Season's Greetings

I wish all of Canada's PAs the very best over the holiday season as well as a happy, healthy and prosperous new year.

See you in Ottawa!

Remote/virtual Endoscopy 'hiccup'

The image at the top right shows a virtual endoscopy probe that has become lodged in a segment of small bowel. The patient had chronic Crohn's disease and, as a result, had multi-focal small bowel strictures; one of which is immediately distal to the probe. The probe created a complete obstruction, exacerbated local inflammation; necessitating the excision of the segment.

I was sorry to see that the batteries had died by the time the specimen arrived in our department (the unit flashes four LED lights every 4 seconds or so). We could have smiled for the camera!

This specimen clearly indicates a contra-indication to virtual endoscopy; ie. in some patients with known chronic Crohn's ileitis.

Time for Change

One of the sub-committees of the PA Section of the CAP has as its mandate the brushing-up and maintenance of a web site for Canada's PAs. So as to avoid stealing any of that site's thunder, as it were, you will notice a few changes on this site; focusing more, I hope, on images and other medical or pathological-based issues confronting PAs. I considered going the other way; writing about issues of a more personal nature but I'm sure you would be bored and quite frankly, I don't have enough interesting stuff to share!

So, accordingly, I'll try to hunt down some interesting images and will re-post as soon as I'm able.

I want to say how glad I am to hear that there are so many people who check this site from time to time. For some, this site has actually served the purpose for which it was created.

job and job

To clarify my 2nd-last post, the filling of the Penticton PA position with an experienced PA is not likely to happen in the near future. That leaves two positions: Kelowna (full time) and Vernon (maternity leave x 1 yr or so; beginning no later than April, 2008).

The most recent edition of the CAP Newsletter has a nice, long piece on PAs which, by its length, is rather flattering. Unfortunately, its content, although valuable, is dated in that all of it precedes the AGM in Toronto and does not cover any of the more recent developments. Fortunately, many of you (those who have joined the CAP) have received the e-blast from the PA Section Executive Committee. The problem is that the general membership is unaware of recent achievements, like the formation of the sub-committees, their chairpersons, and their mandates. The pathologists need to be apprised that the PAs are organized and are actively pursuing their mandate (namely, the advancement of standards of excellence of the profession by agreeing upon national key competencies, an accredited curriculum, grand-mother/fathering of practising PAs, the organization of the PA Section's portion of the 2008 AGM, to name but a few). There may be an explanatory comment penned for the next Newsletter.

I was encouraged to learn recently that UBC's PA training programme (MSc) is well on its way to fruition. My hope is that the CMA Accreditation Office will be involved in the process so that this, or a slightly altered, curriculum will be nationally accredited so that PAs can be trained with a standardized curriculum and will be able to work anywhere in the country. This will, I believe, hasten and facilitate the development of provincial regulatory colleges for the profession (or the inclusion of the profession in colleges that already exist).

I have a thorny issue about which to ask your opinion: when considering that which defines a PA, does one take the term literally ("I assist a Pathologist") and thus include all those who do one, but not both, of surgical pathology or autopsy pathology OR does one insist that the only true PA is one who performs all of the duties listed in the key competencies? There are a significant number of individuals who are in one, or the other, category. Are they to be excluded? Does one create more than one category of PA? Or does one accept all comers? If so, how does one create guidelines and maintain standards?

As you know, the nation's pathologists (or at least those belonging to the CAP) are in the process of arriving at workload guidelines for pathologists; hopefully by the end of the year. The guidelines will consider whether the facility is an academic one or not. Will they also consider whether or not PAs are employed? They should (and I have not heard that they will). If they do not, they will discount the valuable aspect of the process of generating a surgical (or autopsy) pathology report which is provided by PAs and, of course, will potentially over-value the remainder. Pathologists practising at those institutions which do not have PAs will be the first to tell you how important the Gross Description is to the final report. Those who are assisted by PAs may take for granted this aspect of the report, much as the valuable technical work preformed by Medical Laboratory Technologists might be assumed to be a 'given.' PAs have been in existence for so long; a significant number of pathologists who have done their residencies and all of their practices to date with PAs have been conditioned to believe that PAs are part of the system and will naturally feel that their (the pathologists') workload (and salary) 'assumes' the existence of PAs. It should be no different for facilities that do not have PAs. That is, the expectation of the pathologist to sign-out cases who also has to do the Gross, should be upwards of 1/3 less than for the pathologist who has the assistance of a PA. PAs should do whatever they can to ensure that the CAP's pathologists include the PAs' portion of the day-to-day work in a pathology department in their deliberations on this subject. You are no doubt aware that Cytotechnologists are limited to a maximum number of slides that they are expected to view each day and, in fact, each hour. Beyond this number, the thinking goes, the quality of the output decreases (that is, the chance of error increases). The same principle ought to exist for PAs; they should be expected to examine only a certain number of surgical specimens within any day, or hour. The L4E workload system works very well in quantifying the workload of pathologists. It can work equally well for PAs, proportionately. If a PA, performing gross descriptions on surgical pathology specimens, is doing about 1/3 of the work of a pathologist, it will be an easy task to calculate the maximum allowable workload of a PA. Beyond the maximum, it will be assumed that the quality of the work is in jeopardy. This amount, once quantified, should be included in the guidelines and key competencies for PAs; presently being considered by the CAP, the PA Section of the CAP and the CMA Accreditation Office.

