His To Curriculum Training Uk 08

The Royal College of Pathologists
Pathology: the science behind the cure
Curriculum for specialty training in

histopathology and related subspecialties
January 2007 (minor amendments made August 2008)
Unique document number G051
Document name Curriculum for specialty training in histopathology and related subspecialties
Version number 3
Produced by Joint Committee on Pathology Training
Date active January 2007 (minor amendments made August 2008)
Date for review July 2009
Comments The first draft of this curriculum was agreed by the Histopathology CATT on 6 April 2005
and the Joint Committee on Higher Pathology Training (JCHPT) on 17 May 2005 and
approved by College Council on 23 June 2005.
The second draft was approved by PMETB on 12 April 2007 and formally published in
May 2007.
This version has had very minor amendments made as a result of suggestions from the
CATT, changes to the College’s Royal Charter and changes to the College’s house style.
Professor Carrock Sewell
Director of Publications
Joint Committee on Pathology Training

The Royal College of Pathologists
2 Carlton House Terrace
London
SW1Y 5AF
Telephone: 020 7451 6700

Email: education@rcpath.org
Website: www.rcpath.org/education
© The Royal College of Pathologists, 2008

CONTENTS
Introduction .......................................................................................................................................................................................................................4
Entry requirements ..............................................................................................................................................................................................................4
Duration of training ..............................................................................................................................................................................................................5
Subspecialty training ...........................................................................................................................................................................................................5
Training regulations ............................................................................................................................................................................................................6
Flexible training ...................................................................................................................................................................................................................6
Research .............................................................................................................................................................................................................................7
Academic trainees ..............................................................................................................................................................................................................7
Overseas training ................................................................................................................................................................................................................8
Related clinical training .......................................................................................................................................................................................................8
Rationale ............................................................................................................................................................................................................................8
Purpose of the curriculum ...................................................................................................................................................................................................8
Curriculum development .....................................................................................................................................................................................................9
Stages of training and learning .........................................................................................................................................................................................10
Training programmes ........................................................................................................................................................................................................11
Content of learning .........................................................................................................................................................................................................12
Purpose of assessment ....................................................................................................................................................................................................14
Methods of assessment ....................................................................................................................................................................................................14
Evidence of competence ...................................................................................................................................................................................................14
Model of learning ............................................................................................................................................................................................................15
Learning experiences .....................................................................................................................................................................................................15
Supervision and feedback .............................................................................................................................................................................................16
Managing curriculum implementation ..........................................................................................................................................................................18
Curriculum review and updating ...................................................................................................................................................................................18
Equality and diversity .....................................................................................................................................................................................................19
Acknowledgements ........................................................................................................................................................................................................19
2
General histopathology curriculum: stages A–D/ST1–5 .............................................................................................................................................20
Appendix 1 Guidelines for the histopathology curriculum stage A/ST1 ............................................................................................................55
Appendix 2 Training in histopathology subspecialties ........................................................................................................................................65
Appendix 2a Specialist curriculum for cytopathology .................................................................................................................................................65
Appendix 2b Specialist curriculum for forensic pathology ..........................................................................................................................................68
Appendix 2c Specialist curriculum for neuropathology ...............................................................................................................................................75
Appendix 2d Specialist curriculum for paediatric pathology .......................................................................................................................................81
Appendix 3 Good Medical Practice ........................................................................................................................................................................85
Appendix 4 Acronyms .............................................................................................................................................................................................86
Appendix 5a Illustrative example of histopathology training ................................................................................................................................88
Appendix 5b Illustrative timetable of histopathology training ..............................................................................................................................89
3
INTRODUCTION
Histopathology in the UK encompasses surgical pathology, autopsy and cytopathology and subspecialties of forensic pathology, neuropathology and
paediatric pathology; cytopathology may also be practised as a subspecialty. The award of the Certificate of Completion of Training (CCT) will require
evidence of satisfactory completion of training in both Good Medical Practice and the core aspects of histopathology, which are outlined in this
curriculum. Doctors who are applying for entry to the Specialist Register via the award of a certificate confirming eligibility for specialist registration
(CESR) will be evaluated against the Good Medical Practice and core aspects of the curriculum.
The curriculum complies with:

• the Postgraduate Medical Education and Training Board’s (PMETB) Standards for Curricula (March 2005) and
• the training framework described in A Guide to Postgraduate Specialty Training in the UK (commonly known as the Gold Guide).
For trainees with an NTN or NTN(A) in an approved UK training programme, the curriculum is integrated with and supported by the following
documents in order to produce a coordinated training package for the award of the CCT. The relevant package includes:
• a blueprint for the histopathology assessment system
• regulations and guidelines for Fellowship exams
• regulations and guidelines for workplace-based assessment, including multi-source feedback, and the Year 1 Histopathology Assessment
• access to e-learning mapped to the histopathology curriculum
• competency-based framework for graded responsibility
• an online training portfolio (login required).
All examinations and assessments undertaken during training will be clearly linked to the content of the curriculum, and their reliability and validity will
work towards complying with the PMETB’s Principles for an Assessment System for Postgraduate Medical Training.
Doctors applying for a CESR in histopathology must be able to demonstrate equivalence to the requirements for the award of a histopathology CCT.
Such doctors are strongly advised to read PMETB’s Guidance on applying for a CESR under Article 14. In addition, the following guidance is
available from the College and should also be carefully followed in the preparation of a CESR application:
• General guidance on evidence to submit with applications for a CESR (Article 14) in Histopathology (specialty-specific guidance)
• Guidance for CESR applicants in specialties and subspecialties overseen by The Royal College of Pathologists
• CESR curriculum vitae guidance.
Entry requirements
Trainees are eligible for entry to a histopathology training programme following satisfactory completion of a UK foundation training programme or
equivalent. Entry is also possible following post-foundation clinical training.
4
Duration of training
The Royal College of Pathologists anticipates that five years would normally be required to satisfactorily complete the histopathology curriculum to the
required depth and breadth. However, in order to ensure flexibility, the College advises that the minimum duration of training as identified in Schedule
3 of the General and Specialist Medical Practice (Education, Training and Qualification) Order 2003 is four years but that all provisional CCT dates
should be set at five years in the first instance.
The CCT in histopathology will be awarded on the recommendation of The Royal College of Pathologists following:
• evidence of satisfactory completion of the histopathology curriculum and the minimum training period
• satisfactory outcomes in the requisite number of workplace-based assessments (including multi-source feedback)
• attainment of the College’s Year 1 Histopathology Assessment
• FRCPath by examination; the Part 2 of the FRCPath may be in histopathology or a relevant subspecialty according to the training requirements of
the individual
• acquisition of Annual Review of Competence Progression (ARCP) outcome 6.
Subspecialty training
It is possible for trainees to undertake postgraduate subspecialty training in forensic pathology, neuropathology and paediatric pathology after
satisfactory completion of stages A and B of training and attainment of the Part 1 FRCPath. Subspecialty training should normally be undertaken
during stage C of training but there is flexibility to allow subspecialty training to begin later, which in the case of cytopathology normally begins
following satisfactory completion of stage C and attainment of the FRCPath Part 2 in histopathology. Trainees considering undertaking subspecialty
training after the beginning of stage C can contact the College for advice. Satisfactory completion of a recognised sub-specialist training programme
can lead to inclusion against an entry on the Specialist Register. Trainees can complete the CCT requirements and subspecialty training in a
minimum of five years. It is generally expected that trainees undertaking subspecialty training will spend stage D of training predominantly or entirely
within their chosen subspecialty.
Cytopathology (see Appendix 2a)

Trainees may have the subspecialty of cytopathology included against a histopathology entry on the Specialist Register following:
• evidence of satisfactory completion of the cytopathology subspecialty curriculum and two years’ training overall in a recognised cytopathology
training programme
• FRCPath Part 2 in histopathology.
Forensic pathology (see Appendix 2b)

Trainees may have the subspecialty of forensic pathology included against a histopathology entry on the Specialist Register following:
• evidence of satisfactory completion of the forensic pathology subspecialty curriculum and a minimum of three years’ training in a recognised
programme following the completion of stage B. The final year of forensic pathology training can constitute stage D of training.
5
• either:
– FRCPath Part 2 in forensic pathology or
– FRCPath Part 2 in Histopathology and the attainment of either The Royal College of Pathologists’ Diploma in Forensic Pathology or the
Diploma of Medical Jurisprudence (DMJ).
Neuropathology (see Appendix 2c)

Trainees may have the subspecialty of neuropathology included against a histopathology entry on the Specialist Register following:
• evidence of satisfactory completion of the neuropathology subspecialty curriculum and a minimum of two years’ training in a recognised
programme.
• attainment of the FRCPath Part 2 in neuropathology or general histopathology.
Paediatric pathology (See Appendix 2d)

Trainees may have the subspecialty of paediatric pathology included against a histopathology entry on the Specialist Register following:
• evidence of satisfactory completion of the paediatric pathology subspecialty curriculum and a minimum of two years’ training in a recognised
programme
• attainment of the FRCPath Part 2 in paediatric pathology or general histopathology.
Training regulations
This section of the curriculum outlines the training regulations for histopathology. In line with PMETB, this reflects the regulation that only training that
has been prospectively approved by PMETB can lead towards the award of the CCT. Training that has not been prospectively approved by PMETB
can still be considered but the trainee’s route of entry to the Specialist Register changes to CESR.
Flexible training
‘Flexible training’ is the term used to describe doctors undertaking training on a less than full-time basis, normally between five and eight sessions per
week. The aim of flexible training is to provide opportunities for doctors in the National Health Service (NHS) who are unable to work full time. Doctors
can apply for flexible training if they can provide evidence that “training on a full-time basis would not be practicable for well-founded individual
reasons”.
Flexible trainees must accept two important principles:

• part-time training shall meet the same requirements (in depth and breadth) as full-time training
• the total duration and quality of part-time training of specialists must be not less than those of a full-time trainee.
In other words, a part-time trainee will have to complete the minimum training time for their specialty pro rata.
PMETB guidance on approval of flexible training states that from 1 December 2007, “deaneries, in conjunction with Royal Colleges/Faculties, will take
responsibility for ensuring that all flexible training of any kind is undertaken in prospectively approved posts and programmes and that it meets the
statutory requirements of the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003”. Prior to beginning their
6
flexible training, trainees must inform the Training and Educational Standards Department at The Royal College of Pathologists in order that the
Histopathology College Advisory Training Team (CATT) can ensure that their flexible training programme will comply with the requirements of the
CCT programme. The documentation towards a flexible training application will be collected and checked to ensure compliance and a revised
provisional CCT date issued. Separate guidance and an application form are available on the College website for this purpose.
Research
Some trainees may wish to spend a period of time in research after entering histopathology training as out-of-programme research (OOPR).
Research undertaken prior to entry to a histopathology training programme

Trainees who have undertaken a period of research that includes clinical work directly relevant to the histopathology curriculum prior to entering a
histopathology training programme can have this period recognised towards an entry on the Specialist Register. However, as the research is unlikely
to have been prospectively approved by PMETB, their route of entry to the Specialist Register will be through the CESR
Research undertaken during entry to a histopathology training programme

Trainees who undertake a period of out-of-programme research (OOPR) after entering a histopathology training programme and obtaining their
National Training Number (NTN) can have up to one year accepted by the Histopathology CATT towards their CCT. In order to be eligible to have
this period of research recognised towards the award of the CCT, trainees must have their OOPR approved prospectively by PMETB before
beginning their research. Prior to beginning the period of research, trainees must agree the OOPR with their deanery and inform the Training and
Educational Standards Department at The Royal College of Pathologists in order that the Histopathology CATT can ensure that the trainee will
comply with the requirements of the CCT programme. The period of research must include clinical work directly relevant to the Histopathology
curriculum. The documentation towards a CCT recommendation will be collected by the Training and Educational Standards Department at the
College, checked to ensure compliance and a revised provisional CCT date issued. It must be ensured that, following deanery agreement and
acceptance from the Histopathology CATT, PMETB prospectively approve the OOPR in order that the period can count towards a CCT. Separate
guidance and an application form are available on the College website for this purpose.
Trainees must have their OOPR agreed by the relevant Deanery, accepted by the Histopathology CATT and approved by PMETB before
beginning their research.
Academic trainees
Trainees who intend to pursue a career in academic or research medicine may undertake specialist training in histopathology. Such trainees will
normally be clinical lecturers and hold an NTN(A). It is expected that such trainees should complete the requirements of the histopathology curriculum
in addition to their academic work. However, the content of their training, while meeting the requirements of the curriculum, will have to take into
account their need to develop their research and the provisional CCT date should be amended accordingly. NTN(A) holders in histopathology should
consult the Training and Educational Standards Department at the College on an individual basis with regard to the agreement of their provisional
CCT date.
7
Overseas training
Overseas training undertaken prior to entry to a histopathology training programme

Some trainees may have undertaken a period of histopathology training overseas prior to entering a histopathology training programme in the UK.
Such trainees must enter a histopathology training programme at ST1. Trainees can have this period recognised towards an entry on the Specialist
Register but their route of entry to the Specialist Register will be through the CESR.
Overseas training undertaken during entry to a histopathology training programme
Some trainees may wish to spend a period of training overseas as out of programme training (OOPT) after entering a histopathology training
programme in the UK. In order to be eligible to have this period of training recognised towards the award of the CCT, trainees must have
their OOPT overseas training approved prospectively by PMETB before beginning their overseas training. Prior to beginning the period of
overseas training, trainees must agree the OOPT with their deanery and inform the Training and Educational Standards Department at The Royal
College of Pathologists that they will be undertaking overseas training in order that the Histopathology CATT can ensure that the trainee will comply
with the requirements of the CCT programme. The documentation towards a CCT recommendation will be collected by the Training and Educational
Standards Department at the College, checked to ensure compliance and a revised provisional CCT date issued. It must be ensured that, following
deanery agreement and acceptance from the Histopathology CATT, PMETB prospectively approve the OOPT in order that the period can count
towards a CCT. Separate guidance and an application form are available on the College website for this purpose.
Trainees must have their OOPT agreed by the relevant Deanery, accepted by the Histopathology CATT and approved by PMETB before
beginning their training.
Related clinical training

During their histopathology training, some trainees may wish to spend a period of training in a related clinical specialty such as paediatrics, neurology
or oncology, etc. This is acceptable and should be undertaken as out of programme clinical experience (OOPE). However, such a period of training –
although useful to the individual trainee in broadening their understanding of the relationship between histopathology and the clinical specialties – will
not be approved by the CATT towards the requirements of the CCT and the clinical specialties – will not be approved by the CATT towards the
requirements of the CCT.
RATIONALE
Purpose of the curriculum

The purpose of the curriculum for specialty training in histopathology and related subspecialties is to set the standards required by The Royal College
of Pathologists and PMETB for attainment of the award of the CCT in histopathology and its subspecialties (where appropriate), and to ensure that
trainees are fully prepared to provide a high quality service at consultant level in the NHS. In addition, the curriculum also sets the standards against
which CESR applicants will be judged.
8
The educational programme provides:
• experience of the diagnostic techniques required to become technically competent in practical work, and to master the underlying analytical and
clinical principles
• the opportunity to gain knowledge of specialist areas such as cytopathology, forensic pathology, neuropathology and paediatric pathology, in
order to be able to provide specialist advice
• training in the communication and teaching skills necessary for effective practice
• the acquisition of the ability to provide specialist opinion in histopathology
• the acquisition of management skills to lead a department providing an effective service
• experience of research and development projects and critical assessment of published work so as to contribute in a team and individually to the
development of the service
• the acquisition of life-long habits of reading, literature searches, consultation with colleagues, attendance at scientific meetings, and the
presentation of scientific work that are essential for continuing professional development (CPD)
• experience of the practice of clinical governance and audit (specialist and multidisciplinary) through evaluation of practice against the standards of
evidence-based medicine, which underpin histopathology practice.
Clinical governance is defined by the Department of Health as ‘a framework through which NHS organisations are accountable for continuously
improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will
flourish.’ In histopathology, trainees must acquire knowledge of the lines of accountability, quality improvement programmes, clinical audit, evidence-
based practice, clinical standards and guidelines, managing risk and quality assurance programmes. Training in these areas must continue
throughout all stages of the curriculum.
The award of a CCT will indicate suitability for independent professional practice. During training, trainees will be able to use the curriculum to monitor
their progress towards this goal. Formal assessments and examinations will be based on curricular objectives. The curriculum will facilitate regular
assessment of trainees’ progress by trainees and their trainers.
Curriculum development
This curriculum was originally developed by the Histopathology CATT and the Working Group on Run-through Training, with input from the Specialty
Advisory Committees (SAC) on Histopathology and Paediatric Pathology; the Cytopathology, Forensic Pathology and Neuropathology Sub-
committees and Examination Panels of The Royal College of Pathologists. In addition, the College’s Lay Advisory Committee (LAC) was consulted
and a draft version of the curriculum was published on College website for consultation with College Fellows and Registered Trainees on 13 June
2005 for a two-week period.
The content of this curriculum was derived from current UK hospital practice in histopathology. Educational supervisors and trainees were involved in
its development via their representation on various College committees such as the Histopathology CATT, SAC on Histopathology, the related
subspecialty’s sub-committees and the Trainees Advisory Committee (TAC).
9
The curriculum will allow trainees to take control of their own learning and to measure achievement against objectives. It will help in the formulation of
a regularly updated education plan in conjunction with an educational supervisor and the local specialty training committee.
The curriculum was agreed by the Histopathology CATT on 6 April 2005 and the Joint Committee on Higher Pathology Training (JCHPT) on 17 May
2005 and approved by College Council on 23 June 2005.
The curriculum was approved by PMETB on 12 April 2007 and formally published in May 2007. It was republished in July 2008 to incorporate a series
of minor amendments.
Stages of training and learning

