RESIDENCY TRAINING PROGRAM IN GENERAL PATHOLOGY DEPARTMENT OF LABORATORY MEDICINE AND PATHOLOGY UNIVERSITY OF ALBERTA

Transcription

1 RESIDENCY TRAINING PROGRAM IN GENERAL PATHOLOGY DEPARTMENT OF LABORATORY MEDICINE AND PATHOLOGY UNIVERSITY OF ALBERTA Program Director: D. Tung, MD Assistant Clinical Professor of Pathology Revised: February

2 INTRODUCTION The training manual is designed to provide residents in the General Pathology Residency Training Program with an outline of the general and specific objectives of the program and of the rotations available. The manual is also intended to provide an overview of the facilities available to you. The manual serves secondarily as a guide for faculty teaching in the program. The training program is structured to ensure that residents obtain the experience necessary to fulfil the requirements of the Royal College for certification. However, we also attempt to provide for the special interests or needs of individual residents. The program is based at a number of institutions which include the University of Alberta Hospital, DynaLIFE DX Diagnostic Laboratory Services, the Royal Alexandra Hospital, the Misericordia Community Hospital, the Grey Nuns Hospital, the Cross Cancer Institute and the Medical Examiner s Office. There are program coordinators at all of these institutions. The program has both didactic and apprenticeship components and residents are expected to make full use of both. Lists of available didactic teaching sessions, rounds and seminars are included in the manual and you are encouraged to attend, where possible. There are ample library facilities within the Department and in the hospital and university. However, please remember that, while the program provides the learning opportunities, experience, and facilities, the resident remains responsible for utilizing these to their fullest. Enclosed are the Royal College requirements for training and our own objectives for the program. Evaluation will be based on these objectives and on your performance on rotations; you will be provided with regular feedback on your progress. The teaching faculty hopes that you enjoy and profit from your training and the program welcomes your feedback at all times. You are entering an exciting new phase of your career, and we are eager to help you in every way possible in your training. Director General Pathology Training Program 2

3 ORGANIZATION OF PROGRAM The training program is led by the Program Director with the assistance of the Program Administrator and the General Pathology Residency Program Committee. The General Pathology Program Committee meets regularly (four times during the academic year) and major problems may be brought to the committee s attention by contacting the resident representatives, or any of its members. GENERAL PATHOLOGY RESIDENCY PROGRAM COMMITTEE TERMS OF REFERENCE Purpose of the residency program committee: The Residency Program Committee (RPC) in General Pathology assists the program director in planning, organizing and supervising the program. The RPC is responsible to the Chair of the academic Department of Laboratory Medicine and Pathology and to the Associate Dean responsible for Postgraduate Medical Education. Membership of the residency program committee: The Committee is made up of the Program Director as Chair, faculty representing the major training components and training sites in Anatomical Pathology, Hematopathology, Medical Biochemistry, Medical Microbiology and General Pathology, and the Program Administrator. At least one faculty member from each major participating institution sits on the Committee. A resident representative (usually the chief resident) sits on this committee and all residents are welcome to attend the regular Committee meetings. Functions of the residency program committee: 1. To recommend and regularly review policies regarding all aspects of education for the training program, 2. To be aware of the general standards of accreditation and specialty specific training requirements of the Royal College of Physicians and Surgeons of Canada and to ensure that the residency program meets those standards and requirements, 3. To regularly review and update the Rotation Specific Objectives, 4. To survey the overall quality of the Residency Program by regular review and to make recommendations as may be appropriate, 5. To ensure a safe and respectful learning environment for residency education and regularly review resident concerns, 6. To ensure adequate training resources are present (such as computers, microscopes, reference material), 7. To keep accurate accounting records of program funds (a member of the RPC functions as treasurer), 8. To ensure that there is regular evaluation of resident performance according to Departmental and Faculty policy and to confidentially review the progress of each resident in the program (during these reviews residents are excused from the meeting and separate minutes for this portion are generated), 9. To review applicants to the program and make recommendations to the Program Director for acceptance of candidates into the program (often a subcommittee is struck 3

4 consisting of available interviewers as well as the program director and program administrator), 10. To keep minutes of the meetings and report back to the training sites, Departmental and Divisional heads, Departmental Chair and Associate Dean for Postgraduate Medical Education as necessary, 11. To recommend and oversee remediation or supplemental training as required and to be aware of the relevant University of Alberta policies and guidelines, 12. To recommend advancement in the program and to complete the Final In-Training Evaluation Report (FITER). 4

