Virtual Surgical Pathology Syllabus

Johns Hopkins University
School of Medicine
Course Title
Virtual Surgical Pathology
Course/Session Director: Marissa White MD mwhite44@jhmi.edu

Office: 410-614-3964
Cell: 410- 952-9038
Course Coordinator: Nancy Nath nnath2@jhmi.edu
Surgical pathology faculty:

Liz Thompson MD PhD ethomp36@jhmi.edu (small group leader)
Marc Halushka MD PhD mhalush1@jhmi.edu
Kevan Salimian MD PhD ksalimi1@jhmi.edu
Christopher VandenBussche MD PhD cjvand@jhmi.edu
Ashley Cimino-Mathews MD cimino1@jhmi.edu
Examination Schedule: Last day of the rotation
Course Description: Online surgical pathology student rotation for medical students who have
completed the pre-clinical curriculum. This case-based rotation is designed to simulate a surgical
pathology resident experience, and will include remote previewing and sign-out of scanned cases
multiple times per week with surgical pathology faculty and/or senior residents. Assigned
reading will guide independent or group case previewing. Rotators will also be expected to
attend surgical pathology meetings hosted on Zoom including pathology grand rounds, daily QA
conferences, and resident lectures. Rotators will be evaluated at the end of the rotation in the
form of a brief 10-minute presentation on a pathology topic of their choice and a short
assessment.
Course Learning Objectives:
At the end of the course students will:

- Summarize the role of a general surgical pathologist as a member of the
multidisciplinary care team
- List the defining histologic features of several common pathologic entities
- Demonstrate how to determine the pathologic stage for an oncologic resection
- Describe how to approach assessing biopsy specimens
2020-2021 Syllabus Guidelines for Virtual Surgical Pathology Clinical Elective Page 2 of 12
Required Text and Other Materials

- Robbins and Cotran Pathologic Basis of Disease 9th edition (Available for free through
Welch Library and at https://www.clinicalkey.com/#!/browse/book/3-s2.0-
C20110055734)
- The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process. Molavi
***Later referred to as the Molavi book *** (Available for free through Welch Library or if
on VPN https://link.springer.com/book/10.1007%2F978-0-387-74486-5)
- Histology for Pathologists, 5th ed (available for free through the Welch library)
- Quick Reference Handbook for Surgical Pathologists (available for free through the
Welch library)
- College of American Pathologists Cancer Staging Templates:
https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-
templates
Additional resources:
- Basic histology:
 Wheater’s Functional Histology
 Junquiera’s Basic Histology Text & Atlas (available for free on AccessMedicine:
https://accessmedicine.mhmedical.com/book.aspx?bookID=2430)
- Grossing:
 Manual of Surgical Pathology (available for free through the Welch library)
Assignments
1. Virtually attend all resident lectures which begin at or after 10AM (tentatively Monday-
Friday) and view all recorded resident lectures.
a. Final schedule will be sent via e-mail and available on the shared Google
calendar.
b. **Please use a ‘Meeting username’ for attendance purposes (e.g., first initial and
last name)
Meeting ID: 760 060 388
https://jhjhm.zoom.us/j/760060388
If you are calling in from a phone, dial 646-558 8656.
Feel free to call/text chief resident (703-321-6168) if you have any issues.
2. Assigned case previewing for small group “sign-out”:

a. While previewing, students should prepare to discuss the answers to the following
questions:
- What tissue type(s) do you see?
- What appears abnormal, and why?
- Does the abnormality appear non-neoplastic (i.e. inflammatory response,
ectopic tissue, iatrogenic, developmental abnormality, etc.) or
neoplastic, and describe the histologic findings which helped you arrive
at that conclusion.
- If you feel the abnormality represents a neoplasm, attempt to determine
the cell type of origin and if you feel it is benign or malignant.
- Differential diagnosis
b. Render formal final diagnosis for each previewed case, including a grade and/or
pathologic tumor stage and resection margin status if applicable. For weeks 2 and
3, final diagnoses should be e-mailed to your small group leader (either Marissa
White - mwhite44@jhmi.edu or Liz Thompson – ethomp36@jhmi.edu) at least 1
hour prior to the start of sign-out. (This is for your educational purposes only and
will not be graded, have fun and do your best!)
- Tumor grading resources: Chapter 5 “Grading (and classification
systems),” Quick Reference Handbook for Surgical Pathologists
- College of American Pathologists Cancer Staging Templates:
https://www.cap.org/protocols-and-guidelines/cancer-reporting-
tools/cancer-protocol-templates
3. e-Lectures
a. Review of neoplasia histology
b. Careers in pathology
c. Review of cancer grading and staging
d. How to evaluate a surgical resection specimen
4. Additional suggested activities:
a. Head and neck tumor board – Thursdays at 7am (e-mail Marissa White if you
would like to attend)
b. Pathology subspecialty sign-outs and/or QA conferences – variable dates and
times (e-mail Marissa White if you have an interest in attending one of the below
subspecialty sign-puts and/or QA conferences)
- Neuropathology consults
- Cytopathology
- Gynecologic pathology
- Cytopathology
- GI mucosal pathology
- Hematopathology
- General surgical pathology consults
- Breast pathology consults
5. Brief 10-minute group presentation on any surgical pathology topic to be given on the
last day of the rotation on Zoom with screensharing
6. Surgical pathology unknown cases and questions during down-time
http://apps.pathology.jhu.edu/sp/
Required Attendance
- Small group “sign-outs”
- Large group slide review sessions
- Pathology resident Zoom lectures beginning at or after 10AM
- Viewing of all recorded resident lectures
- Daily surgical pathology Zoom consensus conference: Monday – Friday, 1pm
- End-of-rotation group presentations – Last day of the rotation
Evaluation and Grading

A. Formative: How will students know how they are doing in the course?
1. Students will e-mail “final diagnoses” for cases previewed in weeks 2 and 3 to
Marissa White (mwhite44@jhmi.edu), at least 1 hour prior to the start of sign-out.
Students will receive formative feedback on their diagnoses through active
participation during “sign-out”
B. Summative: Indicate the basis for computing course grades and the relative weight of
each assignment, exam, etc.
Attendance to required lectures/conferences, e-mailing final diagnoses in weeks 2 and 3,

and active participation in “sign-out” (80%)
Completion of end of rotation presentation (15%)
Assessment (10 questions) (5%)
Grading Scale (grading scale is determined by the School of Medicine.)

P = Student has an average equal to or exceeding 70% and has met all required
assignments for the class.
U = Student completion of some examinations or assignments is below passing level.
These examinations or assignments must be remediated in order to convert to P.
I = Student has a passing average for the course, but has missed required events, because
of illness or emergency. Student should meet with course director to plan remediation.
F = Student has failed significant required elements of the course, or has an average score
below the passing level for the course. Student should meet with the course director to plan
remediation.
Expectation and Attendance
Participation in lectures, discussions, and other activities is an essential part of the instructional
process. Students are expected to participate regularly. Attendance at virtual sign out, resident
lectures, daily surgical pathology QA conference, pathology grand rounds, and end-of-rotation
presentations is required. Students must adhere to the school’s attendance policy regarding
absences and alerting the appropriate people about missed days.
If you need to miss classes, you are to notify the following individuals of the absence, as far as
advance as possible:
1) Marissa White mwhite44@jhmi.edu (Course Director)

2) Nancy Nath nnath2@jhmi.edu
The JHUSOM policy on student attendance in the curriculum is posted on Blackboard. The
policy is also available at https://hpo.johnshopkins.edu/som/?event=manual&manualid=886.
Weather and Other Emergencies
The School of Medicine follows Johns Hopkins University policy regarding closure due to
weather emergencies. Weather emergencies are available at the phone numbers and website
below, as well as on radio and TV broadcasts
http://www.insidehopkinsmedicine.org/weather.pdf:
Baltimore 410-516-7781
Outside Baltimore 800-548-9004
URL: http://webapps.jhu.edu/emergencynotices
Examinations:
10 question assessment, to be taken on the last day of the rotation on Blackboard.
Classroom Accommodations for Students with Disabilities

If you are a student with a documented disability who requires an academic adjustment, auxiliary
aid or other similar accommodations, please contact the Office of Student Affairs at 410-955-
3416. If you have a documented disability that may impact your work in this class, please work
to get it documents so that we can get proper accommodation.
Statement of Diversity and Inclusion

Johns Hopkins University is a community committed to sharing values of diversity and inclusion
in order to achieve and sustain excellence. We believe excellence is best promoted by being a
diverse group of students, faculty, and staff who are committed to creating a climate of mutual
respect that is supportive of one another’s success.
Teacher Learner Conduct Policy

