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New Trainees’ Welcome Day Histopathology Examinations

New Trainees’ Welcome Day Histopathology Examinations. Dr Sanjiv Manek Chair of Histopathology Examiners’ Panel Royal College of Pathologists 16/9/19. Code of practice for examiners Revised July 2019 (superseding all previous editions). Royal College of Pathologists

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New Trainees’ Welcome Day Histopathology Examinations

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  1. New Trainees’ Welcome DayHistopathology Examinations Dr Sanjiv Manek Chair of Histopathology Examiners’ Panel Royal College of Pathologists 16/9/19

  2. Code of practice for examiners Revised July 2019 (superseding all previous editions)

  3. Royal College of Pathologists Examination regulations – 2019 HISTOPATHOLOGY These regulations must be read in conjunction with the Regulations and Guidelines – College examinations for Fellowship and Diplomas. ENTRY & TRAINING REQUIREMENTS Candidates should normally have undertaken at least one year of histopathology training and be in ST2 before applying to attempt the Histopathology FRCPath Part 1 examination and a further two years of histopathology training before applying to attempt the Part 2 examination. Candidates should obtain guidance from their educational supervisor as to when to sit the examination. Planning should take into account the candidate’s planned CCT date (where applicable) but candidates should apply only when they are ready. Some general guidance is given below, but apart from the sequence in which the examinations can be sat is not intended to be prescriptive.

  4. RCPath TRAINEES' WELCOME DAY

  5. TRAINEES' WELCOME DAY

  6. Examinations and QA • Stage A (Dr Sohail) • Part 1 FRCPath(Drs Khan and Rizvi) • Part 2 FRCPath (Drs McGregor and Smart) • CHCCT (Dr Smart) • CHAT (Professor Suvarna and Dr Benbow) • Quality Assurance (Dr Wahab) ------------------------------------------------------------------ • BMS parts 1 and 2 examinations (Drs McGregor and Moreman)

  7. Stage A Examination • 1st sitting April • Resit or second sitting June • OSPE style with 13-15 stations • Covers a broad range of topics, systems and skills • Digital images used, microscope stations, etc • Borderline group method for marking – changing to BRGM • Pass rate dependent on number of stations failed and global pass mark (includes application of SEM)

  8. Stage A Histopathology Exam – PM Photos Aims • Ability to write a logical description pertinent to the specimen • Identify and describe normal structures and pathology if present • Offer a diagnosis or differential diagnosis • Ability of candidate to link the macroscopic appearances to the clinical history/information Materials required • Macro photographs plus or minus glass slides(s) or photo micrograph • Clinical history Assessor required • No Question design template Write a macroscopic description of this image(s) Give a diagnosis/differential diagnosis Interpret the appearances in the light of the clinical history Examples Infarcted bowel plus e.g. MURAL thrombosis LV/ Aortic aneurysm

  9. Part 1 FRCPath • Twice a year, usually around 150 candidates • Currently combination of SBAs and EMQs, testing core knowledge • New questions added every year • More images used than previously • Includes questions on molecular pathology • Covers full range of topics, systems and pathology • Angoff method of standard setting – done post-exam • Pass rate dependent on global pass mark (includes use of SEM)

  10. FRCPath Part I in Histopathology SBA template

  11. Question 1This is a section of myocardium from a 58 year old man who was thought to havedied following a cardiac event. Choose the most likely history from the following list of options: A The patient had a coronary thrombosis and died rapidly from an arrhythmia B The patient had a myocardial infarct and presented in extremis due to myocardial rupture and haemopericardium. C The patient was treated supportively but died 24 hours after admission from an arrhythmia. D The patient was treated supportively but died of cardiac failure two weeks later E The patient was treated with thrombolysis but died 2 days later.

  12. FRCPath Part I in Histopathology EMQ template

  13. Questions 61-65 Option List A Diffuse sub-epithelial deposits of IgG with membrane spikes B Fibrillar mesangial deposits positive for IgG and C3 C Fibrillar mesangial and capillary wall deposits, negative for IgG, IgA and IgM D Focal segmental positivity for IgM and C3 alone E Large irregular sub-epithelial deposits, positive for C3 and IgG F Linear dense deposits within the basement membrane, positive only for C3 G Linear basement membrane staining for IgG H Mesangial deposits of IgA and C3 I Mesangial and capillary wall deposits positive for all immunoglobulins, C3 and C1q J Negative immunohistochemistry for immunoglobulins and complement K Sub-endothelial deposits, positive for C3, with membrane reduplication Each of these patients has a renal biopsy. For each one, select the most likely immunomorphological findings in the biopsy from the list of options. Each option may be used once, more than once, or not at all. 61 A 20 year old man has an episode of macroscopic haematuria following an upper respiratory tract infection. Now, two months later, he has persistent microscopic haematuria but normal renal function. 62A 62 year old man presents with acute renal failure and haemoptysis. Serology demonstrates positive cANCA. 63 A 36 year old woman has arthralgia, rash, proteinuria and mild renal impairment. Serology demonstrates positive ANA. 64 A 45 year old man presents with nephritic syndrome, three weeks after suffering a throat infection. Serology shows a high titre of ASO antibodies. 65 A 70 year old woman presents with nephrotic syndrome. Investigations reveal a mass on the chest x-ray; serology is negative.

