Goals and Objectives
Residency Training Program - General Pathology
Dr. T. Aziz
I. Objectives of Training
III. Planning and Organization in Training
Revised AG: Nov 26, 2006
1. Overall Objective
The objective of the General Pathology Program is to provide qualified physicians training in all
disciplines of Laboratory Medicine i.e. Anatomical Pathology, Hematopathology, Medical
Microbiology and Medical Biochemistry, so that they are able to function as a consultant to their
clinical colleagues within the context of a regional or community hospital.
They are required to have:
1) Some basic knowledge in clinical medicine.
2) Thorough understanding of:
a. The pathophysiology of disease.
b. The theoretical and practical aspects of laboratory procedures.
c. The diagnosis of disease using surgical and autopsy pathology,
cytopathology and clinical pathology.
3) A working knowledge of quality assurance, continuous quality improvement,
data processing, critical appraisal and laboratory management.
4) The ability to provide educational guidance to medical colleagues,
laboratory technologists, students and other health professionals.
5) The ability to collaborate with research if necessary.
Objectives in CanMEDS format:
At the completion of training, the resident will have acquired the following competencies
and will function effectively as:
At the completion of training, the residents will demonstrate the diagnostic skills required for
ethical and effective patient care and will demonstrate effective consultation skills with
respect to patient care, education and legal opinions.
The level of knowledge in all areas will reflect the needs of community or regional
laboratories. It is not expected that the residents will have the same depth or breadth of
knowledge in the laboratory medicine specialties as residents trained in a single discipline.
The General Pathology residents must be able to recognize and diagnose common
morphological and clinical entities. "Common" may be defined as likely to occur one or
more times in the course of a year in a laboratory medicine population base of 50,000. The
residents must appreciate those clinical situations, cases or specimen types which will require
referral to a laboratory medicine specialist working in a tertiary hospital setting.
While the general pathology residents must be familiar with and able to characterize disease
processes in a wide range of tissues they must develop particular skills in diagnosing common
entities in the realms of dermatopathology, gynecological pathology, breast pathology,
male genitourinary pathology, lower urinary tract pathology, gastrointestinal (including
hepatobiliary and pancreatic) pathology, thyroid and parathyroid pathology, respiratory
tract pathology, autopsy pathology, morphologic hematology (peripheral blood, lymph
nodes, bone marrow biopsies and spleen), and cytopathology (both fine needle and
exfoliative). The residents will recognize the type of case which, because of tissue type, rarity,
complexity, or therapeutic implications will require referral to a tertiary centre. The residents
will also appreciate those cases where consultation with General Pathology colleagues
would be advisable.
The expected knowledge base will include:
Normal anatomy and its common variants with a basic understanding of embryological
The normal gross and light microscopic appearance of tissues both as intact organs and
The principles of tissue fixation and preparation of specimens for microscopic examination.
The normal appearance of tissue cells in common fixatives, exfoliated or obtained by needle
The principles of cell biology, immunology, medical genetics and pathogenic mechanisms
with an understanding of changes seen in disease states.
The principles of light microscopy including polarization, dark field and fluorescence
The principles of specialized histology techniques including histochemical,
immunocytochemical, flow cytometry, morphometry, and hybridization techniques and their
application in diagnosis.
The rules regarding retention of specimens and processed surgical material as well as the
retention of records.
The rules governing consent for postmortem examination and the types of cases which must
be reported to the coroner or medical examiner.
The definitions of cause, mechanism and manner of death.
The sampling of tissues and fluids for the toxicological examination and the legal
requirements for the handling of these samples.
The recognized standards of workplace safety and the rules governing transportation of
The utilization of ancillary techniques such as biochemical, microbiological, photographic,
and radiological studies in surgical and forensic pathology.
The principles of quality assurance pertinent to surgical and autopsy pathology.
The residents will develop and be able to demonstrate the following skills by the conclusion
of the residency program:
To recognize and accurately diagnose a broad range of common inflammatory and
neoplastic conditions on both histological and cytological material.
To provide appropriate strategies for biopsy (histological and cytological), tissue handling,
and reporting to include the features of prognostic and therapeutic importance.
To describe appropriate handling, dissection, and sampling of those tissues normally
received for examination by regional or community hospital laboratories.
To be capable of offering a competent intraoperative consultation (frozen section/ imprint/
cytological) with an understanding of the appropriate use and limitations of these
To obtain satisfactory photomicrographs and photographs of gross specimens.
To perform a complete postmortem examination with appropriate descriptions at the gross
and microscopic levels and incorporating all clinical information.
To be capable of undertaking a complete forensic autopsy in all common situations
excluding homicide. This will require knowledge of relevant autopsy techniques and
expected findings as well as of the practical aspects of establishing time of death and
Medical Biochemistry is the study and measurement of biochemical abnormalities in human
disease and forms a core component of the training program in general pathology.
In all specialties, but especially those that are technologically driven, there is a rapid
evolution to be expected in diagnostic test methodology. In addition, as understanding of
biochemical abnormalities increases, there is a constant need to update and expand test
menus in order to provide rational and efficient strategies to confirm or exclude disease. The
increasing availability of new technologies is also expected to blur the distinction between
traditional clinical disciplines, enhance the capabilities of community or regional hospital
laboratories, and increase the consultative role of the General Pathologist.
The discipline of Medical Biochemistry as it pertains to General Pathology involves the
following major areas of activity:
The supervision and direction of the clinical biochemistry laboratory at the level of a
community or regional hospital.
The provision of consultation services to clinical colleagues with respect to appropriate and
effective biochemical testing strategies and their interpretation.
At completion of training, the residents will have a broad knowledge of biochemical testing
and laboratory instrumentation pertinent to supervising a community or regional hospital
laboratory and offering consultative services to clinical colleagues. The residents must
understand the common disorders of, and test strategies pertinent to diagnosis of:
Body water and electrolytes
Pancreatic function and digestive disease
Cardiac disease and hypertension
Blood sugar control
Iron, porphyrin and bilirubin metabolism
Endocrine function (especially thyroid, parathyroid, gonadal, pituitary, adrenal)
Uric acid metabolism
Common genetic disorders of metabolism
A more basic knowledge of pediatric and prenatal clinical biochemistry, nutrition, cancer-
associated biochemical abnormalities, therapeutic drug monitoring, pharmacokinetics, and
toxicology is required with special emphasis on testing available in community or regional
The residents will demonstrate the following skills by the conclusion of the residency program:
Given a clinical scenario, will provide appropriate advice regarding biochemical test
selection with a view to optimizing laboratory utilization.
Will have a practical knowledge of statistics pertinent to clinical biochemistry. This will include
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.
Will demonstrate knowledge of common analytical techniques and instrumentation in the
Will demonstrate an understanding of laboratory equipment selection.
Will define the components of a quality assurance program and describe the methods of
quality control and their application.
Will demonstrate an understanding of the principles of laboratory safety and the regulations
as they apply to workplace hazards and transportation of dangerous goods.
Will define the basic components of a Laboratory information system and its application to
the modern biochemical laboratory.
Medical Microbiology as applicable to General Pathology includes the following major
areas of activity:
The supervision and direction of the clinical microbiological 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 provision of consultative services to clinical colleagues regarding appropriate
microbiological investigations and their interpretation.
