CMSA

The Colleges of Medicine of South Africa NPC

Nonprofit Company (Reg. No. 1955/000003/08)
Nonprofit Organisation (Reg No 009-874 NPO)
27 Rhodes Ave, PARKTOWN WEST 2193
Private Bag X23, BRAAMFONTEIN 2017
Tel: +27 11 726-7037/8/9
Fax: +27 11 726-4036
General: admin@cmsa-jhb.co.za

Academic Registrar: alv@cmsa-jhb.co.za
JOHANNESBURG Website: www.collegemedsa.ac.za
ACADEMIC OFFICE
June 2014

R E G U L A T I O N S

FOR ADMISSION TO THE FELLOWSHIP OF THE COLLEGE OF

PATHOLOGISTS OF SOUTH AFRICA IN ANATOMICAL PATHOLOGY

FC Path(SA) Anat

1.0 COMPONENTS
At present the examination is a two-part examination; Part 1 and Part 2

2.0 PURPOSE OF ASSESSMENT
The aimof this assessment is to evaluate if the candidate who has completed the minimumtraining period,
has acquired the appropriate professional knowledge, skills and attitude stipulated by the HPCSA training
requirements and standards in order to be licensed by the HPCSA as a practitioner of anatomical pathology
at specialist level. This assessment is one of two components of the HPCSA requirement for registration as
an anatomical pathologist. The other component of the registration requirement is the assessment of a
research submission by the host University

3.0 ADMISSION TO THE EXAMINATION
(to be read in conjunction with the Instructions)

3.1 PART I (Basic Sciences):
3.1.1 A candidate may be admitted to Part I of the examination having:
A post-internship qualification to practise medicine and meeting all criteria required for
registration as a Medical Practitioner with the Health Professions Council of South Africa
(HPCSA)
Completed 18 months fulltime post-internship training as a Registrar in an accredited
Anatomical Pathology teaching laboratory at the time of applying to enter for the Part I.

3.2 PART II (Practicals and Oral):
3.2.1 A candidate may be admitted to Part II of the examination having
A post-internship qualification to practise medicine and meeting all criteria required for
registration as a Medical Practitioner with the Health Professions Council of South Africa
(HPCSA)
Completed three and a half years fulltime post-internship training as an Anatomical
Pathology Registrar in an accredited anatomical pathology teaching laboratory by the time of
the written examination
successfully completed Part I of the FC Path(SA) Anat examination
At least six months to have been spent fulltime in an approved Cytology laboratory;
this may formpart of the minimum3 year training in Anatomical Pathology



The candidate will be/
FC Path(SA) Anat PAGE 2
The candidate will be required to submit a certificate fromthe head of the department(s)
where he/she has been working showing that he/she has properly completed a minimumof 50
autopsies satisfactorily under supervision and is able to cut and stain frozen sections
A portfolio of training must be submitted for assessment to confirmthe above have been
adequately and satisfactorily completed.

3.3 The CMSA may accept part-time training fromregistrars who have completed 4 years in a teaching
hospital including 1 years fulltime training, provided the candidate submits evidence of prior approval by
the Health Professions Council of South Africa of a part-time training programme acceptable for specialist
registration

3.4 Fromthe second semester 2014 the submission of your Portfolio at the time of making your application is
compulsory for all candidates who entered into their Registrar post from1 J anuary 2011

3.5 The CMSA Senate, through its Examinations and Credentials Committee, will review every application for
admission to the examination, and may also consider the professional and ethical standing of the candidate

4.0 FORMAT OF THE EXAMINATION

4.1 Conduct of the Part I examination, with an overall pass mark of 50%, comprises:
4.1.1 One 3-hour closed-book written examination paper, with a sub-minimumof 45%.
The format of the examination will include the following:
Answer all questions
A mixture of essay questions to demonstrate integrative skills and short answer questions
4.1.2 A three-hour closed book practical examination, with a sub-minimumof 50%.
The format of the examination will include the following:
Answer all questions
An H&E-stained section fromeach of 15 different histopathological cases (including
surgical or autopsy cases) to be described and a diagnosis (or differential diagnosis)
exhibited, with mention of any appropriate ancillary investigations that may be required
for the diagnosis.
These slides will comprise basic medical and surgical pathology and each slide will be
diagnosable at a morphological level. No dual pathologies will be included.
Cytopathology will not be included.
No more than three of the cases may be diagnosed incorrectly

