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...
Sunday, October 21, 2007
Sunday, September 30, 2007
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.
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.
Sunday, September 23, 2007
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
- full-time, permanent employment in Kelowna.
- Additionally, I'd like to hear from you if you'd like to do a 2-week locum in Kelowna.
- 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).
- 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)
Thursday, August 30, 2007
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.
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.
Friday, July 27, 2007
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.
Sunday, June 10, 2007
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 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 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.
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