The General Pathologist may be expected to assume some of the responsibilities of an
infectious disease consultant depending on the availability of such resources and an
understanding of common antimicrobial agents and their appropriate use if required.
The organisms for which a working knowledge is required are those that are normally isolated
or otherwise identified in a regional hospital laboratory.
Bacteria: 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, and
common pathogenic mycobacteria.
Fungi: Candida, Aspergillus, Histoplasma, Coccidioides, Blastomyces, Cryptococcus, Mucor,
Parasites: Malaria, ehrlichia, common helminthic infections (cestodes, Enterobius,
Strongyloides, Ascaris), Giardia, Schistosomes, Cryptosporidia, Microsporidia, Entamoeba,
Dientamoeba, blastocystis, echinococcus, Trichinella.
For less common bacterial, fungal, and parasitic organisms there should be a general
understanding of testing strategies, specimen collection and handling, laboratory safety,
and interpretation of diagnostic reports.
A basic knowledge of viral classification and identification techniques is required with
particular emphasis on public health and hospital infection control implications.
The residents must know the common bacterial toxins, associated disease implications, and
toxin identification techniques.
Hospital infection control must be understood in some depth 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.
The residents must know the common quality control procedures applicable to microbiology.
The residents at end of training must be able to demonstrate the following skills:
A practical knowledge of all common bench-level test methods including manual, semi-
automated and automated systems.
The ability to prepare and interpret Gram, Ziehl-Neelsen and special stains for fungi and
The ability to interpret fluorescence microscopy.
The ability to recognize the diagnostic features of common bacterial species on differential
media, including common fermentation patterns.
The ability to interpret culture data from non-sterile body sites, presuming knowledge of the
common components of normal flora.
The ability to describe the common etiological pathogens of infectious disease by disease
process and body site.
The ability to recognize common fungal and parasitic organisms in human tissue and to
utilize serologic and culture investigations for diagnosis.
The ability to utilize and interpret serological investigations for the diagnosis of bacterial and
A working knowledge of the newer molecular diagnostic methodologies and their use in
microbiological diagnosis and outbreak investigation.
The ability to analyze and interpret antimicrobial sensitivity data and to describe specific
techniques for assessing antimicrobial sensitivity.
The ability to interpret quality control data applicable to Medical Microbiology.
Hematopathology and Transfusion Medicine
The level of expertise in hematology must reflect the knowledge base required in a regional
or community hospital. The discipline as applicable to General Pathology includes the
following major areas of activity:
The supervision and clinical direction of a hematopathology laboratory as organized at the
level of a regional or community hospital.
The supervision and clinical direction of a transfusion service in association with provincial
and national blood agencies.
The morphological assessment and diagnosis of blood, bone marrow and lymph node
based disorders with utilization of newer technologies as appropriate.
The provision of consultation services with regard to appropriate and effective
The provision of consultation services regarding appropriate use of, and possible alternatives
to, blood component therapy.
The General Pathology residents must have a basic knowledge of the following:
Normal hematopoiesis and cell biology as it pertains to the structure and function of all
The structure and functional relationships of all components of the reticulo-endothelial
The components of humoral and cellular immunity, the role of complement and its pathways
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 as applicable to blood disorders.
This knowledge base is required as a framework for understanding disorders of hematopoiesis
and coagulation and to successfully resolve problems of blood component therapy.
The knowledge base of hematopathological disorders must include the following:
Common anemias including diagnostic strategies, morphological findings at the peripheral
blood and bone marrow level, clinical associations, complications, and basic principles of
Major causes of polycythemia including diagnostic strategies, morphological features,
clinical associations, complications, and basic principles of management.
Common non-neoplastic disorders of leukocytes including reactive, congenital and drug-
Common neoplastic disorders of leukocytes including diagnostic strategies, common
classification schemes and the role of cytogenetics, stem cell studies, and flow cytometry.
Major categories of lymphoma including common diagnostic strategies, morphological
features, ancillary investigations, and prognostic features.
Common disorders of thrombocytes including diagnostic strategies, clinical associations and
principles of management.
Major disorders of coagulation, congenital and acquired, including strategies for
investigation, clinical associations and principles of management.
Common problems of blood banking including incompatible cross-match, auto- and
alloimmune antibodies and their differentiation, neonatal blood banking issues, types and
investigation of adverse reactions to blood component therapy and the appropriate use of
blood components in the treatment of hematological and coagulation disorders.
At the end of training, the residents will have developed skills in the following:
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.
Peripheral blood film and bone marrow/lymph node biopsy interpretation. This must include
all abnormalities likely to be encountered in a community/regional hospital laboratory
Decision-making regarding appropriate use of newer diagnostic methodologies for
Constructing test strategies to diagnose common disorders of hematopoesis and
Bench level testing in the blood bank and recognition of standards as they apply to the
testing and release of blood products.
Assessing transfusion orders in relation to appropriateness, risks of blood product transfusion,
and alternatives to transfusion.
Transfusion reaction investigation.
Hematology Quality Assurance (QA) and Quality Control (QC) issues and laboratory safety
Skill in bone marrow aspiration and biopsy technique should be acquired.
Laboratory physicians, as active members of the health delivery team, will establish
appropriate relationships with consulting physicians and surgeons.
From time to time, especially in the clinical disciplines, the pathologist may find it helpful, in
the best interests of patient care, to communicate directly with patients, families, and other
health care providers. In this regard the residents must demonstrate skills in communicating,
both in verbal and written form, in a manner appropriate to the intended recipient.
The residents must understand effective clinical history taking and must have a broad
knowledge of the laboratory basis of diagnosis in order to appropriately advise regarding
test strategies and interpretation.
Effective communication with clinical colleagues is essential in order to interpret surgical and
autopsy pathology findings in the clinical context.
The residents must be able to formulate comprehensive and clinically meaningful surgical
pathology reports and organize diagnostic summaries to prioritize the features of
Diagnostic uncertainty must be clearly expressed with appropriate differential diagnoses
and suggestions regarding further studies or ancillary investigations.
There must be an awareness of ethical and medico-legal issues regarding the release and
dissemination of confidential patient information.
The residents must demonstrate awareness of the importance of timeliness, clarity and
accuracy in all verbal and written communications.
The residents must be aware of the strong interface between the laboratory and clinical
The residents must also develop skills in supporting educational and/or research endeavours
of clinical and laboratory colleagues through individual opportunities or group learning
In the realm of surgical pathology the residents must be aware of, and respond
appropriately to, situations in which the laboratory will significantly affect critical patient
management decisions. Such situations will include intraoperative consultations, assessment
of surgical margins, staging procedures, situations where deferral of diagnosis is
recommended, and situations where ancillary investigations or consultation is required for
optimal case management.
In the clinical disciplines the residents will be able to assist in optimal laboratory utilization
appreciating the diagnostic limitations of laboratory tests and the importance of control of
The residents will understand the clinical requirements for turnaround time in specimen
reporting, the range of testing which should be continuously available in the
community/regional hospital and the appropriate laboratory response to critical values.
The residents must understand the value of interdisciplinary and intradisciplinary
collaboration in patient management decisions. This includes the need for case review
including review by external institutions and agencies.
