Subject curriculum

(i) GOAL 
The broad goal of the teaching of undergraduate student in Pathology is provide students with  a comprehensive knowledge of the mechanisms and cause of disease,  in order to enable him/her to achieve complete understanding of the natural history and clinical manifestations of disease, and to prepare him to be a teacher of Pathology.
(ii) OBJECTIVES:
(a) KNOWLEDGE:
            At the end of the course, the student shall be able to:

(1) Describe the structure and ultrastructure of a sick cell, mechanisms of cell degeneration, cell death and repair and be able to correlate structure and functional alterations;

(2) Explain the pathophysiological processes which govern the maintenance of homeostatis, mechanisms of their disturbance and the morphological and clinical manifestations associated with it;

(3) Describe the mechanisms and patterns to tissue response to injury such that he/she can appreciate the pathophysiology of disease processes and their clinical manifestations;

(4) Correlate normal and altered morphology (Gross and Microscopic) of different organ systems in common diseases to the extent needed for  understanding of disease processes and their clinical significance.  

(b) SKILLS :

At the end of the course, the student shall be able to:

(1) Describe the rationale and principles of technical procedures of the diagnostic laboratory tests and interpretation of the results;

(2) Perform the simple bed – side tests on blood, urine and other biological fluid samples;

(3) Draw a rational scheme of investigations aimed at diagnosing and managing the cases of common disorders;

(c) INTEGRATION :
            
            At the end of training he/she shall be able to integrate the causes of disease and relationship of different etiological factors (social, economic and environmental) that contribute to the natural history of disease most prevalent in India.           

(d)       CURRICULUM :

(A)       General Pathology
01.       Scientific study of disease 
02.       Some techniques used in study of disease
03.       Aetiology – causes of disease 
04.       Heredity and disease
05.       Animal cell, connective tissue, bacterial cell
06.       Virus particle & Cellular metabolism
07.       Retrogressive changes; degeneration
08.       Necrosis and gangrene.
09.       Amyloidosis 
10.       Hyperlipidaemia and lipidosis
11.       Glycogen infiltration and glycogen storage diseases, mucopolysaccharides and mucopolysaccharide lipid storage diseases
12.       Disorders of pigmentation
13.       Pathological calcification and uratic infiltration
14.       Inflammation
15.       Phenomenon of repair
16.       Immunity
17.       Hypersensitivity
18.       Autoimmunity ; Autoimmune diseases 
19.       SLE
20.       Transplantation and Immunological tolerance
21.       Host-parasite relationship
22.       Disturbances of nutrition
23.       Environmental disorders
24.       Radiation injury
25.       Circulatory disturbances
26.       Haemorrhage, shock and reaction of body to injury
27.       Disturbance of body fluid and electrolytes
28.       Disturbance of growth of cells
29.       General biology of tumours
30.       Spread of malignant tumours
31.       Aetiology and pathogenesis of cancer
32.       Pathology of tumours
33.       Diseases of infancy and childhood

(B)       Systemic Pathology
01.       Diseases of blood vessels
02.       Diseases of heart
03.       Diseases of red cells and bleeding disorders
04.       Diseases of white cells, lymph nodes and spleen
05.       Diseases of Respiratory system including COPD and Pneumoconioses
06.       Diseases of the oral cavity, jaws and salivary glands
07.       Diseases of the gastrointestinal tract including Barrett’s oesophagus as well as Carcinoma colon
08.       Diseases of the liver and the biliary tract including Liver function tests, Jaundice with its laboratory diagnosis and Hepatocellular carcinoma
09.       Diseases of the kidneys including Tumours like Wilms’ tumour and Renal Cell Carcinoma
10.       Diseases of the lower urinary tract.
11.       Diseases of the male genital tract
12.       Diseases of the female genital tract
13.       Diseases of the breast
14.       Diseases of the endocrine system
15.       Diseases of skin
16.       Diseases of the musculoskeletal system
17.       Diseases of the nervous system
            
(C)       Clinical Pathology
01.       Collection of blood
02.       Haemoglobin estimation
03.       Total and differential leucocyte count
04.       Red cell count, packed cell volume and absolute indices, E.S.R.
05.       Peripheral smear examination
06.       Anaemias
07.       Leukaemias
08.       Blood transfusion – pretransfusion tests
09.       Examination of urine
10.       Examination of C.S.F. and investigation of sterility in males.
11.       Liver function tests and Laboratory diagnosis of jaundice
12.       Renal function tests

 

PRACTICALS
            Practicals and demonstrations in Pathology to cover the above subjects with special emphasis on common laboratory techniques.

