NEUROPATHOLOGY
GENERAL
OBJECTIVES:
Neuropathology
concerns itself with diseases of the central and peripheral nervous
systems and skeletal muscle, and their manifestations in other body
systems. In the course of training, residents must acquire competence in
the pathological diagnosis of neurological disease, using as
appropriate, electron microscopy, fluorescence microscopy,
histochemistry, and other special methods relevant to the study of the
nervous system. A sound basis in anatomical pathology, and in the
anatomy, physiology, and biochemistry of the nervous system is essential
to the interpretation of the neurological disease. Residents must be
competent to correlate neuropathological findings with clinical features
and the results of special investigations, and be able to advise
clinical colleagues on the choice of investigative procedures and their
interpretation. Residents must also acquire skills that will permit them
to undertake laboratory management, supervision of neuropathology
technical laboratories, and postgraduate continuing education.
The purpose of the required training is
to give the resident a degree of independent responsibility for clinical
decisions; an opportunity for further development of the skills required
in making effective relationships with patients; the consolidation of
competence in primary clinical and technical skills across a broad range
of medical practice; and an understanding of the nature of the
relationships between a referring physician and the consulting
neuropathologist. The training requirements that follow are
a minimum. Residents, especially those contemplating an academic career,
are encouraged to take additional training particularly in research.
INTRODUCTION:A
university wishing to have a program in neuropathology accredited must
also sponsor an accredited program in anatomical pathology or general
pathology.
The purpose of this document is to provide program directors and
surveyors with an interpretation of the general standards of
accreditation as they relate to the accreditation of programs in
neuropathology. CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM
There must be an
organized program of rotations and other educational experiences, both
mandatory and elective, designed to provide each resident with the
opportunity to fulfill the educational requirements and achieve
competence in the specialty. The content and organization of each
accredited program in neuropathology must be consistent with the
specialty training requirements. Liaison arrangements within the faculty
should ensure that clinical training during the basic clinical year, in
fulfilment of the specialty training requirements, meets the needs of
residents in neuropathology. Residents must be provided with
increasing individual professional responsibility, under appropriate
supervision, according to their level of training, ability, and
experience for all aspects of the preparation, interpretation, and
reporting of neuropathological material. RESOURCES:There
must be sufficient resources including teaching faculty, the number and
variety of patients, physical and technical resources, as well as the
supporting facilities and services necessary to provide the opportunity
for all residents in the program to achieve the educational objectives
and receive full training as defined by the specialty training
requirements in neuropathology.
In those cases where a university has
sufficient resources to provide most of the training in neuropathology
but lacks one or more essential elements, the program may still be
accredited provided that formal arrangements have been made to send
residents to another accredited residency program for periods of
appropriate prescribed training. Learning environments must include
experiences that facilitate the acquisition of knowledge, skills, and
attitudes relating to aspects of age, gender, culture, and ethnicity
appropriate to neuropathology.
There must be a
sufficient number of qualified teaching staff to supervise residents and
provide teaching in the basic and clinical neurosciences. The teaching
staff should have an appropriate nucleus of full-time teachers.
Laboratory training
must be based on adequate resources to ensure full training for each
resident in all areas of neuropathology. The description of the
integrated program should specify how the responsibility for each of the
components of the program is shared by the participating institutions.
The resources of the program, including volume and variety of
pathological material, laboratory space and equipment, and medical,
scientific, and technical staff, must be satisfactory to the Specialty
Committee in relation to each of the following components:
There must be adequate
numbers of autopsies available to provide full training in gross autopsy
techniques, histotechniques, and postmortem bacteriology techniques. The
volume and diversity of material available for teaching must be
satisfactory to the Specialty Committee. Instruction in postmortem
prosection must be provided under the direction of staff pathologists,
with particular reference to the handling of the brain and spinal cord.
There must be an
adequate volume and range of surgically excised tissues to provide
training in gross examination, dissection, and selection of appropriate
blocks for histological study. Facilities must be available for quick
frozen sections, preferably located close to the surgical theatres. The
range of material must include central and peripheral nervous system
tumours, muscle biopsies, and nerve biopsies.
There should be
adequate material and facilities available for training in exfoliative
neurocytology.
Residents must obtain
experience in the special procedures which may be associated with
medicolegal neuro-autopsies, including neonatal autopsies.
An opportunity should
be provided to study neuropathological specimens from institutions for
retarded children, psychiatric hospitals, and chronic hospitals.
Facilities for training
in the neuropathology of infants and children must be available to the
program, with adequate volume and variety of pathological material.
In addition to adequate
facilities and equipment for routine fixation and staining of tissues,
there must be adequate opportunity to develop skills associated with
special staining procedures. Competence in the operation of the light
microscope must be assured, including the applications of polarizing
optics and fluorescent microscopy. The methods of tissue fixation for
electron microscopy, and the operation of the instrument, must be
thoroughly understood. There must also be adequate facilities and
instruction in histochemistry, immunoperoxidase techniques, molecular
biology and other special methods relevant to neuropathology.
