Competency Portfolio for the Diploma in Cytopathology Guide for Working Group/AFC-Diploma Committee, Educators, and Candidates 2013 EDITIAL REVISION 2015 VERSION 1.2 This portfolio applies to those who begin training on or after July 1 st, 2013. DEFINITION Cytopathology is that area of enhanced competence within Anatomical Pathology or General Pathology concerned with diagnosis through the morphological evaluation of cells and/or microfragments of tissue reflecting the manifestations of disease. Cytopathology testing is carried out on cellular material obtained from a variety of body sites which is analyzed for pathological conditions. Cytopathological testing is done for both diagnostic and screening purposes and plays a very important role in patient management under both circumstances. GOALS Upon completion of training, a diplomate is expected to function as a competent specialist in Cytopathology, capable of an enhanced practice in this area of focused competence (AFC), within the scope of Anatomical Pathology or General Pathology. The AFC trainee must acquire a working knowledge of the theoretical basis of the discipline, including its foundations in the sciences and research. The discipline of Cytopathology includes responsibility for interpretation of gynecological and non-gynecological cytological specimens, management of the cytopathology laboratory, performance of fine needle aspirates (FNAs) of superficial body sites, selection and interpretation of ancillary cytological studies for diagnosis and prognosis, advancement of the discipline of Cytopathology through scholarship, and engagement of governments, other physicians, and other health professions in the promotion of the role of Cytopathology in patient wellness and care. Note: All markers must be signed off by prior to adding to portfolio. Note: All submitted cases or clinical material must be de-identified to preserve patient privacy. This requires the removal of key identifiers, including but not limited to name, birth date, date of consultation, and location (e.g., hospital/clinic, city). In some cases, even without these identifiers, a patient could be identified by other information included in the case or clinical material (e.g., if the patient has a very rare condition, or lives in a remote area with a limited population size). In these instances de-identification may not be sufficient to ensure patient privacy. In such exceptional cases it would be advisable to obtain patient consent This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2015 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Specialty Education, attn: Associate Director, Specialties. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: documents@royalcollege.ca. For questions regarding the use of this document, please contact: credentials@royalcollege.ca. Page 1 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) for the submission. Diplomates 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 diplomate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner. At the completion of training, the AFC trainee must demonstrate evidence of acquisition of the competencies listed in the table below. In the view of the AFC Program Committee, this candidate has acquired the competencies of the diploma program as prescribed in the Competency Portfolio and is competent to practise as a diplomate. YES NO COMMENTS Page 2 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 1. Interpretation of gynecological and non-gynecological cytological specimens 1.1. Provide interpretation of cytopathological specimens, in the context of clinical and diagnostic imaging findings, to offer an accurate diagnosis and effective expert consultation Completion of the Royal College Cytopathology logbook, demonstrating the breadth of cases seen (including gynecological and non-gynecological cases) Satisfactory completion of a structured, in-training exam, demonstrating proficiency in making a diagnosis by the cytopathologic interpretation of a breadth of specimens (glass slides and/or digital images); to be given by Satisfactory completion of a structured oral exam involving complex cases (requiring ancillary studies or other modalities); trainee must demonstrate comprehensive reporting (the exam must include slide interpretation and discussion of theory); to be given by Submit the completed Royal College Cytopathology logbook, signed off by Successful completion of complex case oral exam and intraining exams signed off by that candidate passed; provide list of questions asked for in-training exam and a list of cases for the oral exam Page 3 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 1.2. Perform on-site examination of cytopathological specimens Satisfactory performance of onsite examinations of cytopathology specimens, demonstrating success, proficiency and timeliness in the assessment for adequacy and/or interpretation; must include Royal College Cytopathology logbook of aggregate numbers of specimens performed by type, adequacy (and/or interpretation); must demonstrate a variety of specimen types and sites Submit Royal College Cytopathology logbook with sign-off by 1.3. Act as a consultant to other pathologists for complex cases Collection of five de-identified intra- and/or extradepartmental consultation reports, or Royal College Cytopathology Laboratory Encounter Cards, including details of the diagnosis, educational information to the referring pathologist regarding interpretation, and an approach to the case Submit five de-identified intra- and/or extradepartmental consultation reports or Royal College Cytopathology Laboratory Encounter Cards Page 4 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 1.4. Communicate results of cytopathology examinations, including those critical diagnoses that require expedited reporting Satisfactorily write a comprehensive standard operating procedure (SOP) for reporting of critical diagnoses including expedited reporting Collection of at least two deidentified consultation reports or Royal College Cytopathology Laboratory Encounter Cards, including details of the diagnosis, and a reflection on why this report required expedited reporting Submit SOP document to for sign-off Submit at least two deidentified consultation reports or Royal College Cytopathology Laboratory Encounter Cards communicating the reporting of critical diagnoses Page 5 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 2. Management of the cytopathology laboratory 2.1. Provide consultation on the