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What is a PA?

What is a Pathologists' Assistant?

A pathologists’ assistant is a highly trained allied health professional.

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 and evaluation of all surgical pathological specimens. Pathologists’ Assistants also perform postmortem examinations including prosection, assisting the Pathologist with 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 responsibility 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, grossing technicians, and transcriptionists in the surgical pathology suite and autopsy technicians/morgue assistants in the autopsy room; writing and reviewing surgical pathology and autopsy procedures; inventory control; laboratory operations such as quality assurance, quality control, accreditation inspection preparation, and budgeting; and in the academic setting, supervision of learners (e.g., pathologists’ assistant students, medical students, post-sophomore fellows, and residents) and providing shadowing experiences to prospective Pathologists’ Assistants, and college or high school students interested in healthcare.

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 currently 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 had received on-the-job training (via a 3-year supervised internship) and had 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 capable as mid-level practitioners in anatomic pathology.

Both NAACLS program-trained and grandfathered on-the-job trained Pathologists’ Assistants who pass the ASCP BOC Pathologists’ Assistant Certification Examination use the credentials PA(ASCP) and are qualified as competent mid-level practitioners in anatomic pathology. 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 in three-year cycles, 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.

Pathologists’ Assistant Scope of Practice

Refer to the AAPA journal article in The Cutting Edge, Issue 3 2018

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

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

Macroscopic Description and Dissection

  • Perform the macroscopic description and dissection of all surgical specimens ranging from simple to complex cases including 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 (tissue selection, dissection, embedding, mounting, cutting/staining, cover-slipping)
  • Intraoperative consultation for evaluation of macroscopic specimen adequacy and margins
  • Muscle biopsy preparation
  • Assessment of renal biopsy specimens for adequacy by evaluation of the presence of glomeruli
  • Nerve biopsy orientation and preparation
  • Heart and other transplant biopsy preparation
  • Bone marrow aspirate and biopsy preparation
  • Touch preparations/imprints/squash preparations
  • Tumor mapping
  • Bone saw operation

Imaging

  • Specimen photomacrography
  • Photomicrography
  • Specimen radiography
  • Slide scanning

Postanalytical Tasks

  • Review of macroscopic description transcription.
  • Microscopic triage of surgical pathology cases for quality control and quality assurance purposes.
  • Coding
    • Verify the accuracy and editing of CPT codes.
    • Assign, review, and edit SNOMED codes.
  • Store and properly dispose of specimens.
  • Assist in the organization and coordination of surgical pathology conferences.
  • Assure proper maintenance of equipment and provision of adequate supplies.

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

Preanalytical Tasks

  • Assure proper autopsy authorization, permission, and release of body documents.
  • Review the patient’s medical record including imaging studies and laboratory results, etc.
  • Discuss 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 notify all personnel directly involved.
  • Notify decedent’s physician, the funeral home, and all other appropriate authorities prior to the commencement of the autopsy; and coordinate any requests for special specimen sampling (e.g., organ and tissue procurement for transplantation, research, etc.).

Autopsy Performance

  • Perform 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

  • Select, prepare, and submit 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

Preparation of Reports

  • Clinical history
  • Assist with preparation of the provisional anatomic diagnosis (PAD)
  • Macroscopic (gross) description
  • Assist with preparation of the final summary/clinical pathologic correlation

Postanalytical Tasks

  • Reconstruct and prepare the body for release and maintain HIPAA criteria for the release of the body to the appropriate mortuary or funeral home representative.
  • Assure accurate completion of a microscopic section log.
  • Perform 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.
  • Assist in the organization and coordination of anatomic pathology conferences.
  • Assure proper maintenance of equipment and provision of adequate supplies.

Regulatory

  • Prepare for laboratory accreditation inspection.
  • Write, maintain, and update 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

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

Safety

  • Apply laboratory safety governmental regulations and standards as practical to anatomic pathology.
    • Monitor compliance with safety regulatory agencies (e.g., OSHA).
  • Participate in safety training (e.g., chemical hygiene, infection control), avoid biological hazards, and practice 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

  • Perform laboratory administration activities including surgical pathology workflow and scheduling.
    • Record and evaluate workflow and personnel metrics.
  • Prepare laboratory budgets and purchase equipment.
    • Order supplies/perform inventory control.
  • Perform personnel management activities including hiring, disciplinary action, job description creation, supervision, and performance evaluations.
  • Attend and prepare for conferences (e.g., tumor board, grand rounds, journal club, and morbidity and mortality conferences).
  • Develop, implement, and evaluate a competency testing program encompassing ACGME guidelines where appropriate.
  • Provide guidance in new laboratory design and construction.

Education

  • Educate and train pathology residents, new employees, students, and technical staff.
  • Participate in the development of a didactic curriculum for educational processes.
  • Perform formal evaluation of residents, pathologists’ assistant students, and medical students.
  • Educate nursing and hospital staff on best practices in pathology including proper specimen collection procedures and triage.
  • Present at academic conferences.
  • Community outreach educating colleagues and the public about laboratory medicine.
  • Participate in professional organizations.

Laboratory Information Systems

  • Responsibilities may involve analysis, design and implementation including:
    • Data gathering and analysis of methods and procedures
    • Design recommendations in the form of user proposals
    • Operational instructions
    • Computer program specifications
    • Implementation and support involving systems testing
    • User training

Research

  • Develop Institutional Review Board (IRB) proposals.
  • Coordinate tissue banking activities (e.g., obtain consents, appropriate tissue collection, tissue storage, release of tissues, review of protocols).

Ancillary duties (may include):

  • Maintain equipment (e.g., calibration, performance checks, identification of malfunctions).
  • Assess new technology for possible implementation.
  • Assessment of new technology for possible implementation
  • Validate new tests or instruments.
  • Quality control (e.g., stain check, temperature check).
  • Comply with regulatory requirements for specimen storage and disposal.
  • Service on institutional committees.
  • Participate in faculty recruitment.

  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.
  5. Changes In Healthcare Professions’ Scope of Practice: Legislative Considerations. https://www.ncsbn.org/ScopeofPractice_09.pdf. Published October 2009. Accessed October 1, 2017.

Sustaining Members

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