BRANCH – M.D. (PATHOLOGY)
GUIDELINES FOR COMPETENCY BASED POSTGRADUATE TRAINING PROGRAMME
FOR M.D. PATHOLOGY.
Preamble
The purpose of this programme is to standardize Pathology teaching at Post Graduate level through out the
country so that it will benefit inachieving uniformity in undergraduate teaching as well and resultantly
creating suitable manpower with appropriate expertise.
Programme Objectives
A candidate upon successfully qualifying in the M.D. (Pathology) examination should be -
1) Capable of offering a high qualitydiagnostic opinion in a given clinical situation with an
appropriate and relevant sample of tissue, blood, body fluid, etc., for the purpose of diagnosis and
overall wellbeing of the ill.
2) Able to teach and share his knowledge and competence with others. He / She should be imparted
Training in teaching methods in the subject which may enable them to take up teaching assignments
in Medical Colleges /Institutes.
3) Capable of pursuing clinical and laboratory based research. He /She should be introduced to basic
research methodology so thatthey can conduct fundamental and applied research.
Specific Learning Objectives :-Cognitive Domain-
1) Diagnose routine and complex clinical problems on the basis of Histopathology (Surgical
Pathology) and Cytopathology specimens, Blood and Bone Marrow examination and various tests
of Laboratory Medicine (Clinical Pathology, Clinical Biochemistry) as well as Blood Banking
(Transfusion Medicine).
2) Inrepret and correlate clinical and laboratory data sothat clinical manifestations of desease can be
explained.
3) Advice on the appropriate specimens and tests necessary to arrive at a diagnosis in a
problematiccase.
4) Correlate clinical and laboratory findings with Pathology findings at autopsy, identify
discorrelations and the causes of death due to diseases (apart from purely metabolic causes).
5) Should be able to teach Pathology to undergraduates, postgraduates, nurse and paramedical staff
including laboratory personnel.
6) Plan, execute, analyse and present research work.
7) Make and record observations systematically and maintain accurate records of tests and their
results for reasonable periods of time. Identify problems in the laboratory, offer solutions thereof &
maintain a high order of quality control.
8) Capable of safe & effective disposal of laboratory waste.
9) Able to supervise and work with subordinates and colleagues in a laboratory.
Psychomotor Domain -
1) Able to perform most of the routine tests in a Pathology Laboratory including grossing of
specimens, processing, cutting of paraffin and frozen sections, making smears, and staining.
2) Able to collect specimens by routinely performed non-invasive out-patient procedures such as
vene-puncture, finger-prick, fine needle aspiration of superficial lumps and bone-marrow aspirates,
and provide appropriate help to colleagues performing an invasiveprocedure such as a biopsy or an
imaging guided biopsy.
3) Perform an autopsy, dissect various organ complexes and display the gross findings.
4) Should be familiar with the function, handling and routine care of equipment in the laboratory.
Affective Domain-
1) Should be able to function as a part of a team, develop an attitude of cooperation with colleagues,
and interact with the patient and the clinician or other colleagues to provide the best possible
diagnosis or opinion.
2) Always adopt ethical principles and maintain proper etiquette in dealings with patients, relatives and
other health personnel & respect the rights of the patient including the right to information and
second opnion.
3) Develop communication skills to word reports and professional opinions as well as to interact with
patients, relatives, peers and paramedical staff, & for effective teaching.
Post Graduate Training :
-Based on the available facilities, Department can prepare a list of postgraduate experiments pertaining to
basic and applied Pathology. Active learning should formthe mainstay of postgraduate training there should
be lectures for postgraduates (at least 20 per year) along with seminars, symposia, group-discussions,
Journal clubs. The postgraduate students should regularly the ward roundsof various clinical departments
and learn cases of interest for discussion with the Pharmacology faculty. Each college should have a
medical education unit to generate teaching resource material for U.G. and evolving of problem solving
modules.
The three-year training programme for the M.D. degree may be arranged in the form of postings to different
assignments / laboratories for specified periods as outlined below. The period of such assignments / postings
is recommended for 35 months. Postings schedules may be modified depending on needs, feasibility and
exigencies. For facilities not available in the parent institution as well as for additional knowledge & skill,
extramural postings may be undertaken.