The residents must demonstrate a willingness to seek consultation opinions if so requested by
clinical colleagues with modification of subsequent diagnostic impressions if appropriate.
At the end of training, the residents will understand the basic principles of laboratory
Specifically the residents will have some knowledge of:
Staffing and personnel management.
Budgeting (personnel, materials, capital equipment)
Funding structures for laboratories.
Hospital medical staff organization and roles.
Quality control, quality assurance and continuous quality improvement.
Laboratory safety and the transportation of dangerous goods.
Principles of optimal laboratory utilization.
Equipment purchasing and selection.
Relevant legislation and/or regulations governing the operation of laboratories, including
issues of informed consent.
Relevant legislation and/or regulations governing laboratory operation and informed
Laboratory information systems and components (hardware and software).
It is expected that management issues pertinent to the laboratory will be taught as part of
the academic activities of the residency-training program and may be supplemented with
specific research activities.
As part of an interdisciplinary team of professionals responsible for patient and community
health care, the residents will understand those components of the laboratory and its
services that are required to:
Respond adequately to community, and hospital service demands including the need for
Respond to hospital, community and regional public health needs to detect and control
Provide sufficient and safe blood bank resources.
The residents will demonstrate the ability to recognize and respond to situations where health
advocacy and application of health care resources is required. This will include the
introduction of improved instrumentation and methodologies to augment community health
During the training period, the residents will demonstrate an ability to develop and
implement a strategy for learning including a program of continuing education following
completion of the residency.
There must be a working knowledge of statistics applicable to all aspects of laboratory
medicine and the capability of appraising sources of medical information.
An important aspect of the role of the general pathologist is the continuing education of
laboratory technologists and clinical medicine colleagues. An ability to perform this
educational role must be developed by the senior residency years.
Contribution towards new knowledge is a major role of academic laboratory medicine
specialists and the General Pathology residents must also be familiar with research
methodology. In this regard the residents should have undertaken at least one research
project during the 5-year program and must be familiar with the principles of critical
The residents must develop a broad understanding of the role of the physician within the
community and hospital structure.
The residents must establish a high standard of laboratory medical practice, appreciating
personal limitations in diagnostic skill which will require referral of particular types of case in
the best interests of patient care.
The residents will demonstrate integrity, honesty and compassion in all aspects of the
practice of laboratory medicine as well as personal and interpersonal professional
behaviours of a high ethical standard. These behaviours will include those relating to
confidentiality, respect for others, conflict of interest, codes of conduct, personal and
professional boundaries, consent, and the role of professional self-regulation and continuing
a. Policies and Procedures for Certification and Fellowship. Royal
College of Physicians and Surgeons of Canada, July 2006.
b. Objectives of Training and Specialty Training Requirements in General
Pathology. Royal College of Physicians and Surgeons of Canada, August 2002.
c. General Standards of Accreditation, Royal College of Physicians and
Surgeons of Canada, June 2006
d. Specific Standards of Accreditation for Residency Programs in
General Pathology, Royal College of Physicians and Surgeons of Canada, 2003
The Department of Pathology of McMaster University offers an intensive integrated training
program designed to prepare residents for careers in General Pathology. The length of the
General Pathology Program is 4 years following the Basic Clinical Training Year or PGY1.
Occasionally, residents are granted an optional 5th year of training to acquire expertise in a
subspecialty. The Program provides training in Autopsy Pathology, Surgical Pathology,
Diagnostic Cytopathology, Electron Microscopy, Forensic Pathology, Medical Microbiology,
Hematological Pathology and Medical Biochemistry. A minimum of 2 years is spent in
Anatomical Pathology and 6 months in each of Medical Microbiology, Hematological
Pathology and Medical Biochemistry. In their senior years, residents are required to spend time
in one of the community hospitals functioning like a junior staff.
The diagnostic laboratories and clinical services of all four McMaster teaching hospitals, having
a combined bed capacity of approximately 1,600, contribute to the Program in General
Pathology. The Hamilton Regional Laboratory Medicine Program co-ordinates the activities of
the clinical laboratories in the region. This Program is responsible for the centralization of many
activities which may not otherwise be available. Therefore, residents have available for training
a wide array of clinical laboratory activities.
All Anatomical Pathology work is done at McMaster University Medical Centre, which serves a
mixed 300 bed medical, surgical, obstetrical and pediatric in-patient and out-patient
population. The laboratory provides all routine Anatomical Pathology services. The Regional
Electron Microscopy Unit is centred at the McMaster Division. There are active specialty services
in Dermatology, Inflammatory Bowel Disease, Metabolic Bone and Joint Disease. The Children’s
Hospital forms part of the complex and serves pediatrics and neonatology for the region.
The Hematology Laboratory services in-patient and out-patient populations. Besides routine
Hematology, Pediatric Hematology is centred within the McMaster Division.
The Miocrobiology Laboratory at the McMaster Division provides core lab services.
Clinical Chemistry Laboratories are situated at both the McMaster and Chedoke Divisions.
Neonatal Intensive Care Unit at McMaster is serviced by a separate Micro-chemistry laboratory
which also meets stat needs of other critical care areas. Regional services for Immunology,
Biochemical Genetics and Reproductive Endocrinology are located at the McMaster Division. A
regional service for heavy metal analysis is located at Chedoke division. All enzyme assays from
McMaster are performed at the Chedoke Division laboratory.
St. Joseph’s Hospital
Anatomical Pathology services this 550 bed general hospital with a very active out-patient
department and provides both routine and subspecialty services. The regional Respiratory,
Nephrology and Head and Neck Units are situated at this hospital. A large number of
transbronchial and open lung biopsy specimens are processed annually. The regional Renal
Pathology Laboratory is involved in the transplantation program. Along with the McMaster
Division the Anatomical Pathology Department at St. Joseph’s Hospital handles the bulk of the
diagnostic skin biopsies in the region. The Cytology Laboratory has a high volume of
gynecological and non-gynecological cytology specimens including many fine needle
aspirates from various body sites. The Electron Microscopy facility located in this laboratory
allows direct hands on experience for working up difficult or interesting cases.
The Hematology Laboratory provides general Hematology services, Blood Bank, Coagulation
studies and Immunophenotypings for lymphomas. In addition, it also serves as the Eastern
Canada Reference Centre for Hemoglobinopathy, and is the regional centre for hemolytic
The Microbiology Laboratory performs all routine bacteriology and is the regional centre for
anaerobic bacteriology and parasitology.
The Hamilton regional Virology Laboratory is at St. Joseph’s Hospital. It provides services in viral
isolation, viral serology and chlamydial detection to all the four teaching hospitals, physician’s
offices and referring hospitals outside the region.
The Clinical Chemistry Laboratory performs most routine tests and is the regional reference
centre for toxicology, thyroid, adrenal and renin investigative tests.
Hamilton General Hospital
This 300 bed teaching hospital is, in addition to some general surgery, the regional centre for
cardiac surgery, neurosurgery, trauma and burn units. The Surgical Pathology Laboratory
processes a number of specimens including endomyocardial biopsies from the Cardiovascular
service and brain biopsies from the neurosurgery unit. There are also referred-in cases on
cardiac pathology and neuropathology.