The curriculum is divided into four stages, A–D. Trainees may not progress to the next stage of training until they have satisfactorily completed the
preceding stage. Trainees will gain appropriate experience within their programme to achieve all necessary curricular objectives. During Stage A, all
programmes will provide broadly similar early experience as detailed in Appendix 1. In stages B and C, the precise order of training will vary from
programme to programme. By the end of Stage C, the totality of trainees’ experience should be comparable regardless of their training programme.
During Stages B–D, trainees will be expected to take increasing levels of responsibility for their work as they progress towards independent practice.
This will be facilitated by the assessment of general histopathology competencies as set out in the competency-based framework for graded
responsibility.
Stage A
Stage A of training is 12 months whole-time equivalent. This stage of the curriculum (see Appendix 1) will begin with a formal introduction to the basic
principles of histopathology. Following the induction period, the trainee will receive instruction and practical experience in further aspects of
histopathology. This stage of training will be formally assessed by The Royal College of Pathologists’ Year 1 Histopathology Assessment, a multi-
source feedback exercise and an educational supervisors report, culminating in an ARCP.
In order to satisfactorily complete stage A of histopathology training, trainees must have:

• satisfactorily completed stage A of the histopathology curriculum and a minimum training period of 12 months (whole-time equivalent)
• achieved satisfactory outcomes in the requisite number of workplace-based assessments
• undertaken a multi-source feedback assessment
• performed satisfactorily in The Royal College of Pathologists’ Year 1 Histopathology Assessment
• obtained a satisfactory outcome in the ARCP.
Stage B
Stage B of training is between month 13 and month 36 of whole-time equivalent training. During Stage B of training, the trainee will continue to
broaden their experience and understanding of histopathology. The knowledge gained during this stage of training will be formally assessed by the
FRCPath Part 1 examination.
10
In order to complete stage B of histopathology training, trainees must have:
• satisfactorily completed a total of at least 24 months of training (whole-time equivalent)
• passed the FRCPath Part 1 examination in histopathology
• obtained one or more satisfactory outcomes in the ARCP to indicate satisfactory progress in training.
Stage C
Stage C of training is between month 25 and month 48 whole-time equivalent training. This stage of the curriculum enables the trainee to undertake
further specialised general histopathology training or sub-specialist training in forensic pathology, neuropathology or paediatric pathology. This stage
of training will in part be summatively assessed by the FRCPath Part 2 examination.
In order to complete stage C of histopathology training, trainees must have:

• satisfactorily completed a total of at least 42 months of training (whole-time equivalent)
• passed the FRCPath Part 2 examination in either histopathology or a relevant subspecialty
• obtained one or more satisfactory outcomes in the ARCP to indicate satisfactory progress in training.
Stage D
Stage D of training is between month 43 and month 60 whole-time equivalent training. This stage of the curriculum prepares the trainee for their
consultant post. Trainees pursuing subspecialty training in cytopathology will normally begin their training in stage D. The ARCP undertaken towards
the end of Stage C should identify goals for the trainee to achieve during their final year of training. By the end of Stage D, the trainee should be able
to demonstrate a level of knowledge and skill consistent with practise as a consultant in that specialty in the National Health Service.
In order to complete stage D of histopathology training, trainees must have:

• satisfactorily completed a total of at least 60 months of training (whole-time equivalent).
• satisfactorily completed all areas of the histopathology curriculum (and subspecialty curriculum if applicable)
• obtained an ARCP outcome 6 to indicate that all clinical (and research where relevant) competences have been achieved, leading to the award
of the CCT.
In addition to the above, trainees will also be required to undertake a universal pathology focussed MSF assessment in ST3 and ST5. Depending on
the trainees’ individual progress the ST3 MSF will normally take place in either Stages B or C. The ST5 MSF will normally take place in Stage D.
Training programmes
Training programmes will be quality assured by PMETB and training posts and programmes will be recommended for approval by the relevant
Postgraduate Deanery with input from The Royal College of Pathologists.
11
Training programmes should include suitable rotational arrangements to cover all the necessary areas of the curriculum and should include an
appropriate balance between teaching hospitals, district general hospitals and specialist units, such that each trainee gains the breadth of training
required for satisfactory completion of the curriculum. The exact rotational arrangements will vary according to the size of the departments in the
various training hospitals, the number of placements on the training scheme and the number of other trainees on the training programme. The training
programme should be organised in such a way as to give each trainee some experience in most recognised areas of subspecialisation.
The structure and operation of the training programme is the responsibility of a Specialty Training Committee (STC), which will ensure that every
trainee is provided with an appropriate range of educational experience to complete his or her training.
The local Programme Director or Regional Specialty Advisor are responsible for the overall progress of the trainee and will ensure that the trainee
satisfactorily covers the entire curriculum by the end of the programme.
Each trainee should have an identified educational supervisor at every stage of their training. The educational supervisor is the consultant under
whose direct supervision the trainee is working. A trainer is any person involved in training the trainee (e.g. consultant, clinical scientist, senior
biomedical scientist [BMS]). A trainee may be trained by a number of trainers during their training.
CONTENT OF LEARNING
The curriculum details the level of knowledge and skill that a trainee should acquire to provide a high quality service at consultant level in the NHS.
The general professional and specialty-specific content of the curriculum is outlined below.
1. Basic knowledge and skills (see pages 21–54 and Appendix 1).
2. Clinical histopathology including surgical pathology, autopsy and cytopathology (see pages 21–54).
3. Sub-specialist areas of histopathology. The trainees will acquire a basic knowledge of cytopathology, forensic pathology, neuropathology and
paediatric pathology. Subspecialisation within these areas may be undertaken (see Appendix 2).
4. Generic skills required for histopathology, in accordance with Good Medical Practice (see Appendix 3).
The curriculum outlines the knowledge, skills, attitudes and expertise that a trainee is expected to obtain in order to achieve the award of the CCT.
Additional guidance is provided for ST1 training (see Appendix 1) and subspecialty training (see Appendix 2), outlining the sequencing and learning
for this period of training. For training in ST2–5, it is expected that every trainee should undertake the core training outlined in pages 21–54, but it is
recognised that the sequencing of learning and experience will differ according to the programme. The curriculum maps components of Good Medical
Practice against the clinical components of histopathology and its associated subspecialties.
The recommended learning experiences are listed on pages 15–16. The intended outcomes of learning are benchmarked to identifiable stages of
training; these are listed on pages 10–11.
The Royal College of Pathologists is committed to supporting self-care, promoting well-being and community engagement, prevention and early
intervention with services designed around the patient/service user rather than the needs of the patient/service user being forced to fit with the
services offered. The following common core principles of self-care are therefore supported.
12
These are:
Principle 1: Empower people who use services/patients to make informed choices to manage their condition and care needs more effectively
Principle 2: Communicate effectively to enable people who use services/patients to develop and gain confidence in their self care skills
Principle 3: Enable and support people who use services/patients to use technology to support self care
Principle 4: Enable and support people who use services/patients to develop skills in self care
Principle 5: Enable and support people who use services/patients to participate in service planning and to access support networks.
Further details are available in Supporting People with Long Term Conditions to Self Care: A guide to developing local strategies and best practice
(2005).
Upon satisfactory completion of the histopathology training programme, the trainee must have acquired and be able to demonstrate:
• appropriate attitudes in order to be able to work as a consultant
• good working relationships with colleagues and the appropriate communication skills required for the practice of histopathology
• the knowledge, skills and attitudes to act in a professional manner at all times
• the knowledge, skills and attitudes to provide appropriate teaching and to participate in effective research to underpin histopathology practice
• an understanding of the context, meaning and implementation of clinical governance
• a knowledge of the structure and organisation of the NHS
• the acquisition of management skills required for the running of a histopathology laboratory
• familiarity with health and safety regulations, as applied to the work of a histopathology department.
Purpose of assessment
The Royal College of Pathologists' mission is to promote excellence in the practice of pathology and to be responsible for maintaining standards
through training, assessments, examinations and professional development.
The purpose of The Royal College of Pathologists' assessment system in histopathology and its subspecialties is to:
• indicate suitability of choice at an early stage of the chosen career path
• indicate the capability and potential of a trainee through tests of applied knowledge and skill relevant to the specialty
• demonstrate readiness to progress to the next stage(s) of training having met the required standard of the previous stage
• provide feedback to the trainee about progress and learning needs
• support trainees to progress at their own pace by measuring a trainee's capacity to achieve competencies for their chosen career path
• help to identify trainees who should change direction or leave the specialty
• drive learning demonstrated through the acquisition of knowledge and skill
• enable the trainee to collect all necessary evidence for the ARCP
• gain Fellowship of The Royal College of Pathologists
13
• provide evidence for the award of the CCT
• assure the public that the trainee is ready for unsupervised professional practice.
A blueprint of the medical histopathology assessment system is available on the PMETB website.
Methods of assessment
Trainees will be assessed in a number of different ways during their training. Satisfactory completion of all assessments and examinations will be
monitored as part of the ARCP process and will be one of the criteria upon which eligibility to progress will be judged. A pass in the Year 1
Histopathology Assessment and the FRCPath examination are required as part of the eligibility criteria for the award of the CCT.
Year 1 Histopathology Assessment

Trainees must pass the Year 1 Histopathology Assessment as one of the requirements for satisfactory completion of Stage A of training.
Workplace-based assessment
Trainees will be expected to undertake workplace-based assessment throughout the entire duration of their training in histopathology. These will
comprise:
• Case-based discussion (CbD) (minimum of 6 satisfactory outcomes required per year)
• Directly observed practical skills (DOPS) (minimum of 6 satisfactory outcomes required per year)
• Evaluation of clinical events (ECE) (minimum of 6 satisfactory outcomes required per year)
• Multi-source feedback (MSF) (minimum of 3 during training).
Further separate guidance is provided about the method and required frequencies of these assessments.
FRCPath examination
The major assessments will occur during Stage B of training in the shape of the FRCPath Part 1 examination and summatively towards the end of
Stage C of training in the shape of the FRCPath Part 2 examination.
Evidence of competence
The College does not have any supportive evidence as to the ideal minimum workload figures or subspecialty training periods that will result in a
satisfactory level of competence. It is recognised that this will differ according to the ability and aptitude of the individual trainee and their learning
environment. We believe that a diverse range of material seen under the appropriate supervision and guidance of an educational supervisor is a
superior method of working, towards achieving the required competencies, than the indicative figures below. The College intends to monitor and
gather evidence about the optimal workload figures and training periods required to achieve the desired competencies, in conjunction with the
relevant methods of assessment for training.
14
Therefore, for the time being and as a pragmatic measure, we propose as a guide the following indicative estimates of workload:
• surgical pathology: 500 cases per annum rising to 1000 cases per annum during stages C and D
• autopsy: 20 per annum, 100 by stage D (completion of training)
• cytopathology: 300 cases per annum rising to 600 cases per annum during stages C and D.
Annual Review of Competence Progression

The ARCP is an annual opportunity for evidence gathered by a trainee, relating to the trainee’s progress in the training programme, to document the
competences that are being gained. Evidence of competence will be judged based on a portfolio of documentation, culminating in an Educational
Supervisors Structured Report.
Separate ARCP guidance and forms are available on the College website. A copy of all ARCP forms issued to the trainee must be provided to The
Royal College of Pathologists prior to recommendation for the award of the CCT. Lack of progress, identified by the issue of an ARCP outcome 3 or 5
and necessitating repeat training to rectify deficiencies will lead to the extension of training. Training leading to the issue of an ARCP 3 or 5 and
necessitating repeat training will not be recognised towards the award of the CCT.
Evidence of ARCP outcome 6 is required as part of the evidence for the award of the CCT.
MODEL OF LEARNING
The models of learning can be applied to any stage of training in varying degrees.
The majority of the curriculum will be delivered through work-based experiential learning, but the environment within the department should
encourage independent self-directed learning and make opportunities for relevant off-the-job education by making provision for attendance at local,
national and, where appropriate, international meetings and courses. Independent self-directed learning should be encouraged by, for example,
making use of the e-learning tool or providing reference text books etc. It is the trainee’s responsibility to seek opportunity for experiential learning.
The rotas should also be arranged in such a way that trainees have time available for participation in research projects as part of their training. The
more academically inclined trainees will be encouraged to take time out from the training time to include a more sustained period of grant-funded
research, working towards an MD or PhD.
Learning for knowledge, competence, performance and independent action will be achieved by assessment and graded responsibility for reporting,
allowing trainees at various stages of training to acquire responsibility for independent reporting. Assessment will be set by The Royal College of
Pathologists in the form of workplace-based assessment including multi-source feedback, the Year 1 Histopathology Assessment and the FRCPath
examination.
LEARNING EXPERIENCES
The following teaching/learning methods will be used to identify how individual objectives will be achieved.
15
a) Routine work: the most important learning experience will be day-to-day work. Histopathology trainees are amongst the most closely
supervised groups in postgraduate medical training. This close supervision allows frequent short episodes of teaching, which may hardly be
recognised as such by trainees.
b) Textbooks: histopathology departments have a wide range of reference texts available. These allow trainees to ‘read around’ routine cases
that they are reporting.
c) Private study: more systematic reading of textbooks and journals will be required in preparation for examinations.
d) ‘Black box’ and other departmental teaching sessions: these occur on a regular basis in most departments.
e) Regional training courses: these are valuable learning opportunities. Trainees should be released from service duties to attend.
f) National training courses: these are particularly helpful during preparation for the FRCPath Part 2 examination. In addition to providing
specific teaching, they also allow trainees to identify their position in relation to the curriculum and their peers.
g) Scientific meetings: research and the understanding of research are essential to the practice of histopathology. Trainees should be
encouraged to attend and present their work at relevant meetings.
h) Discussion with BMS: BMS staff can provide excellent training, particularly in relation to laboratory methods, health and safety, service
delivery, procurement and human resources.
i) Multidisciplinary team meetings (MDTs): attendance at and contribution to MDTs and clinicopathological conferences offers the opportunity
for trainees to develop an understanding of clinical management and appreciate the impact of histopathological diagnosis on patient care. The
MDT is also an important arena for the development of inter-professional communication skills.
j) Attachment to specialist departments: attachments of this kind will be required if a training programme cannot offer the full range of specialist
experience needed to complete the curriculum. They will also be beneficial for those trainees in their final year of training who wish to develop a
special interest before taking up a consultant post.
k) E-learning.
SUPERVISION AND FEEDBACK
Specialist training must be appropriately supervised by the senior medical and scientific staff on a day-to-day basis under the direction of a
designated educational supervisor and an STC that links to the appropriate Postgraduate Deanery. Supervision has more than one meaning in
histopathology.
Trainees will work under consultant supervision in the histopathology, cytopathology and autopsy services, gradually widening their knowledge and
experience in each area so that by the time they have passed the FRCPath Part 2 examination they are able to work largely independently. The day-
to-day supervised training will be supplemented by more formal teaching such as ‘black box’ sessions and on regionally and nationally organised
training courses (see above).
If a histopathology report generated by the trainee states that they have been supervised by a consultant, this is usually taken to mean that the
consultant has examined that report with the trainee. It also implies that the consultant accepts not only the microscopic but also any macroscopic
description as accurate, even if the supervisor has not personally reviewed the specimen.
16
However, there is also a more general level of supervision in day-to-day work. A trainee may ask for assistance at any time if a specimen with which
they are dealing is unfamiliar or unusual. In the mortuary, a trainee competent in basic autopsy practice will be able to seek advice if an unusual or
unexpected finding is encountered. Supervision also extends to working relationships and communication within and beyond the histopathology
department.
Educational supervision is a fundamental conduit for delivering teaching and training in the NHS. It takes advantage of the experience, knowledge
and skills of educational supervisors\trainers and their familiarity with clinical situations. It ensures interaction between an experienced clinician and a
doctor in training. This is the desired link between the past and the future of medical practice, to guide and steer the learning process of the trainee.
Clinical supervision is also vital to ensure patient safety and the high quality service of doctors in training.
The College expects all doctors reaching the end of their training to demonstrate competence in clinical supervision before the award of the CCT. The
College also acknowledges that the process of gaining competence in supervision starts at an early stage in training with foundation doctors
supervising medical students and specialty registrars supervising more junior trainees.
The example provided by the educational supervisor is the most powerful influence upon the standards of conduct and practice of a trainee. The role
of the educational supervisor is to:
• have overall educational and supervisory responsibility for the trainee in a given post
• ensure that the trainee is familiar with the curriculum relevant to the year/stage of training of the post
• ensure that the trainee has appropriate day-to-day supervision appropriate to their stage of training
• ensure that the trainee is making the necessary clinical and educational progress during the post
• ensure that the trainee is aware of the assessment system and undertakes it according to requirements
• act as a mentor to the trainee and help with both professional and personal development
• agree a training plan (formal educational contract) with the trainee and ensure that an induction (where appropriate) has been carried out soon
after the trainee’s appointment
• discuss the trainee’s progress with each trainer with whom a trainee spends a period of training
• undertake regular formative/supportive appraisals with the trainee (two per year, approximately every six months) and ensure that both parties
agree to the outcome of these sessions and keep a written record
• regularly inspect the trainee’s training record, inform trainees of their progress and encourage trainees to discuss any deficiencies in the training
programme, ensuring that records of such discussions are kept
• keep the STC Chair informed of any significant problems that may affect the trainee’s training.
In order to become an educational supervisor, a consultant must have significant experience in the specialty, a demonstrated interest in teaching and
training, appropriate access to teaching resources, be involved in and liaise with the appropriate regional training committees, be involved in annual
reviews and liaise closely with the College Regional Specialty Adviser. The deaneries organise extensive training programmes for educational
supervisor’s development. Educational supervisors are expected to keep up-to-date with developments in postgraduate medical training (e.g. by
17
attending deanery and national training the trainer courses), have access to the support and advice of their senior colleagues regarding any issues
related to teaching and training and to keep up-to-date with their own professional development.
This should be read and implemented in conjunction with PMETB’s Standards for trainers.
MANAGING CURRICULUM IMPLEMENTATION
The curriculum outlines the minimum histopathology training requirements for delivery in a regional training programme. It guides educational
supervisors as to what is required to deliver the curriculum and guides trainees in the learning and assessment methods required for satisfactory
completion of training.
It is the responsibility of the Programme Director and their deanery, with the assistance of the regional STC and supported by the Regional Specialty
Advisor, to ensure that the programme delivers the depth and breadth of histopathology and subspecialty training outlined in the curriculum. The
Programme Director must ensure that each post or attachment within the programme is approved by PMETB.
It is the responsibility of PMETB to quality assure training programmes and the responsibility of the Histopathology CATT and Joint Committee on
Pathology Training to ensure training programmes across the UK are able to deliver a balanced programme of training.
It is the responsibility of the educational supervisor of a particular post or attachment within a programme to ensure that the training delivered in their
post meets the requirements of the relevant section(s) of the curriculum. The educational supervisor must undertake regular educational appraisal
with his/her trainee, at the beginning, middle and end of section of training, to ensure structured and goal-oriented delivery of training.
Trainees must register with The Royal College of Pathologists on appointment to ST1 of a histopathology training programme. It is the trainee’s
responsibility to familiarise him/herself with the curriculum and assessment requirements both for the satisfactory completion of each stage of training
and the award of the CCT. They must be familiar with all aspects of the assessment system; workplace based assessment including multi-source
feedback, the Year 1 Histopathology Assessment and the FRCPath examination. It is the trainee’s responsibility to ensure that they apply in good
time for any assessments and examinations that demand an application. Trainees must also make appropriate use of the online training portfolio and
e-learning.
CURRICULUM REVIEW AND UPDATING
The curriculum will be evaluated and monitored by The Royal College of Pathologists as part of continuous feedback from STCs, Programme
Directors, Regional Specialty Advisors, trainers and trainees, underpinned by a programme of visits to quality assure training programmes.
The curriculum will be reviewed in the first instance by the Histopathology CATT within two years of publication. In reviewing the curriculum, opinions
will be sought from the College’s SAC on Histopathology, its related subspecialty sub-committees, the Trainees Advisory Committee, the Lay
Advisory Committee and its Fellows and Registered Trainees.
Any significant changes to the curriculum will need the approval of The Royal College of Pathologists’ Council and PMETB.
18
EQUALITY AND DIVERSITY
Extract from The Royal College of Pathologists’ Diversity and equality policy and approach (December 2006). A full copy of the policy is available on
the College website.
The Royal College of Pathologists is committed to the principle of diversity and equality in employment, membership, academic activities,
examinations and training. As part of this commitment we are concerned to inspire and support all those who work with us directly and indirectly.
Integral to our approach is the emphasis we place on our belief that everyone should be treated in a fair, open and honest manner. Our approach is a
comprehensive one and reflects all areas, of diversity, recognising the value of each individual. We aim to ensure that no one is treated less
favourably than another on the grounds of ethnic origin, nationality, age, disability, gender, sexual orientation, race or religion. Our intention is to
reflect not only the letter but also the spirit of equality legislation.
Our policy will take account of current equality legislation and good practice. Key legislation includes:
• The Race Relations Act 1976 and the Race Relations Amendment Act (RRAA) 2000
• The Disability Discrimination Act 1995 and subsequent amendments
• The Sex Discrimination Act 1975 and 1986 and the 1983 and 1986 Regulations
• The Equal Pay Act 1970 and the Equal Pay (Amendment) Regulations 1983 and 1986
• The Human Rights Act 1998
• The Employment and Equality (Sexual Orientation) Regulations 2003
• The Employment and Equality (Religion or Belief) Regulations 2003
• Gender Recognition Act 2004
• The Employment Equality (Age) Regulations 2006.
The Training and Educational Standards Department collects information about the gender and ethnicity of trainees as part of their registration with
the College. This information is recorded by the College and statistics published on an annual basis in the annual report. Further information about
the monitoring activities of the College trainees, candidates and Fellows are available in the College policy.
ACKNOWLEDGEMENTS
Dr David Bailey (current CATT Chair), Dr Adrian Bateman (immediate past CATT Chair), Dr Kevin West, Dr Hani Zakhour, Dr Nigel Kirkham,
Professor Mike Dixon, Dr Patrick Gallagher, Dr Karin Denton (cytopathology curriculum), Dr Ryk James (forensic pathology curriculum), Professor
Roy Weller (neuropathology curriculum), Dr Isabella Moore (paediatric pathology curriculum), the RCPath Histopathology College Advisory Training
Team and Histopathology Specialty Advisory Committee. Professor Shelley Heard (current Director of Training and Educational Standards), Dr Hani
Zakhour (immediate past Director of Training and Educational Standards), Professor Dame Lesley Southgate and Professor Janet Grant. Miss
Joanne Brinklow.
19
GENERAL HISTOPATHOLOGY CURRICULUM: STAGES A–D/ST1–5
The general histopathology curriculum outlines the training requirements for the award of the CCT in histopathology. The general histopathology
curriculum is supported by and should be used in conjunction with a detailed curriculum for Stage A/ST1 of training at Appendix 1.
All trainees are expected to undertake training in the basic knowledge and skills of histopathology (see pages 21–54 and Appendix 1), and specialist
histopathology including surgical pathology, autopsy and cytopathology (see pages 21–54) along with the generic skills required for histopathology, in
accordance with Good Medical Practice (see Appendix 3).
Trainees are also expected to acquire a basic knowledge of cytopathology, forensic pathology, neuropathology and paediatric pathology.
Subspecialisation within these areas may be undertaken during stages C and D. (see Appendix 2).
20
1. GOOD CLINICAL CARE
Objective: to demonstrate adequate knowledge and skills and appropriate attitudes in routine clinical work.
New specialists will:

