Molecular Pathology Rotation

Molecular pathology is a vital and growing division in the Department of Pathology and Laboratory Medicine, and this area is the future of the practice of pathology. Among the anatomic specialties, pathologists are using molecular assays for detection of chromosomal recombinations for diagnosis and prognosis of various neoplastic entities. In clinical pathology specialties, genetics and infectious disease diagnosis are prominent as molecular-based technology redefines these areas. Thrombophilia is evaluated by molecular probe technology, and lymphoma/ leukemia is studied molecularly for diagnosis. The molecular biology of these afflictions already dictates the treatment of these patients. Within the field of microbiology, numerous probes and amplification assays are available for the rapid diagnosis of bacteria and viruses and emerging microbes, such as West Nile Virus and the SARS associated viruses. Therefore, it is critical for pathology residents to understand the language, techniques and applications of molecular pathology testing and results.

Rotation Structure

The 6 week Molecular Pathology rotation provides an introduction to the specialty, during which residents learn or review the language of molecular pathology and core concepts of DNA and RNA related technologies, such as probe techniques, PCR, TMA, microarray and other molecular tools. The methods of instruction include didactics on a daily basis, rounding in the laboratory, physician interaction with technical specialists/experts (clinical laboratory scientists), bench experience, epidemiologic experience, and laboratory management experience.

Specific Competency Goals and Objectives

Patient Care:

  • Describe molecular testing methods for inherited causes for thrombophilia, such as factor V Leiden, prothrombin 20210 mutation, MTHFR, and platelet glycoprotein III polymorphisms (PIA 1/2).
  • Apply molecular testing methods to neoplasms for patient diagnostic, prognostic and therapeutic decision making.
  • Describe molecular testing methods and interpretation for cystic fibrosis diagnosis and screening.
  • Discuss qualitative and quantitative methods used to determine viral load.

Medical Knowledge:

  • Describe basic molecular biology concepts and language.
  • Identify the different techniques for identifying DNA and RNA.
  • Appropriately apply molecular techniques in different circumstances and for different sample types.
  • Explain the different sample types, their preparation, and appropriate storage for molecular biology tests.
  • Illustrate the use of Bayesian analysis for risk assessments.

Interpersonal and Communication Skills:

  • Effectively interpret and clearly report molecular results in association with pathologic and laboratory findings and clinical history to reach a final diagnosis.
  • Demonstrate the ability to make recommendations for follow-up or confirmatory studies.

Professionalism:

  • Recite the legal, ethical, and social implications of genetic testing.
  • Discuss molecular findings with appropriate concern for patient confidentiality.
    Report all findings in a timely and effective manner.
  • Attend all required conferences, didactics and bench assignments; complete all reading assignments.

Systems-Based Practice and Practice-Based Learning:

  • Relate the the unique billing issues in molecular pathology.
  • Explain quantitation of purified DNA by spectrophotometry/fluorometry and QC of DNA preparations.
  • Review the literature to evaluate new molecular markers of disease.
  • Develop expertise in the use of web-based genomic data bases.