstrate a commitment to their patients, profession, and society through participation in profession-led regulation

Leader 1) Demonstrate knowledge of the methods of quality control in a molecular pathology lab 2) Allocate finite healthcare resources appropriately

Health advocate 1) Recognize how technological advances in molecular biology may apply to improvement in diagnostic pathology 2) Respond to individual patient health needs and issues as part of patient care 3) Acquire appropriate QA/QC knowledge to ensure patient safety and accuracy of medical reports

Scholar 1) Develop and implement a personal continuing educational strategy 2) Apply the principles of critical appraisal to sources of medical information 3) Contribute to the development of new knowledge through research 4) Participate in rounds, conferences and teaching sessions when applicable. 5) Critically evaluate information and its sources, and apply this appropriately to practice decisions 6) Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices

Professional 1) Deliver the highest quality of care with integrity, honesty and compassion 2) Practice medicine in an ethical manner and with a sensitivity to diverse patient populations

P a g e | 203 RESIDENCY TRAINING in Anatomical Pathology ______3) Exhibit appropriate professional behavior and perform duties in a dependable and responsible manner 4) Demonstrate commitment to excellence and ongoing professional development 5) Demonstrate a commitment to their patients, profession, and society through ethical practice

Educational program 1) Time allocation: a) Reading time 2-4 hours per day b) Performing or assisting in diagnostic procedures 2-4 hours per day c) Discussion and interpretation of results 1 hour per day

2) Recommended reading from approved textbooks (below). The recommended readings listed here are good starting points for an introduction into molecular diagnostics. The listed references at the end of each chapter allow for a deeper investigation into each topic and are excellent sources of information. The trainees must familiarize themselves with the appropriate benchtop technique prior to observing it. a) Molecular biology and nucleic acid biochemistry theory. b) Setup of the Molecular Diagnostic Laboratory. c) Extraction of DNA from clinical samples. d) The Polymerase Chain Reaction. e) PCR for detection of Clonal Rearrangements in Lymphoma.

3) Benchtop Technical Curriculum (desired but dependent on assays performed that particular week). a) Observe nucleic acid extraction and purification process b) Observe nucleic acid quantitation process c) Observe PCR assay setup, thermal cycler programming and amplicon detection d) Observe Microsatellite marker analysis e) Observe interpretation and reporting of test results performed the week of the elective.

4) Interpretation of Results (dependent on assays observed previously) a) IgH Rearrangement b) TCR Rearrangement c) Bcl-2 Translocation d) Microsatellite Identity Testing e) Mutation Detection f) Pathogen Genome Detection

Educational materials (These books are available in the Molecular Pathology Laboratory, HMRB B23) 1) Molecular Pathology in Clinical Practice, 2nd Edition. Debra G.B. Leonard. Feb 2016. 2) Cancer: Principles and Practice of Oncology: Primer of the Molecular Biology of Cancer. Vincent T. DeVita Jr., Theodore S. Lawrence, Steven A Rosenberg. 2015. 3) Diagnostic Molecular Pathology: A Guide to Applied Molecular Testing. William B. Coleman and Gregory J. Tsongalis. Nov 2016.

Evaluation 1) Satisfactory completion of this elective will depend on appropriate attendance at technical procedure demonstrations, as well as appropriate background reading as judged by either the Lab Scientist, Molecular Pathology; the Lab Director, Molecular Pathology; or other designated preceptor.

These objectives were harmonized with those of the Department of Pathology and Laboratory Medicine, University of Alberta.

P a g e | 204 RESIDENCY TRAINING in Anatomical Pathology ______Cancer Cytogenetics Site: Diagnostic Scientific Centre – 3535 Research Road NW Preceptors: Dr. Fariborz-Kolvear Additional Staff: Length of Rotation: 2 weeks Prerequisites: Successful completion of PGY3 Last Modified: ?? 2019

Overview

Objectives

P a g e | 205 RESIDENCY TRAINING in Anatomical Pathology ______Molecular Hematology Site: Diagnostic Scientific Centre – 1E-421 Preceptors: Faisal Khan, PhD Additional Staff: Meer-Taher Shabani Rad Length of Rotation: 1 week Prerequisites: Successful completion of PGY3 Last Modified: 2019

General Objectives: Molecular Hematology laboratory plays a key role in the diagnosis and management of various malignant and non-malignant disorders. This laboratory also provides critical information regarding the clinical management of bone marrow transplant patients. Trainees will have one week rotation in the laboratory to observe the molecular techniques currently being carried out in the laboratory that employ immunologic assays (ELISA, binding assays, Western blotting), or polymerase chain reaction (whole blood PCR, reverse transcription directed PCR, real-time PCR and inverse PCR) for: 1. detection of mutations and carrier determination in disorders of hemostasis and thrombosis, 2. the molecular detection and monitoring of abnormal fusion gene transcripts in , 3. detection of mutations in signalling proteins with prognostic value in AML, 4. JAK-2 mutations in chronic MPDs and 5. the determination of blood cell chimerism after bone marrow/PBSC transplantation. For those assays not currently running in the laboratory, the resident will review assay theory, procedures, and previous results with the laboratory director. This rotation will provide opportunity to have a broader understanding of technical aspects, clinical application, and appropriate use/ limitations of molecular techniques in the diagnosis and clinical management of various hematologic disorders. The resident/fellow will also participate in a sign out session of Molecular Hematology. During this session a hematopathologist//hematologist and laboratory director will review all the molecular hematology results of the week. The clinical application, appropriate subsequent testing and advice to clinician will be discussed and the report will be finalized in the light of available clinical information and additional assay performed in various other laboratories.

General expectations: 1. Daily meeting with laboratory section head 2. Daily visit to molecular hematology laboratory and observation of advance molecular testing protocols 3. Participation in at least one molecular sign-out session with consulting hematopathologists 4. Self study, regular review of supplied review papers and powerpoint presentations or other publications/learning materials 5. Write a final quiz consisting of 25 multiple choice and short answer questions relating to molecular protocols and role of molecular testing in diagnosis and monitoring of hematologic disease 6. Participate in module preceptor evaluation

Specific Objectives: At the conclusion of the training week, the trainee will be familiar with and will acquire an understanding of the following competencies:

Medical expert/Clinical decision-maker General Requirements:

P a g e | 206 RESIDENCY TRAINING in Anatomical Pathology ______1. Demonstrate understanding of the value of molecular technologies in diagnosis and therapeutic monitoring of patients with hematologic diseases 2. Demonstrate a knowledge of principles of DNA and RNA based molecular assays 3. Demonstrate a knowledge of principles of advanced immunologic based assays

Specific Requirements: 1. Understand the concepts and distinct features of: a. von Willebrand disease and its classification by vWF multimer gel analysis b. inherited risk factors for thrombosis and corresponding clotting factor gene mutation/polymorphisms c. type 2N vWD vs. mild hemophilia A d. carrier determination in hemophilia A and B e. alpha thalassemia and alpha globin gene deletions f. molecular abnormalities in leukemias and chronic myeloproliferative disorders such as PV, ET and IMF; and residual disease detection by molecular methods g. cell signalling pathway gene mutations as prognostic indicators in acute leukemias such as AML h. hematopoietic cell chimerism after BM/PBSC transplantation and its detection by PCR STR and real-time PCR InDel analyses 2. Awareness of appropriate use of molecular testing and ethical and medical/legal implications of molecular DNA screening assays in a family setting 3. Appreciate the important role of quality assurance in the molecular laboratory 4. Understand the limitations of molecular data

Communicator

General Requirements: 2. Establish effective working relationships with consulting hematologists/ oncologists/pathologists and staff in other specialized laboratories 3. Obtain and synthesize relevant clinical history from physicians, electronic and written health records. 4. Listen and respond effectively. 5. Discuss, in a timely fashion, appropriate information with the health care team.

Specific Requirements: 1. Understand the role of a pathology consultant with respect to molecular testing 2. Act as a consultant to clinical colleagues on the interpretation and relevance of molecular data, with particular regard to their significance in the management of the patient. 3. Understand the role molecular data should provide in a given clinical situation and be able to communicate it effectively and in a timely fashion in an oral and written form. 4. Assist in the continuing education of clinicians/pathologists and other members of the health care team particularly with respect to appropriate use/ordering of advanced molecular testing.

Collaborator General Requirements:

1. Consult effectively with other hematopathologists/clinicians and health care professionals. 2. Contribute effectively to other interdisciplinary team activities including BMT group, adult and pediatric bleeding disorders clinics, and other CLS specialized laboratories.

Specific Requirements: 1. Must have sufficient exposure to advanced molecular methods and use/limitations of molecular data to achieve a sound understanding of the role of molecular technologies in clinical management.

P a g e | 207 RESIDENCY TRAINING in Anatomical Pathology ______2. Demonstrate the ability to advise on the appropriateness of molecular testing and following examination of these, to advise on further appropriate investigations and management 3. Understand and communicate effectively to other health professionals the medico/legal implications of gene based screening in a family or population based setting

Leader General Requirements: 1. Utilize resources effectively to balance patient care, turn-around time, and educational/research needs 2. Allocate finite health care resources wisely 3. Work effectively and efficiently in a health care organization 4. Utilize information technology to optimize patient care, life-long learning and other activities

Specific Requirements: 1. Demonstrate knowledge of the principles of laboratory management and administration particularly with respect to operation of a molecular laboratory 2. Demonstrate knowledge of the methods of quality control in the field of molecular pathology, particularly with respect to PCR based methodologies 3. Demonstrate knowledge of the methods for professional quality assurance as applied to advanced immunologic and DNA/RNA based technologies and the role of external surveys, variance reporting/tracking and other QA programs 4. Demonstrate competence in basic computer skills with emphasis on automated electronic reporting, electronic communication and search strategies

Health Advocate General Requirements: 1. Contribute effectively to improve the health of patients and communities 2. Recognize and respond to those issues where advocacy is appropriate 3. Understand the role of consult pathology in patient’s care

Specific Requirements: 1. As members of an interdisciplinary team of professionals responsible for individual and population health care, the consult pathologist will endeavour to ensure that laboratory practices and test selection are regularly evaluated to determine that they meet these community needs 2. Reinforce to the public and to the profession the essential contribution of laboratory medicine to health

Scholar

General Requirements: 1. Develop, implement and monitor a personal continuing education strategy 2. Critically appraise sources of medical information 3. Facilitate learning of patients, house staff/students and other health professionals 4. Contribute to development of new knowledge

Specific Requirements: 1. Show proficiency in utilizing electronic access to medical literature in researching a given topic in and show familiarity with use of PowerPoint or similar software for preparing a seminar presentation on that topic

Professional

General Requirements: 1. Deliver highest quality patient care

P a g e | 208 RESIDENCY TRAINING in Anatomical Pathology ______2. Exhibit appropriate personal and interpersonal professional behaviors 3. Practice medicine ethnically consistent with obligations of a physician 4. Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to molecular pathology

Specific Requirements: 1. Act as an appropriate role model for students and others 2. Demonstrate a professional attitude to colleagues and other laboratory staff 3. Have an appreciation of the crucial role of the pathologist in providing quality patient care including; knowledge of an individual professional limitations and the necessity of seeking appropriate second opinions/ opinions of specialists from other disciplines

Sample Schedule in Molecular Hematology: Day Time Topic Objectives Details Tour of Familiarity with the Lab layout Monday 9:00 – Molecular department’s physical PCR/non-PCR areas 12:00 Hematology location and services Overview of molecular services and work centres Laboratory offered Other department interactions Training schedule Introduction to Staff Planned testing vs case reviews Reference materials: Review of training program Procedure manual Selected journal publications Laboratory Review of the types of Biohazards Hazards and laboratory hazards present UV light Safety in the laboratory and the Cryogenics regulations in place to Radioisotopes ensure visitor and staff HV Equipment safety including use of PPE Working with PCR products and lab policies Basis of Review of cell biology Review: Molecular principles as they relate to Cell structure and Gene organization Diagnosis molecular testing Properties of DNA/RNA Regulation of gene expression DNA mutations, sequence variations, identity Proteins Cell signaling Laboratory Detailed laboratory services Clients Test Menu and test menu review Procedure manual and GTS listing Hemostasis and oncology service, volumes and TAT

P a g e | 209 RESIDENCY TRAINING in Anatomical Pathology ______Day Time Topic Objectives Details Monday 13:00- Hemostasis Blood clotting, acquired and Review: (cont’d) 16:30 Principles inherited disorders of Primary/secondary hemostasis hemostasis Vascular and circulating components Central role of thrombin in regulation of pro- coagulant and anti-coagulant pathways Inherited defects in coagulation Inherited and acquired risk factors for deep vein thrombosis Hemophilia Specimen requirements, receipt and Diagnosis assay methodology and Carrier vWD 2N FVIII binding assay Observe: assay technique and data Determination analysis. Reporting format and Pathnet Mild QC/QA Hemophilia A Assay principles and set-up or vWD 2N? Reagents and methodology

Case study: Data analysis and interpretation Use in Hem A carrier determination QC/QA Assay principles and set-up Reagents and procedure review Appropriate use of testing Case study: Interpretation and limitations QA/QC issues VWD Sub- vWF multimer analysis Review: typing Assay principles and set-up Appropriate use of testing Discussion of technique Case study: Interpretation and limitations of results QC/QA issues

P a g e | 210 RESIDENCY TRAINING in Anatomical Pathology ______Day Time Topic Objectives Details Tuesday 9:00- DNA- based Review of DNA-based Review: 11:00 Assays Assays DNA structure, melting, Tm, absorbance Specimen handling and DNA extraction and DNA biochemical properties quantification Observe: Specimen requirements and Specimen receipt and DNA extraction procedure for processing DNA testing Review: Qualitative assays Hybridization standard PCR assay Restriction enzyme digestion Gel electrophoresis Allele specific PCR Detection methods Real time PCR theory Limitations, sources of error 11:00- Inherited Risk Thrombosis risk testing Review: 12:00 Factors for Inherited defects in coagulant proteins resulting in Thrombosis increased rsik for DVT functional testing: APC (I) resistance whole blood PCR method theory

Observe: WB PCR method procedure and equipment (FV and FII assays)

Inherited Risk Case study FV Leiden and Case study: Factors for FII polymorphism Discuss data interpretation and QC/QA issues Thrombosis (II) 13:00- Alpha Multiplex PCR testing for Review: 14:00 Thalassemia alpha globin gene deletions Alpha thalassemia and gene defects. PCR method Reagents and equipment Case study: Limitations and sources of error QC/QA issues Gene conversion events.