The Johns Hopkins University School of Medicine is committed to fostering an environment that
promotes academic and professional success in learners and teachers at all levels. The
achievement of such success is dependent on an environment free of behaviors which can
undermine the important missions of our institution. An atmosphere of mutual respect,
collegiality, fairness, and trust is essential. Students should review the JHUSOM Guidelines for
Conduct in Teacher/Learner Relationships, located on Blackboard.
Student Honor Code

Students are reminded of the honor code developed by the medical student body, introduced in
September 1991, is as follows:
As a student at The Johns Hopkins School of Medicine, I pledge:
-To do my own work and be honest in my interactions with peers, faculty, and staff. This applies
to my work on examinations, assignments, and papers as well as work in the laboratory.
-To uphold the high standard of conduct in patient care which has always been maintained by the
Johns Hopkins medical community.
-To base my interactions with other students on mutual respect and cooperation.
-To act on infractions of the honor code and to maintain the confidentiality of all parties
involved.
-To encourage my peers to uphold this honor code.
It is the expectation that Hopkins students live by this code.
Course Evaluation
Please remember to complete the course evaluation for this course. Evaluations will be required
from a rotating sample of 25% of the class. Other students will always have the option of
submitting an evaluation if they choose. This will reduce the overall burden of surveys for
students. There will be no extra credit for completing the evaluation. If you are in the designated
25%, you will receive an incomplete if the course evaluation is not completed by the time grades
are posted for the course. These evaluations are an important tool in the School of Medicine’s
ongoing efforts to improve instructional quality and strengthen its programs. The results of the
course evaluations are kept anonymous—your instructor will only receive aggregated data and
comments for the entire class.
Bibliography
Required:
1. The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process.
Molavi Available for free at https://link.springer.com/book/10.1007%2F978-0-387-
74486-5#authorsandaffiliationsbook)
2. Histology for Pathologists, 5th ed (available for free through the Welch library)
3. Robbins and Cotran Pathologic Basis of Disease 9th edition (Available online at through
Welch Library and at https://www.clinicalkey.com/#!/browse/book/3-s2.0-
C20110055734)
4. Quick Reference Handbook for Surgical Pathologists (available for free through the
Welch library)
5. College of American Pathologists Cancer Staging Templates:
https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-
templates
Suggested:
Wheater’s Functional Histology: A Text and Colour Atlas, 6th Edition
Junquiera’s Basic Histology Text & Atlas (available for free on AccessMedicine)
Manual of Surgical Pathology (available for free through the Welch library)
Course Outline
Virtual Surgical Pathology
In order to have a productive and engaging small group sign-out, the following are expectations
for independent/group case previewing:
1. Prepare to discuss the answers to the following questions:

a. What tissue type(s) do you see?
b. What appears abnormal, and why?
c. Does the abnormality appear non-neoplastic (i.e. inflammatory response,
ectopic tissue, iatrogenic, developmental abnormality, etc.) or neoplastic, and
describe the histologic findings which helped you arrive at that conclusion.
d. If you feel the abnormality represents a neoplasm, attempt to determine the
cell type of origin and if you feel it is benign or malignant.
e. Differential diagnosis
2. Render formal final diagnosis for each previewed case, including a grade and/or
pathologic tumor stage and resection margin status if applicable. For weeks 2 and 3,
final diagnoses should be e-mailed to your small group leader (either Marissa White -
mwhite44@jhmi.edu or Liz Thompson – ethomp36@jhmi.edu ) at least 1 hour prior
to the start of sign-out. (This is for your educational purposes only and will not be
graded, have fun and do your best!)
a. Tumor grading resources: Chapter 5 “Grading (and classification systems),”
Quick Reference Handbook for Surgical Pathologists
b. College of American Pathologists Cancer Staging Templates:
https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-
protocol-templates
WEEK 1
- Virtually attend resident lectures which begin at or after 10AM and view all recorded
resident lectures.
Meeting ID: 760 060 388
- Virtually attend daily SP QA conference
- Surgical pathology unknown cases and questions during down-time
- Monday:
1. Review SFM foundation of histology materials on mScope and Inversus
 SFM Blood cells and stains – 5 Different stains
 Muscle, connective tissue, bone, and cartilage
 Epithelium 1
 Epithelium 2
2. Rotation orientation: 1:45pm – Small group faculty leaders
- Tuesday:
1. Basic histology slide review session: 2pm – Dr. Ashley Cimino-Mathews (Zoom
invitation will be posted on Blackboard)
2. View “Review of neoplasia histology” e-Lecture
3. Read Molavi Chapters 1-3 “Using the Microscope/ Descriptive terms in Anatomic
Pathology / Infection and Inflammation”
- Wednesday:
1. Perform the following on-line learning modules available at
http://pathology.jhu.edu/campus/training-resources-residents.cfm (must be on the VPN or
virtual desktop)
 “Introduction to Pathology of the Colon”
 “Introduction to Pathology of the Esophagus”
 “Introduction to Pathology of the Small Bowel”
 “Introduction to Pathology of the Stomach”
- Thursday:
1. Introduction to Cytopathology session: 2:30pm – Dr. Chris VandenBussche
(Zoom invitation will be posted on Blackboard)
2. Preview GI biopsies 1, 2, and 3
 GI_biopsy_1:
https://digital.pathology.johnshopkins.edu/repos/2551?slide=78945
 GI_biopsy_2:
 GI_biopsy_3:
- Friday:
1. GI biopsy slide review session: 2 pm – Dr. Kevan Salimian (Zoom invitation will
be posted on Blackboard)
2. Reading:
 Molavi Chapters 19 “Breast,” and 25 “Salivary gland”
 Histology for Pathologists chapter 18 “Thymus”
3. View “Review of cancer grading and staging” e-Lecture
WEEK 2
resident lectures.
Meeting ID: 760 060 388