5 SELECTION OF RESIDENTS The program only recruits residents through a national match organized by the Canadian Resident Matching Service (CaRMS) or through the Alberta International Medical Graduate Program. Applicants must be graduates of medical schools accredited by the Liaison Committee on Medical Education (LCME) and must have no previous post-md clinical training. Residents are selected/ranked on the basis of academic qualifications, previous performances, letters of reference and on-site interviews. 5

6 RCPSC Specific Standards of Accreditation for Residency Programs in General Pathology Adopted by Council in April 1998, Revised in June 2012 INTRODUCTION The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in General Pathology. This document should be read in conjunction with the General Standards of Accreditation and the Objectives of Training and the Specialty Training Requirements in General Pathology. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. The program director must have Royal College certification in a laboratory medicine discipline (General Pathology, Anatomical Pathology, Neuropathology, Hematological Pathology, Medical Biochemistry, Medical Microbiology), or equivalent acceptable to the Royal College. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for General Pathology are outlined in the Objectives of Training and the Specialty Training Requirements in General Pathology. Based upon these general objectives, each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. Methods to determine if rotation specific objectives are being met should be employed on a regular basis. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in General Pathology. The structure and organization of each accredited program in General Pathology must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in General Pathology. In addition to offering training in anatomical pathology, hematological pathology, medical biochemistry, medical microbiology, as noted in the Specialty Training Requirements, all accredited programs in General Pathology must offer communitybased learning experiences outside academic centres. 6

7 The resident must be provided with a graduated increase in individual professional responsibility, under appropriate supervision, appropriate to the level of competence and experience. STANDARD B4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients and/or cases, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Specialty Training Requirements in General Pathology. In those cases where a university has sufficient resources to provide most of the training in General Pathology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to General Pathology. 1. Teaching Faculty There must be a sufficient number of qualified teaching staff to supervise residents and provide teaching in the basic and clinical sciences related to laboratory medicine. There should be initial and on-going exposure to General Pathologists, who can serve as role models during residency training. Professional staffing (pathologists, pathology assistants, technologists and other personnel) should be sufficient that service work, academic endeavours and roles of the department can be achieved whether or not residents are present in the department. 2. Volume and Variety of Pathological Material While there are no specified minimum numbers for autopsies, surgical/cytology specimens, or forensic work, the volume and diversity of work available for teaching must be adequate to attain the educational objectives of the program. Material provided in the clinical disciplines must also be of sufficient variety to fulfill the stated training objectives. The program must provide an opportunity for the resident to achieve a level of competence in the practice of laboratory medicine appropriate to direct laboratories in community hospitals or free-standing laboratories with the capability of recognizing those instances where material and/or cases should be referred 3. Laboratory Components of the Program The laboratory program must provide adequate resources to ensure satisfaction of the training objectives in individual domains encompassed by laboratory medicine. It is important for the General Pathology resident to understand the statistical and analytical bases of laboratory testing, test interpretation, and effective laboratory management, including appropriate quality assurance and quality improvement practices. Training in General Pathology must include: a. Anatomic Pathology 7

8 i. Autopsy Pathology There must be adequate numbers of autopsies available to provide full training in gross, histological, photographic and microbiological techniques related to the autopsy. Instruction in post-mortem prosection must be provided under the direction of staff pathologists. Departments of Pathology must ensure prompt resident interpretation and reporting of autopsy findings, including clinicopathological correlation. Completed autopsy protocols should be in the patient's medical record within a timely fashion consistent with provincial/local guidelines. ii. Surgical Pathology There must be an adequate volume and range of surgical specimens to provide training in the gross examination, dissection, and selection of appropriate tissue blocks for histological study. Experience in biopsy and frozen section interpretation is essential. Experience in the range of histological diagnoses across the range of tissues sent for study in community hospital or free-standing laboratories is essential. iii. Cytopathology There must be an adequate volume and mix of cytologic specimens and facilities available for training in cytology, including aspiration cytology, gynecological cytology, and exfoliative cytology. iv. Forensic Pathology Residents must obtain experience in special procedures that may be associated with forensic autopsies. In order to obtain experience in the techniques related to forensic autopsies, a well-structured program of at least two months must be implemented. If necessary, training at an appropriate forensic centre or laboratory must be arranged. v. Technical and Special Methods In addition to adequate facilities and equipment for routine fixation and staining of tissues, there must be adequate opportunity to develop knowledge of the applications of special staining procedures and immunohistochemistry. Competence in the operation of the light microscope must be ensured, including the applications of polarizing optics and fluorescent microscopy. Residents must acquire a basic knowledge of the principles and techniques of morphometry, molecular pathology, and flow cytometry, and their interpretation. b. Hematopathology There must be adequate experience in transfusion medicine, hemostasis and coagulation, morphology, immunohistochemistry, flow cytometry, applied molecular diagnostics, cytogenetics, and interpretation of these results. c. Medical Biochemistry There must be adequate experience in test ordering and patient preparation, methodology, quality control, and interpretation of biochemical findings. In particular, there must be adequate experience in toxicology, newborn screening, immunoelectropheresis, tumour markers, urine and other body fluid analysis, microscopy, and routine biochemical testing. 8

