HLA/Molecular Pathology

Molecular Pathology

 I. Introduction

The molecular pathology rotation will provide the resident a 4 week introduction to the subspecialty of molecular pathology.  The course will provide an introduction to the theory and methods of molecular diagnostics as well as clinical correlation.  The rotation can be completed at any point in the residency training, and the objectives will be the same.

 II. Training goals and objectives 

Patient Care 

  1. Participate in interpretation and sign out of final reports.
  2. Gain experience interpreting gel based and real time PCR results.
  3. Gain experience with interpretation of immunohistochemical assays for steroid receptors including ER, PR, HER2, Ki-67, and EGFR.
  4. Act as a consultant to clinicians and other pathologists for the use and selection of molecular diagnostics.  Provide appropriate consultations regarding test results.
  5. Understand the prognostic and therapeutic consequences of specific molecular test results.
  6. Understand the rationale for specimen requirements used in molecular diagnostics.
  7. Become familiar with basic laboratory procedures used in molecular diagnostics (see medical knowledge below).

 Medical Knowledge 

  1. Review of basic biochemistry of nucleic acids including structure, function, replication, synthesis, and cellular expression.
  2. Understand principles of PCR analysis - including real time PCR and RT-PCR.
  3. Understand principles and logistics of automated immunohistochemical assays and their interpretation.
  4. Through reading and discussion with faculty, understand molecular testing methods not currently in use by the lab.
  5. Read pertinent journal articles and/or book sections provided by the faculty and be prepared to summarize and discuss the reading material.
  6. Prepare and present a short presentation to the laboratory technicians and relevant faculty on a molecular pathology topic of the resident's choice.
  7. Become familiar with basic laboratory procedures used in the molecular diagnostics laboratory.  Procedures observed must include:
    1. DNA/RNA extraction (both manual and automated)
    2. RT-PCR
    3. Preparation of a master mix and sample for PCR
    4. Gel electrophoresis and technical interpretation
    5. Sample set up for real time PCR and technical interpretation.
    6. Restriction fragment digestion used for HPV genotyping. 
  8. Participate in case write-ups and research projects as interested.

 Practice-Based Learning and Improvement 

  1. Participate in the education of other health professionals by providing consultative services regarding test requests and patient results.
  2. Participate in the education of other health professionals by giving a short presentation on a molecular pathology topic of interest.
  3. Manage one's time and schedule to ensure time for laboratory observation, reading, and sign out.
  4. Self-assess areas of limited knowledge and focus self-study in these areas.
  5. Effectively use resource materials to research new or unusual case results.
  6. Appropriately use software and electronic resources to create a presentation on a molecular pathology topic of choice.
  7. Complete an evaluation of the rotation at the end of the course. 

Interpersonal and Communication Skills 

Communicate effectively with laboratory staff, clinicians, and other pathologists.

  1. If more than one resident is on the rotation at a time, work effectively as a team to establish a schedule and participate in group discussions of reading assignments.
  2. Provide consultative services regarding test requests and results.
  3. Present a molecular pathology topic in an effective, clear, concise, and informative manner to peers.
  4. Work as a team with the laboratory staff to schedule time to observe PCR procedures.

 Professionalism 

  1. Act in a professional manner. 
  2. Maintain patient privacy.
  3. Be responsible for own schedule.
  4. Be available for consults.  Return phone calls and pages in a timely manner.  

Systems Based Practice 

Understand the appropriate use of molecular diagnostic services.

  1. Learn about billing and reimbursement for molecular testing.
  2. Review any proficiency testing results performed during the rotation.
  3. Attend and participate in the monthly PCR lab quality assurance/ quality improvement meeting.
  4. Review CAP molecular pathology checklist questions to become familiar with the accreditation requirements.
  5. Review PCR procedure manual as necessary to supplement understanding of molecular diagnostic techniques.
  6. Evaluate and trouble-shoot (in conjunction with faculty) problems identified by the laboratory staff.
  7. Understand the requirements for test validation.  Review data for any tests currently being validated in the lab. Participate in test development and/or validation as interested.  

 III. Reading Materials 

  1. Molecular Pathology Resident Notebook - get this from Dr. Laudadio
  2. Ross, Dennis W.  Introduction to Molecular Medicine.  Third Edition. Springer, 2002.
  3. Killeen, Anthony A (ed).  Molecular Pathology Protocols. Humana Press, 2001.

 IV. Supplementary Materials Available 

  1. Online resources
    1. themedicalbiochemistrypage.org
    2. learn.genetics.utah.edu
    3. www.amp.org
  2. Available Textbooks
    1. Coleman, William B and Tsongalis, Gregory J (eds).  Molecular Diagnostics: For the Clinical Laboratorian. Second Edition.  Humana Press, 2005.
    2. Nussbaum, Robert L., McInnes, Roderick R., and Willard, Huntington F. Thompson & Thompson Genetics in Medicine.  Seventh Edition. Saunders, 2007.
    3. McClatchey, Kenneth D. Clinical Laboratory Medicine. Second Edition. Lippincott, Williams and Wilkins, 2002. 

 V. Staff

Mark J. Pettenati, PhD
Rotation Director; Professor, Pediatrics - Medical Genetics
 
Laboratory Staff:      
Martha Ward
Rena Long
Pam Daniel

Quick Reference

Pathology Residency Training Program
Program Director:
Ryan T. Mott, MD

Tel: 336-716-4311
Fax: 336-716-7595

Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
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Last Updated: 08-18-2014
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.