RCPA Trainee Handbook

RCPA Trainee Handbook
Trainee Handbook
Durham Hall
207 Albion St
Surry Hills NSW 2010
AUSTRALIA
Telephone: +61 (02) 8356 5858

Facsimile: +61 (02) 8356 5828
E-mail: boc@rcpa.edu.au
Website: www.rcpa.edu.au
© October 2008 The Royal College of Pathologists of Australasia
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TABLE OF CONTENTS
Introduction ................................................................................................................................. 4
About the College........................................................................................................................ 4
Summary of Training and Examinations................................................................................... 6
Registration and Training Requirements................................................................................ 11
Examination Requirements ...................................................................................................... 18
Fellowship Requirements......................................................................................................... 22
Faculty of Oral Pathology......................................................................................................... 24
Continuing Professional Development ................................................................................... 25
College Policies......................................................................................................................... 25
Recognition of Overseas Trained Specialists ........................................................................ 26
Forms and Submissions........................................................................................................... 27
Training and Examination Fees ............................................................................................... 34
TRAINING AND ASSESSMENT REQUIREMENTS ..................................................... 35
The Overall Aim of the Training Program ............................................................................... 35
The Pathology Curriculum ....................................................................................................... 40
Basic Pathological Sciences Examination ............................................................................. 51
Anatomical Pathology............................................................................................................... 54
Chemical Pathology .................................................................................................................. 77
Clinical Pathology ................................................................................................................... 102
Forensic Pathology ................................................................................................................. 139
General Pathology................................................................................................................... 180
Genetics ................................................................................................................................... 219
Haematology............................................................................................................................ 243
Immunology ............................................................................................................................. 264
Microbiology ............................................................................................................................ 285

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Diploma in Cytopathology...................................................................................................... 302
Diploma in Forensic Pathology.............................................................................................. 304
Diploma in Molecular Pathology............................................................................................ 309
Diploma in Forensic Medicine [UNDER REVIEW] .............................................................. 319
Faculty of Oral Pathology....................................................................................................... 323
APPENDICES ........................................................................................................................... 334
Appendix 1: Roles and Responsibilities of Councillors in Relation to Training .......... 334
Appendix 2: Accreditation of Laboratory for Training........................................................ 336
Appendix 3: Supervisor’s Role and Responsibilities ......................................................... 338
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I NTRODUCTION
Each year the Royal College of Pathologists of Australasia (RCPA) runs pathology examinations
as part of its Fellowship program. Success in these, and the required pre-examination training,
qualifies the medical graduate to become a Fellow of the College on the approval of the College
Council. Graduates in Medicine or Dentistry may also undertake training and examinations for
Fellowship of the Faculty of Oral Pathology.
Training is accredited and examinations are conducted by the College’s Board of Censors.
Admission to Fellowship certifies the medical graduate as trained and qualified to work as a
specialist in the practice of pathology.
To ensure adequate training the Board offers advice, subject and sub-discipline outlines,
mentoring and training accreditation to help graduates and their supervisors cover the large
amount of work needed to prepare for examinations and acceptance as a Fellow.
This booklet provides medical or dental graduates, and current pathology Trainees and
supervisors, with information on pathology training, examination and qualification requirements.
A BOUT THE C OLLEGE

The Royal College of Pathologists of Australasia (RCPA) was formed in 1956 and was originally
known as the College of Pathologists of Australia. It has undergone two title changes since
then, with “Royal” added in 1971 following permission from Her Majesty Queen Elizabeth II, and
“Australasia” in 1980 to recognise its New Zealand and South-east Asian component.
The College’s primary focus is educational. It is involved in the examination and certification of
pathologists, as well as their ongoing professional development. It also provides professional
leadership, including the setting of professional practice standards, and is heavily involved in
government relations and negotiations concerned with maintaining the role of pathology in
clinical practice.
The College is a not-for-profit organisation established under the NSW Companies Act, with a
Council as its Board of Directors.
In understanding the role of the College and its place in Australian and New Zealand medical
training and qualification systems, the following excerpt from its Memorandum of Association
explains:
“The objects of the College are:
• To promote the study of the science and practice of pathology in relation to medicine; to
encourage research in pathology and ancillary sciences; to bring together pathologists for
their common benefit and for scientific discussion and demonstration; and to disseminate
knowledge of the principles and practice of pathology in relation to medicine by such means
as may be thought fit.
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• To consider and advise as to any course of study and technical training and to diffuse any
information calculated to promote and ensure the fitness of persons desirous of qualifying for
Fellowship of the College”.
To achieve the objectives, there is an annual Pathology Update meeting of the College and local
scientific meetings arranged from time to time; the publication of the journal Pathology and the
Manual of Use and Interpretation of Pathology Tests; the arrangement of workshops, seminars
and various other educational activities; quality assurance programs; the establishment of a
Continuing Professional Development Program; the approval, monitoring and investigation of
training programs proposed by Trainees and their supervisors; and the conduct of appropriate
written, practical and oral examinations for admission to Fellowship and for obtaining
postgraduate diplomas.
TERMS IN USE
The following terms are referred to throughout the document. For ease of reference they are
outlined below:
RCPA Royal College of Pathologists of Australasia
The College Royal College of Pathologists of Australasia
Fellows Qualified pathologists and official RCPA Members
Trainees Medical or dental graduates training as pathologists
Council RCPA Council: the governing body for the College. Consists of
the Executive, elected Fellows from each Australian State and
New Zealand, and the Chairmen of major committees.
State or Regional Councillor Each Australian state has a Fellow elected to the RCPA Council.
These are known as State Councillors. In addition, there are
Regional Councillors elected to Council for Hong Kong, Malaysia
and Singapore. To represent New Zealand, a Vice President is
elected to Council, although training matters are overseen by the
Board of Censors Representative for NZ.
Councillors State or Regional Councillors, also Chairmen of State or Regional

Committees. The Chairmen of the Board of Censors and other
major committees are also members of Council.
Board of Censors RCPA Board of Censors: the RCPA board set up to oversee
training, examinations and applications for Fellowship.
Registrar The Registrar of the Board of Censors: a Fellow of the College

responsible for ensuring that policies of the College and the Board
of Censors are met with regard to training, assessment and
application for Fellowship. The Registrar is the point of contact
with the College for Trainees and the person to whom all enquiries
about training and assessment should be addressed.
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Board of Education An RCPA board set up to provide advice on education issues,

promote research in pathology and raise public awareness of
pathology. The Board coordinates continuing education activities
and the development and publication of educational materials.
State Education Committee An RCPA committee that oversees educational issues relating to
Fellows and Trainees within a particular state. The State
Committee monitors and acts on issues arising in and exclusive to
that State, which affect the interests of Fellows and Trainees.
FRACP Fellow of the Royal Australasian College of Physicians
JSAC Joint Specialist Advisory Committee: a joint committee between

the RCPA and the Royal Australasian College of Physicians
(RACP), which oversees joint training programs (currently in
Endocrinology/ Chemical Pathology, Infectious
Diseases/Microbiology, Haematology and Immunology).
NATA/RCPA Collaboration between the National Association of Testing

Authorities and the College to audit standards and accredit
Australian pathology laboratories.
IANZ International Accreditation New Zealand, the body which accredits

NZ laboratories.
Overseas Trained Specialist A medical practitioner qualified as a pathologist in another country,

seeking recognition as a specialist in Australia through the
Australian Medical Council process, or in New Zealand through the
Medical Council of New Zealand process.
S UMMARY OF T RAINING AND E XAMINATIONS

Training, examination and Fellowship applications are controlled by the Royal College of
Pathologists of Australasia’s Board of Censors. The Board is made up of Fellows appointed by
Council to the position for two year terms, up to a maximum of six years.
The College allows training and Fellowship examination in the following pathology disciplines:
Anatomical Pathology
Chemical Pathology
Clinical Pathology
Forensic Pathology
General Pathology
Genetics
Haematology
Immunology
Microbiology
Oral Pathology (for Fellowship of the Faculty of Oral Pathology).
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In addition the College offers post-Fellowship diplomas in:

Cytopathology
Molecular Pathology
Forensic Pathology
And a special Diploma in Forensic Medicine for non-Fellows
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Fellowship of the RCPA is awarded to those applicants who have:

a recognised medical degree (or dental degree for Fellowship of the Faculty of Oral
Pathology)
applied to the RCPA Board of Censors to determine training and examination requirements
five years of supervised accredited training
success in examinations carried out by the Board and
been accepted by the RCPA Council.
All applicants must undergo formal examination before being offered Fellowship. The Board of
Censors determines which RCPA examinations are to be undertaken, based on the applicant’s
previous training, experience and qualifications.
CONTACTS
Prospective Trainees should seek initial information from the College website at
www.rcpa.edu.au. Go to Careers/Training with Us/A career in Pathology
For further information on the Royal College of Pathologists of Australasia’s training,

examinations and admission to Fellowship contact:
The Registrar, Board of Censors

Royal College of Pathologists of Australasia
207 Albion Street
Surry Hills
NSW 2010 AUSTRALIA
Phone: +61 (02) 8356 5858

Fax: +61 (02) 8356 5828
Email: boc@rcpa.edu.au
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KEY DATES
31 January Closing date for annual registration of Trainees and submission of

Supervisor’s Reports
7 days prior to the Closing date for Application for Part I and Part II Examinations
last working day
in February
28 February Submission of Oral Pathology logbooks
Mid March Admission to Fellowship Ceremony for candidates completing

requirements in the previous year
(held at the RCPA Pathology Update meeting)
28 March Anatomical Pathology Casebook due - Part II & diplomas
Oral Pathology Casebook due - Part II
Final date for payment of annual registration fees
25 April Forensic Pathology Part II Casebooks due
30 April Trainees not re-registered removed from mailing list
May/June Written and practical examinations held
Chemical Pathology Case Commentaries and critical literature

review due at written exam
- Part II
27 June Haematology Dissertations due – Part II
30 June Closing date for applications for Pathological Sciences examination
1 July Genetics Case Reports due – Part I
20 July Supervisors’ Reports due for Part I and Part II examination

candidates
30 July Microbiology Projects due - Part II
Late August Practical and oral examinations held
September/October General Pathology practical assessments held
15 October Supervisor’s Reports due for JSAC Trainees
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31 October Resubmission of Anatomical Pathology Casebooks due (if

requested by Chief Examiners)
Late October Pathological Sciences examination
Early November Repeat Part II written examinations
Late November Repeat examinations for Part II candidates
31 December Supervisors’ Reports due for all other Trainees – may be submitted
with annual registration form.
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R EGISTRATION AND T RAINING R EQUIREMENTS
ENQUIRIES
Prospective pathology Trainees are strongly advised to consult the relevant State or Regional
Councillor before applying to train.
State or Regional Councillors are located in each Australian State, and in Hong Kong, Malaysia
and Singapore. Training enquiries for New Zealand should be directed to the NZ
Representative of the Board of Censors and for Saudi Arabia to the Corresponding Fellow.
Contact can be made through the College.
Councillors provide information and advice on pathology as a career, and will be a continual
contact throughout the training period.
See Appendix 1 for the Role and Responsibilities of Councillors.
MEDICAL OR DENTAL REGISTRATION
Before being accepted for training, Trainees must provide evidence that they are registered
medical (or dental for the Faculty of Oral Pathology) practitioners in Australia or New Zealand, or
entitled to practise medicine in their country of domicile. Medical Registration implies that a
Trainee has completed not less than 12 months in general clinical work as an intern.
A list of medical boards and councils is available on the College website.
PRIVACY AND CONFIDENTIALITY
Any personal information provided by Trainees is strictly confidential to the College staff,
members of relevant College committees, examiners and supervisors. Trainees are therefore
asked on registration forms for their consent to the RCPA providing relevant and necessary
information as above.
The College will manage personal information in accordance with its Privacy Policy. If you wish
to access any information we hold on you or obtain a copy of the College’s Privacy Policy please
contact the Privacy Officer on +61 2 8356 5858.
REGISTRATION FOR TRAINING
Before applying for training with the College, the prospective Trainee must be employed in a
training position in a laboratory accredited by the College for training. Trainees will not be
accredited with training undertaken whilst in an unpaid position, or in an observer position.
A list of accredited laboratories is available on the RCPA website at www.rcpa.edu.au. The

Trainee must nominate a supervisor in the laboratory, who will work with the Trainee to design
and monitor the training program.
Once employment and supervision have been secured, the prospective Trainee can apply at
any time during the year for initial registration. Certified copies of original certificates of medical
qualifications and registration are to be submitted with the application form. To finalise initial
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registration, the Trainee must provide a Prospective Training Program and must pay the
required initial registration fee and the pro rata annual training fee.
Thereafter, Trainees must reapply for annual registration and provide a Prospective Training
Program every year. Trainees who have not re-registered by 30 April will be considered
“incomplete Trainees” and will be removed from the mailing list and web access. A fee will be
incurred for reinstatement.
Once registered, a Member ID No. will be allocated, which will continue through to Fellowship
and beyond. This number must be quoted on all correspondence with the College and will be
used as the candidate number in examinations.
Trainees receive the College newsletter, Pathology Today, the journal Pathology, notice of
scientific meetings and other information. Access is also provided to the password protected
area of the RCPA website, which holds past examination papers, course notes, discussion
forums etc.
Any change of address or proposed changes in training, including extended leave, must be
notified to the Registrar of the Board of Censors in writing, by mail fax or email.
See the Forms and Submissions section for:Application Forms

