PATU-4004 - Clinical Cytopathology

PATU-4004 - Clinical Cytopathology

Elective Title: Clinical Cytopathology
Course Number: PATU-4004
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Prior approval of responsible faculty member required. C-Form required.
Responsible Faculty Director: Ranjana Nawgiri, MD Periods Offered: 2-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty: Cecilia Clement, MD Jing He, MD; Vidarshi Muthukumarana, MD
Location to Report on First Day:
CSW 5.506 Pathology Administration Suite - Cytology Sign-out Room

Goals
1. The student should learn the importance of correct cytology specimen collection, labeling and the necessity for accurate clinical history.
2. The student should become familiar with preparatory techniques and stains used for processing both gynecologic and non-gynecologic cytology.
3. The student should observe both pathologist and radiologist/endoscopist-performed fine-needle aspirations and participate in onsite evaluation of needle aspirations.
4. The student should participate in multi-headed microscope sign-out of Pap tests and non-gynecologic samples and learn how pathologists study and work-up cases for diagnosis.

Objectives
At the completion of this course, the student should:
1. Be able to prepare slides from fine-needle aspirations and other cytology samples.
2. Should know how to accurately and correctly label specimens and complete requests for cytologic students.
3. Should be able to perform a rapid Romanowski stain for onsite evaluation.
4. Know some of the different types of disease diagnosed by cytology including neoplastic, infectious and non-neoplastic.
5. Be familiar with the role of the cytopathologist in diagnosis of disease.

Description of course activities
During the first week, the student will rotate through the Cytopathology preparation laboratory in order to learn proper sample labeling, preparation and staining. During this week, the student will also accompany faculty, residents and fellows for both pathologist-performed and radiologist or endoscopist-performed fine-needle aspirations (FNA). During these excursions, the student will learn how to prepare smears and perform a rapid, onsite Romanowski stain used to give immediate feedback to the person performing aspirate and to determine what other studies will be needed (such as culture, flow cytometry, etc.). In the following weeks, student will continue to participate in FNA procedures but will also sit with the pathologist, residents and fellow during case sign-out. If there are personnel available, one on one through-the-microscope teaching may be done by either cytotechnologist or Cytopathology Fellow. (This may not be possible owing to other responsibilities of cytotechnologists and fellow). The students should attend at least one multidisciplinary meeting per week (but are encouraged to attend more). These include mainly Otolaryngology and Thoracic Tumor Boards; however, gastroenterology and liver conferences are optional. Students are also expected to attend Cytology-Histology Correlation Conference given once per month in Surgical Pathology and once weekly Cytopathology conference usually given within the cytology laboratory. Students rotating for an entire month are expected to give one 45-minute presentation, usually during the final week of the course. The topic is to be chosen by the student and approved by the Course Director. Usually, the presentation is based on a case that the student found especially interesting, either neoplastic or infectious. The student is expected to review current literature regarding the particularly interesting aspects of the case, including any new studies, information or molecular features of the disease. The student will present to Cytopathology faculty, Cytopathology Fellow, cytotechnologists and residents currently rotating through the cytopathology laboratory. After the talk, an evaluation form will be completed by attendees and given to the Director.

Type of students who would benefit from the course
All students can benefit whether or not planning a career in pathology. The rotation is perhaps more valuable for students who plan clinical careers because the rotation provides these students with valuable information concerning proper collection and labeling of samples and a better understanding of how the Cytopathology Laboratory operates and the benefits and limitations of cytopathology..

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:30-12 1-5
Tuesday 8:30-12 1-5
Wednesday 8:30-12 1-5
Thursday 8:30-12 1-5
Friday 8:30-12 1-5
Saturday n/a n/a
Sunday n/a n/a

 Average number of patients seen per week: n/a
 Call Schedule: n/a

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Students are observed during the entire rotation, while Students are observed by faculty, cytopreparatory chief technician, chief cytotechnologist and cytopathology fellow. Student is evaluated on the basis of willingness to participate in assisting with laboratory and FNA procedures, interaction and interest during case signout and appropriateness and insight demonstrated by the student's questions.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    See above: Audience includes faculty, Chief Cytopreparatory technician, Cytotechnologists, Fellow and resident(s) rotating through cytopathology.
  B. Frequency / Duration of Presentation(s)?
    One 45-minute formal presentation per rotation.
  C. Format - What guidelines are set for the student's presentation?
    See above. Students rotating for an entire month are expected to give one 45-minute presentation, usually during the final week of the course. The topic is to be chosen by the student and approved by the Course Director. Usually, the presentation is based on a case that the student found especially interesting, either neoplastic or infectious. The student is expected to review current literature regarding the particularly interesting aspects of the case, including any new studies, information or molecular features of the disease. The student will present to Cytopathology faculty, Cytopathology Fellow, cytotechnologists and residents currently rotating through the cytopathology laboratory. After the talk, an evaluation form will be completed by attendees and given to the Director.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    n/a
  B. Format - What guidelines are set for the student's written work?
   
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Rotating students are encouraged to participate in extra cytology conferences during periods when they are not otherwise occupied. These include infectious disease conference, Surgical pathology unknowns and Surgical Pathology resident or fellow - presented conferences.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Standard elective evaluation is completed by Director using input (verbal and oral presentation evaluation form) from Chief cytopreparation technician, chief cytotechnologist, Fellow and faculty.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
   
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
   
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.