Cytogenetics 0111

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					                    THE UNIVERSITY OF TENNESSEE MEDICAL CENTER
                             DEPARTMENT OF PATHOLOGY

                       PATHOLOGY RESIDENCY TRANING PROGRAM


ROTATION: CYTOGENETICS ROTATION

DURATION: Two Weeks (10 days)
          (Taken consecutively with Molecular Pathology)

FACULTY:       Karla Matteson, Ph.D., Rotation Director

OVERVIEW:

The Cytogenetics rotation is structured to familiarize the resident with basic principles and
techniques used in the Cytogenetics Laboratory. Through rotational activities, the resident will be
introduced to the complexities of human genetic analysis.

The rotation consists of a two week block to be taken concurrently with the Molecular Pathology
rotation. Each week is structured as described below.

Week 1:

      Day 1: Meet with Dr. Matteson and receive an introduction to the laboratory, including
       basic principals of DNA, chromosomes and human genetics.
      Day 1-3: Interact in cytogenetic laboratory observing specimen set up, cell harvesting, and
       chromosome analysis.
      Day 3: Meet with Dr. Matteson and discuss questions that the resident may have
      Day 4-5: Continue interactions in cytogenetic laboratory.
      Goals for week one:
          o Appreciate effect of specimen type and condition on analysis
          o Appreciate breadth of analysis available
          o Achieve basic understanding of biological bases of the analyses
          o Achieve some knowledge on interpretation of various analyses
                    Chromosome karyotype: constitutional and oncology
                    FISH analysis: interphase and metaphase

Week 2:

      Day 1: Meet with Dr. Matteson and receive an introduction to methods in molecular
       genetic analysis.
      Day 1-3: Interact in molecular genetic and cytogenetic laboratories observing analyses.
      Day 3: Meet with Dr. Matteson and discuss questions in molecular or cytogenetics
      Day 4-5: Continue interactions in both laboratories.
      Day 5: Meet with Dr. Matteson for discussion of goals and suggestions for improvement
       of rotation
      Goals for week two:
           o Continue acquiring understanding of cytogentic laboratory activities
           o Acquire some understanding of molecular genetic techniques
PATHOLOGY RESIDENCY TRANING PROGRAM                                  CYTOGENETICS ROTATION



                    PCR
                    Allele specific analysis: at least two platforms
           o   Appreciate the uniqueness of classical genetic disorders
           o   Appreciate the use of techniques for common population variation applications
                    Factor V Leiden
                    Warfarin or Plavix Metabolic assays
                    Kras mutation and colon cancer treatment options
           o   Have a basis for experiences in the Molecular Pathology laboratories in second
               half of rotation

PATIENT CARE

Procedural skills

   1. Objective:
         a. Perform all aspects of culture, harvest, and chromosome analysis on specimens
             submitted to the laboratory (may include peripheral blood, bone marrow, amniotic
             fluid, solid tumors or non-neoplastic tissue). The resident may perform karyotype
             analysis on their own peripheral blood.
         b. Observe and participate, where appropriate, in specimen processing and
             evaluation of each specimen type.
         c. Observe and participate in all aspects of the fluorescence in situ hybridization
             (FISH) procedure, including probe and slide preparation, hybridization and
             detection procedures, fluorescence microscopy and computer analysis.
         d. Observe and participate in performance of DNA isolation, PCR and allele specific
             analysis (at least two platforms).
         e. Observe and participate in K-ras mutation analysis.
   2. Plan:
         a. Procedural skills are taught by actual performance of various cytogenetic
             techniques and/or observation. These skills are taught by cytogenetic
             technologists and Dr. Matteson.
         b. The resident's responsibility is to complete these exercises under the direct
             supervision of a cytogenetic technologist.
   3. Supervision/Assessment:
         a. Procedures are supervised and skills assessed by direct interaction, observation,
             verbal and written assessment by the cytogenetics technologists and Dr. Matteson.

Interpretive Skills

   1. Objective: What interpretive skills must be acquired on this rotation?
         a. The resident will learn karyotype analysis.
         b. Interpret fluorescence in situ hybridization (FISH) on various specimens.
         c. Interpret Polymerase chain reaction (PCR) on various specimens.
         d. Interpret K-ras mutation assays.
   2. Plan:
         a. Complete one’s own karyotype.
         b. Participate in FISH microscopy and interpretation.
         c. Participate in PCR analysis.
         d. Participate in D-ras mutation assays.



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PATHOLOGY RESIDENCY TRANING PROGRAM                                   CYTOGENETICS ROTATION



         e. The resident is responsible for completion of these exercises and is supervised by
            senior cytogenetic technologists and Dr. Matteson.
   3. Supervision/Assessment:
         a. Interpretive skills are assessed by direct daily interaction and written assessment
            by Dr. Matteson.



