Resident Rotation Instruction

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UAB IHC Laboratory

Resident Rotation for Immunohistochemistry (IHC)

Goals

To provide physicians-in-training with the opportunity to develop a thorough understanding of the role of IHC and its interpretation in diagnostic surgical and cytopathology. In addition, the physicians-in-training should obtain a basic understanding of the technical aspects of IHC procedures.

Length of rotation: One-month rotation.

Requirement: Elective.

Prerequisite: Preferably to have at least 3 months experience in surgical pathology.

Director: Daivd C. Chhieng, M.D., M.B.A.

Lead Technician: Debra Horton, M.T. (ASCP)

Objectives

1. Develop a technical understanding of both manual and automated methods in the IHC laboratory.

2. Understand the impact of fixation and methods of tissue pretreatment in affecting the quality of IHC.

3. Learn CPT coding as it relates to IHC.

4. Be able to recommend appropriate and properly interpret immunohistochemical staining panels for the different differential diagnoses.

5. Be familiar with immunohistochemcial panels for common diagnostic problems e.g. carcinoma vs mesothelioma, small blue cell tumors, etc.

6. Be familiar with immunostains for prognostic markers e.g. c-erbB2, EGFR, and MiB1 etc.

7. Be familiar with immunostains for detection of infectious organisms e.g. CMV, H. pylori, etc.

Overview of Duties and Responsibilities

1. The physician-in-training will spend a brief period of time in the IHC lab with the lead technologist, who will discuss the operation of the automated immunohistochemistry instruments, the daily workflow in the IHC lab, and billing of IHC procedures in surgical and cytopathology.

2. He/she will also spend time in Dr. Grizzle’s lab to learn and observe manual performance of IHC. Please contact Rob Stockard at 5-5696 at the beginning of the rotation to set up a time.

3. He/she will be responsible for the daily quality assurance/control evaluation of all of the pathologist-ordered IHC stains prior to the distribution of the slides to the ordering pathologist. If an immunohistochemical stain has questionable features, he/she will immediately bring this to the attention of the technician and/or teaching faculty member.

4. He/she is also expected to present a 30-minute presentation on a topic related to IHC to the IHC laboratory technical staffs and director at the end of his/her rotation. The topic to be presented will be selected during the first week of rotation.

5. He/she will also assist in the development of IHC study set.

6. As opportunity provides, the physician-in-training will participate in the evaluation of new antibody including literature review, selection of vendor, appropriate antibody pretreatment, selection of antibody titer and incubation time, and evaluation of antibody performance.

7. The physician-in-training will also be expected to participate in CAP laboratory inspections and CAP proficiency tests if such opportunity arises.

8. The physician-in-training is expected to be available to laboratory personnel, either in person or by pager, throughout the working day.

9. The physician-in-training is encouraged to initiate or participate in research activities involving IHC e.g. evaluation of new/current antibodies or antibody panels for diagnostic and/or prognostic purposes under the supervision of IHC director or any pathology faculty.

Basis and Method of Resident Evaluation

The physicians-in-training are provided with continuous feedback on their performance throughout their rotation. They are evaluated on their demonstrated ability to provide informative consultation to the service teams, their medical knowledge, their application of this knowledge to efficient/quality patient care, their diagnostic, technical, and observational skills both in the laboratory and at the microscope, and their interpersonal skills, professional attitudes, reliability, and ethics with members of the teaching faculty, peers, laboratory staff, and clinicians. They are also evaluated on their use of medical literature and other resources as well as their presentation skills.

Recommended Reading

1. Dabbs DJ: Diagnostic Immunohistochemistry, Churchill –Livingstone, New York, 2002.

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