CAP Position Statement on Pathologists’ Assistants

INTRODUCTION
The practice of pathology is an integral part of medical care.  It entails the diagnosis of disease and the interpretation of patho-physiological mechanisms through the examination/analysis of human tissue samples, body fluids or other materials and their correlation with related medical judgments.  The resultant diagnosis usually plays a vital role in patient care and often is the single most important factor upon which decisions regarding therapy are made.  These responsibilities must remain those of a duly trained, licensed and certified pathologist and can not be delegated under any circumstance.

POLICY
The Canadian Association of Pathologists (CAP) recognizes that there is a role and a need for appropriately trained and certified non-medical personnel (Pathologists’ Assistants (PAs)) to assist pathologists in the preparation and examination of tissues in the setting of surgical and autopsy pathology.  This delegation of responsibilities is similar to that given to histotechnologists who prepare histological slides and perform other specialized techniques.  The gross examination and selection of tissue for histological evaluation plays a critical role in the accurate diagnosis of disease, this particular delegation must always be performed under the close supervision of a qualified pathologist.

The CAP defines a PA as a laboratory professional who, through appropriately documented delegation by a pathologist of specific responsibilities for which she/he has been properly trained, performs a comprehensive gross examination of surgical specimens and/or of non-forensic autopsies.  In order to ensure high quality medical practice and to fulfill legal requirements, the CAP expects standardization and regulation of basic competencies for PAs as well as a proper certification and licensure and that on-going provincial licensing and maintenance of competence programs include the active involvement of pathologists. These expectations include the following requirements: guidelines for the pathologist supervising a PA, quality assurance guidelines for laboratories employing PAs, a list of key competencies expected by pathologists of PAs and guidelines for issuance of  a  “Certificate of Evaluation” for already practicing PAs.

Finally, the CAP recognizes and strongly supports the important role that some laboratories have had over the years in training and educating PAs and that education of PA's be done as a graduate program within a recognized post-secondary academic institution, and with the active participation of pathologists.  The CAP also invites other organizations to participate in the development of an acceptable accredited educational program for new PAs and the licensing of existing professionals.

ADDENDUM 1
Guidelines for the pathologists supervising a PA

The signing pathologists are responsible for:

    1) signing out the cases
    2) overseeing and directing the work performed by the PA
    3) assigning cases based on complexity and expertise of the PA
    4) performing the microscopic examination of the cases
    5) making the clinicopathologic correlation
    6) communicating with the clinicians responding to other inquires
    7) implementing and maintaining the Quality Assurance program
    8) promoting proper working conditions

ADDENDUM 2
Quality Assurance guidelines for laboratories employing PAs


The Quality Assurance guidelines include Continuing Education requirements, working conditions and risk management.

2.A Continuing Education requirements
A PA must participate in continuing education activities, both intra- and/or extra-departmental, for a minimum of 25 hours/year.

2.B Working conditions
Every pathology department should fulfil the following requirements in the design of a work station:

    1)   adequate ventilation
    2)   satisfactory lighting
    3)   proper water supply and drainage
    4)   adequate working space
    5)   adequate storage facilities for specimens
    6)   acceptable procedures for  disposal of specimens
    7)   fire safety protocol

In addition, proper working conditions also include a:

     8)   procedure’s manual
     9)   dress code
    10) list of responsibilities for the supervising pathologist
    11) easy access for consultation with the supervising pathologist

2.C Risk Management
In order to ensure a safe and healthy workplace, the PA must always enforce the following procedure(s):

    1) universal precautions
    2) Workplace Hazardous Material Information System (WHMIS)
    3) a manual for handling hazardous waste
    4) participation in the Departmental Safety Committee

ADDENDUM 3
Suggested list of key competencies expected of PAs


A PA should perform and assume responsibility for the following tasks:

3.A Preparation and examination of human surgical specimens

    1) data collection and specimen procurement/receipt
    2) obtain clinical history, laboratory data, x-rays and scans when indicated
    3) prepare gross examination and complete dissection and dictation of surgical specimens
    4) prepare tissues for microscopic examination, including preparation for frozen and permanent sections for light, electron and immunoflourescent microscopy
    5) obtain biological specimens for analysis (e.g., bacterial and viral cultures, toxicological material) and perform special techniques as directed by the pathologist

3.B Preparation and examination of human bodies

    1) ascertainment of proper legal authorization for the purposes of non-forensic autopsies
    2) retrieval of the patient’s chart and other pertinent data for review by the pathologist
    3) evisceration and fully dissection of internal organs followed by proper display
    4) removal of brain and spinal cord without damage
    5) proper removal of middle ear, bone marrow and artificial devices
    6) procurement of biological specimens for analysis (e.g., blood and tissue, cultures, toxicological material) and performance of special techniques as directed by the pathologist
    7) notification to the funeral home and coordination of special requests for specimen sampling (e.g., organ transplantation,  research)
    8) release of the body following proper restoration and indication of any biohazards (e.g., contagious diseases, radioactive implants) which may be present

 3.C Responsibilities common to PAs

    1) quality management
    2) collaboration with health professionals
    3) professional responsibility and ethics
    4) photography techniques
    5) safe work practices
    6) supervise the autopsy suite and/or the gross cutting room areas
    7) participate in continuing education activities directed to other health care workers

ADDENDUM 4
Guidelines for issuance of “Certificate of Evaluation” for already practicing PAs


In order to establish a satisfactory scope of practice, the institution, in particular the workstation of the PA should be surveyed by a practicing and licensed pathologist appointed by the provincial agency responsible for the quality assurance program of health care centres.

4.A If the scope of practice is satisfactory, a “Certificate of Evaluation” can be obtained by:

    1) having a minimum of three years of practice
    2) registering in a central register to be established within one year after a formal training is available
    3) receiving a letter of approval by the supervising licensing pathologist

4.B If the scope of practice does not fulfill the criteria, the candidate is expected to qualify by:

    1) having fulfilled the same requirements as those is 3.A
    2) taking a formal evaluation designed by an agency to be designated within two years following registration

 4.C The provision for obtaining a “Certificate of Evaluation” ends five years following the establishment of a central register