More on this subject later...

The importance of procedures...

I cannot emphasize enough the importance of having grossing procedures in place. This may sound like a simplistic statement, especially for those of you who have always had procedures to which you can refer, but for those of you who do not have the benefit of a procedure manual, its benefits may not be immediately obvious.

The creation of a grossing procedure should involve all appropriate staff members before the final version if put into force. All should have the opportunity to read, to make inquiries, and to offer comments or criticism to a new procedure during its writing. Those with additional special knowledge, including broader available resources (eg. the College of American Pathologists), should especially be consulted. From these sources, insights into the rationale for handling a particular specimen in a particular way can be added to the procedure. Once the final version has been agreed upon, it should be distributed to all (or its location on the network -- or shelf -- provided). The procedure is then recognized as constituting 'best practice' and will apply to all cases. All staff will read, and document that they have done so, the manual (annually). This will afford the opportunity for periodic revision of the procedure.

When grossing, the procedure shall be adhered to in all cases except where cases dictate that certain deviations are appropriate (in this instance, the identity of the pathologist with whom the case was reviewed shall be given in the Gross). The knowledge that cases will be handled in a particular manner provides stability and consistency to the quality of the provision of care that a pathology department is able to provide. Everyone knows where they stand -- and where everyone else stands. Quality systems prescribe that procedures must be in place for this reason. The complete manual instantly becomes the primary training resource and reference for newcomers to the gross room, whether PA or Resident Pathologist. Those working in the gross room benefit by knowing that, abiding by the manual, they are providing the best possible 'product' and thus derive a sense of belonging, security and even pride -- rather than operating in a vacuum without valuable information; yet still expected to provide a consistent, excellent product. This scenario may result in a feeling of alienation and fear and resentment by the PA. The manual may provide a reference in the instance where a patient has a question concerning the handling or her/his specimen and thus gives a feeling of confidence to the patient, and her/his clinicians; that consistently high quality of care was provided.

Grossing templates are a form of procedure; they also go a long way to providing quality and consistency in grossing (in the same manner in which microscopic synoptic reports provide quality and consistency to the diagnosis of cancer cases). PAs are very good at following procedures, as long as they are aware of them. If a procedure is NOT in place, who is at fault for not following it? Here's another: Who is at fault if special knowledge is not disseminated and a specimen is handled inappropriately as a result? Who judges that which should be known? How is it documented that information has been disseminated, read and understood? How is competency determined?

It is the responsibility of all, but especially of the pathologists whom we assist (they're the ones who sign the reports), for the sake of our patients, that all special knowledge affecting the appropriate handling of all specimens be communicated. Official lines of communication between pathologists (those who are responsible for having the special knowledge) and PAs (those responsible for employing parts of that special knowledge) are generally undefined. Assumptions should not be made and the process should be transparent to all.

jobs jobs jobs

If you are interested in working in the Okanagan region of British Columbia, will you please give me a call? I'd like to talk to any experienced PA who is interested in

1. full-time, permanent employment in Kelowna.
2. Additionally, I'd like to hear from you if you'd like to do a 2-week locum in Kelowna.
3. If you're a Histotech that has been trained up as a PA; your Histology skills are not too rusty, and you'd like to consider working in Penticton as a PA-Histotechnologist, please contact me (again, this is a full-time, permanent position).
4. Lastly, give me a ring if you'd like to cover a maternity leave (PA) in the spring, 2008, in Vernon (possibly up to a year).

Kelowna is the busiest site by far (but has two PAs and myself; Vernon and Penticton each do about 1/2 the volume of Kelowna -- each has one PA position; each also helping in the Histology lab).

