Pathologists’ Assistant at University of… · San…

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Key Responsibilities

Technical Responsibilities

• Gross Sectioning: Performs routine gross sectioning of various types of specimens, with primary focus on complex cancer specimens: verifies patient information, extracts pertinent clinical history, weighs, measures, dissects, examines, evaluates, sections, inks as required for visualization or orientation, and cassettes specimens; submits specimens including “Rush” by cut-off time; dictates gross description of specimens and clinical data, and documents special instructions; procures tissue as necessary for potential special studies (snap freezing for molecular/genetic/enzymatic studies, electron microscopy, flow cytometry, cytogenetics, etc.); enters Histology data in the computer system; utilizes barcoding system to match requisitions and containers and verify cassettes; loads Histology tissue processors as needed. Standards: Maintains complete accuracy throughout. Submits clear, concise and pertinent dictations. Works proactively with Histology Lab staff to ensure optimal tissue fixation of specimens submitted by the Pathology trainees., and educates Pathology Residents, medical students and staff.

• Frozen Section Diagnosis: Independently obtains and communicates with clinicians/surgeons about intraoperative specimens, performs rapid preparation of H&E-stained frozen section slides for rapid diagnosis by the pathologist. Determines the need to obtain guidance from the attending pathologist regarding orientation, orients and samples the specimen, records sampling methodology, mounts, freezes and sections the specimen using a cryostat. Labels and delivers the slides to the pathologist for rapid diagnosis. As directed, places residual tissue in the appropriate fixative for subsequent processing and communicates specimen handling when handed off. Standards: Applies utmost care when handling and conserving small tissue specimens. Produces cryostat sections with minimal sectioning/staining artifact, and prepares slides demonstrating tissue areas which are representative of the specimen. Utilizes whole slide imaging system when necessary.

• Specimen Receipt: Receives specimens from surgery, clinics and outpatient facilities, ascertains their acceptability against established criteria, investigates incomplete or unacceptable submissions, and provides timely follow-up communication with appropriate individuals/departments/offices to resolve specimen/requisition problems. Contacts clinicians and obtains additional clinical information as needed by the pathologist. Troubleshoots and ensures resolution of specimen receiving problems, including appropriate documentation and communication to pathologist and other MedicalCenter personnel.

  Standards: Follows patient safety standards requiring the use of two patient identifiers. Accessions and labels specimens with complete accuracy, assigns and delivers specimen to appropriate personnel for gross sectioning.

• Accessioning: Initiates appropriate labeling procedures and maintains accurate and complete case and specimen identification throughout subsequent procedures. Accessions specimens into the Pathology computer system as required, using barcoding system. Ensures adequate training of staff to maintain the highest level of accessioning accuracy.

  Standards: Follows patient safety standards requiring the use of two patient identifiers. Accessions and labels specimens with complete accuracy, assigns and delivers specimen to appropriate personnel for gross sectioning.

• Operations: Troubleshoots complex specimen receiving problems, working with pathologists and outside departments as required, including submission of deviation reports and incident reports as needed. As required, performs all operational duties to ensure smooth operations, including specimen receiving, accessioning, daily preparation of lab and assignment board, maintains rapid staining set-up, prepares cryostats and prepares fixative solutions, prepares and places excess specimens into storage/ /discard. Primary responsibility for troubleshooting or ensuring that equipment problems are resolved. Standards: Maintains strict adherence to infection control procedures in preparation and application and frequency of application of disinfectants. Follows guidelines for wearing personal protective equipment and ensures staff and trainees follow those guidelines when working in the Gross Rooms.

• Photography: Photographs gross specimens using digital equipment, for review by the trainees/pathologists, and transfers data to database, when necessary.

• TUG: Consistent with training, UCSF Medical Center Policies, and the TUGs Operations Manual, receives TUGs; removes, distributes and/or places contents in appropriate storage areas; cleans and disinfects TUGs; deploys TUGs; returns TUGs to appropriate holding areas.

