Goals and Objectives

By the end of training in Cytopathology, the Resident will master the following skills:

Patient Care
Know the spectrum of normal cervical cytology, and the predictable effects of age, menstrual cycle, pregnancy, castration and hormonal replacement.

Know the signs of inflammation and infection in cervical cytology, especially as related to sexually transmitted pathogens.

Accurately diagnose lesions of cervical neoplasia, including ASC, low- and high-grade squamous intraepithelial lesions, and squamous carcinoma.

Know the algorithms for follow-up of patients with various diagnoses on cervical cytology.

Know the spectrum of normal endometrial and endocervical cytopathology, including the predictable effects of age, menstrual cycle, pregnancy, castration and hormone replacement.

Accurately diagnose lesions of endometrial and endocervical neoplasia, including glandular atypias and adenocarcinomas.

Know the spectrum of normal, reactive and neoplastic changes in body fluids (CSF, abdominal, pelvic, pleural, and urine.

Know the spectrum of normal, reactive and neoplastic cytology in non-GYN specimens including FNA of various organs/sites.

Accurately diagnose vulvar and vaginal neoplastic lesions, including intraepithelial neoplasias and carcinomas.

Have a working knowledge of fine needle aspiration cytology for superficial and deep lesions.

Be able to perform and evaluate for adequacy fine needle aspirations of lesions under U/S or CT guidance.

Know the main laboratory preparatory techniques/procedures relating to processing and staining GYN and non-GYN specimens.

Have a working knowledge of normal findings inflammatory diseases and neoplasia in cytopathology specimens from the respiratory tract, the breast, the gastrointestinal tract, the urinary tract, effusions, cerebrospinal fluid, salivary glands, the thyroid, lymph nodes, liver, pancreas, kidney, the retroperitoneum, the mediastinum, bone and soft tissue and female genital organs.

Medical Knowledge
Understand the techniques used to obtain and preserve specimens for cytopathologic examination including cervical spatula and brush samples, alveolar lavage and endobronchial brush sampling, urine sediment, cerebrospinal fluid, effusions, fine needle aspiration of tissues and various other non-GYN samples.

Understand the techniques used for the preparation of cytopathologic slides including direct smears, touch preparations, cytocentrifuge preparations, Thin Prep specimens and all cell blocks.

Understand the common staining methods, including the Papanicolau, Diff-Quik, and hematoxylin and eosin techniques.

Understand the use of special stains in cytopathology.

Understand the correlation between cervical, endocervical and endometrial cytology and biopsy diagnoses.

Understand the process and significance of cyto-histologic correlation for GYN and non-GYN specimens.

Practice-Based Learning and Improvement
Understand and learn from QA/QC procedures (screening negatives, resolving technical problems).

Interpersonal and Communication Skills
Know and use the Bethesda classification system for cervical cytopathology.

Be able concisely to convey assessment of specimen adequacy at the time of fine needle aspiration specimen preparation.

Be able to concisely and accurately convey cytologic interpretations in writing and verbally.

Professionalism
Comply with HIPAA standards with regard to confidential patient information. Professional interaction with all the cytopathology staff is demanded. A genuine attitude of concern and assistance is expected towards all clinicians at all levels of interaction.

Systems-Based Practice
Know the administrative structure of the Cytopathology Department, and the role of each member, including the clerical staff, the laboratory staff, the cytotechnologists, and the laboratory supervisor.

Participate in consultative services performing fine needle aspirations, attending Tumor Boards to promote integrated healthcare delivery.

Duration

Residents in PGY1 are assigned to an introductory week of Cytopathology to cover basic techniques and diagnoses.