A clinical learning
experience, in one or more of neurology, neurosurgery or psychiatry, is
recommended and should be electively available to the resident.
Instruction in
laboratory management and quality assurance/improvement is essential.
An active consultation
service is essential to provide experience in acting as a consultant to
clinical colleagues. Residents should participate in consultations, both
elective and emergency, on a continuing basis during training. The residency program
must provide opportunity for residents to acquire the skills and
attitudes appropriate to the provision of neuropathological diagnostic
and consultative services, and to function effectively as members of a
team of laboratory physicians in such a setting. Residents must acquire
competence in the pathological diagnosis of disease in the central and
peripheral nervous system and skeletal muscle, and must be able to
correlate systemic findings with neuropathological abnormalities. Residents must be
competent to advise colleagues regarding the choice of investigative
procedures and their interpretation.
There must be
appropriate liaison and appropriate exposure to teaching services in
neurology, neurosurgery and psychiatry. This may include clinico-pathological
conferences, attendance at rounds of clinical services, and
interdisciplinary clinics. Liaison within the faculty must be such as to
ensure that any clinical training taken on these services meets the
needs of residents in neuropathology. There must be
appropriate liaison with teaching services in anatomical pathology.
Residents must be competent in the broad field of anatomical pathology,
and must work in close association with an accredited residency program
in anatomical pathology. There must be effective interaction between
neuropathology residents and residents in anatomical and general
pathology in the study of autopsy cases.
There must be close
association with an active teaching service in oncology in order that a
full range of neoplastic pathology may be available for teaching. The
pathological changes induced by radiotherapy, chemotherapy and
immunotherapy must be clearly understood by residents.
There must be an active
service in diagnostic neuroradiology with arrangements for the
instruction of residents in all relevant forms of diagnostic imaging.
There should be provision for the study of clinico-pathological
correlations with relevant radiologic findings. ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The academic and scholarly aspects of the program
must be commensurate with the concept of a university postgraduate
education. The quality of scholarship in the program will in part, be
demonstrated by a spirit of enquiry during clinical discussions, rounds,
and conferences. Scholarship implies an in-depth understanding of basic
mechanisms of normal and abnormal states and the application of current
knowledge to practice.
The program must
include lectures and seminars, which may be interdisciplinary in nature,
special courses, technical demonstrations, and journal clubs. The
teaching program should lay emphasis on etiology, pathogenesis, and
tissue reactions. Regular conferences between the neuropathology service
and the clinical services for discussion of clinical cases are
essential.
The program must
include organized teaching in the basic sciences and advanced scientific
knowledge related to pathology, including anatomy, histochemistry,
metabolism, immunology, molecular biology, genetics, and photography
including microphotography.
The academic program
must ensure that residents gain an understanding of the basic principles
and practice of biomedical ethics as it relates to neuropathology.
The program must
ensure that residents learn effective communication skills for
interacting with patients and their families, colleagues, co-workers
from other disciplines, and students. Clearly defined educational
objectives for teaching these skills should be in place.
Residents must be
given opportunities to develop effective skills in collaborating with
all members of the patient care team.
Residents must be
given opportunities to develop effective teaching skills by teaching
junior colleagues and students, as well as through conference
presentations, clinical and scientific reports, and patient education.
Residents must be
given opportunities to develop skills in management as applied to
neuropathology such as efficient practice and records management and the
ethical use of health care resources. Residents should also be prepared
for their role as a health care advocate.
The program must
provide residents with opportunities to gain an understanding of the
principles and practice of quality assurance/improvement. Opportunities
should be provided for residents to participate actively in such
programs in their hospital departments.
There must be a
faculty member with the responsibility to facilitate the involvement of
residents in research and other scholarly work. The academic program
must provide the opportunity for residents to learn biostatistics and
the critical appraisal of research methodology and medical literature.
Such teaching must include issues related to age, gender, culture, and
ethnicity in research protocols and data presentation and discussion. It
is desirable that residents have the opportunity to participate actively
in research programs. An active research program in one or more of the
institutions involved in the residency program is considered essential,
and all residents should be given the opportunity to follow the progress
of such research programs.
A satisfactory level
of research and scholarly activity must be maintained among the faculty
identified with the program.
All programs must
promote development of skills in self-assessment and self-directed
life-long learning. To promote this end, the program should provide
opportunities for residents to attend conferences outside their own
university. SPECIALTY REQUIREMENTS: Approved
training include:
PROGRAMS (WITH TRAINING REQUIREMENTS):
Diplomas(Dip):
Six
months of approved residency training.
Doctor of
Medicine(M.D):
Eighteen
months of approved residency training. Doctor of
Philosophy(Ph.D):
Forty
eight months(four years)of approved residency training. |