Prospective Training Program
Fee Schedule
Closing dates
REGISTRATION FOR JSAC T R A I N I N G
Those applying for training programs supervised by a Joint Specialist Advisory Committee
(JSAC) in Endocrinology/ Chemical Pathology, Infectious Diseases/Microbiology, Haematology
or Immunology with the Royal Australasian College of Physicians (RACP) are advised to consult
the Requirements for Physician Training Adult Internal Medicine (the “Mango Book”) available
on the RACP website at http://www.racp.edu.au/training/adult2003/index.htm
New applicants need to obtain a JSAC application form from the RACP, in addition to the RCPA
Initial Registration form. Copies of the JSAC application form must be sent to both the Royal
College of Pathologists of Australasia and the Royal Australasian College of Physicians. For
subsequent annual registrations, only the JSAC form needs to be completed, with a copy
to the RCPA.
Please note that there are separate JSACs and different forms for the RACP in Australia and
NZ. In both instances a copy of the form must be sent to the RCPA.
TRAINING REQUIREMENTS
All pathology training, be it full or part-time, must be approved by the College’s Board of Censors
early in the first and each subsequent year of training. To gain approval, applicants must send a
Prospective Training Program with their initial and annual training registration forms.
Pathology training and experience is normally full-time. A minimum of five full-time equivalent
years of certified training in laboratories accredited by the Board of Censors, must be completed
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before admission to Fellowship. For joint training with the RACP, one year is retrospectively
accredited for physician training. (Refer to Training Limitation, following.)
Part-time training may be acceptable in certain instances, but must average at least 8 hours per
week, again in an accredited training program. All part-time Training must be prospectively
approved the Board of Censors The number of years of training required in this case will be set
by the Board on an individual basis.
Time spent in research or project work is encouraged and up to one year in relevant work is
readily approved. More extensive research projects will be considered on an individual basis
and Trainees should submit details to the Board. Please check under each discipline chapter in
this Handbook for more detailed training requirements. Applications for accreditation of time
should be prospectively approved.
To specialise in a single discipline, four of the five years of approved laboratory training must be
in that discipline. Trainees are strongly encouraged to spend at least one aggregate year of
their training in one or more branches of pathology other than their chosen discipline.
TRAINING LIMITATION
Training limitation is enforced to ensure that Trainees are exposed to more than one style and
philosophy of pathology practice. Several states/regions have coordinated training programs
with rotations between institutions.
Candidates for RCPA qualifications will not be accredited with more than 4 years training in any
one laboratory. Where the same members of a pathology service/practice supervise
geographically separate laboratories this may be viewed as training undertaken in a single
laboratory and may not fulfil the requirements for a laboratory rotation unless significant
differences in practice and supervision can be demonstrated. Training undertaken in a different
discipline within that service/practice may be acceptable.
RCPA Trainees who are also registered with the Royal Australasian College of Physicians in a
joint specialist training program may not complete both their clinical and laboratory training
entirely within one service of an institution. Rotation may occur either in the laboratory or the
clinical component of JSAC training. Change of supervisor to another member of an integrated
clinical/laboratory service will not qualify as rotation; nor will change to a different geographical
site of an integrated service.
Any short term rotation undertaken must be for a minimum of 2 months. This does not include
secondment to another institution for training in a specific technique or method.
Under exceptional circumstances, and then only at the discretion of the Board of Censors,
special dispensation from the 4 year rule may be granted. However, this should never be
assumed; it must always be applied for at the start of training.
RETROSPECTIVE ACCREDITATION OF TRAINING
Some training may be approved retrospectively. Retrospective accreditation must be sought

from the Board of Censors on initial registration as a Trainee. Applications should include full
supporting documentation such as training and examination results, laboratory and supervisor
information, projects and work history. The training details are to be accompanied by a
statement from the supervisor for each period, verifying the claim.
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Retrospective accreditation is considered on an individual basis; however training undertaken in

an undergraduate program would not generally be recognised.
If retrospective training is approved, the Trainee may be required to pay a fee equivalent to or
part of the Annual Training Fee normally paid for the period of that training.
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TEMPORARY SUSPENSION OF TRAINING
If you intend to take extended leave or suspend your training for any reason, please notify the
Registrar in writing, providing details of the anticipated duration of leave or suspension.
Since 6 weeks leave per annum, including recreational and personal leave is standard, the
College will permit a maximum of 30 weeks leave to be included within the 5 year training
program. If leave of greater than 30 weeks is taken over that period, the Trainee will be required
to undertake additional training time up to the period of additional leave.
If you wish to continue to receive College communications, including the journal and access to
the members’ section of the website, a mailings fee will be payable instead of the annual training
fee. If you do not pay this fee you will need to contact the College to receive an Annual
Registration Form (and Examination Application form if necessary) when you wish to resume
training.
TRAINING PORTFOLIO
All Trainees are provided with a Training Portfolio folder. Trainees are expected to maintain
comprehensive records of their training and examinations, including copies of application forms,
supervisors’ reports, examination results and correspondence with the College. The Record of
Training within this Portfolio must be submitted to the College on request.
ACCREDITED LABORATORIES
Training must be undertaken in a laboratory accredited for training by the Board of Censors.
A current list of laboratories accredited for training is available on the RCPA website.
Laboratory accreditation is based on the range and quantity of work performed, space,
equipment, hospital affiliations, level of staffing, library facilities, laboratory equipment,
experience available, and the adequacy of supervision. Accreditation may be granted to provide
a maximum of 4 years of training for an individual candidate. Laboratories which offer limited or
very specialised experience may only be accredited to provide a shorter duration of training.
Training in other laboratories such as overseas or research laboratories is considered on its

merits. If approval is required for a period in an overseas laboratory, full details of the laboratory
and supervisor must be sent to the Board of Censors with the initial or annual registration form
prior to commencement of the training period. A maximum of 2 years training may be accredited
in a laboratory outside the College’s sphere of activity.
As part of the laboratory accreditation process, site visits of laboratories will be undertaken
periodically by representatives of the Board of Censors. The visit will include consultation with
Trainees, and a review of training facilities and adequacy of supervision.
See Appendix 2 for details of Accreditation of Laboratory for Training.
SUPERVISORS
All training must be supervised. Trainees may nominate their own supervisor and are required
to submit his/her name on the initial and annual registration forms.
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The supervisor of laboratory training will normally be a Fellow of the College; however another
supervisor may be accepted if there is no Fellow available to offer appropriate supervision. Non-
Fellows must have their role approved by the Board of Censors.
Normally, only one supervisor is nominated. If the Trainee spends significant periods working in
an area where the supervisor has no personal involvement, the supervisor must certify that
suitable supervision is being provided. The supervisor must also ensure that adequate
supervision is arranged in their absence. Supervision should not be delegated largely to a non-
pathologist.
In some circumstances shared supervision may be necessary, but there must be a nominated
primary supervisor. For Trainees working towards higher academic degrees (e.g. PhD), the
research project supervisor may not be suitable for nomination as an RCPA supervisor.
Supervisors are asked to provide:

a prospective training (or research) program, on initial registration and annually
an annual supervisor’s report or, for rotations within a year, reports which cover the period of
training
confirmation on the examination application form of the Trainee’s experience and readiness.
See Forms and Submissions for further details of these requirements.
Supervisors are expected to assist Trainees to develop their individual training objectives and to
provide structured feedback of performance on a regular basis. For this reason, the College
recommends that any one supervisor be responsible for no more than two Trainees.
See Appendix 3 for the Role of the Supervisor.

Supervisors’ duties are also listed in the Guide for Supervisors available on the RCPA website.
EDUCATION PROGRAMS
The Pathology Update meeting and the Pathological Sciences Seminar are organised annually
under the auspices of the Board of Education. Details of Board of Education programs are
notified in Pathology Today, on the RCPA website and in regular mailings, which are sent to all
registered Trainees.
Other educational programs may be organised by the State and New Zealand Education
Committees or by training institutions. For further details, Trainees are advised to contact their
State or Regional Councillor or visit the College’s website. The discipline representatives of the
local Committees are available for advice on all aspects of training and are responsible for
organising education programs to meet local needs.
Pathology Update
Pathology Update is held in Sydney each year in March. The Update program, which includes
components covering each discipline, is designed for Trainees, so you are strongly encouraged
to attend this meeting. Each year there are sessions in which the Chief Examiners in each
discipline discuss their approaches to the examination process and explain where students have
made errors in previous exams.
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Trainees are also invited to submit an abstract for the DS Nelson, Board of Education Poster or
the RCPA QAP Trainee Prizes. Details of these awards will be in the registration brochure and
on the Pathology Update website.
Basic Pathological Sciences Seminar

The Pathological Sciences Seminar is held annually and provides an overview of the topics
listed under “Examination Content” for the Basic Pathological Sciences examination (page 52).
Medical Students, Trainees and Junior Medical Officers may attend the seminar. Please note
that the Seminar is not designed to be a preparatory course for the Basic Pathological Sciences
Examination held in October each year.
RCPA education programs are heavily subsidised by Fellows for the benefit of Trainees.
TRAINEE GRANTS AND AWARDS
A number of grants and awards are available for registered Trainees, including the RCPA
Research Award, Travel and Research Grants, the DS Nelson Trainee Prize and the RCPA
QAP Pty Ltd Prize. Please refer to the College website for further details.
COLLEGE COMMUNICATIONS
Trainee Handbook:
The current Trainee Handbook is to be used as a guide for training requirements, but any
printed version may be out of date. When changes are made, due to ongoing policy
development, the most recent version will be available on the College website. Trainees will
always be advised at least 12 months in advance of significant changes in the training program.
Pathology Today:
The College communicates with Trainees through the fortnightly College newsletter, Pathology
Today. Please be aware that from time to time there may be changes in College policy or in the
structure and content of training requirements. Such changes will always be advised through
Pathology Today, and to individual Trainees.
www.rcpa.edu.au
You should be familiar with the RCPA website. The Document Library is where you will find
information on exams, educational activities, publications and policies, plus the website has
discussion and employment forums.
College email address:

The College will keep Trainees informed by email, especially when we need to contact you at
short notice. In order to avoid the ongoing problems of full Hotmail boxes, or out of date work
email addresses, the College offers a free, personal email address to Trainees. Details will be
circulated regularly, or contact the office on boc@rcpa.edu.au.
CHANGES IN REQUIREMENTS FOR TRAINING AND EXAMINATION
From time to time, in consultation with Fellows and Examiners, the Board of Censors may
change the requirements for training and the form and structure of examinations. All care is
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taken to notify significant changes at least a year in advance, and to avoid disadvantaging
Trainees who entered training under different rules.
INFORMATION AND SUPPORT
Your supervisor, the relevant State or Regional Councillor, or in New Zealand the Board of
Censors representative, is available for advice to Trainees of the College.
For specific requests regarding training accreditation and examinations, you should contact
the Registrar of the Board of Censors on boc@rcpa.edu.au .
Trainees are asked not to contact Chief Examiners directly – all correspondence must come
through the College.
If you need general information or clarification of any procedures outlined above, please
contact the Administrator for the Board of Censors, on email at boc@rcpa.edu.au, or phone
+61 2 8356 5825.
E XAMINATION R EQUIREMENTS
Trainees may sit examinations in a single pathology discipline, i.e. Anatomical Pathology,
Chemical Pathology, Clinical Pathology, Forensic Pathology, Genetics, Haematology,
Immunology, or Microbiology, or take General Pathology examinations covering the major sub-
disciplines. The single discipline examinations are designed for those who wish to specialise in
one branch of pathology, while General Pathology training is for Trainees wanting all-round
experience, or for those choosing to work in two or more disciplines.
There are three parts to the examination process:
1. Basic Pathological Sciences Examination:

The examination may be taken before commencement of training. The examination is open
to any intern, medical or dental student in their final year as well as registered trainees.
A pass in Basic Pathological Sciences is not a prerequisite for Part I or General Pathology
examinations, but a pass or exemption must be achieved before proceeding to sit the Part II
examination in any discipline.
2. Discipline specialty Part I:
This is usually taken in the third year of training.
3. Discipline specialty Part II:
This is usually taken in the fifth or final year of training.
Part I and Part II examinations require Trainees to have sufficient knowledge of the work of other
branches of pathology to be able to use and interpret their basic services intelligently. The Part I
and Part II examinations have written, practical and oral components.
For General Pathology, examinations are taken in Pathological Sciences, Clinical Pathology and
Morphological Pathology. The Clinical and Morphological examinations are generally taken in
years 4 and 5. There are also practical assessments in each discipline.
See REQUIREMENTS FOR TRAINING AND ASSESSMENT for details of the training and
examination requirements for each discipline.
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EXAMINATION EXEMPTIONS
Admission to Fellowship is always by examination, although the Board of Censors may grant
exemptions from some components of the examination. Candidates with Australasian
qualifications in disciplines other than pathology may be eligible for some exemptions from the
5 year training period.
Application for exemption can be made on the Application for Examination form, which must be
submitted by seven days before the last working day of February in the year of intended
examination. Trainees seeking an exemption need to submit full details with supporting
evidence. They must also pay the usual examination fee for any examination from which they
are seeking exemption.
Because the form and content of examinations varies from time to time, exemption from a total
examination (e.g. Part I) is valid for five years. Exemption from a single component of an
examination is only granted for the following examination cycle. In subsequent years, the
exemption must be requested at the time of application for examination.
There are no absolute indications for exemption and any application will be treated on its merits,
with relevant postgraduate qualifications, research, publications and experience taken into
account.
EXAMINATION APPLICATIONS
To sit for examinations, apart from Pathological Sciences, Trainees must be registered with the
RCPA training program and employed in a laboratory accredited for training.
Examination forms are available for downloading from the College website. Reminders of the
due date are advertised in Pathology Today towards the end of the preceding year.
An application form must be completed for each year’s examinations. Application for exemption
must also be completed on the Application for Examination form. The appropriate fee and all
relevant documentation must accompany the form.
Applications for all Part I and Part II examinations close at 1700 hours Sydney daylight saving
time, 7 days before the last working day of February each year. Applications for the
Pathological Sciences examination close on June 30 each year. The closing date is observed
strictly.
LATE APPLICATIONS
There will be a period of grace for late applications received up to 1700 hours Sydney daylight
saving time on the last working day of February. However a substantial late fee will be incurred
($275 in 2008). Absolutely no applications will be accepted after this period for Part I,
Part II or General Pathology examinations.
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EXAMINATION TIMETABLES
The written and slide examinations for all subjects are held once a year, usually in June,
followed by the practical and oral examinations, usually at the end of August. The Pathological
Sciences examination is usually held in late October. Repeat examinations in some disciplines,
for Part II candidates only, are held late November.
Examination timetables will be published on the RCPA website.
EXAMINATION VENUES
The June written and practical examinations and the Pathological Sciences examination are
held in Australian state capitals, appropriate centres in New Zealand, Hong Kong, Malaysia,
Singapore, Saudi Arabia and some other major overseas centres if suitable arrangements for
invigilation can be made.
Any Trainees wishing to take an examination at a venue other than a designated examination
centre must make the request when they lodge their examination application, nominating a
suitable invigilator, who should be a Fellow of the College. Where special arrangements are
made for one, or a small number of candidates, the candidate(s) may be charged for the total
costs incurred. Please refer to College Policy: Candidates Sitting in Countries without College
Representation, available on the RCPA website or on request from the College.
The August and November practical and oral examinations are generally held in Sydney, but
may be undertaken in some other venues at the discretion of the relevant Chief Examiner.
WITHDRAWAL FROM EXAMINATION AND FAILURE TO ATTEND
A Trainee who wishes to withdraw from an examination must provide written notice to the Registrar.
The following fees and conditions apply:
Withdrawal more than eight (8) weeks prior to the date of the examination:
A cancellation fee of 10% of the examination fee plus GST will be charged.
Withdrawal less than eight (8) weeks but more than four (4) weeks prior to the examination:
A cancellation fee of 50% of the examination fee plus GST will be charged.
Withdrawal less than four (4) weeks prior to the date of the examination:
There will be no refund of any fees.
Where candidates fail to attend a set of examinations without prior notice of withdrawal, there
will be no refund of any fees. A result of Failed to Attend will be recorded.
Where candidates fail to attend one component of a set of examinations, a result of Failed to
Attend will be recorded for that component. There will be no refund of any fees.
These penalties may be waived where there are extenuating circumstances.
Please refer to College Policy: Examination of Candidates Suffering from Illness, Accident or
Disability, available on the RCPA website or on request from the College.
REFUSAL OF EXAMINATION
20
The Board of Censors may refuse to accept examination applications which do not meet the
stated requirements.
The Board may also refuse to proceed with examination of a Trainee who infringes regulations
or whose behaviour is considered to prejudice the proper management and conduct of the
examination, or for any other sufficient reason. Such Trainees may also be refused permission
to take future examinations.
EXAMINATION RESULTS
Results will be available RCPA website (by Member ID number only) approximately 6 weeks
after completion of the June examinations and within a week of the August examinations.
Wherever possible, Trainees will be notified at the time of examination of a date for the release
of results. Each Trainee will receive written notification of examination results.
In some disciplines, progression from the initial (June) written and practical examinations to
further (August) practical and oral examinations is dependent upon the Trainee’s results.
Trainees will be notified on the website and by mail whether or not they will proceed. Details of
arrangements for the examinations will also be provided at this time.
All enquiries regarding unsuccessful examination results must be directed to the Registrar or the
relevant State or Regional Councillor. Trainees must not directly contact the Chief
Examiner.
REPEAT EXAMINATIONS
A repeat examination will be offered to Part II candidates who have failed the June/August
examinations in the same year and who have met a specified minimum standard. At the
discretion of the Board, this exam may be available to those who have withdrawn with
extenuating circumstances. For those disciplines with written examinations at Part II, candidates
will only be invited to the repeat viva if they have passed the repeat written component.
Applications for repeat examination will close 15 working days after the release of August exam
results. The fee for the repeat examination will be the same as the usual examination fee.
COMMUNICATION BETWEEN CANDIDATES AND CHIEF EXAMINERS
In the interests of fairness and integrity of the examination process, Trainees are not to contact
Chief Examiners directly during the examination cycle, that is between the June and August
examinations, or during the course of the November examinations.
Where special circumstances concerning a Trainee’s performance, such as illness, are known to
exist, they should be communicated as soon as possible. This could be by a telephone call in
cases of emergency, or a letter to a State/Regional Councillor or to the Registrar of the Board of
Censors. Correspondence must not be sent directly to the Chief Examiner.
Lobbying, whether by Trainees, supervisors or other persons, to try to influence examination

outcomes may result in disqualification of the Trainee.
21
EXAMINERS’ COMMENTS
Comments on the performance of Trainees who have failed will be sent to the candidate’s
nominated supervisor (if the Trainee has given written permission for this to occur) following
completion of the examination cycle. Feedback will also be provided directly to Trainees.
Reports for Part II candidates will generally be provided following the August examinations.
Those for Part I candidates may not be available until after the November examinations.
Trainees are strongly advised to discuss these comments with their supervisors, with a view to
remediation of any deficiencies, and to seek further advice where necessary from their State or
Regional Councillor.
General comments on examinations are also published in Pathology Today.
LENGTH OF TIME EXAMINATION PASSES REMAIN VALID
The College does not restrict the number of attempts a candidate may have to pass
examinations. However, if the Part II examination is not completed within 5 years of passing or
being granted exemption from Part I, the candidate will need to either pass Part I again or gain
exemption from it.
In General Pathology, a pass in or exemption from a Practical Assessment is valid for 5 years.
If the relevant examination (Clinical or Morphology) is not completed within 5 years of passing a
Practical Assessment, it will be necessary to either again pass, or obtain exemption from that
Assessment.
A pass or exemption in Pathological Sciences stands indefinitely.
CHANGES IN EXAMINATIONS
The examination and assessment system is under constant review. Ample notice of any
proposed changes will be published in the College newsletters, on the website, circulated to
Councillors and mailed and emailed to Trainees. In all cases there will be a realistic transition
period to allow those already in training to complete their examinations under pre-existing rules
or to accept the change.
F ELLOWSHIP R EQUIREMENTS
Following successful completion of the required training and examinations, Trainees may apply
for Fellowship of the Royal College of Pathologists of Australasia.
Under the College’s Articles of Association a person is eligible for admission as a Fellow if:
Category A – College Trainees
he/she is a graduate in medicine of a university situated in Australia or New Zealand or a

graduate in medicine whose qualifications are approved by the College’s Board of Censors;
and
he/she is entitled to be registered as a medical practitioner in a State or Territory of Australia
or in New Zealand, or is entitled to practise medicine in the country of domicile; and
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he/she has worked for a total of five years in posts approved by the Board of Censors for
training in pathology; and
his/her application for examination for Fellowship has been approved by the Board of
Censors; and
he/she has passed such examinations as the Board of Censors or the Council has
determined; and
the Council considers that the applicant is a fit and proper person to be admitted as a Fellow
of the College.
Category B – Overseas-Trained Pathologists
he/she is a graduate in medicine approved by the Board of Censors; and

he/she has been engaged in full-time medical practice related to pathology for five years full-
time or part-time for periods aggregating five years; or
he/she has engaged in a form of medical practice related to pathology for eight years or
periods aggregating eight years; and
his/her application for examination for Fellowship has been approved by the Board of
Censors; and
he/she has passed such examinations as the Board of Censors or the Council has
determined; and
the Council considers that the applicant is a fit and proper person to be admitted as a Fellow
of the College.
APPLICATION FOR ADMISSION TO FELLOWSHIP
Trainees sitting Part II examinations will be sent an Application for Admission to Fellowship form
with the acknowledgment of their Application for Examination. All applications must include a
statement that the Trainee agrees to the College’s Memorandum and Articles of Association and
by-laws, which are published on the College website at www.rcpa.edu.au.
Trainees must also provide personal references and evidence to support their application. This
includes examination results, medical registration and relevant training information, including
any rotations between pathology laboratories.
The Board of Censors will then make an assessment of the applicant’s training experience and
examination results. If satisfied that they have met training requirements and achieved an
acceptable examination result, the Board will recommend to the College Council that the Trainee
be admitted to Fellowship.
The College Council then considers the application. It may admit the Trainee as a Fellow, reject
his/her application, or suspend a final decision for a period it thinks fit or for further qualification
evidence. The Council will truly and independently determine if each applicant is considered to
be a fit and proper person for admission and if deemed so approve the candidate’s Admission to
Fellowship.
23
In making the decision, Council must ensure that the reason for declining the granting of rights
and privileges offered by the College is based upon legitimate grounds of genuinely
unsatisfactory qualification or safety.
The Chairman of the Board of Censors will not take part in the decision making process with
respect to a candidate’s admission to Fellowship.
In addition, in circumstances where there is a recommendation not to admit an applicant to

Fellowship, only Councillors not practising in the discipline of pathology in which the applicant is
trained will be able to discuss and vote on this issue of that candidate’s admission to Fellowship.
Council should at all times ensure that the principles of natural justice shall apply in its decision-
making.
There is a mechanism for Review of Decision of Council in relation to Admission for Fellowship.
See Regulations Governing Review of Council Decisions on Admission to Fellowship and
Termination of Membership of a Fellow Under Article 49B on the College website.
ADMISSION TO FELLOWSHIP AND ETHICS
Once Trainees are accepted and have paid their entrance fee and annual subscription, they
receive an official Certificate of Fellowship. As College Fellows they are expected to observe
the following ethical principles in Australia, or the code of ethics of the country of practice.
1. The fundamental objective of the practice of Pathology is to promote the welfare of

patients in terms of maintenance or restoration of health.
2. Fellows engaged in the practice of Pathology should be guided by the same ethical
considerations as are practitioners in other areas of medicine. For these purposes the
College follows the Australian Medical Association Code of Ethics (Revised November
1995).
SPECIALIST REGISTRATION
Requirements for specialist registration following attainment of Fellowship of the RCPA (FRCPA)
vary between states and regions. For example:
Australia: FRCPA provides automatic vocational registration with the Health Insurance
Commission.
New Zealand: FRCPA provides automatic vocational registration as a specialist pathologist
with the Medical Council of New Zealand
Hong Kong: FRCPA does not entitle the Fellow to inclusion on the Specialist Register of the
Medical Council of Hong Kong.
F ACULTY OF O RAL P ATHOLOGY

The College also offers a Fellowship of the Faculty of Oral Pathology (FFOP) for dental
graduates fulfilling similar criteria, but applicable to dental practice, as those applicable to
medical graduates. This is also offered to medical graduates and to Trainees and Fellows
wishing to either gain recognition as an Oral Pathologist or to cross over into a career in Oral
24
Pathology. It should be noted that to be recognised as a specialist by Dental Boards in Australia

or New Zealand, dental practitioners must also hold an approved Master’s degree in Oral
Pathology and Oral Medicine.
C ONTINUING P ROFESSIONAL D EVELOPMENT

The Royal College of Pathologists of Australasia offers a Continuing Professional Development
Program (CPDP) to its Fellows, Affiliates and Trainees.
Participation in CPDP, or an equivalent program, is mandatory for Fellows. Proof of participation

is a requirement for registration by some medical boards.
C OLLEGE P OLICIES
Trainees are advised to familiarise themselves with the College’s by-laws, policies, and roles
and responsibilities. Specific documents that should be reviewed include:
Policies
Complaints in Relation to Examinations

Discrimination and Harassment
Complaints Handling
By-Laws
Regulations Governing Review of Council Decisions on Admission to Fellowship and

Termination of Membership of a Fellow Under Article 49B
Regulations Governing Review Process for Review of Decisions of Committees of the College
Council Under Article 49A
Roles and Responsibilities
Ombudsman for Trainees
These and other documentation relevant to trainees can be found on the College website at
www.rcpa.edu.au. Go to Publications and forms/Document library, search category Training
with RCPA.
COLLEGE OMBUDSMAN
An ombudsman is defined as someone who resolves disputes from a neutral, independent

viewpoint. College ombudsmen are appointed for Australia and New Zealand.
The ombudsman is to be consulted only when a reasonable effort has been made to resolve the
problem through normal processes and it still is not resolved. The ombudsman will not have the
authority to reverse decisions but may recommend that a decision be reconsidered or that a
course of action be taken to bring about changes that will help prevent future problems.
Trainees wishing to contact the ombudsman may do so through the State Councillor or College
office on boc@rcpa.edu.au or phone +61 (02) 8356 5825.
25
R ECOGNITION OF O VERSEAS T RAINED S PECIALISTS
AUSTRALIA
Medical practitioners qualified as specialist pathologists in a country other than Australia or New
Zealand, and who are not Fellows of the Royal College of Pathologists of Australasia may apply
for specialist pathologist recognition in Australia. Please refer to the OTS AMC Step Guide Jan
2007 on the College’s website: at
http://www.rcpa.edu.au/applications/documentlibrarymanager2/inc_documentlibrarymana
ger.asp
\
Select Overseas Trained Specialist AON
Applicants must apply initially to the Australian Medical Council (AMC). Information and
application forms are available from:
The Australian Medical Council
PO Box 4810
Kingston ACT 2604
Email: amc@amc.org.au
Website: www.amc.org.au
Applications are processed by the AMC and then submitted to the College for assessment.
Further information is also available from State Medical Boards.
NEW ZEALAND
The Medical Council of New Zealand will assess the eligibility of doctors who have qualified and
practised as specialists overseas for vocational registration in recognised branches. The
procedures include individual consideration of applications via a pre-assessment and formal
assessment stage, which may include a face to face interview with representatives of the New
Zealand Committee of the RCPA.
Applicants must apply initially to the Medical Council of New Zealand. Information and
application forms are available from:
The Medical Council of New Zealand
PO Box 11-649
Wellington
NEW ZEALAND
Email: mcnz@mcnz.org.nz
Website: www.mcnz.org.nz
26
F ORMS AND S UBMISSIONS