• have the breadth of knowledge and skills to take responsibility for safe clinical decisions
• have the self-awareness to acknowledge where the limits of their competence lie and when it is appropriate to refer to other senior colleagues for
advice
• have the potential (or the ability) to take responsibility for clinical governance activities, risk management and audit in order to improve the quality
of service provision.
Surgical pathology
Subject Knowledge Skills and knowledge application Attitudes

Basic knowledge Possess sufficient general clinical Develop the ability to solve complex Understand importance of integration
knowledge including major changes in clinical [and research, when applicable] of clinical and pathological data for
trends of diagnosis and treatment. problems by applying sound knowledge accurate diagnosis.
Possess sufficient knowledge of normal of basic principles without the Understand the increasing need to
anatomy, physiology and requirement always to rely on ‘pattern combine morphological opinions with
pathophysiology. matching’. data from molecular analyses in
diagnostic surgical pathology.
Surgical cut-up Understand principles of specimen Possess sufficient manual dexterity to Understand importance of accuracy
[‘General’] dissection, macroscopic description and perform dissection safely and and requirement for attention to
block selection in neoplastic and non- accurately, without damage to tissues. detail during specimen description
neoplastic disease. and block selection.
Stages B-D: understand principles of Understands importance of ensuring
dissection of all major cancer resection that request form and specimen
specimens and tissue sampling to enable identification is accurate and the
completion of RCPath’s Standards and requirement to identify and resolve
Datasets for Reporting Cancers. any errors or discordance.
Stage A: See Appendix 1.
Laboratory processes Understand the principles of laboratory Stage A: one week’s or equivalent Respect the work of the technical
processing within surgical pathology and experience of laboratory processing staff in preparing slides for viewing.
cytopathology. including section cutting.
21
Surgical reporting Understand the principles of microscopy. Be able to set up a microscope with Understand requirement for attention
[‘General’] Knowledge of the microscopic features of ergonomic safety and operate it to detail during surgical reporting and
the range of normality within tissues as effectively. the need for correlation with the
well as the major common pathological Be able to recognise the microscopic clinical situation.
processes and patterns of disease features of tissue structure in normality Demonstrate an understanding of the
Stage A: See Appendix 1. and disease, as appropriate to one’s importance of surgical pathology to
level of experience. clinicians and patients [e.g.
Stages B-D: develop a special interest in
timeliness and accuracy of reporting].
one or more diseases or organ systems. Able to complete RCPath Standards
and Datasets for Reporting Cancers.
May remain generalised or become
specialised in one or more areas [e.g.
neuropathology, paediatric pathology].
Special techniques Understand principles of ‘special’ Know when to resort to special Understand cost-benefit issues when
histochemical and immunohisto-chemical techniques. considering the use of additional
methods. Be able to recognise histological techniques.
Understand principles of common features of histochemical and Stages B-D: initiate special
molecular pathology techniques. immunohisto-chemical stains in normal techniques in preparation of cases.
Understand principles of electron and diseased tissues.
microscopy.
Molecular pathology Possess sufficient knowledge of Be able to source and request Appreciate the growing role of
molecular techniques as applied within appropriate molecular tests, as clinically molecular techniques in cellular
clinical medicine and particularly within required. pathology.
surgical pathology. Develop the skills to interpret data from Understand the increasing need to
In particular, understand the principles of molecular analyses in the context of the combine morphological opinions with
the polymerise chain reaction and in situ clinical situation and morphological data from molecular analyses in
hybridisation techniques and the clinical appearances when undertaking diagnostic surgical pathology.
situations in which they may be usefully diagnostic surgical pathology. Be prepared to communicate closely
applied to achieve a diagnosis, predict Be able to create a final report that with colleagues undertaking
prognosis and guide management. incorporates both morphological and molecular analyses when
Understand the limitations of molecular molecular data where appropriate. appropriate.
techniques.
22
Autopsy

Pathological basis of A wide knowledge of the pathological basis A high standard of practice in the
disease of disease and the macroscopic/ techniques used for identifying
microscopic pathology of various types of morphological abnormalities at autopsy
death. examination.
Knowledge of the literature relating to
controversial issues and to difficulties in
interpreting subjective changes is
necessary. Have a broad knowledge of
techniques used in identifying
morphological abnormalities.
General Possess knowledge of anatomy, Demonstrate manual dexterity sufficient Be able identify and address the
macroscopic features of major disease to perform autopsies safely and to issues raised by the death.
processes and common tissue dissection demonstrate the major abnormalities. Be responsibility for identification of
techniques relevant to autopsy practice. the deceased and take ultimate
Familiarity with the RCPath’s Guidelines on responsibility for this.
Autopsy Practice, 2002 and Best Practice Demonstrate an understanding of the
Scenarios, 2005. importance of autopsy findings to
Have some understanding of the training clinicians and relatives.
undertaken by anatomical pathology
technologists and the role that they can
appropriately play within all aspects of the
mortuary function
(see www.aaptuk.org).
Clinical liaison Have an understanding of the use of Be able to interrogate the clinical records Be conversant with current clinical
clinical information and the health record in and understand the utility and limitations practice.
autopsy examination and understand the associated with various types of Be able to liaise with clinical
limitations on dissemination of autopsy investigation including imaging, colleagues in order to obtain clinical
examination information to third parties. microbiology and biochemistry. All these information prior to autopsy.
investigation modalities and others can
Know the main side effects of common
provide useful positive or negative clues
treatments and the major
in the diagnostic process.
complications of most surgical
Be able to identify issues to be addressed procedures.
by the autopsy examination.
23
External examination Familiarity with the RCPath’s Guidelines The ability to describe succinctly and
on Autopsy Practice, 2002 and Best correctly the different forms of injury,
Practice Scenarios, 2005. look for external signs of natural and
unnatural death and distinguish
between genuine lesions and post-
mortem artefact.
Autopsy technique Have knowledge of, and the ability to Carry out a normal full evisceration
perform, autopsies in a variety of Dissect the internal organs.
situations, such as the following:
Describe the appearances accurately
• cardiac disease of unknown cause and succinctly.
• death after a period of intensive care Interpret the findings in the light of the
• death associated with the use of clinical information available.
potentially toxic therapeutic agents Present the findings to clinicians either
(e.g. anticoagulants, opiates, immediately or later at a clinical
cytotoxics, etc.) meeting.
• endocrine/metabolic death Ensure that special dissections are
• hepatic disease of unknown cause made in appropriate circumstances.
• intra-abdominal disease of unknown Have skills in techniques used in
cause perioperative autopsies and autopsies
following death in hospital, in a variety
• neurological disease of unknown cause of situations such as:
• renal disease of unknown cause • iatrogenic deaths
• respiratory disease of unknown cause • intraoperative deaths
• the dissection of and testing of • neurosurgical deaths
medical appliances such as
• post-abdominal surgery deaths
intravascular lines, drains and
pacemakers. • post-cardiac surgery deaths
• sudden unexpected death in hospital
and the exclusion of hospital
homicide
• vascular surgery deaths.
24
Deaths in the Have a knowledge of the aims of the
community autopsy and investigations required
where death occurs in various situations,
including examples as follows: 1
• alcoholism
• bodies recovered from fire
• body repatriated from another country
• carbon monoxide poisoning
• deaths without pathological findings
• domestic accidents
• drowning
• drugs of abuse
• epilepsy
• examination of the decomposed body
• hanging
• industrial accidents
• industrial disease, in particular
asbestos and coalmining
• maternal death
• overdoses
• road traffic collisions
• sudden death in infancy
• suicidal sharp force injury.
Histopathology Knowledge of autopsy appearances of Ability to select appropriate tissue Ability to think laterally.
various common fatal conditions. blocks.
1
Saukko P, Knight B. Knight’s forensic pathology (3rd edition). 2004.
25
Microbiology Knowledge of those areas of Ability to take appropriate samples. Ability to think laterally.
microbiology that are relevant to autopsy
practice, e.g meningitis, pneumonia,
endocarditis, tuberculosis, viral hepatitis.
Toxicology Knowledge of those areas of toxicology Ability to take appropriate samples. Ability to think laterally.
that are relevant to autopsy practice, e.g.
drug abuse and evaluation of compliance
with prescribed medications.
Other investigations Knowledge of those areas of Ability to take appropriate samples. Ability to think laterally.
biochemistry, medical genetics and other
investigative modalities that are relevant
to autopsy practice.
Have a basic knowledge of disorders
having an inherited defect and of
procedure relating to appropriate
investigation of families.
Consent Be conversant with current policy in Be able to obtain consent for autopsies Be able to give explanation to
relation to consent for autopsies and for and for further investigation of whole families of the reasons for and
organ retention. organs. – if requested – details of the
investigations required by an autopsy
Be conversant with current policy in
examination.
relation to organ donation.
Understand the legal basis of consent to Be able to explain to families when
autopsy examination and the tissue or organs may need to be sent
circumstances in which consent is not away for expert review and options
required. for funeral, disposal etc.
Understand issues of autopsy

consent, tissue/organ retention and
Coroners’/Procurator Fiscals’
practice.
26
Consent (continued) Be familiar with the duty to report deaths
to the coroner, the preliminary enquiries
that may take place through the coroner
system and entitlement to attend autopsy
examination by interested parties.
Be able to advise as to when an autopsy
is not necessary or when its aims might
be fulfilled by a limited examination.
Be familiar with the practicalities of
identification of bodies.
Be familiar with the various techniques
available for confirming or establishing
identification, the retention of materials
that may be required by the coroner
and/or police and of the need to facilitate
where appropriate the removal of tissues
for transplantation.
Health and safety Be conversant with relevant protocols Be able to work in the mortuary in a Take an active interest in safe
and documentation of departmental safe way. working practices for all staff and
working practices, and be familiar with visitors to the mortuary.
the practicalities of mortuary practice.
Have a working knowledge of the
regulatory aspects of health and safety
issues, sufficient to be able to draw up a
mortuary policy.
27
Health and safety Be familiar with the document Safe
(continued) Working and Prevention of Infection in
the Mortuary and Autopsy Suite (Health
Services Advisory Commission),
Guidelines on Autopsy Practice (RCPath,
2002).
Have some understanding of the design
concepts of a modern mortuary. These
are inextricably linked to health and
safety issues. NHS Estates Building Note
20 specifically covers advice for modern
mortuary design.
Medico-legal issues Be conversant with current legislation A working knowledge of the law relating An impartial stance and a
and regulations relating to medico-legal to death, the investigation of death and commitment to justification of any
autopsies and related matters. disposal of the dead (for those in opinion from a balanced
Scotland, relevant documents in the interpretation of medical literature.
Be familiar with the legislative
background to the investigation of death Crown Prosecution and Procurator
Fiscal Service). A commitment to best autopsy
with knowledge of the relevant parts of
practice.
The Births and Deaths Registration Act
1953; The Coroners' Act 1988; The
Coroners' Rules 1984; The Cremation
Act 1902; The Anatomy Act 1984; The
Human Organ Transplant Act 1989;
Reforming the Coroners and Death
Certification Systems: position paper
2004 (Home Office) and the Human
Tissue Act 2004.
28
Reports A knowledge of College documents Write a final gross and microscopic Caution in reiterating medical
relating to the production of autopsy report with suitable summaries, histories, especially where sensitive
reports. according to the RCPath’s Guidelines personal information is concerned.
on Autopsy Practice, 2002. An impartial stance and a commit-
Familiarity with the RCPath’s Guidelines
ment to justification of any opinion
on Autopsy Practice, 2002 and Best Produce finished reports in a timely
from a balanced interpretation of
Practice Scenarios, 2005. way.
medical literature.
Photography See GMC 2 and Home Office3 guidelines Be able to use a camera. Be aware of confidentiality issues.
and the RCPath’s Guidelines on Autopsy
Practice, 2002.
Teaching Be aware of the value of the autopsy as Appropriate teaching skills. Be prepared to teach at every
a teaching aid. available opportunity.
Inquests Have a working knowledge of judicial Practical experience of judicial inquiries Can maintain an impartial stance.
process particularly within the Coroner's into deaths. Skilled presentation of complex
court and the role of the Be familiar with inquest procedure and issues in a simple manner.
pathologist/medical witness.4 have experience observing inquests Recognises role as provider of
and ideally of giving evidence in court. information to the court and
recognises limitations of expertise.
An ability to identify public interest
issues and to facilitate any
investigations or opinions whose
need is made clear by results of
autopsy examination but which fall
outside personal expertise.
2
GMC. Making and using visual and audio recordings of patients. 2002.
3
Home Office. Guidelines on the use of photographic and other materials obtained during examination. 1994.
4
Dorries C. Coroner’s courts (2nd edition). 2004.
29
Feedback to families Communication skills required to inform An ability to interpret autopsy
and other interested clinical colleagues and other non- findings in the context of past
parties clinical professionals involved in medical history, clinical progression
inquiries into deaths and assist in of disease or injury and
multidisciplinary mortality review. circumstances of death and an ability
to communicate those findings and
opinions fully, clearly and simply to
those who need explanation of them.
Future developments Have a knowledge of the concepts that
underpin continuing professional
development, revalidation and quality
assurance.
Maintain an awareness of developments
in the field and in legislation and
regulations that may lead to
developments of or changes in practice.
Audit (specific to Have a knowledge of the role of Know where to find relevant information Facilitates provision of information
autopsy) confidential enquiries in the investigation from the UK and other professional for mortality review, for open
of certain categories of death – National pathology associations elsewhere in the investigation and for the provision of
Confidential Enquiry into Patient world. information.
Outcome and Death (NCEPOD),
Confidential Enquiry into Maternal and
Child Health (CEMACH) and Confidential
Enquiry into Suicide and Homicide
(CESH) – and the role of the autopsy
within those investigations is necessary.
30
Cytopathology
Trainees aiming for subspecialty training in cytopathology should refer to the subspecialty curriculum (pages 65–68) which should be completed
during stage D. For these individuals, the suggested 6 week cytopathology training per year should be regarded as a minimum recommendation. The
following curriculum sets out education and training requirements in cytopathology during stages A–C for trainees in histopathology. Trainees wishing
to continue working in cytopathology as a consultant should continue to maintain their expertise during stage D of training by continuing the activities
described in the following curriculum. Some trainees may have no desire to work in cytopathology at consultant level, and after achieving FRCPath
Part 2 they will not need to continue to maintain expertise in this way. In the UK, the majority of trainees will eventually be appointed to posts in district
general hospitals. Many are likely to work as histopathologists or cytopathologists, working in diagnostic cytopathology and in the cervical screening
programme alongside histology duties. For these individuals, general training in cytopathology as shown in the following curriculum is appropriate, up
to completion of the FRCPath Part 2 examination. During stage A of training, trainees in histopathology should be able to achieve the required
knowledge, skills and attitudes in cytopathology by completing six weeks of education and training in cytopathology, followed by a further six weeks
per year during stages B and C of the training period (this should be read in conjunction with the ‘Evidence of competence’ section on pages 14–15).
Gynaecological cytopathology