P a g e | 211 RESIDENCY TRAINING in Anatomical Pathology ______Tuesday 14:00- Prognostic DNA-based testing for Review: (con’t) 16:30 indicators in mutations in FLT3, NPM1 Role of FLT3 and NPM1 proteins in cell signalling AML genes PCR methodology AML in children and adults: Karyotypically normal Role of new technologies: population NGS Case Study: Screening for mutations in acute leukemia QC/QA issues and test sensitivity

Day Time Topic Objectives Details Wednes 9:00-10:00 Molecular Observe reporting of Entry into electronic lab system etc day sign outs molecular results

10:30- RNA- based Review of RNA-based Review: 11:00 Assays Assays RNA species, stability, primary and secondary structure Types and biochemical RNA liability, RNAse inhibitors properties of RNA Manual and automated methods cDNA reactions Specimen handling and Primary and nested PCR detection methods processing Quantitative Real-time PCR Reagents and equipment RNA extraction and Assay set up, standards etc quantification Computer data analysis Limitations and sources of error Qualitative PCR assays

Quantitative PCR Assays 11:00- Molecular Translocations in leukemia Review: 12:00 Oncology CML/ALL, APL, and other Translocations and gene fusions AML Cellular consequences

P a g e | 212 RESIDENCY TRAINING in Anatomical Pathology ______13:00- Minimal Molecular assays for fusion Review: 16:40 Residual genes BCR-ABL1 and PML-RARA fusion gene assays by Disease nested PCR Detection (I) Qualitative assays Observe:

Specimen receipt, processing, and RNA extraction

and storage

Equipment and assay reagents MRD (II) RT directed, nested PCR Case study:

M-bcr and m-bcr translocation identification Data interpretation and reporting Appropriate use of testing MRD assay Quantitative, real time PCR Review: (III) Q-PCR theory Assay reagents, controls and standards Data interpretation and sources of error Monitoring RT-directed Q-PCR for Review: Cancer BCR-ABL1 fusion gene Assay reagents and set-up Therapy transcripts reverse transcription reaction PCR controls Observe: M-bcr PCR assay set-up Case study: Data interpretation and report generation

* Residents are expected to attend Hematol Rounds 12:00-1:00, TBCC Auditorium (CC104)

Day Time Topic Objectives Details Thursday 9:00-12:00 Chronic Review of PV, ET, IMF Review: Myeloproliferative Role of new technologies: Diagnostic challenges Disorders NGS Laboratory testing Mutations JAK2 V617F Real time PCR allelic Review: Screening Assay discrimination assay protocol Theory of allelic discrimination PCR Fluorescent probes and assay set up Assay procedure and data Data interpretation and reporting analysis Sources of error and QA/QC Observe: Sample manipulation Assay set-up and run Equipment operation QC/QA and sources of error

P a g e | 213 RESIDENCY TRAINING in Anatomical Pathology ______Day Time Topic Objectives Details Case study: Raw data analysis Report Generation and interpretation 13:00-16:30 Chimerism STR PCR Assay Observe: Assessment DNA banking Specimen manipulation Capillary analyzer overview Electropherogram interpretation Case study: Complete, mixed and no chimerism examples Flow sorted cells and chimerism determination

12:00 – 16:00 Academic Half Day - Adult Hem & Ped Hem/Onc Residents - AWAY

* Residents are expected to attend Hematol Rounds 12:00-1:00, DSC exec 268

08:00 - 12:00 Academic Half Day - AP & GP Residents - AWAY Friday 9:00-12:00 QA and QC QA/QC issues in the Molecular Review: Laboratory Pre-analytic, analytic and post- analytic errors Incident reporting 13:00-15:00 Short Quiz Assessment of trainee 25 Short answer/multiple choice understanding of molecular question quiz techniques and their role in diagnosis and monitoring of hematologic diseases 15:00-16:30 Quiz Answers Review of quiz answers with Quiz review: trainee and feedback session Question and answer session Review of trainee feedback

NOTE: Although this chart outlines the anticipated schedule for rotation through the Molecular Laboratory, the actual testing schedule is determined by specimen volume and batching. Therefore, the timing and amount of laboratory observation must remain flexible during the rotation week. Ample time will be provided for case study review with the Laboratory Director, for those procedures not currently carried out in week of rotation.

P a g e | 214 RESIDENCY TRAINING in Anatomical Pathology ______Section 7.3: Elective Rotations

Program Policy: Sub-Specialty Elective Booking SCOPE: All residents enrolled a Residency Training Program, in the Department of Pathology and Laboratory Medicine, University of Calgary.

PURPOSE: Due to the collective number of residents in the Department of Pathology and Laboratory Medicine it has been decided that there be a standard guideline developed for residents wishing to book sub-specialty rotations/electives.

REQUIREMENTS:  Timing for elective requests: electives for the academic year should be booked as soon as possible and no less than 3-6 months in advance. Some last minute requests can be accommodated but will be based on availability.  PROCEDURE: 1. Resident will consult the master rotation schedule located at: G:\Residents\Resident Resources\Schedules\2017-2018\2017-2018 Resident & Fellow Rota.xlsx

2. Identify elective blocks in your schedule

3. Determine which electives are available for that block a. Sample List of Available “in-house” electives (consult this manuals table of contents for a complete list):  Gyne  Cardiovascular  GI  Lymphoma  Medical liver  Molecular  Medical kidney  Surg Path DSC  Breast  Dermpath  Bone & Soft Tissue  Head & Neck  Endocrine  Lung b. Other External electives: outside electives are always available to the resident. You will need to check the license eligibility with PGME office and in the institute you are requesting for an elective (this historically can take a long time so extra time is needed to plan). This process can vary from institution to institution so be sure to keep this office in the information loop so that any required correspondence can be generated.

4. Consult the Goals and Objectives document for your chosen prospective elective within this manual for preceptor’s contact information.

5. Contact the preceptor (in the case of head/neck or liver the whole subspecialty group must be contacted) by email to request the elective and be sure to include the following information in your request: a. Block # and dates of block. Eg) Block 9, Feb 12 – Mar 11, 2018 b. If there is ‘space’.

Sample email: Good Morning Dr. ____ I have checked the schedule for the (insert years) academic year and there is nobody on the _____ rotation for block 9 (February 12-March 09). I have checked with Cass and she has indicated that there is space for me to be

P a g e | 215 RESIDENCY TRAINING in Anatomical Pathology ______accommodated at FMC. So I was wondering if I can take this block for my rotation before anybody else asks for it. Thanks,

6. Ensure that the final approval is forwarded and/or cc’d to Cassandra (and your home program’s Program Administrator if General Pathology, Neuropathology or ) so that the master rotation schedule and One45 webeval is updated appropriately.

7. Contact the preceptor no less than 2 weeks before the start of your rotation to check in with them and receive any additional instructions for the first day of the block.

Page | 216 RESIDENCY TRAINING in Anatomical Pathology ______Bone and Soft Tissue Pathology (FMC) Preceptors: Drs. Mara Caragea, and Doha Itani Duration: 4 weeks (not to be shared with other subspecialties/duties) Prerequisites: Successful completion of first half of PGY3 Preference will be given to rotation requests outside of the Christmas/New Year holiday period Rotation Contact: Dr. Mara Caragea [email protected] Last Updated: February, 2018 by M. Caragea

Summary: This four week elective is designed to provide an overview to bone and soft tissue (BST) pathology, with an emphasis on tumor pathology. Throughout the elective, the resident is expected to review, report and discuss all incoming consultations with the BST pathologist on service, attend the multi- headed microscope sessions and TBCC Sarcoma Rounds (weekly), study the available slide sets, and review reading materials related to bone and soft tissue pathology. The resident is also expected to present at (at least) one of the TBCC Sarcoma Rounds during his/her rotation. The resident should also be grossing all soft tissue/bone cases that come through the FMC Department during his/her elective.

Objectives: Medical Expert: 1) to become familiar with the pathological features of common soft tissue abnormalities, including tumors of the following categories: fibroblastic, fibrohistiocytic, adipocytic, vascular, perivascular, smooth/skeletal muscle, nerve sheath, and other (synovial sarcoma, epithelioid sarcoma, undifferentiated sarcoma) 2) to become familiar with the pathological features of common bone tumors in the following categories: osteogenic, chondrogenic, fibrogenic, osteoclastic giant cell rich, notochordal, and miscellaneous/undefined (fibrous dysplasia, cysts of bone, and Ewing sarcoma) 3) to become familiar with the pathological features of common non-neoplastic conditions of bone, including: osteomyelitis, osteoarthritis, rheumatoid arthritis, gout, pseudogout, osteonecrosis, osteomalacia, and osteoporosis 4) to become familiar with the 2013 WHO Classification of Bone and Soft Tissue Tumors 5) to become familiar with the French Federation Grading System for soft tissue tumors 6) to develop an approach to classifying osteosarcoma and grading 7) to gain experience with the gross features, cutting, sampling, and photographing of fresh bone and soft tissue specimens 8) to gain practical knowledge of the application of immunohistochemistry as it relates to bone and soft tissue pathology (see provincial guidelines for IHC use) 9) to gain practical knowledge of the molecular approaches to the diagnosis of bone and soft tissue lesions 10) to become familiar with the accessing and correlating of radiographic images with bone and soft tissue lesions

Communicator: 1) to communicate effectively with the rotation preceptors, support staff, and sarcoma team, as necessary. This will be done both informally (verbal, email, etc.) and through the use of formal presentations or surgical pathology reports.

Collaborator: 1) the resident will contribute to the understanding of the pathological findings and therefore the treatment of the patient through interaction with the sarcoma “team” (through direct communication and via presentation at rounds)

Page | 217 RESIDENCY TRAINING in Anatomical Pathology ______2) the resident will assist in obtaining intradepartmental consultations as appropriate

Leader: 1) the resident will effectively utilize information technology to optimize patient care, facilitate communication, and document self-learning 2) the resident will manage time effectively and prioritize learning opportunities so as to meet the objectives of the rotation within the given time allotment

Health advocate: 1) the resident will demonstrate understanding and compliance with safety guidelines while in the gross room (particularly with reference to the bone saw)

Scholar: 1) the resident will recognize or acknowledge major areas of weakness in this specialty area, and will address them through self-learning 2) the resident will facilitate the learning of others with regards to soft tissue and bone pathology by sharing and/or presenting appropriate cases at gross rounds, surgical pathology rounds, and/or Sarcoma Rounds 3) the resident will search the literature for up-to-date reviews on unfamiliar entities

Professional: 1) the resident will demonstrate appropriate professional behavior during the elective, including timeliness, respect for others, protection of confidentiality of patient information, etc.

Evaluation: A short, informal slide and written examination will be administered at the end of the rotation. Dr. Caragea will complete an ITER (upon consultation with the rest of the BST group) at the end of the rotation.

Page | 218 RESIDENCY TRAINING in Anatomical Pathology ______General Hematology & PBS Morphology Duration: 3 weeks Prerequisites: Successful completion of first half of PGY3 Rotation Dr. Thomas Fourie, M.D., FRCPC; [email protected] Contact/Supervisor: Ph: (403) 944-8714 Last Updated: September 2017

Preceptors: Meer-Taher Shabani-Rad, MD, FRCPC Carolin Teman, MD, MS, FCAP Hematopathologist/Clinical Section Chief Surgical Pathologist and Hematopathologist Room 7526, FMC McCaig Tower 7th Floor Room 7557, FMC McCaig Tower 7th Floor Ph: (403) 944-4754 Ph: (403) 944-8503 [email protected] [email protected]

Adnan Mansoor, MD, FCPS, FRCPC, FCAP Etienne Mahe, MD, FRCPC, FCAP Hematopathologist Hematopathologist Room 7522, FMC McCaig Tower 7th Floor Room 7523, FMC McCaig Tower 7th Floor Ph: (403) 944-4232 Ph: (403) 944-5290 [email protected] [email protected]

Xiu Yan Jiang, MD, Msc, FRCPC Parham Minoo, MD, PhD Hematopathologist Clinical Assistant Professor Diagnostic and Scientific Center Rm. 7563, FMC McCaig Tower, 7th Floor 1E-411 9-3535 Research Rd NW 1403-29th Street NW, Calgary, AB, T2N 2T9 Ph: (403) 770-3548 Ph: (403) 944 4570 [email protected] [email protected]

Afshin Shameli, MD, PhD Tariq Roshan, MD, PhD, FRCPC, M.PATH Hematopathologist Hematopathologist Rm. 7527, FMC McCaig Tower, 7th Floor Rm. 7568, FMC McCaig Tower, 7th Floor 1403-29th Street NW, Calgary, AB, T2N 2T9 1403-29th Street NW, Calgary, AB, T2N 2T9 Ph: (403) 944 6625 Ph: (403) 944-6601 [email protected] [email protected]

Brenda Wood, MLT III General Hematology Lab FMC McCaig Tower 7th Floor Laboratories Ph: (403) 944-1608 [email protected]

GOALS & OBJECTIVES

Peripheral blood smear morphology is often the first line tests of a patient with haematological signs and symptoms. From these tests, most of the more specialized hematology tests follow. Remember that although the patient is not physically present, each laboratory request is a bona fide patient consultation,

Alberta Public Laboratories performs approximately 2,000 complete counts per day, of which the cell counter, according to present parameters, flags approximately 6% of the samples. A laboratory technologist then reviews the samples, with special attention to blood cell morphology. A laboratory technologist may then refer the smear to a hematopathologist, or it may comply with the criteria that are specified in the standard operating procedures for referral to

Page | 219 RESIDENCY TRAINING in Anatomical Pathology ______a hematopathologist.

The general hematology rotation also includes exposure to screening of G-6PD and Pyruvate kinase deficiencies, Eosin-5-maleimide flow cytometry for hereditary spherocytosis, ESR and body fluid cytospin.

Objectives & Learning Outcomes (CANMED Guidelines):

Medical Expert/Clinical Decision Maker:

 Use correct terminology in description of cells and understand the clinical significance of morphologic findings and quantitative abnormalities  Principles of current technology of cell counters  Erythrocyte sedimentation rate  Principles of cell staining  Red cell morphology and clinical relevance, including red cell inclusions, thalassemia, haemolytic and red cell enzymopathies  Normal white blood cell morphology and development as well as reactive cell morphology  Neoplasia of the lymphocyte lineage  Neoplasia of the granulocyte lineage  Granulocyte dysplasia  Hereditary granulocyte and lymphocyte morphologic abnormalities  Platelet abnormalities – hereditary and acquired  Know the laboratory methods in the workup of haemolytic anemias, including membrane defects and enzyme deficiencies.

Communicator:

 Develops skills in application of clinical history for interpretation of PBS specimens from patients of varied ages and clinical settings.  Gains experience in dealing with abnormal finding of PBS specimens.  Communication with technical staff and the extent of information could be acquired from them.  Communicates and shares insights with the multidisciplinary teams.

Collaborator:

 Collaborates with laboratory colleagues and other health care personnel.  Collaborates with outside physicians for follow up and continued management.  Collaborates in different clinical settings to optimize the diagnostic results.

Leader:

 Learns to manage a laboratory

Health Advocate:

Page | 220 RESIDENCY TRAINING in Anatomical Pathology ______ Learns to become an advocate to involve and improve the diagnostic achievements by laboratory methods.

Scholar:

 Research the subjects that are listed under medical expert/decision maker  Is encouraged to review the literature on a topic of interest in order to give a presentation toward the end of the rotation.  Learns about the structure of clinical laboratory, the value of laboratory results and laboratory research in the management of patients.

Professional:

 Conducts himself/herself in a professional manner, demonstrating respect for the confidentiality and dignity of patients and their families.  Demonstrates knowledge of his/her limitations.  Accepts guidance and supervision from members of the multidisciplinary team.  Recognizes the ethical and legal issues related to clinical laboratory services.

Learning Outcomes: At the end of this rotation the resident will understand:

Technology  Know the principles of current technology of cell counters.  Understand the principle and limitations of the erythrocyte sedimentation rate  Peripheral blood cell morphology and quantitative changes  Use correct terminology in description of cells and understand the clinical significance of morphologic findings and quantitative abnormalities  Know red cell morphology and the clinical relevance of abnormal morphologic findings including red cell inclusions, thalassemia, haemolytic anemias and red cell enzymopathies  Know normal white blood cell morphology and development as well as reactive cell morphology  Identify and classify neoplasia of the lymphocyte lineage  Identify and classify neoplasia of the granulocyte lineage  Identify and describe granulocyte dysplasia  Identify and describe hereditary granulocyte and lymphocyte morphologic abnormalities  Identify hereditary and acquired platelet abnormalities  Microorganisms and parasites in the blood  Identify bacterial and parasitic infections  Body fluids  Understand the principle of cytocentrifuge  Be able to identify neoplastic cells in fluids  Hemolytic anemias and abnormalities of globin chain synthesis  Have a general approach to investigate haemolytic anemias  Know the principles of the tests for red cell membrane defects and red cell enzyme deficiencies

Page | 221 RESIDENCY TRAINING in Anatomical Pathology ______

Suggested Reading:  Blood Cells: A Practical Guide, 4th Edition, by Barbara J. Bain  Practical Hematology, 10th Edition, Lewis SM, Bain BJ, Bates L  Color Atlas of Hematology, College of American Pathologists  Color Atlas of Body Fluids, College of American Pathologists  For Aperio Access, contact Tom Krypton to set up an account for you: Thomas Kryton Digital Imaging Specialist, Virtual Microscopy Lab (403) 220-8322 [email protected]

Notes: In addition to the monthly schedule provided for general hematology in advance, the following training sessions will be arranged based on patient’s appointment.

