P.G. Curriculum M.D. Pathology

Index

 

 

1. Goal
2. Objectives
3. Syllabus
4. Teaching Programme
5. Posting
6. Thesis
7. Assessment
8. Job Responsibilities
9. Suggested books
10. Model Test Papers

 

 

 

 

 

 

 

 

 

 

PG Curriculum

MD Pathology

 

• The infrastructure and faculty in the department will be as per MCI guidelines..

 

1. Goals 

The goal of MD course in Pathology is to produce a competent pathologist who:

•  Has acquired the competence pertaining to basic instrumentation and procedures required for the practice of Pathology in the community and at all levels of health care system.
•  Has acquired skills effectively in communicating the diagnosis to the patients especially cancer patients. He should be able to demonstrate empathy and have a humane approach towards patients and their families and respect their sensibilities.
•  Demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities.
•  Practice the specialty of Pathology in keeping with the principles of professional ethics.
•  Function as a productive member of a team engaged in health case, research and education.

 

2. Objectives

•  Has the competence to diagnose important pathological conditions in various fields like histopathology, cytopathology, haematology & Immunopathology.
•  Has acquired skills in effectively interpreting all laboratory reports.
• Develops skills as a self-directed learner, recognize continuing educational need, use appropriate learning resources, and critically analyze  published literature in order to practice evidence-based pathology.
•  Demonstrates competence in basic concepts of research and epidermiology.  Can organize and supervise the desired managerial and leadership skills.

 

3. Syllabus 3.1. Theory

 General Pathology  Cellular adaptation cell injury and cell death

•  Mechanism, morphology and examples of cell injury, necrosis and apoptosis.
• Subcellular and cellular responses and adaptation to injury  Intracellular accumulations, pathological calcification and cell aging.

 Acute and chronic inflammation

•  Vascular and cellular events in acute inflammation, chemical mediators, outcome and morphological patterns of acute inflammation.
•  Chronic inflammation with special reference to granulomatous inflammation.
•  Systemic effects and effects of deranged inflammation.

 

 

 Tissue renewal and repair: Regeneration healing and fibrosis.

•  Control of normal cell proliferation and tissue growth, mechanism of tissue regeneration, repair by healing and fibrosis.
•  Extracellular matrix and cell matrix interactions.

 Hemodynamic disorders, thrombo embolic disease and shock.

•  Edema, hyperemia, congestion and haemorrhage.
•  Normal Hemostasis, thrombosis, DIC, embolism, infarction and shock.

 Genetic Disorders

•  Principles of genetics, normal karyotyping.
• Mutations, Mendelian disorders, disorders with multifactoral inheritance cytogenetic disorders involving autosomes and sex chromosomes.
•  Single gene disorders with nonclassic inheritance.
•  Diagnosis of genetic disorders involving molecular and genetic techniques.

  Neoplasia

•  Definition, nomenclature and biology of tumor growth.
• Molecular basis of cancer with special reference to carcinogenic agents and molecular basis of multistep carcinogenesis
•  Epidemiology and clinical features of tumors.
•  Grading, staging and laboratory diagnosis of cancer.

 Infectious  Diseases

•  General principles of microbial pathogenesis, bacterial, fungal, parasitic and viral infections.

 Environmental and nutritional pathology

•  Common environmental and occupational exposures leading on to diseases.
•  Nutritional deficiencies and obesity related disorders.

 Disease of Infancy and Childhood

•  Congenital anomalies, birth injuries, diseases of neonates, inborn errors of metabolism, tumor and tumor like lesions of infancy and childhood.

 

 Systemic Pathology  Blood vessels, lymphatic and veins

•  Normal morphology, congenital anomalies, atherosclerosis, hypertensive vascular disease.
•  Inflammatory and neoplastic diseases of all the vessels.

 Heart

•  Normal morphology, its blood supply and effect of aging on heart.
•  Ischemic,       hypertensive, valvular,          congenital       heart   diseases         and cardiomegaly  Pericardial diseases.
•  Tumors of the heart.

 Lungs

•  Congenital anomalies
•  Obstructive and restrictive pulmonary diseases.  Diseases of vascular origin.
•  Infections and tumors of lung  Lung transplantation  Diseases of pleura.