4.2 Conduct of the Part II examination, with an overall pass mark of 50%, comprises:
4.2.1 Two 3-hour closed-book written examination papers, each with a sub-minimumof 50%
The format of the examination will include the following:
Answer all questions
A mixture of essay questions to demonstrate integrative skills and short answer questions
These will be divided as follows:
Molecular pathology, principles of pathology and special techniques including
electron microscopy, immunohistochemistry and special investigations and
laboratory management as well as ethical considerations
The practice of surgical pathology and cytopathology











4.2.2.../
FC Path(SA) Anat PAGE 3

4.2.2 A series of Practical examinations, each (unless otherwise stated) with a sub-minimumof 50%,
comprising:
An autopsy examination, with (barring exceptional circumstances) a time-limit of three
hours. This will be performed in the candidates department prior to the practical
examination week.
The format of the examination will include the following:
Scrutiny of the clinical file(s)
External examination of the body
Appropriate dissection
Presentation of the findings, with clinicopathological correlation and a provisional
anatomical diagnosis
Performance of frozen section or smear if necessary

(NB: Histopathological examination is not a requirement)

If this examination is passed with a mark of more than 60% this mark may be carried over
12 months should the candidate be unsuccessful with the Part 2 examination
4.2.3 Two three-hour closed book practical examinations, each with a sub-minimumof 50%.
The format of the examination will include the following:
Answer all questions
The first practical consists of an H&E-stained section from each of 15 different
histopathological cases (including surgical or autopsy cases) to be described and a
diagnosis (or differential diagnosis) exhibited, with mention of any appropriate ancillary
investigations that may be required for the diagnosis. There should be
5 slides each graded high complexity, moderate complexity and standard complexity.
The diagnoses and appropriateness of the cases should be approved by all examiners and
the moderator.
The second practical consists of appropriately stained exfoliative or aspiration smears
from each of 15 different cases to be described and a diagnosis
(or differential diagnosis) exhibited, with mention of any appropriate ancillary
investigations that may be required for the diagnosis. There should be 5 slides each
graded high complexity, moderate complexity and standard complexity. The diagnoses
and appropriateness of the cases should be approved by all examiners and the moderator.
Not more than three of the cases may be diagnosed incorrectly in either examination (the
degree of complexity will be taken into account in marking each answer)
The basic tenet is that the pass in each slide and the examination overall should be that
the candidate must demonstrate the ability to practice histo- and cyto-pathology safely at
a generalist level.
4.2.4 Two closed-book objective structured practical examinations (OSPEs) of up to 3-hours duration
each, with an overall sub-minimumof 50% (except for certain inter-active components).
The format of the examination will include the following:
Answer all questions
Each OSPE will consist of multiple stations which may include any combination of the
following
macroscopic museumor fresh specimens (or appropriate photographs)
immunohistochemical stains
electron photomicrographs
molecular diagnostics
renal biopsies
liver biopsies
muscle and nerve biopsies
brain smears
frozen sections
bone pathology
any other systembased pathology eg dermatopathology, cardiac pathology
inter-active components

FC Path(SA) Anat PAGE 4

4.2.5 An oral examination:
Candidates will be questioned on any aspect of anatomical pathology as relevant to the
practicing general anatomical pathologist regarding:
Differential diagnosis
Theoretical considerations
Ability to deal with complex diagnostic problems
Use of special investigations
Laboratory management (including safety issues)
Accreditation issues
Ethical and moral issues pertaining to the practice of anatomical pathology
Examiners will assess the ability of candidates to practice safely as general anatomical
pathologists in a general anatomical pathology practice.
Candidates must achieve a pass mark of 50% to pass this component of the examination

4.3 The weighting of the final mark will be as follows:
Written component 15%
Histopathology slides 25%
Cytopathology 20%
OSPE 1 and 2 20%
Autopsy 10%
Viva voce 10%

Overall the candidate must achieve a mark of 50% to pass and not fail any of the components. Failure to pass more
than 3 of the slides in the histopathology and cyto-pathology component will result in failure of this examination
component and thus failure.










































JOHANNESBURG
June 2014
FC Path(SA) Anat PAGE 5

5.0 ADMISSION AS A FELLOW

5.1 Only candidates who have completed training in a CMSA recognised registrar post may be awarded a
fellowship if successful in the examination.