Following is a list of the forms and documents Trainees are required to submit at various stages
of training. All forms are available for downloading from the RCPA website at www.rcpa.edu.au
(go to Publications/Document library, search to Training and exams) or on request from the
College. On completion they should be sent to:
The Registrar, Board of Censors

Royal College of Pathologists of Australasia
207 Albion St
Surry Hills NSW 2010
AUSTRALIA
Telephone: (02) 8356 5858

Facsimile: (02) 8356 5828
E-mail: boc@rcpa.edu.au
SUMMARY OF FORMS AND SUBMISSIONS
WHEN FORM MUST BE SUBMITTED FORM REQUIRED
RCPA Trainees
Commencement of training Application for Initial Registration, including
any request for retrospective accreditation
By 31 January each year Annual Registration and Notification of
Supervised Training for current year, plus
previous year’s Supervisor’s Report (if not
already submitted).
Trainees who do not submit Supervisor’s
reports in accordance with the above
requirements will not have their training time
accredited.
By 20 July for Trainees taking a Part I or Supervisor’s Report in relevant discipline –

part II exam. JSAC Trainees are to use the RCPA form in
this instance.
Joint RACP/RCPA Trainees (JSAC)
Commencement of training RCPA Application for Initial Registration,

including request for retrospective
accreditation of physician training
27
Commencement of training (Cont.) AND

For Australian Trainees
Copy of JSAC Application for Approval to Formatted: Bullets and
Commence or Continue Advanced Training Numbering
OR for NZ Trainees
Copy of Form AT3 Prospective Approval of an
Advanced Training Programme
By the 15 of February in subsequent years Copy of JSAC Form as above plus Copy of
JSAC Supervisor’s Report for previous year (if
copy not submitted at time of submission to
RACP)
By 20 July for Trainees taking an exam RCPA discipline Supervisor’s Report. Note
that the RACP JSAC form is not to be used for
exam candidates.
Examination candidates
By 7 days before the last working day in Application for Examination for current year.
February This application cannot be accepted until
Annual Training registration, Supervisor’s
report and fee has been received (where
relevant).
LINKS TO INFORMATION FOR JOINT TRAINEES WITH RACP
Haematology
http://www.racp.edu.au/training/adult2003/advanced/vocational/haematology.htm
Immunology/Allergy
http://www.racp.edu.au/training/adult2003/advanced/vocational/immun_allergy.htm
Chemical Pathology/Endocrinology
http://www.racp.edu.au/training/adult2003/advanced/vocational/endo_chem.htm
Microbiology/Infectious Diseases
http://www.racp.edu.au/training/adult2003/advanced/vocational/infectious_micro.htm
INITIAL REGISTRATION
28
Applications for initial registration can be submitted at any time. An initial registration fee and a
pro rata annual training fee will be applicable. Any retrospective accreditation of training may
incur a fee equivalent to or part of the annual training fee for the period.
The completed form must be accompanied by:

the initial registration and pro rata annual training fee
the prospective training program (see below)
signed acceptance by the supervisor of the proposed program
certified copies of medical and other relevant qualifications and medical registrations. The
College does not accept responsibility for the safekeeping or return of original documents.
application for retrospective accreditation of previous training (if relevant), with supporting
documentation. Joint Trainees must formally apply for retrospective accreditation of RACP.
for Australian citizens/permanent residents whose basic medical qualification was not gained
in Australia or New Zealand, proof of having passed the AMC examination.
ANNUAL REGISTRATION AND NOTIFICATION OF SUPERVISED TRAINING
Registration must be renewed each year. For RCPA only trainees renewals must be returned by
31 January. Joint RACP/RCPA trainees must renew by 15 February. A late fee is charged for
late applications. Trainees moving to new positions only may submit their applications by the
end of February without penalty.
Trainees who have not re-registered by 31 March will be taken off the mailing and web access
list. A fee will be charged for reinstatement.

the annual training fee and any late fee payable
the prospective training program.
Trainees are advised to submit this application as early as possible, so that any problems or
inadequacies in the prospective training program can be remedied in advance.
JSAC A P P L I C A T I O N TO COMMENCE OR CONTINUE ADVANCED TRAINING
New joint Trainees are required to complete the Initial Registration form for the RCPA in addition
to the JSAC Application to Commence or Continue Advanced Training (copy to the RCPA). In
subsequent years, only the JSAC form need be completed, with a copy to the RCPA.
The forms for joint training are available from the Royal Australasian College of Physicians.
Note that the RACP has different forms for Australia and New Zealand.
The form must be submitted to the Royal Australasian College of Physicians by the advertised
closing date, with a copy and payment to the RCPA. Please note that registration closing
dates and fees differ for the two Colleges.
For Australian Trainees, please send to: The Royal Australasian College of Physicians
145 Macquarie Street
Sydney NSW 2000
29
For New Zealand Trainees, please send to: Royal Australasian College of Physicians
PO Box 10 601
Wellington 6036
NEW ZEALAND
APPLICATION FOR EXAMINATION
The Application for all Examinations, except Pathological Sciences, must be submitted by 5.00
pm Sydney daylight saving time seven days before the last working day of February in each year
in which the candidate wishes to present for examination. This date is advertised on the College
website and in Pathology Today, which all registered candidates receive. The closing date for
the Pathological Sciences examination is 30 June.

the full examination fee, including the fee for any exemption sought
comprehensive supporting documentation for any exemption sought
confirmation from the candidate’s supervisor of their experience and readiness for
examination
an additional copy of the form, both forms to have a recent photograph attached.
Forms must be signed by the candidate. Incomplete applications will not be processed and no
responsibility will be taken for subsequent delays.
There will be a period of 5 working days grace for late applications, however a substantial fee
($275 in 2007) must be paid for any late application.
PROSPECTIVE TRAINING PROGRAM
A Prospective Training Program must be submitted on initial registration and with the Trainee’s
Annual Registration form each year. Please note that inadequate training programs will be
returned for revision.
In order to gain a full understanding of the intended outcomes of the training program and a
commitment to the process, it is vital that the supervisor and the Trainee spend some time
together in developing the program. A new supervisor should be certain to elicit from the
Trainee any previous difficulties with specific skill areas, examination failures (and perceived
reasons), and omissions or deficiencies in training experience.
The Program should be devised by the supervisor in conjunction with the Trainee and with
reference to the discipline checklists in the Trainee Handbook. The prospective training
program should include the following elements:
1. A very brief overview of the laboratory and its networks

This provides the context for the Trainee, their stage of training and the resolution of any
previous difficulties or deficiencies in training.
2. Planned exposure to relevant experience

This should include the major aspects of the discipline, or test groups, that the Trainee is
30
expected to experience in the ensuing year. It should also specify any standard rotations
that the Trainee will be undertaking to other laboratories within a group.
In the case of previous difficulties, specific outcomes or achievements should be determined.

For example, the Trainee may have identified goals for the development of a specific skill
set.
3. Specific responsibilities of the Trainee

What specific responsibilities will the Trainee be given, relevant to their level of skill and
experience? For example: checking laboratory reports; liaising with clinicians; quality control
of assays; trialling of new methods.
4. Additional external experience required

Are there specific services which are not provided by the laboratory?
If so, what arrangements are being made for the Trainee to receive this experience
elsewhere?
5. Intended participation in projects or research

To what extent will the Trainee be developing core skills or gaining additional skills through
participation in projects and research throughout the year?
6. Educational program
List any regular activities in which the Trainee will be participating, e.g. weekly journal club,
departmental administrative or patient care meetings, as well as planned attendance at
conferences or seminars.
7. Teaching and presentation activities

What responsibilities will the Trainee have for, e.g. tutorials to medical students. Are any
conference papers anticipated?
The Prospective Training Program submitted to the College need only be 2-3 pages. The
Trainee is, however, encouraged to relate this program to the specific learning outcomes set out
under “Core Competencies” and for each discipline, with a time line for the achievement of
specific skills. This will allow more comprehensive monitoring of progress and enable both
Trainee and supervisor to determine whether the Trainee is encountering difficulties.
The supervisor should meet with the Trainee at least every 3 months, to provide structured
feedback on their performance and review progress of the training program.
SUPERVISOR’S REPORT
This form is to be completed by the supervisor, detailing the Trainee's progress during the year.
Supervisor’s Report forms for each discipline and for Morphological and Clinical Pathology can
be downloaded from the RCPA website.
Trainees must submit their Supervisor’s reports with their annual registration, unless the Trainee
is sitting a Part ! or Part II examination, in which case they must submit their Supervisor’s report
by July 20 of the year of the examination.
If Trainees do not submit their Supervisor’s reports in accordance with the above requirements
their training time will not be accredited.
31
Supervisors’ reports for JSAC trainees in Chemical pathology, Haematology, Immunology and
Microbiology are to be submitted to the RCPA by the 15 October.
Examination candidates should be aware that:
• If the Supervisor’s Report is not submitted by the due date, the candidate may not be
eligible to sit the examination.
• In the case of a borderline examination result, the Supervisor's Report may mean the
difference between success and failure.
• If a Trainee is unable to obtain the Supervisor’s Report, the form should be submitted
with a statement to that effect.
It is the Trainee’s responsibility to:

1. obtain the report form, which is available for each discipline on the College website
2. request the supervisor to complete the form, well in advance of the due date
3. ensure that the exact dates for the beginning and end of the training period have been
entered on the front of the form. These periods are totalled on application for Fellowship.
4. discuss the completed report with the supervisor
5. submit the form to the College by the due date.
When more than one supervisor is involved, additional reports may be required and Trainees
need to check with the Registrar about this. It is the Trainee's responsibility to request reports
from supervisors involved in training other than the one nominated on the Annual Registration
form.
APPLICATION FOR ADMISSION TO FELLOWSHIP
The completed Application for Admission to Fellowship form must be submitted to the College
after the completion of all fellowship requirements in order for the date of completion to be
confirmed for Council endorsement of Fellowship.
APPLICATION FOR ACCREDITATION OF LABORATORY FOR TRAINING OF

CANDIDATES IN PATHOLOGY
This form is used by laboratories wishing to apply for accreditation for pathology training.
Laboratories which are currently accredited will be sent a form for reapplication six months
before the date of expiry of their accreditation.
32
For new applications, the form is available on the RCPA website or from the College on request
to boc@rcpa.edu.au.
33
T RAINING AND E XAMINATION F EES

Training and examination fees are set by Council each year. Fee schedules are published on
the College website at www.rcpa.edu.au and distributed with the Application for Annual
Registration and Examination forms.
¾ All fees are to be paid in Australian dollars.

