PATU-4017 - Acting Internship: Surgical Pathology

PATU-4017 - Acting Internship: Surgical Pathology

Elective Title: Acting Internship: Surgical Pathology
Course Number: PATU-4017
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Palawinnage V. Muthukumarana, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty: Dr. Thaker; Dr. Qiu
Location to Report on First Day:
Clinical Services Wing 5.506

To acquaint the student with the gross and microscopic appearance of various neoplastic and non-neoplastic diseases encountered in surgical pathology and to correlate these changes with the clinical presentations and etiopathogenesis.

At the completion of a four-week elective the student should be able to: 1. Recognize the macroscopic features of various pathologic conditions major organ systems including the GI tract, GU system, Breast, Head and Neck region and extremities. 2. Recognize the gross and microscopic appearance of various types of neoplastic and non-neoplastic lesions and inflammatory diseases. 3. Observe how to properly handle surgical specimens to afford accurate diagnoses. 4. Gain an appreciation for value and limitations of intra-operative consultation by means of frozen section and touch preparations. 5. Acquire an insight into pathologic staging procedures used for evaluating malignancies. 6. Interpret morphologic findings in terms of etiology, pathogenesis and with clinicopathologic correlations.

Description of course activities
Students will rotate with the pathology faculty, pathologist assistant, fellows and residents in dissecting, sectioning and photographing gross specimens. Cases will be reviewed and discussed by the attending staff during the daily sign-out time (an estimated total number of 300 specimens per week). Students also will participate with the residents in case presentations at various surgical pathology conferences. Students are required to present one didactic lecture in surgical pathology and participate in interdisciplinary conferences each week (review and prepare slides with the attending staff prior to the conference).

Type of students who would benefit from the course
The elective is beneficial to all students wanting to enhance their knowledge of pathology, from those wishing to pursue a career in pathology to those students interested in surgery and its subspecialties, gynecology, radiology, and related fields.
Students wishing to rotate in the Surgical Pathology A/I will need to sign up for two consecutive 3-week blocks.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00 5:00
Tuesday 8:00 5:00
Wednesday 8:00 5:00
Thursday 8:00 5:00
Friday 8:00 5:00

 Average number of patients seen per week: 100
 Call Schedule: Alternate Saturdays

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

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 daily in their interactions in gross room activities, microscopic sign-out, and during conferences
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Surgical pathology faculty, fellows and residents
  B. Frequency / Duration of Presentation(s)?
    1, 30 minute didactic pathology lecture
  C. Format - What guidelines are set for the student's presentation?
    Powerpoint slide presentation
  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)?
    As related to optional research activities
  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
    Oral   Written multiple choice   Written essay / short answer   OSCE

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)?
    While on service, students are expected to attend all relevant pathology fellow/resident conferences including, anatomic pathology, grand rounds, interesting cases, unknowns & tumor boards.

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".

7.  Other Modes of Evaluation
  Please explain below.

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.
    Weekly evaluation of student progress is communicated to the student by the director.

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.
    Diagnostic skills includes histopathologic, immunohistochemistry evaluation and molecular studies.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Pathologic staging of malignant neoplasms and attending multidisciplinary tumor boards where the results of molecular studies for patient management are discussed.

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)?
    The student will participate in the daily review and signing out biopsies and surgical sign out. The student is expected to learn the skills needed for frozen sections.

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?
    The student who enrolls in the surgical pathology acting internship will be actively involved with residents in reviewing and entering diagnoses, which will provide experience for the students eventual PGY1 internship.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Feedback will be provided through weekly evaluation of student progress, as communicated to the student by the Course Director. Any deficiencies and a plan for improvement will be addressed during these evaluation sessions, as necessary.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The student will rotate on a daily basis with two Surgical Pathology faculty members each week during sign-out and frozen sections evaluations. As a result, during a typical one-month rotation, the student will potentially have the opportunity to directly interact with all Surgical Pathology faculty.

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.