1) The resident on general hematology rotation will attend the weekly hemoglobin electrophoresis sign out sessions with hematopathologist on service (Usually Thursday mornings X 4). 2) One session training (1 hour) on technical aspects of HPLC and Gel electrophoresis by special hematology staff (Coordinator: Donna Grisak). 3) One session training (1 hour) to observe technical aspects of screening test for PK deficiency by special hematology staff (Coordinator: Donna Grisak). 4) One session training (1 hour) to observe technical aspects of screening Sickle test and assay for G6PD deficiency by general hematology staff (Coordinator: Julie Strorozhenko). 5) One session training (1 hour) to observe Osmotic fragility test, hemolysis curve and the interpretation of results (Coordinator: Donna Grisak). Self-schedule 2-day molecular pathology exposure with Robert Hay (Tel# 220-4240) at the Molecular Pathology is strongly recommended. A detailed weekly schedule is available in a separate manual for residents prior to commencement of this elective.

Page | 222 RESIDENCY TRAINING in Anatomical Pathology ______Sample PBS Weekly Schedule

WEEK 1

Monday, Sep 25 Tasks for the Day – 9:00 to 16:30 Assigned To  Arrange a lab session: Beckman Coulter and PBS staining - Contact

Brenda Wood (944-1608)  Reading: RBC  Review of cases and sign-out of PBS slides with the pathologist Doctor on service 10:00 Orientation with Rotation Supervisor Dr. Fourie (Rm 7524) 12:00 – 13:00 Lunch Tuesday, Sep 26 Tasks for the Day – 9:00 to 16:30 Assigned To  Reading: Granulocytes

 Review of cases and sign-out of PBS slides with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Bone Marrow Rounds Lab (Rm 7581) 12:00 – 13:00 Lunch Wednesday, Sep 27 Tasks for the Day – 9:00 to 16:30 Assigned To  Reading: Granulocytes  Review of cases and sign-out of PBS slides with the pathologist Doctor on service

12:00 – 13:00 Lunch Thursday, Sep 28 Tasks for the Day – 9:00 to 16:30 Assigned To  Reading: Platelets  Review of cases and sign-out of PBS slides with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Lymphoma Review Session Lab (Rm 7581) 12:00 – 13:00 Hematology Rounds TBCC (Rm CC104) Friday, Sep 29 Tasks for the Day – 9:00 to 16:30 Assigned To  Reading: Lymphocytes  Review of cases and sign-out of PBS slides with the pathologist Doctor on service 8:00 – 12:00 Resident Academic Half Day

12:00 – 13:00 Lunch

Page | 223 RESIDENCY TRAINING in Anatomical Pathology ______WEEK 2 Monday, Oct 2 Tasks for the Day – 9:00 to 16:30 Assigned To  Arrange times for Cytocentrifuge, ESR, Sickle solubility test and G-6PD test observation - Contact Brenda Wood (944-1608)  Review teaching slides  Review of cases and sign-out of PBS slides with the pathologist Doctor on service

12:00 – 13:00 Lunch Tuesday, Oct 3 Tasks for the Day – 9:00 to 16:30 Assigned To  Review teaching slides  Review of cases and sign-out of PBS slides with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Bone Marrow Rounds Lab (Rm 7581)

12:00 – 13:00 Lunch Wednesday, Oct 4 Tasks for the Day – 9:00 to 16:30 Assigned To  Review teaching slides  Review of cases and sign-out of PBS slides with the pathologist Doctor on service

12:00 – 13:00 Lunch Thursday, Oct 5 Tasks for the Day – 9:00 to 16:30 Assigned To  Review teaching slides  Review of cases and sign-out of PBS slides with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Lymphoma Review Session Lab (Rm 7581) 12:00 – 13:00 Hematology Rounds TBCC (Rm CC104) Friday, Oct 6 Tasks for the Day – 9:00 to 16:30 Assigned To  Review teaching slides  Review of cases and sign-out of PBS slides with the pathologist Doctor on service 8:00 – 12:00 Resident Academic Half Day

12:00 – 13:00 Lunch

Page | 224 RESIDENCY TRAINING in Anatomical Pathology ______WEEK 3

Monday, Oct 9 Tasks for the Day – 9:00 to 16:30 Assigned To  Self-review and reporting of peripheral blood smears  Review of PBS with the pathologist Doctor on service

12:00 – 13:00 Lunch Tuesday, Oct 10 Tasks for the Day – 9:00 to 16:30 Assigned To  Self-review and reporting of peripheral blood smears  Review of cases and sign-out of PBS with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Bone Marrow Rounds Lab (Rm 7581)

12:00 – 13:00 Lunch Wednesday, Oct 11 Tasks for the Day – 9:00 to 16:30 Assigned To  Self-review and reporting of peripheral blood smears  Review of cases and sign-out of PBS with the pathologist Doctor on service

12:00 – 13:00 Lunch Thursday, Oct 12 Tasks for the Day – 9:00 to 16:30 Assigned To  Self-review and reporting of peripheral blood smears  Review of cases and sign-out of PBS with the pathologist Doctor on service Multi-headed Microscope 10:00 – 12:00 Lymphoma Review Session Lab (Rm 7581) 12:00 – 13:00 Hematology Rounds TBCC (Rm CC104) Friday, Oct 13 Tasks for the Day – 9:00 to 16:30 Assigned To  Self-review and reporting of peripheral blood smears  Evaluation Doctor on service 8:00 – 12:00 Resident Academic Half Day

12:00 – 13:00 Lunch

Page | 225 RESIDENCY TRAINING in Anatomical Pathology ______Hemoglobin Disorders

Duration: 1 week taken in conjunction with PBS Prerequisites: Successful completion of first half of PGY3 Rotation Dr. Thomas Fourie, M.D., FRCPC; [email protected] Contact/Supervisor: Dr. Xiu Yan Jiang, MD, MSc, FRCPC; [email protected] Last Updated: September 2017

Preceptors:

Meer-Taher Shabani-Rad, MD, FRCPC Hematopathologist/Clinical Section Chief Room 7526, FMC McCaig Tower 7th Floor Ph: (403) 944-4754 [email protected]

Mireille Lareau Tech II, FMC Special Hematology FMC McCaig Tower 7th Floor Ph: (403) 944-8070 [email protected]

GENERAL OBJECTIVES: The resident/fellow spends one week in the Special Hematology Laboratory. It is based at the 7th Floor, McCaig Tower, Foothills Medical Center, Alberta Public Laboratories. The emphasis of this rotation is on the appropriate workup of patients with hemoglobin disorder, interpretation of laboratory results, and clinical consultation.

General expectations:

1. Understand the genetics, biochemistry, and pathophysiology of hemoglobin disorders. 2. Become familiar with how hemoglobin tests are performed. 3. To know how to choose which hemoglobin testing methods are needed based on the patient’s profile and laboratory data. 4. Exposure to molecular assays associated with hemoglobin disorder.

SPECIFIC OBJECTIVES: At the completion of training week, the trainee will be familiar and will acquire understanding of the following competencies:

Medical Expert: 1. Understand the decision making algorithm for screening of hemoglobinopathies 2. Understand the role of HPLC, hemoglobin gel electrophoresis and sickle cell screen in the workup of hemoglobinopathies 3. Understand when molecular analysis or genetic analysis for hemoglobinopathies are indicated 4. Demonstrate understanding of a role of consultative practice in hematopathology 5. Demonstrate understanding of the most common hemoglobin disorders

Page | 226 RESIDENCY TRAINING in Anatomical Pathology ______Communicator: General Requirements: - Establish effective working relationships with consulting physicians/hematologists. - Obtain and synthesize relevant clinical history from physicians, electronic and written health records. - Listen and respond effectively. - Discuss in timely fashion appropriate information with the health care team.

Specific Requirements: - Understand the role of a hematopathology consultant. - Act as a consultant to clinical colleagues on the interpretation and relevance of pathological findings, with particular regard to their significance in the management of the patient. - Understand the role pathologic findings should provide in a given clinical situation and be able to communicate it effectively and in a timely fashion in an oral and written form. - Assist in the continuing education of clinicians and other members of the health care team.

Collaborator General Requirements: - Consult effectively with other physicians and health care professionals. - Contribute effectively to other interdisciplinary team activities.

Specific Requirements: - Must have experience in hemoglobin disorders sufficient to achieve a sound understanding of the effects of disease and the role of pathology in clinical management. - Demonstrate the ability to advise on further appropriate investigations and management.

Leader General Requirements: - Utilize resources effectively to balance patient care, turn-around-time and educational/research needs. - Allocate finite health care resources wisely. - Work effectively and efficiently in a health care organization. - Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements - Demonstrate knowledge of the principles of laboratory management and administration. - Demonstrate knowledge of the methods of quality control in the field of hemoglobin disorder. - Demonstrate knowledge of the methods for professional quality assurance as applied to hemoglobin disorder. - Demonstrate competence in basic computer skills with emphasis on automated electronic reporting, electronic communication and search strategies.

Page | 227 RESIDENCY TRAINING in Anatomical Pathology ______Health Advocate General Requirements: - Contribute effectively to improved health of patients and communities. - Recognize and respond to those issues where advocacy is appropriate. - Understand the role of consult hematopathology in patient’s care.

Specific Requirements: - As members of an interdisciplinary team of professionals responsible for individual and population health care, the consult hematopathologist will endeavour to ensure that laboratory practices and test selection are regularly evaluated to determine that they meet these communities’ needs. - Reinforce to the public and to the profession the essential contribution of laboratory medicine to health.

Scholar General Requirements: - Develop, implement and monitor a personal continuing education strategy. - Critically appraise sources of medical information. - Facilitate learning of patients, house staff/students and other health professionals. - Contribute to development of new knowledge.

Professional General Requirement: - Deliver highest quality patient care. - Exhibit appropriate personal and interpersonal professional behaviours. - Practise medicine ethnically consistent with obligations of a physician. - Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to special coagulation.

Specific Requirements - Act as an appropriate role model for students and others. - Demonstrate a professional attitude to colleagues and other laboratory staff. - Have an appreciation of the crucial role of the hematopathologist in providing quality patient care. This will include knowledge of an individual professional limitations and the necessity of seeking appropriate second opinions.

Learning outcomes: At the end of this rotation the resident will understand: - Know the principles of Hemoglobin gel electrophoresis, HPLC, sickle cell screen and molecular analysis for alpha thalassemias - Understand the laboratory workup of hemoglobinopathies

SUGGESTED READING: 1. Color Atlas of hemoglobin disorders James D. Hoyer, MD, Steven H. kroft, MD, College of American Pathologists (CAP), 2003 2. Haemoglobinopathy Diagnosis Barbara J. Bain second edition 2006 3. Lecture available on APL-G drive: Case studies on hemoglobin disorders

Page | 228 RESIDENCY TRAINING in Anatomical Pathology ______Sample Hemoglobin Disorder Schedule WEEK 4

Monday, Oct 16 Tasks for the Day – 9:00 to 16:30 Assigned To  Arrange for observation of sickle cell screen during the course of

the week - Contact Mireille Lareau (403-944-8070)  Hemoglobinopathy bench Lab Tech or Supervisor

 Reading: Beta thalassemia  Hemoglobinopathy sign-out Lab Tech or Supervisor 10:00 Orientation with Rotation Supervisor Dr. Fourie (Rm 7524) 12:00 – 13:00 Lunch Tuesday, Oct 17 Tasks for the Day – 9:00 to 16:30 Assigned To

 Hemoglobinopathy bench  Reading: Alpha thalassemia  Hemoglobinopathy sign-out Lab Tech or Supervisor Dr. Gary Sinclair 10:00 – 12:00 Molecular Lab (alpha thalassemia only) *At the DSC* (403-770-3594) 12:00 – 13:00 Lunch Wednesday, Oct 18 Tasks for the Day – 9:00 to 16:30 Assigned To

 Hemoglobinopathy bench Lab Tech or Supervisor  Reading: Variant hemoglobins  Hemoglobinopathy sign-out Lab Tech or Supervisor 12:00 – 13:00 Lunch

Thursday, Oct 19 Tasks for the Day – 9:00 to 16:30 Assigned To

 Hemoglobinopathy bench Lab Tech or Supervisor  Hemoglobinopathy sign-out Lab Tech or Supervisor Multi-headed Microscope 10:00 – 12:00 Lymphoma Review Session Lab (Rm 7581) 12:00 – 13:00 Hematology Rounds TBCC (Rm CC104) Friday, Oct 20 Tasks for the Day – 9:00 to 16:30 Assigned To

 Hemoglobinopathy bench Lab Tech or Supervisor  Reading: Self-directed  Evaluation Pathologist 8:00 – 12:00 Resident Academic Half Day 12:00 – 13:00 Lunch

Page | 229 RESIDENCY TRAINING in Anatomical Pathology ______“Rural” Community Surgical Pathology (Red Deer, Alberta) Preceptors: Dr. H. Paulin ([email protected]) Duration: 4 weeks (flexible in terms of duration) Prerequisites: Successful completion of PGY3 Location: Red Deer Regional Hospital, Department of Laboratory Medicine and Pathology Last Revised:

Introduction: This community-based hospital serving a population of approximately 300,000 people with over 20,000 surgical and 45,000 cytology specimens annually. The elective is targeted towards, but not exclusive to, senior pathology residents with preliminary training in Surgical Pathology, Cytology and, ideally, Hematopathology. The elective is flexible and may be specifically tailored towards the goals of the resident.

Please see Goals and objectives for Surgical Pathology for CanMeds roles

Goals/Objectives: 1) Provide experience working in the routine laboratory functions for a community based hospital 2) Take part in fine needle aspirations, bone marrow biopsy clinics and multidisciplinary hospital rounds 3) Facilitate professional interactions directly with patients, a broad range of laboratory staff, colleagues and other health care professionals 4) Contribute to a patient-centered, shared, decision-making process which optimizes patient outcomes 5) Participate in various laboratory based continuing education activities and administrative tasks (including quality control/assurance measures). Through these activities, exposure to all of the CanMEDs 2005 guidelines (including roles as a Medical Expert, Collaborator, Communicator, Leader, Health Advocate, Scholar and Professional) would be experienced.

Funding: Funding for residents from the University of Alberta and the University of Calgary is kindly provided by Distributed Learning and Rural Initiatives (DLRI) Grant

Page | 230 RESIDENCY TRAINING in Anatomical Pathology ______Gynaecologic Pathology Preceptors: Drs. M. Duggan, M. Koebel, T. Ogilvie, S. Lee Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre & South Health Campus Contact: Dr. M. Koebel ([email protected]) Last Revised: Dr. M. Duggan: March 13, 2019

General Objectives: During a 4 week focused surgical pathology rotation in gynecologic pathology, the resident will develop the knowledge and skills necessary to approach, diagnose, and report pathologies of the female genital tract. The resident will acquire these skills through grossing gynecologic specimens and interpreting the resultant microscopy, formulating reports, and reviewing the cases with the appropriate staff pathologists. In addition, the resident will participate in self-directed study, as well as research and teaching activities when available, to complement the service aspect of the rotation.