• Morgue: May assist with autopsies and other morgue duties.

• Other Duties As Assigned.

Technical EXPERT

• Receives supervision from the Medical Directors, Anatomic Pathology faculty, Site Manager, Supervisor or designees. Works closely with laboratory and other health care personnel.

• Under minimal direction of a supervising pathologist, routinely performs gross sectioning of the most complex surgical specimens as determined by the Medical Director.

• Applies sound judgment during dissection of these surgical specimens according to established guidelines.

• Prepares documentation explaining dissection and tissue selection methodology as needed for the subsequent light microscopic examination by the staff pathologist.

• Trains staff, students and trainees in approaches to specimen dissection and handling.

• Assists in the evaluation of grossing performance of trainees and staff members as requested.

• Advises on grossing standards and grossing manual updates. Incorporates changes on to web Surgical Pathology Manual.

• Standards: Performs sectioning according to methodologies outlined in the on-line dissection guide. Maintains complete accuracy throughout. Submits clear, concise dictations. Maintains high-level communications with trainees assigned to the cases.

MORGUE TECHNICAL RESPONSIBILITIES

• PERFORMS AUTOPSY PROCEDURES:
• Reconciles autopsy permit information pertaining to the decedents to be autopsied.
• Informs trainees about the legal aspects of autopsies and permit requirements associated with the autopsy. Coordinates procedure with trainees, attendings, clinicians and other hospital personnel.
• Prepares tables and instruments for autopsy. Checks body identification to ensure proper decedent is being autopsied. Transfers the decedent from the morgue refrigerator and places the decedent on the table.
• Performs basic and specialized autopsy procedures, such as external examination, organ evisceration, brain and spinal cord removal, organ dissection, tissue sampling, and suturing following established protocols and infection control procedures.
• Decontaminates tables, instruments, and equipment following autopsies and conferences.
• Notifies Patient Relations or ED Registration when autopsy is completed.
• Accurately accessions autopsy data in CoPath.
• Prepares fixatives and other laboratory reagents.

• MORGUE OPERATIONS:
• Responsible for maintaining protocol in the receipt and release of decedents from the morgue, including reviewing release documents for completeness and validity.
• As required, harvests tissue for research projects following protocols, as directed.
• Prepares tissue and organs for conferences, and sets up instruments, including dissecting microscope.
• Maintains pathology specimen filing system. Rinses and bags tissue for disposal under direction of medical director. Labels organs saved at autopsy. Retains and disposes of specimens in the morgue storage room following Dept./Medical Center requirements.
• Prepares decedents for viewing by family members as arranged by Patient Relations or Nursing Services.
• Assists with radiography and photography of specimens, including special diagnostic procedures, and managing digital gross photography archive system.
• Maintains departmental log books.
• Submits census statistics (Daily Morgue Report) of decedents in morgue to Patient Relations and/or ED Registration. Opens morgue at 7:30 a.m., as required.
• Generates (in Excel) and distributes Late List and autopsy On-Call schedule.
• Creates Flowsheet folder and Progress Form for trainees.
• As requested, arranges autopsy reports to be mailed to legal next-of-kin, and clinicians.
• Registers outside cases/specimens, and assigns Insurance Plan Code upon completion of Basic Insurance Concepts, Insurance Master File and Visit Management training.
• Maintains flowsheet filing.
• Assists in reviewing, revising, copying, distributing and editing Autopsy Manual.

• OTHER DUTIES AS ASSIGNED: (including, but not limited to)
• Incumbent performs other duties as assigned by supervisor and/or medical director.
• Incumbent maintains laboratory standards and Medical Center standards.
• Incumbent must be able to work some holidays and work overtime to complete cases, if required.