MEDICAL KNOWLEDGE

   1. Objectives:
      The resident is expected to become proficient with the appropriate indications and
      specimen requirements for cytogenetic evaluation of constitutional chromosome disorders,
      myeloid and lymphoid malignancies, solid tumors and FISH. Residents will be able to
      discuss the conventional and molecular cytogenetic findings in the context of the clinical
      presentation of patients with the various disorders, relevant physical examination findings,
      natural history and implications for family members. Cytogenetic evaluation of
      hematopoietic malignancies will also be covered during the Hematopathology rotation.
   2. Plan:
          a. Basic reading content should include constitutional disorders, myeloid and
              lymphoid disorders, FISH and solid tumors.
                  1. The recommended reading text is the ASCP Molecular Pathology
                      Compendium.
                  2. Computer Resources:
                      Online Mendelian Inheritance in Man at
                      (http://www.ncbi.nlm.nih.gov/Omim/) and also, Atlas of Genetics and
                      Cytogenetics in Oncology and Haematology at
                      (http://www.infobiogen.fr/services/chromcancer/).
                  3. Bi-weekly meetings with Dr. Matteson.
                  4. Genetics lecture series.
   3. Supervision/Assessment:
          a. Ongoing assessment occurs through daily interaction with cytogenetic
              technologists and Dr. Matteson
          b. Resident performance on RISE exam.

PRACTICE BASED LEARNING AND IMPROVEMENT

   1. Objectives: Residents participate in the analysis and evaluation of specimens completed
      during their rotation.
   2. Plan:
          a. Daily review of cases.
          b. Morphologic and clinical correlation for cases which pose diagnostic challenges.
          c. Participation in laboratory QA activities.
          d. Utilize scientific literature and reference resources to interpret cases.
   3. Supervision/Assessment:
          a. Assessment is through daily interactions with cytogenetic technologists and Dr.
              Matteson.




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PATHOLOGY RESIDENCY TRANING PROGRAM                                   CYTOGENETICS ROTATION



INTERPERSONAL AND COMMUNICATION SKILLS

   1. Objectives: Appropriate interaction with cytogenetics faculty and staff, clinicians, hospital
      staff, other UTMCK faculty which demonstrate effective exchange of information.
   2. Plan:
          a. Daily interaction with cytogenetic technologists and Dr. Matteson.
          b. Communication of test results with ordering physicians as deemed appropriate.
   3. Supervision/Assessment: Communication skills are assessed by daily interactions with
      cytogenetic technologists and Dr. Matteson. Assessment is in writing from Dr. Matteson.

PROFESSIONALISM

   1. Objectives: The resident will function as a team member in the laboratory, adhere to
      ethical principles, complete all assignments and respect those around him/her.
   2. Plan:
          a. Attend laboratory assignments daily and on time.
          b. Work effectively with laboratory personnel and Dr. Matteson.
          c. Respect patient privacy issues.
   3. Supervision/Assessment: Professionalism is assessed by daily interactions within the
      laboratory and is assessed in writing by Dr. Matteson.

SYSTEMS-BASED PRACTICE

   1. Objectives:
         a. Awareness and responsiveness to the larger context of the health care system and
             as it pertains to submission of cytogenetic specimens and cytogenetic diagnoses.
         b. Ability to call on system resources to provide optimal cytogenetic evaluation.
   2. Plan:
         a. Daily interaction with departments ordering tests (Pathology,
             Hematology/Oncology, OB/Gyn, Pediatrics) in obtaining pertinent clinical and
             laboratory information to perform the appropriate cytogenetic test and assist in
             accurate interpretation.
         b. Interaction and utilization of the knowledge base of individuals from other services
             who order cytogenetic tests.
         c. The resident uses library resources and the hospital information system to assist in
             the evaluation of cases.
   3. Supervision/Assessment: Written assessment by Dr. Matteson.



PROCESS FOR MONITORING COMPETENCY BASED OUTCOMES:

The effectiveness of the rotation in accomplishing goals and objectives for patient care, practice
based learning and improvement, interpersonal and communication skills, professionalism and
systems based practice are evaluated on an ongoing basis by cytogenetic technologists and Dr.
Matteson as they have one on one interaction with the resident during rotational activities. Dr.
Matteson will document any areas for improvement on the rotation evaluation. Dr. Matteson may
also discuss areas for improvement with individual residents during the rotation itself. Areas of
concern documented in the rotation evaluation will be discussed with the resident during their
semi-annual evaluations or sooner as needed and action plans developed as appropriate.


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PATHOLOGY RESIDENCY TRANING PROGRAM                                 CYTOGENETICS ROTATION



Resident performance on the genetics and molecular pathology special topics portion of the RISE
exam will provide an objective measure of rotation effectiveness. Medical knowledge in molecular
pathology and cytogenetics will also be assessed in a written examination on the hematology
rotation.

Rotation evaluations, competency based evaluations, results of slide/written exams and RISE
exams for each resident will be assessed by the evaluation and advancement committee on at
least a semi-annual basis. This committee will determine if the competencies have been
achieved and will recommend promotion to the next post graduate year. The evaluation and
advancement committee will also make recommendations to the program director regarding
appropriate remediation plans when competencies are not met. The program director will discuss
this with the resident at which time an individualized action plan will be developed, documented
and monitored. Remediation plans and progress reports will also be reviewed by the evaluation
and advancement committee.



Revised January 2011




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