One of these jobs just might be the opportunity that you've been looking for and, just think?!, it's in the Okanagan. What a great place to live (or visit), in any season!

email william.stinson@interiorhealth.ca)
phone (250) 862-4300 (ext. 7273)

Back in the saddle

I was wrong; it wasn't the hard drive (although the computer geek thought so at first too...and sold me a new one) and the root of the problem wasn't the 'bad' strip of RAM (bought one of those too). It was the mother board/CPU. So the old PC is toast and I have a new shiny PC under the desk. I'm having real problems using email but everything else seems to be functioning just fine. I have to say that the folks at Computer Central in Westbank were really nice and they were kind enough to refund everything that I had spent during the diagnostic process and put it toward the new machine. They (thank goodness!) managed to get all my files, images, contacts, etc. off of the old hard drive and copied them over to the new. What a relief!

You're probably pretty tired of looking at the image of the ectopic pancreas so I thought the first thing I ought to do is change it. In its place are 2 shots of a gastric lesion which has an hemorrhagic, ulcerated surface. On cut surface, it is solid, firm, moderately hemorrhagic and extends through the full thickness of the wall to within less than 0.1 cm of the serosa. Microscopy (much like an image which I posted last year) is consistent with a gastro-intestinal stromal tumour. The difference with this mass is that it is somewhat better circumscribed and may be less likely to metastasize.

It's beginning to look like I'll be training, with the pathologists' assistance, a new PA for the Interior. This should happen some time within the next 2 months (the sooner, the better). I have been trying for some time to source a replacement for one of our PAs who resigned within the last few months. With about 20,000 surgical pathology cases at Kelowna General Hospital, the two remaining PAs (including myself) have certainly been kept out of mischief (and that's a very good thing!).

I should report a most pleasant development. I have made inroads into assisting with the autopsy service recently. I had cut a brain or two from time to time but hadn't been involved in the case from the start (clinical history, all of the dissection, reporting, etc.) until now. I know that many of you will have a hard time believing that insofar as you are responsible for ALL of the duties surrounding autopsies save for the micro sign-out; and it has been this way since you were hired. It has been a long, slow process to break in to the autopsy service here in Kelowna and there's a long way to go. There are very few cases. The PAs have been kept very busy dealing with the grossing of surgical pathology specimens. The pathologists can't be expected to simply take me at my word (that I have some experience in autopsies); I have to prove myself all over again. This isn't all bad; in fact, I consider it yet another challenge that I am more than willing to take on. As always, I wish there was a way to convince the clinicians to ask for more autopsy consents. The autopsy is too good a teaching tool for PAs and Residents to let it fade into nothingness.

On a personal note, I have taken up bicycling in a moderately big way. I bought a new lighter bike and am riding to work every day. I haven't been run over yet (although I have had several near-misses). I have certainly learned how to change a flat tire (the shoulders are strewn with lots and lots of broken glass). My legs, if I ignore the pulled muscle on the right side, are gradually getting stronger and the hills are [VERY gradually] getting smaller and smaller. If I can keep a semblance of muscle tone over the winter, I'll likely be re-gearing in the spring (so that I can go FAST!).

I'm still enjoying kayaking on Lake Okanagan. I have yet to sell my Ottawa house and have therefore not yet purchased an abode in Kelowna (wanna buy a house?!).

That's enough for now. I'll comment on developments with the PA Section of the CAP (for those of you who are not members -- and therefore did not receive the recent communique) next time.

Now I have to see if I can remember how to post these images! Wish me luck.

dead home PC

My home PC is dead and has been that way for about a month. I think it's the hard drive. There'll be no posts until I get it fixed and backed-up; sorry.

Congratulations!

Congratulations to Canada's PAs on the successful completion of the first annual general meeting as a Section of the Canadian Association of Pathologists! What an exciting time this is for us! Despite not attending, I could feel the excitement from all the way out here in BC. Elections were held for the inaugural Executive Committee (thank-you for electing me Secretary-Treasurer -- barely beating out a fellow Okanagan PA, Danielle Lee), the list of key competencies was discussed, and grandmother/fathering was touched upon briefly but, most importantly, Canada's PAs took a giant step forward in the recognition that the PA, and the product that s/he provides, is valued and that all of that day-to-day slugging is worth it after all. In my new role, I expect that I'll provide a more thorough summation of the meeting on the PAs' web site, so please check it out in the next week or so.