Cervical screening Rationale, methodology and organisation Ability to source information on the Understand the importance of the
programme (CSP) of the CSP. CSP. CSP to the population.
Basic understanding of roles of Ability to liaise with key individuals Respect the confidentiality of
component organisations, failsafe. locally. women’s data.
Issues of data confidentiality, Patient Read and signed PIAG guidance.
Information Advisory Group (PIAG).
Smear taking Smear-taking technique. Ability to access teaching material and Understanding of the role and
Technical aspects of spreading and expertise of staff outside the pathology responsibilities of other health
fixing a smear. department. professionals in the CSP.
Liquid-based cytopathology (LBC)
techniques, if appropriate.
Microscopy Setting up a microscope for screening. Screening. Attention to detail, vigilance.
How to screen a smear. Marking appropriate cells for
discussion.
Photomicrography.
Use of national Understanding of national nomenclature. Able to categorise abnormalities.
classified
nomenclature
31
Specimen adequacy Understanding of criteria for adequacy. Ability to diagnose inadequate smear.
Infections Knowledge of features of infections in Ability to recognise infections. Understanding of the psychological
cervical smears. effects on women of diagnosis of
infections.
Borderline nuclear Understanding of criteria for diagnosis. Ability to diagnose borderline change. Understanding of significance of
change diagnosis to women.
Awareness of uncertainty in
diagnosis in some cases.
Awareness of the dangers of
overcalling and under calling.
Dyskaryosis Knowledge of criteria for diagnosis of Ability to diagnose these abnormalities.
mild, moderate and severe dyskaryosis. Ability to formulate appropriate
Knowledge of criteria for diagnosis of management advice.
glandular abnormality. Ability to take and weigh advice on
Knowledge of criteria of diagnosis of diagnosis from screening staff.
possibly invasive lesions.
Knowledge of features of common pitfalls
in the diagnosis of dyskaryosis (e.g.
tubo-endometrioid metaplasia [TEM],
follicular cervicitis, metaplasia).
Management of Basic knowledge of process of Understanding of the CSP as a
women colposcopy, treatment modalities. patient centred multidisciplinary
approach.
Audit (specific to Knowledge of process of audit in cervical Demonstrate the ability to undertake Ethos of audit, openness and
cytopathology) screening. clinical audit, normally by performing at disclosure in cervical screening.
Basic knowledge of guidelines for audit least one clinical audit project per year.
of invasive cancer.
Awareness of quality assurance team.
New technologies Knowledge of liquid-based Keeping up with new developments
cytopathology, HPV testing and other through journals and other media.
new developments.
32
Non-gynaecological cytopathology

Technical aspects Basic knowledge of preparation and Able to recognise faults and artefacts of Ability to work with BMS staff.
staining techniques for common preparation, e.g. air-drying.
specimen types. Panels of antibodies for particular
Knowledge of use of special techniques, diagnostic applications, e.g.
e.g. immunocytochemistry. mesothelioma.
Diagnosis Features of malignancy in sites Able to diagnose malignancy with Care and attention to detail.
commonly investigated with confidence in specimens from breast, Acknowledgement of personal
cytopathology. gastro intestinal (GI) tract, respiratory limitations.
Features of specific non-malignant tract, urinary tract, head and neck, Awareness of work within a
diagnoses, e.g. infection. lymphoreticular system, serous fluids multidisciplinary team.
and thyroid.
Ability to integrate clinical information
and histology or other investigations
into diagnosis.
Ability to recognise when definitive
diagnosis is beyond capability.
Reporting Requirements for a report. Ability to write an accurate report that Understand multidisciplinary
Relevant datasets. gives clinicians the information they approach to diagnosis and
need. management.
Nationally recognised coding systems.
Knowledge of the likely outcome in
terms of further investigation or
management of the patient.
33
Neuropathology
The following curriculum sets out education and training requirements in neuropathology during stages A-C for trainees in histopathology. It is
essential for the good practice of histopathology that all trainees gain a relevant working knowledge of the normal and diseased nervous system, as
the brain, spinal cord, muscle and peripheral nerves are major organ systems in the body and their pathologies impinge on many, if not all, other
organ systems. In the UK, neuropathology services are largely concentrated in specialist centres with regional neurology and neurosurgical services.
Provision for secondment of trainees to local specialist neuropathology units or laboratories will therefore need to be robust and on a regular basis.
During stages A and B, prior to the FRCPath Part 1 examination, trainees in histopathology should be able to achieve the required knowledge, skills
and attitudes in neuropathology by completing four weeks of education and training in neuropathology within specialist neuropathology units or
laboratories etc., followed by a further four weeks spread across stage C of the training period (this should be read in conjunction with the ‘Evidence
of competence’ section on pages 14–15).

Basic knowledge Possess basic knowledge of the normal Develop the ability to solve clinical Develop the practice of integrating
structure, function and development of problems by applying knowledge of clinical, radiological and pathological
the nervous system. basic principles of pathology to the data in formulating accurate
Be familiar with the clinical, radiological nervous system. pathological diagnoses.
and genetic information required to
ensure accurate pathological diagnoses
of neurological disorders.
Surgical Tumours: Possess sufficient knowledge Smears and frozen sections: Develop Develop the practice of integrating
neuropathology of the major primary and metastatic the ability to prepare smears; interpret clinical, radiological (CT, MRI, etc.)
tumours of the brain spinal cord and their smears and cryostat sections; to and pathological data for accurate
surrounding tissues, in particular the recognise the limitations of intra- diagnosis.
pathology of astrocytic tumours. operative diagnoses. Develop respect for the views and
Be aware of the genetics of nervous Histology and immunocytochemistry: wishes of patients and relatives.
system tumours and their relevance to Develop ability to interpret histology and Develop respect for the right to
treatment. immunocytochemistry for the accurate confidentiality and act with
Non-neoplastic lesions: Possess diagnosis of tumours and non- compassion and integrity at
sufficient knowledge of the range of neoplastic lesions of the central and all times.
common inflammatory and degenerative peripheral nervous system tumours.
lesions and malformations in
neurosurgical pathology practice.
34
Medical Muscle disease: Have a working Develop the ability to interpret muscle Develop the practice of liaising with
neuropathology knowledge of histology and and nerve histology and histochemistry clinicians and valuing clinical and
histochemistry of skeletal muscle and the for accurate diagnosis of disease. radiological data in accurate
major pathological and genetic features Acquire skill in the interpretation of CSF diagnosis of pathological material.
of neurogenic and myopathic and cytopathology. Understand the importance of
dystrophic muscle diseases. genetics in the diagnosis and
Peripheral nerve diseases: Have a basic management of muscle, nerve and
knowledge of the histology and central nervous system (CNS)
pathology of peripheral nerves. disease.
Central spinal fluid (CSF) cytopathology:
Possess a working knowledge of CSF
cytopathology in the diagnosis of
diseases of the brain and spinal cord.
Autopsies and Autopsies: Possess sufficient knowledge Develop skills in autopsy technique for Understand the relevance of clinical
post-mortem of the anatomy and pathology of the the examination of the central and and radiological data in planning and
brain pathology central and peripheral nervous systems peripheral nervous system at autopsy. successfully completing a
and how the nervous system interacts Recognise limitations and when to refer neurological autopsy.
with the other organ systems in the body. cases or specimens to a specialist
laboratory.
Develop the ability to interpret
histological and immunocyto-chemical
preparations for the evaluation of major
pathological lesions of the nervous
system.
35
Autopsies and Fixed brains: possess sufficient Develop the manual dexterity for cutting
post-mortem knowledge of anatomy and pathology of brains and taking appropriate blocks.
brain pathology the nervous system in all age groups Develop skills in reporting of
(continued) including fetuses for the selection of pathological findings and the
appropriate blocks for histology and for presentation of evidence in court.
evaluating trauma, vascular disease,
infections, tumours, multiple sclerosis,
dementias, epilepsy, fetal and childhood
disorders of the nervous system.
Forensic neuropathology: possess
sufficient knowledge for the evaluation,
reporting of pathological findings and
their presentation in court.
Know the procedures for liaising with
police, lawyers and courts.
Possess knowledge of health and safety,
law, ethics and legal practices
as they apply to the practice of
neuropathology.
36
Paediatric pathology
The following curriculum sets out education and training requirements in paediatric pathology during stages A-C for trainees in histopathology. In the
UK, paediatric and perinatal pathology services are mainly delivered by the specialist units/laboratories associated with tertiary perinatal, surgical and
paediatric oncology centres. Regular secondments of trainees to such centres will have to be built into the training programmes. During stages A and
B, prior to the FRCPath Part 1 examination, trainees in histopathology should be able to achieve the required knowledge, skills and attitudes in
paediatric pathology by completing four weeks of education and training in paediatric pathology followed by a further four weeks spread across stage
C of the training period (this should be read in conjunction with the ‘Evidence of competence’ section on pages 14–15). The objective of these
attachments is for the general histopathology trainees to gain a basic understanding of a range of disorders (including neoplasms) occurring in infants
and children. This should include six supervised fetal/perinatal autopsies and attendance at all local paediatric/perinatal MDTs.

Basic knowledge Possess basic knowledge of the normal Develop the ability to solve clinical Understand the importance of
structure, function and development of all problems by applying knowledge of integration of clinical, radiological
major organ systems. basic principles of pathology. and pathological data in formulating
Be familiar with basic clinical, radiological accurate diagnoses.
and genetic information required to
ensure accurate pathological diagnoses.
Surgical cut-up Understand principles of specimen Possess sufficient manual dexterity Understand importance of accuracy
dissection, macroscopic description and to perform dissections safely and and requirement for attention to
block selection in neoplastic and non- accurately. detail during specimen description,
neoplastic paediatric diseases. Be able to triage the fresh tumour marking the margins (if necessary)
Understand the relationship between the specimens securing sufficient material and block selection.
prognosis and the various genetic for histological diagnosis.
abnormalities in the most common
paediatric neoplasms.
Surgical reporting Knowledge of the microscopic features of Be able to recognise the microscopic Understand requirement for attention
the range of normality within tissues and features of tissue structure in normality to detail during surgical reporting and
the major common pathological as related to the age of the patient and the need for correlation with the
processes and pattern of disease as in common disease processes. clinical situation.
applied to the paediatric age range. Demonstrate an understanding of the
importance of timeliness and
accuracy of reporting.
37
Surgical reporting Be able to complete datasets for some
(continued) paediatric neoplasms (e.g. standard
operating procedure [SOP] for renal
neoplasms).
Perinatal autopsies Possess basic information about Demonstrate manual dexterity sufficient Understand issues of autopsy
development of the major systems such to perform perinatal autopsies, including consent, tissue/organ retention,
as CNS, GI, respiratory, lympho-reticular post-mortem dissection techniques implications of sampling for
and genito-urinary systems. specific to paediatric cases (the cytogenetics, coroners’/procurator
Aware of the changes occurring after examination of the heart and CNS). fiscals’ practice.
death in utero in macerated stillbirths and Be able to develop skills in the Understand the implications of the
implications for interpretations of presentation and demonstration of the Human Tissue Act.
abnormalities identified on macroscopic salient macroscopic findings. Demonstrate an understanding of the
and histological examination. Be able to recognise basic dysmorphic importance of autopsy findings for
Aware of major fetal features of the most features, assess gestational age (using genetic counselling, from the
common chromosomal abnormalities published tables and growth charts); parental and clinicians’ point of view.
(trisomy 21, 18 and 13) in fetal life. recognition of major features of
Aware of the most common intrauterine growth restriction.
complications of prematurity (lung Be able to appropriately sample internal
disease, necrotising enterocolitis, CNS organs for histological examination;
complications). develop awareness of appropriate
Possess sufficient knowledge of sampling for ancillary investigations
anatomy, macroscopic features of major (microbiology, virology, cytogenetics
disease processes in fetal and perinatal and biochemistry).
life and common tissue dissection Be able to apply photography and
techniques relevant to X-rays as an accurate way of
perinatal/paediatric autopsies. documentation of abnormalities.
Be able to recognise signs of
maceration and timing of intrauterine
death in stillbirths.
38
Perinatal autopsies Be able to recognise major features
(continued) of iatrogenic lesions related to
procedures in intensive care unit
(e.g. pneumothorax in a premature
ventilated baby).
Placenta Possess basic knowledge of the most Be able to appropriately examine
common disorders affecting placenta singleton and twin placenta with
(inflammatory lesions, infarction and sampling for histology.
placental insufficiency).
Paediatric autopsies Possess basic knowledge related to the Assist in at least one autopsy on Understand issues related to dual
subject of sudden infant deaths. sudden infant death (natural or (forensic and paediatric)
unnatural). investigations of suspicious deaths.
39
2. MAINTAINING GOOD MEDICAL PRACTICE
Objective: to keep knowledge and skills and appropriate attitudes up to date.

• take responsibility for and keep up-to-date in their own relevant professional and self-development, and facilitate that of others
• acknowledge that the balance of their skills and expertise will change as their careers progress and they specialise in certain areas of clinical
practice.
Trainees should hold at least one position of responsibility during training and attend at least one management course.