 

P.G. Curriculum

COURSE CONTENT FOR DCP

    
    A Theory

  1. General  pathology including immunopathology
  2.  Systemic pathology
  3.  Hematology
  4.  Blood Banking including Transfusion medicine
  5.  Cytopathology
  6.  Laboratory organization including Quality control
  7.  Basic microbiology & Clinical biochemistry

B Techniques and their applications

     General

  1. Principles of sample collection for Hematology and Clinical Pathology,
  2. Histopathology and cytology specimens urine analysis, stool examination,
  3. pregnancy tests, microbiological and biochemical tests
  4. waste disposal  and universal precautions
  1. CYTOLOGY
  2. 1. Fine needle aspiration cytology- staining & interpretation.
  3. 2. cytology of body fluids – staining and interpretation

 

Histopathology

  1. 1. Histopathologic techniques section cutting
  2. 2. Haematoxylin and Eosin stain and special stain which include PAS stain,Alcian blye stain reticulin stain Masson's  Trichrome and perl's stain
  3. 3.priniciples of immunohistochemistry and immunofluorescence

Hematology

1. Anticoagulants
2. Preparation of Leishman's stain and reagents for blood counts
3. Hands on experience in different methods of Haemoglobin estimation RBC,WBC,platelets and Reticulocyte counts, AEC, PCV, ESR and absolute indices and coagulation tests

  1. Preparation and interpretation of peripheral smear and Bone marrow
  2. Hemolytic workup including sickle cell preparation, Hb F& electrophoresis etc.
  3. Cytochemistry – peroxidase/sudan black B,PAS,LAP,NSE and perl's stsin
  4. Quality control and use of automated cell counters
  5. Cleaning of Glass ware

Blood bank

1.Bloodgrouping and typing
2.Cross matching
3.Coombs’ test
4.Donor screening and blood collection
5.Testing for STS, HIV, Hepatitis B&C
6.Rh antibody titration
7.Cold agglutinin titre
8.Quality control

Microbiology

  1. Experience of interpretation and reporting of
    1. Gram’s stain
    2. Z.N.
    3. Hanging drop
    4. KoH/Lactophenol preparation for fungi

 

  1. Sterilization techniques, culture methods, identification   
  1. Hands on experience and interpretation of serological tests like Widal,VDRL,HIV ,HBV, RF, ASO.

 

Clinical Biochemistry 
Basic Biochemistry applied to biochemical investigation:-
          pH-meter,flame photometer,Semi Autoanalyser and Autoanalyser Electrophoresis Carying out biochemical investigations like blood sugar, urea, creatinine, proteins, bilirubin,SGOT,SGPT,Alkaline phosphatase etc.

COURSE CONTENT FOR MD

The study of Pathology Anatomy includes all aspects of Pathology as encompassed in the branches of General and Systemic Pathology.  Only the broad outlines are provided.

A)    General Pathology:
Normal cell and tissue structure and function. The changes in cellular structure  and function in disease. Causes of disease and its pathogenesis. Reaction of cells, tissues, organ systems and the body as a whole a to various sublethal and lethal injuries. 
B)   Systemic Pathology:       
       The study of normal structure and function of various organ systems and the 
       aetiopathogenesis , gross and microscopic alterations of structure of these organ
       systems in disease & functional correlation with clinical features.

2.    Haematology
       The study of Haematology includes all aspects of the diseases of the blood and
       bone marrow. This would involve the study of the normal, and the causes of 
       diseases and the changes thereof.

3.    Laboratory   Medicine   (Clinical   Biochemistry/Clinical   Pathology  including 
       Parasitology).

4.    Transfusion  Medicine (Blood- Banking).

5.    In the following   fields  the  student  is  expected  to acquire  a general acquaintance of 
        techniques  and principles  and  to  interpret  data

  1. Immunopathology
  2. Electron microscopy
  3. Histochemistry
  4. Immunohistochemistry
  5. Cytogenetics
  6. Molecular Biology
  7. Maintenance of records
  8. Information retrieval, Computer, Internet in medicine.

It is difficult to give a precise outline of the Course Content for postgraduate training. A
postgraduate  is  supposed  to  acquired not  only professional  competence  of  a  well –
trained    specialist   but   also   academic maturity, a capacity  to  reason  and  critically 
scientific data as well as to keep himself  abreast of the latest developments in the field of the pathology and related sciences.  A brief outline of what is expected  to be learnt during the MD Course is given under each head.

