General Resident Competencies

The Accreditation Council for Graduate Medical Education has defined six areas of competency in which all residents are to be trained and evaluated. These goals and objectives of each of the rotations are based on these competency areas. The areas are listed below, with a number of competencies that are COMMON TO ALL rotations. Additional goals and objectives specific to particular rotations are listed with those rotation descriptions.

Patient Care:

Residents must demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services. This includes:

All AP Rotations:

  • becoming proficient in the standard techniques for the gross evaluation, dictation, and dissection of specimens, paying particular attention to issue of diagnostic and prognostic significance
  • understanding when it is appropriate and preferable to deviate from standard dissection techniques to better demonstrate the pathology in a particular case
  • becoming proficient in specimen photography, including knowing how to best prepare the specimen for photography and use of the photographic apparatus
  • looking up, prior to signout, any clinical terms or abbreviations used on the requisition form
  • generating appropriate differential diagnoses based upon gross examination of the specimen and the clinical questions in the case, and triage the specimen appropriately for optimal diagnostic evaluation
  • promoting expedient signout of cases: preview slides, correct gross descriptions, and bring cases to signout in a timely fashion
  • identifying when it is appropriate to track down prior material from the patient of relevance to the current evaluation and obtain that material prior to signout
  • reliably order special stains and ancillary studies as directed by the attending
  • integrate frozen section diagnoses into the final report

Additional Competencies for AP-2 residents

  • refining and perfecting gross room skills, including proactive tissue storage for ancillary studies
  • being able to search the literature, as needed, in the workup of cases, and bring that information to signout
  • analyze frozen sections for possible discrepancies
  • understand the workings of the histology and immunohistochemistry labs

All CP Rotations:

  • becoming proficient in the use and interpretation of diagnostic assays relevant to each laboratory
  • promoting laboratory medicine consultation as a means of efficiently providing optimal care

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and application of this knowledge to pathology. This includes:

All AP and CP Rotations:

  • know and apply basic and clinically supportive sciences to problems in diagnostic medicine

All AP Rotations:

  • demonstrating an ability to glean from the specimen requisition form, procedure performed, and electronically available medical information, the pertinent clinical questions to be addressed during the specimen examination
  • formulating appropriate microscopic differential diagnoses for the case
  • understanding what, if any, special procedures can be performed to resolve the differential diagnosis
  • understanding the clinical significance of the diagnoses being made, including implications for the subsequent treatment and prognosis of the patient
  • understanding the data elements which need to be included in the pathology report to provide the treating clinicians with the information they need for the subsequent care of the patient

All CP Rotations:

  • acquire critical skills in clinical pathology and understanding of laboratory principles
  • appropriately increase their knowledge base with literature searches, reading texts, accessing journals on current cases
  • learn the principles of laboratory automation
  • become familiar with the strengths and limitations of current and emerging laboratory technologies
  • perform appropriately on the end of rotation quizzes

Practice-based Learning and Improvement:

Residents must be able to demonstrate the ability to investigate and evaluate their diagnostic and consultative practices, appraise and assimilate scientific evidence and improve their patient care practices. This includes:

All AP and CP Rotations:

  • actively seeking additional clinical information by consulting patient information systems within the hospital
  • using on-line literature searching resources to identify recent advances in our understanding of the disease processes manifested in the cases
  • learning to critically evaluate clinical and scientific studies, using knowledge of study designs and statistical methods
  • accepting and learning from constructive feedback and guidance from those in a position to provide such input, including attending physicians, laboratory supervisors and housestaff colleagues
  • use the daily case material to systematically assess his/her current level of skills, and with attending advice, develop a plan to remediate deficiencies and enhance areas of strengths
  • promoting self-evaluation to develop life-long learning skills

All AP Rotations:

  • monitoring their active case lists, and organizing their cases and time in such a way as to provide as timely as possible final reports without compromising the care of the patients

All CP Rotations:

  • becoming proficient at QA design and implementation
  • expertly evaluating tests and procedures for clinical utility

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with other health care providers, patient, and patient's families. This includes:

All AP and CP Rotations:

  • effectively conversing about general pathology with clinicians, housestaff, and medical students
  • attending conferences and be able to discuss the key features of their cases
  • when indicated, contacting the members of the clinical team and eliciting appropriate key information about the patient's medical history and specific questions to be addressed during evaluation of the specimen
  • contacting members of the clinical team in cases where the diagnosis is unexpected and has significant clinical implications for the patient
  • demonstrating an ability to prepare and present cases at intra- and interdepartmental conferences
  • effective teaching of fellow residents, pathology assistant students, technicians, and medical students

All AP Rotations:

  • dictating a well organized, understandable, grammatically correct clinical history and gross description

All CP Rotations:

  • proficiently handling and documenting all consultations

Professionalism:

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. This includes:

All AP and CP Rotations:

  • demonstrating unconditional respect for patients, clinical colleagues, and the medical profession
  • showing up on time for scheduled activities (signout, rounds, conferences, etc.)
  • responding promptly when on service and/or on call to a service need and promoting the efficient, thorough, and expeditious processing of that specimen so as not to compromise subsequent patient care
  • demonstrating an understanding of the importance of preserving patient privacy and confidentiality in the performance of their duties
  • understanding medical error and its causes, and responding appropriately when errors occur
  • interacting with fellow residents, assisting as needed to promote efficient running of the service
  • interacting with clinical colleagues in a non-confrontational and professional manner

Systems-based Practice:

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to call on system resources to provide pathology services that are of optimal value. Pathologists occupy a unique position within health care delivery. Free from the day-to-day details of direct patient care delivery, pathologists have the opportunity and obligation to analyze and explore human disease. Residents must acquire the ability to assume this role by learning to:

All AP and CP Rotations:

  • collaborate with other members of the health care team to improve patient care
  • promote the practice of evidence based health care delivery, drawing upon literature and other investigative work
  • educate our clinical colleagues in diagnostic criteria and the anatomic and laboratory manifestations of human disease
  • use special procedures and additional testing judiciously to assure accurate diagnoses without wasting or misusing health care resources
  • effectively use ancillary clinical information systems to improve patient care delivery
  • participate actively in programs assuring the quality of health care, including presentation of cases at case conferences and at morbidity and mortality conference
  • understand the difference between part A and part B pathology services in a hospital setting
  • demonstrate an awareness of regulations such as CLIA (Clinical Laboratories Improvement Act) and HIPAA (Health Insurance Portability and Accountability Act) Privacy and Security rules, and assure compliance with these rules to improve the health care delivery system
  • understand the roles of accurate CPT (Clinical Procedural Terminology) and ICD (International Classification of Disease) coding in assuring appropriate reimbursement for health care delivery
  • promote and participate in obtaining tissue and other human material for research which will advance our understanding of human disease, without compromising patient care or patient rights
  • demonstrate an appreciation of the importance of accurate data entry into the department's Clinical Information System which will allow appropriate retrieval of cases for approved research or educational purposes
  • appreciate the impact of our diagnoses on the lifestyles, insurability, subsequent management, and long term care of patients