Overall clinical Possess sufficient clinical and pathology Correct interpretation of pathological Understand the quantity and quality
judgement knowledge to enable integration of features in the context of available of clinical information required for
clinical data and pathological features. clinical information. accurate diagnosis in most
situations.
Other curricula have used: Critical
appraisal of the available clinical and
laboratory data in coming to
diagnostic/treatment decisions.
Recognise own Know the extent of one’s own limitations Be willing to consult and to admit
limitations and know when to ask for advice. mistakes.
Written records Possess knowledge of the appropriate Produce accurate reports with clear Appreciate the importance of timely
content of reports. conclusions and other written dictation, cost-effective use of
Understand the principles of diagnostic correspondence. medical secretaries and the growing
coding and report archiving. use of electronic communication.
Understand the problems faced by Be aware of the need for prompt and
people for whom English is not a first accurate communication with
language. clinicians.
Know the relevance of data protection Show courtesy towards medical
pertaining to patient confidentiality. secretaries and clerical staff.
Decision making Understand clinical priorities for Analyse and manage clinical problems Be flexible and willing to change in
investigation and management. effectively. the light of changing conditions.
Be willing to ask for help.
40
Life-long learning Understand the importance of continuing Recognise and use learning Be self-motivated and eager to learn.
professional development. opportunities. Show willingness to learn from
Use the potential of study leave to keep colleagues and to accept
one up to date. constructive feedback.
Able to maintain a professional
portfolio.
Monitor own performance through audit
and feedback.
Good use of Understand use of email, internet, fax Demonstrate competent use of Demonstrate the acquisition of new
information and the telephone. database, word processing and attitudes in patient consultation in
technology Know the principles of how to retrieve statistics programmes. order to make maximum use of IT.
and utilise data recorded in clinical Know how to undertake searches Demonstrate appropriate techniques
systems. (including literature searches) and to be able to share information on
Know the principles of literature access websites and health-related computer with the patient in a
searching using medical databases. databases. constructive manner.
Demonstrate an understanding of the Apply the principles of confidentiality in Be prepared to use video-
range of possible uses for clinical data the context of IT. conferencing and telepathology
and information and appreciate the Be able to using digital imaging devices systems when appropriate.
dangers and benefits of aggregating effectively.
clinical data. Be able to use videoconferencing and
Define the main features, responsibilities telepathology equipment when
and liabilities in the UK and Europe necessary
pertaining to confidentiality.
Know the principles of video-
conferencing and telepathology.
41
The organisational Possess an understanding of the Be an active participant in clinical Make the care of your patient your
framework for clinical important aspects of clinical governance: governance. first concern.
governance and its • medical and clinical audit Be able to undertake medical and Respect patients’ privacy, dignity and
application in practice
• research and development clinical audit. confidentiality.
• integrated care pathways Be actively involved in audit cycles. Be prepared to learn from mistakes,
• evidence-based practice Be active in research and development. errors and complaints.
• clinical effectiveness Critically appraise medical data Recognise the importance of
• clinical risk systems research. teamwork.
• to define the procedures and the Practise evidence-based medicine. Share best practice with others.
effective action when things go wrong Aim for clinical effectiveness (best
in one’s own practice or that of others practice) at all times.
• complaints procedures Educate self, colleagues and other
• risk assessments. healthcare professionals.
Understand the benefits a patient might Be able to handle and deal with
reasonably expect from clinical complaints in a focused and
governance. constructive manner.
Learn from complaints.
Risk management Possess knowledge of such matters as Confidently and authoritatively discuss Willingness to respect and accept
health and safety policy, policies on relevant risks with patients and to patients’ views and choices.
needle stick injuries, note keeping, obtain informed consent. Willingness to be truthful and to
communications and staffing numbers. Able to balance risks and benefits with admit error to patients, relatives and
Possess knowledge of risk management patients. colleagues.
issues pertinent to laboratory processing.
Possess knowledge of risk assessment,
perception and relative risk.
Know the complications and side effects
of treatments and investigations.
42
Evidence Know and understand: Able to critically appraise evidence. Display a keenness to use evidence
• the principles of evidence-based Ability to be competent in the use of in the support of patient care and
medicine databases, libraries and the internet. own decisions therein.
• the types of clinical trial
Ability to discuss the relevance of
• the types of evidence.
evidence with individual patients or their
families.
Clinical audit Know and understand the audit cycle, Involvement in ongoing audit. Consider the relevance of audit to
data sources and data confidentiality. Demonstrate the ability to undertake benefit patient care and individual
Understand the principles of internal and clinical audit, normally by performing at performance (i.e. to clinical
external quality assurance. least one clinical audit project per year. governance).
Guidelines Know the advantages and disadvantages Demonstrate the ability to utilise Show regard for individual patient
of guidelines. guidelines. needs when using guidelines.
Be able to contribute to the evolution of Show willingness to use guidelines
guidelines. as appropriate.
Structure of the NHS Know the structure of the NHS, primary Develop skills in managing change and Show an awareness of equity in
and the principles of care groups and hospital Trusts. managing people. healthcare access and delivery.
management Know the local Trust’s management Develop interviewing techniques and Demonstrate an understanding of the
structure (including chief executives, those required for performance reviews. importance of a health service for the
medical directors, clinical directors and Be able to build a business plan. population.
the pathology laboratory). Show respect for others, ensuring
Be able to utilise one’s position in the
Know finance issues in general in the NHS to best effect. equal opportunities.
NHS, especially budgetary management
and commissioning.
Understand the importance of a health
service for the population.
43
Relevance of outside Know the role and have an Recognise situations when appropriate Be open to constructive criticism.
bodies understanding of the relevance to to involve these bodies and individuals. Accept professional regulation.
professional life of:
• the medical royal colleges
• General Medical Council (GMC)
• Postgraduate Dean and deaneries
• PMETB
• defence unions
• British Medical Association (BMA)
• specialist societies.
Know of central government health
regulatory agencies (e.g. National
Institute for Health and Clinical
Excellence [NICE], Healthcare
Commission [HCC], NHS Quality
Improvement Scotland, National Patient
Safety Agency [NPSA]).
Media awareness Know the importance of media Recognise situations when it may be Act professionally.
awareness and public communications appropriate to implement such training Be willing to ask for help.
training and where to obtain it. and/or seek further advice from the
Trust.
44
3. TEACHING AND TRAINING, APPRAISING AND ASSESSING
Objective: to demonstrate the knowledge, skills and attitudes to provide appropriate teaching and to participate in effective research.

• be able to demonstrate the potential to teach and train effectively at all levels of undergraduate and postgraduate education where required
• demonstrate skills and strategies in the process of feedback to colleagues and trainees, ensuring positive and constructive outcomes
• be capable of judging competence and professional attributes in others.

To have the skills, To have the skills, attitudes and practices Identify adult learning principles. Facilitate learning process.
attitudes and of a competent teacher. Identify learner needs. Identify learning outcomes.
practices of a
Structure of a teaching activity. Construct educational objectives.
competent teacher
Varied teaching strategies. Design and deliver an effective
Identify learning styles. teaching event.
Principles of evaluation. Communicate effectively with the
learners.
Use effective questioning
techniques.
Teach large and small groups
effectively.
Select and use appropriate teaching
resources.
Give constructive effective feedback.
Evaluate programmes and events.
Use different media for teaching that
are appropriate to the teaching
setting.
45
To be able to plan and Know the principles of performing a Undertake systematic critical review of Demonstrate curiosity and a critical
analyse a research research study. scientific literature. spirit of enquiry.
project Know how to use appropriate statistical Ability to frame questions to be Ensure patient confidentiality.
methods. answered by a research project. Demonstrate knowledge of the
Know the principles of research ethics Develop protocols and methods for importance of ethical approval and
and the structure and function of local research. patient consent for clinical research.
research ethics committees. Be able to use databases. Humility.
Know how to write a scientific paper. Be able to accurately analyse data.
Understand the principles of research Be able to write a scientific paper.
funding and how to obtain it.
Have good written and verbal
presentation skills.
Be able to initiate, complete and
publish/present at least one research
project or two case reports by the end
of training.
Appraisal and Understand the concepts of appraisal Able to maintain an appraisal portfolio. Demonstrate a positive attitude to
assessment and assessment. Develop the ability to undertake an appraisal.
Understand how to conduct an appraisal effective appraisal or assessment. Be aware of equality and diversity
interview or assessment. issues as they relate to appraisal.
46
4. RELATIONSHIPS WITH PATIENTS
Objective: to ensure that the trainee has the knowledge, skills and attitudes to act in a professional manner at all times.

• be skilled in building relationships of trust with patients and their families, through effective interpersonal skills, a courteous and compassionate
approach, and respect for their privacy, dignity and cultural and religious beliefs
• follow the principles and legal aspects of consent and confidentiality
• be able to manage difficult and complex situations with patients and their families, to advise them appropriately and to manage complaints
effectively.

Patient safety Understand the issues around patient Demonstrate awareness of patient Show regard for patient safety.
safety and the role of the NPSA. safety in a practical situation.
Be aware of the NPSA National
Reporting and Learning System.
Continuity of care Understand the relevance of continuity of Ensure satisfactory completion of Recognise the importance of
care. reasonable tasks at the end of the punctuality and attention to detail.
shift/day with appropriate handover. Recognise the importance of
Ensure appropriate documentation communication with patients/carers.
of/for handover.
Make adequate arrangements to cover
leave.
Informed consent Know the process for gaining informed Give appropriate information in a Respect for patients’ and relatives’
consent. manner patients understand and be points of view and wishes.
Understand the principles of consent able to gain informed consent from Consider the patient’s needs as an
issues as relating to cellular pathology patients. individual.
clinical practice and research. Demonstrate appropriate use of written
Know how to gain consent for a research material.
project.
Confidentiality Be aware of relevant strategies to ensure Use and share all information Respect the right to confidentiality.
confidentiality. appropriately.
Avoid discussing one patient in front of
Be aware of situations when
another.
confidentiality might be broken.
Be prepared to seek patient’s wishes
before disclosing information.
47
Within a consultation Know how to structure the interview to Listen. Demonstrate an understanding of the
identify the patient’s: need for:
Use ‘open’ questions followed by
• concerns/problem list/priorities appropriate ‘closed’ questions. • involving patients in decisions
• expectations Avoid jargon and use familiar language.
• offering choices
• understanding • respecting patients’ views
Be able to communicate both verbally
• acceptance. and in writing to patients whose first • dress and appearance that is
language may not be English in a appropriate to the clinical situation
manner that they understand. and patient.
Use interpreters appropriately.
Give clear information and feedback to
patients and share information with
relatives when appropriate
Reassure ‘worried well’ patients.
Breaking bad news Know how to structure the interview and Be able to break bad news in steps Act with empathy, honesty and
where it should take place. appropriate to the understanding of the sensitivity.
Be aware of the normal bereavement individual and be able to support
process and behaviour. distress.
Have awareness of organ donation Avoid jargon and use familiar language.
procedures and role of local transplant Encourage questions.
coordinators. Maintain appropriate hope whilst
avoiding inappropriate optimism.
Complaints Have awareness of the local complaints Manage dissatisfied patients/relatives. Act promptly and with honesty and
procedures. Anticipate potential problems. sensitivity.
Have an awareness of systems of Be prepared to accept responsibility.
independent review.
48
Doctor-patient Understand all aspects of a professional Help the patient appreciate the Adopt a non-discriminatory attitude
relationship relationship. importance of cooperation between to all patients and recognise their
Establish the limiting boundaries patient and doctor. needs as individuals.
surrounding the consultation. Develop the relationship that facilitates Seek to identify the healthcare belief
Deal with challenging behaviour in solutions to patient’s problems. of the patient.
patients that transgress those Deal appropriately with behaviour falling Acknowledge patient rights to accept
boundaries, e.g. aggression, violence, outside the boundary of the agreed or reject advice.
racism and sexual harassment. doctor-patient relationship in patients,
e.g. aggression, violence, sexual
harassment.
Educating patients Know investigation procedures including Give information to patients clearly in a Consider involving patients in
about: possible alternatives and choices. manner that they can understand, developing mutually acceptable
• disease Be aware of strategies to improve including written information. investigation plans.
• investigations adherence to therapies. Encourage questions. Encourage patients to access:
• therapy Negotiate individual treatment plans • further information
including action to be taken if patient • patient support groups.
deteriorates or improves.
Environmental and Understand the risk factors for disease Advise on lifestyle changes. Suppress any display of personal
lifestyle risk factors including: Involve other healthcare workers as judgement.
• diet appropriate.
• exercise
• social deprivation
• occupation
• substance abuse
• behaviour.
Epidemiology and Know the methods of data collection and Assess an individual patient’s risk Consider the:
screening their limitations. factors. • positive and negative aspects of
Know diseases that are notifiable. Encourage participation in appropriate prevention
Know principles of primary and disease prevention or screening • importance of patient
secondary prevention and screening. programmes. confidentiality.
Respect patient choice.
49
Legal issues Understand the legal issues relating to Liaison with the coroner/procurator Act with compassion at all times.
surgical pathology and cytopathology fiscal.
reporting.
Know the legal responsibilities of
completing death certificates.
Understand the legal framework of the
coronial/procurator fiscal system,
including the types of deaths that should
be referred to the coroner/procurator
fiscal.
50
5. WORKING WITH COLLEAGUES
Objective: to demonstrate good working relationships with colleagues and appropriate communication skills.

• strive for continuing improvement in all aspects of their work and that of colleagues while mindful of priorities and high standards
• have effective interpersonal skills which enable them to bring out the best in colleagues, to resolve conflicts when they arise and to develop
working relationships within the team
• Support teams that bring together different professions and disciplines and other agencies, to provide high quality healthcare.

Clinical teams Understand how a team works. Be able to communicate effectively. Show respect for others opinions.
Understand the roles and responsibilities Seek advice if unsure. Be conscientious and work
of team members, especially within the Recognise when input from another cooperatively.
department and within multidisciplinary specialty is required for individual Respect colleagues, including non-
teams. patients. medical professionals and recognise
Know how a team works effectively. Be able to work effectively with other good advice.
Know the roles of other clinical health care professionals, including Recognise own limitations.
specialties and their limitations. demonstration of material at MDT
meetings.
Respect skills and contribution of
colleagues.
Recognise own limitations.
Recognise when to delegate.
Show leadership and supervise safely.
Stages B-D: Delegate, show leadership
and supervise safely.
51
Communication with Know: Use appropriate language. Be prompt and respond courteously
colleagues • how to communicate with other Select an appropriate communication and fairly.
members of the pathology method.
department, other departments and
other members of the
multidisciplinary team
• how to communicate in writing,
through letters and reports
• when to phone a general practitioner
(GP).
Complaints Have awareness of the local complaints Anticipate potential problems. Act with honesty and sensitivity and
procedures. Manage dissatisfied colleagues. promptly.
Have an awareness of systems of Be prepared to accept responsibility.
independent review.
Interactions between: Know the roles and responsibilities of Delegate, show leadership and Show respect for others opinions.
• hospital and GP team members. supervise safely Be conscientious and work co-
• hospital and other Know how a team works effectively. Be able to communicate effectively. operatively.
agencies, e.g. Know the roles of other clinical Handover safely. Respect colleagues, including non-
social services specialties and their limitations. medical professionals, and recognise
Seek advice if unsure.
• medical and good advice.
surgical specialties Recognise when input from another
specialty is required for individual Recognise own limitations.
patients.
Be able to work effectively with GPs,
other medical and surgical specialists
and other healthcare professionals.
Creating an Be aware of the advantages and
environment in which disadvantages of guidelines.
mistakes and
Report and investigate critical incidents.
mismanagement of
patients can be Take appropriate action if you suspect
openly discussed and you or a colleague may not be fit to
lessons learned practise.
52
6. HEALTH
Objective: to understand the importance of the personal health of the doctor.

• act quickly and effectively if they have reason to believe that their own or a colleague’s conduct, performance or health may put patients at risk.

Personal health Know of occupational health services. Recognise when personal health takes Recognise personal health as an
Know of one's responsibilities to the priority over work pressures and to be important issue.
public. able to take the necessary time off.
Know not to treat oneself or one’s family.
Stress Know the effects of stress. Develop appropriate coping Recognise the manifestations of
Have knowledge of support facilities for mechanisms for stress and ability to stress on self and others.
doctors. seek help if appropriate.
53
7. PROBITY
Objective: to be able to demonstrate probity in all aspects of professional practice.

• always act in their personal and professional lives to maintain public trust in the profession
• undertake duties such as writing reports, giving evidence and completing and signing documents in a timely, honest and conscientious way
• through their leadership encourage the development and practice of these qualities in their colleagues.

Service information Legal framework for advertisements. Recognise absolute importance of
accuracy and impartiality.
Writing reports and Honesty and integrity.
giving evidence Timeliness.
Research Obtain ethical approval. Put safety and care of patients first.
Conduct research with honesty and
integrity.
Financial dealings Not induce patients to accept
private medical care.
Manage funds for the purpose for
which they are intended.
Declare conflicts of interest.
54
APPENDIX 1 GUIDELINES FOR THE HISTOPATHOLOGY CURRICULUM STAGE A/ST1
There is no intention to use this appendix as a measure of aptitude or achievement. It is simply an indication of the range and level of experience that
could be reasonably expected of a trainee in Stage A. In serving as an indicator, the surgical pathology list should be interpreted in the light of
workload and case-mix in the training department. Surgical specimens considered ‘routine’ in some departments, for example an oesophagectomy,
would be infrequent in others. Thus, its inclusion in the list does not mean that experience of this specimen type is mandatory, only that a Stage A
trainee should be familiar with the handling and reporting of similar major resection specimens from cancer cases. Naturally, some cancer specimens
(e.g. pancreatectomy or laryngectomy) are considered too complex for a Stage A trainee to dissect independently.
Some experience of specialised areas of pathology is also expected during Stage A and trainees should spend a short period of attachment to
neuropathology and paediatric pathology.
The level of knowledge gained within each of the areas described below will vary between trainees. However, for each disease process listed, it is
recommended that the trainee possesses at least a basic level of knowledge within the following eight categories:
• epidemiology
• aetiology
• pathogenesis
• clinical features
• pathological features (macroscopic and microscopic)
• natural history
• management options
• major complications of therapy.
It is important that sufficient basic knowledge of major pathological processes is gained at this early stage. This should include topics such as: causes
of and responses to cellular injury, acute and chronic inflammation, neoplasia, the effects of genetics and the environment in health and disease,
infections and the basics of immunology.
55
Surgical pathology
System Gross pathology Microscopy Knowledge base

