The residents will rotate for 2 sequential months during the last 6 months of their first year of residency in the Cytopathology Section. Evaluation will be based on participation in tasks below.
In order to maximize the residents' learning and understanding of Cytopathology they are required to have completed several months on either autopsy or surgical pathology before they rotate through Cytopathology.
The first 2 months of the Cytopathology rotations are in-house at the NIH. During this time the resident gains experience in the preparation and microscopic examination of cytology material. The first few days on the cytology rotation the resident is assigned to the specimen preparatory area and is taught the essentials of the various types of cytology preparations and the philosophy behind them. They are also expected to become proficient in the preparation of cytospins, smears, Diff Quik stains and Grocott Methenamine silver stains.
The resident is expected to review all of the daily cytology material after it has been screened by the cytotechnologists. He/she may either do this alone or with the Cytopathology Fellow. After the cases are completed they are reviewed with the attending cytopathologist on service. During the sign-out the resident is also instructed in the utilization of routine and immunohistochemical stains on cytologic preparations.
During the NIH cytopathology rotations the residents have the opportunity on a daily basis to discuss relevant clinical aspects of the cases with the clinicians. Residents call clinicians to obtain additional history, if required, and call clinicians to report urgent diagnoses. Clinicians frequently visit the cytopathology laboratory to review their cases. Residents review cases with clinicians at a multiheaded microscope and illustrate pertinent findings.
Residents are instructed in FNA techniques by the Cytopathology Fellow and the attending on service. Their initial instruction takes place on table foods that simulate clinical samples (Orange, apple and liver placed sequentially into a hole in a sponge), which are then utilized for instruction in smear preparation. After this initial instruction residents are advised on the proper introduction of FNA on the clinical ward -- what to tell the patient regarding the procedure, limitations, possible side effects, etc. Residents are encouraged to participate actively on the FNA service and are encouraged to do at least 15 FNAs while on the service over 2 months. While participating on the FNA service they also take part in the immediate adequacy assessment that takes place on the ward.
Biopsies of previous and concurrent surgical pathology material are correlated with cytology cases on virtually all cases during sign-out when the material is available. The rotations at George Washington University (GWU) Medical Center are provided to present the residents with a spectrum of cytology that is a high volume in Gyn samples and more like that of a community hospital. During these 2 months off-ite, the residents' role is similar to those mentioned above. At GWU, the residents screen FNA material obtained in the clinic and rescreen all other specimens. They provide microscopic descriptions and diagnoses for each case and then review with the attending cytopathologist.
Cytopathologists are frequently called upon to consult on cases with the clinician. This interchange includes both discussing the clinical aspects of the cases as well as a microscopic review. It is customary for the resident to discuss the clinical aspects of the case with the clinician, relate the diagnosis to the clinician and also take part in the microscopic review. Generally it will be the attending or the fellow who runs the actual microscopic review. The resident may be called upon to present cytopathology cases at various clinicopathologic conferences while on the service, if the cytopathology fellow is not available. In this scenario, the attending will review all aspects of the case with the resident and fully prepare him or her for the presentation.
Although residents are expected to review all of the cytology cases while on the cytopathology service, rendering diagnosis and reviewing all of the cases with the attending or Fellow-on-service, the resident does not assume independent sign-out responsibility. The resident does, however, become trained in the performance of fine needle aspirations, and does perform fine needle aspirations under the supervision of an attending or fellow.
Residents rotate through the cytology section for 2 months during the first year at NIH and for 2 months at George Washington University Medical Center during the second year of residency. The resident is responsible for previewing all of the cases as time allows. The cytopathology attending who is on service is responsible for going over all aspects of all cases with the resident. Since the fellow is on service 75% of the time, this responsibility is partly enacted by him/her. This process involves training in performance of FNAs, triaging of specimens, morphologic review, ordering of special stains, communicating with clinicians, and discussion of the differential diagnosis. The cytology fellow is involved in the education of residents on an ongoing basis through case reviews, case presentation at regular working clinical/pathologic conferences and challenging case conferences. He/she is also responsible for giving a total of several formal resident lectures per year (three at NIH and one at NNMC). As time goes on during the year the fellow assumes graduated responsibility for the primary sign-out of cases. The resident does not assume independent sign-out responsibility for cytopathology cases.
In the event that a STAT cytology case is encountered on the weekend, the resident should follow the outline below.
During the second year of residency, the resident will spend 2 sequential months rotating through the Cytopathology Section at George Washington University (GWU). The focus will be on cervical/vaginal cytology and on the performance and interpretation of fine needle aspirations.
Further information about the Laboratory of Pathology (LP) can be found on our public Web site. This site contains the detailed Specimen Collection Guide and LP Staff Directory. The LP Web site is a useful supplement to this manual.