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Electives - Radiology

Radiology and Pathology Correlation **Does not count towards 12-week limit of clinical Radiology**

Elective Number: E74bb (lottery)

Rotation Supervisor: Dr. Juan M. Olazagasti

Coordinator: Sandy Kerns (sk9ef@virginia.edu); 924-9484

Rotation Duration: 2-weeks

Rotation Location: UVA Medical Center, Main Hospital

Available: 4a, 6-9, 11, 12, 13a & 14

Time to Report: 8:00 am

Place to Report: Residency/Student Elective Office - Room 1832

Typical day: 7:45 am - 5:00 pm

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Rotation Supervisor.
  • All requests for days off must be emailed to Sandy Kerns, Education Coordinator (sk9ef@virginia.edu)
  • Students are allowed to take off 1 day per week to interview between November 1 and February 1.
  • Specific days missed must be approved by the Rotation Supervisor.

Dress Code: Professional attire
Attitude/Expectations: Active participation and learner engagement is expected while on the rotation. Students should become part of the team by looking up clinically relevant information in Epic and participating in patient care as possible, e.g. introducing themselves to the patient and asking the patient relevant questions.

Number of students per rotation: 2

Course Requirements:
Lecture Attendance: Micropath conference on Thursday evenings at 4 pm (every other week; ask attending) and Thoracic tumor board on Tuesday at 7 am in the Cancer Center are required.
Additional Requirements: Present a radiologic-pathologic case of patient's clinical presentation, relevant imaging, procedure performed, and accompanying relevant issues (why US instead of CT, or why core and FNA needed for accurate path), what made the pathology a lymphoma, or lung cancer - specific type of nuclei, stains, type of treatment, and prognosis, etc. Work to make the presentation full circle with the idea of longitudinal learning. This will be presented at the end of the rotation, in PowerPoint format, to elective director, or assigned faculty/trainee. Have fun creating your presentation; learn and enjoy the case, whatever you feel relevant that will enhance the learning experience is welcome! Email your PPT presentation to sk9ef@virginia.edu. It will be saved on the Radiology department’s I-drive.

Responsibilities:
Student responsibilities:

  • Time – 40 hours/week – No night call, weekend call, nor weekend rounds
    • Direct patient care (with radiologist and pathologist); 15- 35% of time
    • Indirect patient care (observation of attending and/or house staff) - with radiologist and             pathologist; 15 – 35% of time
    • Rounds (clinical teaching and case discussions) huddle, case discussions; pathology           consultations; 5-15% of time
    • Didactic sessions – conferences, online articles, tutorials; 3 – 5% of time
    • Other  (specify) case preparation/literature search and review; 5-8% of time
  • Work- specific tasks: (assisting in body procedures, potentially counseling families, etc.); related reading; presentations; lectures; and papers

Course Description:
The radiology-pathology elective is a two week rotation available for up to two fourth year medical students per rotation. The objectives of the rotation center on students following the course of a patient from clinical presentation, through medical imaging, evaluation and interpretation leading to image guided biopsy and finally through ultimate pathologic diagnosis. While the course is run by radiology, the cytology fellows serve as liaisons for the pathology portion of the elective that happens in the department of pathology. 

The pathology portion of the medical student’s elective will include:

  • A tentative schedule with the timing subject to change due to clinical service demands of the fellows
    • First Monday of rotation: brief intro to cytology with fellows
    • Wednesdays and Fridays, 9:30 am: 1st Wednesday – formal intro to cytology, both Wednesdays and Fridays – case reviews
  • The pathology portion of the elective will take place in the Pathology Department, which is located on the 3rd floor of the Hospital Expansion.

Rotation Goal:
By the end of the rotation, the student should have a comprehensive understanding of the process that occurs when a request for a biopsy is placed: including image evaluation, preferred modality for the case, informed consent, FNA/core needle, pathologic workup with cytological evaluation and analysis of the slides, such as tissue adequacy and stains/tests needed by cytopathology that lead to an accurate diagnosis.

General Learning Objectives:

  • Imaging:
    • Given a clinical case and imaging study, create a differential diagnosis by disease mechanism that may include benign and malignant neoplasia, infectious and inflammatory, degenerative, congenital, and vascular disorders.
    • When given a lesion on imaging, explain how planning for tissue diagnosis and biopsy is performed, including all the steps involved and how to accomplish this in the safest, least expensive manner.
    • Compare and contrast pros and cons of different imaging modalities and determine the best method to perform a biopsy for a given case.
  • Informed Consent:
    • Describe the concepts of informed consent, image safety and dose reduction, patient centered care and how these apply to image guided interventions.
  • Interdisciplinary:
    • Given a clinical case and presentation, render an all-inclusive approach to diagnosis, correlating radiologic images with microscopic pathology specimens

Specific Learning Objectives:

Pathology Learning Objectives
Participate in early morning “huddles,” regarding pre-procedural case discussions with clinical presentations and imaging findings, approach to the procedure/biopsy, and consideration of which is the best imaging modality to be utilized. Further dialogue including the informed consent form, pre-anesthesia care, family counseling and literature search of interesting cases may also be performed, if ……appropriate. In appropriate cases, after the tissue is obtained, there will be interactive pathology slide preparation, discussion regarding the specimen findings and relevant differential diagnosis based on the clinical history and pathology/cytology findings.

  • Given a tissue specimen, determine how to triage for histologic examination and possible ancillary studies.
  • Given a histologic session of a mass lesion, distinguish between the features seen in neoplastic and reactive conditions.
  • Given a tissue diagnosis of a neoplasm, distinguish between the morphologic features of benign and malignant diagnoses and lines of differentiation.

Students are expected to be interactive participants, being present during the informed consent and actual procedures, and in talking to patients and their families. They will have active discussions with cytology technologists, fellows, and pathology faculty. They will also follow up on their cases as the specimens are subsequently tested and results surface, in order to close the loop of diagnosis and further patient care and treatment:

Suggested Readings/Resources:
http://pubs.rsna.org/journal/radiology  - good source of multiple articles on radiologic pathologic correlation, very well done, though some are relatively rare. Use the search tool on the upper right corner and type “radiologic pathologic and the topic of interest. Below is an example of the site:
http://pubs.rsna.org/action/doSearch?SeriesKey=&AllField=RADIOLOGIC+PATHOLOGY

https://www.ncbi.nlm.nih.gov/pubmed/27311804  -Article of how a Radiologic-pathology elective is done in another institution.

http://www.sciencedirect.com/science/article/pii/S1076633210001339?via%3Dihub  - Article on using the ACR appropriateness criteria to teach evidence based medicine

https://link.springer.com/book/10.1007%2Fb137876   - downloadable book on radiologic-pathologic correlation

Radiologic-pathologic Correlation—An Advanced Fourth-year Elective



 

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