Able to describe and take appropriate Report means producing minimum data for
blocks from: cancer report with staging data
General Correct specimen orientation. Know how to set up a microscope Normal anatomy and histology.
Open fresh specimen. correctly. Pathological basis of disease.
Know when and how to obtain fresh tissue Recognise normal histology and normal Common pathological abnormalities.
for touch preparation, freezing, electron variations of common tissue types
microscopy etc. Knowledge of appropriate histochemical
Inking of excision margins. stains for glygogen, fat, mucins and
amyloid.
Lymph node anatomy and dissection in
cancer specimens. Familiarity with basic immunohisto-
chemical markers for major tissue and
tumour types and interpretation of a basic
panel of immunohistochemical markers on
an undifferentiated tumour.
Breast Mastectomy. Diagnose invasive cancer on needle Ductal carcinoma in situ, invasive
Wide local excision for macroscopic biopsy. ductal carcinoma, invasive lobular
tumour. Report mastectomy or wide local excision carcinoma, fibrocystic change,
specimens. fibroadenoma.
Axillary lymph node dissection.
+/- screening specimen for
microcalcification.
Upper Radical oesophagectomy. Recognise Helicobacter associated Helicobacter associated gastritis,
gastrointestinal Radical gastrectomy. gastritis; oesophageal and gastric reactive gastritis, Barrett’s oesophagus,
tract malignancy on biopsy. oesophageal carcinoma, gastric
Antrectomy.
Report oesophageal and gastric carcinoma, coeliac disease, duodenitis
malignancy resection specimens.
56
Able to describe and take appropriate Report means producing data for cancer
blocks from report with staging data
Lower Colectomy/proctectomy for cancer or Recognise colorectal carcinoma on Appendicitis, inflammatory bowel
gastrointestinal inflammatory bowel disease. biopsy. disease. Not otherwise specified
tract Appendicectomy. Identify presence of inflammatory bowel (NOS), hyperplastic polyp,
disease (IBD) and attempt to classify type adenomatous polyp, high-grade
Polypectomy.
on biopsy. dysplasia, colorectal carcinoma.
Distinguish hyperplastic (metaplastic)
from adenomatous polyps.
Recognise high-grade dysplasia.
Report colorectal carcinoma resection
specimens.
Respiratory Open biopsy of lung. Recognise presence of cancer in Squamous cell carcinoma, small cell
Pneumonectomy or lobectomy. biopsies. carcinoma, adenocarcinoma,
Diagnose small cell and squamous metastatic carcinoma NOS.
carcinoma on biopsy.
Report lung cancer resection specimens.
Skin Accurate gross description of skin lesions. Diagnose basic skin cancer types Basal cell carcinoma, squamous cell
Appropriate handling of orientated or including squamous cell carcinoma, basal carcinoma, melanoma, melanocytic
complex skin specimens. cell carcinoma, and typical cases of naevi, haemangioma, seborrhoeic
melanoma. keratosis, actinic keratosis, chronic
Recognise presence of severely atypical dermatitis NOS, epidermal inclusion
features in naevi. cysts, dermatofibroma.
Adequate morphological description of
features seen in an inflammatory skin
biopsy.
Lymph node Lymph node for neoplastic and non- Screen lymph node dissections for Follicular hyperplasia, sinus
pathology neoplastic disease. metastatic tumour. histiocytosis, high-grade lymphoma,
Taking tissue for supplementary Recognise common reactive node granulomatous diseases, metastatic
techniques (e.g. flow cytometry). patterns including follicular hyperplasia carcinoma.
and sinus histiocytosis.
Detect high-grade lymphoma in lymph
node specimen.
57
ENT Mucosal biopsy. Recognise reactive changes in tonsils; Simple and allergic nasal polypi.
Head and neck Tonsillectomy. distinguish from HG lymphoma. Pleomorphic adenoma,
Identify main types of salivary gland adenocarcinoma, Warthin’s tumour.
Nasal polypectomy.
tumour.
Salivary gland tumour.
Female genital Hysterectomy and/or salpingo- Recognise leiomyomata, secretory and Leiomyoma, secretory and proliferative
tract oophorectomy for malignant or benign proliferative endometrium, endometrial endometrium, endometrial atrophy,
disease. and cervical carcinoma. endometrial carcinoma, cervical
Cervical loop/ cone biopsy. Report hysterectomy and/or salpingo- carcinoma, chronic cervicitis, ovarian
oophorectomy. cystic follicles/theca cysts, ovarian
cystadenoma, ovarian
cystadenocarcinoma
Liver and gall Open biopsy of liver. Report cholecystectomies. Chronic cholecystitis, cholesterolosis.
bladder Resections for metastatic tumour. Recognise normal liver on needle biopsy. Steatosis, cirrhosis NOS, chronic
Cholecystectomy. Value of special stains. hepatitis NOS, metastatic carcinoma.
Identify presence of cirrhosis, hepatitis or
metastatic tumour in needle biopsy.
Cardiovascular Blood vessels, including temporal artery Recognise inflammation in temporal e.g. temporal arteritis, atheroma.
system biopsy. artery specimen.
Male genital tract Vas deferens. Report normal vas deferens. Prostatic adenocarcinoma, benign
Prostate biopsies and chippings. Recognise presence of cancer in prostatic hyperplasia.
Orchidectomy and prostatectomy prostatic needle biopsies. Germ cell tumours.
specimens. Report orchidectomy.
Recognise seminoma, embryonal
carcinoma.
Endocrine Thyroidectomy. Recognise normal thyroid and Benign nodular goitre.
pathology Parathyroidectomy. parathyroid. Know main types of carcinoma.
Recognise benign nodular goitre.
58
Soft tissue Soft tissue tumour resection, simple (i.e. Recognise morphological features Lipoma, angiolipoma, neurofibroma,
lumpectomy). suggestive of main subtypes of tumours dermatofibroma.
(i.e. lipomatous, fibromatous, Recognise high-grade sarcoma.

myomatous, neural, vascular Knowledge of immunohistochemical
characteristics). techniques to apply.
Understand value of cytogenetics.
Neuropathology Neurosurgical tumour resection and biopsy Distinguish intrinsic from metastatic Knowledge of the classification of
specimens. tumours of the brain. tumours of the central nervous system.
Recognise benign tumours of the Understand the value of
meninges and peripheral nerves. immunohistochemistry in the diagnosis
of CNS tumours.
Renal and Renal biopsies. Assess deviation from normal histology. Bladder carcinoma, renal cell
urological Bladder biopsies. Recognise presence of cancer in bladder carcinoma, chronic pyelonephritis.
pathology biopsies. Understand the value of immuno-
Nephrectomy specimens.
Recognise glomerular changes that might histochemistry and electron
indicate glomerulonephritis, e.g. microscopy in the diagnosis of
hypercellularity, crescent formation glomerulonephritis.
Report nephrectomy.
Osteoarticular Handling a trephine bone-biopsy. Normal bone. Osteoporosis versus osteomalacia.
pathology Use of calcified versus de-calcified Normal synovium. Main types of primary bone tumours.
sections.
Paediatric Description and sampling of small Recognise common inflammatory and Common paediatric tumours, e.g.
pathology resection specimens; handling, neoplastic conditions occurring in neuroblastoma, nephroblastoma,
examination and sampling of placentas. childhood. rhabdomyosarcoma.
Awareness of special stains in
paediatric pathology.
Understand value of cytogenetics.
59
Autopsy pathology
It is envisaged that trainees will perform at least 20 autopsies during Stage A. It is also envisaged that during one month's attachment to paediatric
pathology, they should attempt one post mortem under close supervision of a consultant. Stage A trainees should begin to understand the level of
certainty with which macroscopic features can be interpreted at autopsy and when histological examination of autopsy tissues is important. They
should begin to recognise histological changes that occur due to post-mortem artefact.
Systems Anatomical features and dissection technique Clinico-pathological knowledge base

General Methods for identification of the patient. Procedures for obtaining consent for autopsy. Workings of the
External examination including breast examination. coroner’s (or procurator fiscal’s) system.
Removal of organs. Full details of current practice for retention of organs and
tissues.
Organ weights.
Familiarity with current College Guidelines on Autopsy
Practice, 2002.
Knowledge of normal organ weights.
Cardiovascular Excision of heart. Normal, age-related and pathological abnormalities of cardiac
Master one technique for the dissection of the heart. valves.
Anatomy of the coronary arteries, their ostia and branches. Identification of acute and healed myocardial infarcts,
macroscopically and histologically.
Dissection of aorta and major abdominal branches.
Assessment of ventricular thickness and atrial and ventricular
dilatation.
Pulmonary embolism.
Respiratory Removal of lungs from mediastinum. Identification of respiratory tract infection and pneumonia.
system Dissection of pulmonary vessels and major bronchi. Assessment of chronic bronchitis and emphysema.
Dissection of individual lobes. Appearances of primary and secondary lung tumours.
Upper Removal and dissection of oesophagus, stomach and Range of appearances due to autolysis in stomach.
gastrointestinal duodenum in continuity. Identification of oesophageal varices, gastric erosions and
tract Identification of ampulla of Vater. peptic ulcers.
Assessment of pyloric stenosis.
60
Lower Identification and dissection of superior mesenteric artery. Identification of colonic diverticula.
gastrointestinal Examination of intestinal mucosal surface. Identification of bowel necrosis and distinction from autolysis
tract or post-mortem change.
Hepatobiliary Removal of liver and its dissection. Assessment of hepatic congestion and dilatation of hepatic
system Identification of portal and hepatic veins. veins.
Dissection of gallbladder, common bile duct and pancreatic Appearances of intra- and extrahepatic ducts.
ducts. Identification of secondary tumours.
Identification of hepatic cirrhosis.
Nervous system Removal of brain. Sites of berry aneurysms.
Dissection of Circle of Willis and venous sinuses. Identification of old and recent cerebral infarcts.
One method for sectioning of cerebral and cerebellar Assessment of cerebral and cerebellar atrophy.
hemispheres and brain stem. Taking of ‘key’ blocks for histological examination.
Urogenital system Dissection of renal arteries and veins and ureters. Estimation of degree of cortical atrophy.
Removal of kidneys and examination of cut surfaces and renal Identification and assessment of cortical scarring and cyst
pelvices. formation. Hydronephrosis and ureteric dilatation.
Examination of bladder mucosa and identification of ureteric Prostatic disease.
orifices.
Examination of the prostate gland.
Examination of the testes and female genital system.
Endocrine system Removal of pituitary. Size and overall appearance of thyroid gland.
Identification of parathyroid glands and dissection of thyroid. Size of parathyroid glands.
Removal of adrenal glands. Adrenal cortical hyperplasia or adrenal atrophy.
Lympho-reticular Examine all lymph node groups (e.g. mediastinal or para- Significance of lymphadenopathy in different anatomical sites.
system aortic) for evidence of lymphadenopathy. Clinical explanation for splenic enlargement or atrophy.
Examination of the spleen. Identification of secondary deposits in vertebral bone marrow.
Exposure of vertebral bone marrow.
Musculoskeletal Identify fractures. Osteoporosis.
system Explore sites of recent internal fracture fixation.
61
Report Preparation of report according to consultant’s protocol and Detailed list of all macroscopic abnormalities.
with reference to College’s Guidelines on Autopsy Practice, Summary relating abnormalities to aspects of clinical history
2002 and Best Practice Scenarios, 2005. (wherever possible).
Include the cause of death in the Office of National Statistics Appropriate tissue blocks for histology (with appropriate
(ONS) format and a clear clinicopathological summary. consent).
The paediatric Examination of the heart and vascular connections in situ. Features of maceration and dysmorphism.
autopsy Removal of the brain; dissection of the thymus. Assessment of growth and development.
Organ weights and measurements with reference to normal
range.
Complex post-mortem examinations

These autopsies and special techniques are not part of the Stage A curriculum. However, Stage A trainees may take the opportunity to observe or
assist in these examinations should the opportunity arise.
Assessment of traumatic injury, for example, after road traffic accident.

Methods of sampling for toxicology, for example, in suicide.
Removal of eyes, dissection of middle ear.
Removal of spinal cord.
Post-mortem examination in haemopoietic malignancy, including sampling of bone marrow from iliac crests and femur.
Post-mortem examination of a decomposed body.
Post-mortem examination in a case of suspected drowning.
External examination of a body by a forensic pathologist.
Post mortems in patients dying after complex cardiothoracic surgery.
Assessment of the changes following complicated gastrointestinal surgery.
62
Cytopathology
Trainees should spend the equivalent of at least six weeks in cytopathology during Stage A.
Category Topic Knowledge base

Gynaecological Cervical screening. Rationale, methodology, organisation.
cytopathology Basic knowledge of the numerical reporting system, patient call and recall
mechanisms, failsafe.
Specimen preparation. Sampling devices used and the fixation of specimens.
Normal smear. Normal cellular components including cyclical and post-menopausal variations; the
inadequate smear.
Benign cellular changes. Squamous metaplasia.

Inflammation – specific agents, e.g. Trichomonas, Candida, viruses. Non-specific
changes, follicular cervicitis, degeneration/regeneration.
Borderline nuclear changes. Recognise borderline changes and the implications of the use of this category.
Cervical intraepithelial neoplasia Recognise mild, moderate and severe squamous dyskaryosis and endocervical
(CIN), CGIN and dyskaryosis cellular abnormalities.
Squamous carcinoma and Recognise malignant cells of squamous, endocervical, endometrial and ovarian
adenocarcinoma. origin.
Management of women with abnormal Implications of reporting abnormal smears, and awareness of the role of colposcopy
smears and colposcopy. in the diagnosis and management of cervical disease.
Quality assurance including internal Basic knowledge of current national quality standards and indicators.
quality control (IQC), external quality
assurance (EQA) and audit.
New technologies in cervical Basic knowledge of liquid-based cytopathology, automated screening devices, HPV
screening. testing.
63
Category Topic Knowledge base
Non- Technical aspects. Seen sample preparation and have a basic knowledge of the range of methods for
gynaecological Interpretation. converting a raw sample into a slide.
cytopathology Recognise normal cell populations and the typical patterns of the common benign
Reporting.
and malignant neoplasms seen in the respiratory tract, effusions, urine and the
miscellany of needle aspirate samples from breast, thyroid, salivary gland, lymph
node and other sites.
Understand the structuring of reports especially with regard to the variation in
certainty in individual cases, and have an appreciation of the clinical uses of
cytopathology and the consequence of reports – positive and negative.
Correlation with histology where available.
64
APPENDIX 2 TRAINING IN HISTOPATHOLOGY SUBSPECIALTIES
APPENDIX 2a SPECIALIST CURRICULUM FOR CYTOPATHOLOGY
Some trainees will aim to become specialist cytopathologists, acting as local leads and providing specialist diagnostic services, within their Trust and
beyond. These individuals should undertake the general histopathology curriculum until the end of stage C, and then undertake the activities in this
specialist curriculum during stage D (ST5). This is likely to necessitate rotation to different departments and secondment to other organisations.
Opportunities for research or management projects exist during this period.
Aims and objectives

On completion of training in cytopathology the trainee must have acquired and be able to demonstrate:
• the ability to diagnose material from all non cervical specimen types prepared by all methods and stains and ability to use this diagnostic
information in a clinical setting
• an in-depth understanding of the cervical screening program, to a level allowing the trainee to fulfil a leadership or coordinating role, and
diagnostic competence in cervical cytopathology
• the ability to function as a local expert in cytopathology.
Trainees will complete a logbook documenting their experience of specialist training in cytopathology. A review of the logbook will form part of the
annual review.
The cytopathology logbook should:

• contain a record of formal quality assurance e.g. EQA performance and personal performance monitoring data such as PPV
• include samples of clinical cases in depth, for example histopathology/cytopathology correlation cases, and an audit of a case of cervical cancer.
Other useful inclusions would be critical review of diagnoses subsequently found to be incorrect and diagnoses arrived at after MDT review.
Critical review of experience in one-stop clinics and colposcopy should be included
• be supported, where appropriate, by photomicrographs and numerical data.
65
Cervical cytopathology

Cervical Detailed knowledge of all guidance Regular attendance at meetings of Comfortable communicating with staff
Screening relating to the CSP. screening programme committees within from a wide variety of professional
Programme (CSP) Knowledge of roles and responsibilities the Trust and the community. backgrounds.
of hospital-based programme Able to communicate effectively with lay
coordinator, screening commissioner and people with regard to the CSP, which
lead cytopathologist. has a very high level of public and
Knowledge of the benefits and limitations media exposure.
of cervical screening.
Cytopathology- Knowledge of reasons why smears and Ability to review histology and Understanding of the limitations of
histopathology biopsies may not correlate. cytopathology of non-correlating cases cervical histology and cytopathology.
correlations Understanding management options in and present results to gynaecologists at Working within a multidisciplinary team.
non-correlating cases. MDTs.
Ability to contribute to discussions on
clinical management of patients.
Cervical Features of common and rarer pitfalls in Review cases presented as difficult. This
cytopathology- diagnosis of dyskaryosis. may involve accessing local or more
diagnosis widely referred cases.
Be able to make a likely classification
and management plan on difficult cases.
Quality assurance Fully understand the role of the cervical Undertake a period of secondment to the
screening quality assurance testing QAT.
(QAT).
66
Non-gynaecological cytopathology

Specimen taking Techniques, risks and benefits of Fine Ability to perform a fine needle aspirate Learning a clinical skill
needle aspirates. from superficial sites e.g. breast. Having the communication skills for a
consultation with a patient.
Immediate Principles, benefits and disadvantages of Regular attendance at one-stop clinics. Having confidence in a diagnosis that
diagnosis one-stop clinics. Ability to make and communicate a firm will be immediately communicated to
Familiarity with immediate stains, e.g. diagnosis quickly to clinicians. the patient.
DiffQuick. Recognition of limits of competence-
Features of specimen adequacy for when not to give a firm diagnosis.
radiologically guided deep dine needle Ability to confirm adequacy of deep FNA
aspirations (FNAs). specimens.
Breast screening Place of cytopathology in the BSP. Access to BSP documentation. Understanding of role of cytopathology
programme (BSP) Principles of the breast screening Attendance at local BSP meetings. in this multidisciplinary, multi agency
program, and quality assurance. process.
Morphology Knowledge of appearance of normal and Familiarity with all commonly used Awareness of the relative merits of
abnormal cells on all preparation staining and preparation techniques and different staining and preparation
techniques (LBC, direct smears, the ability to recognise normal and modalities.
cytospins etc) and all stains. abnormal cells in such preparations.
Diagnostic Features of malignancy in more unusual Ability to diagnose malignancy in these Wide experience in all aspects of
capability specimen types, specimens. diagnostic cytopathology.
e.g. pancreatico-biliary tract, upper Ability to diagnose more exotic infections
urinary tract. in these patients.
Diagnosis of infections including in the
immunosuppressed patient.
Application of Knowledge of application of Appropriate use of ancillary techniques. Receptive to new ideas.
techniques immunocytochemistry, flow cytometry, Knowledge of advantages and Ability to interact with other
molecular techniques and other limitations. professionals and departments in
investigations in diagnostic organising and interpreting these
Able to apply results to
cytopathology. specimens.
clinicopathological decision-making.
67
APPENDIX 2b SPECIALIST CURRICULUM FOR FORENSIC PATHOLOGY
The following pages summarise the forensic pathology curriculum. All knowledge skills and attitudes listed in the general histopathology autopsy
curriculum form part of the overall curriculum for forensic pathology. Particular requirements relating to paediatric pathology and neuropathology
follow the tabulated curriculum.
Aims and objectives
On completion of the forensic pathology training programme, the trainee must have acquired and be able to demonstrate:
• proficiency in the autopsy techniques required for the pathological investigation of deaths requiring medicolegal scrutiny, in all age groups,
involving all organ systems and in all states of preservation. (Trainees should ensure that they undertake enough autopsies to achieve a high level
of competence to reflect the nature of their work as a forensic pathologist)
• proficiency in the evaluation and recording of a death scene, the examination of the body in situ and the retrieval of evidence
• the ability to provide evidence impartially, justifying any opinions given from a balanced interpretation of cited medical literature and validated
experience
• the ability to be able to work within the judicial system giving appropriate consideration to process, continuity and disclosure.
Trainees will have to complete a logbook that will identify the extent of their experience and the degree of involvement of trainers. A directly
maintained and up-to-date logbook will be used as part of annual review, together with the views of the educational supervisor and other members of
senior staff involved in the trainee's work. The logbook is more than a list of cases observed. It is there not only to demonstrate the breadth of
casework to which a trainee has been exposed, but also to give an indication of the approach that has been taken to each case and thus to indicate
exposure of the trainee to determination of issues, analysis of the situation and development of the strategy in dealing with the individual case. All
cases attended by the trainee will be documented and it is anticipated that all major types of forensic case will be included in the logbook.
In each case, the trainee should take contemporaneous notes regarding the initial briefing, the examination of the scene, the post-mortem
examination and the results of further examinations. These notes should cover the issues that are raised at each point and document the strategy that
is developed to deal with these issues, such as, for example, at the initial briefing, the determination of the need of other professionals at specific
times; at the scene of a death, the means of removal of trace evidence without contamination from one of a number of bodies at the same scene; at
the post-mortem examination, the need for particular methods of dissection in sudden unexpected deaths in infancy; following special investigations,
the need for specific special stains on histological material.
Thus at each stage of the investigation of a death, the trainee will have to assess the information available, analyse it and decide on a strategy for
investigating that death. This is not a matter for the trainee on his/her own, but rather will form a record of how well the trainee has understood the
processes of analysis and strategy in cases he/she observed, and how well the trainer is making the important issues, and strategy for dealing with
those issues, clear to the trainee.
68
The logbook also includes details of the breadth of casework that must be covered, the specialised dissections to be made by the trainee and an
indication as to the satisfactory completion of these dissections, either evidenced by a photographic record of each, and the counter-signature of the
training supervisor or by performing a number of such techniques under the direct supervision of their educational supervisor and signed up once they
have demonstrated their competence.