Rotation specific objectives: Medical expert The resident will: 1) Gross various large gynecologic pathology specimens: a) Effectively and efficiently describe, cut and sample the gynecologic pathology cases using clinical, radiologic and laboratory data available and laboratory protocols as a guide for appropriate management. 2) Sign-out the large and an assortment of small (ie. biopsies, curetting) gynecologic pathology specimens with the attending pathologist a) Accurately and succinctly describe the microscopic findings, provide a pathologic diagnosis and/or generate a differential diagnosis. b) Select the appropriate immunohistochemical stains and molecular biological procedures relevant to the problem based on the gross, histologic, clinical, radiologic, laboratory and other data available. 3) Review Dr. Duggan’s TBCC gynecologic oncology tumour board cases, consults, and intra- departmental consultations. 4) Maintain a logbook of the cases seen (site, specimen, diagnosis based on WHO classification). 5) Independently review Dr. Duggan’s resident teaching slide file.

Communicator The resident will demonstrate the ability to: 1) Obtain and synthesize information from clinical and other colleagues. 2) Communicate effectively with technical staff (ie. in the gross room, at the time of frozen sections) and transcriptionists. 3) Formulate clear, concise, and complete reports that accurately and adequately describe the specimen and the diagnosis. 4) Demonstrate ability to answer questions on etiology, pathogenesis, and pathology of disease without preparation and be able to openly admit circumscribed ignorance without loss of face. 5) Assist in the continuing education of physicians and other members of the hospital staff by participating effectively in interdisciplinary rounds and meetings (including presentation at rounds).

Collaborator The resident will: 1) Become part of the clinical team through interactions with clinical colleagues directly and at rounds. 2) Understand the role of the intra-and extra departmental review of diagnostic material.

Page | 231 RESIDENCY TRAINING in Anatomical Pathology ______

Leader The resident will: 1) Utilize time and resources effectively to balance patient care, learning needs and outside activities. a) Understand finite health care resources and use discretion in utilization of resources without unnecessary waste. b) Utilize resources effectively (ie. glass slide teaching sets, recommended reading, power point presentations from the Gynecologic Pathology half-day didactic lecture series) in order to facilitate self-directed learning. 2) Demonstrate an ability to run a quality control program in gynecologic pathology.

Health Advocate The resident will: 1) Recognize and respond to those issues, circumstances, or situations in which advocacy on behalf of patients or the community is appropriate a) Identify populations at risk of certain gynecologic pathologies b) Recognize the fundamental role of epidemiological research in understand the pathophysiology and etiology of disorders. 2) Demonstrate understanding of the roles of screening programs, with specific reference to cervical cancer screening programs. 3) Demonstrate the ability to recognize those situations that require consultation or notification of the Department of Health.

Scholar The resident will: 1) Develop, implement, and document a personal continuing education strategy a) Accept responsibility for self-learning and self-evaluation. b) Demonstrate ability to identify gaps in knowledge and experience. c) Assess personal learning needs and choose an appropriate learning method. d) Evaluate the outcome of the self-learning experience. 2) Apply the principles of critical appraisal to sources of medical information and stay current with evidence based literature pertinent to the practice of gynecologic pathology

Professional The resident will: 1) Deliver the highest quality practice of surgical pathology with integrity, honesty and compassion. 2) Demonstrate effective consultation, as an anatomical pathologist, with respect to patient care, education and legal opinion. 3) Recognize personal limits of expertise. The resident must be able to: a) Recognize when he/she should seek consultation from another pathologist. b) Recognize when he/she should seek consultation from a specialist other than a pathologist. 4) Exhibit appropriate personal and interpersonal behaviors. For this the resident will: a) Demonstrate appropriate interpersonal relationships with peers, supervisors, support and clinical staff, showing concern, respect for others, and sensitivity to gender/ethnic and other social issues b) Respond appropriately to criticism c) Act as an appropriate role model for students and others. d) Address interpersonal differences in professional relations. e) Maintain an appropriate balance between personal and professional roles f) Be accountable for his/her personal actions g) Have a high degree of self-awareness

Page | 232 RESIDENCY TRAINING in Anatomical Pathology ______h) Be reliable and conscientious in the discharge of his/her professional responsibilities.

5) Practice surgical pathology in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. The resident will: a) Demonstrate an ethical approach to the performance of duties within the laboratory. b) Know and understand the professional, legal and ethical codes to which physicians are bound. c) Understand and apply relevant legislation relating to the health care system in order to guide him/her in the practice of surgical pathology. d) Recognize, analyze and know how to deal with unprofessional behavior in the practice of medicine, including but not exclusive to health problems such as psychiatric illness or substance abuse, taking into account local and provincial regulations.

Rounds Attendance at Gynecologic Oncology Tumor Board Rounds at TBCC every Thursday at 0800 hours is mandatory, and presentation of the pathology of select cases at these rounds may be requested. The resident will have Friday morning protected to attend the Department of Pathology academic half-day teaching.

Assessment An in-training evaluation (One45) will be completed by the rotation preceptor and discussed with the resident at the end of the elective period. No formal mid-rotation is required; however the preceptors are encouraged to provide feedback informally throughout the rotation.

Required reading 1) Rosai: Rosai and Ackerman’s Surgical Pathology, Mosby; 9th edition (2004), Chapter 19. 2) WHO Classification of Tumours, Pathology & Genetics (2003). Tumours of the Breast and Female Genital Tract, Chapters 2-7.

Other references 1) Mills: Sternberg’s Histology for Pathologists, Lippincott Williams & Wilkins; 3rd ed. (2006) 2) Clement and Young: Atlas of Gynecological Pathology, Saunders; 2nd ed. (2008) 3) Kurman: Blaustein’s Pathology of the Female Genital Tract, Springer; 5th ed. Ed. (2010) 4) Crum and Lee: Diagnostic Gynecologic and Obstetric Pathology. Saunders; 1st ed. (2010)

GTMAD Aperio Course – (Dr. Maire Duggan Gynecological Pathology Resident Teaching File) The glass slide teaching file is no longer routinely available for resident review. Instead all cases (approximately 300) have been scanned into Aperio and is available for all residents who have access. Please contact Ton Kryton for access ([email protected] )

Course Access Step-by-Step Guide  Website: http://digitalmicroscopy.ucalgary.ca  Enter your username and password

Page | 233 RESIDENCY TRAINING in Anatomical Pathology ______o The Courses, Lessons, Specimens, eSlides, TMA Blocks and Analysis screen will appear

o  Click Courses o The Courses screen appears

o  Click GTMAD o Course Details and Lessons Screen Appears

o  Click the book icon(blue arrow) of the first row of Course Lessons: note lesson number as this is the unique and identifying number of the case. o Course Details and Lesson Details of Lesson Number and Lesson Specimens screen appears

Page | 234 RESIDENCY TRAINING in Anatomical Pathology ______

o

o  The Lesson Specimens displays the glass slide Accession number, Image, Tissue, Organ, Description, Content (when available), and Diagnoses of the Lesson Number.  Click the Image of the Lesson Specimens to review the pathology  Click the book icon(blue arrow) of each successive Lesson Number in order to review the entire teaching file.

Page | 235 RESIDENCY TRAINING in Anatomical Pathology ______Laboratory Informatics Preceptors: Dr

Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Rotation Dr. Supervisor/Contact: Last Revised:

Overview This elective is intended for residents in a laboratory medicine training program (anatomic, general or neuropathology, hematopathology, medical biochemistry or medical microbiology). The rotation will serve as an introduction to laboratory informatics and will help prepare the resident to utilize informatics tools in teaching, research and quality assurance.

The rotation will also assist the resident in meeting key and enabling competencies in all of the CanMEDS roles (as outlined below). The rotation will involve extensive exposure to actual pathology informatics problems along with structured readings and didactic sessions on hospital LIS systems, quality assurance, statistics, telepathology, digital imaging and emerging technologies. The resident will have an opportunity to spend time with staff from the Alberta Public Laboratories quality and data management departments. Specific exposure to digital imaging slide scanner(s) will be arranged.

The resident will also have the opportunity to work on a brief informatics related problem (depending on time available and resident interest and aptitude). The primary preceptor will be Dr. Christopher Naugler, section head of pathology informatics for Alberta Public Laboratories. Additional medical staff from the Division of Clinical Pathology at the University of Calgary as well as support staff will be utilized when appropriate.

By the nature of the practical situations encountered, there will be broad applicability of the training to laboratory management/leadership in general. The rotation will be 4 weeks in length.

Specific Rotation Objectives (relevant CanMEDS objective in brackets) At the completion of this rotation the resident will: 1) Understand the role of laboratory informatics in the documentation, storage and dissemination of laboratory data. (Medical Expert, enabling competency 5.4: Appropriately document and disseminate information related to procedure performed and their outcomes). 2) Be able to describe the key technical components of pathology informatics including laboratory informatics systems, analyzer interfaces, regional and provincial data repositories and office electronic medical records (Communicator, enabling competency 5.1: Maintain clear, accurate, and appropriate records (e.g. written or electronic) of clinical encounters and plans). 3) Understand the role of laboratory informatics tools in integrating and disseminating laboratory and clinical data across disciplines (Collaborator, enabling competency 1.4: Work with others to assess, plan, provide and integrate care for individual patients (or groups of patients)). 4) Be able to apply laboratory informatics tools to the study of healthcare resource utilization (Leader, key competency 3: Allocate finite healthcare resources appropriately). 5) Apply statistical techniques as part of an overall laboratory quality assurance and improvement strategy (Leader, enabling competency 1.2: Participate in systemic quality process evaluation and improvement such as patient safety initiatives). 6) Be aware of the use of laboratory informatics in measuring pathologist workload as well as institutional and regional workforce

Page | 236 RESIDENCY TRAINING in Anatomical Pathology ______planning (Leader, enabling competency 1.4: Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding). 7) Be familiar with various software and hardware applications of laboratory informatics in patient care (Leader, enabling competency 2.4: Employ information technology appropriately for patient care). 8) Gain practical experience in the use of laboratory informatics tools in the measurement of test utilization as well as techniques to relate this to overall population health (Health Advocate, enabling competency 3.1: Identify the determinants of health of the populations, including barriers to access to care and resources). 9) Become familiar with the use of telepathology and digital slide scanning in teaching and clinical practice (Scholar, key competency 4: Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices). 10) Be aware of emerging laboratory informatics research tools including bioinformatics and computer modeling (Scholar, enabling competency 4.4: Conduct a systematic search for evidence; 4.5: Select appropriate methods to address the question). 11) Understand the role of pathology informatics in maintaining and safeguarding patient records (Professional, enabling competency 2.2: Fulfill the regulatory and legal obligations required of current practice)

Christopher Naugler MD FRCPC 16 Oct 2010

Page | 237 RESIDENCY TRAINING in Anatomical Pathology ______Breast Pathology (FMC) Group Preceptors: Drs. H. Yang T. Ogilvie; Dr. N. Bures; P. Klonowski; L. Galman; C. Leudtke Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre Contact: Dr. H. Yang ([email protected]) Last Revised: February 2011

Summary This 4 week elective is to build upon foundations of breast pathology that have been seen during the surgical pathology blocks. Throughout the elective, the resident is responsible for:  Frozen section/ gross/ sign out of all breast cases assigned to the rotation preceptor pathologist.  Frozen section diagnosis on sentinel lymph nodes  Review and discussion of the breast consultation cases with the consulting pathologist.  Review of the ER/PR/her-2 IHC & SISH cases with the ER/PR scoring pathologist.  Participation in the following rounds: o TBCC Breast Tumor Board Rounds (Mondays at 1200; TBCC Basement, Room CCB21) o Breast Diagnostic Rounds and the Departmental Breast Pathology Rounds (Thursdays at 0800; Teaching Room MT7578). Studying the available teaching slide sets and designated reading materials related to breast pathology.

General Objectives Medical Expert  The resident should have a basic understanding of:  Normal breast anatomy, physiology, and molecular biology  Genetic basis of breast cancer  Normal microscopic appearance of the breast during various patient ages and physiological states  Gross dissection of breast specimens  Microscopic appearance of common non-neoplastic and neoplastic conditions  Grading of breast cancer using modified Bloom Richardson scoring  TNM staging of breast cancer  Use of immunohistochemistry  ER/PR and Her2Neu testing  Sentinel lymph nodes (at the time of frozen sections, processing and microscopic interpretation with TNM staging)

Communicator  Listen and communicate questions and ideas effectively  Communicate effectively with laboratory staff  Communicate effectively in written forms, specifically in pathology forms  Communicate effectively with other clinicians and surgeons at frozen section and rounds

Collaborator  Be involved at various interdisciplinary rounds (attendance at TBCC Breast Rounds once a week, breast pathology rounds once a week and breast diagnostic rounds every other week)

Page | 238 RESIDENCY TRAINING in Anatomical Pathology ______Leader  Understand important aspects of quality control and quality assurance in breast pathology (ER/PR receptor, Her2Neu studies, sentinel lymph nodes…) Health Advocate  Demonstrate understanding and compliance with safety guidelines in the gross room  Being thorough in the examination of the breast specimens at the time of gross inspection

Scholar  Have an awareness of major areas of weakness in this specialty area and address with self- learning  Facilitate the learning of breast pathology with others by sharing/presenting cases at gross rounds, surgical pathology rounds, TBCC breast rounds, breast diagnostic rounds and Friday Unknown slide rounds  Review and search relevant literature for up-to-date information  Review available teaching slide sets

Professional  Exhibit appropriate personal and interpersonal professional behavior

Books 1) Rosen’s Breast Pathology, 3rd Ed., by Paul Peter Rosen 2) Biopsy Interpretation of the Breast, by Stuart J. Schnitt and Laura C. Collins 3) Breast Pathology: A Volume in Foundations in Diagnostic Pathology series, by Frances P O’Malley and Sarah E. Pinder 4) Pathology of the Breast, 2nd Edition by Fattaneh Tavassoli 5) Diagnostic Problems in Breast Pathology by Frederick C. Koerner 6) Robbins Pathology

Page | 239 RESIDENCY TRAINING in Anatomical Pathology ______Gastrointestinal (GI) Pathology Preceptors: Drs. Stefan Urbanski, Vincent Falck, Parham Minoo, Leslie Eidus, Shaun Medlicott, Andrew Schell, Emma Whitcomb, Marie-Anne Brundler, Konstantin Koro, Kate O’Connor. Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre, Peter Lougheed Centre & Rockyview General Hospital Contact: Dr. Stefan Urbanski ([email protected]) Last Revised: September 2017

Preamble: This is an INTENSIVE GI-exclusive rotation, aimed at lifting the resident’s knowledge and acumen to the next level. During the 4 week focused rotation in GI/liver/pancreatobiliary pathology, the resident will develop the knowledge and skills necessary to approach, diagnose, and report the common pathologies of the digestive system.

The resident will acquire these skills through reading daily GI biopsies, grossing complex surgical specimens, interpreting the resultant microscopy, formulating reports, and reviewing the cases with the appropriate pathologists. In addition, the resident will review teaching case collections and participate in self-directed study, as well as research and teaching activities when available, to complement the service aspect of the rotation.

NOTES 1. Residents must get approval for the rotation from the rotation preceptor at least 3 months prior to the start of the rotation. All rotators must register with the AP program administrator.

2. This rotation is distributed between all CLS sites, including the Alberta Children’s Hospital but excluding the DSC. The resident is strongly encouraged to make every effort to work with and learn from EACH member of the GI Pathology Group. For the rotation at the sites outside the FMC, the resident should contact that pathologist DIRECTLY as soon as the elective application is approved, to create a realistic schedule based on each individual’s ability.