The Forensic Pathology Unit is also located at this hospital. Rotations through this service provides
senior residents with an intensive experience in Forensic Pathology.
The Microbiology Laboratory services the hospital and is also the regional Mycology laboratory.
It also has an investigative and service commitment to sexually-transmitted diseases.
The Chemistry Laboratory processes a large volume of routine specimens daily. In addition, it is
the regional centre for lipid investigations, calculi analysis and enzyme and iso-enzyme analysis.
Henderson General Hospital
This is a 450 bed general hospital which has an active Gynecology department, solid Tumor
Oncology service and Hematology Oncology service. The Hamilton Clinic of the Ontario
Cancer Treatment and Research Foundation (Juravinski Cancer Centre) is attached to this
hospital and provides the laboratories with a large consultation load.
The Anatomical Pathology laboratory provides both routine and specialized pathology services.
A wide variety of specimens from cancer patients are processed. The close association with the
Regional Cancer Clinic offers the residents an ideal opportunity to study a variety of
malignancies from various organs, both from in-patients and referred-in cases.
The Hematology Laboratory processes a large number of blood smears and bone marrows
annually because of the leukemia lymphoma service. Opportunities are also available in the
study of lymphoma pathology. The laboratory supports the regional facility for therapeutic
plasmapheresis and granulocyte harvest. It also performs vitamin B12 and folate assays for the
region. The Hematology Laboratory provides the regional cytochemistry and
The Microbiology Laboratory is a busy general laboratory providing the regional services of
Clostridium difficile assays. The central media laboratory is situated in this hospital.
The Chemistry Laboratory provides hospital routine service and is the regional laboratory for Beta
HCG, alsph-fetoprotein and urinary steroid assays.
Halton Healthcare, Credit Valley Hospital and Joseph Brant Memorial Hospital
Halton Healthcare has about 360 beds, Credit Valley Hospital 375 beds, and Joseph Brant
Hospital 400 beds. All three are general community hospitals where 4 th year residents may be
sent for periods up to three months to be exposed to multiple disciplines as practiced by general
pathologists in community hospitals. Special emphasis is placed on aspects of management
and pathology not covered in large training centres.
III. Planning and Organization in Training
i. General Overview
Because of the nature of the Regionalized Laboratory Program in the Hamilton District, residents
are required to spend time in different laboratories of different hospitals to achieve the
maximum benefit of their rotations.
The four year post BCT rotation is summarized as follows:
- PGY2 -
12 months of Anatomic Pathology, mainly surgical and autopsy pathology
Two month blocks in each of
Medical Biochemistry, and
Six months in Anatomic Pathology.
Three months in Diagnositic Cytology.
Two months in Forensic Pathology.
One additional month in an Anatomic pathology rotation.
Two month blocks in each of
Two months each in
Six months elective including Community
The scheme fulfils the basic requirements of the Royal College for the General Pathology
Examination, i.e. two years in Anatomical Pathology; six months each in Hematological
Pathology, Medical Microbiology, Medical Biochemistry; six months elective including at least
one month of community hospital rotation.
The PGY 2 year should provide a strong foundation in Anatomic Pathology.
The PGY 3 year begins the exposure to Clinical Pathology and completes basic anatomic
pathology training. At the completion of the PGY3 year the resident should be able to handle
most common surgical specimens and be competent at hospital autopsies.
In more senior years, the training is more subspecialized but with a chance for revision if
necessary. The main emphasis here is to train residents to become a consultant pathologist.
They will be given opportunities to communicate directly with clinicians under supervision. For
example, they will be allowed to discuss cases with surgeons during operating room
consultations; they will also participate in presentations at rounds and to answer relevant
questions. During their last two months of clinical pathology rotation in each subspecialty they
will be exposed to clinical as well as laboratory consults. In addition, senior residents are
encouraged to provide teaching for medical students or their junior colleagues. They are also
encouraged to be observers in various hospital committees. They will be exposed to the various
aspects of laboratory through a non-teaching community hospital. Individual residents may also
be appointed extra responsibilities of a senior or chief resident.
ii. Detailed rotation descriptions
The residents will spend 4 months each in three hospitals. McMaster Medical Centre, St. Joseph’s
Hospital, and Henderson General Hospital. They will not only learn the basic technical and
interpretive skills in Anatomical Pathology but will also be exposed to a variety of autopsy and
surgical pathology in different institutions which will give them some idea about any subspecialty
anatomical pathology training if necessary in the senior years of their rotations. Each hospital
may have their routine practices. These are usually printed and given to residents by the
supervising pathologist of each hospital at the beginning of their rotation.
The residents will learn to write a precise and concise clinical abstract with relevant positive and
negative findings from the chart of the patient. They will be instructed in the various techniques
of performing autopsies, how to interpret gross and microscopic findings and how to write a
comprehensive autopsy report including a clinical pathological correlative summary of the
case. This will include both adult and pediatric autopsies. Most of the pediatric autiosies are
performed at McMaster University Medical Centre.
At the end of the year the residents shouls be able to perform, under minimal supervision, a
complete autopsy, interpret gross and microscopic findings and write a reasonable autopsy
report. During this period they will also be expected to present their findings at autopsy
conferences in the institution where they are located. Depending on the aptitude of the
residents, they may also be given the responsibility of presenting autopsy findings at mortality
rounds with supervision from staff pathologist.
2 Surgical Pathology
Residents should spend the first couple of weeks in their first year orientating themselves
through the histopathology laboratory gaining some insight on the routine histopathology
The actual period and format of this orientation will be tailored according to the circumstances
of different histopathology laboratories and the corresponding supervising staff pathologist. The
residents will be instructed and supervised in the various aspects of gross examination and
microscopic description of excised tissues. At the end of the first year of training, the residents
should be able to conduct the appropriate gross examination, selection of appropriate blocks
for histological study,m and interpretation of most common microscopic findings. They should
also be able to write a comprehensive surgical pathology report. They will learn to problem
solve difficult cases with pathologists involved. In addition, the residents should learn all aspects
of Operating Room consultation and be competent with interpretation of most routine frozen
sections. They should also learn the actual technical skill of cutting frozen sections.
3 Diagnostic Cytology
Residents are expected to attend cytology seminars or lectures in the Academic Half Days,
Regional Cytology Quality Control meetings, and any additional workshops available to them.
Most residents will not be able to cope with the actual studying of cytological materials at this
stage but this exercise is encouraged in exceptional cases.
The residents will spend two months each in Hematological Pathology, Medical Microbiology
and Medical Biochemistry. The essence of this period is to expose residents to all aspects of
laboratory procedures in the different areas of Clinical Pathology. In addition to bench rotations
supervised by teaching technologists, there will also be discussion sessions with supervising
professional staff and ongoing sessions in the Academic Half Days. Because of regionalization of
laboratory facilities in the Hamilton district, residents will be under the guidance of one
supervising staff professional of that particular clinical subspecialty. They will be, however,
rotating through other clinical laboratories in the Program as needed.
Six months that can be spent in general or subspecialty rotations as determined based on
resident’s needs and abilities.
