The ophthalmology residents at the Jules Stein Eye Institute, UCLA medical school are an integral part of the daily functioning of the pathology lab. While this manual is written for the Jules Stein resident, the guidelines here are also helpful for ophthalmology at other training programs. Responsibilities include accessioning, obtaining adequate history, writing a thorough gross description, preparation for embedding, microscopic descriptions, and editing final changes in the typed gross and microscopic descriptions. The residents are also an integral part of the medical student teaching process that gives them an opportunity to teach ocular anatomy to the medical students.
In general, surgical pathology material comes in a number of general categories: 1. gross only (identification) 2. biopsies 3. cytologic samples such as conjunctival smears, fine needle aspirations, vitrectomy specimens 4. whole eyes 5. eviscerations 6. exenterations.
Another important function of the ophthalmology residents is the processing and study of autopsy eyes.
SPECIFIC RESIDENT RESPONSIBILITIES
Surgical Pathology Service: Residents are responsible for obtaining the surgical specimens from the operating theater, accessioning specimens, obtaining a complete and adequate history, describing the gross appearance, properly labeling cassettes and providing adequate orientation for processing. The residents will also perform the microscopic examination and provide a diagnosis. The attending pathologist supervises all work.
OR Schedule: The OR schedule should be reviewed the day before the operation to prepare for special cases such as intraocular tumors, fine needle aspirations, lymphoid lesions and other specimens that require urgent handling. Notify the pathology staff of such cases.
Accessioning Specimens: All specimens are to be accessioned by the residents on the computer. This is a simple and easy but important process. Eye Pathology Staff or the resident departing from the service will teach the incoming resident. It is critical that for consultations received from referring pathologists, laboratories and ophthalmologists, all packing material be saved until the case has been signed out. Immediately upon receiving and opening the packages all slides and blocks should be recorded in the login book. The envelopes and packages should be carefully checked for paraffin blocks or stray slides that may have separated during transport. The paperwork that comes with case should be compared to what was recieved to verify its correct identity and to be sure that the number of slides and blocks as well as their labels are accurate. Any discrepancy should be clarified immediately with the referring hospital, laboratory or physician.
Preparing Reports: All reports will be prepared for sign out. Included will be a detailed and accurate clinical history, a detailed gross description and a microscopic description. Each report should be reviewed for accuracy of description, diagnosis, content, spelling and grammatical errors. All errors should be corrected directly on the computer. There is a specific format for preparing these reports that will be discussed in following sections. In our system we value the contribution made from residents evaluating cases de novo and attempting to make a diagnosis free of bias. We implore you to write the report without the attending input at first. You will see that this will force you to consider histology and induce a great deal of reading around cases.
The Resident Manual for Ophthalmic Pathology (this site) should be carefully studied prior to the rotation and be used as a reference during the rotation. This will replace the methods sections in the textbook.
In the past, reading from the pathology section of the Academy series was assigned to the residents as the only reading source. However, in an effort to emphasize specialty reading around your cases, we have provided a number of textbooks for your use on the rotation. It is expected that the resident will read these basic texts and current articles pertaining to their caseload. In general, the pathology section of the Academy manual will be covered adequately in your first year during the Wednesday evening sessions and again in Basic Science sessions prior to Grand Rounds. The resident should be amply prepared to discuss the literature on any of their important cases. It is the philosophy of this service that we provide not only histologic diagnoses but also investigate information that would be useful to patients and our clinical colleagues. You should read widely around each case.
Recommended reading and references:
1. Section 4 Ophthalmic Pathology and Intraocular Tumors- this is currently a good starting point.
2. http://www.missionforvision.com and follow the links to the ocular pathology tutuorial. This is a very well illustrated site with current information about eye pathology diseases. It is actively being constructed and will soon replace the textbook. Abundant clinical information is provided. Currently, the conjunctival section essentially complete.
3. Ocular Cytopathology , 1993 Excellent for analysis of cytology specimens. A new edition is planned and will be free on http://www.medrounds.org/ soon!
4. Online Resourse: http://www.medrounds.org/: see review of anatomy and ocular pathology study guide.
5. Board Review on http://www.medrounds.org/ is a very good review of the most commonly asked board questions. Although not sufficient for this course it is an excellent self testing review and contains unique information and excellent photos with provided links for more information.
Evaluations: All residents are carefully evaluated during the rotation. Evaluations are based on performance of service duties (including preparation for sign out) and fund of knowledge. Fund of knowledge is tested orally in daily activities. Formal testing is performed each week over assigned reading and current cases. Each test is cumulative. At the end of the rotation the test scores are compared to residents in your class, all previous residents and residents at your level who took similar examinations. The examinations are rigorous and are generally a series of open ended questions to allow the resident to express both the breadth and depth of their knowledge. In addition there are numerous pictures for which simple diagnostic identification is necessary or an answer to a question about the disease. The residents are evaluated on their teaching ability, their thoroughness and care in following cases, their interactions with staff, students and referring physicians, and their puntuality. All evaluations will be reviewed with and reported to the resident, department chairman, and the clinical committee. If you wish an interim evaluation, simply ask. If you are not doing well the attending pathologist will undoubtedly let you know.
Residents are encouraged to make constructive remarks during and after the Pathology rotation. Changes in the program have been initiated as a result of previous comments. This manual is the compilation of work by attendings, residents and fellows. Resident should understand that since the implementation of this curriculum scores on standardized tests specifically, OKAPs, have risen dramatically attesting to the effectiveness of the resident studying regimen. Most of the residents find the course rigorous but well within their reach. Inadequate performance is rare and is dealt with on an individual basis in consultation with the Chair and Clinical Committee.
Teaching Medical Students: Residents are assigned teaching duties each Monday morning for 3rd and 4th year UCLA Medical Students. This is to be performed in a prescribed manner. Please study this link.