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Scope of Practice Review

Pathologists' Assistant Scope of Practice Review Period

Why update the scope of practice?

In late 2017, the American Association of Pathologists’ Assistants (AAPA) formed a task force to address revising the current pathologists’ assistant scope of practice. This task force included a diverse group of pathologists’ assistants and an academic pathologist. Pathologists’ Assistants on this task force included representatives from academia, clinical instruction, former ASCP BOC examination committee members, community hospitals, laboratory management, and grossing operations management. This task force was formed in response to concerns expressed by the AAPA membership and the Pathologist’ Assistant Training Program Directors (APATP) that the current scope of practice was outdated and in need of updating.

After careful review of the current pathologists’ assistant scope of practice, review of the American Society for Clinical Pathology Board of Certification task analysis, and research of trends in the utilization of the pathologists’ assistant, a revised pathologists’ assistant scope of practice was created and is now proposed by this task force. The scope of practice task force and the AAPA Board of Trustees invite you, the AAPA membership to review this updated scope of practice and provide comment.

As you are aware, a scope of practice is not a job description and does not need to cover every technique and every possible job or task a pathologists’ assistant may perform over their professional career, and should not attempt to do so. However, a change or update to the scope of practice should reflect the evolution of abilities of the pathologists’ assistant, as reflected in this revised scope of practice.

Please review the updated scope of practice below and use this opportunity to submit feed back. Responses can be submitted through the online survey form, forum, or by email to info@pathassist.org. The comment period for the revised pathologists’ assistant scope of practice will be 45 days (June 15 deadline).

Pathologists' Assistant Scope of Practice

A pathologists’ assistant is a highly trained, certified allied healthcare professional who is qualified by academic and practical training to provide various services in anatomic pathology under the direction and supervision of a licensed, Board Certified or Board Eligible anatomic pathologist. Pathologists’ assistants are academically and practically trained to provide accurate and timely processing of a variety of laboratory specimens, including comprehensive macroscopic examination of all surgical pathological specimens. Pathologists’ assistants also perform postmortem examinations including prosection, rendering the provisional anatomic diagnosis, composing the clinical history, recording the macroscopic anatomic findings, and submitting tissue sections for microscopic examination. Pathologists’ assistants play a critical role in the delivery of healthcare services in both surgical pathology and autopsy pathology. They are key partners in assisting the pathologist to arrive at a pathologic diagnosis, but it is the sole province of the pathologist to render a diagnosis.

Pathologists’ assistants often are responsible for the organization and efficient and effective operation of the surgical pathology suite and the anatomic pathology service. This may comprise personnel management including supervising accessioners, lab aides, and transcriptionists in the surgical pathology suite and dieners in the autopsy room; writing and reviewing surgical pathology autopsy procedures; inventory control; laboratory operations such as quality assurance, quality control, and budgeting; and in the academic setting, supervising learners (e.g., pathologists’ assistant students and residents).

A pathologists’ assistant need not provide all the services listed in the Scope of Practice in the performance of their duties, however, it is expected that the pathologists’ assistant will have received appropriate academic and practical training to provide these services.

Pathologists’ assistants prepare for their roles as mid-level practitioners in anatomic pathology by successfully completing a NAACLS accredited Pathologists’ Assistant training program and by attaining certification as a Pathologists’ Assistant from the American Society for Clinical Pathology Board of Certification (ASCP BOC). Prior to 2010 Pathologists’ Assistants who have received on-the-job training (via a 3-year supervised internship) and have successfully attained certification as a Pathologists’ Assistant, from the American Society for Clinical Pathology Board of Certification have the same qualifications as NAACLS program-trained individuals and are competent as mid-level providers in anatomic pathology.

Those passing the ASCP BOC Pathologists’ Assistant Certification Examination use the credentials PA(ASCP). To maintain a level of expertise and awareness of changes and advances in practice and maintain certification, the Pathologists’ Assistant must complete approved Credential Maintenance Program (CMP) requirements, as defined by the American Society for Clinical Pathology Board of Certification. Following completion of the CMP program, the CM superscript designation is appropriate; PA(ASCP)cm.