HISTOLOGY LAB TECHNICAL RESPONSIBILITIES

• ROUTINE HISTOLOGY:

  Provides direction to staff regarding daily workflow. Demonstrates expert technical skill embedding, sectioning, routine and special staining at the expert level, following all technical standards. Completes workload within time deadlines. Meets highest levels of productivity and quality.

• SECTIONING:

  Performs or directs other staff in preparation of the most difficult specimens presenting sectioning problems. Difficult types of specimens may include anything from insufficiently processed specimens to nearly invisible biopsy specimens. Routinely sections specimens following the most difficult sectioning specifications regarding thickness, orientation, serial sectioning, sectioning for PCR and in situ work-up. Maintains the highest level of productivity (20-25 blocks/hour) while preparing superior quality slides.

• CONTROL SPECIMENS:

  Oversight of inventory of control blocks used for special stains. Anticipates needs and requests control specimens from the pathologists, as needed.

• OTHER TECHNICAL RESPONSIBILITIES:

  Proactively troubleshoots and resolves technical problems, communicating with supervisor regarding resolution. In addition to operations oversight of staining and processing areas, manages specific assignments within the lab, e.g. department files, coordination of lab in-services, performance improvement projects, etc.

• LABORATORY OPERATION:

  Maintains QC documentation files. Assists manager as designated in completion of annual safety requirements, which may include annual safety training schedule, air monitoring, respirator testing. Assists in assuring compliance with technical and general policies and procedures. Determines need, advises manager and oversees repair of equipment for the area of responsibility. Provides general oversight of the physical facilities and environment regarding cleanliness, safety and need for repairs, including resolution in the supervisor’s absence. Assists manager in completion of competency assessment.

CYTOLOGY LAB TECHNICAL RESPONSIBILITIES

• ROUTINE CYTOLOGY:

  Provides technical support to the cytology laboratory by forwarding specimens to the cytology laboratory. Technical functions encompass specimen preparation using a wide variety of technical procedures. Preparatory techniques require a high level of accuracy, independent judgment and the ability to produce high volumes of specimens.

• TECHNICAL: Receives a wide variety of fresh and fixed specimens for cytopreparation. Preparation protocols include direct smears for fixation and air-drying, centrifugation, cytocentrifugation, and T2 ThinPrep processing. Prepared slides are stained using specific programs, coverslipped, labeled, and triaged for evaluation by faculty and staff. Gynecological material is accessioned, bar-coded and prepared on a multiload T3 processor. Slides are stained and loaded into an Imager for pre-evaluation. Prepares urinary sample as requested for ImmunoCyt fluorescent testing. Prepares and documents research cases, as requested. Prepares samples for cell blocks, special stains, and flow cytometry.

• MAINTENANCE: Provides basic maintenance and troubleshooting for automation in the lab, including the cassette printer, automatic stainer, coverslipper, ThinPrep processor, multiload processor and imaging station.

• Incumbent performs other duties as assigned.
• Incumbent maintains laboratory standards and Medical Center standards.
• Incumbent must be able to work some holidays and work overtime to complete cases if required.

EM LAB TECHNICAL RESPONSIBILITIES

• ELECTRON MICROSCOPY:

  Performs all technical components of electron microscopy procedures as outlined in the EM Technologist descriptions. Technical components include specimen receipt, gross evaluation, fixation, tissue processing, thick sectioning, ultrathin sectioning, and operation of the electron microscope including electron microscopic examination and photography, and darkroom printing of micrographs. Communicates closely with pathologists regarding diagnostic priorities.

