Laboratory of Pathology - Staff

A. Laboratory of Pathology Mission, Vision and Philosophy

Our Mission:

Our mission is to achieve the highest level of quality in diagnostics, education and research.

Our Vision:

The Laboratory of Pathology, Center for Cancer Research, NCI, is a partner with the clinical and research community at the NIH. By continuing to expand the scope of our expertise and by incorporating the newest tools of diagnosis, training, and research, our goal is to be a globally recognized center of excellence for clinical diagnostics, disease research, and pathology education.

Our Philosophy:

In our ongoing management of our programs, and in our strategic planning process, we have been guided by a set of core values that define our organizational culture. These are:

• To respect the contributions and diversity of the people in our workplace.
• To promote excellence in patient care and clinical trial support.
• To hold ourselves to the highest standards of ethical conduct.
• To maintain a commitment to a high-quality work life.
• To be good stewards of our resources.

Diagnostics

We take responsibility for all anatomic pathology services for the NIH Clinical Center as well as others who seek our expertise through consultation. Our goal is to provide the highest quality and most accurate diagnostic interpretation in the most efficient manner. This goal is supported by a commitment to continuous quality improvement.

Education

Through participation in clinical and research conferences and training of residents and fellows, we provide leadership in anatomic pathology. As an organization that applies state-of-the-art technology to tissue and cell-based diagnostics, we share our expertise and teaching with the clinical and scientific community.

Research

We support the research mission of the NIH through our support of clinical research protocols and by seeking to apply leading edge technology to diagnostic questions. In this endeavor we value originality, scientific integrity, and ethical behavior, thereby setting a high standard for pathology research excellence for ourselves and for the international pathology community.

B. Accreditation and Certification

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

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

C. Resident Service and Participation

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

• • LP Safety Manual
  • Clinical Services General Policy Manual
  • Autopsy Manual
  • Grossing Manual
  • Request for Human Biological Materials
  • Other manuals must be reviewed in each section as required by each Clinical Chief.

D. Pagers and On-Call

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

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

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

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

NEVER HESITATE TO CALL THE STAFF ON DUTY FOR ADVICE AND INSTRUCTIONS. NEUROPATHOLOGY STAFF AND OTHER SUB-SPECIALTY STAFF ARE ALWAYS AVAILABLE.

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

On-Call:

Residents are not required to be present at the institution during periods of on-call. No call is required of PGY-1 residents and PGY-2 residents may have up to a total of nine weeks on call.  All on-call schedules are in full compliance with ACGME standards.  Residents take weekend and evening calls, with the stipulation that all residents must have at least 1 full 24-hour day off in 7, as averaged over a 4-week period. A single resident covers all clinical services: surgical pathology, autopsy, and cytology. A separate attending staff pathologist is designated for each service.

Residents take call from home and are not required to stay in the hospital. They carry a pager with a radius range of 50 miles, giving them the flexibility to pursue personal activities during their call responsibilities. During the first 2 years of experience, the resident serves a total of 17 and one-third weeks on call. Most of this call time is served in the first year of residency. Third-year residents are relieved of call responsibilities, but are available to advise and mentor junior residents. In addition, to ensure that no resident carries an excessive burden, a back-up resident is available for coverage if a resident receives more than 2 autopsies to perform on any call day.

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

E. Leave and Back-Up Coverage

Vacations should be taken during an autopsy or cytology rotation or elective. If vacation is taken during autopsy rotation, back-up coverage must be arranged, and the Chief of the Autopsy Service notified. If vacation is taken during a cytology rotation, a make-up rotation should be scheduled with the Chief of the Cytopathology Section. Try not to take vacation during the month of July. Complete a request for Administrative/Annual Leave in the Integrated Time and Attendance System (ITAS) .  For additional information about Leave and Back-Up Coverage policies in LP, please go (here).

Attendance at scientific meetings or courses will be covered by Administrative Leave. As with Annual Leave, back-up coverage by another resident should be arranged well in advance. Residents must inform the program director of any future attendance to scientific meeting or courses at least 120 days in advance.  Once the program director approves the request, a travel request should be completed immediately in order to initiate a travel request through the travel planner.  This will assist the travel planner in NIH travel deadlines and requirements on the resident's behalf.  All travel requests must be approved in advance by the Program Director and routed through the Office of the Chief (OOTC) travel planner. Please see "I am requesting a Travel Action". 

"Emergency" use of annual or sick leave will be defined as any leave not scheduled in advance. If the resident taking emergency leave is on the autopsy service, the resident on cytology rotation will cover.   If two or more autopsies occur, then the resident on elective rotation will step in. If the resident taking emergency leave is on the in-house surgical service, then a second-year resident on elective will cover. If the resident taking emergency leave is on the submitted service, then the third-year fellow on elective will cover.  Service coverage for all leave scheduled in advance will be arranged among the residents on an individual basis. The resident scheduling the leave is held responsible for arranging for the back up coverage.

Coverage of emergency leave will be coordinated by the Chief Resident, in consultation with the Program Director and Attending(s) of the services involved.

F. Extramural Rotations

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

Outside elective rotations must be approved in advance by the Program Director. Due to the rotation requirements by individual institutions, the Elective Rotation Approval Form must be submitted a minimum of 3 months in advance (see Appendix A2) for all outside rotations. For rotations in Washington D.C., we will need at least 4 months advance notice due to the D.C. Board requirements of acquiring either a Medical Registrant Form or Medical Training License prior to the start of any elective rotation, see additional information (here).  This form must also be completed prior to institution of required outside rotations so that appropriate notification and liability coverage can be maintained.

G. Statistical Concepts

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

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

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

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

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

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

H. Tissue Distribution for Research Purposes

Requests for human biological materials for research are regulated by both internal Laboratory of Pathology procedures and the NIH Clinical Center (CC) Medical Administrative Series M01-2. 

Approved requests for surgical and autopsy research specimens are handled in accordance with the "Requests for Human Biological Materials" procedure (see LP Policies Manual - Section 3).

The CC Tissue Procurement Nurse or LP Clinical Laboratory Manager can assist with this process. For more information, please see LP Policies Manual - Section 3, Requests for Human Biological Materials.

I. Library Resources, Literature Review and Editorial Board

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

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

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

The NIH Fellows Editorial Board (FEB) is service available to NIH fellows. The FEB is a way for you to have your manuscripts (grants, papers, etc.) reviewed by your peers for editorial content. The Board will not judge the scientific merit of the manuscript/grant. All submissions will remain confidential!

• If you are interested in taking advantage of this service, contact NCIEditors@mail.nih.gov
• Within 10 days, the Board will edit your document for form, clarity and content. They will not, however, evaluate its scientific merit.
• Authors will be able to meet one-on-one with a Board member to discuss any suggested editorial changes.
• Multiple submissions are encouraged until a final product is optimally developed.

J. Mental or Emotional Conditions Inhibiting Performance or Learning and Drug- or Alcohol-Related Dysfunction

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

Residents meet with the Program Directors on a one-on-one basis every 6 months. At these meetings, they are interviewed about their satisfaction with the program, and any personal concerns that they may have about their professional circumstances, or demands from their personal lives.

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

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

All residents receive and sign a Resident Agreement or "Contract" that outlines access to counseling, medical and psychological support services, policies on physician impairment, professional benefits and obligations, conditions of reappointment, grievance procedures, policies on gender or other forms of harassment,and other institutional policies and procedures.