5.2 Candidates who have written the examination as a prerequisite from the HPCSA for inclusion on the
specialist register are not eligible to be awarded a Fellowship but will be sent a letter confirming their
success in the examinations

All other candidates will be asked to sign a declaration as below:


I, the undersigned, do solemnly and sincerely
declare

that while a member of the CMSA I will at all times do all within my power to promote the objects of the
CMSA and uphold the dignity of the CMSA and its members

that I will observe the provisions of the Memorandumand Articles of Association, By-laws, Regulations
and Code of Ethics of the CMSA as in force fromtime to time

that I will obey every lawful summons issued by order of the Senate of the said CMSA, having no
reasonable excuse to the contrary

and I make this solemn declaration faithfully promising to adhere to its terms


Signed at .............. this .......... day

of .. 20 ..

Signature


Witness
(who must be a Founder, Associate Founder, Fellow, Member, Diplomate or Commissioner of Oaths)

5.3 A two-thirds majority of members of the CMSA Senate present at the relevant meeting shall be necessary for
the award to any candidate of a Fellowship

5.4 A Fellow shall be entitled to the appropriate formof certificate under the seal of the CMSA

5.5 In the event of a candidate not being awarded the Fellowship (after having passed the examination)
the examination fee shall be refunded in full

5.6 The first annual subscription is due one year after registration (statements are rendered annually)














JOHANNESBURG
June 2014
FC Path(SA) Anat PAGE 6

A P P E N D I X A

1.0 SYLLABUS

1.1 The discipline of Anatomical Pathology will include cytology and the understanding of basic pathological
processes at the systemic, cellular and molecular level and the study of the macroscopic, light microscopic
and ultra-structural morphology of organic and functional disease processes and the special techniques used
in their investigation and diagnosis (including relevant molecular techniques such as PCR and in situ
hybridisation)

1.2 Part I:
Cell (including gene) and tissue (histology) structure
Gross anatomy and microanatomy
Embryology and development
The basic principles of pathology
The molecular and genetic bases of disease
The principles of immunology
The pathology of general systemic and systematic diseases
The principles of the light microscope, including fluorescent microscopy and photomicroscopy,
and of the electron microscope
Practical consideration:
Recognition of medical pathology
Recognition of simple surgical pathology

All of the above will be at the level of Robbins textbook of pathology

1.3 Part II:
Diagnostic surgical pathology and cytology
The use of special stains, immunohistochemistry, electron microscopy, morphometry and relevant
molecular techniques (including in-situ hybridisation, polymerase chain reaction and cytogenetic
analysis) in diagnostic anatomical pathology. (If molecular pathology cannot be covered practically then
arrangements for a 3-month training period in a relevant molecular pathology laboratory should be
undertaken covering ISH, cytogenetic analysis and polymerase chain reaction)
The classification, pathogenesis and epidemiology of disease relevant to being able to give a diagnostic
opinion
Laboratory management and the place of Anatomical Pathology in health care.
Ethical and moral issues pertinent to Anatomical Pathology


















JOHANNESBURG
June 2014
FC Path(SA) Anat PAGE 7

A P P E N D I X B

GUIDELINES FOR CANDIDATES AND EXAMINERS

1.0 CANDIDATES

1.1 Recognised training centres should have a supervisor for registrars in training. The supervisor should be on
the panel of examiners and be familiar with the examination and the CMSA regulations. It is desirable that
each registrar will be assigned to a senior mentor to guide themthrough their training period

1.2 The role of the supervisor should include discussion of the regulations for the FC Path(SA) Anat
examination with prospective candidates; indication of the breadth and depth required for different aspects of
the examination; discussion of the methods of assessments used in the examination, informing the candidate
of the limitations of his or her hospital as a training institution

1.3 On written request written reports on their performance will be made available to unsuccessful candidates
after the examinations fromthe CMSA convenor. These must be such as to allow unsuccessful candidates
to learn where they have made mistakes and correct their deficiencies in specific areas.