¾ Trainees in Australia only are required to pay GST on the annual training fee.
Continuing Trainees are required to pay their annual training fee by 31 January each year.
After that date a late fee is payable, except for JSAC Trainees and Trainees changing
employment.
Trainees who do not pay their annual training fee by 30 April will be considered “Incomplete
Trainees” and a fee will be required for reinstatement.
Trainees wishing to defer their training are advised to continue to receive College mailings
and access to the members’ section of the College website by paying a deferment/mailings
fee.
Fellowship examination fees are GST exempt. Annual training fees for Australian Trainees;
all Diploma fees and all administration fees (including late fees) attract GST.
Trainees who are granted exemption from any examination/s must pay the equivalent fee.
The fee for all repeat examinations is the same as for the initial attempt.
Trainees who withdraw from an examination may receive a partial refund of their fee,
depending on the time of notification of withdrawal. Please refer to Withdrawal from
Examination in this Handbook and to the RCPA Policy available on the website.
Late fees will be applicable for the late submission of annual registration and examination
applications (where late application is allowable). Late fees attract GST.
34
TRAINING AND ASSESSMENT REQUIREMENTS
T HE O VERALL A IM OF THE T RAINING P ROGRAM
Pathologists have considerable skills which enable them to contribute significantly to the
provision of high quality efficient and effective health care. The skills they develop as a
consequence of training first as a medical practitioner and then as a specialist pathologist allow
them to understand clinical disease processes and their diagnosis.
The Royal College of Pathologists of Australasia has developed this position statement in order
to provide information to health care providers, pathology trainees, government administrative
bodies and the broader community on the skills and role of pathologists. In particular, this paper
outlines how pathologists significantly contribute to the delivery of high quality appropriate
medical care.
Pathology is the branch of medicine that is involved in understanding the cause and processes
of disease. It does this by looking at changes in the tissues of the body, in blood and other body
fluids. Some of these changes show the causes while others reflect the severity of the disease
and are used to follow the effects of treatment.
Pathologists are specialist medical practitioners working in the field of pathology. This means a
pathologist will have completed a general medical degree followed by a period of time in a
teaching hospital working as a clinical doctor. Following this, pathologists will have undergone a
minimum of 5 years additional training in pathology and have passed a series of examinations to
become a specialist.
The primary role of the pathologist is to perform or supervise the performance of tests on blood,
other body fluids, body secretions and samples of tissue taken at surgery or as a part of a
medical examination or autopsy. Where appropriate, the pathologist may render a clinical
interpretation or consultation based on the results of the test.
In addition, some pathologists see patients and may be involved directly in the performance of
procedures and the delivery of care.
At present, pathology practice has eight different areas of activity relating either to the methods
used or the types of disease that they investigate. These are:
• Anatomical Pathology
• Chemical Pathology
• Forensic Pathology
• Genetics
• Haematology
• Immunology
• Microbiology
• General and Clinical Pathology
35
The pathologist has the ultimate responsibility for the test results, the quality and safety
standards of the laboratory, advising clinicians on the interpretation of test results and the further
investigation of the patient.
All laboratories in Australasia must participate in recognised quality assurance activities and
receive formal accreditation to ensure doctors and patients can be confident that test results are
reliable. The pathologist is primarily responsible for ensuring accreditation requirements are met
at all times. No other medical specialty has promoted and implemented quality assurance to the
sophisticated standard that has been achieved in the area of laboratory medicine.
Pathologists and their training

As with much modern medical care, the practice of pathology is a team activity. On the one
hand, there is a range of other members of laboratory team involved in providing pathology
testing. On the other there are clinicians who are specialists in their own field of medicine who
refer patients to pathologists for investigation and who treat patients guided by the pathologist’s
test results. Pathologists, scientists and technicians form an integrated laboratory team, but
pathologists are also active in the support of doctors and other medical professionals in the
clinical setting. Pathologists routinely supervise the laboratory to ensure pathology results are
appropriate and of the highest standard, and provide interpretation and further advice on the
clinical implications of these results. In other words pathologists, through their medical
background and extensive training, understand the needs of other clinicians caring directly for
patients and at the same time understand the exact requirements in the laboratory to produce
accurate, appropriate and timely results.
The value of pathologists to modern medical practice is thus related both to the depth and
breadth of their initial training, and to their subsequent continuing professional development.
Pathologists’ training encompasses:

• Training as a doctor, giving a broad understanding of disease processes from a clinical
system perspective
• Experience in treating patients and directly requesting pathology services
• The depth of a minimum five-year training program provided by the RCPA covering a range
of scientific, technical and clinical aspects of pathology along with management, safety and
quality issues for the laboratory.
An important further area of experience that distinguishes a pathologist from an experienced

well-trained scientist is that as a senior medical student, intern and resident medical officer, the
pathologist has been a referrer to a pathology service and has been trained in responsibly
requesting diagnostic pathology investigations. The pathologist, therefore, has first hand
experience of what is required of a timely efficient and accurate service.
As a fully trained medical practitioner the pathologist has a clear appreciation of the medical
significance of a patient’s results and is able to assess which require urgent notification to the
treating clinician. As a consequence of their combined training, the pathologist can also advise
clinicians on the most appropriate investigations both for an individual patient and for a group of
patients.
A doctor’s training is broad. The medical student should receive a thorough grounding in the
basic sciences of Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology, Immunology
and Anatomical Pathology, as much as in aspects within those subjects of relevance to clinical
36
practice and clinical pathology including Chemical Pathology, Haematology, Microbiology,

Immunopathology and Histopathology. In addition, as a student, intern and resident medical
officer pathologists have had personal exposure to all aspects of clinical medicine including
Internal Medicine, Surgery, Paediatrics, Obstetrics and Gynaecology, Psychiatry, Anaesthetics,
Emergency Medicine and Intensive Care.
No other members of laboratory staff have the breadth of training or the clinical experience
equivalent to that of the pathologist.
While medical specialists other than pathologists have the same broad medical training, they will
not, as a rule, have the detailed and comprehensive understanding of laboratory medicine
provided by training in pathology. In consequence, they may not have as extensive knowledge
on how to competently interpret some complex patterns of test results and understand what
further testing may be appropriate to help in diagnosing and monitoring patients’ conditions.
Assisting clinicians in the quality use of pathology by advising on the most effective and efficient
program of tests is a major activity for many pathologists.
Finally, because of the breadth of their training, pathologists are better able to coordinate testing
when more than one discipline is involved (either laboratory or clinical) e.g. multi-discipline
testing of cerebrospinal fluid obtained at lumbar puncture.
Specific roles of pathologists

Pathologists have a wide range of skills to fulfil the following roles:
1. Expert
• Expert in clinical interpretation of diagnostic tests and an understanding of the nature

and causation of disease processes
• Expert in understanding the principles of analysis and technical details of tests used
to diagnose and monitor disease
• Expert in the development and assessment of new testing methodologies
• Expert in knowing the appropriate test to be performed: in a specific clinical situation
(“the right test at the right time for the right patient”)
• Expert in interpretation of individual and groups of test results and the significance
these results will have on patient management
• Expert in quality methodologies in the laboratory
• Expert in safety requirements for laboratories
• Expert in the effect of disease and therapy on laboratory tests.
2. Communicator
• Communicates with the clinicians treating patients at two levels:

Ability to understand the needs of the clinician and the patient from the
perspective of delivery of pathology services
Ability to provide clear and unambiguous laboratory result interpretations to
discuss the implications of testing and further methods of testing available to the
treating clinicians to assist in the diagnosis and management of their patients
• Communicates with other staff in the laboratory about testing methodologies, quality
control techniques and delineating protocols for the issuing of results
37
• Communicates with administrators and government as required to ensure laboratory

medicine is given appropriate support
• Communicates with other clinical specialists and pathologists on issues of patient
care and professional practice and in seeking and providing referral opinion on
difficult cases
• Communicates with patients and the wider community on issues relating to laboratory
medicine
38
3. Collaborator
• Consults effectively with other medical practitioners and health care professionals
• Contributes effectively to other inter-disciplinary team activities such as peer review
sessions and other education and quality activities
4. Manager
• Supervises and manages a laboratory effectively

• Uses personal resources effectively to balance laboratory and clinical skills along
with own individual learning needs
• Uses available health care resources appropriately and effectively
• Works effectively and efficiently in the provision of pathology services
• Provides clinical direction
5. Health Advocate
• Identifies the important determinants of health which affect patients

• Contributes to improving the health of patients and of the community
• Responds to issues of advocacy as appropriate
6. Scholar, Teacher and Researcher
• Develops and monitors a personal continuing education strategy

• Critically appraises sources of medical information and applies them in appropriate
ways to the practice of pathology
• Develops training and education sessions for medical practitioners undergoing
postgraduate training in pathology and in pathology for postgraduate trainees in the
clinical specialities, medical students, laboratory scientific and technical staff and
other health professionals.
• Contributes to the development of new knowledge and research
7. Professional
• Delivers the highest quality service with integrity and honesty

• Demonstrates appropriate personal and interpersonal behaviour
• Practices pathology ethically, consistent with the obligations of a medical specialist
39
T HE P ATHOLOGY C URRICULUM
As part of its accreditation program for Medical Colleges, the Australian Medical Council has
adopted the CanMEDS approach to the key competencies required of medical specialists. The
RCPA training curriculum has therefore incorporated CanMEDS into a framework suitable for
pathology, as explained below. (CanMEDS 2000, Canadian Medical Education: Directions for
Specialists, http://rcpsc.medical.org/english/publications/canmed_e.html)
This framework includes the “generic” roles and core competencies, common to every branch of
pathology, set out in the “Generic Curriculum”. The discipline-specific competencies, embodied
in the role of the “Medical Expert” are set out in this Handbook under the requirements for each
discipline.
RATIONALE FOR THE CURRICULUM
With the assistance of the Medical Education Department of the University of Sydney (later
CIPHE), the College has developed an educational process which ensures that the needs of
Trainees and the profession are well-matched, and that there is consistency between learning
outcomes, their assessment, and the necessary learning activities. The technical term for this
concept is “constructive alignment” (Biggs, 2003).
The process of constructive alignment started with identification of the learning outcomes of
the education program. These are descriptions of observable, and therefore assessable,
behaviour. In a work-based education program, such as that undertaken in specialist medical
training, learning outcomes can and should be couched in terms of performance (what the
Trainee does), in preference to mere competence (what the Trainee can do).
The next step was to consider how the achievement of each learning outcome was to be
assessed, both summatively, as a formal statement of the proficiency of the Trainee, and
formatively, as a means of providing feedback to the Trainee and the supervisor on the
Trainee’s progress towards the desired proficiency. Useful formative assessment requires
feedback to the Trainee on the ways in which his/her performance reaches, or does not reach,
the required standard, and discussion about learning activities which may assist in reaching that
standard.
Finally, the Trainee should have access to a range of learning activities which are clearly
linked both to learning outcomes and to their assessment. Since individual Trainees will have
different learning needs, based on their existing competence and on their preferred modes of
learning, and one of the desired attributes of the proficient Trainee and of the practising
pathologist is that of a self-directed learner, it follows that the role of the College is to encourage
Trainees’ exploration of the available choices and opportunities, rather than to be a provider of
those learning activities, except in the rare cases where no suitable learning materials are
available from other sources.
THE FRAMEWORK OF THE CURRICULUM
The framework set out below has been used, with some variations, by the different disciplines to
develop their individual curricula. The framework applies the principle of constructive alignment
to the different roles of the Pathologist. Those roles that are common to all disciplines have
formed the basis for the development of the core curriculum.
40
41
The tasks of the Pathologist are grouped as follows:

1. Discipline-Specific Functions of the Pathologist as Medical Specialist in the
Laboratory
2. Functions of the Pathologist as Manager in the Laboratory
3. Other Professional Functions of the Pathologist
In addition, there are Generic Processes employed by the Pathologist in undertaking these
tasks.
These four groups of professional activities are set out below. This framework was used by
each discipline to identify:
(i) the learning outcomes required for each task, then
(ii) how the achievement of those learning outcomes may be assessed (both formatively and
summatively), and finally
(iii) what learning activities or opportunities the Trainee may require to achieve the required
level of proficiency for each learning outcome.
Tasks Learning Assessment Learning

Outcomes Activities
Discipline-Specific Functions of the Pathologist as Medical Specialist

in the Laboratory
Selection, Accession, Management

and Processing of Specimens
Production of Laboratory Data
Storage and Retrieval of Laboratory Data
Analysis of Laboratory Data
Accessing Sources of Information
Developing an Opinion
Communicating an Opinion
Monitoring Patient Progress
Functions of the Pathologist as Manager in the Laboratory
Quality Control
Laboratory Safety
42
Compliance with Legislation
Human Resource Management
Finance and Budget
Other Professional Functions of the Pathologist
Developing New Knowledge

through Research
Undertaking Self-Education and

Continuing Professional Development
Educating Colleagues, Staff, Patients

and Families
Providing Data for Planning and Evaluation
Generic Processes Employed by the Pathologist
Quality Assurance
Patient Safety
Ethics and Confidentiality
Communication
Collaboration
Accessing Information for Education

and Research
(With thanks to Professor Rufus Clarke, University of Sydney, 2003)
GENERIC CURRICULUM
The generic curriculum is designed to address the core functions and roles of the pathologist
that are shared across the disciplines.
An online learning and recording tool to support this curriculum is under development and will be
available to all Trainees in 2009. The tool is provisionally called ‘e-LOG’ (electronic Learning
Outcomes Guide). Initially, all second year Trainees, excluding those in a JSAC program, will be
required to maintain records of their participation. e-LOG is designed to be a flexible tool,
allowing the Trainee to choose or design their own activities according to need and relevance,
43
and to proceed at their own pace. It is designed to be simple and helpful rather than onerous.
Minimum requirements are relatively small and will be clearly specified. e-LOG will consist of:
1. A self-assessment and planning tool

2. A menu of suggested learning activities mapped to the curriculum. Mostly they will be
activities that the Trainee does in the normal course of work, or should be readily
accessible in the workplace. A small number of these activities, e.g. relating to laboratory
safety, are compulsory, thus ensuring that appropriate resources are made available.
3. Access to supporting resources, including online modules, documents, web links and a
calendar of relevant meetings.
4. A facility for recording activities and documenting learning.
5. A tool to facilitate review and formative feedback from the supervisor.
6. A summary and feedback form for submission to the RCPA.
Supervisors are requested to allow quarantined time for the Trainee to complete the
documentation. 30-60 minutes per week is suggested.
Assessment of the generic curriculum:
1. Formative assessment: Trainees and supervisors will negotiate appropriate intervals to

review the activities and learning recording in e-LOG, and plan for further development.
This assessment is to assist with learning and is not reported to the RCPA.
2. Assessment of knowledge: This is covered in existing written and oral examinations.
3. Assessment of attitudes and workplace performance: Recorded in annual Supervisor’s
Report.”
44
SUGGESTED LEARNING
LEARNING OUTCOMES ACTIVITIES
Laboratory
Safety Apply laboratory safety procedures, to protect self Participate in orientation program for
and staff against infection, radiation, toxic and fire new staff members.
hazards.
Schedule meeting with OHS Officer
Participate in drills and meetings
where occupational health and safety
issues are addressed.
Locate and ensure ability to use
equipment for biological, chemical
and fire safety, first aid and
resuscitation.
Review incident reports if available
Review and apply quality control strategies for Review summaries of relevant
Quality monitoring processes and outputs in the requirements for lab accreditation and
Management laboratory as appropriate to discipline. performance, for example the NATA
and Quality Checklist for Laboratory
Recognise the cost-effectiveness of current and
Assurance Accreditation.
proposed laboratory procedures and equipment
in the context of limited resources. Participate in case/slide reviews, peer
review meetings, external quality
assurance (e.g. RCPA QAP) and
continuing professional development
activities
Identify location of current literature
on QC strategies, risk management,
informatics and evidence based
medicine in laboratories.
Participate in workflow checks to
ensure effective and efficient
laboratory function.