- Monday:
1. View “How to evaluate a surgical resection specimen” e-Lecture
 Additional tumor grading resources: Chapter 5 “Grading (and classification
systems),” Quick Reference Handbook for Surgical Pathologists
 College of American Pathologists Cancer Staging Templates:
https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-
protocol-templates
2. Read Molavi chapter 28 “Soft tissue and bone”
3. Watch 3 gross dissection videos:
 Thyroid Dissection
 https://www.youtube.com/watch?time_continue=1&v=K7N86p2IYoc&feature=e
mb_lo
 Gallbladder Dissection
 https://www.youtube.com/watch?v=V1D8kj0adec&feature=emb_logo
 Ascending Aorta
 https://www.youtube.com/watch?v=yNo6I0-fSK4&feature=youtu.be
- Tuesday:
1. Preview four cases
1. 7610 https://digital.pathology.johnshopkins.edu/repos/451?slide=70431
 35-year-old female, bowel resection for bowel obstruction, past surgical history of
c-section
 60-year-old female, bilateral orchiectomy
 30-year-old female, total thyroidectomy for hyperthyroidism
 65-year-old male, soft tissue mass excision, history of a ventral hernia repair
- Wednesday:
1. Small group case sign-out with attending via Zoom
2. Start to prepare end-of-rotation group presentations
3. Read Molavi chapters 22 “Lung” and 11 “Prostate”
- Thursday: Preview five cases

1. Scanned slide https://digital.pathology.johnshopkins.edu/repos/2551?slide=78273
 30-year-old male, superficial parotidectomy for a parotid mass
 70-year-old female, lumpectomy for a palpable 2 cm breast mass
 50-year-old male, local excision for a cheek mass
 45-year-old female, breast biopsy for a 1cm hypoechoic mass detected on 1 st

routine screening mammogram
 80-year-old male, brain biopsy, recent history of intracranial hemorrhage
- Friday
1. Small group case sign-out with attending via Zoom.
2. Preview five cases:
 75-year-old female, lobectomy for multiple lung lesions, history of
smoking
 80-year-old male, lung wedge resection, history of bladder cancer status
post radical cystoprostatectomy and smoking
 50-year-old female, lung wedge resection, new diagnosis of a
retroperitoneal mass detected on imaging and bilateral pulmonary nodules.
One pulmonary lesion is more amendable to excision and is excised first
 30-year-old male, superficial soft-tissue mass excision, history of multiple
superficial soft-tissue masses
 50-year-old male, resection of a soft tissue mass anterior to the
sternocleidomastoid muscle
WEEK 3
resident lectures.
Meeting ID: 760 060 388
- Monday:
2. View “Careers in pathology” e-Lecture
3. Continue to work on end-of-rotation group presentations
- Tuesday: Preview three complete, multi-slide cases