Surgical Pathology 
Knowledge

  1. The   student   should   be  able  to  demonstrate  an    understanding   of  the                                                              histogenetic and patho-physiologic processes associated with various lesions                                           
  2. Should  be   able  to   identify   problems  in  the laboratory and offer  viable                                 solutions.

Skills

  1. Given the clinical and  operative data,  the student should be able to identify,                               and systematically  and  accurately  describe  the  chief     gross  anatomic

alterations in the surgically removed  specimens  and  be able to correctly                                      diagnose at  least  80 percent of the  lesions  received on an average day from the surgical services of an average teaching  hospital.

  1. A student should be able to demonstrate ability to perform a systematic gross                                                                                                  

Examination  of the tissues  including the  taking of appropriate tissue  sections and  in  special  cases  as  in intestinal  mucosal biopsies, muscle biopsies  and nerve  biopsies, demonstrate  the orientation of tissues  in paraffin  blocks.

  1. The student should  be able to identify and systematically and  accurately         describe the chief  histomorphological  alterations in  the  tissue received in  the  surgical pathology service. He/She  should  also correctly  interpret  &  correlate  with  the clinical data  to diagnose  at least  90%  of the  routine  surgical material received on an average day. He/She  should be able to  diagnose  at  least  75%  of the classical  lesions  being  commonly encountered  in  the  surgical  pathology  service  without  the  aid of  the clinical  data.
  2. Be    conversant    the   automatic  tissue   processing   machine  and  the principles  of  its  running .
  3. Process a tissue ,make a paraffin block and  cut sections of good quality on  a  rotary  microtome.
  4. Stain  paraffin sections with  at  least  the  following:

(i)         Haematoxylin  and   eosin 
(ii)        Stains  for collagen, elastic  fibers  and  reticulin

  1. Iron  stain
  2. PAS  stain
  3. Acid  fast  stains
  4. Any  other stains  needed  for  diagnosis.
  5. Demonstrate understanding of the principles of:
  6. Fixation  of  tissues
  7. Processing  of tissues  for section cutting
  8. Section cutting  and  maintenance  of  related equipment
  9. Differential  (Special) stains  and  their utility
  10. Cut  a  frozen  section  using  freezing  microtome / cryostat, stain  and  interpret the slide in correlation  with  the  clinical data  provided, and  correctly diagnose  at least 75 per cent of the lesions  within 15 minutes. Perform fat stain on frozen section.
  11. Demonstrate      the    understanding     of    the    utility   of   various              immunohistochemical

stains especially  in  the  diagnosis  of  tumour subtypes.

Autopsy  Pathology
            Knowledge

  1. Should  be aware  of  the technique  of autopsy .
  2. Should have  sufficient  understanding  of various disease  processes  so  that  a meaningful  clinico-pathological  correlation  can  be made.
  3. Demonstrate  ability  to  perform  a complete  autopsy  independently   with some  physical  assistance , correctly  following  the  prescribed    instructions. Correctly  identify  all  major  lesions  which  have  caused,   or  contributed  to, the  patient’s  death  on  macroscopic  examination  alone on  microscopy  in  at  least  90%  of  the autopsies in an average    teaching  hospital.
  4. In  places  where  non- medicolegal   autopsies  are  not  available  each    student /candidate  should  be made  to dissect  organs  from atleast five   medico-legal  autopsies.
  5. Write  correctly  and  systematically  Provisional  and  Final  Anatomic  Diagnosis  reports.

Cytopathology 
            Knowledge

  1. Should  possess the  background  necessary  for  the  evaluation  and  reporting of  Cytopathology  specimens.
  2. Demonstrate  familiarity  with,  the  following  keeping  in mind the   indication  for  the  test.
    1. Choice of site  from which smears  may be taken (as in the   case  of  vaginal  smears)
    2. Type of samples.
    3. Method  of  obtaining  various  specimens  (urine sample,  gastric smear, colonic lavage etc.)
    4. Be  conversant  with  the  principles  and  preparation  of    solutions of  stains.