  14. Part 2 FRCPath • To test diagnostic and deductive skills across the range of histology and cytology including simple and complex cases, handling of specimens and dealing with frozen sections, MDMs, management and governance issues • To test knowledge of guidelines, up to date ancillary studies and molecular pathology • To assess whether a trainee is ready and safe for independent reporting

  15. Part 2 FRCPath • Twice a year • Usually 80 – 90 candidates • Held in 5 centres within UK plus one centre in Jordan/Egypt (Spring exam) • Pre-exam meetings for short surgical and cytology cases selection and setting marking schemes on a closed marking system • Central marking a week after the exam (includes diagnostic cytology and short surgical histology cases – often marked simultaneously)

  16. Structure of the Part 2 Exam • Short surgicals (20) • OSPE 1 viva • OSPE 2 (written exercise) • Long cases (4) • Frozen sections with viva (6) • Diagnostic cytology (8) • Macroscopic pathology with viva (4)

  17. Timetable Day 1 morning Diagnostic cytology Day 1 afternoon Long cases, OSPE 1 (viva) and Frozen sections (viva) Day 2 morning Short surgical cases Day 2 afternoon OSPE 2 (written exercise) and Macroscopic pathology (viva)

  18. The Surgicals • Set and marked centrally (dates for these arranged in advance) • 20 cases to report in 3h 20m, plus 20 minute rest break mid morning • 10 Sets of 2 slides circulated around candidates • Both biopsies and larger specimens, straightforward and difficult cases • All organ sites and specialities are covered • 20 minutes per set of 2 to produce written answers to both cases then slides are moved on • Strict time criteria

  19. Long Cases • Set centrally but marked locally according to central marking scheme • 4 cases • Set of sections including special stains/immunohistochemistry and sometimes also photos/EM • Sufficient information and material given to produce a firm diagnosis • 20 minutes per case to produce written answer

  20. The OSPEs – OSPE 1 • Viva with 2 examiners • Written scenario provided during viva • Structured discussion • Usually covers management/governance issues • Set centrally but marked locally according to central marking scheme

  21. The OSPEs – OSPE 2 • Written scenario usually with set of data and/or reports and/or images • Usually covers a diagnostic scenario and may involve MDM setting and/or include cytology and/or molecular pathology • May involve adherence to reporting protocols/guidelines grading/staging etc • Set centrally and marked locally according to central marking scheme

  22. FRCPath Part 2 in Histopathology Objective Structured Pathology Examination (OSPE 2) This is a written exercise and the candidate must ask the specific questions asked in the spaces on the question paper, not in an answer book. Please ensure that you have written your candidate number in the appropriate spaces on the form. Please ensure that you write neatly and legibly in the spaces provided. The object of this OSPE is to ensure that the candidate is familiar with standard clinical practice in this area.

  23. Frozen Sections • 6 cases divided as two sets of 3 • 20 minutes to look at each set and make notes (40 minutes in all) • 20 minute viva to discuss cases with 2 examiners • Key approach ‘ What will you tell the surgeon’ • NOT done over a double headed microscope • Set (centrally) and marked locally on performance in viva not on any written answers. Marked according to central marking scheme

  24. Diagnostic Cytology • 8 cases (Pap and Giemsa) with slides circulated in pairs with 20 minutes for each set and written answers to be produced (2 hours) • Set and marked centrally by Cytology subgroup (chair Dr Louise Smart) • Tests full range of diagnostic specimens including exfoliative, effusion and aspiration cytology

  25. Macroscopic Pathology • Set centrally and marked locally according to central marking scheme • 4 cases as two sets of two cases over 40 minutes • Macroscopic photo provided with brief history and question paper • Felt pen provided to mark blocks taken on photographs • 20 minute viva with two examiners • Marked on performance in viva

  26. Pass or Fail • Need to pass each section • The sections are close marked - a number of serious diagnostic errors means candidate is unlikely to pass • All sections are double marked or more for borderline candidates • Central marking teams mark cases using candidate number only and have no information about individual candidates including performance in other sections and number of attempts

  27. FRCPath Examination in Histopathology Candidate feedback

  28. CHCCT • Once a year from 2018 • Whole day examination • Morning 20 slides of cervical cytology to test diagnostic and management abilities • Afternoon 4 questions to test knowledge of guidelines, research data, novel methodology, etc. This may or may not include interpretation of slides • Set and marked centrally

  29. CHAT • Twice a year • OSPE style – several stations, including viva stations • Using images, biochemical and toxicology data, radiology, etc • To test knowledge of autopsy pathology, formulation of cause of death, interpretational skills, coronial rules, HTA related issues, etc • Set and marked centrally. Borderline group method • At one centre only • Pass rate dependent on passing a number of stations and/or pass mark (with or without application of SEM)

  30. The FutureGeneral Principles • Try to utilise similar standard setting and marking schemes • More digital images including virtual microscopy • More molecular pathology • Clear regulations and rules to dispel myths and introduce more transparency • Changing examination over the next few years with change in curriculum

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