9 d. Medical Microbiology There must be adequate experience in bacteriology, antimicrobial sensitivity testing, parasitology, mycology, virology, infection control, and molecular diagnostics. e. Additional areas common to more than one of the above domains include the following: i. Immunology and immunopathology ii. Medical Genetics and principles of cytogenetic analysis iii. Pediatric pathology and laboratory testing that includes an adequate volume and variety of teaching material, taught by an appropriate number of faculty iv. Laboratory administration; instruction and experience in managing of laboratories of secondary care facilities must be available v. Information management and data processing applicable to laboratories vi. Experience with lab information systems and computers vii. Principles of laboratory statistics including sensitivity and specificity, accuracy and precision, test optimization, and test validation viii.there must be adequate opportunity to develop knowledge of quality assurance practices specific to practice all areas of laboratory medicine 4. Consultation The resident must have on-going opportunity to act as a consultant to clinical colleagues on the interpretation and clinical relevance of laboratory findings in all areas of General Pathology. 5. Community Learning Experiences Community experiences that provide a learning environment with appropriate supervision based on rotation-specific objectives must be available. This assumes administrative support and linkages with the program. Exposure to laboratories in smaller community hospitals and free-standing laboratories should be an integral part of the program. The program must include training in facilities with laboratory physicians practising General Pathology. 6. Supporting Services - Clinical, Diagnostic, Technical Accredited programs in other disciplines of laboratory medicine are beneficial but not essential for an adequate General Pathology program. The integration of General Pathology residency with other active teaching services in General Surgery, Internal Medicine, Hematology, Diagnostic Radiology, Medical Oncology, Pediatrics, Obstetrics and Gynecology, and Psychiatry, through the attendance at rounds and interaction with residents and staff in these other disciplines, is encouraged. Introduction to and use of telepathology and digital imaging should be encouraged. 9

10 STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfill all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Subspecialty Training Requirements in General Pathology and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert In addition to the General Standards of Accreditation, the following requirements apply: - Regular rounds in each of the specialty areas should be an integral part of the program. Residents should be encouraged to attend multidisciplinary conferences provided by clinical departments, and participate in presenting relevant laboratory findings. 2. Communicator The General Standards of Accreditation apply to this section. 3. Collaborator The General Standards of Accreditation apply to this section. 4. Manager In addition to the General Standards of Accreditation, the following requirements apply: - The program must provide residents with opportunities to gain a working knowledge of the principles and practice of quality assurance monitoring as it applies to the appropriate utilization of the laboratory, and specifically quality control programs applicable to each area of the laboratory. General Pathology residents must participate in quality assurance programs in both the laboratory and in the hospital setting. Working knowledge is defined as the ability to use information in the day-to-day practice of General Pathology. 5. Health Advocate In addition to the General Standards of Accreditation, the following requirements apply: - The program must provide residents with opportunities to participate in infection control, blood product safety, reporting of communicable diseases, reporting of genetic diseases, advocating for the patient s benefit in use and interpretation of laboratory testing, advocating for genetic testing, and public safety, where appropriate. 10

11 6. Scholar In addition to the General Standards of Accreditation, the following requirements apply: - The program must provide residents with appropriate resources, time and supervision to complete a research or scholarly project. 7. Professional The General Standards of Accreditation apply to this section. STANDARD B6: ASSESSMENT OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of assessment data on each resident enrolled in the program. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. Adopted by Council Revised SSRC June