2.0 EXAMINERS

2.1 Question papers will be carefully reviewed by the convenor, other examiners and the moderator before the
examinations, and all care will be taken to ensure that the questions are appropriate and free from
ambiguities, grammatical errors, errors of vocabulary and spelling errors

2.2 Standards used in the oral examination will be the same for each candidate

2.3 At least two examiners will examine each candidate in the practical and oral parts of the examination.
Examiners should play a minor role in the examination of candidates with whomthey have worked closely in
the recent past. At least one examiner will be froma different centre to the one conducting the examination.

2.4 In the oral and practical parts of the examinations, each examiner should submit his or her own independent
assessment of each candidate. Discrepancies between the assessments will be discussed at the examiners
meeting. The consistency of the examinations as a whole will be assessed

2.5 Examiners should familiarise themselves with the basic theoretical considerations involved in examinations,
in medical examinations in particular

2.6 All new examiners should undergo a period of familiarisation during which they act as observers of the
practical and oral parts of the examination. During this period they will not submit assessments of
candidates.

3.0 WRITTEN PAPERS

3.1 Where "open ended" questions are used they are designed to test your depth of knowledge,
understanding and the ability to organise the material. Do not be mislead by the apparent "simplicity"
of the question. It is the answer that matters:
3.1.1 The Part I written examination may consist of questions from the following sections:
Cell (including gene) and tissue (histology) structure
Gross and microanatomy
Embryology and development
The basic principles of pathology
The molecular and genetic bases of disease
The principles of immunology
The pathology of general systemic and systematic diseases
The principles of the light microscope including photomicroscopy, fluorescent microscopy,
the electron microscope


3.2/
FC Path(SA) Anat PAGE 8

3.2 Recommended reading for the Part 1 will include:
Standard texts on Pathology (eg Robbins and Cotran: Pathologic Basis of Disease;)
Standard texts on Molecular Medicine (eg: Trent)
(For reference - Molecular Biology of The Cell, Eds. Bruce Alberts et al)
The relevant recent literature in the major pathology journals

3.3 The Part II written examination will consist of questions on:
Diagnostic histopathology and cytopathology
The use of special stains, immunohistochemistry, electron microscopy, morphometry, molecular
diagnostics in diagnostic anatomical pathology
The classification, pathogenesis and epidemiology of disease relevant to being able to give a diagnostic
opinion
Laboratory management and the place of anatomical pathology in health care
3.3.1 Paper 1 will include questions on:
Basic principles of pathology
Molecular pathology
Autopsy pathology
Laboratory management
Use of special stains, immunohistochemistry, electron microscopy, morphometry etc
in diagnostic anatomical pathology
3.3.2 Paper 2 will include questions on:
Diagnostic histopathology and cyropathology
Classifications of tumours

3.4 Recommended reading for Part II will include:
Standard texts of diagnostic, surgical pathology. (eg Silverberg's Principles and Practice of Surgical
Pathology; Rosai and Ackerman's Surgical Pathology etc)
Standard text on cytology. (eg Bibbo - Diagnostic cytopathology)
Standard texts of specific organ systems and regions. (eg dermatopathology, soft tissue tumours,
gynaecological pathology WHO Blue books etc)
The relevant recent literature on anatomical pathology.