A pathologists’ assistant is qualified by formal academic and practical training to perform the following tasks under the direction and supervision of a licensed, Board Certified, or Board Eligible anatomic pathologist:

(Comment: this scope of practice is not meant to be utilized as a job description)

Preanalytical Tasks

  • Assurance of proper specimen collection and submission prior to accessioning
  • Assisting clinicians with specimen collection questions, triage of limited samples, and esoteric testing
  • Assurance of appropriate specimen accessioning and/or verification of unique patient identifiers
  • Assurance of proper specimen handling and fixation prior to processing
  • Obtain and review pertinent clinical information and history, including imaging studies, laboratory results, and operative records
  • Discussion of cases and history with surgeons, clinicians, and pathologists

Macroscopic Description and Dissection

  • Perform the macroscopic description and dissection of surgical specimens ranging from simple to complex cases including all pertinent macroscopic information for the staging of complex cancer cases

Tissue Sampling

  • Prepare and submit tissue sections for light microscopy
  • Obtain samples for ancillary studies including, but not limited to:
    • Tumor triage
    • Lymphoma protocol
    • Flow cytometric analysis
    • Immunofluorescence
    • Immunohistochemistry
    • Microbial cultivation
    • Molecular microbiology
    • Cytogenetic analysis
    • Electron microscopy
    • Tissue banking and clinical trials
    • Research
    • Microarray
    • Institutional tumor registries

Perform Surgical Pathology Special Procedures including, but not limited to:

  • Decalcification
  • Frozen section (cut/stain)
  • Intraoperative consultation for evaluation of macroscopic specimen adequacy
  • Muscle biopsy preparation
  • Assessment of renal biopsy specimens for adequacy by evaluation of the presence of glomeruli
  • Nerve biopsy orientation and preparation
  • Bone marrow aspirate and biopsy preparation
  • Touch preparations/imprints/squash preparations
  • Tumor mapping
  • Bone saw operation

Imaging

  • Specimen photomacrography
  • Photomicrography
  • Specimen radiography

Postanalytical Tasks

  • Microscopic triage of surgical pathology cases for quality control and quality assurance purposes
  • Coding
    • Verification of accuracy and editing of CPT codes
    • Assigning, reviewing, and editing of SNOMED codes
  • Storage and proper disposal of specimens

Prosection of adult, neonatal/perinatal, pediatric, forensic, or infectious autopsies

Preanalytical Tasks

  • Assurance of proper autopsy authorization, permission, and release of body documents
  • Review of the patient’s medical record including imaging studies and laboratory results, etc.
  • Discussion with the attending pathologist(s) to identify any special techniques and procedures to be utilized in the completion of the postmortem examination (e.g., tissue for microbial cultivation, histochemistry, molecular analysis, microarray, PCR analysis, immunofluorescence, toxicological, viral, or electron microscopic studies, etc.), and notifying all personnel directly involved
  • Notification of the decedent’s physician, the funeral home, and all other appropriate authorities prior to the commencement of the autopsy; and coordinating any requests for special specimen sampling (e.g., organ and tissue procurement for transplantation, research, etc.)

Autopsy Performance

  • Performance of postmortem examinations including:
    • External examination
    • In situ organ inspection
    • Evisceration
    • Dissection and dictation or recording of data including organ weights, measurements, presence and quantitation of body fluids, and macroscopic anatomic findings

Tissue Sampling

  • Selection, preparation, and submission of appropriate and ample tissue samples for the following:
    • Frozen section
    • Permanent section
    • Immunofluorescence
    • Electron microscopy
    • Microbial cultivation
    • Tissue banking or research
    • Cytogenetic analysis
    • Toxicology
    • Decalcification
    • Microarray
    • Metabolic studies

Autopsy Special Procedures

  • Perform Autopsy special procedures including:
    • Obtaining blood/body fluids for clinical pathologic testing
    • Cut and stain frozen sections
    • Bone marrow sampling
    • Spinal cord removal
    • Long bone removal
    • Coronary artery perfusion
    • Central nervous system perfusion
    • Corneal removal and/or orbital enucleation
    • Temporal bone removal
    • Sample collection for research