Section / Subject Duration in Month
(i) Surgical Pathology and Autopsy 14
(ii) Surgical Pathology Techniques 1
(iii) Haemotology 8
(iv) Cytopathology 6
(v) Laboratory Medicine 2
(vi) Transfusion Medicine /BloodBank 1
(vii) Basic Sciences including Immunopathology,
Electronmicroscopy, Molecular Biology,
Research Techniques and Cytogenesis, etc. 1
(viii) Elective / Reorientation 2
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Total = 35 months
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The training programme should be designed to enable the student toacquire a capacity to learn and
investigate for himself / herself, tosynthesize and integrate a set of facts and develop a faculty to reason.
The curricular programmes and scheduling of postingsmust provide the student with opportunities to
achieve the above broad objectives. Must of the learning is to be accomplished by the student himself.
Interactive discussions are to be preferred over didactic sessions. The student must blend as an integral part
of the activities of an academic Department that usually revolves around three equally important basic
functions of teaching, research and service. As mentioned earlier the emphasis is recommended under a
residency programme or learning while serving / working. The following is a rough guidelines to various
teaching / learning activities that may be employed : -
.Collection of specimens including Fine needle aspiration of superficial lumps.
. Grossing of specimens.
. Performing autopsics.
.Discussions during routine activities such as during signing out of cases.
.
ancillary procedures needed.
Presentation and work-up of cases including the identification of special stains and
. Clinico-pathological conferences.
. Intradepartmental and interdepartmental conferences related to case discussions.
. Conferences, Seminars, Continuing Medical Education (CME) Programmes.
. Journal Club.
. Research Presentation and review of research work.
.Guest and in-house lectures.
.Participation in workshops, conferences and presentation of papers, etc.
.Laboratory-work.
.Use and maintenance of equipment.
.Maintenance of records.
.Teaching undergraduates and paramedical staff.
Post Graduate Examination :-
The Post Graduate Examination shall be in three parts :-
1) Thesis, to be submitted by each candidate at least 6 months before the date of
commencement of the theory examination.
2) Theory : There shall be four theory papers – as given separately
3) Practicals and Viva /Oral
The practical examination shall consist of the following and should be spread over two days.
(i) Clinical Pathology : Discussion of a clinical case history.
Plan relevant investigationsof the above case (Two investigations
should be performed including at least one Biochemistry
exarcise).
Complete urinalysis.
(ii) Haematology : Discuss haematology cases given the relevant history.
Plan relevant investigations.
Perform complete hemogram and atleast two tests preferably
Including coagulation exercise.
Identify electrophoresisstrips, osmotic fragility charts, etc.
Examine, report and discuss around ten cases given the history and
Relevant blood smears and / or bone marrow aspirate smears.
(iii)Transfusion Medicine : Perform blood grouping.
Perform the necessary exercisegiven a relevant history.
(iv) Histopathology &
Cytopathology : Examine report and discuss ten to twelve histopathology and three
to five Cytopathology cases given in the relevant history and slides.
Perform a Haematoxylinand Eosin stain and myspecial stain on a
paraffin section.
Report on a frozen section.
(v) Autopsy : Given a case history and relevant organs (with or without slides).
Give a list ofanatomical diagnosis in a autopsy case.
(vi)Gross Pathology : Describe findings of gross specimens, give diagnosis and identify
the sections to be processed.
(vii) Basic Sciences : Identify electronmicrographs.
Identify gels, results of PCR, immunological tests including staining
for direct / indirect immuno fluorescence.
Identify histochemical and immunohistochemistry stains.
All practical exercises are to be evaluated jointly by all the examiners. An oral question-answer section
should be conduced at the end of each exercise.
(a) Viva on dissertation and research methodology.
(b) General Viva.Voce.
Course Content :-
The study of Pathology Anatomy includes all aspects of Pathology as encompassed in the branches of
General and Systemic Pathology. Onlythe broad outlines are provided.
1) A) General Pathology:
Normal cell and tissue structure and function. The changes in cellular structure and
function in disease. Causes of disease and its pathogenesis. Reaction of cells, tissues,
organ systems and the body as a whole to various sublethal and lethal injuries.
B) Systemic Pathology:
The study of normal structure and function of various organ systems and the
aetiopathogenesis, gross and microscopic alterations of structure of these organ
systems in disease & functional correlation with clinical features.
2) Haematology:
The study of Haematology includes all aspects ofthe diseases of the blood and bone marrow.
This would involves the study of the normal, and the causes of diseases and the changes thereof.
3) Laboratory Medicine(Clinical Biochemistry /ClinicalPathology including Parasitology).
