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U n i v e r s i t y  o f  P i t t s b u r g h  S c h o o l  o f  M e d i c i n e

D e p a r t m e n t  o f  P a t h o l o g y

 
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  1. Medical Knowledge
    1. General Clinical Neuropathology
      1. Develop knowledge base to competently perform clinical duties as a neuropathologist. Skills: Obtain educational objectives, develop comprehensive knowledge of medical principles and pathogenesis of neurological disease. Assessment: Review of objective tests, surgical and autopsy write-ups, evaluation of conference presentations.
    2. Autopsy Neuropathology
      1. Utilize clinical and neurological histories to appropriately design autopsy neuropathological evaluation. Skills: Comprehensively redacts clinical record, compose clinical summaries critically analyze new information in a conceptual manner. Assessment: Clinical case presentation at rounds and conferences, review of autopsy reports. Complete neuropathology for 200 autopsies over two years.
      2. Design and perform appropriate autopsy neuropathological evaluation. Skills: Remove brain, inspect skull, dissect and identify portions of peripheral nervous system. Assessment: Attending review of tissues at conferences
      3. Design and perform appropriate gross examination, dissection and sampling of neurological tissue from autopsy. Skills: Perform complete examination of fresh and fixed brain and spinal cord, capacity to cut and define section planes and gross landmarks, cassette selected brain regions. Assessment: Review of gross and microscopic presentations
      4. Design and perform appropriate microscopic examination of neuropathological autopsy. Skills: Critically evaluates histology, identifies diagnostic features, define abnormalities, plan and carry out special stain analysis, acquire histological images to document findings. Assessment: Attending assessment of clinical evaluation at conferences and sign out, histological image acquisition
      5. Prepare and present complete neuropathological autopsy analysis. Skills: Clear, organized, accurate and concise clinical summaries, interpret laboratory data, examine gross and microscopic material, interpret and discuss findings. Assessment: Attending evaluation of case presentations, PADs and FADs
    3. Surgical Neuropathology
      1. Prepare for intra-operative consultations. Skills: Comprehensively redact clinical record, compose clinical summaries, critically analyze new information in a conceptual manner, explain procedures required for muscle and peripheral nerve biopsy. Assessment: Review of each intra-operative consultation, night before case preview.
      2. Perform appropriate intra-operative consultations. Skills: Communicate with surgeon, prepare touch, smear and frozen sections, analyze microscopic findings and render correct diagnosis. Assessment: Review of each intra-operative consultation
      3. Perform appropriate grossing of neuropathological surgical specimens. Skills: Review specimen requisition, define any needed clinical information and submit specimen for appropriate studies. Assessment: Review of each surgical case at sign out
      4. Design and perform appropriate microscopic analysis. Skills: Review of each surgical case and image acquisition. Assessment: Review of each surgical case and monthly review
      5. Design and prepare surgical neuropathological report. Skills: Document gross and microscopic findings, create error free surgical pathology report to communicate to referring physician. Assessment: Review of case sign out.
    4. Neuromuscular Pathology
      1. Understands how muscle and nerve biopsies are performed and processed, the indications for muscle and nerve biopsies, and how to choose sites for biopsy. Can differentiate artifact from true pathologic findings and trouble-shoot problems in processing. Knows which enzyme histochemical and immunostains are useful in evaluating muscle and nerve biopsy specimens. Is able to identify histopathologic changes of myopathy and neuropathy. In particular, can distinguish: 1) neurogenic atrophy from type 2 fiber atrophy, 2) an inflammatory myopathy from a muscular dystrophy, and 3) inclusion body myositis from inflammatory myopathies. Is able to identify features of mitochondrial, lipid storage, glycogen storage, and congenital myopathies. Can distinguish demyelinating from axonal neuropathies and identify inflammatory demyelinating, vasculitic, and amyloid and toxic neuropathies.
        Assessment: Review of presentations at sign-out and monthly review.
    5. Neurodegenerative Pathology
      1. Utilize preliminary clinical history to appropriately design autopsy neuropathological evaluation.
        Skills: Obtain essential clinical information needed prior to handling specimens before fixation; determine need for cultures, saving frozen samples, etc. and whether case should be banked.