I am told that there were a number of those in attendance who had voiced an interest in the PA position in Kelowna (full-time, permanent). IMPORTANT: if you wish to apply, please send me your resume within the next 2 -3 days (william.stinson@interiorhealth.ca ) and please call me ((250) 862-4300 (ext. 7273)).

I also understand that there had been some interest in the vacant Penticton PA position. Although it appears that I am bound to train an individual from within for this position, I would still be very interested to learn the names of those who are genuinely interested in applying, if this job is posted at some future date. Penticton is a smaller centre in which the PA position would, like that in Vernon, be a combination of grossing and assisting in the Histology lab. So, I'd be interested in a PA/Histotechnologist who is, or is able to be, registered with the CSMLS and who's Histo skills are not too rusty. Please feel free to contact me. Unlike the Kelowna position, there's no great rush for this position; I expect that training may begin in the fall.

I'll likely have more to say later but, right now, I'm on my way to work. It's a fabulous Okanagan day. I think I'll take my bike.

CIHI resurfaces!

Those of you whose employers monitor performance, in part, by following workload will be pleased to hear that the application which I submitted in 2003 (!) has finally made it to the point where it, along with many others, is being discussed. As you know, virtually nothing that PAs do is accurately reflected in the the workload units. For example, each surgical case described, regardless of its complexity and regardless of how many specimens make up that case, earns 4 units. Fashioned somewhat after the model provided by the pathologists -- wherein they charge a larger and larger fee depending upon the complexity of the specimen -- the PAs will soon be able to claim workload units more commensurate with their efforts. For those PAs who do autopsies (ie. the history, the dissection, the interpretation and recording), units will soon be allocated for that too.

In many instances, the units generated will more accurately reflect how busy the PAs really are and may justify additional resources and personnel. Comparison form PA to PA and from PA to other staff will be enabled. This is the wish of the CIHI: that the units more accurately reflect the real-life situation in labs across the country. If the time studies are performed honestly and accurately, the resultant workload units will be accurate. Then, if the wording of the units is succinct and understandable such that there is no chance to claim duplicate, or additional units for the same task; and if those claiming the units use them in the manner intended, the resultant number will be a true reflection of per staff workload and the per unit workload.

It is encouraging to know that this issue is proceeding.

For those of you who will be attending the CAP AGM next weekend, I'd appreciate your consideration (and vote please!) as I shall be offering my services for several executive positions from Chair, to Vice Chair, to Secretary and several sub-committee chairs. Please make sure that you vote (whether you attend the meeting or not). I am told that a method for voting by proxy will be communicated to the CAP members very soon. Also, if you are unable to attend but would like to offer your services on a committee, please make sure that you let Lloyd Kennedy (interim Chair) know via the CAP Secretariat.

A permanent, full-time PA position at Kelowna General Hospital has been posted. I would welcome all applicants' resumes. Please apply within the coming week. The salary is at the Tech III level. You will be given advanced standing on the pay scale depending upon your past experience and a Qualification Differential is added to your salary for degrees which you have earned (eg. MSc = ~$100/month). Depending upon when the successful applicant can start, I may be able to hire a locum or two within the next month or so also (same salary, plus travel and accommodation). The bonus (of course) is the fantastic summer weather in the Okanagan combined with the resort atmosphere, the lake and all of the activities that take place on it and near it.

I will post a new picture within the next week. I am still working on adding the feature whereby the reader can click on the microscopic image and it will open Spectrum Webviewer. Your patience is appreciated.

At the CAP, one of the discussions will concern the listing of Key Competencies (of PAs). This is basically a job description; describing that which constitutes a PA. I am sure that the discussion will involve a large number of people who have differing ideas of what should be, and what need not be, included. The document was distributed by the CAP Secretariat earlier this week. Don't hold back. Make your feelings known. If you want to expand upon, or reduce, the scope of the list, make sure you say so.

most recent publications

A few things that some of you might be interested in:

1. Plasmacytoid Urothelial Carcinoma of the Urinary Bladder, Report of Seven Cases. K. T. Mai, P. C. Park, H. M. Yazdi, E. Saltel, S. Erdogan, W. A. Stinson, I. Cagiannos, C. Morash. Case Study of the Month, European J Urology 50 (2006) 1111-1114.

2. The 3-Dimensional Structure of Isolated and Small Foci of Prostatic Adenocarcinoma, The Morphologic Relationship Between Prostatic Adenocarcinoma and Prostatic Intraepithelial Neoplasia. K. T. Mai, B. F. Burns, W. A. Stinson, C. Morash. Research Article, Appl. Immunohistochem Mol Morphol 15(1) 2007: 50-55.

