Residency & Fellowship Programs: AP Rotations

Frozen Section/Intraoperative Consultation

ABOUT FROZEN SECTION PATHOLOGY:
Cytogenetics Laboratory Director:


Genetics Diagnostic Laboratory Co-Director:


Cytogenetics Laboratory Location:



Recommended Rotation Length:
 

During the course of residency training in Pathology, residents in AP only, AP/CP, and AP/NP programs are required to rotate in Frozen Section/Intraoperative Consultation.  Total time spent in this rotation is generally eight to twelve weeks during residency. There is usually only one resident assigned to the frozen section rotation during any block.  Rotations are generally two to four weeks per year for PGY 1-4 AP/CP residents, PGY1-3 AP-only residents, and PGY1-2 AP/NP residents.  The goals and objectives listed below are for the initial rotation and, as noted, include additional goals and objectives for the advanced rotations in later postgraduate years.

The Frozen Section service can be busy, with roughly 5-25 frozen section cases a day. Many cases include multiple specimens from the same patient.

The material encountered on this Frozen Section rotation includes specimens from the following areas: 

Gastrointestinal Pathology
Genitourinary Pathology
Cardiovascular Pathology
Thoracic Pathology
ENT Pathology
Breast Pathology
Pediatric Pathology
Soft Tissue Pathology
Skin Pathology
Ophthalmic Pathology
Hematopathology

Frozen sections from some other clinical services are performed by residents assigned to other Pathology rotations.  These include the specific mandatory rotations in Gynecologic Pathology and Neuropathology.

Each resident is evaluated by the Attending Pathologists with whom he/she worked for the period.

The goals and objectives for the Frozen Section rotation are: 

DIAGNOSTIC AND PATIENT CARE ACTIVITIES

Residents must demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services.  These include:

  • Obtaining pertinent information from the patient’s clinical record using  the pathology laboratory information system (COPATH), and the hospital clinical information system (WEBCIS)
  • Show a working knowledge of confidentiality and security requirements for patient-related information.
  • Demonstrate the ability to select appropriate tissue for frozen section, freeze and cut the tissue, prepare and stain the slides.
  • Advanced rotators:  Initiate or discuss the appropriate special studies (ultrastructure, cytogenetics, immunohistochemistry, etc.) which will be necessary for final diagnosis with the attending pathologist

MEDICAL KNOWLEDGE

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to Pathology.

  • Understand the basic types of neoplastic and non-neoplastic lesions likely to be encountered in individual organs.
  • Advanced rotators:  Understand the differential diagnosis for lesions in specific organs based on specific patient history and the histologic features to discriminate between the various entities to arrive at a diagnosis.
  • Understanding of clinical-pathologic correlation for major diseases/tumors in all the sub-specialty areas in Surgical Pathology.

INTERPERSONAL AND COMMUNICATION SKILLS

 Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with other healthcare providers, patients, and patient’s families.

  • Ability to communicate with clinicians and other healthcare professionals in obtaining and relaying clinical information and diagnostic information.
  • Ability to communicate with attending pathologists when working on cases.
  • Advanced rotators: Ability to effectively present cases in an articulate and professional manner in the department and in various clinical departments.  Present interesting/difficult frozen section diagnosis cases with the final pathology at departmental conferences.

SYSTEMS-BASED PRACTICE

Residents must demonstrate awareness of the role of pathology in large medical systems and public health.

Residents will show an understanding of appropriate billing for frozen section diagnosis and intra-operative consultation.

Advanced Rotators:  Residents will understand appropriate use of intra-operative consultation.

PROFESSIONALISM

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

  • Knowledge of HIPAA regulations regarding patient privacy.
  • Respect for peers, colleagues, other medical personnel patients, and patient’s families.
  • Availability and responsiveness to pages for intraoperative consultation.
  • Appropriate dress for the operating room environment and for the adjacent hospital and neighborhood.

PRACTICE-BASED LEARNING AND IMPROVEMENT

Residents will demonstrate competency in the generation of a frozen section stained slide within the required benchmark to final diagnosis of 20 minutes for an uncomplicated case.

Residents shall evaluate their diagnostic ability with review of final diagnoses on cases on which they have performed frozen section diagnosis. This includes review of false positive and false negative results and their root cause.

Residents shall review turn-around-time for frozen section diagnoses during the first two weeks of the rotation; any cases exceeding the recommended time will be reviewed as part of the quality assurance assessment.  The effect of any recommended changes will be assessed in the second two weeks of the rotation.

 

 
 
Contact the Pathology Webmaster at PathWebMaster@columbia.edu