Research Fellowship in Breast and Gynaecological Pathology

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

Research Fellowship in Breast and Gynaecological Pathology

Overview

The Research Fellowship in Breast and Gynecological in the Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital is a comprehensive and intense fellowship based in Singapore’s premier healthcare institution for women and children. The fellowship will also provide a golden opportunity to learn breast pathology from Prof Tan Puay Hoon, who is an internationally renowned pathologist, an editor of the WHO blue book and an avid researcher in breast pathology for which she has received several accolades. Fellows can expect themselves to see both breast and gynaecological and surgical specimens, frozen sections, participate in multidisciplinary team meetings and academic activities including slide teaching sessions and journal presentations. They will be able to gain experience in interpreting molecular tests used in diagnosing breast and gynaecological cancers including fibro epithelial lesions of breast, screening for Lynch syndrome for endometrial cancers and genotyping for molar pregnancy. There will be an opportunity to be involved in ongoing research activities in the department. They will also be able to attend local conferences organized by the SGIAP and Singapore cytology Society.

Aim of Programme

To expose the fellow to the sub-specialty discipline of gynecological and breast pathology.

Duration of Programme

3 months – 12 months

Number of Training Places

Maximum 2 research fellows at any one time

Learning Outcomes

At the end of the programme, trainees will be able to:

• gain comprehensive knowledge and skills in diagnosing common and rare pathological entities in breast and gynaecological pathology.
• see through the large teaching archives of the department.

Trainees should expect to be able to:

• appreciate the spectrum of benign and malignant pathology in breast and gynecological disorders.
• keep up to date with the current trends, evidence-based practices and recommendations in breast and gynecological pathology.
• keep abreast of the latest molecular advances in breast and gynecological pathology and how this translates to clinical practice.

Content Areas

Breast

• Epithelial tumors of the breast: benign epithelial proliferations, papillary neoplasms, epithelial-myoepithelial tumors, adenomas, lobular neoplasia, in situ carcinoma, invasive carcinoma and its variants, common and rare
  
• Fibro epithelial tumours of the breast: fibroadenoma, phyllodes tumour
• Rare tumors of the breast: Mesenchymal neoplasms, hematolymphoid neoplasms
• Interpretation of breast biomarkers and ancillary stains in breast pathology and see consult and interesting cases with Prof Tan Puay Hoon and the breast pathology faculty
• Attend the quarterly SingHealth breast subgroup meetings.
  

Vulva/vagina

• Inflammatory conditions of the vulvar/vaginal skin
• Cutaneous neoplasia: VIN/VAIN, Squamous cell carcinoma, adnexal neoplasia, melanocytic lesions
  
• Soft tissue neoplasia of the vulva and vagina.
  

Cervix

• Benign variations in the endocervix such as metaplastic, reactive changes, microglandular hyperplasia, tunnel clusters
• Neoplasia: squamous intraepithelial lesion, glandular neoplasia, squamous cell carcinoma, endocervical adenocarcinoma and its variants, common and rare.

Uterine corpus

• Common artefacts in endometrial biopsy
• Normal physiological changes in the endometrium
• Benign conditions: disordered proliferative changes, hormonal effect, tubal metaplasia, eosinophilic changes, polyps
• Hyperplasia: Simple/complex; with and without atypia
• Endometrial neoplasia: Endometrioid adenocarcinoma and its variants, serous carcinoma, clear cell carcinoma, undifferentiated carcinoma etc.
• Soft tissue neoplasia: leiomyoma and its variants, STUMP, leiomyosarcoma, PEComa, inflammatory myofibroblastic tumour, endometrial stromal sarcoma etc.
• Fallopian tube: STIC and serous carcinoma.
  