And something a little older:

3. Proposed technique for sectioning of mastectomy specimens and submission of tissue for microscopic examination of breast carcinoma. K. T. Mai, H. M. Yazdi, B. F. Burns, D. G. Perkins, D. Mirsky. Correspondence, Histopathology 39, 2001: 323-327.

Spectrum Webviewer

With Quorum Technologies' able assistance, I'm going to try to allow access to a web-based version of Aperio Technologies' software called Spectrum Webviewer - simply by clicking on the image. The images that I have been posting are far too small to appreciate anything even remotely subtle. This will enable manipulation of the images, zooming in and out, etc. Wait 'till you see it! It's pretty neat.

Much ado

You may notice that a couple of my previous posts have been edited and re-posted.

I regret that my comments may have caused some consternation.

New Image

The images illustrate an interesting case that I saw recently. This young male patient had a long history of recurrent pancreatitis of unknown etiology. He was otherwise healthy. A Whipple's procedure was performed and we found an area of thickening in the wall of the duodenum adjacent to the Ampulla of Vater (gross image) which turned out to be ectopic pancreas (micro image). Notice in the gross image that the pancreatic tissue is between the mucosa and serosa. The bile and pancreatic ducts were markedly ectatic and the pancreas was diffusely fibrotic.

Professional Extenders?

Many of you have no doubt read with interest the one-page article in the Winter, 2007 CAP Newsletter entitled Professional Extenders for Pathologists, authored by Dr. Raymond Maung. Dr. Maung states that he intends to discuss this issue at the CAP AGM in June. There are many points within the article with which I could take issue but in the interests of brevity and diplomacy, I will make just one comment: there are so many pathologists across this country whose practice depends upon PAs that I think raising this discussion at the CAP will be enlightening.

It is refreshing and encouraging that an attempt is being made to measure the portion of the pathologists' workload traditionally dedicated to grossing. If the numbers are anywhere near accurate, they will further validate the practice of PAs. I support the thinking that up to 1/3 of a pathologist's time at a tertiary-care facility is, or ought to be, dedicated to grossing. PAs and Histotechs who perform gross descriptions have never been given the recognition that they deserve. All provincial ministries have been essentially unaware, for over 30 years, that someone other than pathologists have been doing all of this work.

I am so glad to see that the CAP has included a day-long session specifically for PAs at this year's meeting. I regret that I will likely not be able to attend but want to send my best wishes to all those who will be there.

...of the MONTH?!

Edited and re-posted 2007/04/25:

I find myself (yet again) in the position wherein I am compelled to apologize. The image of the month has become an image of ... well ... more than a month. I'm sorry. I have a number of good cases but I've been running and biking and walking the dog and going to work 7 days a week and...well...there's precious little time for some of the other things that, although I know they matter. are also on the list but seem to get bumped down the list.

I was flattered recently by an in-person comment by a colleague, a Heamatotechnologist who was retiring. He was kind enough to mention that he checked this site from time to time. This person is such a well-respected gentleman that I was truly moved to learn that he bothered to spare any interest in a site which had little to do with his life's work. I do hope that we get together some time this season for a round, or demi-round, of golf.

I had a question/comment recently from a reader who stated that I received a lot of comments. Would that this were true!

While providing some instruction to another PA today, it occurred to me that a considerable amount of evidence, and data, exists for altering a patient's diagnosis, treatment and prognosis based upon sentinel lymph node status but I was wondering whether anyone had heard about any studies concerning the status of the 'highest' lymph node found in an axillary tail -- that is, the lymph node which is the furthest from the tumour; opposite, if you will, the sentinel node.

I promise that I will get an image within the week.

I hope that as many of you as possible are planning to attend this year's CAP (and CAPA) meeting in Toronto. Remember that even if your employer can only provide limited support, a substantial amount of your expenses (including your spouse's airfare, etc...to a point) are tax deductible.

Best regards to all of you. 2007 looks like a very good year for Canada's PAs!

Future Posts

I hope you like the new look and I hope none of you is overly frightened by the photo (of me)! In the near future, look forward to a photo, or a case, of the month. This may grow into a quiz format to challenge you into digging into the books. With your comments, I will be glad to consider any/all ideas. Some of you might consider submitting some of your best photos for the page.

I hope you are all managing the long winter months. I know that I've had just about enough of no kayaking and no biking.