4.0 AUTOPSY

4.1 When it is difficult to organise the autopsy examination at the same venue as the practicals and orals it
may be held at the centre where the candidate usually works with an examiner or moderator from a
different centre, if feasible:
All attempts will be made to allow the candidate sufficient time to peruse the clinical notes before
starting the autopsy

4.2 The examination will comprise:
The autopsy frominitial examination of the body to the completion of dissection
Clinico-pathologic correlation
A provisional anatomical diagnosis
The candidate may have assistance with opening the skull, removing spinal cord and opening the bowel
Unless there are exceptional circumstances the autopsy must be completed within 3 hours of
commencement.
Performance of a frozen section or smear if necessary

(NB: Histopathological examination is not a requirement)








5.0/
FC Path(SA) Anat PAGE 9

5.0 PRACTICAL

5. 1 The practical examination will have four parts:
The two 3-hour slide-diagnostic practicals, each with a sub-minimum greater than 50%.
(See: Regulations) AND a requirement to fail out-right no more than three individual questions with a
mark of <50%.
The two OSPEs each of which includes multiple stations, and may last up to 3-hours and will include
some inter-active station(s).

6.0 ORAL EXAMINATION

6.1 This will have a duration of not less than 20 minutes and will require all examiners to be present.

7.0 RECOMMENDED READING

7.1 General textbooks of Pathology/Surgical Pathology:
Robbins Pathologic Basis of Disease
Rosai and Ackermans or Silverbergs Surgical Pathology
Weidners Modern Surgical Pathology
Fletchers Diagnostic Histopathology of Tumours
Bibbos Cytopathology etc

7.2 Various reference volumes for specialised areas including:
AFIP Tumour fascicles
WHO Pathology of Tumour
Rosens Breast Pathology
Blausteins Pathology of the Female Genital Tract
Weedons Pathology of the Skin
Greenfields Neuropathology

7.3 Reviews and seminal articles in leading Pathology journals:
Histopathology
Human Pathology
American Journal of Surgical Pathology
Seminars in Diagnostic Pathology
Diagnostic Histopathology
Archives of Pathology & Laboratory Medicine



















JOHANNESBURG
June 2014
FC Path(SA) Anat PAGE 10

A P P E N D I X C

THE PRACTICAL EXAMINATIONS

1. THE AUTOPSY

1.1 Candidates:
You will be expected to acquaint yourself with the clinical history (fromthe clinical notes provided),
examine the cadaver externally, carry out an appropriate dissection and then (after presenting them
formally to the examiners) formulate a provisional pathological diagnosis (or differential diagnosis) from
the relevant clinical and macroscopic findings
You may have to performa frozen section or smear if requested
You will, barring exceptional circumstances (such as an unusually difficult dissection), have to complete
these tasks within 3-hours (not including exploring the clinical history)
The autopsy will be performed under continuous observation by two examiners; the prosector may help
with removal of the calvarium, spinal cord and opening of the bowel.

1.2 Examiners:
The standard is that which is expected of a competent Anatomical Pathologist
Two examiners on the Part II panel must examine, these do not necessarily have to be fromdifferent
centres

A passmark of 60% or more in the autopsy examination will allow the candidate to carry this result for 1 year should
they be unsuccessful overall in the FC Path(SA) Anat Part II exam

2. THE SLIDE DIAGNOSTIC PRACTICALS AND THE OSPEs

2.1 Candidates:
Subject to specific instructions issued at each examination, you will be expected to diagnose and report
on a variety of autopsy, and/or cytopathological and/or surgical pathology cases (which may be
specimens, slide preparations or images), indicating your preferred diagnosis (or differential diagnosis)
and, where appropriate, what ancillary procedures you would employ to confirm(or refute) the diagnosis
you have offered
You will be required to make some of the diagnoses inter-actively ie with the examiner(s) present at
the time and able to interrogate you.

2.2 Examiners:
The standard is that which is expected of a competent generalist Anatomical Pathologist
The candidate will fail an individual case if she/he misses, or misinterprets, major diagnostic information
in the case material which would compromise patient safety or future management
The candidate will fail the examination if the required subminima are not attained (Refer to the text of
the Regulations for details of the sub-minima that may be required)
OR
The candidate reached his/her conclusions by fraudulence or dishonesty in the examiners opinion.
Candidates failing the examination outright but passing the autopsy segment by 60% or more will be
exempted fromthe autopsy for a maximumperiod of one year.










JOHANNESBURG
June 2014