Medical Expert: Through this intensive subspecialty rotation, the resident is expected to enhance his or her diagnostic skills and knowledge in the common digestive pathologies, particular in the following currently important and challenging areas:  Reflux esophagitis and eosinophilic esophagitis, and their differential diagnosis  Barrett’s esophagus and the assessment for dysplasia  Reactive gastropathy  Common types of chronic gastritis  Gastric polyps  Gastric carcinomas  Celiac disease and mimicries  Microscopic colitis  Inflammatory bowel diseases (IBD)  Differential diagnosis of colitis  Colorectal polyps  Colorectal carcinoma (surgical and molecular pathology)  Appendiceal mucinous neoplasms and pseudomyxoma peritonei  Differential diagnosis of common types of hepatitis (including NASH)  Hepatocellular carcinoma and differential diagnosis

Page | 240 RESIDENCY TRAINING in Anatomical Pathology ______ Pancreatic and biliary carcinomas (surgical pathology)  GI neuroendocrine tumors  GIST  Pediatric features in GI pathology

Communicator: 1) To communicate effectively with the rotation preceptors, support staff, gastroenterologists, GI surgeons, surgical and medical oncologists, as necessary. This will be done both informally (verbal, email, etc.) and through the use of formal presentations or surgical pathology reports. 2) The resident will contribute to the understanding of the pathological findings and therefore the treatment of the patient through interaction with clinicians (either through direct communication or via presentation at rounds). 3) The resident will assist in obtaining intradepartmental consultations as appropriate. Leader: 1) The resident will effectively utilize information technology to optimize patient care, facilitate communication, and document self-learning. 2) The resident will manage time effectively and prioritize learning opportunities so as to meet the objectives of the rotation within the given time allotment. Health advocate: 1) The resident will demonstrate understanding and compliance with safety guidelines while in the gross room. 2) The resident will learn and acknowledge the components of a successful screening program, and the implications to the overall health of a society. Scholar: 1) The resident will recognize or acknowledge major areas of weakness in this specialty area, and will address them through self-learning. 2) The resident will facilitate the learning of others with regards to GI/liver/pancreatobiliary pathology by sharing and/or presenting appropriate cases at gross rounds, surgical pathology rounds, Gastroenterology rounds, and/or GI oncology rounds. 3) The resident will search the literature for up-to-date reviews on unfamiliar entities. Professional: 1) The resident will demonstrate appropriate professional behavior during the elective, including timeliness, respect for others, protection of confidentiality of patient information, etc.

The objectives will be achieved through various means as follows. 1) Routine service work assignments: Daily: To work on the routine GI/liver biopsy cases (at least 10 non-polyp cases and all liver biopsies) with one or two of the preceptors; whoever is on biopsy service that day. Upon permission from the preceptor(s), the resident will preview the slides and then sign out the cases with the preceptor(s). The resident must have a draft report ready in the system for sign- out, and this must be efficient, and consistent the preceptor’s normal work flow.

Weekly: Every week, the resident is required to gross and sign out at least 3 relatively complex and difficult surgical specimens of GI/liver/pancreato-biliary cases (particularly malignant tumors and IBD), including all Whipple specimens. The residents should obtain the permission from the pathologist on service (not limited to the above GI pathologists) before selecting the specimen to work on. The resident will preview the slides and will be responsible for signing out each case with the pathologist who is responsible for the case. Upon getting request and/or permission from the responsible pathologist, the resident may consult one of the GI faculty in the work up of the case(s) when necessary.

Page | 241 RESIDENCY TRAINING in Anatomical Pathology ______TBCC advanced GI malignancy rounds: The resident will join the responsible preceptors (VF, PM or XSG) to review the cases for this bi-weekly rounds, and the resident must be responsible for the presentation to the rounds (including taking micrography, making PPT presentation, and presenting to the rounds), under the instruction and at the presence of the preceptor.

GI consult service: The resident is encouraged to join the preceptors whoever is on GI consult service to review the GI consult cases, when it is available.

2) Review teaching case collections: The resident is encouraged to review the teaching cases collected by any preceptor, if there is any. It is the resident’s responsibility to obtain the collections, to self-review the slides, and to seek tutoring. The resident must make sure to keep the collections safe and undamaged and to timely return all of the collections to the preceptor by the end of the rotation.

3) GI Pathology Rounds It is mandatory for the rotating resident to participate in the bi-weekly city-wide GI pathology rounds on every other Monday morning. Rounds are held at FMC or RGH. Consult the weekly schedule for location.

4) Lectures by preceptors: The preceptors are encouraged to give various forms of lectures to the rotating resident(s) on certain topics in GI pathology, if it is possible by the preceptor. The topics and lecture time will depend on the availability of the preceptors on a voluntary basis.

5) Self-education and output of rotating resident(s): The rotating resident is encouraged to make effort in an intense self-education during the rotation through reading GI pathology textbooks* and the up-to-date literature on certain topics. The resident is required to have the following output during and by the end of the rotation.

Case presentation: During the rotation, the resident is required to present at least one interesting GI case (encountered in the rotation) to the residents’ Surgical Pathology Rounds. The resident should well prepare for the presentation and be the moderator for the group discussion. The preceptor who is responsible for the case should make every effort to attend.

6) Regarding Possible Research Work The resident is encouraged to develop a research project (include writing a case report) with any of the preceptors during, before or after the rotation. However, it is not encouraged to spend significant time on research work during the rotation

Evaluation: Prior to the rotation, the resident will be provided with this curriculum by and discussed with the rotation preceptor. Each of the preceptors will participate in the evaluation about the resident’s performance during and after the resident’s rotation using the current “Daily Evaluation Form: Biopsy and Large Surgical Specimen, and making comment by email if necessary. Dr. Gui will solicit the inputs from other preceptors who are involved and complete the evaluation in the end.

*Recommended Reading 1. Dr. Odze & Goldblum’s Surgical Pathology of GI Tract, Liver, Biliary Tract, and Pancreas 2. WHO Classification of Tumours of the Digestive System, Fourth Edition

Page | 242 RESIDENCY TRAINING in Anatomical Pathology ______Liver Pathology Preceptors: Drs. Stefan Urbanski; Vincent Falck; Konstantin Koro; Kate O’Connor; Emma Whitcomb; Andrew Schell; Parham Minoo Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre (other locations: South Health Campus / Rockyview General Hospital) Contact: Dr. Stefan Urbanski Last Revised: September 3, 2019

Overview Develop an approach to the examination and diagnosis of neoplastic and nonneoplastic pathology of the liver.

Rotation expectations: - Mandatory attendance of at least 3 of 4 weeks; or 75% of service days, whichever is greater - Successful completion of written and digital slide exam at the end of rotation - Presentation of at least one (1) liver pathology case at specialty group rounds (GI/Liver weekly rounds, liver transplant rounds). Liver topic presentation during other rotations (autopsy rounds, CPC, lecture, etc.) may be applied to meeting this requirement (at the discretion of rotation preceptors). - Participation in a personal learning project (see Scholar section)

Objectives Medical Expert The resident will: 1) Demonstrate working knowledge of the anatomy, embryogenesis, and histology of the liver. 2) Demonstrate skill in the gross dissection and sampling of liver – needle core biopsy, wedge resections, segmental/lobar resections, and hepatectomy, or autopsy liver. 3) Demonstrate working knowledge in integrating clinical, radiologic and laboratory testing data available to generate a list of most likely differential diagnoses to guide further workup and ancillary studies utilization. 4) Demonstrate working knowledge and application of current staging protocols (AJCC 8th Ed.) for intrahepatic, hilar, and extrahepatic malignancies. 5) Demonstrate working knowledge in the classification of liver neoplasms (benign and malignant) and utilization of ancillary studies (special stains and immunohistochemistry, etc.) in making a diagnosis. 6) Demonstrate proficiency in the interpretation of liver needle core biopsies, adequacy requirements for interpretation for medical liver disease and neoplastic (primary and metastatic) conditions. a. Accurately and succinctly describe the microscopic findings, provide a pathologic diagnosis and/or generate a differential diagnosis. b. Provide appropriate grade and stage for specific medical liver disease conditions. c. Select the appropriate immunohistochemical and special stains (and molecular biological procedures, where applicable) relevant to the problem based on the gross, histologic, clinical, radiologic, laboratory and other data available. 7) Demonstrate working knowledge of histological findings seen in acute and chronic liver allograft rejection 8) Review of oncology tumor board cases, consults, and intra- departmental consultations. 9) Maintain a logbook of the cases seen (site, specimen, diagnosis based on WHO classification). 10) Independently review resident teaching slide file.

Page | 243 RESIDENCY TRAINING in Anatomical Pathology ______

By the end of the rotation the resident will demonstrate a working knowledge of the following select (but not limited to) neoplastic and non-neoplastic conditions:

Lesions and Hepatocellular lesions: Neoplasms  Nodular regenerative hyperplasia  Focal nodular hyperplasia  Hepatic adenoma, including subtypes (HNF1a-inactivated, B-catenin activated, inflammatory/telangiectatic, etc.)  Hepatocellular carcinoma (HCC) and variants (histologic grading, histologic subtypes: carcinosarcoma, clear cell, combined HCC- cholangiocarcinoma, lymphoepithelioma-like, sarcomatoid, scirrhous, steatohepatitic, among others)  Combined hepatocellular-cholangiocarcinoma  Fibrolamellar carcinoma (molecular genetic findings) Biliary neoplasms and tumor-like lesions  Bile duct adenoma   Mucinous cystic neoplasm  Intraductal papillary and tubulopapillary neoplasms  Intrahepatic cholangiocarcinoma and precursor lesions (biliary intraepithelial neoplasia) Vascular and Perivascular Neoplasms  Hemangioma  Epithelioid hemangioendothelioma  Angiosarcoma  Kaposi sarcoma Non-neoplastic  Acute hepatitis  Acute liver failure  Autoimmune hepatitis  Fatty liver disease (non-alcoholic, alcoholic, medication/drug, etc.) and macro- vs. micro-vesicular steatosis  Granulomatous hepatitis  Biliary disease, including primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC), etc.  Genetic hemochromatosis and interpretation iron in liver specimens  Wilson disease  Drug-induced liver injury Transplant  Acute cellular rejection  Late cellular rejection  Chronic rejection  Mechanical complications of liver transplant (vascular and biliary causes)

Communicator The resident will demonstrate the ability to: 1) Obtain and synthesize information from clinical colleagues, available electronic medical records, and other (where applicable). 2) Communicate effectively with technical and support staff. 3) Formulate clear, concise, and complete reports that accurately and adequately describe the specimen and the diagnosis.

Page | 244 RESIDENCY TRAINING in Anatomical Pathology ______4) Demonstrate ability to answer questions on etiology, pathogenesis, and pathology of disease without preparation and be aware of knowledge limitations. 5) Assist in the continuing education of physicians and other members of the hospital staff by participating effectively in interdisciplinary rounds and meetings.

Collaborator The resident will: 1) Become part of the clinical team through interactions with clinical colleagues directly and at rounds. 2) Understand the role of the intra-and extra departmental review of diagnostic material.

Health Advocate The resident will: 1) Recognize and respond to those issues, circumstances, or situations in which advocacy on behalf of patients or the community is appropriate 2) Demonstrate the ability to recognize those situations that require consultation or notification of the Department of Health.

Leader The resident will: 1) Utilize time and resources effectively to balance patient care, learning needs and outside activities. a. Understand finite health care resources and use discretion in the utilization of resources without unnecessary waste. b. Utilize resources effectively (i.e. glass slide teaching sets, recommended reading, PowerPoint presentations from the GI Pathology half-day didactic lecture series) in order to facilitate self-directed learning. 2) Demonstrate understanding of quality as it pertains to liver specimens. 3) Understand the importance of turn-around-time for diagnostic liver biopsies due to (1) the high level of stress experienced by patients with symptomatic or image detected lesions and (2) the need to start curative and/or palliative treatments as quickly as possible to reduce morbidity and/or mortality

Professional The resident will: 1) Demonstrate appropriate time management skills, including punctuality, timely case preparation and review, timely submission and follow-up of forms required for ancillary testing, and prompt and effective communication where delays occurred or anticipated 2) Deliver the highest quality practice of surgical pathology with integrity, honesty and compassion. 3) Demonstrate effective consultation, as an anatomical pathologist, with respect to patient care, education and legal opinion. 4) Recognize personal limits of expertise. The resident must be able to: a. Recognize when he/she should seek consultation from another pathologist. b. Recognize when he/she should seek consultation from a specialist other than a pathologist. 5) Exhibit appropriate personal and interpersonal behaviors. For this the resident will: a. Demonstrate appropriate interpersonal relationships with peers, supervisors, support and clinical staff, showing

Page | 245 RESIDENCY TRAINING in Anatomical Pathology ______concern, respect for others, and sensitivity to gender/ethnic and other social issues b. Respond appropriately to criticism c. Act as an appropriate role model for students and others. d. Address interpersonal differences in professional relations. e. Maintain an appropriate balance between personal and professional roles f. Be accountable for his/her personal actions g. Have a high degree of self-awareness h. Be reliable and conscientious in the discharge of his/her professional responsibilities. 6) Practice surgical pathology in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. The resident will: a. Demonstrate an ethical approach to the performance of duties within the laboratory. b. Know and understand the professional, legal and ethical codes to which physicians are bound. c. Understand and apply relevant legislation relating to the health care system in order to guide him/her in the practice of surgical pathology. d. Recognize, analyze and know how to deal with unprofessional behavior in the practice of medicine, including but not exclusive to health problems such as psychiatric illness or substance abuse, taking into account local and provincial regulations.

Scholar The resident will: 1) Develop, implement, and document a personal continuing education strategy and participate in personal learning project (PLP). The resident will meet with a preceptor at the start of the rotation (no later than end of the first week) to identify a learning objective, learning strategy and approach to meet this requirement. These points will again be revisited at mid- point evaluation and at the end of the rotation. The primary goal is to highlight important aspects in continuing education, including: a. Accept responsibility for self-learning and self-evaluation. b. Demonstrate the ability to identify gaps in knowledge and experience. c. Assess personal learning needs and choose an appropriate learning method. d. Evaluate the outcome of the self-learning experience. 2) Apply the principles of critical appraisal to sources of medical information and stay current with evidence-based literature pertinent to the practice of hepatic pathology

Recommended Reading: Some resources are available digitally through the Clinical Key Database, University of Calgary library

1. Biopsy Interpretation of the Liver, Michael Torbenson 2. Practical Hepatic Pathology: A Diagnostic Approach 2nd Edition; Romil Saxena 3. MacSween's Pathology of the Liver, 7th Edition, By Alastair D. Burt, MD, Linda D. Ferrell, MD and Stefan G Hubscher, MD 4. Scheuer's Liver Biopsy Interpretation 9th Ed., Jay Lefkowitch 5. Current peer-reviewed articles pertinent to the cases under discussion/diagnosis (see the current list of recommended articles)

Page | 246 RESIDENCY TRAINING in Anatomical Pathology ______Cardiovascular Pathology Preceptors: Dr. Y. Wang, Dr. W. Yu and Dr. M. Brundler (Pediatric cases, +/- OCME staff) Duration: 4 weeks Prerequisites: successful completion of PGY2. (Should align this rotation prior to Renal rotation so as to overlap EM rotation x 2 blocks) Location: Alberta Childrens’ Hospital Contact: Dr. Y. Wang ([email protected]) Last Revised: November 2013

Definition: Cardiovascular pathology is a branch of Anatomical Pathology concerned with the study of disorders of the heart and vascular system.

General objectives: Develop an approach to the examination and diagnosis of pathology of the cardiovascular system, including cardiac biopsy, cardiac examination at autopsy, and vascular pathology.

