Cytology Fellows

[LSU Pathology]

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We are having discussion in our cytology fellowship program about when it is appropriate for cytotechs to accompany the fellows for FNA / rapid interpretation to assist with staining and whatever else.

One of our senior staff members suggests that the fellow should always handle rapid interps alone, without cytotech assistance.

We were curious about what other programs are doing as far as -

does the fellow go alone or with a cytotech / resident?

if the fellow does go alone, do you push a microscope cart to various hospital locations or do you have a centralized area to serve the entire hospital ?

is there a requirement to have a resident on your cytology service every month ?

Any information you can share would be appreciated...

 

[HbyHA]

Usually the entire team goes (attending, fellow, and resident), though sometime the resident and fellow go ahead and set up alone. i have never seen a cytotech accompanying the team. occasionally (depending on the attending on-service) the fellow will issue a prelim diagnosis themselves.

we have a microscope cart that we push to a few main locations. we usually have at least one resident on service, but the cytology service is entirely fellow driven and does not require a resident. being a resident on cytology can at times be like being a med student all over again...

hope this is useful

 

[mrp]

Attendings here do the wet-read on FNAs, on a microscope that gets pushed around on a cart.

We don't have a cyto fellowship.

If a resident is on cyto (not alwasy) they usually tag along.

 

[deschutes]

On things like EBUSes and thyroid U/S-FNAs, a cytotech goes ahead with cart and makes smears. Once decent material starts showing up, the cyto resident/fellow/attending is paged. This was instituted after a year or so of huge swaths of resident/fellow time getting swallowed up between getting paged to the O.R. or ultrasound suite and actually having something to smear.

As our program has 4 sites and the cyto fellows aren't always rotating, residents sometimes do CT bx adequacy assessments, and call for backup if it's a difficult case.

For EUS-FNAs and we-do FNAs, usually the whole team goes along but the resident or fellow goes first and gets situated.

 

[2121115]

Our FNA service is quite busy. There is always a resident or fellow (roughly interchangeable roles) on service (but not at the same time) and they are given autonomy to function independently. For image guided cases, the resident or fellow (which ever one is on service covering FNAs that day) goes alone and does the smears and staining and then issues a prelim read. For palpable masses, we do the sticks ourselves and the attending will help perform the stick and issue a prelim read if needed. For most of the day the resident works alone (with attending help if needed, only a page away) and issues prelim reads. The next day the resident signs out cases with the attending when the alcohol smears and cell blocks are ready.

Cytotechs are available to go to cases (smears, stains, adequacy assessment) when the resident/fellow is occupied by another case, in other words if there are 2 cases at once.

It is basically a fellow/resident run service. Cytotechs are there to help with work overflow. It puts a lot of responsibility on the resident (I recall that people have had surgeries canceled/scheduled based on my prelim read), but that is good training for the future.

 

[BierstiefelAndy]

In our institution, the cytotechs (not the fellows or residents) go on adequacy assessments for the CT and EUS-guided FNAs, when requested. Fellows are called down on cases where a second opinion is needed. We do not do "rapid" reads in contrast to some other places.

We do not push carts around although I've seen places where cytologists push carts around. If FNAs are not performed in the designated sites such as the FNA clinic or CT/EUS suites, where there are microscopes set up, we are not obligated to do adequacy reads and our clinicians are understanding of that.

Fellows run the palpable FNA service and also perform ultrasound-guided FNAs alongside the radiologists. EBUS, EUS, and thyroid cases are the exceptions (those are clearly done by the thoracic surgeons, GI, and endocrinology folks, respectively).

Not all services are covered by a resident. Sometimes, some services are run by the attending alone. Cytology isn't like surgical pathology and for residents, the cytology services are more education-oriented. Residents have a good life in "Happy Valley".

 

[Cyton]

In our institution, the cytotechs (not the fellows or residents) go on adequacy assessments for the CT and EUS-guided FNAs, when requested. Fellows are called down on cases where a second opinion is needed. We do not do "rapid" reads in contrast to some other places.

We do not push carts around although I've seen places where cytologists push carts around. If FNAs are not performed in the designated sites such as the FNA clinic or CT/EUS suites, where there are microscopes set up, we are not obligated to do adequacy reads and our clinicians are understanding of that.

Fellows run the palpable FNA service and also perform ultrasound-guided FNAs alongside the radiologists. EBUS, EUS, and thyroid cases are the exceptions (those are clearly done by the thoracic surgeons, GI, and endocrinology folks, respectively).

Not all services are covered by a resident. Sometimes, some services are run by the attending alone. Cytology isn't like surgical pathology and for residents, the cytology services are more education-oriented. Residents have a good life in "Happy Valley".

Similar to our program except fellows push carts for the palpable FNA's

 

[yaah]

Here it's a mix between fellows/residents going for adequacy and cytotechs. I think lately it is trending more towards cytotechs. Fellows/residents do the FNAs that aren't done by clinicians though. Whoever goes to the assessment stains the slides - it seems uncommon to have a cytotech AND a fellow go.

There is always a resident on cytology but they are not always covering FNAs. So sometimes it's just the fellow + attending or just the cytotech + attending.