Pat yourself on the back - maybe later

Re-posted (edited version; I apologize for any resultant incoherency) - 2007/04/25:

Analysis of statistics which support good practice by PAs and their contribution to high quality healthcare have not been possible at many centres before. Most centres experienced a more or less gradual introduction of PAs which spanned decades. In contrast, the Interior has a clearly-defined date at which time PAs were introduced.

I have heard previously of oncologists and GI surgeons who want their patients' specimens only examined by PAs (links have been provided via the AAPA site on previous occasions). Finding a sufficient number of lymph nodes at the first sitting increases the provision of accurate reports in a timely fashion (turnaround times are reduced).

I would like to remind PAs of the importance of not only finding all of the lymph nodes in the mesocolon but also of identifying the proximity of lymph nodes relative to the radial margin (requiring that the margin be inked and then serially sectioned at right angles to the margin). If nodes are within 0.3 cm of the margin, this fact is a significant predictor for metastasis. If an insufficient number of nodes are found at the first exam, the fat should be re-examined after a day's fixation in a clearing solution such as modified Carnoy's fixative. A comment concerning the quality of the radial margin on total mesorectal resections (TME) should be added to your gross description. There are different methods of grading the margin which include a numbering system, from 1 to 3, reflecting the relative completeness of the margin. Another -- which I prefer -- uses description (ie. intact vs. incised, irregular and/or conically-shaped vs. incomplete) . While on the topic of TMEs, the prosector should give the location of the mass relative to the peritoneal reflection (above, astride or below). Except in cases where the tumour is situated very close to the anal resection margin, the rectum is to be left unopened, fixed over night, and serially sectioned transversely. This is without a doubt the best way of accurately ascertaining the depth of invasion and of providing with certainty the distance from the tumour to the radial margin.

It's about time!

I know that this may be hard to believe for many PAs elsewhere in Canada, but this past week marked a milestone here in the Interior Health Authority's gross rooms. The first Okanagan-wide surgical pathology (for grossing) procedures were distributed. So much effort since spring, 2005 has gone into just keeping our heads above water that progress has been terribly slow at times (and for this I apologize). Manpower levels are beginning to get to the point where gradual improvements can now be made. These 'in-brief' procedures, and all submitted in the future, will improve our ability to meet the requirements of the soon-to-be-implemented quality management system in which the existence of policy and procedure manuals (and abiding by them) is a cornerstone. Standardization of methodology will result in an overall improvement in quality and consistency in surgical pathology. The pathologists' participation in the creation of procedures is absolutely necessary in order to guarantee an excellent product. Their input will be needed at the first round of revisions of the procedures, beginning in six months.

The next step is to consider, and to implement, gross description templates. This is a contentious issue for some pathologists who may not appreciate the power of templates to ensure a minimum level of quality; and to do so invisibly and seamlessly from their perspective. The transcriptionists, if a space in the template is mistakenly left blank, will interact with the PA so that the blank is filled in before the report and the slides find their way to the pathologist's desk. Issues surrounding concerns about PAs' grammar, vocabulary or accents become unnecessary as the templates are primarily in point form. Each template has a space where the PA may provide additional, free-text description, as necessitated by the each specimen's unique nature. Well-designed templates require very little additional description of this sort however. Templates, much like synoptic reports for diagnosis, answer all the necessary questions for both pathologist and oncologist; little more and no less. Superfluous, flowery, or unnecessary language is avoided. They are far easier, and far less time-consuming, to decipher than a traditionally-worded description. They have been in use at many other centres for many years and have been well received by PAs, transcriptionists, residents, oncologists and pathologists alike. Like procedures, gross description templates provide a quality assurance tool which improves our product.

The last step in the creation of the manual will be to make up the full-length policy and procedure documents. These will provide more information than the brief versions; will give the rationale behind various methods and will list references. Policy and procedure documents governing the general rules for handling specimens, safely, telepathology, photography and other gross room functions will also be written.

As Laboratory Medicine in the Interior Health Authority moves towards participation with The University of British Columbia Medical School, the manuals will be an excellent resource for training of medical residents in surgical pathology.

Other news...

A second PA is starting in Kelowna on the 15th of January. Considerable renovations are being effected in the near future to allow for a safe work space for the PA, to provide office space for more pathologists and a clinical microbiologist, and to improve work flow in the gross room for frozen sections, etc. One of our PAs is returning from parental leave tomorrow. Welcome back!

Wish us luck; our Meditech IT system is being upgraded (?improved). I'll reserve judgment on whether it'll be any more user-friendly than it is currently. So often, IT systems and "user-friendliness" seem to have a hard time co-existing.