 Head and Neck

•  Oral cavity: - inflammatory disease and tumors  Diseases of teeth and supporting structures.
•  Upper airways and ear – congenital anomalies, infections and tumors.
•  Salivary glands – Infections autoimmune disorders and tumors.
•  Thymus – Developmental autoimmune and inflammatory disorder and tumors.

 Gastro Intestinal Tract

•  Congenital anamalies, infections inflammatory and vascular disorders and tumors of esophagus, stomach, small and large intestines, appendix and anal canal.
•  Diseases of the peritoneum

 Liver

•  Normal morphology with general features of hepatic disease including LFTs.
• Infectious, autoimmune drug induced, metabolic and circulatory disorders of liver. 
•  Hepatic diseases associated with pregnancy, neonates organ and bone marrow transplantation.  Liver transplantation
•  Nodules and tumors of liver.

 Biliary tract

• Congenital anomalies, injuries, Gallstones, cholecystitis and tumors of gall bladder and extra hepatic bile ducts.

 Pancreas

• Congenital anomalies, pancreatitis and neoplasms of pancreas.  

 Kidney

•  Clinical manifestations of renal diseases
•  Congenital anomalies
•  Diseases affecting glomeruli, tubules, interstitium and blood vessels.
•  Cystic diseases of kidney.
•  Tumors of kidney

 Lower urinary tract and male genital system.

•  Congenital anomalies, inflammation and tumors of ureter, urethra, penis, testis and epididymis.
•  Inflammation, enlargement and tumors of prostate.

 Female genital tract

•  Embryology, Anatomy, Physiology and histology of female genital tract.
• Congenital anomalies, inflammation and tumors of vulva, vagina, cervix, uterus, fallopian tubes and ovaries.
•  Gestational and placental disorders.

 Breast

•  Inflammations, benign epithelial lesions and tumors of the breast.  Diseases of male breast.

 The Endocrine System

•  Normal hormonal levels and functions of all the endocrine glands.
• Hypo and hyperactivity of glands of endocrine system i.e. pituitary, thyroid, parathyroid, pancreas, adrenals and pineal gland.
•  Autoimmune diseases, inflammations and tumors affecting these glands.  Skin
•  Disorders of pigmentation and melanocytes
•  Inflammatory, vesiculobullous and infectious disease
•  Tumors of the epidermis, dermis and skin appendage.

 

 Musculoskeletal system

 Bones 

• Modelling, growth and development, genetic and acquired abnormalities in bone cells, matrix and structure, features necrosis and infections of bones, tumors and tumor like lesions.  Joints 
•  Arthritis, tumor and tumor like lesions.
•  Soft tissue 
•  Tumors and tumor like lesions

 Peripheral nerves and skeletal muscles  General reactions of motor units.

•  Inflammatory, infectious, hereditary, metabolic and traumatic neuropathies  Atrophy, dystrophy, myopathies of the skeletal muscles.  Diseases of neuromuscular junction
•  Tumors of peripheral nerves and skeletal muscle bundles

 Central Nervous System

•  Degenerative, metabolic, toxic, demyleinating, infectious, cereberovascular malformations and traumatic injuries of skeletal muscle bundles.  Tumors

 Eye

• Infections, inflammatory, congenital diseases and neoplasms of orbit, eyelid, conjunctiva sclera, uvea, cornea, retina and optic nerves

 

 Cytopathology  General Cytology

•  Origin & principles with stress on basic structure of a mammalian cell.
•  Recognition and classification of different cell types.
•  Fundamental concepts of neoplasia – Benign & malignant.

 Cytology of Female Genital Tract

•  Normal FGT
•  Cytologic evaluation of menstrual disorders and hormonal abnormalities  Benign disorders of uterus, cervix and vagina.
•  Intraepithelial lesions and squamous carcinoma of the uterine cervix  Adenocarcinoma and related lesions of the uterine cervix.
•  Proliferative disease and carcinoma of the endometrium.
•  Disease of vagina and vulva.
•  Tumorous and non-tumorous conditions of ovary and fallopian tubes.

 Cytology of Respiratory tract

• Non-cancerous and cancerous lesions including conventional and aspiration cytology.