A minimum of three months will be spent in Diagnostic Cytology. This consists of a combination
of teaching sessions, recent case discussions and multiheaded microscopy teaching sessions. In
addition, to ongoing review of current cases, study files are available. Import body sites are
systematically covered. The residents will have a pre-rotation 35 mm slide and glass slide
evaluation. They will be expected to attend quick stains of samples obtained from the
Radiology Department. About ½ hr each morning will be spent on preliminary screening of
Gynecological and Non-Gynecological Cytology smears. Cases will be discussed with
cytotechnologists and/or pathologists involved. Multiheaded microscopy sessions will be given
by all staff pathologists and teaching cytotechnologists. At the end of the rotation the residents
will be given a post-evaluation 35 mm slide and glass slide examination. These cases will be
discussed with the supervising cytopathologist, after which decisions will be made to see if firther
cytology rotation is desirable. Depending on the aptitude of individual residents, sometimes
they ar encouraged to sign out routine cases under double-headed microscopy examination
with the staff pathologist involved.
During this year the resident will also spend two months in Forensic Pathology where they will
have full responsibility for the performance of medical legal autopsies and preparation of the
report under the supervision of one of the two full-time forensic pathologists. When assisting the
forensic pathologist with difficult cases, the importance of information at the scene is
emphasized and they may have the opportunity of accompanying the pathologist to the scene
or viewing a police scene video. A forensic reference library is available in the Forensic
Department at the Hamilton General Hospital. This includes an extensive collection of 35mm
teaching slide collections. In addition, to ongoing forensic lectures covering most areas of
Forensic Pathology incorporated in the Academic Hal-Days, residents are also encouraged to
attend the Forensic Courses given in Toronto. They may also have the chance of visiting the
Centre for Forensic Science in Toronto and they can expect to accompany staff pathologists for
court appearances. Residents should be competent in performing hospital autopsies bedore
their rotation through the Forensic Pathology Department. In addition, to basic Forensic
Pathology practice, they will learn to recognize the complicated and the potentially
complicated cases so that they may be able to make an adequate record of the findings and
seek expert opinion. It is unrealistic to expect total competence in the practice of Forensic
Pathology in the short span of two or even three months and an emphasis is placed on the
recognition of one’s limitations and the availability of additional expertise.
For their additional month of anatomic pathology, residents may choose to spend some time in
Electron Microscopy, Cardiovascular Pathology, Neuropathology, Gastrointestinal Pathology,
Pulmonary Pathology, Renal Pathology, Gynecological Pathology or Pediatric Pathology. They
may also arrange to spend some time in another institution such as Toronto Sick Children’s
Hospital. They may also do further Forensic Pathology training.
They will continue with their Clinical Pathology training for six months.
It is compulsory for residents to spend two additional months in each of the Clinical Pathology
areas. They should already have acquired basic knowledge in most of the laboratory
procedures. The fifth year with the ongoing Clinical Pathology sessions in the Academic Half-
Days enables consolidation of their knowledge. Consequently, the residents will function more
like a consultant for their clinical colleagues and laboratory technologists during this six month
period. They will also be encouraged to attend relevant hospital committee meetings along
with the supervising clinical pathologists. Chances will be available for them to revise some of
the laboratory procedures they have learned in the first and second years.
One to three months, during the first half of the fourth year of training, will be spent in a
community hospital where residents will function as a general pathologist. In addition, aspects
of laboratory management and data processing, etc. should be emphasized. The remaining
months of this year residents may spend in areas of Anatomical Pathology or Clinical Pathology
as necessary. They also may spend some time in research if desired.
Senior residents during or after their bench rotations, should try to incorporate consultative and
administrative aspects of clinical pathology in their training. This is best done during the last two
months of rotation in each of the clinical pathology subspecialties and during the community
Some examples are listed:
1. Development and evaluation of new analytical methods and instruments.
2. Implementation and introduction into service of new analytical methods and instruments.
3. Dealing with questions, concerns and problems referred (technical or administrative) from
medical technologists or clinicians.
4. Taking “beeper call” where applicable.
5. Participation in clinical or teaching rounds.
6. Signing out tests that require interpretation, with or without supervision.
7. Reviewing test results to recommend further management on selected patients.
8. Performing clinical consults at the request of clinicians where applicable.
9. Follow-up of critical laboratory values.
10. Participation in laboratory operations management: e.g. QC, QA, workload analysis,
proficiency testing, accreditation.
11. Participation in laboratory financial management eg. Budgeting, cost-accounting.
12. Participation in personnel management eg. Employee selection, evaluation.
13. Representing department at interdepartmental meetings or hospital committees.
Ref: 1. Special Report: ASCP Colorado Spring Conference. The future content and structure of
residency training in Pathology. AJCP 93:706-711, 1990.
2. ASCP Colorado Springs Conference IV: Clinical Pathology Residency. Curriculum Reform AJCP
100: S7-S14, S16-S19, 1993.
Individual residents may be appointed to be either Chief of Senior Resident and given the
added responsibility of administration for the resident group and be their representative on the
General Pathology Postgraduate Education Subcommittee.
Outline of Haematology Rotation for General Pathology Residents
Cell Diagnostics – in depth training is provided in blood, bone marrow and lymph node
morphology, the laboratory diagnosis of malignant and nonmalignant hematologic disease,
including the use of specialized techniques such as cell surface markers, stains, DNA techniques
(Faculty – Dr. C. Ross, Dr. M. Trus), Henderson Hospital
Transfusion Medicine – this training develops the resident’s expertise in transfusion medicine, red
cell immunology, and blood transfusion practice.
(Faculty – Ms. P. O’Hoski/Dr. R. Warkentin), Henderson Hospital
Red Cell Disorders – this covers the special laboratory investigations of hemoglobinopathy and
hemolytic anemias, and iron metabolism.
B12 & Folate (Henderson Hospital)
(Faculty – Mr. J. Lafferty), St. Joseph’s Hospital
Hemostasis – this rotation covers the congenital and acquired coagulopathies, platelet
disorders, and prothrombotic disorders, including factor assays, protein analyses, platelet
investigations and molecular testing in hemostasis/thrombosis.
(Faculty – Dr. C. Hayward), MUMC
2 months – PGY3
A) 1st Four Weeks
-Learn morphology of blood films, smears and marrow aspirates at Henderson General Hospital
-study case collections in the morning
-review and sign out current cases in the afternoon
-Learn automated blood counting machine technology including quality control
-One on one review of morphology with senior technical lab supervisor for the first two weeks of
-Learn Folate, B12 assays and chromosome analysis
-Do marrow aspirates if chances permit – 5-10 needed one morning per week
-Study lymphoma and marrow biopsy cases
B) 2nd Four Weeks
-Learn Blood Banking including quality control under guidance of Dr. T.E. Warkentin at Hamilton
-Morphology review case collection or current cases, later afternoon.
2 Months – PGY4
C) Four Weeks
-Coagulation tests, Factor assays, Heparin assay, Molecular DNA, platelet function studies,
fibrinolysis including quality control in different tests
-Morphology review case collection or current cases, later afternoon.