4) Transfusion Medicine (Blood-Banking).
5) In the following fields, the student is expected to acquire a general acquaintance of techniques and
principles and to interpret data :
a) Immunopathology.
b) Electron microscopy.
c) Histochemistry.
d) Immunohistochemistry.
e) Cytogenetics.
f) Molecular Biology.
g) Maintenance of records.
h) Information retrieval, Computer, Internet in Medicine.
It is difficult to give a precise outline of the Course Content for postgraduate training. A postgraduate is
supposed to acquired not only professional competence of a well-trained specialist but also academic
maturity, a capacity to reason and critically scientific data as well as to keep himself/herself abreast of the
latest developments inthe field of the pathology and related sciences. A brief outlineof what is expected to
be learnt during the M.D. Course is given under each head.
Surgical Pathology:-
Knowledge-
.The student should be able to demonstrate an understanding of the histogenetic and
patho-physiologic processes associatedwith various lesions.
. Should be able to identify problems in the laboratory and offer viable solutions.
Skills-
.Given the clinical and operative data, the student should be able to identify, and
systematically and accurately describe the chief gross anatomic alterations in the
surgically removed specimensand be able to correctly diagnose at least 80percent of
the lesions received on an average day from the surgical service of an average
teaching hospital.
. A student should be able to demonstrate ability to perform a systematic gross
examination of the tissuesincluding the taking of appropriate tissue sections and in
special cases as in intestinal mucosal biopsies, muscle biopsies and nerve biopsies,
demonstrate the orientation of tissues in paraffin blocks.
. The student should be able to identify and systematically and accuratcly describe the
chief histomorphological alterations in the tissue received in the surgical pathology
service. He /She should also correctly interpret & correlate with the clinical data to
diagnose at least 90% of the routine surgical material received on an average day. He
/She should be able to diagnose at least 75% of the classical lesions being commonly
encountered in the surgical pathology service without the aid of the clinical data.
. Be conversant the automatic tissue processing machine and the principles of its
running.
. Process a tissue, make a paraffin block and cut sections of good quality on a rotary
microtome.
. Stain paraffin sections with at least the following:
(i) Haematoxylin and eosin.
(ii) Stains for collagen, elastic fibers and reticulin.
(iii) Iron stain.
(iv) PAS stain.
(v) Acid fast stains.
(vi) Any other stains needed for diagnosis.
. Demonstrate understanding of the principles of:
(i) Fixation of tissues.
(ii) Processing of tissues for section cutting.
(iii) Section cutting and maintenance of related equipment.
(iv) Differential (Special) stains and their utility.
. C
correlation with the clinical data provided, and correctly diagnose at least 75 percent of
ut a frozen section using freezing microtome /cryostat, stain and interpret the slide in
the lesions within 15 minutes. Perform fat stain on frozen section.
.
especially in the diagnosis of tumour subtypes.
Demonstrate the understanding of the utility of various immunihistochemical stains
Autopsy Pathology :-
Knowledge –
. Should be aware of the technique of autopsy.
.
meaningful clinico-pathological correlation can be made.
Should have sufficient understanding of various disease processes so that a
. Demonstrate ability to perform a complete autopsy independently with some physical
assistance,correctly following the prescribed instructions. Correctly identify all major
lesionswhich have caused, or contributed tothe patient’s death on macroscopic
examination alone on microscopy in at least 90%of the autopsies in an average
teaching hospital.
. In places where non-medicolegal autopsies are not available each student / candidate
should be made to dissect organs from atleast five medicolegal autopsies.
.Write correctly and systematically Provisional and Final Anatomaic Deagnosis
reports.
Cytopathology:-
Knowledge -
. Should possess the background necessary for the evaluation and reporting of
Cytopathology specimens.
. Demonstrate familiarity with, the following, keeping in mind the indication for the test:
(i) Choice of site from which smears may betaken(as in the case of vaginal
smears).
(ii) Type of samples.
(iii) Method of obtaining various specimens (urine sample, gastric smear, colonic
lavage, etc.)
(iv) Be conversant with the principles and preparation of solution of stains.
Skills-
. Independently prepare and stain good qualitysmears for cytopathologic examination.
.Be conversant with the techniques for concentration of specimens: i.e., various filters,
centrifuge and cytocentrifuge.
. Independently be able to perform fine needle aspiration of palpable superficial lumps in
patients; m ty smears and be able to decide on the type of staining in a ake good quali
given case.