 Cytology of GIT

• Lesions of oral cavity, salivary glands, oesophagus, stomach, small intestine, colon and rectum.  

 Cytology of kidney & lower urinary tract

• Cancerous & non-cancerous lesions, conventional cytology, aspiration cytology, urine & brushings.

 Breast cytology

• Cytological diagnosis of all breast lesions on FNA.

 Cytology of thyroid, lymph nodes, neck masses.

• Aspiration cytology of all common lesions.

 Cytology of Skin, Bone & Soft tissue Cytology of common lesions  Cytology of Liver, Spleen, Pancreas, Retroperitoneum, Abdominal lumps

Cytology of neoplastic and non-neoplastic lesions  Cytology of Testis & Prostate.

 Miscellaneous

•  Lesions of eye, orbit
•  Mediastinum
•  CNS – Touch smears

 Cytology of all effusions & fluids in the absence as well as presence      of  cancer.

 

 Haematology   Clinical Correlation 

• Signs & Symptoms , General & Systemic examination) with various haematological disorders.

 Biology of stem cell & disorder of Haematopoiesis.

•  Overview of stem cell biology and cellular biology of haematopoiesis.
• Transcription factors and humoral regulation in normal and malignant haematopoiesis.
• Interaction between haematopoietic stem cells, progenitor cell and stromal compartment of bone marrow.
•  Stem cell homing & mobilization.

 Erythroid maturation, differentiation and abnormality.

 Pathobiology of human erythrocyte & Haemoglobin.

 Anaemias  o Approach to anaemia in adults and children in: Clinical correlation & diagnostic modalities. o Classification of anaemias (Morphological, pathophysiological and        based on erythropoiesis ie Proliferative vs non-proliferative)

• Iron deficiency anaemia including iron metabolism and differential   diagnosis from other microcytic hypochromic anaemias.  o Disorder of  iron metabolism including iron overload.
• Anaemia of chronic disorders with special reference to infections, collagen vascular disorders, inflammation etc.
• Megaloblastic anaemia and other causes of megaloblastosis.
• Definition, lab diagnosis of Haemoglobin disorders like Thalassemia, sickle cell anaemia, Haemoglobin associated with altered  Oxygen  affinity.
• Red blood cell enzymopathy, membrane disorder, autoimmune  hemolytic anaemia, non immune hemolytic anaemia, paroxysmal nocturnal haemoglobinuria. o Approach to Pancytopenia

 WBC disorders, complement and immunoglobin biology 

 Normal granulopoiesis 

•  Acquired and congenital disorders of phagocytosis (neutrophil, monocyte, eosinophil and macrophages)   Disorder of lymphocyte function   Storage disorder.
•  Lympocyte response to the various viral disorders like infectious   
•  Mononucleosis, Hepatitis & Dengue
•  Hematological responses to Viraemia and parasitic infections

  Haemotological malignancies:-

•  Conventional & molecular cytogenetic and immunohistochemical  basis of haematological malignancies.
•  Classification (FAB, WHO).  Their basis and diagnostic approach to various haematological malignancies.  
•  Pathophysiology, prognostic factors, cytochemistry, cytogenetics of     various acute myeloid and lymphoblastic leukaemias 
•  Pathophysiology and classification of MDS, MPD/MDS, myeloproliferative disorders 
•  Pathophysiology of Non-Hodgkin’s  lymphoma, Clinical staging of Hodgkin’s lymphoma. Role of molecular cytogenetics and immunohistochemistry in Hodgkin’s and Non-Hodgkin’s lymphoma and lymphoproliferative disorders . AIDS related and Transplant related lymphomas.
•  Plasma cell dyscrasias & Mastocytosis especially with reference to practical aspects of the clinical approach to patient.
•  Role of chemotherapy and antineoplastic agents based on molecular  mechanism of haemotological malignancies, clinical use of haematopoietic growth factors.
•  Late complications of Haematological disorders.

 Haematopoietic stem cell transfusion 

•  In: Immunodeficiency state, Genetic disorders  haematological    
• Malignancies and  Non-haematological disorders. Practical aspect of umbilical cord stem cells transplantation. Peripheral stem cell collection.  Role of stem cell in tissue repair. Complications of Haematopoietic stem cell transplant.
•  Gene transfer for haematologial disorders.