12 Contents Objectives of Training RCPSC Objectives of Training and Specialty Training Requirements in General Pathology Approved by Education Committee, 2000 (Revised 2012) (Please also see Policies and Procedures for Certification and Fellowship) Definition General objectives Specific objectives Specialty training requirements Objectives of Training DEFINITION A General Pathologist is a specialist who is trained in diagnosis and in laboratory management, incorporating and integrating all aspects of laboratory methodology, playing a key role in quality assurance and the introduction of emerging technologies. This includes providing consultation to medical colleagues using morphologic techniques such as histopathology, cytology, autopsy, forensics and clinical laboratory methods, namely biochemistry, laboratory hematology, blood transfusion and microbiology. General Pathology is distinct because the training is divided between Anatomical Pathology and clinical laboratory medicine. General Pathologists are trained to practice in a variety of settings including large metropolitan, regional, and community hospitals, and may play a role in teaching or research. General Pathology can also be a route for sub-specialty or diploma training. GOALS Upon completion of training, a resident is expected to be a competent specialist in General Pathology capable of assuming a consultant s role in the specialty. The resident must acquire a working knowledge of the theoretical basis of General Pathology, including its foundations in the basic medical sciences and research. Residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centred care and service to a diverse population. In all aspects of specialist practice, the graduate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner. GENERAL PATHOLOGY COMPETENCIES: At the completion of training, the resident will have acquired the following competencies and will function effectively as a: 12

13 Medical Expert Definition: As Medical Experts, General Pathologists integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patientcentred care. Medical Expert is the central physician Role in the CanMEDS framework. Core competence will be reflected in achievements at the introductory and working knowledge levels. This is the minimum training required to achieve successful completion of training in General Pathology. Introductory knowledge is defined as the ability to recognize, identify, or describe principles. For example, knowledge of viral classification and identification techniques. Working knowledge is defined as the ability to use information in the day-to-day practice of General Pathology. For example, the ability to diagnose common inflammatory and neoplastic conditions both histologically and cytologically; advise on appropriate biochemical testing and laboratory instrumentation pertinent to supervising a community or regional hospital laboratory; offer consultative services to clinical colleagues on such things as laboratory utilization. Key and Enabling Competencies: General Pathologists are able to 1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centred medical care 1.1. Perform a General Pathology consultation, including the presentation of welldocumented assessments and recommendations in written and/or verbal form 1.2.Demonstrate use of all CanMEDS competencies relevant to General Pathology 1.3. Identify and appropriately respond to relevant ethical issues arising in patient care 1.4.Demonstrate the ability to prioritize professional duties when faced with multiple cases and problems 1.5.Demonstrate compassionate and patient-centred care 1.6. Recognize and respond to the ethical dimensions in medical decision-making 1.7.Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed 2. Establish and maintain clinical knowledge, skills and attitudes appropriate to General Pathology 2.1.Apply working knowledge of the clinical and fundamental biomedical sciences relevant to General Pathology, including: Anatomical Pathology Normal anatomy and its common variants with a basic understanding of embryological development Common inflammatory and neoplastic conditions on both histological and cytological material in all organ systems 13

14 Normal gross and light microscopic appearance of tissues both as intact organs and biopsy material Principles of tissue fixation and preparation of specimens for microscopic examination Normal appearance in common fixatives of tissue cells, either exfoliated or obtained by needle aspiration Principles of cell biology, immunology, medical genetics and pathogenic mechanisms with an understanding of changes seen in disease states Principles of light microscopy including polarization, dark field and fluorescence microscopy Principles of specialized histology techniques including histochemical, immunocytochemical, flow cytometry, morphometry, and hybridization techniques and their application in diagnosis Regulations regarding retention of specimens and processed surgical material as well as the retention of records Regulations governing consent for post-mortem examination and the types of cases that must be reported to the coroner or medical examiner Relevant autopsy techniques and expected findings as well as the practical aspects of establishing time of death and identifying remains Definitions of cause, mechanism and manner of death, including which autopsies should be referred to Forensic Pathologists Principles of sampling of tissues and fluids for toxicological examination and the legal requirements for the handling of these samples Recognized standards of workplace safety Regulations governing transportation of dangerous goods Utilization of ancillary techniques such as biochemical, microbiological, photographic, and radiological studies in pathology Principles of quality assurance pertinent to surgical, cytology and autopsy pathology Gross and microscopic appearance of diseased tissue and cells Medical Biochemistry Demonstrate a working knowledge of physiology, biochemical testing and laboratory instrumentation pertinent to supervising a community or regional hospital laboratory and offering consultative services to clinical colleagues. The General Pathologist must understand the pathobiology of, and test strategies pertinent to, the diagnosis of common disorders of: Body water and electrolytes Acid-base control 14

