Goals and Objectives
On completing the Cytogenetics laboratory rotation(s), the resident is expected to be able to:
- Demonstrate familiarity with cytogenetic nomenclature, and identify major constitutional chromosomal abnormalities, and their clinical manifestations.
- Demonstrate knowledge of the common recurrent chromosomal aberrations in hematologic and solid neoplasms.
- Demonstrate familiarity with the role of molecular techniques used to identify constitutional and somatic chromosomal aberrations, including in-situ hybridization, quantitative amplification assays and conventional CGH, array-based CGH and SNP-array-based assays.
- Understand the role of Chorionic Villous Sampling (CVS) and amniocentesis, and the specific technical and clinical considerations in evaluation of these specimens.
- Review and evaluate FISH analyses of tumor specimens, including paraffin FISH.
- Understand the sample requirements, clinical implications and limitations of these tests - both in constitutional and cancer testing - and, when appropriate, communicate these to ordering physicians.
- When these tests are inadequate to answer relevant clinical questions, help the treating physician identify clinically appropriate tests, laboratories performing such tests, and assist the clinician in interpreting these tests.
- Identify time-critical results - especially in the prenatal setting - and convey them in a timely manner to clinicians.
Practice Based Learning and Improvement
- Continuously update their knowledge in sciences and clinical fields related to the tests performed in the Cytogenetics laboratory.
- Demonstrate an understanding of clinical test development and validation procedures - both technical and clinical. This will be done primarily by review of validation of tests already performed in the laboratory.
- Participate actively in educating and instructing others in matters related to Cytogenetics.
- Ask a definable question or questions related to tests being performed in the cytogenetics laboratory, new clinical, technical or biological issues related to cytogenetics that may arise or have arisen during or before the rotation, search for relevant scientific information, critically appraise the information using the principles of evidence-based medicine, and evaluate the significance of this to the practice of molecular genetic pathology. The fellow shall present this information at departmental conferences (clinical pathology journal club, Pathology Chief of Service conference, clinical genetics conference, laboratory specific conference) and/or at national conference(s).
Interpersonal and Communication Skills
During the rotation, residents must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with other health care providers, laboratory personnel, patients, and patients' families. Towards this end they shall:
- Develop effective working relationships with professional and technical staff, and outside consultants.
- Demonstrate effective verbal communication skills when communicating results to clinicians, at the appropriate level for the information being transmitted; convey and explain test results clearly, precisely, and concisely to physicians in direct conversations, or at conferences; communicate effectively with technical personnel when troubleshooting assays, or when managing the laboratory.
- Develop excellent written skills for communication of complicated results when issuing reports, for the development and implementation of new laboratory policies and procedures, and for presentation of scientific research data, as appropriate.
- Develop presentation skills that include selection of appropriate presentation materials and visual aids, good oral presentation and mannerisms, and the ability to answer questions effectively.
During the rotation, residents must demonstrate a commitment to professional responsibilities, adherence to highest ethical standards, and respect for all. Towards this, they shall:
- Demonstrate respect and compassion for the patient and a dedication to patient care.
- Treat each sample as belonging to a patient, and not just a number.
- Show respect for the confidentiality of all patient information.
- Conduct themselves with integrity and honor; If they identify any errors, or any areas where there is a possibility unreliable results, quickly bring this to the attention of those responsible so errors may be prevented, or corrected immediately.
- Demonstrate reliability in all assigned activities;
- Demonstrate perfect attendance at all laboratory activities;
- Demonstrate completeness in the workup of all cases in the Cytogenetics laboratory.
- Educate other health care professionals in the technical functioning of and clinical implications of the various functions of the molecular pathology laboratory.
- Pursue continuing professional growth and educational opportunities.
Systems Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to call on system resources to provide molecular genetic pathology services that are of optimal value. Towards this they shall, where appropriate:
- Provide guidance to clinicians and counselors to ensure that molecular testing performed in the cytogenetics laboratory is used and integrated into patient care in an appropriate and cost-efficient manner.
- Understand the clinical implications and cost-effectiveness of the tests performed in the molecular pathology laboratory and their implications for patient management.
- Provide information on alternative testing approaches that may be used, when appropriate.
- Demonstrate knowledge of scientific, legal, and ethical issues relating to molecular testing.
- Understand standards and regulations governing laboratory operations including Clinical Laboratory Improvement Amendments (CLIA), and evaluate laboratory compliance with these standards and regulations.
- Fellows will evaluate the compliance of the laboratory with these standards using the CAP checklists and NY State standards. They will present assist the laboratory director in developing the annual laboratory Quality Improvement Program and present a review of this semi-annually at the departmental QA conference.
- Demonstrate an understanding of and sensitivity ethical issues related to molecular genetic testing, as well as a knowledge of NY State regulations regarding informed consent for molecular genetic testing.
- Understand the implications not only to patients, but also their families, of results of cytogenetics tests.
- Understand the need for informed consent, as well as the legal requirement for informed consents in NY State, and monitor compliance of the laboratory with this requirement.
- Demonstrate knowledge of the impact of laboratory management and activities on other health care professionals, organizations, and society.
- Understand financial and economic systems in which the molecular laboratory operates, including billing, the appropriate use of current procedural terminology codes, diagnostic codes, and health insurance and reimbursement issues.
- Practice cost-effective health care and resource allocation that does not compromise quality of care.
- Be an advocate for quality patient care and contribute to clinician education.
- Demonstrate the ability to assess, understand, and use the resources, personnel, and health care systems necessary to provide optimal care.