45
Recognise, report and analyse

quality problems when they arise in
the laboratory
Participate in the implementation of a
plan for testing and evaluating new
technology or advances that may
improve the quality of laboratory
practice and patient care.
Legislation
Demonstrate basic knowledge of requirements of Review summaries and seek advice
from appropriate senior staff.
Approved Pathology Provider (Australia) or other
Locate sources of pathology financing
relevant undertakings.
information, e.g. Medicare Benefits
Recognise the basic legal aspects of medical Schedule.
litigation and the potential role of pathologists as
Document incidents and discussions
defendants or consultants in such action.
that may have medicolegal
Identify acceptable standards of billing practice implications and discuss with
appropriate to the work setting supervisor or a senior colleague
Human
Resource Review and use orientation and training protocols Participate in human resources
Management for new staff. management as directed by Head of
Department
Observe administrative procedures in
Identify techniques to provide constructive
relation to selection and appointment
feedback to staff
of staff.
Identify principles of conflict resolution in the
Reflect on observation of interactions
workplace.
in the workplace.
Participate in conflict resolution

46
course or read articles on the subject

Senior trainees assist in the
orientation and mentoring of junior
trainees
Providing Data
for Planning for Identify requirements for reporting clinical and Assemble clinical information to assist
Health Care laboratory information (e.g. pathology laboratory in health care service delivery
Service reporting to registries) and the provision of new
Delivery services.
Practice ethically, which includes:

Ethics and - promptness of reporting
Confidentiality Review appropriate literature and
- interacting appropriately with clinicians,
guidelines including the National
laboratory staff and other health professionals
Patient Safety Education Framework
- knowing when to seek opinion from others
Comply with legal, ethical and medical
requirements relating to patient records and
documentation, including confidentiality, informed
consent and data security.
Differentiate between ethically appropriate and
ethically inappropriate procedures.
Identify appropriate courses of action in regard to
unprofessional conduct by or ill health in a
colleague.
Comply with copyright and intellectual property
rules.
Recognise and respect cultural and religious
factors impacting on professional practice.

47
As Communicator
Communication
Employ effective oral, written and electronic Participate in a communication and or
communication strategies, including the presentation skills workshop
production of concise, grammatically correct
Compose written reports at an
written reports.
appropriate level of responsibility and
Advise clinicians on the choice and performance seek feedback from supervisor,
of laboratory procedures and the interpretation colleagues and clinicians
and relevance of pathological findings.
Document telephone communication
Comply with guidelines for handling sensitive of pathological findings,
information. interpretations, clarification of
requests and complaints where
Demonstrate good interpersonal communication appropriate, seeking feedback from
skills such as active listening and giving and supervisors and colleagues.
accepting appraisal
Collaboration
and teamwork Demonstrate effective participation as a member Identify the roles of health care team
of health care teams within the laboratory and members.
the wider clinical setting.
Identify the elements of an effective
team
Identify whether these elements exist
in your team.
Apply available technologies to
.
share information and to network
with colleagues.
Plan and construct learning activities
in collaboration with supervisor, peers

48
and laboratory staff.
Patient Safety
and Health Access and read relevant sections of
Advocacy the National Patient Safety Education
Advocate for, and protect, patient rights. Framework document.
Promote understanding of health and disease,
including relevant epidemiology and public health
issues, to patients, clinicians and the community.
Practice the habit of identifying and documenting Formulate a learning plan

Self-Education own learning needs and planning educational
and Continuing Complete an online learning style
strategies to meet them.
Professional inventory and , and explore a variety
Development Identify own learning style, apply it to learning of ways to learn
activities.
Participate in clinical and pathology
Plan, implement and monitor a personal educational meetings and journal
continuing education strategy, including self- clubs.
assessment activities.
Apply various computer-based
Critically appraise the medical literature, and instructional tools, such as electronic
apply it clinically as a medical specialist, teacher tutorials for confirming or updating
and researcher. knowledge and skills.
Demonstrate an up to date knowledge of medical Review RCPA CPDP documentation
and pathological literature. to identify and apply activities and
recording strategies that may be
applicable.
Educating Employ effective oral, visual or written modes as Participate in teaching,

Colleagues, appropriate to educate laboratory personnel, clinicopathological meetings and,

49
Staff and peers, medical students and other health conference presentations
Patients professionals, incorporating the principles of adult
Review literature on principles of
learning.
adult learning
Translate and convey pathology-related concepts Prepare posters or educational
and information to non-pathologists. articles of scientific investigations in
pathology and present to peers and
other health professionals.
Facilitate patient education if relevant
to discipline.
Appraise different sources of medical Use clinical and laboratory databases
Accessing and for research for collecting, organising
information, discriminating between them in
using sources and analysing data.
terms of their currency, format, authority and
of Information relevance.
for education Use a standard bibliographic
and research Develop a personal strategy, using IT software application (e.g. EndNote) to
where appropriate, to discover, store, access and download citations from a search and
share information resources organise them into a personal
database.
Apply and interpret basic statistical and
epidemiological concepts and data Read reference material on basic
statistical concepts including
distribution, mean, median, standard
deviation, statistical significance,
confidence intervals, correlation,
sensitivity, specificity, predictive
values, incidence and prevalence
Consult a medical librarian,
statistician or researcher

50
B ASIC P ATHOLOGICAL S CIENCES E XAMINATION

Please refer also to the general requirements for training and examinations set out at the front of
this Handbook and the Generic Curriculum.
INTRODUCTION
The purpose of the Basic Pathological Sciences Examination is to assess the candidate’s
familiarity with the most important pathological processes and biological principles of disease
that form essential knowledge for any medical graduate who considers a career in the
pathological disciplines if not any medical speciality.
All Trainees, regardless of discipline, must successfully pass or be exempted from the Basic
Pathological Sciences examination. JSAC Trainees are exempt from the BPS exam but are still
required to apply for an exemption from the exam. From 2006, the examination may be taken
before commencement of training. The examination will be opened up to any intern, medical or
dental student in their final year as well as registered trainees.
A pass in Basic Pathological Sciences is not a prerequisite for Part I or General Pathology
examinations, but a pass or exemption must be achieved before proceeding to sit the Part II
examination in any discipline.
This change in policy from previous years has become necessary because of recent changes in
the curricula of many if not all medical schools in Australia where a shift away from pathology as
a ‘core discipline’ has occurred. Hence an understanding of basic pathobiological processes is
no longer guaranteed in many medical graduates. However, such ‘core knowledge’ is essential
for a successful start into the training program and satisfactory progress.
PURPOSE OF THE EXAMINATION
The purpose of the Pathological Sciences examination is to assess a basic understanding of:
• scientific knowledge that can be found in undergraduate, up-to-date textbooks of
pathology
• the principles of scientific methodology that underpin the daily diagnostic work of
pathologists, including antibody technology, molecular biology and cytogenetics
• factual knowledge of what was once described as "general pathology", comprising
mechanisms of cellular injury, cellular growth and cell death, inflammation and tissue
repair, haemodynamic disorders, genetic disorders, immunity, environmental hazards,
neoplasia and infectious diseases; and
• to encourage a lifelong professional interest in keeping abreast of new advances.
Candidates should also be able to display some comprehension of the newer scientific methods
that have led to advances in understanding of the mechanisms of disease, such as molecular
cloning, adult and embryonic stem cells, molecular and cytogenetic methods in the diagnosis of
disease and prediction of disease outcome, etc.
© October 2008 The Royal College of Pathologists of Australasia 51

EXAMINATION FORMAT
The examination will be a single 2 hour paper comprising:

• two compulsory essay questions (1 hour)
• 40 multiple choice questions (1 hour, 1.5 min per question).
The pass mark will be 60%, with the essay and MCQ components averaged.
EXAMINATION CONTENT
Candidates are expected to know base subjects in pathology disciplines other than that in which
they are primarily training, so they can make intelligent assessment of results, at least equal to
that of their clinical colleagues.
The exam will concentrate on the following general subjects (please note that the list of
examples is not exhaustive):
• Cellular pathology (cell growth and ageing, cell injury and death)
• Acute and chronic inflammation, healing and repair
• Immunity (building blocks of the immune system, hypersensitivity reactions, autoimmune diseases,
AIDS, amyloidosis)
• Haemodynamic disorders (oedema, thrombosis, embolism, infarction, shock)
• Genetic basis of disease (genetic mechanisms of disease; basic knowledge of the more common
genetic diseases as well as an understanding of commonly-used genetic tests
• Microbiology (general principles of microbial pathogenesis, common viral and bacterial infections, the
most common parasitic infections)
• Neoplasia (biology of benign and malignant tumours, epidemiology of cancer, molecular and cellular
oncogenesis)
• Occupational and environmental pathology (common toxins and manifestations in the human body,
such as asbestos, smoking, industrial toxins)
• Nutrition, metabolism (common nutritional deficiencies, obesity)
• Acid-base balance and fluid/electrolyte disturbances (basic physiological and pathophysiological
mechanisms).
In each of these subjects, emphasis will be placed on:

• Nomenclature and definitions of disease
• Classification of diseases
• Disease processes/pathogenesis
• Causation/aetiology
• Scientific methodology and new diagnostic methods
• Ethics, social and political aspects of pathology and disease
• Analysis of data (e.g. incidence, prevalence, accuracy, precision, predictive value,
correlation).


A NATOMICAL P ATHOLOGY
this Handbook.
INTRODUCTION
Anatomical Pathology is the study of organs and tissues to determine the causes and effects of
particular diseases. An Anatomical Pathologist’s findings are fundamental to medical diagnosis,
patient management and research.
Anatomical Pathology involves macroscopic pathology, histopathology (the combination of these
two usually being referred to as “surgical” pathology), cytopathology and morbid anatomy.
Histopathology is concerned with the microscopic examination of tissues, taken either as biopsy
samples or resection specimens. Tissues are assessed macroscopically, and material is taken
for microscopic examination for the purpose of diagnosis, prognosis and directing appropriate
treatment. Cytopathology is the study of individual cells, aspirated or obtained from body fluids
or tissues (including exfoliative cytology), to detect abnormalities. Morbid anatomy is the use of
the autopsy to determine the cause of death and investigate both the associated and “incidental”
(unrelated to cause of death) effects of drugs, toxins and disease processes on bodily organs.
Anatomical pathologists work with almost all medical specialties, including surgeons and general
practitioners, using techniques available in the anatomical pathology laboratory to provide
information and advice essential to clinical practice.
PERSONAL CHARACTERISTICS NEEDED
The Anatomical Pathologist needs the following traits:
• a flair for identifying and differentiating visual cues
• ability to make critical decisions on a regular and recurring basis
• ability to undertake problem solving activities
• a high level of self motivation
• a methodical and analytical approach to work and diagnosis
• an enjoyment of the scientific basis of medicine and research
• ability to work as part of a team as well as autonomously
• communication and interpersonal skills
• teaching skills

AIMS OF THE TRAINING PROGRAM
At the time Trainees complete the requirements for Fellowship, they should:
• Have a sophisticated understanding and perspective of anatomical pathology in all its

branches and the role of anatomical pathology in diagnosis and patient management
• Be able to independently report routine histopathology (including frozen sections),

cytopathology and autopsy pathology and realise their own limitations and when to refer
cases for further opinion
• Offer expert opinion to clinicians as to the choice of biopsy material most likely to yield
relevant information for the suspected disease process being investigated
• Be able to liaise with clinicians, explain the limitations of biopsies and cytological
preparations in the interpretation of results and formulate clinico-pathological correlations
• Have sufficient knowledge and personal communication skills to regularly participate in

clinico-pathological review meetings
• Have sufficient knowledge of laboratory procedures to be able to “trouble-shoot” problems,

including accessioning problems, artefacts, staining problems etc. to ensure accurate and
high quality material is available for the formulation of diagnostic opinions and be able to
talk to scientific staff about the laboratory and its problems
• Have a working knowledge of laboratory management procedures and be able to deal with
staff problems
• Be aware of how a laboratory budget is formulated and how their own practice, including
selective requests for special procedures might impact on a laboratory budget, and the
possible “adverse” budgetary effects of indiscriminate ordering of tests (both internal and
external to the laboratory).
• Understand the need for, and principles of, continuing education and participation in CPDP
• Be prepared and able to offer guidance and teaching to trainees in Anatomical Pathology
At the final assessment (Part ll) in Anatomical Pathology the candidates should be aware that
they are required to convince the Board of Censors, through the panel of examiners that they
have sufficient knowledge and experience for “the safe and unsupervised practise of Anatomical
Pathology” and that they are ready for their position as (junior) consultants in the medical
multidisciplinary team.
To gain Fellowship as a specialist Anatomical Pathologist requires 5 years of accredited training

in the discipline, which includes surgical pathology, morbid anatomy and cytopathology. The
training program must include a period in cytopathology equivalent to a minimum of 3 months
full time in a department, processing and reporting sufficient gynaecological and nongynaecological
cytopathology to ensure competence in the discipline. Continued exposure to
cytopathology must be ensured throughout the usual five years of training.