. Given the relevant clinical data, he / she should be able to independently and correctly :
(i) Evaluate hormonal status in all cases as may be required.
(ii) Diagnose the status of malignancy or otherwise in at least 75% of the cases
received in a routine laboratory and categorise them into negative,
inconclusive and positive.
(iii) Demonstrate ability in the technique of screening and dotting the slides for
suspicious cells.
(iv) Indicate correctly the type of tumour, if present, in at least 75% cases.
(v) Identify with reasonable accuracy the presence of organisms, fungi and
parasites in at least 75% of cases.
Haematology :-
Knowledge-
.Should demonstrate the capability of utilizing the principlesof the practice of
Haematology for the planning of tests, interpretation and diagnosis of diseases of the blood
and bone marrow.
. Should be conversant with various equipments used in the Haematology laboratory.
. Should have knowledge of automation and quality assurance in Haematology.
. Correctly plan a strategy of investigating at lest 90% of the cases referred for special
investigations in the Haematology Clinic and give ample justification for each step in
consideration of the relevant clinical data provided.
Skills-
. Correctly and independently perform the following special tests, in addition to doing the
routine blood counts:
(i) Haemogram including Reticulocyte and Platelet counts.
(ii) Bone marrow staining including stain for iron.
(iii) Blood smear staining.
(iv) Cytochemical charactization of leukemia with special stains like Peroxidase,
Leukocyte Alkaline Phosphatase (LAP),PAS,Sudan Black, etc.
(v) Hemolytic anaemia profile including HbF, Hb electrophoresis, etc.
(vi) Coagulation profile including PT, APTT.FDP.
(vii) BM aspiration and BM biopsy.
.Domonstrate familiarity with the principle and interpretation of results and utility in
diagnosis of the following :
(i) Prelease. lateletfunction tests including platelet aggregation and adhesion and PF3
(ii) Thrombophilia profile : Lupus anticoagulant (LAC), Anticardiolipin
Antibody (ACA), Activated Protein C Resistance (APCR), Protein C (Pr c),
Protein S (Pr S) and Antithrombin III (AT III).
(iii) Immunopheno typing of leukaemias.
(iii) Cytogenetics.
. Describe accurately the morphologic findings in the peripheral and bone marrow
smears, identifying and quantitating the morphologic abnormalities in disease states and
arriving at a correct diagnosis in at least 90% of the cases referred to the Haematology
clinic, given the relevant clinical data.
.
Laboratory Medicine :-
Knowledge -
.Process knowledge of the normal range of values of the chemical content of body
fluids, significance of the altered valuesand its interpretation.
. Prossess knowledge of the principles of following specialized organ function tests and
the relative utility and limitations of each and significance of the altered values:
(i) Renal function test.
(ii) Liver function test.
(iii) Gastric and Pancreatic function.
(iv) Endocrine function test.
(v) Tests for malabsorption.
. Know the principles , advantages and disadvantages scope and limitation of Automation
in laboratory.
. Know the principles and methodology ofquality control in laboratory.
Skills –
. Plan a strategy of laboratory investigation of a given case, given the relevant clinical history
and physical findingsin a logical sequence, witha rational explanation of each step; Be able to
correctly interpret the laboratory data of such studies, and discuss their significance with a
view to arrive at a diagnosis.
.Domonstrate familiarity with and successfully perform.
(i) routine Urinalysis including Physical, Chemical and Microscopic,
examination of
(ii) macroscopic and microscopic examination of Faeces and identify the ova
and cysts of common parasites.
(iii) A complete examination; physical, chemical and cell content of
Cerebrospinal fluid (C.S.F.), Pleural and Peritoneal fluid.
(iv) Seman analysis.
(v) Examination of Peripheral Blood for the commonly occurring parasites.
. Independently and correctly perform a least the following Quantitative Estimations by
Manual Techniques and / or Automated Techniques :
(i) Blood urea.
(ii) Blood sugar.
(iii) Serum Proteins total & fractional.
(iv) Serum Bilirubin total & fractional.
(v) Serum amylase.
. Demonstrate familiarity with the following Quantitative Estimations of blood / serum by
Automated Techniques, serum cholesterol, Uric acid, Serum Transaminases(ALT and AST
/SGOT and SGPT), etc.
.
of normal solutions, moral solution and Buffers.