Medico-legal issues Detailed knowledge of the coroner and Ability to practise informed by legal Understands the role of the expert
fiscal systems in the UK (weighted requirements and ethical principles. witness in the court and criminal judicial
towards area of practice) and an Able to operate to any professional systems.
awareness of different systems abroad. standards and within any codes of Understands the value of uniform
A detailed knowledge of legislation, practice agreed or published by the standards and the importance of
authoritative guidelines or current policy College. practicing within agreed parameters.
related to death, disposal, certification, Ability to practise informed by the Understands the importance of integrity
post-mortem examination, consent, Coroners Rules, Police and Criminal and continuity of evidence, security of
confidentiality, tissue retention, use of Evidence Act, Criminal Procedure and records, notes and samples and
the health record, transplantation and Investigations Act and other relevant disclosure.
regulation of the medical profession. law, regulation or policy. Integrity.
Knowledge of UK criminal and civil court Ability to give evidence honestly,
procedure, the roles of the prosecution impartially, clearly and simply.
and defence and the rules of evidence.
Detailed knowledge of UK law relating to
criminal evidence and of appropriate
practices relating to report writing, notes,
communications, materials and retained
samples.
Knowledge of the role of the expert
witness.
Knowledge of the use of visual aids in
the giving of testimony.
69
Crime scenes Detailed knowledge of the practical Ability to practise at crime scenes Understands need for investigation of
systems of death scene investigation and within expertise and to recognise need scenes by multidisciplinary team using
familiarity with common scenes. for other expertise. appropriate expertise.
Knowledge of the respective roles of the Ability to retrieve trace evidence and Understands the need to practise
coroner/procurator fiscal, the police, the formulate strategies for appropriate safely, and aims to maintain the dignity
senior investigating officer, the crime investigation and prioritisation of of the deceased and the privacy of the
scene manager, the scene of crime activities. bereaved.
officer and the forensic scientist. Understand the need for attention to
Knowledge of what to record at a scene, detail and correlation with history.
features to be sought and the taking and Understand need for demonstration of
interpretation of temperatures, samples continuity and disclosure.
and trace evidence. How to minimise
Understands the benefits of working in
DNA contamination and how to examine
a team.
and remove a body safely.
Knowledge of the use of other experts
such as archaeologists, entomologists,
odontologists and other, specialised
forensic scientists.
Forensic autopsy Detailed knowledge of forensic post- Able to carry out all required Works methodically and with attention
practice mortem techniques. techniques. to detail.
Knowledge of the findings in homicides, Able to detect abnormalities and Develops and carries out defined
suicides, accidents, the examination of interpret them correctly. strategies.
skeletal or decomposed remains, mass Able to record findings accurately and Able to refine or modify approach, as
disaster, maternal death, infant death, contemporaneously and to archive necessary.
industrial and transportation deaths and them appropriately. Recognises own limitations and is able,
deaths where other suspicious
where appropriate, to seek advice and
circumstances apply.
assistance from others.
70
Forensic autopsy Knowledge of the investigation of Able to sample appropriately and Understands need for confirmation and
practice (continued) hospital homicide, deaths following interpret results. detailed documentation of positive and
alleged medical negligence and a Able to provide appropriate samples negative findings.
comprehensive knowledge of the effects and information. Understands contextual nature of drug
of and complications of, medical level interpretation and the need in
Able to interpret drug levels and place
treatment. selected cases for expert referral.
them in a clinical context.
Detailed knowledge of autopsy Uses adjunctive tests appropriately and
Able to provide appropriate samples
histopathology. can seek specialist assistance where
and information. Able to interpret
Knowledge of basic toxicology and results within their clinical context. necessary.
pharmacokinetics including tolerance Distinguishes own field of expertise
Able to define roles and
and post-mortem redistribution. from that of others.
responsibilities when involving other
Knowledge of circumstances in which expertise.
toxicological examination might be
appropriate.
Knowledge of the use of biochemistry,
immunology, haematology, microbiology,
virology and medical genetics in post-
mortem examinations.
Knowledge of circumstances and
findings requiring input from other
experts.
Familiarity with imaging methods;
thorough knowledge of their uses in
autopsy practice.
Health and safety Knowledge of risks posed by bodies at Able to recognise hazards; perform Understand importance of maintaining a
scenes and in the post-mortem room. risk assessments and identify safe safe working environment and role in
Detailed knowledge of working practices systems of work in the individual case. protecting others at crime scenes and in
appropriate to risk. the post-mortem room.
71
Opinion Knows how an expert is defined and Able to write reports according to the Understands the need to demonstrate
what is required of the expert by the needs of the individual case and in a the basis of expertise and its continuing
courts. scientific, evidence-based fashion validity, to keep within expertise and to
citing the medical literature and justify opinion.
personal experience to justify opinion.
Communication Knowledge of the use of, and limitations Ability to communicate clearly and Recognises the need of ‘service users’
of, conferences and briefings and authoritatively in stressful situations – the Coroner/Procurator Fiscal, police,
appropriate conduct and record keeping and to develop clear and sensible courts, doctors, bereaved – to
in such meetings. demarcation of responsibility within understand pathological findings and
Knowledge of the value of visual and the multidisciplinary team involved in the opinions are derived from them.
other aids in the presentation of complex suspicious death investigation.
issues.
Neuropathology for forensic pathology
A high standard is expected for the following areas:
• The normal brain and spinal cord.

• Techniques for the removal and preservation of the brain, spinal cord and eye.
• Dissection, macroscopic and microscopic pathology of:
o trauma
o ischaemia/hypoxia/hypoglycaemia
o sudden death of ‘CNS origin’ including deaths associated with epilepsy and other longstanding neurological disorders
o alcohol, drugs of abuse and carbon monoxide.
Emphasis when assessing this will not be exclusively on correctness of diagnosis but to a significant degree on the identification of the abnormal, the
instigation of appropriate strategies for further investigations and referral.
72
Paediatric pathology for forensic pathology
A high standard is expected for the following areas:

• post-mortem techniques in paediatric pathology
• Sudden Unexpected Death in Infancy (SUDI)/Sudden Infant Death Syndrome (SIDS)
• other sudden, natural deaths (including those related to inherited disease).
In addition, the following specific areas are included:

• protocols for multi-agency investigation
• protocols for post-mortem examination
• sampling
• examination for soft tissue injury (dissection, microscopy and ageing)
• examination for fracture (dissection, removal, microscopy and ageing) to include skull, ribs and metaphyses
• examination of the eyes (removal, dissection and microscopy for haemorrhage)
• inflicted and accidental infant injury and ‘shaking’ injury
• the examination of found fetal/neonatal remains and the determination of livebirth, age at ‘death’ and time since death.
Emphasis when assessing this will not be exclusively on correctness of diagnosis but to a significant degree on the identification of the abnormal, the
instigation of appropriate strategies for further investigations and referral.
73
Forensic histopathology
This should be seen as a guide to those areas where a higher level of knowledge and/or skill in post-mortem diagnosis is expected than that
developed in the first three years of ‘general’ training.
In general terms, this means the histopathology of: injury; those conditions that may give rise to sudden death; those conditions which may simulate
injury or complicate injury; those conditions occurring as a consequence of medical treatment and those conditions arising out contact with toxic
substances. The table that follows gives examples of the sort of conditions included. It is not intended to be a complete list.
Injury Inflammation relating to trauma, in all organ systems, of whatever type – appearance, differential, ageing.
Drugs and toxins Effects in all organ systems including pathology of alcohol and drugs of abuse; hyperpyrexia and
rhabdomyolysis; vasculitis; hypersensitivity, allergy and anaphylaxis; hepatic necrosis; acute tubular necrosis
and papillary necrosis; pulmonary fibrosis, etc.
Cvs Histopathology of shock, DIC and sepsis; hypertrophy (morphometry and microscopy); IHD (including
atherosclerosis, infarction, grafts and stents); inflammation (including myocarditis, toxic effects and cardiac
manifestations of systemic disease); cardiomyopathy; storage disorders; basic conduction system disorders.
Respiratory Infection (bacterial, fungal, viral, in immunocompromised); inflammation (allergic, systemic, vascular, toxic,);
organisation and fibrosis (inflammatory/infective, allergic, toxic, industrial); embolism (air, fat, thrombus, amniotic
fluid); aspiration; diffuse alveolar damage; haemorrhage.
Gi Ulceration and erosion (toxic, ‘stress’, peptic); ischaemia; peritonitis; hepatic necrosis; cirrhosis; hepatitis;
pancreatitis.
Endocrine Phaeochromocytoma; pituitary haemorrhage and infarction; adrenal haemorrhage.
Renal Infection; infarction; toxic effects (papillary necrosis, interstitial nephritis, tubular necrosis, myoglobinuria,
ethylene glycol), ischaemia; diabetes; acute GN; DIC.
Lymphoreticular Bone marrow aplasia, drug/toxin effects; identification of neoplasia; infection.
GU Identification of early pregnancy.
Soft tissues and skin Mimics of injury; burns; electrocution; deep venous thrombosis.
Legislation/ literature of relevance

Lists of relevant legislation covering England and Wales, Scotland and Northern Ireland and of other relevant literature are available from the College
website (www.rcpath.org).
74
APPENDIX 2c SPECIALIST CURRICULUM FOR NEUROPATHOLOGY
Specialist training in neuropathology builds on the experience gained during the first two years of training in histopathology. The specialist curriculum
is an education and training programme for trainees who enter full-time training in neuropathology in ST3 (post FRCPath Part 1) with the objective of
taking the FRCPath Part 2 examination in neuropathology. It is a guide to the range and level of experience that a specialist trainee should gain
during the years between the Part 1 and Part 2 FRCPath examinations. It is also a guide to the attitudes, skills and knowledge that should be
developed in a programme of life-long learning throughout a pathologist’s career as a consultant.
Specialist training in neuropathology requires a minimum of two years spent in specialist neuropathology units or laboratories with appropriate
rotations and secondments as required. Liaison by trainees and trainers with the British Neuropathological Society (BNS) (www.bns.org.uk) will
ensure support from neuropathologists on a national basis. Attendance at relevant postgraduate courses and national and international conferences
and courses are also part of the training programme. The training period should allow time for research and a period at an overseas centre of
excellence is also strongly recommended.
Aims and objectives

On completion of training in neuropathology the trainee must have acquired and be able to demonstrate:
• proficiency in the autopsy techniques required for the investigation of neurological disease; competency in special techniques required to achieve
adequate examination of the brain, spinal cord, middle and inner ears, eyes, skeletal muscle and peripheral nerves
• proficiency in the formulation of clinicopathological diagnoses from the autopsy findings and the clinical record, including the results of
neuroradiological investigations
• proficiency in the diagnosis of tumours of the nervous system in biopsy samples, including interpretation of tumours arising in non-CNS tissue and
adjacent tissues which may present as neurological disease
• proficiency in the diagnosis of neuromuscular disorders from muscle and nerve biopsy tissue, including the interpretation of special techniques
and evaluation of genetic data
• proficiency in the interpretation of CSF cytology preparations.
Trainees will complete a logbook documenting their experience of specialist training in neuropathology. A review of the logbook will form part of the
annual review.
75
The neuropathology logbook should:
• document the autopsies performed in training related to the diagnosis of nervous system diseases. In each case the trainee should include
contemporaneous notes regarding the clinical scenario, the post-mortem examination, the results of any further ancillary investigations and
formulation of the clinicopathological correlation and diagnosis. Details of cases which were observed can be included to increase the breadth of
exposure to nervous system disease where appropriate
• document the fixed and fresh brain dissections performed during training. In each case the trainee should include contemporaneous notes
regarding the clinical scenario, the investigations performed and formulation of the clinicopathological correlation and diagnosis. Details of cases
which were observed can be included to increase the breadth of exposure to nervous system disease where appropriate
• document a wide range of neuro-oncological diagnoses by including examples of common tumour types to which the trainee has been exposed
• document a range of neuromuscular disorders in muscle and nerve biopsy material to which the trainee has been exposed.
A directly maintained and up-to-date logbook will be used as part of annual review together with the views of the educational supervisor and other
members of senior staff involved in the trainee’s work. The logbook is more than a list of cases observed or investigated. It is there not only to
demonstrate the breadth of casework to which a trainee has been exposed, but also to give an indication of the approach that has been taken in each
post-mortem case and thus to indicate exposure of the trainee to determination of issues, analysis of the situation and development of the strategy in
dealing with the individual cases.
76
Basic knowledge Possess knowledge of the embryology, Develop the ability to solve complex Develop close liaison with clinicians,
development, genetics, anatomy, clinical and research problems by geneticists and radiologists for the
histology, physiology and biochemistry applying sound knowledge of basic provision of accurate diagnoses and
of the nervous system and adjacent principles and the scientific method. appropriate advice on the treatment
structures as they apply to the practice Develop the ability to perform and management of patients with
of neuropathology. independent and collaborative research. neurological disease.
Possess knowledge of the principles of Develop the ability to devise appropriate Develop timeliness, flexibility and
clinical neurology, neurosurgery, audits of activity to ensure a cost accuracy in work practices and
psychiatry and epidemiology as they effective and efficient neuropathology personal relationships.
apply to the practice of neuropathology. service. Maintain respect for the views and
Possess knowledge of audit Develop skills in converting knowledge wishes of patients and relatives.
procedures. into diagnoses and advice on Respect the right to confidentiality and
Possess knowledge of law, ethics and management and treatment. act with compassion and integrity at all
legal practices as they apply to the times.
practice of neuropathology. High standards of work and
Possess knowledge of the health and interpretation and accuracy.
safety regulations for handling nervous Recognise own limitations and the
system tissue particularly in relation to technical limitations.
transmissible spongiform
encephalopathies, Acquired Immune
Deficiency Syndrome (AIDS) and
hepatitis and other pathogens.
Surgical Tumours: Possess sufficient know- Smears and frozen sections: Develop the Develop close working relationships
neuropathology ledge of the clinical, radiological, ability to prepare smears and to interpret with clinicians, radiologists, geneticists,
genetic and therapeutic aspects of smears and cryostat sections for the laboratory disciplines and oncologists to
primary and metastatic tumours of the provision of intra-operative advice on ensure a seamless service for the
brain, spinal cord and their surrounding lesions of the nervous system. diagnosis management and treatment
tissues. To recognise the limitations of intra- of diseases of the nervous system.
Possess in-depth knowledge of the operative diagnoses.
pathology of primary and metastatic
tumours of the brain, spinal cord and
their surrounding tissues as set out in
the World health organisation (WHO)
classifications of tumours.
77
Surgical Non-neoplastic lesions: Possess an in- Histology and immunocytochemistry:
neuropathology depth knowledge of inflammatory, Develop the ability to interpret the
(continued) vascular, metabolic, genetic and histology and immunocytochemistry of
degenerative lesions and malformations paraffin sections for the accurate
that arise in neurosurgical pathology diagnosis of tumours and non-neoplastic
practice. lesions of the central and peripheral
nervous systems.
Medical Muscle disease: Possess sufficient Develop the ability to interpret the Develop close working relationships
neuropathology knowledge of the clinical, histology, histochemistry and electron with clinicians and appreciate the value
electrophysiological, genetic and microscopy of normal and pathological of clinical and radiological data for the
therapeutic aspects of muscle disease. muscle and nerve for accurate diagnosis accurate diagnosis of disease.
Have an in-depth knowledge of the of disease. Fully understand the importance of
histology, histochemistry and Acquire the ability to interpret genetics in the diagnosis and
immunocytochemistry and ultrastructure cytopathology of the CSF particularly for management of muscle, nerve and
of skeletal muscle in health and the diagnosis of tumours. CNS disease.
disease. Develop the ability to interpret brain
Possess a working knowledge of the biopsies for the diagnosis of metabolic
genetics of the major neurogenic, and degenerative diseases of the
myopathic and dystrophic muscle nervous system.
diseases.
Peripheral nerve diseases: Possess
sufficient knowledge of the clinical,
electrophysiological, genetic and
therapeutic aspects of peripheral nerve
diseases.
Have an in-depth knowledge of
histology, histochemistry and
immunocytochemistry and ultra-
structure of peripheral nerves and their
diseases. Possess a working
knowledge of the genetics of the major
peripheral nerve diseases.
78
Medical CSF cytopathology: Possess
neuropathology knowledge of CSF cytopathology in the
(continued) diagnosis of diseases of brain and
spinal cord.
Brain biopsies: possess sufficient
knowledge of brain diseases that can
be diagnosed by brain biopsy.
Autopsies and Possess in-depth knowledge of the Develop skills in autopsy techniques, Understand the relevance of clinical
post-mortem brain anatomy and pathology of the fetal, and particularly in relation to the examination and radiological data in planning and
pathology postnatal central and peripheral of the nervous system, skull, spine and successfully completing a neurological
nervous systems and how the nervous orbit, dissection and examination of the autopsy.
systems interact with the other organs blood supply of the brain and spinal cord Recognise limitations and when to refer
of the body. and in the examination of peripheral cases or specimens to a specialist
Possess in-depth knowledge of the nerves and muscle. laboratory.
anatomy and pathology of the skull, Develop the manual dexterity for removal Value of anatomy, clinical and
spine and adjacent structures. of the brain and spinal cord, examination radiology.
Fixed brains: Possess in-depth of blood vessels and peripheral nerves,
Understand legal processes and liaison
knowledge of anatomy, histology and and for cutting unfixed and fixed brains.
with police and courts.
pathology of the fetal and postnatal Develop the ability to interpret the
nervous system. macroscopic, histological appearances of
Pathology: Possess in depth know- the normal and abnormal nervous
ledge of the range of disorders of the system and related tissues.
nervous system, their clinical features, Acquire skills in selecting histological
their macroscopic and histological blocks for histology at autopsy and for
appearances in post-mortem tissue, taking appropriate blocks from unfixed
their diagnostic features in immuno- and fixed brains for the accurate
cytochemical of ultrastructural diagnosis of disease.
preparations.
79
Autopsies and Such disorders of the fetal and Develop the ability to select and interpret
post-mortem brain postnatal nervous system are itemised appropriate histological,
pathology on the College and BNS websites – immunocytochemical, ultrastructural,
(continued) www.rcpath.org and www.bns.org.uk – biochemical, microbiological, molecular
and in the major comprehensive genetic and proteomic techniques for the
textbooks on neuropathology but diagnosis of neurological disease.
knowledge should be continually Develop skills in reporting of pathological
updated by recent journal publications findings and the presentation of evidence
on human and experimental in court.
neuroscience and neuropathology.
Forensic neuropathology: Posses
sufficient knowledge to evaluate and
report the forensic pathology of the
child and adult Nervous system and
presentation those findings in court.
Brain banking: possess knowledge of
the procedures involved in brain
banking.
80
APPENDIX 2d SPECIALIST CURRICULUM FOR PAEDIATRIC PATHOLOGY
The specialist curriculum is an education and training programme for trainees who enter full-time training in paediatric pathology in ST3 (post
FRCPath Part 1) with the objective of taking the FRCPath Part 2 examination in paediatric pathology or for trainees who have passed FRCPath Part 2
in general histopathology but have subsequently decided to undertake subspecialty training in paediatric pathology.
Specialist training in paediatric and perinatal pathology builds on the experience gained during the first two years of training in histopathology. It
requires a minimum of two years spent in specialist departments and, since few, if any, such departments can offer training in every aspect of
paediatric and perinatal pathology, appropriate rotations and secondments will be required. Attendance at relevant postgraduate courses and national
and international conferences and courses are also desirable. The training period should allow time for research and a period at an overseas centre
of excellence is also strongly recommended.
The curriculum set out below is a guide to the range and level of experience that a specialist trainee should gain during the years between the Part 1
and Part 2 FRCPath examinations. It is also a guide to the attitudes, skills and knowledge that should be developed in a programme of life-long
learning throughout a pathologist’s career as a consultant.
Aims and objectives