Trainees and supervisors are to ensure experience is gained in special areas that may not be
available in the primary training laboratory, including exfoliative and fluid based cytology, fine
needle aspiration cytology, coronial autopsies, neuropathology, gynaecological-obstetric
pathology and neonatal-paediatric pathology.
Knowledge of the specialised techniques of immunofluorescence microscopy, electron

microscopy, immunohistochemistry and histochemistry will also be expected, sufficient to enable
Trainees to advise clinicians of the requirements and likely benefits of such techniques and to
assist in result interpretation.
Knowledge of the appropriate use of molecular testing as ancillary diagnostic and prognostic
tools in anatomical pathology is also expected.
ASSESSMENT
The examination process includes:
• Basic Pathological Sciences
• Autopsy Assessment, any time after 15 months of training
• Anatomical Pathology Part I, which may not be taken until the third year of training
• Anatomical Pathology Part II, which may not be taken before the fifth year of training.
These durations refer to full-time training (or part-time equivalent) in an accredited laboratory.
The Part I examination is the major hurdle leading to Fellowship in the discipline of Anatomical
Pathology. It tests knowledge of disease processes and diagnostic ability, including knowledge
of the special techniques required for diagnosis. The examination is broad based and may test
knowledge across the general field of Anatomical Pathology, the understanding of disease
processes, the ability to recognise and describe gross and microscopic lesions, competence in
clinico-pathological correlation, and knowledge of laboratory techniques, including occupational
health and safety related issues.
Success in the Part II examination leads to Fellowship, which may currently be obtained via two
streams*:
1. Anatomical Pathology
2. A major research component.
The previous slanted examinations in one of the following sub-disciplines:
• Forensic Pathology
• Neuropathology
• Paediatric Pathology
are only available to trainees who have commenced on this path, who have advised their
intention by the examination closing date in February 2006, and who have received written
approval from the Board of Censors. Information as to the requirements (for candidates in the

above category/situation) should be obtained directly from the College office).
Autopsy Assessment
Due to the decline in hospital autopsy rates, all candidates taking their Part I examination
from 2005 will be required to complete the Autopsy Assessment, in order to demonstrate
competency in autopsy pathology prior to Fellowship.
The Autopsy Assessment:
• is a “stand-alone” component
• may be completed at any time after 15 months of training
• must be completed in addition to performance of an autopsy required to meet the

requirements of a slanted Part II examination *
• is a requirement for candidates in Anatomical Pathology. To achieve Fellowship, a

satisfactory result for the autopsy component must be achieved.
Procedure
The full procedure and form for the assessment is available on the RCPA website (from the
Members site go to Publications and Forms/Document Library/Training and Exams – Exam
information).
• The procedure will include:
- An introductory session with the assessors and candidate during which the candidate
could be expected to demonstrate adequate knowledge of relevant OH&S matters,
knowledge of correct completion of paperwork (consent etc.) and relevant knowledge of
any legislative requirements pertinent to the autopsy process or specific case being
examined
- The actual performance of an autopsy including demonstration of any required specialised
dissection of the main organ system involved in causation of death
- The interpretation of the macroscopic findings
- The selection of appropriate specimens for ancillary investigations
- The selection of appropriate blocks for histology
- The examination and interpretation of histological sections
- The submission of a written report including macroscopic findings, histological
interpretations and clinico-pathological correlation.
It is strongly advised that the decision as to when to present for the autopsy assessment be
made by the candidate in consultation with his/her supervisor. Candidates should ensure they
have sufficient experience in autopsy performance before they present for the assessment. No
specific number of autopsies is required to be performed prior to presenting for the assessment
as the requisite number for competency to perform autopsies may vary from candidate to
candidate. However, it is suggested that the candidate have personally performed a minimum of
10 autopsies before presenting for the assessment.

PART I EXAMINATION
The Part I Examination is the major hurdle in the RCPA Fellowship examinations.
The format is:
Phase 1
• A 3 hour essay-type written paper
• A 4 hour practical examination of 20 cases that will consist entirely of histopathology slides
(biopsy, surgical and autopsy pathology). Full details are available on the RCPA website.
Candidates who are successful at Phase 1 will then be invited to proceed to Phase 2.
Phase 2
• A 3 hour (plus changeover time) practical examination in which candidates progress through
a series of stations. This may comprise the following in any combination:
- Frozen sections
- Cytopathology cases (e.g. exfoliative and/or effusion fluid cytology and fine-needle
cytopathology)
- Histopathology (biopsy, surgical and autopsy pathology)
- Special stains
- Immunoperoxidase slides
- Photographs of immunofluorescence examination
- Electron micrographs
- Macro photographs, which may include forensic-based material.
Some cases might consist of multiple components (e.g. biopsy slides + immunofluorescence
photographs + electron micrographs).
• Two 20-minute oral examinations.
EXEMPTION GUIDELINES FOR UNSUCCESSFUL PART I CANDIDATES
Each component of each phase of the Part I examination will be assessed as pass, borderline or
fail.
A borderline result in any component is NOT to be considered a “borderline pass”.

Any candidate with a fail in any component, or more than one borderline result at the completion
of the Part I examination will not be considered to have passed the Part I and must repeat all
borderline or failed components to complete the requirements for Part I and progress to the Part
II examination.
Any candidate receiving a borderline grade in both the written and practical components of
phase 1 of the Part I examination will not ordinarily be allowed to progress to phase 2 in that
year
As a guide, ordinarily for the written paper, a fail grade is considered to be <46%, a borderline
result as 46 to 50%, a clear pass as > 51% and a meritorious pass as > 60%.

It should also be noted that:
• no candidate having obtained a fail grade in any component of the examination will ordinarily
be granted an exemption from that component
• no candidate receiving a fail in either component of the phase 1 will be granted an exemption
of the other component, except in the case where the candidate has gained a meritorious
pass in the other component where an exemption may be granted at the discretion of the
Chief Examiner,
• ordinarily a candidate re-sitting the second special practical will be required to also attend
the oral examinations
• a candidate cannot proceed to the Part II examination until all components of the Part I
examination have been completed successfully.
The Part l and Part ll examinations must ordinarily be sat in separate years, with the exception of
candidates in their 5th year of training who, having previously been unsuccessful at the Part l
examination and pass the Part l in their 5th year – these candidates may then attempt the Part ll as
an “exit” examination in the November round of examinations.
• a candidate with or without exemptions must pass all components of the Part I examination
within five years of the first attempt; otherwise he/she will ordinarily be required to re-sit the
full examination again.
• Exemptions for any one component of the Part I examination are only valid for one year.
P A R T II E X A M I N A T I O N
Trainees at Part II must show continued development and enhancement of their professional
skills and expertise. A higher standard of professionalism than that of the Part I is expected
from all Trainees including those in the research stream.
Trainees with permission to continue to a slanted examination or a major research component

should advise the Board of Censors as soon as possible after the Part I Examination so the
Board can advise appropriate requirements.
The format is (refer to details below):
• A Casebook of 8 cases
Phase 1
• A 4 hour practical examination of 15 cases that will consist entirely of histopathology slides
(biopsy, surgical and autopsy pathology).
Candidates who are unsuccessful at Phase 1 will be invited to participate in the cytopathology
component of the Phase 2 examination.

Phase 2
• A 2 hour OSCE-style practical examination in cytopathology comprising 12 to 15 cases.
• Two 20-minute oral examinations.
All components must be passed to gain an overall pass at Part II.
A Repeat Part II examination, is available in November for candidates who have failed the:
1. histopathology slide practical in June (these candidates may choose to sit the cytology
component in August or may postpone this component of the examination until November)
2. cytology component in August OR
3. oral component in August.
CASEBOOK REQUIREMENTS
The Casebook comprises 8 cases. The aims are to produce for each case:
• A succinct presentation of no more than 10 pages (single spaced type) with the discussion,
clinicopathological correlation, at least twice as long as the remainder of the presentation
• A bibliography of approximately 15 to 30 references and including recent peer-reviewed

Literature
• A comprehensive and critical but selective appraisal of the cited literature
• High quality photomicrographs/illustrations
Expensive binding and production are not necessary and will not affect outcomes
Repetition must be avoided, and the Casebook should include an example from each of the
following:
1. thoracic pathology, including cardiovascular and respiratory systems
2. head and neck, oral pathology or abdominal pathology, including gastrointestinal pathology,
hepatopathology and salivary gland pathology
3. immune system, including lymph nodes or spleen
4. endocrine system;
5. kidney, lower urinary tract or male reproductive system;
6. female reproductive system or breast pathology;
7. central or peripheral nervous system, or voluntary muscle;
8. skin, bone, joint or soft tissue pathology;

Within this spectrum of systems, the following should also be included:
• at least one case where immunohistochemistry (e.g. peroxidase-based immunohistology or

immunofluorescence) was used to facilitate the diagnosis;
• at least one case where electron microscopy formed part of the diagnostic work-up (this
could be combined with immunohistology for a particular case, e.g. a renal biopsy);
• at least one case where techniques in cytogenetics or molecular biology were used to
facilitate the diagnosis (this could be combined with one or more of the
immunohistochemistry-EM cases, e.g. a small round cell tumour);
• one autopsy case. For those Trainees who have undertaken the autopsy assessment, this
case should usually be alternative to that assessed, i.e., if the assessment was a hospital
based autopsy or a congenital abnormality in a paediatric or perinatal case, then this case
should be coronial or peri/neonatal case which would ordinarily be the subject of review by a
perinatal mortality review committee and vice versa;
• one paediatric/perinatal case; and
• at least one case with a major emphasis on Cytopathology.
PREPARATION OF THE CASEBOOK

1. Cases must have been handled personally by the Trainee as part of their supervised
training.
2. At least two cases must have been handled in the 12 months immediately preceding the
submission date.
3. The cases must not be used in any other Casebook at any time, or by any other Trainee.
To this end, the Trainee will be expected to make the following signed and dated declaration
at the beginning of the Casebook:
I certify that the cases which comprise this Casebook were examined and
reported by me as part of my personal supervised practice during my
accredited training in Anatomical Pathology. None has been used by any
other Trainee for any other Casebook. Cases and were reported by
me during the last 12 months. The case reports are original and have not
been reported in any other Casebook.
4. Individual case reports in peer-reviewed journals or peer-reviewed oral and/or poster

presentations (e.g. Trainee presentations at Pathology Update), for which the Trainee is the
principal author, the oral presenter, or where the Trainee has had significant input into the
publication, are acceptable.
Again, the case must have been reported by the Trainee in his or her practice during the period of
training. A copy of the journal article or presentation should be included as part of the Casebook.
The supervisor needs to certify that the case report fulfils these criteria by making a signed
and dated declaration to the effect that:

As the supervisor for Dr. …………………, I certify that I have audited the
cases that form this Casebook. Each case was examined and reported
personally by Dr. ……………….. during his/her training in Anatomical
Pathology, and Cases ….. and ….. were reported by him/her during the last
12 months. The case reports are original and have not been reported in
any other Casebook.
5. Candidates undertaking and completing a PhD thesis directly related to human anatomical
pathology during the training period may be exempt from up to four of the eight cases in the
Casebook, providing the remaining four cases or publications are on subject matter other
than the topic of the thesis. The number of cases exempted will depend on the breadth of
the topic covered and will be at the discretion of the Chief Examiner.
SUBMISSION OF THE CASEBOOK

1. Casebooks must be received at the College by 31 March each year, so that they can be
assessed in advance of the practical and oral examinations.
2. Two hard copies plus an electronic copy on CD must be submitted. Hard copies may be
spiral bound.
3. Casebook results are ordinarily released when Trainees are notified of their progress to the
oral examination.
4. Revised Casebooks must be received at the College by 31 October each year, so that the
results are available for ratification at the November Board of Censors meeting.
5. If revised Casebooks are not received by the due date, results may be held over until the
next year, in which case two new cases may be required to ensure at least two cases were
reported during the 12 months before the submission date.
6. In exceptional circumstances, the Board of Censors may allow a candidate to sit a three hour
essay-type written paper in place of the Casebook.
ASSESSMENT OF THE CASEBOOK