1. Prostate needle core biopsies (7 scanned slides): 60-year-old male prostate needle
core biopsies, elevated PSA and family history of breast and pancreatic cancer
 Prostate #1_1: https://digital.pathology.johnshopkins.edu/repos/2551?slide=78254

2. Skin lesion resection (3 scanned slides): 80-year-old female, resection of a 1cm

lower extremity lesion
 Skin #1_1 Lateral (blue ink), medial (green ink), and deep (black ink)
resection margins (perpendicular tissue sections to resection margins):
 Skin #1_2 Lesion to deep resection margin (black ink):
 Skin #1_3 Additional deep resection margin (perpendicular tissue sections
to resection margin):
3. Assign a pathologic stage to a cancer resection (5 scanned slides): 70-year-old

patient, distal pancreatectomy for 5 cm pancreatic mass with splenectomy and
partial hepatectomy
 Pancreas tumor #2_1 Spleen:
 Pancreas tumor #2_2 Liver:
 Pancreas tumor #2_3 Four Peripancreatic lymph nodes:
 Pancreas tumor #2_4 Pancreatic resection margin (resection margin
sampled en face):
 Pancreas tumor #2_5 Representative section of 5 cm pancreatic tumor:
- Wednesday:
2. Finalize end-of-rotation group presentations
3. Preview cardiovascular pathology cases (slide links and clinical histories will be
posted on Blackboard)
- Thursday:
1. Cardiovascular pathology slide review session: 2 pm – Dr. Marc Halushka (Zoom
invitation will be posted on Blackboard)
2. Finalize end-of-rotation group presentations
- Friday:
1. 10-minute end-of-rotation group presentations via Zoom with screensharing: 2pm
2. End of rotation assessment (Blackboard)
Website Links
e-Lectures: http://somlv.med.jhmi.edu/
mSCOPE tutorial: http://oacapps.med.jhmi.edu/bb/tutorials/mscope_tutorial.mp4

- Login: first_year
- Password: jhmi
JHH Digital slide set: https://digital.pathology.johnshopkins.edu

- Login: personal JHED
Grossing Videos and Gastrointestinal Disease Tutorials (must be on VPN or virtual

desktop): http://pathology.jhu.edu/campus/training-resources-residents.cfm
Surgical pathology unknown cases and questions: http://apps.pathology.jhu.edu/sp/
You must be on campus or virtually on campus (VPN) to have access to mSCOPE and the
gastrointestinal pathology learning modules. You must use the FULL Pulse SecureVPN program
and not the web client. Inversus and JHH Digital pathology sites are accessible using your
JHED ID as a login.

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Johns Hopkins University

Course/Session Director: Marissa White MD mwhite44@jhmi.edu

Course Coordinator: Nancy Nath nnath2@jhmi.edu

Surgical pathology faculty:

Examination Schedule: Last day of the rotation

Course Learning Objectives:

At the end of the course students will:

Required Text and Other Materials

2. Assigned case previewing for small group “sign-out”:

Evaluation and Grading

Attendance to required lectures/conferences, e-mailing final diagnoses in weeks 2 and 3,

Grading Scale (grading scale is determined by the School of Medicine.)

Expectation and Attendance

1) Marissa White mwhite44@jhmi.edu (Course Director)

Weather and Other Emergencies

Classroom Accommodations for Students with Disabilities

Statement of Diversity and Inclusion

Teacher Learner Conduct Policy

Student Honor Code

Virtual Surgical Pathology

1. Prepare to discuss the answers to the following questions:

2. Rotation orientation: 1:45pm – Small group faculty leaders

- Surgical pathology unknown cases and questions during down-time

- Thursday: Preview five cases

 45-year-old female, breast biopsy for a 1cm hypoechoic mass detected on 1 st

- Tuesday: Preview three complete, multi-slide cases

 Prostate #1_3: https://digital.pathology.johnshopkins.edu/repos/2551?slide=78277

2. Skin lesion resection (3 scanned slides): 80-year-old female, resection of a 1cm

3. Assign a pathologic stage to a cancer resection (5 scanned slides): 70-year-old

mSCOPE tutorial: http://oacapps.med.jhmi.edu/bb/tutorials/mscope_tutorial.mp4

JHH Digital slide set: https://digital.pathology.johnshopkins.edu

Grossing Videos and Gastrointestinal Disease Tutorials (must be on VPN or virtual

Surgical pathology unknown cases and questions: http://apps.pathology.jhu.edu/sp/

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