15 Renal function Liver function Lipid metabolism Bone metabolism Pancreatic and digestive function Cardiac and vascular function Blood glucose and carbohydrate metabolism Iron, porphyrin and bilirubin metabolism Endocrine function, including but not limited to thyroid, parathyroid, gonadal, pituitary, and adrenal Uric acid metabolism Protein metabolism Demonstrate introductory knowledge of nutrition, cancer-associated biochemical abnormalities, therapeutic drug monitoring, pharmacokinetics, toxicology, and pediatric and prenatal clinical biochemistry, with special emphasis on testing available in community or regional hospital laboratories Demonstrate working knowledge of statistics pertinent to clinical biochemistry, including the concepts of sensitivity, specificity, efficacy, precision, accuracy, incidence, prevalence, predictive value, reference ranges, means, standard deviation, variance, parametric and non-parametric distribution, and the control of pre-analytical variables Demonstrate working knowledge of common analytical techniques and instrumentation in the biochemical laboratory Demonstrate working knowledge of resource-efficient laboratory equipment selection Demonstrate working knowledge of the basic components of a laboratory information system and its application to the modern biochemical laboratory Medical Microbiology Demonstrate a working knowledge of bacterial organisms and their clinical presentation, appropriate specimen collection, microscopic appearance, culture characteristics, diagnostic tests, and drug sensitivity, including those that are normally isolated or otherwise identified in a regional hospital laboratory. These bacterial organisms include but are not limited to Staphylococci, streptococci, Corynebacteriae (including other aerobic and facultative gram-positive rods), Clostridia, Neisseriae (including moraxella), Enterobacteriaceae, Campylobacter, Pseudomonas (and other common gram negative opportunistic bacilli), Hemophilus, Bordatellae, Legionellae, Chlamydiae, Mycoplasmae, Spirochetes, and common pathogenic mycobacteria 15

16 Demonstrate introductory knowledge of common fungal, parasitic and viral organisms in pathologic specimens, and the ability to utilize serologic and culture investigations for diagnosis, including but not limited to: Candida, Aspergillus, Histoplasma, Coccidioides, Blastomyces, Cryptococcus, Mucor, Pneumocystis Malaria, ehrlichia, common helminthic infections (cestodes, Enterobius, Strongyloides, Ascaris), Giardia, Schistosomes, Cryptosporidia, Microsporidia, Entamoeba, Dientamoeba, blastocystis, echinococcus, Trichinella Hepatitis A, B, and C, and Human Immunodeficiency Virus (HIV), with emphasis on serologic testing Demonstrate an introductory knowledge of testing strategies, specimen collection and handling, laboratory safety, and interpretation of diagnostic reports for less common viral, bacterial, fungal, and parasitic organisms Demonstrate a working knowledge of hospital infection control, including prevention and control of infection and epidemics, disinfection and sterilization procedures, appropriate handling and disposal of infectious materials, employee health and laboratory safety issues, and pertinent public health regulations Demonstrate an introductory knowledge of molecular diagnostic methodologies and their use in microbiological diagnosis and outbreak investigation Demonstrate knowledge of common quality control procedures applicable to microbiology Hematological Pathology and Transfusion Medicine Demonstrate a working knowledge of: Normal hematopoiesis and cell biology as it pertains to the structure and function of all hematopoietic elements The structure and the functional relationships of all components of the reticulo-endothelial system The components of humoral and cellular immunity, the role of complement and its pathways of activation The components and functional relationship of the hemostatic and fibrinolytic systems, including control mechanisms Immunohematology including major blood group systems and the role of the human leukocyte antigen (HLA) system Genetics and molecular diagnostics as applicable to hematologic disorders Hematopathological disorders, specifically common problems of all hematopoietic and lymphoid tissues including diagnostic strategies, morphologic findings, clinical associations, complications, and basic principles of management The role of cytogenetics, molecular studies, and flow cytometry Hemostasis and coagulation disorders, including thrombosis 16