Prepare standard solutions and reagents relevant to the above tests, including the preparation
. Explain the principle of Instrumentation, use and application of the instruments commonly
used in the laboratories, eg., Photoelectric colorimeter,Spectrophotometer, pH meter,
Centrifuge, Electrophoresis apparatus, ELISA Reader, low cytometer.
Transfusion Medicine (Blood Banking) :-
Knowledge -Students should possess knowledge ofthe following aspects of Transfusion Medicine:
.Basic immunology.
. ABO and Rh groups.
. Clinical significance of other blood groups.
.Transfusion therapy including the use of whole blood and RBC concentrates.
.Blood component therapy.
. Rationale of pre-transfusion testing.
.Infections transmitted in blood.
. Adverse reactions to transfusion of blood and components.
.Quality control in blood bank.
Skills -
Students should be able to correctly and independently perform the following :
.Selection and bleeding of donors.
. Preparation of blood components i.e., Cryoprecipitates, Platelet concentrate, Fresh Frozen
Plasma, Single Donor Plasma, Red Blood Cell concentrates.
. ABO and Rh grouping.
. Demonstrate familiarity with Antenatal and Neonatal work :
(i) Direct antiglobulin test.
(ii) Antibody screening and titre.
(iii) Selection of blood for exchange transfusion.
. Demonstrate familiarity with principle and procedures involved in:
(i) Resolving ABO grouping problems.
(ii) Identification of RBC antibody.
(iii) Investigation of transfusion reaction.
(iv) Testing of blood for presence of :
(a) PBV (Hepatitis B Virus Markers).
(b) HCV (Hepatitis C Virus Markers).
(c) HIV (Human Immunodeficiency Virus Testing).
(d) VDRL.
Basin Sciences (in relation to Pathology) : -
a) Immunopathology:
Knowledge –
(i) Demonstrate familiarity with the current concepts of structure and function of the immune
system, its aberrations and mechanisms thereof.
(ii) Demonstrate familiarity with the scope, principles, limitations and interpretations of the
results of the following procedures employed in clinical and experimental studies relating
to immunology :
(a) ELISA techniques.
(b) Radioimmuno assay.
(c) HLA typing.
(iii) Interpret simple immunological tests used in diagnosis of diseases and in research
procedures.
(a) Immunoelectrophoresis.
(b) Immunofluorescence techniques especially on kidney and skin biopsies.
(c) Anti-nuclear Factor (ANF).
(d) Anti-neutrophil cytoplasmic antibody (ANCA).
b) ssElectron Microscopy :
Knowledge –
(i) Demonstrate familiarity with Principles and Techniques of electron microscopy and the
working of an electron microscope (including Transmission and Scanning Electron
Microscope: TEM and SEM).
(ii) Recognise the appearance of the normal subcellular organelles and their common
abnormalities (when provided with appropriate photographs).
C) Enzyme Histochemistry :
Knowledge –
Should be familiar with the principles, use and inrerpretation of common enzyme
histochemical procedures (Alkaline Phoshatase, Acid Phosphatase, Glucose-6-Phosphate
Dehydrogenase, Chloroacetate Esterse).
d) Immunohistochemistry :
Knowledge –
Demonstrate familiarity with the principles and exact procedures of various
immunohistochemical stains using both PAP (Peroxidase-Antiperoxidase) and AP-
AAP (Alk. Phosphatase-anti Alk. Phosphatase) ABC (Avidin-Biotin Conjugate)
Systems;
Employing monoclonal and polyclonal antibodies. Be aware of the limitations of
immunohistochemistry.
Skills (desirable) –
Be able to perform immunohistochemical staining using paraffin section with at least
one of the commonly used antibodies (Cytokeratin or LCA) using PAP method.
e) Molecular Biology:
Knowledge –
Should understand the principles of Molecular Biology especially related to the
understanding of disease processes and its use in various diagnostic tests.
Should be conversant with the principle & steps and interpretations of a Polymerase Chain
Reaction (PCR Western Blot, Southern Blot, Northern Blot and Hybridisation procedures).
f) Cytogenetics :
Knowledge –
Demonstrate familiarity with methods ofKaryotyping and Fluorescent in-situ
Hybridisation(FISH).
g) Tissue Culture:
Knowledge –
Demonstrate familiarity with methods of tissue culture.
h) Principles of Medical Statistics:
Knowledge –
Demonstrate familiarity with importanceof statistical methods in assessing
data from patient material and experimental studies.
