Neuropathology Rotation Specific Objectives for Residents

Neurosurgery residents at the University of Ottawa will spend 12 weeks in neuropathology at the Civic campus of The Ottawa Hospital. The residents will be expected to participate in all daily activities involving reviewing and reporting of neuropathological cases in conjunction with supervising staff member. Residents will also participate in rounds and teaching sessions planned by the neuropathologists during the rotation.

MEDICAL EXPERT

General Objectives:

• to gain practical knowledge of gross and microscopic anatomy of the nervous system. • to understand the correlation between neuropathological lesions and neuroradiological imaging. • to understand the correlation between neuropathological lesions and clinical signs and symptoms. • to understand the indications for tissue of , muscle, nerve, as well as the limitations of these procedures. • to understand the relevance of in patient care. • to increase the understanding of mechanisms of neurological .

Specific Objectives:

1. Autopsy

• residents should be able to summarize the clinical history from a chart and identify the specific questions to be answered by the autopsy. • residents should be able to remove the brain, , eyes, peripheral nerves, and muscles by themselves promptly and without causing damage. • residents should be able to name every grossly visible structure of the brain and spinal cord and their vessels. They should be able to indicate the function of the different parts of the brain. • residents must be aware of circumstances (such as subarachnoid hemorrhage) in which special procedures are called for before fixation of the brain, and be prepared to act accordingly. • residents should be familiar with the risks associated with conventional infectious agents and prions, and with the procedures used to reduce this risk. • residents should be able to select and take appropriate samples for histological examination. • residents must be able to recognize the histological appearance of all parts of the brain or spinal cord. • residents must be able to obtain a diagnosis in all common lesions, and to classify less common lesions in the appropriate group.

Neuropathology Rotation Objectives 2009 • residents must be able to correlate pathological findings with clinical signs and symptoms.

2.

• residents must be able to handle neurosurgical specimens appropriately, including obtaining smears, frozen sections, preparing tissue for culture or flow cytometry, and fixing samples for electron microscopy. • residents must be able to provide an appropriate gross and microscopic description of surgical specimens. • residents must be familiar with the technical principles involved in special stains in neuropathology, as well as their diagnostic significance. • residents should be able to identify the use and pitfalls of the different antigenic markers utilized in immunoperoxidase, immunofluorescence, and lectin immunohistochemistry procedures. • residents should be able to interpret the microscopic findings in the light of clinical and radiological information, and to incorporate this process into a written comment. • residents must be able to achieve an appropriate diagnosis in all common conditions, and to recognize uncommon conditions. • residents should be familiar with normal and abnormal CSF cytology. • residents must understand the value of electron microscopy in neuropathological diagnosis, and be able to use the equipment themselves.

3. General

• residents should demonstrate understanding of the process of fixation of tissues for diverse purposes, and the role of different fixatives in the laboratory. • residents must be familiar with basic concepts in general anatomic pathology, including:

i. inflammation: acute, chronic and granulomatous ii. necrosis iii. infectious agents iv. neoplasia: benign and malignant tumours (including metastatic tumours) and associated grading schema

• residents should be able to obtain high quality photographs of gross and microscopic specimens. • residents should be able to describe major mechanisms of disease affecting the nervous system and muscle.

COMMUNICATOR

• residents must obtain a relevant history from the chart and/or referring and communicate the results of the autopsy to the referring physician in a concise written summary explaining how the autopsy results relate to the clinical history. • residents must communicate neuropathology results to the referring physician in a timely fashion.

COLLABORATOR

• the resident will work effectively with referring and other healthcare professionals to ensure that a neuropathological diagnosis is obtained.

MANAGER

• the resident will show punctuality and demonstrate good time management skills by timely completion of neuropathologic procedures and reports. • the resident will take appropriate precautions to protect herself/himself, the patient and lab personnel against transmission of infectious .

HEALTH ADVOCATE

• the resident will contribute to improved health of patients and communities by recognizing and responding to those issues where advocacy is appropriate.

SCHOLAR

• the resident will present at least one conference per month at Grand Rounds and/or at Neurosurgery Rounds during academic ½ day activities. • the resident will demonstrate a personal learning strategy and effective reading schedule. • the resident will be able to critically assess the neuropathology literature.

PROFESSIONAL

• the resident will interact with pathologists, technologists, and staff in a professional and courteous manner. • the resident will demonstrate utmost respect for the specimens which he/she is handling.