17 Major congenital and acquired disorders of coagulation, including strategies for investigation, clinical associations, and principles of management Common problems of blood banking, including but not limited to incompatible cross-match, auto- and allo-immune antibodies and their differentiation, and neonatal blood banking issues Investigation and classification of adverse reactions to blood component therapy Appropriate use of blood components in the treatment of hematological and coagulation disorders Current Canadian Blood Services (CBS) policies, procedures and products, including autologous and directed donations 2.2.Describe the CanMEDS framework of competencies relevant to General Pathology 2.3.Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up-to-date, and enhance areas of professional competence 2.4.Contribute to the enhancement of quality care and patient safety in General Pathology, integrating the available best evidence and best practices 3. Perform a complete and appropriate clinicopathological assessment of a case 3.1. Identify and explore issues to be addressed in the handling of a case 3.2. Elicit a history that is relevant, concise and accurate to context and preferences for the purposes of disease prevention and health promotion, diagnosis and/or management 3.3. Perform a focused examination that is relevant and accurate for the purposes of disease prevention and health promotion, diagnosis and/or management 3.4.Select medically appropriate investigative methods in a resource-effective and ethical manner 3.5.Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans 4. Use preventive and therapeutic interventions effectively 4.1. Implement a management plan in collaboration with clinicians and, when appropriate, the patient or patient s family 4.2.Demonstrate appropriate and timely application of preventive and diagnostic interventions relevant to General Pathology 4.3. Ensure appropriate informed consent is obtained for pathology procedures 4.4. Ensure appropriate communication with patients and/or family members with respect to the handling of surgical and post-mortem procedures in the context of a multicultural society 17

18 5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic 5.1.Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to General Pathology, including: Anatomical Pathology Diagnose a broad range of pathological conditions from surgical pathology, cytology, and autopsy materials Handle specimens appropriately and obtain satisfactory photomicrographs and photographs Perform an intraoperative consultation Perform a complete autopsy, including for medico-legal purposes Medical Microbiology Use a microscope for morphologic assessment of microorganisms effectively Analyze microbiologic data and correlate it to clinical information Develop, adhere to and review quality control data Review and supervise bench level tests available and develop test algorithms Hematopathology and Transfusion Medicine Perform morphological assessments and diagnosis of blood, bone marrow and lymph node based disorders with utilization of current technologies as appropriate Review and supervise bench level tests available in a community or regional hospital hematology laboratory. This will include manual, semi-automated, and automated tests in addition to the basic principles of test methodology and instrumentation Make decisions regarding appropriate use of current diagnostic methodologies for hematological Construct test algorithms to diagnose common disorders of hemostasis and coagulation Supervise bench level testing in the blood bank and recognize standards as they apply to the testing and release of blood products Assess transfusion orders in relation to appropriateness, risks and alternatives to transfusion Investigate transfusion reactions Conduct bone marrow aspiration and biopsy Develop, adhere to and review quality control data Review and supervise bench level tests available and develop test algorithms 18

19 Medical Biochemistry Use a microscope for morphologic assessment of urinalysis and body fluids effectively Interpret protein electropheresis and immunofixation studies Develop, adhere to and review quality control data Review and supervise bench level tests available and develop test algorithms 5.2. Ensure appropriate informed consent is obtained for procedures 5.3.Document and disseminate information related to procedures performed and their outcomes 5.4. Ensure adequate follow-up is arranged for procedures performed 6. Seek appropriate consultation from other health professionals, recognizing the limits of their own expertise 6.1.Demonstrate insight into their own limits of expertise 6.2.Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care 6.3.Recognize the type of case that, because of tissue type, rarity, complexity, or therapeutic implications, will require referral 6.4.Recommend appropriate follow-up care services for a patient or a patient s family, if Communicator Definition: As Communicators, General Pathologists effectively facilitate patient care through their role in the doctor-doctor and the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. Key and Enabling Competencies: General Pathologists are able to 1. Develop rapport, trust, and ethical therapeutic relationships with patients and families 1.1.Recognize that being a good communicator is a core clinical skill for physicians 1.2. Establish appropriate communication with patients and their families when the situation arises 1.3. Respect patient confidentiality, privacy and autonomy 1.4. Facilitate a structured clinical encounter as required 1.5. Ensure appropriate communication with patients and/or family members with respect to handling of surgical and post-mortem procedures, including appropriate cultural sensitivity 19

