Cytopathology Clinical Fellowship Program

II. GOALS & OBJECTIVES

The following 6 sections describe the general goals and objectives for the overall fellowship program in relation to the six core competencies as defined by the Accreditation Council on Graduate Medical Education (ACGME).

Patient Care

Goal
Fellows must develop diagnostic competence to provide for effective patient care.

Competencies

  1. Demonstrate diagnostic decision-making skills appropriate to his/her level of training.
  2. Manage appropriate laboratory staff.
  3. Demonstrate ability to triage testing as to importance or urgency in a cost-effective and appropriately time-sensitive manner.

Objectives

  1. Construct appropriate written reports in language that other physicians, especially surgeons and oncologists, will understand.
  2. Demonstrate ability to order appropriate ancillary testing through ancillary laboratories.
  3. Show the ability to examine and properly classify GYN and non-GYN cytology cases including FNA biopsies and exfoliative non-gynecologic cytopathology specimens from various body sites.
  4. Communicate the proper technique and complications of the FNA procedure to others in a concise manner.
  5. Develop knowledge of administrative and quality control activities in the cytopathology lab.
  6. Demonstrate knowledge of on-site adequacy evaluation, as well as, a preliminary diagnosis, of specimens obtained through FNA from clinicians, radiologists, and pathologists.

Medical Knowledge

Goal
Fellows must demonstrate knowledge of established and evolving aspects of cytopathology diagnostic testing and state of the art ancillary studies applied to cytopathology.

Competencies

  1. Demonstrate knowledge of the normal cytopathology of the organ systems.
  2. Demonstrate knowledge of both neoplastic and non-neoplastic disease entities seen in cytopathology.
  3. Demonstrate an ability to apply this knowledge in varied clinical settings.

Objectives

  1. Obtain an acceptable score on written examinations (PEC exam by the American Society of Cytopathology).
  2. Demonstrate an acceptable level of performance during daily sign-out activities, as assessed by rotation specific evaluations and more broadly within the 360-degree evaluations.
  3. Demonstrate ability to decide what type of testing is needed to limit the differential diagnoses in most cases.
  4. Shows an analytical approach to clinical conditions and their cytologic manifestations.
  5. Illustrates the appropriate knowledge about ancillary techniques and their application in cytology in various organs and cytological specimens.
  6. Knowledge of how to distinguish dysplasia & neoplasia from benign and reactive conditions of various organs, and to be able to distinguish the pitfalls in cytological diagnoses and how to avoid them.

Practice- Based Learning and Improvement

Goal
Fellows must be able to evaluate and adopt new knowledge as changes demand. This includes the development or refinement of skills that will be used long after fellowship training has ceased.

Competencies

  1. Identify strengths, deficiencies and limits in one's knowledge and expertise.
  2. Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
  3. Locate, appraise and assimilate evidence from scientific studies related to cytopathology.
  4. Use information technology to optimize learning
  5. Participate in the education of medical students, residents and other healthcare professionals, as documented by evaluations of a fellow's teaching abilities by faculty and/or learners.

Objectives

  1. Demonstrate ability to search the medical literature to answer medically related questions that arise in daily practice.
  2. Appropriately utilize available texts and self-learning resources, such as study sets, etc.
  3. Construct and complete a quality improvement/research project with appropriate guidance.
  4. Demonstrate ability to critically evaluate original publications at journal clubs, other conferences, and in the evaluation of diagnostic cases.
  5. Demonstrate progression in skill level, as assessed on bi-annual review with fellowship director.
  6. Demonstrate effective and knowledgeable case presentation(s) at divisional conferences.
  7. Demonstrate ability to perform appropriate biomedical literature searches through available electronic tools (example: Pub Med search).
  8. Demonstrate ability to teach trainees and students while on-service.
  9. Understand the basic technique of cytology specimen preparation and attend FNAs that require on-site assessment.

