To achieve an appropriate level of competency during their training, residents must be actively involved in the procedures and interpretations which are part of the care of real patients. However, this involvement must be under an appropriate level of supervision so as not to compromise patient care, and that supervision should be graded to the level of training of the resident. All residents must be aware of their individual limitations and not attempt to provide clinical services or do procedures for which they are not trained and certified to do without supervision, except in instances of extreme urgency where such action may be life-saving.
Pathology residents at any level of training may, without prior certification, provide preliminary interpretations of pathologic or physiologic tests or data, but any communication of these interpretations to other clinicians or caregivers must clearly identify the interpretation as preliminary and therefore not actionable, and all interpretations must be individually reviewed by an attending pathologist before they are deemed final. Residents may address questions about appropriate usage or interpretation of routine tests and/or special procedures as they feel is supported by their knowledge base, but should clearly identify themselves as a resident and seek appropriate senior resident, fellow, or attending input as needed.
Residents may perform postmortem examinations and dissections only after having seen the procedures demonstrated by a trained technician, senior resident, or attending pathologist, and only to the extent allowed by the autopsy permission granted by the family member and by standard autopsy service practices. If, in the performance of a postmortem examination, findings are uncovered which suggest that the death may have been non-natural, the resident should cease the procedure and contact the attending pathologist for further instructions.
Residents in their first year of anatomic pathology training (AP-1) may not order special procedures (immunostains, molecular pathology) during their first six months of training without first discussing this with a senior resident, fellow, or an attending pathologist.
Residents may perform gross examination and dissection of surgically removed specimens only after having had the appropriate dissection techniques for that type of specimen demonstrated to them by a trained technician, senior resident, or attending pathologist, or after having read dissection instructions specific for that type of specimen in the department's grossing manual. Specific questions should be addressed to the senior resident in charge of the gross room or an attending pathologist.
Residents may perform fine needle aspirations only under the direct supervision of an attending pathologist or the cytology fellow, and only after having observed this procedure. A fellow may act as a supervisor only after that fellow has successfully performed a minimum of five such procedures under direct attending supervision, and has been deemed competent for a supervisory role by all attending cytopathology staff.
Residents may perform bone marrow aspirations and/or biopsy only under the direct supervision of an attending pathologist or the senior hematology fellow and only after they have observed two such procedures.
Residents may supervise apheresis procedures only under the supervision of the blood bank fellow or an attending pathologist.
Residents on-call should follow all service-specific policies concerning when to contact the on-call pathologist for any patient-care matter. In the absence of a specific policy to the contrary, the resident should contact the appropriate on-all pathologist for ALL patient care matters. All diagnostic procedures performed and evaluated during such call periods are to be reviewed by the attending prior to a definitive diagnosis being rendered.
If questions arise concerning the level of prior experience needed for a particular procedure/interpretation, contact the chief resident, Residency Program Director, one of the Associate Program Directors, or the director of the service for which the procedure/interpretation is being performed.