20 2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals as appropriate 2.1.Gather information about a disease, and about a patient s beliefs, concerns, expectations and illness experience where relevant, such as in an autopsy situation 2.2.Seek out and synthesize relevant information from other sources, such as a patient s family, caregivers and other professionals 3. Convey relevant information and explanations accurately to patients and families, colleagues and other professionals 3.1. Deliver information to a patient and family, colleagues and other professionals in a professional manner and in such a way that it is understandable, encourages discussion and participation in decision-making 3.2. Communicate with clinical colleagues in order to assist in the interpretation of laboratory findings in the clinical context 3.3. Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing behavioural and/or communication issues in difficult situations 4. Develop a common understanding on issues, problems and plans with patients, families, and other professionals 4.1. Explore problems to be addressed from a patient encounter effectively, including the patient s context, responses, concerns, and preferences 4.2. Respect diversity and difference, including but not limited to the impact of gender, religion and cultural beliefs on decision-making 4.3. Encourage discussion, questions, and interaction in the encounter 5. Convey effective oral and written information about a medical case 5.1.Maintain clear, concise, accurate, and appropriate records of medical encounters and plans Demonstrate the ability to formulate comprehensive and clinically meaningful surgical pathology reports and organize diagnostic summaries to prioritize the features of importance. Diagnostic uncertainty must be clearly expressed with appropriate differential diagnoses and suggestions regarding further studies or ancillary investigations Demonstrate awareness of the importance of timeliness, clarity and accuracy in all verbal and written communication including critical results 5.2. Present verbal reports of clinical encounters and plans 5.3.Demonstrate understanding of the processes and potential roles of the General Pathologist surrounding communication with public or media regarding medical issues and events 20

21 Collaborator Definition: As Collaborators, General Pathologists effectively work within a health care team to achieve optimal patient care. Enabling Competencies: General Pathologists are able to 1. Participate effectively and appropriately in an interprofessional health care team 1.1.Describe the General Pathologist s roles and responsibilities to other professionals 1.2.Describe the roles and responsibilities of other professionals within the health care team 1.3.Recognize and respect the diversity of roles, responsibilities and competencies of other professionals in relation to their own 1.4. Work with others to assess, plan, provide and integrate care for individuals and groups of patients Provide consultative services to clinical colleagues regarding appropriate investigations and their interpretation 1.5.Work with others to assess, plan, provide and review other tasks, such as research problems, educational work, program review or administrative responsibilities 1.6. Participate in multidisciplinary team meetings 1.7. Enter into interdependent relationships with other professionals for the provision of quality care 1.8.Describe the principles of team dynamics 1.9. Respect team ethics, including confidentiality, resource allocation and professionalism Demonstrate leadership in a health care team 2. Work with other health professionals to prevent, negotiate, and resolve conflict 2.1.Demonstrate a respectful attitude towards others 2.2.Work with others to prevent conflicts 2.3. Employ collaborative negotiation to resolve conflicts 2.4.Respect differences and address misunderstandings and limitations in other professionals 2.5.Recognize one s own differences, misunderstanding and limitations that may contribute to interprofessional tension 21

22 Manager Definition: As Managers, General Pathologists are integral participants in health care organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the health care system. Key and Enabling Competencies: General Pathologists are able to 1. Participate in activities that contribute to the effectiveness of their health care organizations and systems 1.1.Work collaboratively with others in their organizations 1.2. Participate in systemic quality process evaluation and improvement, such as patient safety initiatives 1.3.Demonstrate knowledge of laboratory safety, the transportation of dangerous goods, and all aspects of quality as defined by current International Standards Organization (ISO) standards for clinical laboratories and by provincial laboratory accreditation standards 1.4.Describe the structure and function of the health care system as it applies to laboratory medicine, including the roles of physicians, other health professionals, and administrative personnel 1.5.Describe principles of health care financing, including physician remuneration, budgeting, and organizational funding 1.6. Supervise and direct the clinical laboratory at the level of the community or regional hospital 1.7. Demonstrate an understanding of the role and structure of provincial and national hospital programs as they pertain to the role and utilization of the hospital laboratory, including but not limited to infection control, impact analysis, and blood supply and distribution 1.8. Participate in quality improvement initiatives or activities in all laboratory disciplines 1.9.Develop, adhere to and review quality control data 2. Manage their practice and career effectively 2.1.Set priorities and manage time to balance practice requirements, outside activities, and personal life 2.2.Manage a laboratory including: The supervision and direction of the clinical biochemistry, clinical microbiological, and hematopathology laboratory at the level of the community or regional hospital The direction of a hospital infection control program as it pertains to the role and utilization of the hospital laboratory The supervision and clinical direction of a transfusion service in association with provincial and national blood agencies 22