        Assessment: Review thoroughness of evaluation prior to fixation of specimen.
      2. Organize clinical history prior to dissection.
        Skills: Obtain complete clinical history including neurological neuropsychological and radiological evaluations in order to properly dissect the specimen
        Assessment: Evaluation of verbal presentation at brain cutting
      3. Perform gross examination and dissection of specimen.
        Skills: Learn gross neuroanatomy necessary for proper dissection. Learn patterns of cortical and subcortical neurodegenerative changes occurring in major neurodegenerative diseases. Learn to identify acute, subacute and old cerebral infarcts. Learn proper method of inspection, dissection and selection of sections for histological analysis.
        Assessment: Review of gross descriptions and adequacy of sections taken.
      4. Perform microscopic evaluation of specimen.
        Skills: Know the standard evaluation, histopathological changes and special stains required for assessment of AD and other neurodegenerative diseases. Apply standard criteria (CERAD, Braak-tangle, Braak-PD, NIA-RI, etc) for evaluation and assessment of major neurodegenerative disorders . Know the relationship of AD and Dementia with Lewy Bodies (DLB) and the DLB scoring system. Know the differential diagnosis of fronto-temporal dementias. Know the differential diagnosis of Parkinsonism. Know the differential diagnosis for neurodegenerative diseases characterized by aggregation of tau (tauopathies). Know the differential diagnosis for neurodegenerative diseases characterized by aggregation of alpha-synuclein (alpha-synucleinopathies). Know the basic clinical history, gross appearance and microscopic findings of Parkinson's Disease, amyotrophic lateral sclerosis, Huntington's Disease and Progressive Supranuclear Palsy. Know the major prion protein disorders including clinical history, gross and microscopic appearance, and special handling precautions for Creutzfeldt-Jakob Disease
        Assessment: Attending assessment of adequacy of microscopic evaluation of the case and reporting.
      5. Prepare a Final Neuropathological Report.
        Skills: Write complete narrative of clinical history with all pertinent positive findings and negative findings, including going beyond the medical record (i.e., calling the physicians involved), if needed. Prepare a complete gross descriptions of findings. Complete a complete microscopic description of the findings. Prepare a final comment relating clinical history to gross and microscopic findings, stating what criteria were used to reach the final diagnosis.
        Assessment: Attending assessment of adequacy of final Neuropathology report.
    6. Ophthalmic Pathology
      1. Develop basic surgical pathology competence in examining ophthalmic specimens.
        Skills: Gain familiarity with the normal anatomy of ocular structures submitted to Pathology and their relationship to visual function. Learn to identify, orient, and systematically examine enucleation specimens. Be able to identify diagnostic features of corneal pathologies and to discuss causes of bullous keratopathy. Be able to identify and document pathologic features of prognostic significance in ocular neoplasms. Learn to recognize sequelae of diabetes, end-stage glaucoma, and trauma including child abuse. Assessment: Review of gross and microscopic descriptions and preliminary diagnostic impression prepared for weekly Ophthalmic Pathology conference and sign-out.
      2. Assimilate knowledge concerning the major pathologic reactions of the eye through reading assignments, quizzes, and examination of pathologic case material.
        Skills: Develop self-study and teaching skills with relation to the major categories of ophthalmic pathology (development and aging, inflammation and infection, cornea and conjunctiva, melanocytic tumors, lid and orbit, diabetes and vascular pathology, retinal degeneration, hereditary syndromes). Assessment: Performance on on-line quizzes and weekly virtual microscopy unknown case discussion. For advanced trainees, review of additional quiz material prepared by trainees.
    7. Research Neuropathology
      1. Develop comprehensive knowledge of research neuropathology. Skills: Read appropriate general scientific and specialty journals, identify scientific and clinical advances and issues pertinent for investigation. Assessment: Review of participation in clinical and scientific conferences and discussions.