D) Two Weeks
-Hemoglobin analysis (Thalassemia, Hemoglobinopathy) at St. Joseph’s Hospital
-Morphology late afternoon
C) Two Weeks
2 Months – PGY5
The emphasis here is for the resident to act as a consultant to laboratory technologists and
clinical colleagues. Every effort should be made to participate in clinical consults and
laboratory trouble-shooting. Quality Assurance should be consolidated at this stage. Residents
are also encouraged to attend relevant administrative meetings as advised by their supervising
A) 3 Weeks
-Blood Banking/Transfusional Medicine at McMaster Medical Centre
-Hemolytic disease of newborn
-Morphology in later afternoon
B) 3 Weeks
-Coagulation at McMaster Medical Centre
C) 3 Weeks
Review morphology and special stains and markers
at Henderson General Hospital.
Outline of Medical Biochemistry Rotation for General Pathology Residents
General Pathology residents spend a minimum of six months in Medical Biochemistry during their
five year training program. This six months is arranged such that the residents spend two months
during PGY 2, two months during PGY 3 and 4 and two months during PGY 5 of the residency
training program in General Pathology.
The overall objective of this period of training is to provide the resident with the necessary skills,
competence and confidence to oversee the Biochemistry Laboratory in a community hospital
and to be an effective resource for Medical Biochemistry for medical colleagues in the
community. In keeping wit the stated requirements of the Royal College of Physicians and
Surgeons of Canada the residents should acquire the skills required to supervise and direct the
clinical biochemistry laboratory of a community or regional hospital.
• Recommended to clinical colleagues appropriate and effective biochemical testing
strategies and their interpretation.
• Understand and interpret quality control and quality assurance information related to
Residents will acquire these skills during rotation through “core” laboratories (adult and
pediatric), special chemistry and immunology laboratories. In each laboratory the resident
works with medical biochemist(s), clinical chemist(s), technical specialist(s), lab manager(s) and
senior technologist(s) for various aspects of their training.
During Medical Biochemistry rotations residents will attend clinical rounds where cases pertinent
to Medical Biochemistry and presented and discussed (e.g. Endocrinology, Nephrology,
Gastroenterology and grand rounds in Internal Medicine, Surgery or Pediatrics). Residents will
have the opportunity for ongoing interaction in the clinical arena through participation in Out
Patient Clinics, Medical Biochemists or in Endocrine or Nephrology Clinics.
The weekly case presentation seminars attended by the General Pathology residents rotating
through Clinical Biochemistry, the Medical Biochemistry residents and the Postdoctoral Trainees
in Clinical Chemistry provide an opportunity for consolidation of knowledge around laboratory
practice and interpretative skills. These seminars may be attended by all General Pathology
residents during other rotations if their schedules permit.
First Rotation –PGY3
During the first two months rotation residents will become familiar with the range of routine
biochemistry testing and will spend three weeks in three main core laboratories. During this
rotation residents should plan to attend any schedule management meetings and become
familiar with internal, regional and external quality control programs. They will review, on a daily
basis, with the senior technologist any problems requiring intervention in the analytical process
resulting from quality control information or inconsistent patient data. Residents will liaise daily
with the medical biochemist or clinical biochemist regarding any consultation requests or
queries regarding the laboratory from the clinical community. There will be an opportunity, on a
daily basis, to discuss questions related to methodology, test selection and interpretation as well
as any day to day problems which may arise in the operation of the laboratory.
Second Rotation – PGY4
This two month rotation will be spent in the main special chemistry and immunology laboratory
with short rotations to other specialty locations if required. They will become familiar with the
principles of immunoassay as applied to endocrine and toxicology testing, alsong with
electrophoresis immuno electrophoresis and immuno fixation, with an emphasis on the
interpretative component. They will understand the measurement of the various lipo proteins
with the emphasis on interpretation of data. They should acquire basic familiarity with the
principles of more advanced techniques requiring gas chromatography high pressure liquid
chromatography and mass spectrometry as applied to the provision of special toxicology,
endocrinology and biochemical genetic testing.
During this rotation the residents will be expected to undertake a project involving the selection
of a new piece of laboratory equipment. This may involve an actual planned acquisition by the
laboratory or it may be done as a practice case scenario.
Third Rotation – PGY5
This rotation will be spent primarily in the main special chemistry and immunology laboratory and
in the core laboratory associated with that hospital. Any areas which have been missed during
the first two rotations will be completed during this time and the remainder will be devloted to
review and enhancement of management and interpretative skills. Residents will be expected
to carry the on-call pager for clinical chemistry with the appropriate faculty back up and to take
a turn as “duty biochemist”.
The following outline is a guide only and the time spent in each area is subject to negotiation
according to the need and personal objectives of each resident. These should be negotiated
at the beginning of each rotation and forwarded to all members of faculty involved with
resident training. Each day also includes a meeting with senior technical staff and supervising
chemist as previously discussed.
Week One – Core Laboratory #1
• Orientation and laboratory safety
• Specimen handling and work flow
• Regulations related to workplace hazards and transportation of dangerous goods
• Basics of the Laboratory Information System (LIS)
• Urinalysis – R & M
• General knowledge of the principles of routine chemistry automation
• Understand laboratory quality assurance and review with the senior technologist and
quality control problems which occur
• Review renal function, electrolyte/acid base balance
• Review 5 to 10 abnormal urine microscopies each day
• Review with the senior technologist the quality control date
• Discuss with the medical biochemist, clinical chemist or lab manager any problems
which are presented and participate in consultation
Week Four – Core Lab #2
• Orientation and review of LIS
• Compare the work flow organization and instrumentation of this laboratory with your previous
experience in core lab #1
• Review the specific clinical requirements of that hospital to understand the rationale for different
• Review blood gases to understand the principles of measurements, sample requirements and
perform the procedure
• Review liver function and testing rationale for hepatocellular and obstructive disease
• Monitor the quality control data for the blood gas analyzers and review with the senior
technologist any unusual problems which arise
• Set up at least one set of abnormal data early each day. Follow the clinical outcome and
discuss with the biochemist the clinical outcome and performance of the laboratory looking at
factors such as turnaround time
• Learn the principles of immunoassay and the operation of the immunoassay analyzers in the
• Learn the various cardiac markers and the role of the laboratory in the diagnosis of myocardial
• Review thyroid function and testing as related to the community and the hospital setting
Week Seven – Core Lab #3
• Orientation and overview of laboratory organization
• Review quality control/assurance program for the automatic immunoassay section and
understand the equipment differences specific to the laboratory
• Learn the routine “Endocrine” tests and tumour markers which are performed on these
• Review non-automated tests done in the core laboratory and procedures for fluid analysis, e.g.
CSF,l ascetic fluid, joint fluid, etc.