 Haemostasis  & Thrombosis.

•  Megakaryocyte and platelet structure.  Molecular basis of platelet   function, activation.  Role of blood vessel, coagulation system and fibrinolytic system in haemostasis.
•  Clinical evaluation of bleeding disorder.
•  Clinical & diagnostic aspects of :  o Haemophilia,
•  o Coagulation factor deficiency, o Von Willebrand disease, o Thrombotic and non thrombotic purpura ,
• Hereditary and acquired platelet disorders
•  Factors effecting coagulation, Venous Thromboembolism and role of lupus anticoagulant.

 Human blood group antigen and antibody.

• Principle, indication and storage of red blood cell, WBC. & platelet and plasma transfusion.  Various methods of  component separation and plasma derivatives with special reference to Fresh frozen plasma, cryoyoprecipitates, albumin and Immunoglobulin. Graft Rejection, GVH diseases, Transfusion Reactions, Blood grouping & cross matching.

 Haematological manifestations of various diseases like liver disorders, renal disorders, infections, cancers, AIDS and Parasitic diseases.

 Haematological problem in surgical patients.

 Spleen and its disorders.

 Current topics and recent advances.

 

 Immunopathology  Innate immunity 

• Role of phagocytic cells, complement, mast cells & humoral mechanisms.

 Specific Acquired Immunity- 

•  Details about antibody production & action, Brief principles about memory,  Ag specificity & vaccination

 Cell involved in Immune response-  

• T- lymphocytes, B-lymphocytes, macrophages, dendritic cells and natural-killer cells, dendritic cells, Natural killer Cells

 Cytokines with details about their properties and functions  Structure and function of histocompatibility molecules and disease association  Disorders of the immune system o All hypersensitivity reactions

• Autoimmune disorders with special reference to SLE, Rheumatoid arthritis, Sjogren’s syndrome, systemic sclerosis, polyarteritis nodosa and other vasculitides, Mixed connective tissue disorders and inflammatory disorders.
• Immunodeficiency syndrome – Acquired with emphasis on AIDS

 Amyloidosis including pathogenesis, special stains & clinical correlation.  Transplant rejection in detail  Graft Vs Host Disease

3.2 Practical

 Histopathology  Histological techniques

•  Principles of grossing  Fixation and fixatives.
•  Tissue processing and microtomy
•  Theory of staining and its implications
•  Details of haematoxylin and eosin stain
• Principles of special stains used in histopathology with their practical applications.
•  Processing of bones
• Immunocytochemical,          enzyme,          histochemistry,          immunoflourescence techniques
•  Details, techniques and uses of immunohistochemistry.
•  Internal and external quality control and management of laboratory.
• Principles & application of all types of microscopes e.g. light, electron, fluorescence etc.
• Block cutting,
• Staining - routine (H & E), 
• Mounting and labelling of slides 
•     Special stains  PAS stain
•  ZN stain
•  Reticulin stain
• Masson’s trichrome stain  Cytopathology
• Fixation & staining of smears
• Processing of fluid specimens  Cyto centrifugation
• Filtration procedures
• Liquid based cytology
• Preparation of cell blocks
• Stains 
•  Pap stain
•  Ziehl Neelsen stain  Giemsa stain
•  H & E stain

 Haematology  

•  Interpretation of a Hemogram 
• Preparation & examination of blood & Bone marrow with relevant special stains
•  Bone marrow aspiration & biopsy procedure   ESR  
•  Reticulocyte count preparation & interpretation of smear for Reticulocyte count  Hemoglobin electrophoresis   Osmotic fragility,
•   BT, CT, PTI, PTTK, FDP, Fibrinogen  G6PD
•   Plasma Hb  Fetal Hb
•  Coomb’s test  Sickling test 
•  LE cell phenomenon 

 Clinical Pathology

•  Complete urine examination with reference to its physical, chemical and special tests.
•  Semen examination – Physical, chemical (pH, Liquefaction time) and microscopic examination.
•  Stool examination – Physical and microscopic examination