In PGY3, residents take a core rotation of 8 weeks in the lab to cover the following topics from the teaching collections under the supervision of the cytopathology attending:

Gynecologic Cytopathology: Normal, inflammation and infection
Gynecologic Cytopathology: Squamous cell abnormalities (ASC, SIL, SCG)
Gynecologic Cytopathology: Glandular abnormalities (AGC, AGUS, AIS, Ca)
Gynecologic Cytopathology: Vulva/vag, Extrauterine Ca, FNA of FGT
Non-Gynecologic Cytopathology: Respiratory, Breast, GIT
Non-Gynecologic Cytopathology: Fluids, Head and Neck
Non-Gynecologic Cytopathology: Liver, Pancreas, Kidney, Pediatric
Non-Gynecologic Cytopathology: Lymph nodes, Bone and Soft Tissue

Review examinations are given at the end of the course.

PGY3 residents additionally spend one week at MetroHealth Medical Center for practical training in fine needle aspiration technique.

PGY3 and PGY4 residents spend five additional weeks working with the Cytopathology attendings at regular case signout.

In addition, each year in the fall, during the AP morning lecture series, a unit of cytopathology lectures is given to for residents at all levels. The cytology lecture schedule is as follows:

Pap: Normal and Benign Cellular Changes
Pap: Atypical Squamous Cells of Uncertain Significance and HPV Testing
Pap: Squamous Intraepithelial Lesions and Squamous Carcinoma
Pap: Atypical Glands of Uncertain Significance and Adenocarcinoma
Fine Needle Aspiration: Ovary and Female Genital Tract
Gynecologic Cytopathology Review
Fine Needle Aspiration: Thyroid
Fine Needle Aspiration: Salivary Gland
Non-Gynecologic Cytopathology Review
Fine Needle Aspiration: Bone and Soft Tissue
Fine Needle Aspiration: Lymph Nodes
Fine Needle Aspiration: Kidney and Retroperitoneum
Respiratory Tract Cytology
Urine Cytology
Pleural Effusion Cytology
Resp/Effusion Review
Fine Needle Aspiration: Breast
Fine Needle Aspiration: Breast II
Liver/Bile Duct/Pancreas

Duties and Responsibilities of Residents by Year

Residents in all years should attend the cytopathology lecture series which is taught as a component of the 8AM didactic sessions, in the fall.

PGY1:
Become familiar with the layout and personnel of the laboratory, common staining procedures in cytopathology including Papanicolau, Diff-Quick and Methenamine Silver preparations.

Attend signout daily, alternating between the signouts for gynecologic cytopathology and non-gynecologic cytopathology on a daily basis.

PGY 3 & 4:
Residents in the cytopathology core are expected to spend the majority of their time on cytopathology activities and to complete all of the core slide sets and examinations.

Attend signout daily, alternating between the signouts for gynecologic cytopathology and non-gynecologic cytopathology on a daily basis.

Attend Thursday morning group session to review a set of unknown cases and to submit written diagnoses.

Learn proper methods for the collection and preparation of samples as direct smears, cytospin preparations and ThinPrep slides by spending time with the technical staff in the preparation laboratory.

Participate in weekly exams throughout the rotation, and the final slide exam at the end of the rotation, which covers both gynecologic cytopathology and non-gynecologic cytopathology.

Attend any ASCP teleconferences that may be scheduled during the rotation.

Attend and perform fine needle aspiration procedures of superficial lesions under the supervision of a member of the Staff

In the last weeks of the rotation, participate actively in the independent screening and rescreening of cytopathology materials in addition to attending the final signout conference.

Teaching Staff

Rosemary Farag, M.D.

Gretta Jacobs, M.B.B.S.

Gregory MacLennan, M.D.

Raymond Redline, M.D.

Jay K. Wasman, M.D.

Joseph E. Willis, M.D.

Daniel Hunt, S.C.T, ASCP-Laboratory Supervisor

Supervision and Evaluation

Residents are supervised and evaluated according to the Goals and Objectives set out in this Program Statement by faculty who interact with the Residents in signout conferences during the cytopathology rotation, as well as the Cytopathology Teaching Coordinator. Evaluations also take into account performance and progress on unknown slides and quizzes as well as the final slide examination.