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CAP Position Statement
on Pathologists’ Assistants
INTRODUCTION
The practice of pathology is an integral part of medical care.
It entails the diagnosis of disease and the interpretation of
patho-physiological mechanisms through the examination/analysis of human
tissue samples, body fluids or other materials and their correlation
with related medical judgments. The resultant diagnosis usually plays a vital role in patient
care and often is the single most important factor upon which decisions
regarding therapy are made. These
responsibilities must remain those of a duly trained, licensed and
certified pathologist and can not be delegated under any circumstance.
POLICY
The Canadian Association of Pathologists (CAP) recognizes that there
is a role and a need for appropriately trained and certified non-medical
personnel (Pathologists’ Assistants (PAs)) to assist pathologists in
the preparation and examination of tissues in the setting of surgical
and autopsy pathology. This
delegation of responsibilities is similar to that given to
histotechnologists who prepare histological slides and perform other
specialized techniques. The
gross examination and selection of tissue for histological evaluation
plays a critical role in the accurate diagnosis of disease, this
particular delegation must always be performed under the close
supervision of a qualified pathologist.
The CAP defines a PA as a laboratory professional who,
through appropriately documented delegation by a pathologist of specific
responsibilities for which she/he has been properly trained, performs a
comprehensive gross examination of surgical specimens and/or of
non-forensic autopsies. In
order to ensure high quality medical practice and to fulfill legal
requirements, the CAP expects standardization and regulation of basic
competencies for PAs as well as a proper certification and licensure and
that on-going provincial licensing and maintenance of competence
programs include the active involvement of pathologists.
These expectations include the following requirements: guidelines for
the pathologist supervising a PA, quality assurance guidelines for
laboratories employing PAs, a list of key competencies expected by
pathologists of PAs and guidelines for issuance of
a “Certificate of
Evaluation” for already practicing PAs.
Finally, the CAP recognizes and strongly supports the
important role that some laboratories have had over the years in
training and educating PAs and that education of PA's be done as a
graduate program within a recognized post-secondary academic
institution, and with the active participation of pathologists. The
CAP also invites other organizations to participate in the development
of an acceptable accredited educational program for new PAs and the
licensing of existing professionals.
ADDENDUM 1
Guidelines for the pathologists supervising a PA
The signing pathologists are responsible for:
1) signing out the cases
2) overseeing and directing the work performed by the PA
3) assigning cases based on complexity and expertise of the PA
4) performing the microscopic examination of the cases
5) making the clinicopathologic correlation
6) communicating with the clinicians responding to other inquires
7) implementing and maintaining the Quality Assurance program
8) promoting proper working conditions
ADDENDUM 2
Quality Assurance guidelines for laboratories employing PAs
The Quality Assurance guidelines include Continuing
Education requirements, working conditions and risk management.
2.A Continuing Education requirements
A PA must participate in continuing education activities, both intra-
and/or extra-departmental, for a minimum of 25 hours/year.
2.B Working conditions
Every pathology department should fulfil the following requirements in
the design of a work station:
1) adequate
ventilation
2) satisfactory
lighting
3) proper water
supply and drainage
4) adequate working
space
5) adequate storage
facilities for specimens
6) acceptable
procedures for disposal
of specimens
7) fire safety
protocol
In addition, proper working conditions also include a:
8)
procedure’s manual
9) dress code
10) list of responsibilities for the supervising pathologist
11) easy access for consultation with the supervising pathologist
2.C Risk Management
In order to ensure a safe and healthy workplace, the PA must always
enforce the following procedure(s):
1) universal precautions
2) Workplace Hazardous Material Information System (WHMIS)
3) a manual for handling hazardous waste
4) participation in the Departmental Safety Committee
ADDENDUM 3
Suggested list of key competencies expected of PAs
A PA should perform and assume responsibility for the
following tasks:
3.A Preparation and examination of human
surgical specimens
1) data collection and specimen procurement/receipt
2) obtain clinical history, laboratory data, x-rays and scans when
indicated
3) prepare gross examination and complete dissection and dictation of
surgical specimens
4) prepare tissues for microscopic examination, including preparation
for frozen and permanent sections for light, electron and
immunoflourescent microscopy
5) obtain biological specimens for analysis (e.g., bacterial and viral
cultures, toxicological material) and perform special techniques as
directed by the pathologist
3.B Preparation and examination of human bodies
1) ascertainment of proper legal authorization for
the purposes of non-forensic autopsies
2) retrieval of the patient’s chart and other pertinent data for
review by the pathologist
3) evisceration and fully dissection of internal organs followed by
proper display
4) removal of brain and spinal cord without damage
5) proper removal of middle ear, bone marrow and artificial devices
6) procurement of biological specimens for analysis (e.g., blood and
tissue, cultures, toxicological material) and performance of special
techniques as directed by the pathologist
7) notification to the funeral home and coordination of special
requests for specimen sampling (e.g., organ transplantation,
research)
8) release of the body following proper restoration and indication of
any biohazards (e.g., contagious diseases, radioactive implants) which
may be present
3.C Responsibilities common to PAs
1) quality management
2) collaboration with health professionals
3) professional responsibility and ethics
4) photography techniques
5) safe work practices
6) supervise the autopsy suite and/or the gross cutting room areas
7) participate in continuing education activities directed to other
health care workers
ADDENDUM 4
Guidelines for issuance of “Certificate of Evaluation” for already
practicing PAs
In order to establish a satisfactory scope of
practice, the institution, in particular the workstation of the PA
should be surveyed by a practicing and licensed pathologist appointed by
the provincial agency responsible for the quality assurance program of
health care centres.
4.A If the scope of practice is satisfactory, a
“Certificate of Evaluation” can be obtained by:
1) having a minimum of three years of practice
2) registering in a central register to be established within one year
after a formal training is available
3) receiving a letter of approval by the supervising licensing
pathologist
4.B If the scope of practice does not fulfill
the criteria, the candidate is expected to qualify by:
1) having fulfilled the same requirements as those
is 3.A
2) taking a formal evaluation designed by an agency to be designated
within two years following registration
4.C The provision for obtaining a “Certificate
of Evaluation” ends five years following the establishment of a
central register |