 Immunopathology 

•  Agglutination Reactions- Principle, Techniques & practical Applications
•  All tests based on ELISA – Principle, Techniques & practical Applications  Protein electrophoresis – Principle, Technique & practical applications    Immunoelectrophoresis  
•  Detailed knowledge of ANA & ANCA profile 
•  Immunohistochemistry Principle, Techniques & Practical Applications
•  Immunoflourescence – Principle, Techniques & Practical Applications
•  RIA (Radio immunoassay) Principle, Techniques & Practical Applications  PCR- Principle, Techniques & Practical Applications
•  FISH, CISH, SKY -Principle Techniques & Practical Applications
•  Flow Cytometry- Principle, Techniques & Practical Applications
•  Blot techniques – Principle, Techniques & Practical Applications  

 

4. Teaching Programme

4.1.  General Principles

•  Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training is skills oriented.
•  Learning in postgraduate program is essentially self-directed and primarily emanating from clinical and academic work. The formal sessions are merely meant to supplement this core effort.

 

4.2. Teaching Schedule

1. Journal Club	Once a week
2. Subject seminar	Once a week
3. Slide discussion	Once a week
4. Central sessions.	Once a week

5. Postings

Residents should be posted in all the sections – Histopathology, Cytopathology, Hematology, Clinical Pathology and immunology during all the 3 years.

6. Thesis 

6.1.  Every candidate shall carry out work on an assigned research project under the guidance of a recognized Postgraduate Teacher, the project shall be written and submitted in the form of a Thesis.

6.2.  Every candidate shall submit thesis plan to the University within the time frame set by the university.

6.3.  Thesis shall be submitted to the University six months before the commencement of theory examination i.e. for examination May/June session, 30^th November of the preceding year of examination and for

November/December session 31^st May of the year of examination.

6.4. Identify a relevant research question; (ii) conduct a critical review of literature; (iii) formulate a hypothesis; (iv) determine the most suitable study design; (v) state the objectives of the study; (vi) prepare a study protocol; (vii) undertake a study according to the protocol; (viii) analyze and interpret research data, and draw conclusions; (ix) write a research paper. 

7. Assessment

• All the PG residents are assessed daily for their academic activities and also periodically.

 

7.1. General principles

•  The assessment is valid, objective, and reliable. 
•  It covers cognitive, psychomotor and affective domains. 
• Formative, continuing and summative (final) assessment is also conducted in theory as well as practicals/clinicals. In addition, thesis is also assessed separately. 

7.2. Formative Assessment 

• The formative assessment is continuous as well as end-of-term. The former is be based on the feedback from the senior residents and the consultants concerned. End-of-term assessment is held at the end of each semester (upto the 5th semester). Formative assessment will not count towards pass/fail at the end of the program, but will provide feedback to the candidate.

 

7.3. Internal Assessment

The performance of the Postgraduate student during the training period should be monitored throughout the course and duly recorded in the log books as evidence of the ability and daily work of the student. Marks should be allotted out of 100 as followed.

                          Sr. No.                      Items                                                         Marks

1. Personal Attributes                                               20
2. Practical Work                                                       20        3.                     Academic activities                                              20

4. End of term theory examination                    20
5. End of term practical examination                20         

1. Personal attributes:

Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable in emergency situations shows positive approach.

Motivation and Initiative: Takes on responsibility, innovative, enterprising, does not shirk duties or leave any work pending.

Honesty and Integrity: Truthful, admits mistakes, does not cook up information, has ethical conduct, exhibits good moral values, loyal to the institution.  

 Interpersonal Skills and Leadership Quality: Gets on well with colleagues and paramedical staff, is respectful to seniors, has good communication skills. 

 

2. Practical Work:

 Availability: Punctual, available continuously on duty, responds promptly on assignments and takes proper permission for leave. 

 Diligence: Dedicated, hardworking, does not shirk duties, leaves no work pending, does not sit idle, competent in practical work.

 Academic ability: Intelligent, shows sound knowledge and skills, participates adequately in academic activities, and performs well in oral presentation and departmental tests.  

 Performance: Proficient in presentations and discussion during academic sessions in the department.

 

3. Academic Activity: Performance during presentation at Journal club/ Seminar/ Case discussion/ Stat meeting and other academic sessions. Proficiency in skills as mentioned in job responsibilities.  