• EM TECHNICAL STANDARDS:

  Maintains and ensures maintenance of all technical standards. Receipt: Selects cortical tissue containing glomeruli for EM and IF studies. Applies non-contaminating technique during specimen grossing to preserve tissue antigenicity. Maintains high level of communication with pathologists regarding specimen quality, amount and adequacy. Documents work promptly, adheres to established processing schedules, maintains complete accuracy in labeling throughout, and adheres to Standard Precautions and chemical safety standards. Thick sectioning and Ultramicrotomy: Pre-trims blocks according to specification, leaving clear supporting resin surrounding tissue. Cuts sections which are free of sectioning and staining artifact. Performs precision final trimming of block to prevent tissue damage and/or loss. Orients block precisely in the ultramicrotome to minimize tissue loss during set-up. Prepares thin sections free of section contamination and sectioning artifact(wrinkle free, no compression or chatter), as well as cuts at the appropriate thickness. Prepares consistently clean and well-stained sections, which possess good contrast, which delineates ultrastructural detail. EM Examination and Photography: Applies good judgment in determining the amount of photography required to document pathologic features as well as unexpected features. Maintains high level communication with pathologists regarding diagnostic needs for each case, and communicates EM findings immediately upon completion. Digital photographs must be “well-composed”, to include low magnification survey photographs and appropriate higher magnification photographs which demonstrate pathologic ultrastructure. Maintains accurate log documentation of microscope usage. Maintains a high level of communication with technical manager regarding problems encountered. Utilizes non-contaminating technique to maintain the microscope in optimal operating condition. Assists trainees and medical students with interpretation of cellular ultrastructure. Darkroom printings: Photographic prints must be sharply focused and possess optimal contrast to demonstrate cellular detail. Accurate labeling of prints.

• IMMUNOFLUORESCENCE MICROSCOPY:

  FROZEN TISSUE PREPARATION, SECTIONING AND STAINING FROZEN SECTIONS WITH FLUORESCEIN LABELED ANTIBODIES FOR PATHOLOGIST’S EXAMINATION: Mounts, orients and freezes various biopsy specimens at –25°C. Cuts serial frozen section slides using a cryostat after first level sectioning into tissue and identifying required tissue structures. Performs direct or indirect immunofluorescence staining procedures on sections which require fixation, washing, and staining with fluorescein conjugated antisera—up to 9 antisera treated slides at one time. Coverslips slides. Stains H&E slides on frozen sections. Maintains tissue files in ultralow freezer. Standards: Freezes specimen rapidly to prevent freezing artifact. Mounts specimens in the same sectioning plane. Cuts sections of consistent thickness and positions sections in the same location on each slide, conserving tiny specimens. Orients skin biopsies with epidermal/dermal junction present. Accurately dilutes antibody reagents. Uses non-contaminating technique throughout. Mounts sections free of bubbles and artifacts.

• MUSCLE HISTOCHEMISTRY:

  FROZEN TISSUE PREPARATION, SECTIONING AND HISTOCHEMISTRY. Divides fresh specimen for EM, LM and Histochemistry. Mounts, orients, snap-freezes and stores the histochemistry sample according to stringent guidelines. Cuts 10 micron serial sections using a cryostat, collects 10 slides for duplicate staining: H&E, Trichrome and routine histochemistry staining panel. Performs other Histochemistry stains as requested. Standards: Performs optimal mounting, maintaining cross-section orientation of fibers. Freezes the specimen under optimal conditions—ensures proper freezing and storage to minimize freezing artifact. After freezing, maintains the specimen in optimal low-temperature conditions throughout subsequent handling. Cuts flat sections to minimize trapping of reagents. Maintains exacting preparation and staining standards. Independently troubleshoots technical problems.

• NERVE TEASE: SPECIMEN PREPARATION AND TEASING(MICRODISSECTION).

  Prepares nerve tease specimens for micro-dissection utilizing initial dissection, osmication, and infiltration with glycerol or resin. Dissects nerve sheath from fibers, and performs micro-dissection of individual fibers from nerve bundles using a stereomicroscope and micro-dissection needles. Manipulates and mounts individual fibers on to a glass slide for examination by the pathologist. Individual fiber dissection requires performing extremely fine hand manipulations over the course of several hours, taking care to maintain visualization of individual fibers during and upon completion of dissection. Standards: Maintains longitudinal orientation and maintains visualization of individual fibers throughout processing and handling.