Skills

  1. Independently    prepare   and   stain   good    quality    smears   for  cytopathologic  examination.
  2. Be conversant with the techniques for concentration of specimens:i.e. various filters, centrifuge and cytocentrifuge.
  3. Independently  be  able  to  perform fine needle  aspiration  of  palpable   superficial  lumps  in  patients;  make  good  quality smears, and be able   to decide  on  the type of staining in  a given case.
  4. Given    the    relevant    clinical   data,   he/she   should   be    able   to  independently  and  correctly:
    1. Evaluate    hormonal     status    in   all   cases   as  may  be    required.
    2. Diagnose  the   status  of  malignancy  or  otherwise  in  at  least  75% of  the cases  received   in  a routine  laboratory        and    categorize   them  into  negative,  inconclusive  and       positive.
    3. Demonstrate  ability  in  the  technique  of  screening  and   dotting  the  slides   for  suspicious  cells.
    4. Indicate  correctly  the  type  of  tumour , if  present, in  at 

            least 75% cases.
(v)       Identify   with    reasonable    accuracy   the  presence   of   
           organisms, fungi  and  parasites  in atleast   75%  of  cases.

Haematology
            Knowledge

  1. Should demonstrate the capability of utilising the principles of the practice of Haematology for the planning of tests, interpretation and diagnosis of diseases of the blood and bone marrow.
  2. Should   be  conversant  with  various  equipments  used in the  Haematology laboratory.
  3. Should have knowledge  of  automation and             quality assurance in  Haematology.
  4. Correctly plan a strategy  of  investigating at least 90% of the cases referred for special investigations in the Hematology Clinic and give ample justification for each step in consideration of the relevant clinical data provided.

Skills

  1.  Correctly  and independently perform the following special tests, in 

        addition to doing the routine blood counts:

    1. Haemogram including  Reticulocyte  and Platelet  counts.
    2. Bone marrow staining including stain for iron
    3. Blood smear staining
    4. Cytochemical characterization of leukemia with  special  stains like Peroxidase, Leukocyte Alkaline  Phosphatase (LAP), PAS, Sudan Black, etc.
    5. Hemolytic anemia profile including HbF, Hb electrophoresis etc.
    6. Coagulation profile including PT,APTT.FDP.
    7. BM aspiration and BM biopsy
  1. Demonstrate  familiarity with the principle and interpretation of results 

      and  utility in diagnosis of  the following:
(i)         Platelet function tests including platelet  aggregation  and    adhesion and PF3 release
(ii)        Thrombophilia  profile:    Lupus   anticoagulant   (LAC),
Anticardiolipin Antibody (ACA), Activated  Protein C Resistance (APCR) ,Protein C (Pr C), Protein  S (Pr S) and Antithrombin  III (AT III)

  1. Immunophenotyping of leukaemias
  2. Cytogenetics
  3. Describe  accurately  the  morphologic  findings  in the peripheral and bone marrow smears, identifying and quantitating  the morphologic abnormalities in disease states and arriving  at  a correct diagnosis in at least 90% of the cases referred to the Haematology clinic, given the relevant clinical data.

Laboratory Medicine 
            Knowledge

  1. Possess knowledge of  the  normal  range of values  of  the  chemical  content of body  fluids, significance  of  the altered values and its interpretation.
  2. Possess knowledge of the principles of following specialized organ  function tests and the relative utility and limitations of each and significance of the altered values.
    1. Renal function test
    2. Liver function test
    3. Gastric and Pancreatic function
    4. Endocrine function test
    5. Tests for  malabsorption
      1.  Know the principles, advantages  and  disadvantages  scope  and limitation of Automation in laboratory.
      2. Know the principles and  methodology  of quality control in laboratory.

Skills

  1. Plan a strategy of  laboratory  investigation of a given case, given the relevant  clinical  history  and  physical  findings  in a logical sequence, with a rational explanation of each step;  Be able  to  correctly  interpret  the laboratory  data of such studies, and discuss their  significance with a view to  arrive  at  a diagnosis.
  2. Demonstrate  familiarity  with  and  successfully  perform

i)          routine  Urinalysis including Physical, Chemical and Microscopic,  
            examination of the sediment.
ii)         macroscopic and microscopic examination of Faeces and identify the ova and cysts of common parasites. 
iii)        A   complete examination;  physical, chemical  and cell content  of  Cerebrospinal Fluid (C.S.F). , Pleural and Peritoneal fluid.
iv)        Semen analysis.
v)         Examination  of  Peripheral  Blood  for  the  commonly  occurring  parasites.

  1. Independently  and  correctly  perform at least  the  following  Quantitative  Estimations by Manual Techniques and/or  Automated  Techniques.
    1. Blood urea
    2. Blood sugar
    3. Serum Proteins total & fractional
    4. Serum Bilirubin total & fractional
    5. Serum amylase
      1. Demonstrate familiarity with  the  following  Quantitative Estimations  of  blood/ serum by Automated Techniques.