Specific activities: 1. Participate in gross description, dissection, microscopic examination and reporting of formalin- fixed hearts received in consult from the adult autopsy service at the Foothills Medical Centre 2. Participate in gross description, dissection, microscopic examination and reporting of fetal and pediatric autopsy hearts at Alberta Children’s Hospital 3. Examine endomyocardial biopsies received by the cardiovascular pathologist on service, both for primary disease and for assessment of transplant rejection 4. Spend time with the collection of pediatric hearts with congenital abnormalities available at the Alberta Children’s Hospital 5. When available, participate in dissection of autopsy hearts from the Office of the Chief Medical Examiner 6. Participate in the gross and microscopic examination of other cardiovascular specimens including valves and vascular biopsies 7. Attend clinical rounds with relevance to cardiovascular pathology if possible (monthly cardiac M&M conference)

Specific Objectives: Medical Expert 1) Have an understanding of normal cardiovascular anatomy and histology. 2) Demonstrate appropriate technique for gross dissection of cardiac specimens.

3) Understand the use of ancillary studies and special stains in the pathologic evaluation of cardiovascular specimens. 4) Demonstrate knowledge of basic cardiovascular physiology as well as the link between the respiratory and cardiovascular system physiologies. 5) Demonstrate an understanding of techniques used clinically to evaluate cardiovascular physiology and function and to assess for cardiac pathology. 6) Develop an understanding of genetic syndromes that have findings or effects in the cardiovascular system, including those presenting before or at birth, as well as those developing later in life. 7) Demonstrate an approach to the diagnosis of endomyocardial biopsies for primary disease. 8) Understand the criteria for the diagnosis of acute and chronic rejection in cardiac transplantation, and demonstrate an approach to the assessment of rejection in cardiac transplant biopsies and a method for signing out these cases.

Page | 247 RESIDENCY TRAINING in Anatomical Pathology ______9) Demonstrate an understanding of congenital diseases of the cardiovascular system and how anatomical abnormalities can affect cardiac function. 10) Develop an approach to myocardial disease and an understanding of ancillary techniques to evaluate for myocardial disease. 11) Demonstrate knowledge of prostheses used in cardiovascular disease, including valve prostheses and vascular grafts. 12) Be able to describe the pathogenesis of atherosclerotic cardiovascular disease.

Communicator 1) Establish effective communication with clinicians and surgeons, including an understanding of the information required from the pathologist by clinical colleagues. 2) Obtain and synthesize relevant history from charts, laboratory and cardiac imaging studies, and verbally from other physicians. 3) Demonstrate the ability to write informative and complete reports of surgical and autopsy specimens and the ability to produce these reports in a timely fashion. 4) Demonstrate effective and respectful communication with non-physician members of the health care team including technicians and laboratory assistants. 5) Understand the value of effective communication with families, particularly in the case of diseases with genetic implications.

Collaborator 1) Work in concert with clinical colleagues including cardiologists and surgeons in order to optimize patient care. 2) Demonstrate effective teamwork with members of the clinical team as well as with other pathologists, including consulting pathologists. 3) Demonstrate an understanding of the value of consulting colleagues for the benefit of patient care. 4) Facilitate learning of other trainees including fellow residents, medical students, as well as pathologist and clinician colleagues.

Leader 1) Demonstrate an understanding of resource utilization as it applies to pathology. 2) Demonstrate effective time management skills and an ability to prioritize various duties appropriately. 3) Demonstrate knowledge of the methods of quality control and quality assurance in cardiovascular pathology.

Health Advocate 1) Understand the role of the pathologist in advocating for patient care at an individual and community level.

Scholar 1) Demonstrate an ability to answer clinical questions through literature searches and an ability to critically appraise and synthesize information from a variety of sources. 2) Develop, implement and monitor a personal learning strategy.

Professional 1) Deliver high quality patient care within a timely fashion and in an effective manner. 2) Demonstrate respect both for other health care professionals as well as for patients. 3) Demonstrate an understanding of ethics as it applies to medicine and exhibit ethical behavior in the pathology setting. 4) Understand personal limitations and the importance of consultation in order to achieve best patient care.

Page | 248 RESIDENCY TRAINING in Anatomical Pathology ______References  Robbins and Cotran. Pathologic Basis of Disease. 8th Edition  Burke A and Tavora F. Practical Cardiovascular Pathology. Lippincott Williams and Wilkins. Philadelphia, 2011.  Silver, Gottlieb and Schoen. Cardiovascular Pathology. Churchill Livingstone. Philadelphia: 2001. Important entities - Atherosclerosis - Sudden cardiac death - Hypertension - Valvular heart disease o Hypertensive heart disease o Aortic stenosis o Pulmonary hypertension o Rheumatic heart disease - Vascular aneurysms and dissections o Complications of valvular disease - Vasculitis - Infective endocarditis - Vascular tumors - Noninfective endocarditis o Hemangiomas - Carcinoid heart disease o Lymphangiomas - Cardiomyopathies o Glomus tumor o Dilated o Kaposi sarcoma o Hypertrophic o Angiosarcoma o Restrictive - Vascular interventions - Myocarditis o Balloon angioplasty - Pericardial disease o Vascular stents o Pericarditis o Vascular replacement - Cardiac tumors - Congenital heart disease o Myxoma o VSD o Rhabdomyoma o ASD o Papillary fibroelastoma o Pulmonary stenosis - Cardiac transplantation o PDA o Transplant rejection o Tetralogy of Fallot - Peripheral vascular disease o Coarctation of the aorta - Diseases of veins and lymphatics o AVSD - Use of electron microscopy in cardiac o Aortic stenosis pathology o Transposition of the great - Use of immunohistochemistry and arteries molecular techniques in cardiac o Truncus arteriosus pathology o Total anomalous pulmonary - Gross and microscopic examination of venous connection cardiovascular specimens o Tricuspid atresia - Pathology of medical and surgical - Ischemic heart disease interventions of cardiovascular disease

Page | 249 RESIDENCY TRAINING in Anatomical Pathology ______Pulmonary (Thoracic) Pathology Preceptor(s): Dr. Margaret Kelly, Dr. Angela Franko, Dr. Moosa Khalil, Dr. Stefan Urbanski Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre Contact: Dr. M. Kelly Last Revised: never

General Objectives 1. Acquires knowledge, including typical clinical presentation as well as pathologic criteria, of common as well an uncommon non-neoplastic lung diseases (Appendix 1). Patient care, medical expert, practice based learning and improvement and system based practice a. Review of current cases, including consultations and in-house material, surgical, biopsies and autopsies, with faculty member • b. Dictation of case-related reports and correspondence as appropriate • c. Review of teaching file cases to supplement current case material as appropriate • d. Read appropriate text book chapters or articles related to topics • e. Do literature review of unusual topics • f. Participate in monthly Journal Club (JC) 2. Acquires knowledge of common and uncommon neoplastic lung diseases (Appendix 2). Patient care, medical expert, practice based learning and improvement and system based practice a. Review of current cases, including consultations and in-house material, surgical, biopsies and autopsies, with faculty member b. Dictation of case-related reports and correspondence as appropriate c. Review of teaching file cases to supplement current case material as appropriate d. Read appropriate text book chapters or articles related to topics e. Do literature review of unusual topics f. Participate in monthly Journal Club (JC) 3. Recognizes and acquires pertinent clinical and radiologic information for the interpretation of lung diagnoses. Professionalism, patient care, medical expert, practice based learning, communication skills. a. Recognizes the importance of correlating clinical, radiologic and pathologic findings and if there is an apparent discrepancy between any of these, investigate further and make sure that all information is correct. b. The ability to correlated radiology with clinical and with pathological findings is crucial. c. For surgical specimens, including those reviewed as part of intramural consults, medical rounds or in the course of frozen section, seeks information relevant to pathological interpretation using electronic tools as appropriate (i.e. Millenium and Netcare) and if information not adequate, proactively consults referring physicians, as appropriate. d. For extramural consultation cases, identifies pertinent information from material received including review with chest radiologist of outside imaging studies as appropriate. If information not available from material received, proactively contacts referring physicians, as appropriate 4. Understands the clinical significance of diagnosis rendered. Professionalism, patient care, medical expert, systems-based practice, collaborative and communication skills. a. For intramural cases seen as peer-to-peer consultations or in the course of routine surgical specimens, demonstrates the ability to discuss results with pathology peers, surgeons or pulmonologists as indicated. Demonstrates the ability to construct appropriate surgical reports.

Page | 250 RESIDENCY TRAINING in Anatomical Pathology ______b. For frozen section cases, demonstrates the ability to effectively communicate with operating surgeons in a timely fashion. c. Participates in interdisciplinary case review conferences, including the bi-monthly Interstitial Lung Disease conferences, and the Thoracic Tumor Pathology conferences and Clinicopathologic Pulmonary Rounds both of which occour every 2-3 months. d. For extramural consultation cases, demonstrates the ability to discuss implication of diagnosis in terms of prognosis and potential treatment with attending faculty and referring pathologist. Demonstrates the ability to dictate diagnoses and consultation letters to referring physicians conveying this information. e. For both intramural and extramural cases, demonstrates the understanding of rapid TAT critical to good patient care. 5. Demonstrates appropriate and cost-effective use of ancillary techniques in work up of pulmonary, pleural and mediastinal specimens. Patient Care, Practice-based learning and System-based practice. Manager skills • a. Is capable of discussing the value and role of immunohistochemical studies, immunofluorescence, electron microscopy and molecular diagnostic techniques in the clinical evaluations of neoplastic and non-neoplastic lung, pleural and mediastinal diseases b. Understands the costs of these ancillary studies c. Assists in establishing best practices in work-up of pulmonary, pleural, and mediastinal specimens 6. Acquires procedural and gross-microscopic correlation skills related to thoracic surgical specimens. Professionalism, patient care, medical expert. a. Demonstrates ability to gross surgical specimens such as wedge biopsy, lobectomy and pneumonectomy for both neoplastic and non-neoplastic disease, including explant lung for allograft transplantation. b. Photographs specimens as appropriate. c. Capable of expressing differential diagnosis of macroscopic lesions. d. Demonstrates understanding of disease process by determining appropriate technique for grossing and appropriate sampling for microscopic sections 7. Demonstrates respect and good working relationship with all support staff, including secretaries, technicians, Pathologist Assistants, residents, and consultants. Professionalism and interpersonal skills, management, collaborative and communication skills. a. Is familiar with vision, mission and core values of Anatomic Pathology. b. Has positive and constructive interactions with all members of the team. c. Is capable of accepting constructive criticism. d. Demonstrates helpful demeanor such as assisting with cases, grossing, or other shared activities. e. Is punctual. f. Ensures coverage for absences when necessary and informs faculty if delays are to occur. 8. Identifies and accomplishes various quality activities. Practice-based learning and system-based practice a. Resolution of case discrepancies discovered in the course of practice or conference participation. b. Resolution of any laboratory defects discovered in the course of practice 9. Demonstrates familiarity with CAP accreditation standards for Surgical Pathology laboratories including Lab safety guidelines. Practice-based learning, management skills

Medical expert The resident will: 6) Gross thoracic (lung and mediastinal) pathology specimens:

Page | 251 RESIDENCY TRAINING in Anatomical Pathology ______a) Effectively and efficiently describe, cut and sample the thoracic pathology cases using clinical, radiologic and laboratory data available and laboratory protocols as a guide for appropriate management. 7) Sign-out the large and lung biopsy pathology specimens with the attending lung pathologists on those services. a) Accurately and succinctly describe the microscopic findings, provide a pathologic diagnosis and/or generate a differential diagnosis. b) Select the appropriate immunohistochemical stains and molecular biological procedures relevant to the problem based on the gross, histologic, clinical, radiologic, laboratory and other data available. 8) Review cases for multidisciplinary discussion for interstitial lung disease (MDD ILD) rounds, thoracic pathology rounds and CPC (if scheduled), consults, and intra-departmental consultations. 9) Maintain a logbook of the cases seen (site, specimen, diagnosis based on WHO classification or ATS classification if applicable). 10) Independently review resident teaching slide files of Dr. Kelly and Dr. Franko. 11) Attend ROSE sessions with Dr. Moosa Khalil in the lung biopsy suite at FMC when scheduled. 12) Meet with Dr. Adrian Box and learn how molecular testing relating to lung disease is implemented on a day to day basis.

Communicator The resident will demonstrate the ability to: 6) Obtain and synthesize information from clinical and other colleagues. 7) Communicate effectively with technical staff (ie. in the gross room, at the time of frozen sections) and transcriptionists. 8) Formulate clear, concise, and complete reports that accurately and adequately describe the specimen and the diagnosis. 9) Demonstrate ability to answer questions on etiology, pathogenesis, and pathology of disease without preparation and be able to openly admit circumscribed ignorance. 10) Assist in the continuing education of physicians and other members of the hospital staff by participating effectively in interdisciplinary rounds and meetings (including presentation at rounds).

Collaborator The resident will: 3) Become part of the clinical team through interactions with clinical colleagues directly and at rounds. 4) Understand the role of the intra-and extra departmental review of diagnostic material.

Leader The resident will: Utilize time and resources effectively to balance patient care, learning needs and outside activities. a) Understand finite health care resources and use discretion in utilization of resources without unnecessary waste. b) Utilize resources effectively (ie. glass slide teaching sets, recommended reading, power point presentations from the Pulmonary Pathology half-day didactic lecture series) in order to facilitate self-directed learning.

Health Advocate The resident will: 4) Recognize and respond to those issues, circumstances, or situations in which advocacy on behalf of patients or the community is appropriate a) Identify populations at risk of certain lung pathologies

Page | 252 RESIDENCY TRAINING in Anatomical Pathology ______b) Recognize the fundamental role of epidemiological research in understand the pathophysiology and etiology of disorders. 5) Demonstrate understanding of the roles of screening programs, with specific reference to lung cancer screening programs. 6) Demonstrate the ability to recognize those situations that require consultation or notification of the Department of Health.

Scholar The resident will: 3) Develop, implement, and document a personal continuing medical education strategy a) Accept responsibility for self-learning and self-evaluation. b) Demonstrate ability to identify gaps in knowledge and experience. c) Assess personal learning needs and choose an appropriate learning method. d) Evaluate the outcome of the self-learning experience. 4) Apply the principles of critical appraisal to sources of medical information and stay current with evidence based literature pertinent to the practice of thoracic pathology

Professional The resident will: 6) Deliver the highest quality practice of surgical pathology with integrity, honesty and compassion. 7) Demonstrate effective consultation, as an anatomical pathologist, with respect to patient care, education and legal opinion. 8) Recognize personal limits of expertise. The resident must be able to: a) Recognize when he/she should seek consultation from another pathologist. b) Recognize when he/she should seek consultation from a specialist other than a pathologist. 9) Exhibit appropriate personal and interpersonal behaviors. For this the resident will: a) Demonstrate appropriate interpersonal relationships with peers, supervisors, support and clinical staff, showing concern, respect for others, and sensitivity to gender/ethnic and other social issues b) Respond appropriately to criticism c) Act as an appropriate role model for trainees and others. d) Address interpersonal differences in professional relations. e) Maintain an appropriate balance between personal and professional roles f) Be accountable for his/her personal actions g) Have a high degree of self-awareness h) Be reliable and conscientious in the discharge of his/her professional responsibilities. 10) Practice surgical pathology in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. The resident will: a) Demonstrate an ethical approach to the performance of duties within the laboratory. b) Know and understand the professional, legal and ethical codes to which physicians are bound. c) Understand and apply relevant legislation relating to the health care system in order to guide him/her in the practice of surgical pathology. d) Recognize, analyze and know how to deal with unprofessional behavior in the practice of medicine, including but not exclusive to health problems such as psychiatric illness or substance abuse, taking into account local and provincial regulations.