 

4. End of term theory examinations conducted at end of 1^st, 2^nd year and after 2 years 9 months.

 

5. End of term practical/oral examinations after 2 years 9 months.

 

•   Marks for personal attributes and work done should be given annually by all the consultants under whom the resident was posted during the year. Average of the three years should be put as the final marks out of 20.

 

• Marks for academic activity should be given by the all consultants who have attended the session presented by the residents. 

 

•  The Internal assessment should be presented to the Board of examiners for due consideration at the time of Final Examinations. 

 

7.4. Summative Assessment

•  Ratio of marks in theory and practicals will be equal.  
•  The pass percentage will be 50%.  
•  Candidate will have to pass theory and practical examinations separately.  

 

A. Theory examination (Total = 400 marks)  

                          Title                                                                                         Marks

Paper 1:  Patho-physiology and General principles of Pathology

100 including Applied Pathology

Paper 2:  Immunopathology, Molecular Biology, Cytogenetics and

100  Experimental Pathology including Cancer Research

Paper 3:  Histopathology - Cytology including recent advances in

100 

the concerned Topics.

Paper 4:  Haematology, ImmunoHaematology & Blood Transfusion

100  with Recent advances in the concerned topics.

 

 

B. Practical & viva voce examination (Total = 400 marks)

     

Splitting of marks: Total 300

 

Practical Examination (300 marks) is conducted over two days and the student evaluated out of 300 marks which is distributed as follow:

1. Clinical case with routine and special haematology test (25 marks)
2. Haematology slides 10 slides (100 marks)
3. Cytology slides 5 slides (50 marks))
4. Histopathology slides – 10 slides (100 marks)
5. Grossing and histopathological techniques (20 marks)
6. Spots (5 marks)

 

           Oral: 100

8. Job Responsibilities

•  Reporting in Clinical Pathology  Routine hemograms.
•  Routine urine examination  
•  Routine Stool examination.
•  Cytology of fluids like CSF, Pleural fluid etc.
•  Perform procedures 
• Grossing
• Bone marrow aspiration & Biopsy
• Fine needle aspiration 
•  Attend reporting sessions with consultant in  
• Histopathology
•   Cytopathology
•  Haematology
• Interpret under supervision all Immunopathology techniques & special              haematology techniques.  
•  Assist in undergraduate teaching especially practical classes.

 

9. Suggested Books

9.1 Core books

•               Basic Pathology by Robin’s                                   
•              Surgical Pathology by Ackerman                                   
•             Cytopathology Atlas (McKee)
•              Diagnostic Cytopathology (Gray)              
•              Wintrobe’s Clinical Hematology                                      
•              Practical Hematology (Dacie)                               
•              Essential immunology (Roitt)                                

9.2 Reference Books

 WHO Fascicles 

•              Silverberg’s Principles and practice of Surgical                         
•              Diagnostic Cytopathology (Koss)                                    
•              Comprehensive cytopathology (Bibbo)                
•              Cytopathology (Naib)                                            
•             Diagnostic cytopathology (Orell) Pathology & Cytopathology
•              Greenfield’s Neuropathology                                                      
•              Heptinstall’s pathology of kidney                                     
•              Lever’s histopathology of skin                   
•              Primer of Dermatopathology                                 
•              Pathology of Placenta (FOX)                                
•             Schiffer’s Brain Tumors
•              Liver biopsy interpretation (Scheuer)                  
•             Tumors of Fetus and Newborn (Isaacs)
•               Dahlin’s Bone tumors                                            
•               Urological Pathology            (Murphy)                  
•              Spencer’s Pathology of Lung                               
•              Cardiovascular Pathology (P Chopra)      
•  Williams Pathology of GIT  Clinical diagnosis and                                                                                                  management by Laboratory methods   Postgraduate hematology (Hoffbrand)         Immunopathology – Lobo & Stites.
•  Blood Cells – A Practical Guide (Barbara Bains)  

 

9.3 Journals 

•  Indian Journal Of Pathology & Microbiology
•  Indian Journal Of Haematology & Transfusion Medicine
•  Indian Journal Of Cytology
•  Cytopathology
•  Acta Cytologica
•  Cancer
•  Archives Of pathology
•  British Journal Of Haematology
•  American Journal Of Pathology
•  Human Pathology

 

10.     Model Test Papers