pathology sign-out question

[retinalball]

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hi,

I will be spending time with a ocular pathologist during my ophtho clerkship. We will be with him during sign out.

What is sign-out?

 

[jenesaispas0005]

I'm not a resident, just a 4th year applying to pathology, but I think of signout as the pathology equivalent of rounding with the attending. You're going over the slides with the attending on a multi-headed scope and they dictate their diagnosis/impression and teach about the cases. Before sign-out, the residents are supposed to 'preview' the cases, which is like pre-rounding, and a lot of the time will dictate or write up what they think the cases are.

 

[TinyFish]

I'm not a resident, just a 4th year applying to pathology, but I think of signout as the pathology equivalent of rounding with the attending. You're going over the slides with the attending on a multi-headed scope and they dictate their diagnosis/impression and teach about the cases. Before sign-out, the residents are supposed to 'preview' the cases, which is like pre-rounding, and a lot of the time will dictate or write up what they think the cases are.

Lol. I like the pre-rounding and rounding analogy. Yes. The attending needs to see all the slides...the residents prepare the paperwork and (hopefully) preview all the cases and write up a diagnosis before sign-out. During sign-out, the attending looks at the slides and tweaks the resident's diagnosis (or sometimes completely changes it ). It's important to ask during your interviews whether residents actually get to preview their cases before sign-out or not. I asked this when I interviewed because I guess it was a standard question.

Now, as a resident, I can't imagine how annoying it would be not to be able to preview your cases before seeing them with the attending. I mean, it wouldn't matter as much to preview every single adenoma, etc. that I came across, but I would want to preview all more complicated cases.

 

[KCShaw]

The shorter version is that you, as a rotating medical student, will be sitting in at the microscope while the pathologist looks at slides (and hopefully talks about them/teaches). Yes, it's...-kinda- like rounds. "Sign-out" is the term used when the pathologist finalizes their report, or..signs it out. The term is widely used to include the time during which the pathologist reviews slides and dictates diagnoses (which ultimately end up on the final, published report).

I don't know many places that have a lot of eye path, and even those that do or have a consult service..I would be surprised if they have very many cases on a daily basis. Or maybe I'm just missing out on that niche, I dunno.

 

[zao275]

I think the only Ophthalmic path fellowship program in the US is at The Methodist Hospital in Houston.

http://pathinfo.wikia.com/wiki/Ophthalmic_Pathology_Fellowship_Directory

If anyone knows of another one, please let me know so I can add it to the wiki.

 

[KCShaw]

Interesting -- are non-path opthalmology trained residents with this fellowship "allowed" to sign-out eye cases (a la derm)? Oddly, I never really thought about it, even when we were having issues with eye consults (albeit a pretty rare occurrence).

 

[gschl1234]

I think the only Ophthalmic path fellowship program in the US is at The Methodist Hospital in Houston.

http://pathinfo.wikia.com/wiki/Ophthalmic_Pathology_Fellowship_Directory

If anyone knows of another one, please let me know so I can add it to the wiki.

There's one at Hopkins. It looks like there are 2 per year but I'm not sure if the funding is dependent on year.

 

[caffeinegirl]

MEEI/Harvard also has an eye path fellowship
http://www.masseyeandear.org/for-professionals/ophthalmology/fellowship-program/eye-pathology/

 

[Enkidu]

Why would anybody do this fellowship? 2 years? And then how often will you get an eye case?

Edit: Do people actually have eye biopsies, or do pathologists only see enucleations?

 

[Autopsy101]

We have an occular pathologist at our hospital. He is the chairman of the opthomology department. He is board certified in opthomology and has then completed opthomologic pathology fellowship - similar to dermpath trained dermatologists. The specimens he signs out include corneal button specimens, conjunctival biopsies, enucleations, and some skin biopsies of eyelid for bcc and sk.

 

[KCShaw]

There is an American Association of Opthalmic Pathologists (http://www.eyepath.org/) and although I have no idea how well that organization is thought of in that field, they do offer a surprisingly long list of ocular pathology fellowships.

Edit: Looking more closely, it may not be well maintained -- the Methodist Hospital one isn't on one page but is on a separate link, and I didn't see the Hopkins one.

 

[green mantis]

I worked w/ 2 ocular pathologists when I was a resident. Both were ophthalmologists. I think the AAOP even had a conference at my institution when I was a resident. I kind of wonder if any pathology-trained people go into this subspecialty.

I gotten a few ocular pathology specimens since I've started. They're mostly pterygiums w/ a rare corneal button. I've also seen some wedge excisions of the eyelid, usually for BCCs.


----- Antony

 

[zao275]

Thanks for the info. Will try to add these to the wiki.

The ophtho pathologist at Methodist did both ophtho and path residency and THEN an ophtho path fellowship (talk about a lot of training). But she does pathology (surg path, cytopath, as well as eye path) now and not any clinical ophtho.