23 The provision of consultation services regarding appropriate use of, and possible alternatives to, blood component therapy The management of staffing and personnel The supervision of budgeting (personnel, materials, capital equipment) The supervision of workload measurements 2.3. Participate in hospital medical staff organization 2.4.Demonstrate working knowledge of funding structures for laboratories 2.5.Demonstrate working knowledge of laboratory management 2.6.Demonstrate working knowledge of principles of optimal laboratory utilization The management of equipment purchasing and selection 2.7. Implement processes to ensure personal practice improvement 2.8. Employ information technology appropriately for patient care Demonstrate working knowledge of laboratory information systems and components (hardware and software) Demonstrate awareness of and comply with personal privacy legislation and policy 2.9. Describe an approach to evaluating emerging technologies with a view to the possibility of integration in the laboratory 3. Allocate finite health care resources appropriately 3.1. Recognize the importance of just allocation of health care resources, balancing effectiveness, efficiency, and access with optimal patient care 3.2.Apply evidence and management processes for cost-appropriate care 4. Serve in administration and leadership roles, as appropriate 4.1.Chair or participate effectively in committees and meetings 4.2. Lead or implement change in health care 4.3. Plan relevant elements of health care delivery (e.g., work schedules) Health Advocate Definition: As Health Advocates, General Pathologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. Key and Enabling Competencies: General Pathologists are able to 23

24 1. Respond to individual patient health needs and issues as part of patient care 1.1. Identify the role of laboratories regarding the health needs of individual patients 1.2. Identify opportunities for advocacy, health promotion, and disease prevention for individuals to whom they provide care 2. Respond to the health needs of the communities that they serve 2.1.Describe the practice communities that they serve 2.2. Identify opportunities for advocacy, health promotion, and disease prevention in the communities that they serve, and respond appropriately Respond adequately to community and hospital service demands, including but not limited to the need for population screening, detection, and control of infectious Demonstrate the ability to recognize and respond to situations where health advocacy and application of health care resources is required, including the introduction of improved instrumentation and methodologies to augment community health care Identify opportunities to advocate for appropriate infection control, blood product safety, reporting of communicable diseases, reporting of genetic diseases, genetic testing where appropriate, and public safety 2.3.Appreciate the possibility of competing interests between the communities served and other populations or organizations 3. Identify the determinants of health for the populations that they serve 3.1. Identify the determinants of health of the populations, including barriers to access to care and resources 3.2. Identify vulnerable or marginalized populations within those served and respond appropriately 4. Promote the health of individual patients, communities, and populations 4.1.Describe an approach to implementing a change in a determinant of health of the populations they serve 4.2.Describe how public policy impacts the health of the populations served 4.3. Identify points of influence in the health care system and its structure 4.4.Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism 4.5. Identify the possibility of conflict inherent in the role of health advocate for a patient or community with that of manager or gatekeeper 4.6.Describe the role of the medical profession in advocating collectively for health and patient safety 24

25 Scholar Definition: As Scholars, General Pathologists demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. Key and Enabling Competencies: General Pathologists are able to 1. Maintain and enhance professional activities through ongoing learning 1.1.Describe the principles of maintenance of competence 1.2.Describe the principles and strategies for implementing a personal knowledge management system 1.3.Recognize and reflect on learning issues in practice 1.4. Pose an appropriate learning question 1.5. Incorporate quality improvement activities for continuing medical education 1.6.Access and interpret relevant evidence 1.7. Integrate new learning into practice 1.8. Evaluate the impact of any change in practice 1.9.Document the learning process in accordance with provincial or national guidelines 2. Critically evaluate medical information and its sources, and apply this appropriately to practice decisions 2.1.Describe the principles of critical appraisal 2.2.Critically appraise retrieved evidence in order to address a clinical question 2.3. Integrate critical appraisal conclusions into clinical care 3. Facilitate the learning of other health professionals, patients, families, students, residents, the public and others, as appropriate 3.1.Describe principles of learning relevant to medical education 3.2. Identify collaboratively the learning needs and desired learning outcomes of others 3.3.Select effective teaching strategies and content to facilitate others learning 3.4.Demonstrate an effective lecture or presentation 3.5.Assess and reflect on a teaching encounter 3.6. Provide effective feedback 3.7.Describe the principles of ethics with respect to teaching 25