collection, triaging, processing and storage of cytopathological material Successful completion of an Intraining Evaluation Report (ITER) documenting achievement of competence in the cytopathology preparation (prep) room rotation; AND EITHER Satisfactory completion of two Royal College Cytopathology Laboratory Encounter Cards, demonstrating the ability to recognize and resolve processing problems at a consultant level of expertise Satisfactory completion of a structured oral examination on the collection, triaging, processing and storage of cytopathological material; the structured oral exam is to be given by the pathologist Submit one ITER for the prep room rotation; AND EITHER Submit two Royal College Cytopathology Laboratory Encounter Cards, demonstrating resolution of processing problems Submit the results of a structured oral exam; provide a list of questions asked and sign off by Page 6 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 2.2. Work effectively as a member of the cytopathology team Satisfactory completion of a Royal College Cytopathology multi-source feedback assessment of interprofessional team work in the cytopathology laboratory; this must include input from cytotechnologists, administrative staff and other support staff, and may include clinical staff Submission of a completed Royal College Cytopathology multisource feedback assessment 2.3. Participate in the administration of a cytopathology laboratory Satisfactory completion of at least two de-identified Royal College Cytopathology Laboratory Encounter Cards demonstrating ability to solve an administrative issue in cytopathology; may be a real life case scenario or simulated case from ; topics may include, but are not limited to: budgeting, utilization, lab safety, equipment selection/ purchasing, licensure Successful completion of a needs assessment for changes in instrumentation, new technologies and/or procedures in cytopathology laboratory Complete at least two deidentified Royal College Cytopathology Laboratory Encounter Cards; sign-off by Submit needs assessment for sign-off by Page 7 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 2.4. Design, implement, monitor and evaluate a comprehensive quality assurance (QA) program in cytopathology Documentation of participation in the QA program of the cytopathology laboratory AND EITHER Successful completion of at least two Royal College Cytopathology Laboratory Encounter Cards on participation in laboratory metrics as recommended by accreditation bodies Satisfactory completion of at least one assignment on a key indicator of lab metrics Submit an ITER for participation in the QA program of the laboratory AND EITHER Submit at least two Royal College Cytopathology Laboratory Encounter Cards on participation in laboratory metrics; sign-off by Submit an assignment on a key indicator of lab metrics; sign-off by Page 8 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 3. Performance of fine needle aspiration (FNA) of superficial body sites 3.1. Perform fine needle aspirations (FNAs) on superficial body sites proficiently Satisfactory performance of FNAs on superficial body sites with proficiency, safety and success attested by the Logbook must include the aggregate numbers of FNAs performed, listed by superficial body site Submit Royal College Cytopathology logbook; signoff by 3.2. Communicate clearly the details and risks of the FNA procedure to a patient, and obtain appropriate informed consent Satisfactory completion of an observed performance of obtaining appropriate informed consent which must include clear explanation of the procedure and potential outcomes Submit written evaluation by Page 9 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 4. Selection and interpretation of ancillary cytological studies for diagnosis and prognosis 4.1. Select ancillary cytopathological studies in a judicious and effective manner, and interpret accurately at the level of a consultant Satisfactory completion of at least two de-identified cytopathology reports, demonstrating appropriate selection and interpretation of each of the following ancillary tests: o cytochemistry o immunomarkers AND EITHER One report for at least one of the following: o flow cytometry o molecular diagnostic test o cancer cytogenetic test o fluorescence in situ hybridization (FISH) test Submit a case write-up addressing at least one of the above Submit at least three deidentified cytopathology reports or two reports and one case-write-up; specified cases as shown in the markers column; sign off by Page 10 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 5. Advancement of the discipline of Cytopathology through scholarship 5.1. Supervise junior trainees and/or cytotechnologists Satisfactory supervision of junior trainees and/or cytotechnologists Submit compiled teaching evaluations completed by junior trainees and/or cytotechnologists, sign off by 5.2. Conduct a scholarly project related to Cytopathology Submission of a research proposal (including submission of ethics approval) related to a Cytopathology topic Submit a completed research proposal and ethics approval related to a Cytopathology topic Submission of a completed manuscript, suitable for submission to a peer reviewed journal, on research work in Cytopathology Submit a manuscript of research work in Cytopathology Submission of learning module and/or curriculum Submit a learning module and/or curriculum related to Cytopathology Page 11 of 12
COMPETENCY PTFOLIO F THE DIPLOMA IN CYTOPATHOLOGY (2013) 6. Engagement of governments, other physicians, and other health professions in the promotion of the role of Cytopathology in patient wellness and care 6.1. Describe the impact of public health policies relevant to Cytopathology 6.2. Educate others about the role of Cytopathology in patient care Satisfactory completion of an assignment summarizing the impact of a current or recent public health policy on Cytopathology Submission of assessment of at least one effective presentation related to cytopathology findings at departmental and/or multidisciplinary conferences Submit an assignment summarizing the impact of a current or recent public health policy on Cytopathology; sign off by Submit assessment and sign-off of presentation of cytopathology findings at departmental and/or multidisciplinary conferences Approved Specialty Standards Review Committee May 2013 Editorial revisions Office of Specialty Education January 2014 Editorial revisions Cytopathology AFC Committee June 2015 Page 12 of 12