Systems Based Practice

Goal
Fellows must demonstrate an awareness of and responsiveness to the various regulatory bodies (including institution based policies, local and national regulatory agencies) that affect daily practice and laboratory management.

Competencies

  1. Incorporate considerations of cost awareness and risk-benefit analysis in diagnostic evaluations.
  2. Understand the various administrative and technical functions involved in running a cytopathology-oriented laboratory.
  3. Understand the need for quality assurance assessments.
  4. Participate in laboratory management as appropriate on laboratory based rotations.
  5. Know the role of regulatory agencies that affect the practice of cytopathology.

Objectives

  1. Participate in mock or internal College of American Pathologists (CAP) inspections when possible.
  2. Attend rotation specific laboratory management meetings.
  3. Demonstrate ability to choose appropriate immunohistochemistry panels, in situ hybridization studies, and molecular testing appropriate to making a specific diagnosis. Familiar and laboratory information system and learn how to use electronic medical record to access reports and clinical history.
  4. Participate in appropriate faculty-supervised quality improvement/research projects.
  5. Review the roles of various regulatory organizations (CAP, state, and federal, such as the Joint Commission on Accreditation of Healthcare Organizations, JCAHO) that are involved in regulating laboratory practice and how they can impact cytopathology.
  6. Understand the role of cytopathology in the practice of medicine.
  7. Demonstrate the ability to understand the meaning of critical values and effective communication with ancillary personnel, physicians and regulatory agencies.

Professionalism

Goal
Professional behavior in one of the most basic requirements of any physician, including cytopathologists. This includes demonstrating reliability, punctuality, appropriate demeanor, appearance, completion of work assignments, and ethical behavior.

Competencies

  1. Compassion, integrity, and respect for others.
  2. Responsiveness to patient needs that supersedes self-interest.
  3. Respect for patient privacy.
  4. Communicate effectively with physicians and other healthcare professionals.
  5. Work effectively as a member of a health care team.
  6. Act in a consultative role to other physicians and healthcare professionals.
  7. Function as a team player.

Objectives

  1. Obtain at least satisfactory evaluations of interactions with physician colleagues, attending staff, support personnel, as evidenced by the 360-degree and other evaluations.
  2. Schedule outside activities so as not to interfere with work-related activities and service commitments.
  3. Demonstrate an understanding and working knowledge of the Health Insurance Portability and Accountability Act (HIPAA) and sensitivity to protecting the disclosure of patient specific information by completing HIPAA on-line training modules.
  4. Follows the highest standards of professionalism and ethics, and shows respect for patients and members of the health care team.
  5. Performs assignments with accuracy, diligence and timeliness.

Interpersonal and Communication Skills

Goal
Fellows should be able to communicate with a variety of medical center faculty, trainees, and staff. These functions are critical to being a successful cytopathologist. This must also be done with a working knowledge of patient privacy rights.

Competencies

  1. Demonstrate mutual respect for others in communicating with faculty, other trainees, and support personnel.
  2. Convey diagnoses and available diagnostic testing results to other physicians and appropriate support personnel in an accurate manner that reflects the limitations of the currently available findings.

Objectives

  1. Demonstrate ability to convey preliminary diagnoses in verbal and written form that includes appropriate limitations, such as differential diagnoses still to be considered, other information still needed (and/or pending).
  2. Be able to communicate information verbally and in writing in a format and style that is appropriate for the level of the practitioner or support personnel with whom one is interacting.
  3. Accurately convey final diagnoses both orally and in writing to the submitting physician and other appropriate personnel (fellows, physicians, radiologists, and other healthcare personnel).
  4. Write complete reports in a timely fashion. Reports must also be accurate, grammatically correct, and easily understood.
  5. Demonstrate ability to seek consultations from other members of the faculty (usually as directed by the attending) and accurately convey the consulting pathologist's impressions to the primary sign-out attending. Able to initiate surgical pathology-cytology correlation as needed.