• Review with both oral and written practice exam questions used as a basis for discussion
Second Rotation – Main Special Chemistry and Immunology Laboratory
• Orientation and laboratory safety
• Learn indications and criteria for therapeutic drug monitoring
• Review the principles of immunoassay and tests related to anticonfulsant and antibiotic therapy
• Acquire an overview of chromatographic techniques and learn the indications and
requirements for laboratory testing of drugs of abuse and therapeutic monitoring of drugs which
cannot be measured by immunoassay
• Endocrine testing for hormones and/or neuro transmitters which are measured by
chromatographic techniques, e.g. metanephrines and catecholamines, with special emphasis
on patient preparation, interferences and interpretation
• Radioimmunoassay for non-automated hormone analysis
• Review the quality assurance procedures in this laboratory, if not completed during week one
and two and begin learning about special enzyme techniques (e.g. pseudocholinesterase) and
• Report lipoprotein electrophoresis with the clinical chemist
Week Five to Eight
• Report electrophoresis/immunofixation tests with the clinical chemist/medical biochemist
• Review with both oral and written practice exam questions used as a basis for discussion
Third Rotation – Year Five
This period should be used for review and consolidation of knowledge and skills in Medical
Biochemistry, part of which may be spent in a community hospital laboratory. Residents should
undertake on-call responsibilities and act as on duty biochemist during the day, fielding on calls
requisitioning information (excluding calls for results). Residents will be expected to do three to
five practice examination questions each week. These will be marked and reviewed with the
resident on a weekly basis.
Appendix One lists the names, location and telephone numbers of the Medical Biochemists.
Clinical Chemists and Medical Laboratory Technologists who will work with the residents during
the medical biochemistry rotation.
Appendix Two lists resources you may find helpful.
Appendix Three outlines the evaluation procedure.
Hamilton Regional Laboratory Medicine Program
Director – Dr. Matthew McQueen
Dr. Vijay Grey (905) 521-2100 x 76595
Ms. Nancy Wakefield (905) 521-2100 x 75022
Dr. Ed Young (905) 527-4322 x 42067 (389-4411)
Ms. Joan Weppler (905) 527-4322 x 42075 (389-4411)
Dr. Stephen Hill (905) 527-4322 x 46045 (527-0271)
Dr. Joe Macri (905) 527-4322 x 46046 (527-0271)
Dr. Cynthia Balion (905) 527-4322 x 46120 (527-0271)
Mr. Mark Donahoe (905) 527-4322 x 46130 (527-0271)
Dr. (V.) Tony Chetty (905) 522-1155
Ms. Teresa Difrancesco (905) 522-1155 x 3061 (522-4941)
Tietz Textbook of Clinical Chemistry Bartis and Ashwood, 1999
Sanders Manual of Clinical Laboratory Science, Lehmann, 1998
Clin Chim Acta
Annals of Clinical Biochemistry
American Journal of Clinical Pathology
American Society of Clinical Pathologists/Check Sample Program
American Association of Clinical Chemistry/Continuing Education Programs
Therapeutic Drug Monitoring
Clinics in Laboratory Medicine
Evaluation will be based on performance during seminars and a one hour written examination during
final week of the rotation.
Input from medical biochemists, clinical biochemists and senior technologists from each site will be
Outline of Medical Microbiology Rotation for General Pathology Residents
General Pathology residents spend a minimum of six months in Medical Microbiology
during their hospital training period. The objective of this period of training is to provide residents
with the training and skills that will enable them to supervise a microbiology laboratory in a
secondary care institution.
The trainee is involved in hospital infection control during the bacteriology rotation and is
exposed to administrative activities in the participating laboratories. There is the opportunity for
involvement in the management of patients with infection by attachment to the infectious
disease consultation service, including exposure to pediatric infectious diseases.
Each rotation has specific objectives defined by the Resident in consultation with the supervisor.
In addition, the Resident is encouraged to define personal objectives and discuss these with the
supervisor. Methods of achieving the stated objectives will vary, but include hand-on bench
work, discussions with supervisory technologists and the microbiologists, and formal seminars.
The residents also attend regional seminars and rounds. Formal training in basic sciences will be
covered in the seminar series.
Graded responsibility is provided. In the final year of training, the resident is expected to be
familiar with the day-to-day operation of the laboratory during the one month rotation through
the diagnostic microbiology laboratory.
Rotation Duration Place
Routine diagnostic bacteriology 2 months Hamilton Health Sciences Corporation
(incl. 1 week infection control) General Division
Anaerobic bacteriology 2 weeks St. Joseph’s Hospital
Parasitology 2 week s St. Joseph’s Hospital
Virology 2 weeks St. Joseph’s Hospital
Mycobacteriology 1 week Hamilton Health Sciences Corporation
Mycology 1 week Hamilton Health Sciences Corporation
Routine diagnostic bacteriology 2 weeks (as listed above)
Parasitology 1 week “
Virology 1 week “
Mycology 1 week “
Review 1 week “
Clinical infectious diseases 2 weeks “
Time to visit the Public Health Laboratory will be scheduled our of the time allocated to routine
diagnostic microbiology. In the final six month elective period available for General Pathology
residents in their final year, additional time can be spent in Microbiology, depending on the
individual needs of the resident.
Evaluation of the programme and the trainee will be performed on a regular basis and includes a
review of the stated objectives of the programme and the trainee’s personal goal (see Evaluation
The rotation goals are as follows:
1. Clinical Practice of Microbiology – The resident shall:
(a) Be familiar with the epidemiology, pathogenesis, and clinical manifestations of common and
important infectious diseases and be able to recommend the appropriate tests for diagnosis;
(b) Be knowledgeable about the principles of prevention of infection, understanding
recommendations regarding immunization;
(c) Be able to discuss the major groups of antimicrobial agents, in terms of site of action, spectrum
of organisms against which each may be effective, mechanisms of resistance, route of
administration, toxic effects, and use of therapeutic drug monitoring. Antiviral, antifungal and
antiparasitic drugs will be included.
2. Diagnostic Bacteriology - The following general objectives are common to each laboratory,
these include specimen collection, transportation to the laboratory, specimen processing,
interpretation of results and reporting of results. The resident will become familiar with the following
methodologic techniques: isolation, anti-microbial susceptibility testing, electron microscopy,
nucleic acid detection, light and fluorescent microscopy, serological techniques and antigen
The resident is expected to be familiar with:
a) The organization and staffing of the laboratory:
b) Specimen collection, including criteria for the acceptability of specimens, proper handling
and safe transport, routine processing (selection of media and principles of its use), and the
reporting of significant results, including antibiotic susceptibility.
c) The identification of common bacterial pathogens;
d) Methods and principles of direct examination of specimens, including direct staining and
antigen detection methods. The resident should understand the principles, methods, and
interpretation of serological tests for the diagnosis of infections.
e) Tests for determining antimicrobial susceptibility with knowledge of the advantages and
disadvantages of the available methods.
f) Issues of safety in the laboratory.
g) The principles of quality control and the implementation of a quality assurance programme
in the laboratory. This applies to all the laboratories the resident rotates through.
3. Anaerobic Bacteriology – The resident should be familiar with the classification of anaerobes
and the types of infections associated with these organisms. Specimen selection and collection,
transportation, processing and identification of important organisms should be covered. The
resident should understand the methods of antimicrobial susceptibility testing, the indications for
performing susceptibility testing, and the reporting and interpretation of results.
4, Mycobacteriology – The resident should be familiar with the classification of mycobacteria, the
types of infections associated with these organisms, and the collection and processing of
specimens, including specific safety procedures as they relate to mycobacteria. The resident will
be familiar with the methods of direct examination of specimens for acid-fast bacilli. Identification
and susceptibility testing of mycobacteria will be covered.