Pre and post-test: There will be a slide and short question exam early on in the preceptorship and this will be repeated once it has been completed. The resident will get a good idea of their strengths and weaknesses and what progress they have made during the preceptorship.

Page | 253 RESIDENCY TRAINING in Anatomical Pathology ______Pulmonary Books: These are available within the department. • Katzenstein and Askin's Surgical Pathology of Non-Neoplastic Lung Disease. Anna-Luise A Katzenstein. • Practical Pulmonary Pathology. Kevin O Leslie and Mark R Wick. • WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart  (Travis, W.D., Brambilla, E., Burke, A.P., Marx, A., Nicholson, A. G, 2015). • pTNM 8th Edition, AJCC Staging Manual: The resident will be familiar with this version of lung cancer synoptics and should be able to adequately classify specimens according to this.

Appendix

A. Non-neoplastic Lung Diseases

1. Pediatric disease A. Congenital and acquired cystic lesions

2. Infections A. Bacterial 1. Common 2. Unusual including Legionnaires disease, Nocardiosis and Actinomycosis B. Mycobacterial 1. Mycobacterial tuberculosis 2. Atypical mycobacterial C. Fungal 1. Aspergillosis-invasive, semi-invasive/cavitary, mycetoma, 2. Coccidiodes 3. Cryptococcosis 4. Histoplasmosis 5. Blastomycosis 6. Mucormycosis 7. Pneumocystis jiroveci D. Viral 1. CMV 2. HSV/Varicella 3. Adenovirus 4. SARS 5. Influenza, RSV, parainfluenza

3. Diffuse Lung Disease: the latest classifications of idiopathic intersitial lung disease should be used. A. Diffuse alveolar damage/acute interstitial pneumonia B. Usual interstitial pneumonia/idiopathic C. Desquamative interstitial pneumonia D. Respiratory Bronchiolitis (RB) and RB-interstitial lung disease E. Non-specific interstitial pneumonia F. Non-classifiable interstitial pneumonias G. Organizing Pneumonia/Cryptogenic organizing pneumonia H. Lymphocytic interstitial pneumonia I. Sarcoidosis and its variants J. Langerhans’ cell histiocytosis K. Pulmonary alveolar proteinosis L. M. Diffuse pulmonary lymphangiectasis

4. Allergic lung disease

Page | 254 RESIDENCY TRAINING in Anatomical Pathology ______A. Extrinsic allergic alveolitis/Hypersensitivity Pneumonitis B. Eosinophilic pneumonia-acute and chronic C. Drug reactions

5. Airway and obstructive disease A. Asthma B. Bronchiolitis, including constrictive (obliterative) bronchiolitis C. Bronchiectasis (including cystic fibrosis) D. Follicular bronchiolitis E. Aspiration F. Allergic bronchopulmonary fungal disease G. Emphysema H. Bullae/Blebs

6. Vascular disease A. Emboli and infarcts B. Pulmonary hypertension 1. Chronic passive congestion 2. Thrombotic pulmonary hypertension 3. Plexogenic pulmonary hypertension 4. Veno-Occlusive Disease 5. Pulmonary capillary hemangiomatosis C. Vasculitis 1. Wegener granulomatosis 2. Churg Strauss syndrome 3. Microscopic polyangiitis D. Pulmonary hemorrhage 1. Wegener granulomatosis 2. Goodpasture syndrome 3. Idiopathic pulmonary hemosiderosis 4. Other E. Intravenous Drug Abuse/IV talcosis

7. Pneumoconiosis A. Coal worker’s B. Silicosis C. Asbestosis D. Berylliosis E. Mixed dust F. Hard metal disease/giant cell interstitial pneumonia

8. Bone marrow and stem cell transplant pathology affecting the A. Infection B. Graft versus host C. Other changes

9. Miscellaneous pathology A. Calcification and ossification B. Amyloid C. Connective tissue involvement D. AIDS involvement E. Other immunodeficiency

Page | 255 RESIDENCY TRAINING in Anatomical Pathology ______B. Neoplastic Lung Diseases

1. Benign neoplasms A. Hamartoma/Chondroma B. Sclerosing hemangioma C. Papillomas D. Adenomas (papillary, pleomorphic, alveolar) E. Clear cell tumor F. Multifocal Micronodular pneumocyte hyperplasia G. Meningothelial-like nodule

2. Low grade/malignant non-epithelial neoplasms A. Pleuropulmonary blastoma B. Inflammatory myofibroblastic tumor C. Solitary fibrous tumor D. Epithelioid hemangioendothelioma E. Synovial sarcoma F. Kaposi sarcoma

3. Malignant epithelial neoplasms and precursor lesions: The latest classification of lung tumorw (WHO 2015) and the A. Squamous cell carcinoma B. Small cell carcinoma C. Adenocarcinoma and variants D. Large cell carcinoma and variants E. Sarcomatoid carcinoma (pleomorphic, spindle cell, giant cell, pulmonary blastoma) F. Large cell neuroendocrine G. Carcinoid tumors (typical and atypical) H. Neoplasms of salivary gland origin I. Metastatic carcinomas

4. Hematolymphoid Processes A. Nodular lymphoid hyperplasia B. Low grade lymphomas including MALT lymphomas C. High grade lymphomas including post transplant lymphoproliferative disease D. Lymphomatoid granulomatosis-lymphoma E. Leukemic infiltrates F. Erdheim-Chester disease G. Dendritic cell sarcomas

5. Pleural disease A. Mesothelioma B. Reactive and fibrotic mesothelial processes C. Vascular neoplasms

6. Mediastinal disease A. Thymoma B. Mediastinal lymphomas C. Other

Page | 256 RESIDENCY TRAINING in Anatomical Pathology ______Head and Neck Pathology Preceptors: Drs. Vincent Falck & Roderick Simpson Duration: 4 weeks Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre Contact: Dr. Roderick Simpson ([email protected] ) Last Revised:

Overview Develop an approach to the examination and diagnosis of pathology of the head and neck, including

Objectives Medical Expert 1)

Communicator 1)

Collaborator 1)

Health Advocate 1)

Leader 1)

Professional 1)

Scholar 1)

Page | 257 RESIDENCY TRAINING in Anatomical Pathology ______Frozen Section Preceptors: Various Duration: 1 to 4 weeks Prerequisites: completion of PGY4 Location: Foothills Medical Centre Contact: Dr. Carolin Teman Last Revised: June 2018

Overview To enable residents to become proficient in the preparation of a frozen section for rapid diagnosis and intra-operative consultation. Though the focus will be on the technical aspects of the frozen section, the resident will be expected to perform gross and microscopic examination of specimens as well as reporting of results if another resident is not assigned to frozen sections that day. However, competency in these areas is expected to have been achieved during prior surgical pathology rotations.

Objectives

Medical Expert 1) Competently carry out the technical components of a frozen section, including: a. appropriate gross examination, dissection, and selection/sampling of fresh tissue for microscopic review b. embedding, cutting, and staining of frozen sections c. procuring appropriate tissue samples for special studies as indicated 2) Demonstrate effective, appropriate, and timely performance of diagnostic frozen section procedures 3) Demonstrate a microscopic approach to specimens commonly submitted for frozen section and the ability to make accurate diagnoses.

Communicator 1) Communicate effectively with technical staff during the frozen section process 2) Communicate clearly in both verbal and written form with the operative team a. call the operating room to report and discuss frozen section results with surgeons b. communicate effectively both the diagnosis and the adequacy of the tissue c. be capable of giving appropriate further direction to the clinician if needed d. describe the rationale for the wording of frozen sections

Collaborator 1) Describe the importance of clinicopathologic correlation and the modes by which additional clinical information may be obtained. 2) Recognize when diagnostic difficulty is encountered and know when to consult with the clinician or colleagues as appropriate. 3) Be aware of when to defer a case.

Health Advocate 1) Demonstrate understanding and compliance with safety guidelines of the laboratory to minimize occupational risk related to mechanical, chemical and biological hazards. 2) Be aware of what steps to take if an infectious risk is identified, a chemical spill occurs, or an injury is sustained.

Page | 258 RESIDENCY TRAINING in Anatomical Pathology ______Leader 1) Be able to describe the following principles as they relate to frozen sections: a. appropriate uses and limitations of the procedure b. approximate rates of diagnostic accuracy, false positives and false negatives c. quality control procedures for frozen section diagnosis (e.g. comparison to final diagnosis)

Professional 1) Recognize personal limits of expertise, when to seek additional information from the clinician or consultation with another pathologist, and when to defer a case to permanent sections. 2) Exhibit appropriate personal and interpersonal behaviors during interactions with staff pathologists, technical staff, support staff, operating room nurses, and clinicians, by: a. Responding appropriately to criticism b. Acting as a role model for students and others c. Addressing interpersonal differences in professional relations d. Being reliable, conscientious, and accountable for personal actions 3) Practice pathology in an ethically responsible manner.

Scholar 1) Accept responsibility for self-learning and self-evaluation, recognize gaps in knowledge, and choose appropriate learning methods to address gaps or improve understanding of relevant subject matter. 2) Critically appraise sources of medical knowledge. 3) Facilitate the learning of medical students, other residents, or other learners when they are present in the frozen section room.

Page | 259 RESIDENCY TRAINING in Anatomical Pathology ______Endocrine Pathology Preceptors: Drs. Moosa Khalil, Martin Hyrcza, Roderick Simpson, Konstantin Koro, Vincent Falck Duration: 4 weeks recommended (2 weeks accepted) Prerequisites: Successful completion of PGY2 Location: Foothills Medical Centre Contact: Dr. Moosa Khalil ([email protected] ) Last Revised: September 5, 2019

Overview This rotation is for enhancing the knowledge and the diagnostic abilities of trainees in common areas of endocrine pathology (thyroid gland, parathyroid glands, adrenal glands, endocrine pancreas, endocrine tumors of the gastrointestinal tract and lungs)

Objectives

Medical Expert The resident will: 1) Demonstrate adequate knowledge of basic histology of the endocrine organs 2) Learn how to handle and interpret endocrine pathology-related frozen sections 3) Conduct gross examination of various endocrine pathology specimens, and demonstrate knowledge of gross features of both neoplastic and non-neoplastic diseases and the gross findings relevant to patient management (staging of malignancies) 4) Become competent in the interpretation of the histomorphologic features of common endocrine neoplastic and non neoplastic diseases and be able to formulate a diagnosis/differential diagnosis 5) Understand the role of ancillary studies in the diagnosis and prognostication of endocrine diseases 6) Formulate clear, concise, and complete reports that accurately and adequately describe specimens and the histopathologic features. List the results of the ancillary studies and their significance, when indicated 7) Participate in the review and sign out of endocrine pathology consults 8) Independently review teaching slides of unusual and rare entities

Communicator The resident will demonstrate the ability to: 1) Appropriately communicate with clinicians, radiologists and pathologist to gather essential information required to formulate accurate and comprehensive reports. 2) Communicate effectively with technical staff (ie. in the gross room, at the time of frozen sections) and transcriptionists 3) Demonstrate ability to answer clinically relevant questions (on etiology, pathogenesis, and pathologic features) 4) Attend and participate effectively in tumour board meetings (presentation is optional) 5) Attend and participate effectively in pituitary rounds as time permits Collaborator The resident will: 1) Become part of the team through interactions with clinical endocrinology and surgery colleagues, when there is an opportunity. 2) Collaborate in research activities, if possible.

Health Advocate The resident will: 1) Recognize and respond to those issues, circumstances, or situations in which advocacy on behalf of patients or the community is appropriate

Page | 260 RESIDENCY TRAINING in Anatomical Pathology ______2) Demonstrate the ability to recognize those situations that require consultation or notification of the Department of Health. Leader The resident will: 1) Utilize time and resources effectively to balance patient care, learning needs and outside activities. a. Understand finite health care resources and use discretion in the utilization of resources without unnecessary waste. b. Utilize resources effectively in order to facilitate self-directed learning. 2) Demonstrate understanding of quality as it pertains to endocrine specimens. Professional The resident will: 1) Deliver the highest quality practice of surgical pathology with integrity, honesty and compassion 2) Demonstrate effective consultation, as an anatomical pathologist, with respect to patient care, education and legal opinion 3) Recognize personal limitations and consult expert opinion when required Scholar The resident will: 1) Develop, implement, and document a personal continuing education strategy 2) Maintain a logbook of the cases encountered and make the preceptor(s) aware of deficient areas before the end of the rotation 3) Participate in building an educational image bank (scanned slides) of rare and uncommon entities 4) Submit educational slides for the surgical pathology rounds and be available for the discussion 5) Present a topic pertaining to endocrine pathology during microscopic rounds (at least once)

Recommended Reading: 1. Rosai and Ackermans Surgical Pathology Chapters 9, 10, and 16 2. Sternberg’s Diagnostic Surgical Pathology Chapters 13 and 14 3. AFIP Atlas of tumor pathology Series 4, #8 (adrenal glands and extradrenal paraganglia) and # 21 (tumors of the thyroid gland and parathyroid glands) 4. Endocrine Pathology (Foundations in Diagnostic Pathology) – by Lester Thompson 5. Diagnostic Pathology Endocrine – by Nose et al. 6. WHO Classification of Tumors of Endocrine Organs, 2017

Page | 261 RESIDENCY TRAINING in Anatomical Pathology ______Outline of topics required to gain minimum exposure: A. Thyroid Gland Pathology

i. Thyroiditis ii. Benign nodular disease iii. Common malignant thyroid neoplasms: Papillary carcinoma (variants), follicular carcinoma, poorly differentiated carcinoma, anaplastic carcinoma, and medullary carcinoma. iv. Formulating synoptic reports for thyroid cancer v. Evaluating thyroid gland fine needle aspiration cytology samples vi. Formulating thyroid cytology report s according to the BSRTC (2017) vii. Recognizing the limitations and pitfalls in surgical pathology and cytopathology of the thyroid gland

B. Parathyroid Gland

i. Parathyroid hyperplasia ii. Parathyroid adenoma iii. Parathyroid carcinoma

C. Adrenal Glands:

i. Normal histology and immunohistochemistry ii. Benign nodular disease iii. Adrenal cortical carcinoma iv. Pheochromocytoma

D. Gastroenteropancreatic neuroendocrine tumors:

i. Well differentiated neuroendocrine tumors (GI, G2, G3) ii. Neuroendocrine carcinoma (small cell type, large cell type) iii. Role of immunohistochemistry in the diagnosis and grading (Ki 67) of neuroendocrine tumors

E. Pulmonary neuroendocrine tumors:

i. Typical carcinoid tumor ii. Atypical carcinoid tumor iii. Small cell carcinoma iv. Large cell neuroendocrine carcinoma v. Understanding the differences in the diagnostic criteria and terminology in comparison to those of the gastroenteropancreatic tumors

Hereditary syndromes relevant to endocrine/neuroendocrine tumors

Page | 262 RESIDENCY TRAINING in Anatomical Pathology ______PGY5 – Junior Staff - Anatomy/Histology Block 11 Supervisors: Dr. Amy Bromley ([email protected]) & Dr. Carolin Teman [email protected] Preceptors: All Staff Duration: 4 weeks (1 block) Prerequisites: completion of PGY4 Location: Foothills Medical Centre Contact: Chief Resident, Dr. Bromley Last Revised: March 2018

General Objectives The primary objective of this rotation is to practice being responsible for an entry level educational experience to ensure all incoming residents have a baseline knowledge of anatomy and histology, as will be necessary for them to be successful in their future training. This block was initially created to address the diminishing amounts of anatomy and histology taught in medical school, and correct this deficiency prior to residents entering their core pathology rotation. As the rotation developed, it also became an opportunity for junior residents to practice their teaching skills and become more acquainted with the lab. As junior staff, the senior resident will work with the chief resident to ensure that the course is comprehensive, and taught in an appropriate, efficient manner. The junior staff resident will assist the chief resident in addressing any issues or concerns that may arise throughout the course, and liaise with the co-program directors where necessary. The junior staff resident is also responsible for any necessary remediation for course participants.