Ovary

• Normal physiological and pregnancy-related changes in ovaries
• Benign changes: Endometriosis
• Epithelial ovarian neoplasms: Benign, borderline and malignant neoplasms (serous, endometrioid and mucinous neoplasms, clear cell carcinoma, brenner tumours etc.)
• Sex cord-stromal tumours: granulosa cell tumours, stromal tumours, granulosa cell tumour, sertoli-leydig cell tumour etc.)
• Germ cell tumours: teratoma (mature/immature), dysgerminoma, yolk sac tumour, embryonal carcinoma, struma ovarii etc.).

Training Methods

1. Case Reporting

• Observe examination of gynaecological and breast surgical specimens handling of unfixed surgical specimens for frozen section assessment

2. Clinico-pathologic Conferences

• Departmental pathology journal club/Peer review and learning session/Tumour boards 
• Gynaecology oncology rounds

3. Structured Educational Activities

• Review of glass slide collection
• Review of key gynaecological and breast pathology articles
• Presentation of a topic of current interest during the weekly department pathology journal club/peer review and learning session

4. Research

• Training site: Department of Pathology and Laboratory medicine (Histopathology), KKH 
• Night calls: Fellows are not expected to do night calls

Team of Experts

1. The Research Fellowship in Breast and Gynecologial Pathology is managed by the following experts.

   ​Breast Pathology	Gynaecological Pathology
   Prof Tan Puay Hoon	Dr Mihir Gudi
   Dr Mihir Gudi

2. Supervisory Method
   The trainee would be supervised at all times by SMC-approved supervisors from department of Histopathology. KKH. They will have hands-off experience and will not be signing out cases or handling gross specimen cut up.

II Assessment and Evaluation

Aims of Assessment

Trainees will need to demonstrate their proficiency level based on the following competencies:

(A) Medical Knowledge

• Trainees must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological, social-behavioral sciences and the application of medical knowledge to diagnosis. Trainees must demonstrate the ability to interpret, synthesise and summarise knowledge.
  

(B) Practice-Based Learning and Improvement

• Trainees must be able to recognise errors and discrepancies in practice.
• Trainees must demonstrate life-long learning skills and continuous self-assessment based on reflection and feedback.
• Trainees must demonstrate teaching and learning skills, and perform research to contribute to medical education of health professionals.

(C) Interpersonal and Communication Skills

• Trainees must demonstrate effective team interactions and leadership within the laboratory.
• Trainees must demonstrate effective interactions with the interdisciplinary teams.

(D) Professionalism

• Trainees must demonstrate ethical behavior in carrying out their duties.
• Trainees must accept responsibility for cases assigned and follow through with them.
• Trainees must be able to give and receive feedback.
• Trainees must be responsive to every patient’s individual needs.

(E) Systems-Based Practice

• Trainees must contribute to patient/laboratory safety initiatives.
• Trainees must demonstrate cost effective test utilisation.

Assessment Approaches

The fellow will be assessed at regular intervals by face-to-face meeting with the supervisor as well as by the case log book and feedback from the laboratory.

The assessment will be based on his/her performance in routine service work such as:

• presentation at residency teaching meetings,
• journal club presentation,
• feedback score from supervisor,
• as well as, in educational/research activities.
  

Evaluation Process

The general overall grading system evaluates the trainee’s performance upon completion of the programme. All trainees will be given a general overall grading status at the end of the programme based on the grading criteria requirements incorporating the six competencies that trainees must demonstrate throughout the programme.

* Trainees who have attained a USP grade are given options to extend their training. This will depend on the faculty's evaluation of the trainee's clinical skills and professional attitude.

III Target Audience and Eligibility Requirements

Target Audience

Junior pathologists in regional countries with an interest in breast and gynaecological pathology

Pre-requisite/Eligibility Requirement(s)

• Candidates must be able to converse in English.
  
• Candidates will have hands off experience and will not be expected to sign out cases or cut up specimens.

IV Other Information

Course Fees

Fees will be disclosed upon acceptance.

Funding

Candidates should be self-funded or have funding from external sources/institutions.

Certification

A certificate will be awarded to each trainee at the completion of the programme.