Serum cholesterol ,Uric acid, Serum Transaminases (ALT  and  AST/SGOT  and  SGPT), etc.

  1. Prepare standard solutions  and  reagents  relevant  to  the above tests, including the preparation  of  normal solution, molar solution and Buffers.
  2. Explain the principle  of  Instrumentation, use and application  of  the instruments commonly  used  in the labs eg..Photoelectric  colorimeter,  Spectrophotometer, pH   meter,  Centrifuge,  Electrophoresis apparatus, ELISA  Reader , flow cytometer

Transfusion  Medicine  (Blood Banking) 
            Knowledge 
                  Students should possess knowledge of the following aspects of Transfusion
                  Medicine.

  1. Basic immunology
  2. ABO and Rh groups
  3. Clinical significance of other blood groups
  4. Transfusion therapy including the use of whole blood and RBC concentrates.
  5. Blood component therapy
  6. Rationale of pre-transfusion testing.
  7. Infections transmitted in blood.
  8. Adverse reactions to transfusion of blood and components
  9. Quality control in blood bank

Skills
      Student should be able to correctly and independently perform the following

  1. Selection and bleeding of donors
  2. Preparation  of blood components i.e. Cryoprecipitates, Platelet concentrate,                                                                                          Fresh Frozen Plasma, Single Donor Plasma, Red Blood Cell concentrates .
  3. ABO  and Rh grouping.
  4. Demonstrate familiarity with  Antenatal  and Neonatal work
        1. Direct antiglobulin test
        2. Antibody screening and titre
        3. Selection of blood for  exchange transfusion
          1. Demonstrate familiarity with  principle and procedures involved  in       
      1. Resolving ABO grouping problems.
      2. Identification of  RBC  antibody
      3. Investigation of transfusion reaction.
      4. Testing of blood for  presence  of                                                          (a)                HBV (Hepatitis B Virus Markers).
        1. HCV (Hepatitis C Virus Markers )
        2. HIV (Human Immunodeficiency Virus        Testing)
        3. VDRL

Basic Science (in relation to Pathology)
a)  Immunopathology 
     Knowledge 
(i)         Demonstrate familiarity with the current concepts of structure and function of the immune system, its aberration and mechanisms thereof.
(ii)        Demonstrate familiarity with the scope, principles, limitations and  interpretations of the results of the following procedures employed in clinical and experimental studies relating to immunology.

            1. ELISA techniques
            2. Radioimmunoassay
            3. HLA typing

(iii)       Interpret simple immunological tests used in diagnosis of diseases and in research procedures.

  1. Immunoelectrophoresis
  2. Immunofluorescence        techniques               especially on kidney and skin biopsies
  3. Anti-nuclear Factor (ANF)
  4. Anti- neutrophil  cytoplasmic  antibody  (ANCA)

b)   Electron  Microscopy
       Knowledge

  1. Demonstrate  familiarity  with Principles  and techniques  of  electron microscopy  and the working of an electron microscope (including Transmission  and  Scanning Electron  microscope: TEM and SEM)
  2. Recognise  the appearance of the normal subcellular organelles   and their  common abnormalities (when provided with   appropriate  photographs).

c)   Enzyme Histochemistry 
       Knowledge 
Should be familiar with the principles, use and interpretation of common enzyme   histochemical  procedure   (Alkaline   Phosphates,     Acid        Phosphates,  Glucose-6-Phosphate  Dehydrogenase ,    Chloroacetate       Esterase. 
d)   Immunohistochemistry 
      Knowledge 
Demonstrate  familiarity with the principles and  exact procedures of  various immunohistochemical stains  using both PAP  ( Peroxidase-  Antiperoxidase)  and  AP-AAP (Alk.  Phosphatase-anti  Alk.  Phosphatase) ABC (Avidin-Biotin  Conjugate)  Systems;  employing  monoclonal and polyclonal antibodies. Be aware of the limitations of immuno his to chemistry.
      Skills (desirable )
Be able to perform immunohistochemical staining using paraffin section with at least one of the commonly used antibodies (Cytokeratin or LCA) using PAP method.

e) Molecular Biology
       Knowledge 
Should understand the principles  of  Molecular  biology especially related  to the understanding  of disease processed and its use in various  diagnostic tests.
Should be conversant with the principle & steps and interpretations of a Polymerase Chain Reaction (PCR Western Blot, Southern Blot, Northern Blot and Hybridisation procedures.

f)    Cytogenetics  
          Knowledge 
Demonstrate familiarity with methods of Karyotyping  and  Fluorescent-in-situ Hybridisation (FISH)