Specific Objectives Medical Expert Residents must: 1) Assess the presentations given by the junior residents for content, clarity, and delivery 2) Compose remedial materials where necessary 3) Evaluate the course as a whole, and in conjunction with participant feedback, modify the course to address any issues raised.

Communicator and Health Advocate Residents must: 1) Communicate effectively with the junior residents, chief resident, staff pathologists, and technical and support staff in the laboratory 2) Deliver clear, effective instruction in both a one-on-one and group setting 3) Understand the importance of basic histology and anatomy to the safe practice of pathology 4) Effectively confer the importance of understanding basic histology and anatomy to the safe practice of pathology to the junior learner.

Collaborator and Leader Residents must: 1) Adhere to team work principles (communication, reliability, conflict management, leadership, respect, problem solving) 2) Displays appropriate time management skills

Scholar Residents must: 1) Understand the principles of human anatomy and histology 2) Demonstrate capability of self-directed study using appropriate texts and information sources, and the ability of interpreting information in the context of accepted evidence based medicine practices

Page | 263 RESIDENCY TRAINING in Anatomical Pathology ______3) Identify gaps in knowledge and expertise and create a learning plan to address them 4) Understand the principles of and demonstrate a commitment to continuing education 5) Impart knowledge on more junior learners

Professional Residents must: 1) Display sensitivity to gender/ethnic and other social issues, with peers, supervisors, support and clinical staff 2) Demonstrate an ethical approach to the performance of duties within the laboratory 3) Recognize limitations and seek assistance when required 4) Respond to criticism appropriately 5) Act in a collegial manner

Assessment A comprehensive evaluation form (ITER) will be completed with input from junior residents and the chief resident.

Page | 264 RESIDENCY TRAINING in Anatomical Pathology ______Appendix A: Millennium Millennium Tips and Tricks for Dictation

DEFINITION: Dictate, to speak or read for a person to transcribe or for a machine to record.

Learn about the recording equipment you are using. Information about Desktop Recorder can be found in Soft Tech procedure AP04-1.05 Desktop Recorder Dictation https://CLS.labqms.com/labFrame.asp?DID=21372&ScH=T or on AHS insite: https://ahs.labqms.com/labFrame.asp?DID=24788

If you require assistance and/or training with the Desktop Recorder software please contact the AP Clerical Operations Assistant, Jennifer MacCallum (403-944-0704, [email protected] ).

 Pause slightly before beginning to record and pause briefly before stopping recording. This will eliminate “clipped” words.

 Identify yourself at the beginning of the report by providing your initials as per the rota and also state who you are dictating for.

 State the accession number from the label on the container.

 Read the Single (sp) or Multiple (sm) specimen template clearly • Example: This is Amy Bromley, initials AMB, dictating gross descriptions for Dr. Ogilvie on May 27, 2017. Single Specimen template, last name C-L-A-R-K, first name K-E-N-T, surgical number SF-17-12345.

 Dictate the “SPEC” code filling in the blanks as appropriate, in (__) in the example below.

 Example: The specimen is received (fresh, in formalin…). The container is designated as “(right breast)”.

 Continue dictating the gross description.

 Use multiple adjectives in one sentence being thorough but succinct. • Example: The specimen is an 8.5 x 3.0 x 1.0 cm, green gallbladder with a smooth serosal surface filled with thick bile and a single cholesterol stone measuring 1.5 x 1.5 x 1.5.

 When grossing larger specimens, dictate the blocks as per the example below:

Representative sections are submitted as follows: A1-A2 multiple perpendicular sections of medial margin with adjacent rubbery firm tissue A3-A4 medial-most edge of tumor A5 medial aspect of tumor with adjacent inferior and deep margins A6 superior margin adjacent to tumor (contiguous with A5) A7-A8 two contiguous sections of tumor (A7 includes inferior and deep margin, A8 includes superior margin and possible biopsy site) A9 skin closest to tumor (grossly uninvolved) A10-A13 remainder of tumor submitted from medial to lateral, including adjacent inferior margin A14-A16 multiple perpendicular sections of lateral margin closest to tumor

Remember!! 1. Gross is dictated in present tense. 2. Microscopic and diagnosis are in past tense 3. Do not dictate the requisition, transcription will transcribe the clinical history and specimen description verbatim from the requisition 4. Write firmly and legibly on frozen section requisitions including your initials and your staff person’s initials

Page | 265 RESIDENCY TRAINING in Anatomical Pathology ______5. Frozen sections are transcribed verbatim by transcription from the requisition, these do not need to be dictated

6. Speak clearly and at a regular pace, (your regular speaking voice is perfect). Do not mumble or let your voice “fade out” at the end of sentences or when using small words such as the, that, a, or an.

7. Ensure your dictation makes sense and don’t run all your sentences together.

8. Try to avoid the “ums, ers and ahs”.

Dictating Sentences and Paragraphs: Start a new sentence or a new line by saying new line. Begin a new paragraph preceded by a blank line by saying paragraph or new paragraph.

Dictating Punctuation: Say punctuation marks such as period, comma, colon, quote, end quote, bracket and end bracket.

Avoid unintentional noises when dictating, i.e., making extraneous sounds, background conversations, eating, chewing gum, music playing or phones ringing. These noises all come through on the dictation.

When dictating measurements, pause slightly after the digits but not between by and the next digit. “2 (pause) x 3 (pause) x 4 cm” For this number Say this

0 Zero

1000 One thousand

1205 One thousand two hundred and five

3.18 Three point one eight

2 x 3 x 4 cm Two by three by four centimeters

When dictating dates and times: For this Date or time Say this April 12, 1942 April twelfth nineteen forty-two 1:00 one o’clock 8:35 pm eight thirty five pm

When dictating the gross description, if you want to go back and add additional information, please clearly indicate where you want the dictation to start, also where you want it to end.

When dictation is completed, include a phrase such as “end of dictation” or “Thank You” to indicate the dictation for this case is complete.

ENUNCIATING CORRECTLY The following are prefixes that may be difficult to understand during dictation.

ante - before anti - against, counter

Inter - among, between intra - inside

hyper - above, beyond, more than normal hypo - beneath, under or below

arteriole - a minute arterial branch arterial - pertaining to the artery or to the arteries

Page | 266 RESIDENCY TRAINING in Anatomical Pathology ______Medical Transcription Staff List The transcription staff is here to help you with any questions you have, all of the contact information for each APL site is listed below. If transcription has any difficulty understanding a dictation they will send you an email to notify you that the case needs review.

ACH Phone Initials Kathryn Buchanan 955-2327 klb Holly Reznechenko 955-2326 hr DSC Chalmers, Kim 770-3240 kc Cyr, Tracy 770-3605 tc Tremblay, Carmen 770-3437 ct Trudeau, Shelly 770-3841 st FMC Christen, Cailey 944-5643 csc Patram, Wendy 944-4736 wp PLC Bird, Meghan 943-5638 mrb McLean, Michelle 943-5628 mlm RGH Daniels, Kelly 943-3418 kld Howden, Michele 943-3418 mh SHC James, Hilda 956-1350 hj Scott, Rhonda 956-1356 rjs Zawada, Olga 956-1348 oz Santos, Janice 956-1381 js

IMPORTANT NOTES IF YOU ARE TRANSCRIBING A REPORT Refer to the LIS12-1.30 Report Format procedure in Soft Tech.

 Do not change fonts  In the Diagnosis field, use two tabs only and an “enter” must be used at the end of the line to ensure reports stay lined up when going through the print server. Before saving report, click the Display Code icon and check for the hard returns in the Diagnosis field  When transcribing a date, use the format YYYY-MM-DD  In any Diagnosis field, only use a period for complete sentences  One line must be left between the last line of text and the next field heading.  Leave one blank line between paragraphs  Do Not use any special characters, these will be changed to an asterix* when crossing the interface from Millennium.

If you copy and paste from a Word Document into Millennium it is very important that you change any quotes or other special characters so that they cross the interface properly.

Page | 267 RESIDENCY TRAINING in Anatomical Pathology ______Millennium Special Characters Special characters include:  ~ tilde  & converted to "and"  ^ removed  \ removed  | removed  © copyright  ≈ approximately  ≤ less than or equal  ≥ greater than or equal to  ® registered  square or curvy brackets { } [ ]  Bullet is converted to 'o';  ° temperature  ™ trade mark  §  ¶  ‡  ‘ apostrophe – from MSWord  “” smart quotes – from MSWord  ½ as typed in word document

Page | 268 RESIDENCY TRAINING in Anatomical Pathology ______Appendix B: Sign off Sheet

ACKNOWLEDGMENT OF RECEIPT OF HANDBOOK

The Resident Handbook contains important information about the Anatomical Pathology Residency Training Program, and I understand that I should consult the Program Directors or Program Administrator regarding any questions not answered in the handbook.

Since the information, policies, and procedures described herein are subject to change at any time, I acknowledge that revisions to the handbook may occur. All such changes will generally be communicated through official email or memoranda, and I understand that revised information may supersede, modify, or eliminate existing policies and information.

I have had an opportunity to read the handbook, and I understand that I may ask my Program Directors or Program Administrator any questions I might have concerning the handbook. I accept the terms of the handbook. I also understand that it is my responsibility to comply with the policies contained in this handbook, and any revisions made to it. I further agree that if any modifications are made to the handbook, I thereby accept and agree to such changes.

I have received an electronic copy of the Handbook on or before the date listed below which is available on-line for reference at any time. Additionally, I understand that this form will be retained in my confidential file.

Therefore, according to the Program Policy: General Expectations for Residency Training, I hereby certify that I have read the following sections of the document entitled “A Handbook and Guide to Residency Training in Anatomical Pathology”:  Section 1: Welcome and Introduction  Section 2: Educational Opportunities  Section 3: Research  Section 4: Evaluation  Section 5: Other Miscellaneous  Appendix A: Millennium  Appendix D: Competence By Design

______Resident Name(Printed) Signature of Resident Date

______Program Representative Signature Date

Page | 269 RESIDENCY TRAINING in Anatomical Pathology ______Appendix C: Emergency Contact Information

Please provide emergency contact information for the program to have on file in case of personal injury, code purple, code black, code grey, code green, or code orange which could occur after regular operating hours.

Resident Information

Full name (first last): ______

Home Address: ______

Home Phone: ______Cell phone: ______

Primary Emergency Contact

Name: ______Relationship: ______

Address: ______

Home phone: ______Work phone: ______

Cell/Other phone: ______

Secondary Emergency Contact

Name: ______Relationship: ______

Address: ______

Home phone: ______Work phone: ______

Cell/Other phone: ______

I consent to the above information being kept in my confidential file and used in case of emergency.

______Resident Name(Printed) Signature of Resident Date

______Program Representative Signature Date

Page | 270 RESIDENCY TRAINING in Anatomical Pathology ______Appendix D: Competence By Design – under construction The Competence Committee – Terms of Reference <- click here National Standards for Training AFTER July 1, 2019 (CBD Program Stream)

A quick overview Infographic of Competence By Design and the things Residents need to know:

Page | 271 RESIDENCY TRAINING in Anatomical Pathology ______

Page | 272 RESIDENCY TRAINING in Anatomical Pathology ______How to Log in to ePortfolio(for Faculty): Access the system using your Royal College ID:

1. Using a web browser, go to: https://mainport.royalcollege.ca 2. The login page appears.

3. If you do not know, or you have forgotten your Royal College ID, click the link “Forgot your Royal College ID?”

4. Enter the email address you were registered with and you will receive an email with your Royal College ID. (If you do not know which email you were registered with you can contact Anna or Cassandra for help with this)

5. If you have your Royal College ID but do not know, or you have forgotten your password, click the link “Forgot your Password?”

6. Enter your Royal College ID and email address. You will receive an email with a link that allows you to set a new password.

Page | 273 RESIDENCY TRAINING in Anatomical Pathology ______7. Upon successful login to MAINPORT, click on the CBD tab to access the Resident ePortfolio.

*Please note that upon first login, it may take up to 30 seconds for this page to render completely however this response time will improve for subsequent page loads.*

8. If you need additional help getting started, please email Anna Thomas (General Pathology) or Cassandra Saubak (Anatomical Pathology) or the royal college directly at [email protected]. The offices are open Monday to Friday, 8:00 a.m. to 5:00 p.m. eastern, and they will respond to your inquiry during those business hours.

Page | 274 RESIDENCY TRAINING in Anatomical Pathology ______How to complete an observation in ePortfolio (for Faculty):

*For additional information on completing an observation, a 30 minute webinar is available from the royal college website: http://www.kaltura.com/index.php/extwidget/preview/partner_id/1688662/uiconf_id/22517242/entry_id/1_kp g6ulbo/embed/auto?

1. Using a web browser, go to: https://mainport.royalcollege.ca 2. The login page appears.

3. Enter your royal college ID and password. If you already use Mainport to document CME activities, the same ID and password can be used. If you don’t have a password, refer to the document “E-portfolio login for new users” for instructions.

4. The Mainport dashboard screen will appear. Select the CBD tab. If you have been on- boarded to e-portfolio, you should have a “CBD” tab. If you do not see this tab, contact the support team at the royal college (See contact information at the bottom of this document).

Page | 275 RESIDENCY TRAINING in Anatomical Pathology ______5. This screen will appear. Make sure the role listed under your name is “observer”. If not, select it from the dropdown menu. Observations that have already been added will appear under the “pending observations” tab. You can accept or decline a pending observation. Once accepted, the observation can be completed (Go to step 9 for instructions on completing an observation).

6. The following screen will appear. Search for the learner name.

Page | 276 RESIDENCY TRAINING in Anatomical Pathology ______

7. Select the learner’s name and click “Next”

8. Select “EPA/IM Observation” and click “Next”

Page | 277 RESIDENCY TRAINING in Anatomical Pathology ______

9. The following screen will appear. Select the Stage. For Block 1 PGY1 residents, this is “1- Transition to Discipline”. Select the EPA that you are evaluating. In this example: “1.2 Participating in basic specimen handling” and then select “Part A”

10. Fill out the following observation form. The fields with a red asterisk* are mandatory. The observation is evaluated using the O-score entrustability scale (in the red box) . This scale is explained below.

Page | 278 RESIDENCY TRAINING in Anatomical Pathology ______The O score entrustibility scale rates how you felt working with this resident during the observation.

Level Descriptor

1 “ I had to do” i.e. requires complete hands on guidance

2 “I had to talk them through” i.e. able to perform tasks but requires constant

direction

3 “I needed to prompt” i.e. demonstrates some independence but requires

intermittent direction

4 “I needed to be there just in case” i.e. independent but unaware of some of the risks and requires supervision for safe practice 5 “I did not need to be there” i.e. complete independence, understands risks and performs safely, practice ready

11. The milestones associated with this EPA will appear. These are optional and you can select “not observed” as appropriate.

12. Narrative Feedback is a required field. Please use this opportunity to provide constructive and actionable comments that will help the trainee learn. When the form is complete, click “submit” and confirm “yes”. You can also save a draft to complete later.

Support If you need help accessing or using the Resident ePortfolio, you can contact Anna Thomas (General Pathology) or Cassandra Saubak (Anatomical Pathology), or email the royal college directly at [email protected]. The offices are open Monday to Friday, 8:00 a.m. to 5:00 p.m. eastern, and they will respond to your inquiry during those business hours.

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