Frozen Section Rotation (AP-3)
- Surgical Pathology Staff
Senior residents in their third year of anatomic pathology training participate in intraoperative clinical care by serving as the front-line contact for frozen section consultations. During this rotation, all frozen section intraoperative consultations are the primary responsibility of the frozen section resident. These are evaluated under the direct supervision of an attending surgical pathologist, who is assigned to the service on a daily rotational basis. The frozen section resident is the default on-call resident for all weeknights Monday through Thursday, just as the frozen section attending each day is the on-call attending that evening.
It is crucial that the frozen section resident accurately communicate to the resident who will be grossing in the case how the specimen looked when it was received and what manipulations have been done to it. This is more difficult now that the frozen section area and gross room are physically removed from each other, but can be accomplished by writing notes and taking photographs. Photography of the specimen, especially after initial dissection, is important because the in-house built frozen section management application has the ability to share these photographs immediately with the operating room.
Additional Resident Duties and Responsibilities
- Keep your beeper on for 24-hour availability, from 7:30 AM Monday to 5 PM Friday.
- The frozen section coverage on the last day of the rotation is performed by the person finishing the frozen section month who is on call until 8:00 AM of the morning when the new frozen section resident starts.
- Obtain the OR schedule on the afternoon before a day of coverage, look up previous material, and request relevant slides on prior material for cases likely to generate frozen sections.
- Arrive no later than 7:30 AM (ORs start at 7:00 AM) to be available for specimens/questions from the OR. Inform the staff that you are present and where you can be found.
- When specimens arrive for frozen section (FS), label containers with case number, examine the tissue, perform touch preps if indicated, select tissue to freeze and orient on chuck. Ask for assistance from the FS attending if you have any questions on how to process the specimen.
- Provide a written description of the specimen for the resident who will be responsible for the final prosection, including weight, size, orientation, sections taken, etc., attached to the protocol.
- Photograph interesting specimens before freezing, if sectioning will destroy the integrity of the specimen, and after sectioning, and ensure that the images are quickly loaded into the ImageDrop folder for filing and possible sharing with the operating room.
- Help technicians freeze, cut, and stain when appropriate.
- Look at slides immediately when ready (verifying case and part numbers, size of tissue and number of pieces).
- Review slides with the FS attending, providing relevant history and previous material when available.
- Assure that all diagnoses are properly entered into the FSLink application and transmitted to the appropriate OR. Since the FSLink application is new, diagnoses must also be recorded on the paper frozen section form. If the operating room does not acknowledge receipt of the electronically transmitted diagnosis, call OR/surgeon with the diagnosis and acknowledge the diagnosis yourself in the FSLink application. Be sure to correctly indicate in the FSLink application the number of tissue blocks frozen for diagnosis and the number of unique touch prep sites used for diagnosis (this controls the billing for the specimens); consult with the signout to determine which of the frozen blocks should "count" for billing purposes.
- Photocopy diagnosis and separate the paperwork:
- original to originals box behind FS desk
- yellow and pink copies to residents' slide box
- xerox with yellow protocol sheet, description, original containers, frozen controls and original specimen in formalin on resident's FS shelf
- Before putting a specimen in formalin, take fresh tissue as needed for special studies. Be sure to accurately document what you have done for the grossing resident. If frozens are busy and you are unable to take care of this within a reasonable amount of time, alert the ultimate grossing resident who may be able to help.
- Make sure that you have recorded enough information so that the ultimate grossing resident will understand how the specimens were handled at FS. For difficult cases, go over the specimen with the grossing resident at the time the frozen section is performed. Such communication is expected and essential for optimal patient care.
- If there is an AP-2 resident also rotating on the frozen section service, work with that resident to provide appropriate frozen section experience while retaining responsibility for smooth operation of the service. Although the AP-2 resident may cover the service alone during the AP-3's lunch or teaching/conference responsibility, the AP-3 resident should otherwise be present for all frozen sections. Difficult cases should be handled by the AP-3 resident.
- Supervise gross room technical staff to assure a clean, properly equipped working environment. This includes making sure that each cutting station is clean and appropriately stocked, that clean and sharp cutting instruments are readily available, that photographic stations are clean and stocked, and that all shelved supplies are stocked.
- Be responsible for any rushes (kidney, heart, biopsy, etc.) that come out after 5:00 PM.
Additional Goals and Objectives for the Frozen Section / Gross Room Rotation
- Become proficient in quickly and accurately evaluating a specimen received for intraoperative consultation, selecting sections appropriate to answer the surgeons questions.
- Understand the key decision points for surgery and how information obtained at frozen section can direct the source of the surgery.
Interpersonal and Communication Skills:
- Learn how to communicate diagnoses clearly and succinctly to surgeons, providing the information they need without providing more information than is appropriate for the material examined.
- Learn how to supervise junior residents in the gross room, providing them with needed assistance without simply assuming their duties.