5. Parasitology – The resident should be familiar with the classification, morphological
appearance, and clinical manifestations of the common parasitic diseases seen in Canada,
returning travelers, and in immunocompromised patients. The resident shall describe the types of
specimen suitable for parasitological examination, the processing of these specimens, and be
aware of other special diagnostic tests available for the diagnosis of parasitic infections (e.g.
serology, antigen detection, PCR).
6. Virology - The broad objective of this rotation is to review the viruses causing human disease.
Residents are expected to acquire sufficient knowledge of the natural history, pathogenesis,
epidemiology, clinical presentation, laboratory diagnosis, prevention and treatment of viral
infections to enable them to conduct a thorough laboratory investigation for a possible viral
etiology of infection.
Residents will acquire sufficient knowledge to be able to recognize specific viruses and their
cytopathic effect in various tissues. This will include an understanding of the effect of viruses on all
organ systems and appropriate diagnostic tests for the detection and identification of viruses in
tissue and other specimens, including the use of immunohistochemical staining procedures, DNA
hybridization, and electron microscopy. Tests for the diagnosis of chlamydial infections will be
For viruses which are non-culturable or cannot be grown from infected tissue, residents should be
aware of serological tests which can detect specific antiviral antibodies as well as antigen
detection techniques including DNA detection and in what circumstances these tests are
7 Mycology - The resident should understand the appropriate specimen to collect for
diagnosis of fungal infection, the method of collection, processing, and culturing. This will
included the use of various media, direct staining procedures, and special safety precautions
to be taken when dealing with the pathogenic fungi. The resident should be able to identify
fungi of medical importance, and be familiar with the epidemiology and clinical features of
common or clinically important fungal infections. The serology of fungal infections and the
use of susceptibility testing will be covered.
8. Public Health Laboratory - The resident will be exposed to special functions of the Public
Health Laboratory including its reference functions. The resident should be able to describe
the referral process for when unusual organisms are encountered or when isolation of
uncommon organisms or certain diagnostic tests not routinely performed are requested.
9.Infection Control/Employee Health - The resident shall become familiar with hospital
outbreak management, employee health screening for infections such as TB or HIV, and
notifiable diseases for reporting and Department of Public Health Services.
a) Be able to design and supervise an infection control programme, including the prevention,
surveillance, diagnosis and control of hospital infections. The resident should understand the
role of the laboratory in the investigation of nosocomial outbreaks;
b) Be familiar with the principles and practice of sterilization and disinfection;
c) Be involved in relevant areas of employee health.
Sample rotation in Medical Microbiology
Week 1 Orientation to laboratory, safety, use of equipment
Specimen reception and processing
Explanation of culture media and it uses
Microbiology and stains
Quality assurance (throughout rotation)
Week 2 Examination of genital specimens
- demonstration of normal flora
- recognition of pathogens
- identification of organisms
- reporting results, with antibiotic susceptibility
Week 3 Examination of respiratory specimens
- demonstration of normal flora
- recognition of pathogens
- identification of organisms
- reporting results, with antibiotic susceptibility
Week 4 Examination of wound, urine and faecal specimens
-demonstration of normal flora
- recognition of pathogens
- identification of organisms
- reporting results, with antibiotic susceptibility
Week 5 Processing of blood cultures; identification of pathogens; reporting results with
Rapid diagnostic tests (antigen detection, etc.)
Week 6 Susceptibility testing (automated system, Kirby-Bauer, etc.)
Week 7 Infection Control
Teaching laboratory rounds are held at 10:30 a.m. each day; Infectious Disease
case reviews are held weekly (Friday afternoon); weekly meeting with supervisor
iii. Additional academic activities
1 Residents Academic Half-Days
Residents are given exclusive time off half a day per week to attend their academic
sessions held Wednesday mornings at the Micheal De Groote Centre. Such sessions not
only include block slide seminars and lectures in general and systemic anatomical
pathology but also includes sessions in basic science such as immunology and
cytogenetics. A number of sessons are devoted to each of the three clinical pathology
areas. Slide seminars of recent interesting cases in the region are presented regularly.
Basic topics of general scientific interest are discussed by residents with supervision of
staff. Critical appraisal sessions are integrated into the Academic Half-Day.
2 Anatomical Pathology Slide Seminars
These take place weekly as part of departmental rounds at each hospital. Residents are
given interesting “unknown” anatomic pathology cases to work up and present in a one
Clinical and Pathology Rounds are held in different hospitals weekly.
4 External Conferences
Residents are encouraged to participate in conferences outside Hamilton such as the
Canadian Congress of Laboratory Medicine meeting and their workshops, Ontario
Association of Pathologist meetings and their seminar and International Academy of
Pathologist meetings and their workshops.
5 Residents’ Research Day
Both junior and senior residents are encouraged to be involved in research projects.
Presentation will take place during the Residents’ Research Day usually during the last
Friday of March. Most to the time such papers are submitted for presented at national or
6 Academic Studies
Academic studies offered by the Academic Studies office at McMaster University cover
a variety of basic science and clinical pathological topics.
7 Multidisciplinary Academic Half-Day
These are sessions organized for all residents in the various training programs at McMaster
University. Topics of general interest such as Canadian Medical Protective Association,
Ethical Issues in Medicine, Sexual Harassment are presented. They are compulsory for all
residents. Attendance will be taken and submitted to corresponding Program Directors.
Evaluation of Residents
This is done on a frequent informal basis to assist the progress of the residents. It may occur
between residents and individual staff pathologists, or between residents and supervising
pathologist of the rotation. A formal evaluation assessing the resident’s knowledge, skills and
attitudes will be performed at the end of each rotation, or at the end of each 3 months rotation
if the rotation is longer than 3 months. This will be the result of observations made by the
supervising pathologist, any staff pathologist at the time and/or technical staff. The results will be
discussed with the residents. Finally, a summary type of evaluation, i.e. an interim training
evaluation, will be written by the Program Director taking all the formal evaluations into
consideration. A final intraining internal evaluation (FITER) will be written at the end of their
training for the Royal College of Physicians and Surgeons.
Objective assessment of knowledge is performed annually using the program provided for by
the American Society of Clinical Pathology. This usually takes place in the month of May.
An appeal mechanism is available for residents as laid down by the McMaster University Faculty
Policy and Procedures.
Evaluation of Program
To maintain anonymity of the residents, the program, the rotations, the facilities of individual
laboratories, residents as a group will evaluate the professional and technical staff twice a year.
The senior or chief resident will present the summary fo the Program Director whereby either
compliments or complaints will be transmitted accordingly. As in the case of evaluation of
residents, this is a mechanism by which the training program may be improved. Resident smay
also evaluate individual rotations on forms provided by the Postgraduate Education office every
General Pathology Education Subcommittee
Dr. T. Aziz - Chair General Pathology
Dr. M. Sur - Anatomical Pathology Representative
Dr. A. Don-Wauchope - Medical Biochemistry Representative
Dr. C. Balion - Medical Biochemistry Representative
Dr. C. Ross - Hematology Representative
Dr. D. Arnold - Hematology Representative
Dr. N. Heddle - Hematology Representative
Dr. P. Jayaratne - Medical Microbiology Representative
Andrew McFarlane - Lab Specialist Representative
Karen Moffat - Lab Specialist Representative