      2. Design, propose and perform investigation of neuropathological topic. Skills: Identify strengths and weaknesses of experimental design, gather appropriate data for investigation. Assessment: Review of conference presentations and weekly assessment of research progress. Bi-monthly presentation to Division of NP case or disease entity.
      3. Present and publish scientific investigation. Skills: Create platform and poster presentations, write scholarly scientific articles. Assessment: Assessment of presentations and paper drafts

  2. Patient Care
    Provide professional clinical neuropathological consultations of high quality.
    1. Skills: Review and redact autopsy and surgical cases. Assessment: Presentation at brain cutting and signout.
    2. Skills: Competently, efficiently and thoroughly evaluate surgical neuropathologic cases. Assessment: Presentation at signout and QA conferences.
    3. Skills: Competently and thoroughly evaluate gross skull and brain findings and succinctly summarize. Assessment: Brain conference presentation.
    4. Skills: Complete and thorough identification of microscopic features. Assessment: Acquisition of microscopic images.
    5. Skills: Obtain components of the history that are useful in interpreting the muscle biopsy. Assessment: Review at case sign-out and monthly review.
    6. Skills: Able to summarize the important components of the history and findings on routine and special stains. Provides differential diagnosis and clinical correlation.
      Assessment: Review at case sign-out and monthly review.

  3. Communication Skills
    1. Teaching
      1. Design and deliver effective instruction for students at various levels. Skills: Read topic background and construct lectures, demonstrate anatomical and pathological findings. Assessment: Evaluation of monthly conferences
      2. Encourage students through appropriate balance of challenge and rewards. Skills: Constructively criticize trainee presentations. Create teaching cases (1/month). Assessment: Evaluation of conference feedback
    2. Communicate with external and internal clinicians.Skills: Effectively transmit specialty neuropathology results. Assessment: Signout conferences
    3. Effectively communicate case processing with technical personnel. Skills: Effectively work with technical team to efficiently process specimens. Assessment: Signout and turnaround time.
    4. Able to work with technicians in coordinating the proper muscle biopsy processing and in ordering the important stains. Able to teach residents and students. Is able to communicate (verbally and in writing ) the histopathologic findings with the referring physician and understand the importance of clinical pathologic correlation. Assessment: Review at case sign-out and monthly review. Review of muscle conference presentations. Feedback from residents, students, and staff.
  4. Professionalism
    1. Develop effective relationship with allied professionals and ancillary staff. Skills: Fully integrate and contribute to health professional team, punctual attendance to patient care responsibilities, appropriately interact with staff, trainees and attendings, use appropriate professional judgment in performing duties in an ethical manner. Assessment: Attending observations on service with daily and monthly feedback
    2. Effectively communicate neuropathological expertise. Skills: Complete specimen diagnostics in a timely fashion and communicate to medical team. Assessment: Attendings observations on service and feedback from other professional staff
    3. Develop professional reputation. Skills: Actively participate in national and international conferences, maintain current CV, and NIH Biosketch. Assessment: Review of conference participation and annual review
    4. Recognize professional limitations and seek appropriate consultations with literature and peers. Skills: Be aware of limitations and seek requisite information and consultations, accept criticism and suggestions for improvement. Assessment: Review of each intra-operative consultation and monthly review.
  5. Practiced Based Learning / Improvement
    Develop systematic approach to neuropathological cases.
    1. Skills: Practice evidence based medicine. Assessment: Oversee weekly QA and daily signout conferences.
    2. Critically analyzes the microscopic findings. Reviews the pertinent literature. Assessment: Review at case sign-out and monthly review.
  6. System Based Practice
    Coordinate efficient diagnostic work up of neuropathological cases.
    1. Skills: Interact with hospital-based services to timely and efficiently process cases.
      Assessment: Turnaround time analysis.
    2. Skills: Perform detailed and complete grossing and dictation.
      Assessment:360 degree evaluation.
    3. Handles minor issues with regard to proper processing of specimens and turn-around time. Orders special stains. Brings cases to the attending in a timely manner. Attends conferences and presents at conferences as assigned. Assessment: Attending observations. Participate in monthly staff meetings.