Imaging

  • Photomacrography of the body, internal organs, lesions, and other pertinent findings and external or internal identification markings
  • Photomicrography
  • Image analysis
  • Radiography of fetal/neonatal decedents

Preparation of Reports

  • Clinical history
  • Provisional anatomic diagnosis (PAD)
  • Macroscopic (gross) description
  • Final summary/clinical pathologic correlation

Post-analytical Tasks

  • Reconstruction and preparation of the body for release and maintaining HIPAA criteria for the release of the body to the appropriate mortuary or funeral home representative
  • Assuring the accurate completion of a microscopic section log
  • Performance of duties related to completion and finalization of the autopsy procedure and report including administrative maintenance of anatomic pathology protocols; photomacrography and photomicrography images; assignment, review, and editing of SNOMED codes; and compliance with laboratory accreditation criteria
  • Assisting in the organization and coordination of anatomic pathology conferences
  • Assuring the proper maintenance of equipment and provision of adequate supplies

Regulatory

  • Laboratory accreditation inspection preparation
  • Writing, maintaining, and updating policy and procedure manuals
  • Monitor compliance with regulatory agencies (e.g., The Joint Commission, College of American Pathologists [CAP], state and local accrediting agencies)

Quality Improvement

  • Preparation and maintenance of quality assurance monitors (e.g., frozen section/permanent section concordance/discordance, turn-around-time reports)
  • Participation in quality assurance/process improvement activities
  • General problem solving and troubleshooting in pathology technical issues
  • Review of microscopic slides for section adequacy (not diagnostic interpretation)

Safety

  • Application of laboratory safety governmental regulations and standards as applied to anatomic pathology
    • Monitoring of compliance with safety regulatory agencies (e.g., OSHA)
  • Participation in safety training (e.g., chemical hygiene, infection control), avoidance of biological hazards, and proper use of personal protective equipment
  • Maintain the cleanliness of the surgical and autopsy pathology suites, gross station, and instruments with daily disinfection

Management Activities

  • Laboratory administration activities including surgical pathology workflow and scheduling
    • Record and evaluate workflow and personnel metrics
  • Preparation of laboratory budgets and purchase equipment
  • Personnel management including hiring, disciplinary action, job description creation, and performance evaluations
  • Conference preparation and attendance (e.g., tumor board, grand rounds, journal club, and morbidity and mortality conferences)
  • Development, implementation, and evaluation of a competency testing program, encompassing ACGME guidelines where appropriate
  • Provide guidance in new laboratory design and construction

Education

  • Education and training of pathology residents, new employees, students, and technical staff
  • Participate in the development of a didactic curriculum for learners
  • Perform formal evaluation of residents
  • Educate nursing and hospital staff on best practices in pathology including proper specimen collection procedures and triage
  • Grand Rounds presentation
  • Community outreach educating colleagues and the public about laboratory medicine
  • Participation in professional organizations

Research

  • Institutional Review Board (IRB) proposal development
  • Coordination of tissue banking (e.g., obtain consents, appropriate tissue collection, tissue storage, release of tissues, review of protocols)

Ancillary duties may include:

  • Equipment maintenance (e.g., calibration, performance checks, identification of malfunctions)
  • Laboratory information system implementation and troubleshooting
  • Assessment of new technology for possible implementation
  • Validation of new tests or instruments
  • Quality control (e.g., stain check, temperature check)
  • Ordering of supplies/inventory control
  • Compliance with regulatory requirements for specimen storage and disposal
  • Service on institutional committees
  • Participation in faculty recruitment

References:

  1. AAPA Bylaws, Scope of Practice. www.pathassist.org
  2. American Society for Clinical Pathology Board of Certification Task Analysis
  3. Vitale J, Brooks R, Sovocool M, Rader WR. Value-Added Benefits and Utilization of Pathologists’ Assistants. Arch Pathol Lab Med. 2012;136:1565-1570.
  4. Grzybicki DM, Reilly TL, Hart AR, et al. National Practice Characteristics and Utilization of Pathologists’ Assistants. Arch Pathol Lab Med. 2001;125:905-912.

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