On completion of the paediatric pathology training programme, the trainee must have acquired and be able to demonstrate:
• proficiency in the autopsy techniques required for the pathological investigation of early fetal loss, intrauterine deaths, neonatal, infant and child
deaths
• proficiency in histopathological examination of a wide range of paediatric surgical specimens, including placentas, and a wide range of paediatric
neoplasms.
Trainees will have to complete a logbook, which will identify the extent of a trainees’ experience and the degree of involvement of trainers.
The paediatric pathology logbook should:

• document all post mortem cases attended and examined by the trainee and it is anticipated that all major types of paediatric/perinatal autopsy
cases will be included in the logbook. In each case the trainee should include contemporaneous notes regarding the clinical scenario, the post-
mortem examination, the results of any further ancillary investigations and formulation of the clinicopathological correlation and diagnosis.
• include details of the breadth of casework covered, the specific approaches to be made by the trainee during a post-mortem and an indication as
to the satisfactory completion of the case, countersigned by the training supervisor
• include reported examples of the major categories of the surgical paediatric/perinatal pathology specimens, including examples of the more
common paediatric neoplasms.
81
A directly maintained and up-to-date logbook will be used as part of annual review together with the views of the educational supervisor and other
members of senior staff involved in the trainee’s work. The logbook is more than a list of cases observed or investigated. It is there not only to
demonstrate the breadth of casework to which a trainee has been exposed, but also to give an indication of the approach that has been taken in each
post-mortem case and thus to indicate exposure of the trainee to determination of issues, analysis of the situation and development of the strategy in
dealing with the individual cases.

Basic knowledge Understand the basics of embryology, Develop the ability to solve complex Understand importance of integration of
cytogenetics, molecular genetics and clinical (and research, when applicable) clinical and pathological data for
clinical genetics as they apply to the problems by applying sound knowledge accurate diagnosis.
practice of paediatric pathology. of basic principles without the Respect for parents’ points of view and
Understand the basics of anatomical and requirement always to rely on ‘pattern wishes.
physiological aspects of normal and matching’.
Respect the right to confidentiality and
abnormal pregnancy with pathology of act with compassion at all times.
abortion, the embryo and pre-viable
fetus.
Understand the basics of developmental
physiology, particularly in respect of
postnatal adaptation.
Possess knowledge of law and ethics as
applied to paediatric and perinatal
pathology.
Possess basic knowledge of the
epidemiology of pregnancy-related
disease, fetal and perinatal diseases and
paediatric disorders.
82
Perinatal Understand normal growth, how it is Demonstrate manual dexterity and Understand importance of accuracy and
autopsies assessed and of prenatal and postnatal expertise in all specialist techniques requirement for attention to detail during
growth restriction and basic pathology of used in the performance of the following dissection, tissue sampling and
stillbirth. types of perinatal post mortems: pre- interpretation of ancillary investigations.
Understand the pathogenesis of viable fetus, fetus terminated for Respect the death and the bereaved
malformation syndromes and the congenital abnormalities, premature and understand the importance and
identification of those important for neonate, stillbirth (premature and full significance of post-mortem
genetic counselling. term) and intrapartum death. examinations to them (including issues
Possess knowledge of prenatal, perinatal Be able to observe carefully and to of timeliness).
and paediatric infectious disease. record observations succinctly. Understand general principles of law
Possess knowledge of iatrogenic Be able to appropriately assess fetal and ethics as applied to perinatal
diseases relevant to modern growth and maturation using standards pathology and modern fetal and
management of paediatric diseases, for body and organ developments; perinatal medicine.
particularly in the field of neonatal recognise features of intrauterine growth
intensive care and paediatric oncology. restriction.
Possess knowledge of pathology of Be able to demonstrate appropriate
hydrops foetalis and a basic knowledge expertise in interpretation of post-mortem
of inborn errors of metabolism. histological findings and interpretation of
all ancillary investigations with
Possess knowledge of pathology and
recognition of limitations of such
pathogenesis of intrapartum and early
investigations.
neonatal death of the normally formed
infant. Be able to understand the principles of
classification of fetal and perinatal
deaths; be aware of the scope of the
national audit studies (CEMACH).
Placenta Possess knowledge of the development, Be able to examine singleton and twin Demonstrate an understanding of the
normal structure, function and pathology placenta with adequate sampling for importance of placental examination to
of a singleton and multiple pregnancies histology. clinicians and patients (e.g. timeliness
(twin placenta). and accuracy of reporting).
83
Paediatric Possess broad knowledge of pathology Be able to demonstrate some experience Demonstrate an understanding of the
autopsies and other issues (investigations) of in the performance of autopsies on legal and ethical issues surrounding the
sudden unexpected death in infancy, sudden unexpected death in infancy, cases of non-accidental injury; the
including forensic aspects of perinatal observe and follow the national and limitations of pathological findings in
and paediatric pathology (including the College guidelines in investigation of explanation of some of the infant
investigation of suspected fatal child infant deaths. deaths.
abuse). Be able to contribute to the multi-agency Understand that ability to interpret the
Understand the pathogenesis of case conferences. findings may be exceeded and other
complications of paediatric surgery Be able to demonstrate findings to expertise may be required.
(including post-operative deaths after clinicians with clear clinicopathological Understand the issues of tissue/organ
cardiac surgery). correlation; be able to document retention and coroners’/procurator fiscal
pathology using photography or video. practices.
Paediatric surgical Knowledge of specific childhood Be able to use techniques of special Understand requirement for attention to
pathology diseases including inherited metabolic value in paediatric pathology such as: detail during surgical reporting and the
diseases, bowel motility disorders, photography, specimen radiology, and need for correlation with the clinical
children’s tumours, etc. in the context of fine dissection. situation.
histological or autopsy material. Be able to demonstrate a high standard Demonstrate an understanding of the
Knowledge of the spectrum of paediatric of recognition and interpretation of importance of surgical pathology to
disease processes affecting all major histological appearances in a wide range clinicians and patients (timeliness and
organ systems. of paediatric surgical pathology. accuracy of reporting).
Understand limitations of own ability to
interpret the findings and the need for
seeking second opinion.
Special Understand principles of ‘special’ Be able to know when to resort to special Understand cost-benefit issues when
techniques histochemical and immunohistochemical techniques. considering the use of additional
methods. Be able to recognise histological features techniques.
Understand principles of common of histochemical and
molecular pathology techniques and immunohistochemical stains in normal
electron microscopy as applied to and diseased tissues from a wide range
paediatric solid tumours. of paediatric specimens.
84
APPENDIX 3 GOOD MEDICAL PRACTICE
The following table indicates where the Good Medical Practice headings can be found in the curriculum. These sections are also
cross-referenced with the PMETB’s Criteria for Entry to the Specialist Register.
Good Medical Practice Page number

Good clinical care 21
Maintaining good medical practice 40
Teaching and training, appraising and assessing 45
Relationships with patients 47
Working with colleagues 51
Health 53
Probity 54
85
APPENDIX 4 ACRONYMS
AIDS Acquired immune deficiency syndrome

ARCP Annual Review of Competence Progression
BMA British Medical Association
BMS Biomedical scientist
BNS British Neuropathological Society
BSP Breast Screening Programme
CATT College Advisory Training Team
CbD Case-based discussion
CCT Certificate of Completion of Training
CEMACH Confidential Enquiry into Maternal and Child Health
CESH Confidential Enquiry into Suicide and Homicide
CESR Confirming eligibility for specialist registration
CNS Central nervous system
CPD Continuing professional development
CSF Central spinal fluid
CSP Cervical Screening Programme
DMJ Diploma of Medical Jurisprudence
DOPS Directly observed practical skills
ECE Evaluation of clinical events
EQA External Quality Assurance
FNA Fine needle aspiration
FRCPath Fellowship of The Royal College of Pathologists
GI Gastro intestinal
GMC General Medical Council
GP General practitioner
HCC Healthcare Commission
HPV Human papilloma virus
IBD Inflammatory bowel disease
86
IQC Internal quality control
JCHPT Joint Committee on Higher Pathology Training
LBC Liquid-based cytology
MDT Multidisciplinary team meeting
MSF Multi-source feedback
NCEPOD National Confidential Enquiry into Patient Outcome and Death
NHS National Health Service
NICE National Institute for Health and Clinical Excellence
NOS Not otherwise specified
NPSA National Patient Safety Agency
NTN National Training Number
NTN(A) National Training Number (Academic)
ONS Office of National Statistics
OOPR Out-of-programme research
OOPT Out-of-programme training
PIAG Patient Information Advisory Group
PMETB Postgraduate Medical Education and Training Board
QAT Quality assurance testing
SAC Specialty Advisory Committee
SIDS Sudden infant death syndrome
SOP Standard operating procedure
ST Specialty training
STC Specialty Training Committee
SUDI Sudden unexpected death in infancy
TEM Tubo-endometrioid metaplasia
UK United Kingdom
WHO World Health Organisation
87
APPENDIX 5a ILLUSTRATIVE EXAMPLE OF HISTOPATHOLOGY TRAINING
ARCP R ARCP ARCP ARCP ARCP ARCP 6
F1 F2 ST1 * ST2 ST3 ** ST4 *** ST5 Consultant
Foundation Stage A Stage B Stage D ~

programme Stage C ‡
Earliest Certificate of
Entry into opportunity for Completion of Training
run-through Year 1 (CCT) or Certificate
training Assessment † confirming Eligibility for
(competitive Specialist Registration
interview)
* Trainees must have passed the Year 1 RCPath Assessment by the end of Stage A/ST1.
Failure to pass the Year 1 Assessment will prevent the trainee from progressing to Stage B.
** Trainees must have passed the Part 1 FRCPath examination by the end of Stage B/ST3.
Failure to pass the Part 1 examination by the end of ST3 will prevent the trainee from progressing to Stage C.
*** Trainees must have passed the Part 2 FRCPath examination by the end of Stage C/ST4.
Failure to pass the Part 2 examination by the end of ST4 will prevent the trainee from progressing to Stage D.
‡ Specialty training – either general histopathology, or subspecialty training in forensic pathology, neuropathology and
paediatric pathology.
~ Specialty training or subspecialty training including cytopathology.
88
APPENDIX 5b ILLUSTRATIVE TIMETABLE OF HISTOPATHOLOGY TRAINING
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
ST1 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Begin RCPath Year RCPath Year Earliest
Stage A. NTN 1 Assessment 1 Assessment opportunity to
end Stage A
awarded
Earliest Part 1 Part 1 Part 1 Part 1 Earliest
opportunity to FRCPath FRCPath FRCPath FRCPath opportunity to
begin opportunity results opportunity results exit Stage B
Stage B
Earliest Part 1 Part Part 1 Part 1 Last
opportunity to FRCPath 1FRCPath FRCPath FRCPath opportunity to
begin opportunity results opportunity results exit Stage B
Stage C
Part 2 Part 2 Earliest Earliest Part 2 Part 2 Last
FRCPath FRCPath opportunity to opportunity to FRCPath FRCPath opportunity to
opportunity results exit Stage C begin opportunity results exit Stage C
Stage D
Exit Stage D.
CCT awarded
89

His To Curriculum Training Uk 08

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

His To Curriculum Training Uk 08

Diunggah oleh

Hak Cipta:

Format Tersedia

The Royal College of Pathologists

Pathology: the science behind the cure

Curriculum for specialty training in

Joint Committee on Pathology Training

Telephone: 020 7451 6700

© The Royal College of Pathologists, 2008

The curriculum complies with:

Cytopathology (see Appendix 2a)

Forensic pathology (see Appendix 2b)

Neuropathology (see Appendix 2c)

Paediatric pathology (See Appendix 2d)

Flexible trainees must accept two important principles:

Research undertaken prior to entry to a histopathology training programme

Research undertaken during entry to a histopathology training programme

Overseas training undertaken prior to entry to a histopathology training programme

Related clinical training

Purpose of the curriculum

Stages of training and learning

In order to satisfactorily complete stage A of histopathology training, trainees must have:

In order to complete stage C of histopathology training, trainees must have:

In order to complete stage D of histopathology training, trainees must have:

Year 1 Histopathology Assessment

Annual Review of Competence Progression

SUPERVISION AND FEEDBACK

MANAGING CURRICULUM IMPLEMENTATION

CURRICULUM REVIEW AND UPDATING

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

Subject Knowledge Skills and knowledge application Attitudes

Understand issues of autopsy

Subject Knowledge Skills and knowledge application Attitudes

Subject Knowledge Skills and knowledge application Attitudes

Subject Knowledge Skills and knowledge application Attitudes

Subject Knowledge Skills and knowledge application Attitudes

Objective: to keep knowledge and skills and appropriate attitudes up to date.

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

Objective: to understand the importance of the personal health of the doctor.

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

Objective: to be able to demonstrate probity in all aspects of professional practice.

New specialists will:

Subject Knowledge Skills and knowledge application Attitudes

System Gross pathology Microscopy Knowledge base

(i.e. lipomatous, fibromatous, Recognise high-grade sarcoma.

Systems Anatomical features and dissection technique Clinico-pathological knowledge base

Complex post-mortem examinations

Assessment of traumatic injury, for example, after road traffic accident.

Category Topic Knowledge base

Benign cellular changes. Squamous metaplasia.

APPENDIX 2a SPECIALIST CURRICULUM FOR CYTOPATHOLOGY

Aims and objectives

The cytopathology logbook should:

Subject Knowledge Skills and knowledge application Attitudes

Subject Knowledge Skills and knowledge application Attitudes

Aims and objectives

F1 F2 ST1 * ST2 ST3 ST4 * ST5 Consultant