1. Casebooks will be assessed as satisfactory or unsatisfactory.
2. Trainees who satisfactorily complete the Casebook, but are unsuccessful in the practical or
oral components of the examination, will receive a Casebook exemption when they re-sit
Part II.
3. Trainees who achieve a pass grade in the practical, but whose Casebooks are assessed as
unsatisfactory, will be exempt the practical and allowed to revise and re-submit the
Casebook. The Part II examination will not be complete until a satisfactory standard is
attained in the Casebook.
4. Trainees who produce particularly good reports may be approached with regard to the
inclusion of selected cases in a case-based teaching collection e.g., College website, or for

publication in the RCPA journal Pathology.
PART II PRACTICAL EXAMINATIONS
Histopathology practical
This exam involves 15 cases where, for some, the diagnosis may not be straightforward, and for
which there may be no definite diagnosis. Emphasis will be on rational and scientific
approaches to differential diagnosis as part of problem solving in diagnostic Anatomical
Pathology.
Candidates who obtain a borderline result in the practical examination will be invited to
participate in the oral examinations. However, they will be required to successfully examine and
form an acceptable opinion on an additional number of slides (6 to 10 cases) through discussion
of these cases across a double header microscope, with either the Chief or Associate Chief
Examiner or other senior examiner.
Cytopathology practical
In view of the difficulty in providing sufficient cytopathology slides from the same case, this
component of the examination is run as an OSCE-style examination (in which candidates
progress through a series of stations), similar to the Part I second special practical. The
examination comprises a 2 hour (plus changeover time) examination of 12 to 15 cases or
stations. This format may only be altered at the chief examiner’s discretion.
Most cases will represent examples of important and common diseases and classical less
common disorders that may be encountered in day-to-day cytology practice.
Candidates receiving a borderline mark for the cytopathology examination, who have completed all
other components of the Part ll examination satisfactorily may be asked to examine and form an
acceptable opinion on an additional number of cases through discussion of these cases across a
double header microscope, with either the Chief or Associate Chief Examiner or other senior
examiner.
This opportunity will be at the discretion of the Chief Examiner and will not be available to any
candidate obtaining a clear fail result for the cytopathology examination.
ORAL EXAMINATIONS
As the phase 1 and phase 2 components are primarily designed to assess different areas of the
candidate’s skills, passes in any one component will ordinarily exempt the candidate from that
component until the end of the next set of the examinations. At the discretion of the Chief
Examiner however, candidates re-presenting for any component of the examination may be
required to also re-present for an oral examination as the College has a duty to ensure that, at
the time of recommendation for Fellowship, the candidate has reached a standard required for
the “safe and independent practice of Anatomical Pathology”.
Candidates who are considered to be of borderline grade in both orals or who obtain disparate
results in the two orals, will be offered a third oral with the Chief and Associate Chief Examiners,
to be held as soon as possible after completion of the initial orals
CANDIDATES WITH EXEMPTIONS

• no candidate having obtained a fail grade in any component of the examination will ordinarily
• As the phase 1 and phase 2 components are primarily designed to assess different areas of
the candidate’s skills passes in any one component will ordinarily exempt the candidate from
that component until the end of the next set of the examinations. Exemptions for any one
component of the Part II examination are only valid for the next examination. Beyond this,
there must be re-application to, and approval by, the Board of Censors for any previously
granted exemption.
• Each component of each phase of the Part I examination will be assessed as pass,
borderline or fail.
• A borderline result in any component is NOT to be considered a “borderline pass”.
Any candidate with a fail in any component, or more than one borderline result at the completion
of the Part II examination will not be considered to have passed the Part II and must repeat all
borderline or failed components to complete the requirements for Part II.
RESEARCH STREAM
Trainees may opt for a research stream but must demonstrate competence in all aspects of
Anatomical Pathology to gain Fellowship. Trainees must apply to the Board of Censors
prospectively for project, laboratory and supervisor approval. The research must be considered
relevant and significant enough to lead to a PhD or MD by thesis.
Research Trainees will be required to undertake the Pathological Sciences Examination and
Part I and Part II examinations. At the Part II, the Trainee may be tested orally on the subject of
his/her thesis as well as being tested on gross and microscopic anatomical pathology. The
Board of Censors will consider each case individually and inform applicants of the examination
process required.
OVERSEAS TRAINED SPECIALISTS
For Overseas Trained Specialists exempted from Part I, the Part II Casebook may be replaced
by a Special Practical (equivalent to the Part I Phase 2 practical examination) as outlined above. At
the discretion of the Board of Censors, some Overseas Trained Specialists, particularly those
required to undergo further training before sitting for the Part II examination, may be required to
produce a Casebook and/or take a written examination, as well as sit the Special Practical
examination.
See Recognition of Overseas Trained Specialists at the front of this Handbook.
The College no longer offers special Part II Examinations slanted to Forensic Pathology,
Paediatric Pathology and Neuropathology.
Only those candidates who have obtained special permission from the Board of Censors
by 20 February 2006 will be entitled to sit for the slanted Part II exams
under the conditions outlined below.

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN ANATOMICAL PATHOLOGY
The following knowledge and experience requirements are to be read in conjunction with the
Table of Tasks, Learning Outcomes, Activities and Assessment in Anatomical Pathology, below.
PART I EXAMINATION
Stained Tissue Sections
• principles of tissue fixation
• principles of manual and automated tissue processing; detection of defects in H & E
• sections; correction technical errors responsible;
• stains for acid-fast bacilli, fungi and iron pigment; interpretation of stains such as those for
mucin, fat, RNA, muscle fibres, reticulin, elastin and collagen;
• approximately 2,500 accessions, including biopsies from medical and gynaecological cases
as well as surgical specimens.
Frozen Sections
• uses, limitations and artefacts of frozen sections
Autopsies
• sufficient experience in performing general and, where appropriate, special autopsies

including Coronial autopsies
• detailed knowledge of autopsy pathology
Cytology
• principles of exfoliative and aspiration cytology
• techniques of collection and methods of preparation
• experience in screening gynaecological smears and assessment of no fewer than 250

abnormal gynaecological smears and 250 non-gynaecological preparations
• experience in the performance, preparation and reporting of 30 fine needle aspirations.
Immunology and Immunohistochemical Techniques
• basic immunopathological changes in biopsies from kidney, bone marrow, skin, blood
vessels and the lymphoid system.

• principles of, and techniques used for the localisation of antigens in tissue sections e.g.
immunoperoxidase, immunofluorescence, in-situ hybridisation and FISH
Electron Microscopy, Cytogenetics, Flow Cytometry and Histochemical Techniques
• possible applications and proper method of tissue preservation for these special
morphological and cytological techniques
Record Keeping and Disease Indexing
• record keeping and disease indexing systems.
Safety Precautions
• procedures for staff protection against infections, e.g. HIV, viral hepatitis and tuberculosis;
• exposure to radiation from bodies or surgical specimens;
• toxicity of chemicals; and
• precautions against fire and other laboratory hazards.
PART II EXAMINATION
Preparation for Part II is as for Part I with the following additions.
Preparation, Interpretation and Reporting of Biopsy Cases
• a total of 7,500 accessions.
Autopsies
• substantial experience additional to that required for Part I, including hospital based,
Coronial and perinatal/paediatric autopsies, together with examination of the relevant
histological slides and generation of written reports on each case.
Cytology
• further experience in both exfoliative and fine-needle aspiration cytology, including both
gynaecological and non-gynaecological cytopathology.
• a total of at least three months full time equivalent experience in cytopathology during their
period of training.
AIDS IN THE ACQUISITION OF KNOWLEDGE

No single text or journal will be sufficient for preparation for examinations or for the practice of
Anatomical Pathology at consultant level.
Candidates should have access to at least one comprehensive text on surgical pathology and
autopsy pathology and one comprehensive text on cytopathology.
The texts listed below are not compulsory, nor do they necessarily cover all the Anatomical
Pathology that a Trainee should know and information for examination may come from books,
especially in the sub-specialty regions of Anatomical Pathology, and journals outside this list.
RESOURCE TEXT BOOKS
For surgical pathology, one of the following or a text of similar breadth and depth is suggested:-
Brunning, Richard D et al, Rosai and Ackerman's Surgical Pathology
Or
Silverberg, Principles and Practice of Surgical Pathology and Cytopathology
For Cytopathology, use one or a combination of the following to cover all aspects of
cytopathology:
Atkinson B (Ed): Atlas of Diagnostic Cytopathology, WB Saunders
DeMay RM: Practical Principles of Cytopathology, ASCP Press
DeMay RM: The Art & Science of Cytopathology, ASCP Press
Ramzy I (Ed): Clinical Cytopathology & Aspiration Biopsy: Fundamental Principles & Practice
Appleton & Lange.
Orell S. et al Fine Needle Aspiration Cytology
Solomon and Nayar (Eds) The Bethesda System for Reporting Cervical Cytology 2nd Edn,
Springer-Verlag
NPAAC Guidelines found at www.health.gov.au

Requirements for Gynaecological (Cervical) Cytology, 2004
Performance Measures for Australian Laboratories Reporting Cervical Cytology
Journals (this is a very limited list and Trainees should seek the advice of their Supervisor as to
appropriateness at each level of training).
General medical background
New England Journal of Medicine

Lancet
Medical Journal of Australia
Pathology/Cytopathology

American Journal of Surgical Pathology

Pathology
Journal of Pathology
Journal of Clinical Pathology
Seminars in diagnostic Pathology
Pathology case Reviews
Human Pathology
Acta Cytologica
Other Learning Resources
The “InView” set of teaching modules produced jointly by the RCPA and IPath Diagnostics, the
Queens University of Belfast, are recommended to Trainees as teaching adjuncts and are based
on an analytical approach to diagnosis.
Current modules include:-
• Breast Cytopathology
• Breast Histopathology
• Urine Cytopathology
• Uterine cervix histopathology
AFIP Series of Fascicles/Tumour Atlases
WHO Tumour Atlases
There are also numerous useful web sites which are available and Trainees should seek the
advice of their Supervisor as to appropriateness at each level of training.
TABLE OF TASKS, LEARNING OUTCOMES, ACTIVITIES AND

ASSESSMENTS IN ANATOMICAL PATHOLOGY
See over. This table must be read in conjunction with the Generic Curriculum, at the front of this
Handbook, and Knowledge and Experience to be Attained, above.

FUNCTIONS OF THE ANATOMICAL PATHOLOGIST AS MEDICAL SPECIALIST IN THE

LABORATORY
Potential Assessment
Methods
Tasks Learning Outcomes Learning Activities For all tasks the

components of the Part I
and part II RCPA exams are
important assessment tools
Accession, Specimen Acquisition • Read laboratory manual

Management - advise clinicians on appropriate choice • Participate in daily laboratory • Written Paper
and Processing and selection of specimens, and the activities • Viva Parts I and II
of Specimens limitations of any proposed investigation
Specimen Accession
- Demonstrate the knowledge • Read laboratory manual • Written Paper
required to establish and monitor a • Have a working knowledge of the • Viva Parts I and II
reliable method for specimen content of NATA/NPAAC or other
identification and laboratory relevant guidelines and where to
accession access the information
- learn to “trouble shoot” if error • Participate in daily laboratory
identified activities
Specimen Cut-Up
- photograph specimens (and • Read laboratory manual • Essay question Part I
indicate sites of block selection) • Participate in daily laboratory
when appropriate activities
- cut up specimens, and select • Read textbooks
blocks, appropriately
- know how to handle fresh
specimens and how to triage when
ancillary tests are required

- understand the occupational

health and safety issues of dealing • Part I essay question
with specific tissues • Part I and Part II viva
question(s) – to discuss the
Tissue Fixation principles and problems with
- select appropriate fixation regimes, and specimen processing and
be able to detect and correct errors in this • Read laboratory manual stains.
process • Spend sufficient time (minimum of
Embedding and Sectioning a week on at least three separate • Provide regular tutorials to
- select appropriate embedding and rotations) in the pathology scientific staff using cases that
sectioning techniques, and detect and laboratory learning about and being illustrate issues around
correct errors in these processes involved in tissue fixation, histochemistry and
embedding, sections, staining imunohistochemistry
Staining (including special stains, histo- and
- perform and interpret routine stains, and immuno-histochemistry) sections
detect and correct errors in these
processes
- select, perform and interpret appropriate
special stains, and detect and correct
errors in these processes
Histochemistry
- select appropriate fixation, preparation
and staining techniques, and detect and
correct errors in these processes
Immunology, Immunofluorescence and

Immunohistochemistry
- select appropriate preparative • Essay question in Part I
techniques for the localisation of antigens exam
in tissue sections, and detect and correct +/- Viva – part I and II
errors in these processes Part 1 special practical
Part 2 practical
Frozen Sections
- prepare frozen sections when

appropriate, detect and correct

technical errors and artefacts • Read laboratory manual Part I essay
- understand the occupational • Regularly accompany pathologists Part I special practical
health and safety issues to frozen sections – attend Part II cytology practical
- report frozen section results to sufficient frozen sections by Part I
surgeons via ‘phone or in theatre exam to achieve learning outcomes
and convey any limitations of the
information/interpretation
conveyed
Cytology
- select appropriate techniques for
collection and specimen preparation, and • Read laboratory manual. • +/- Essay question –part I
detect and correct errors in these • Textbook reading. exam
processes Part I special practical
Fine Needle Aspiration

- select appropriate preparative • Read laboratory manual.
techniques, and detect and correct • Textbook reading. • +/- Essay question – Part I
errors in these processes • Participate in daily laboratory exam
- understand the occupational activities- including attendance at
health and safety issues FNAs
- perform per-cutaneous fine needle
aspirations
Electron Microscopy • Participate in laboratory teaching

- select appropriate fixation, program for electron microscopy.
embedding, sectioning and • Read laboratory manual
staining techniques, and detect • Textbook reading
and correct errors in these • Participate in daily laboratory
processes activities.
- interpret results of commonly used
electron microscopy (esp. renal
EM)

Cytogenetics • Participate in laboratory teaching • Present autopsy findings at a

- demonstrate a working knowledge program for cytogenetics and flow departmental or
of appropriate fixation, preparation cytometry interdepartmental meeting
and staining techniques for • Read laboratory manuals. • +/- Essay question –part I
samples sent for cytogenetic • Textbook reading. exam
analysis • Participate in daily laboratory • Complete casebook
- know which units/consultants to activities related to selecting of requirements for Part II
contact for expert advice tissue for cytogenetics and flow • Complete Autopsy
cytometry assessment as required for
Fellowship
Flow Cytometry
- select appropriate specimen
preparation techniques, and
demonstrate a working knowledge
of interpretation/correlation of
results
Autopsies
- perform sufficient hospital and • Read laboratory autopsy manual.
coronial autopsies to be competent • Textbook reading
at these procedures and gain a • Participate in the department’s
good knowledge of anatomy and autopsy programme
macroscopic pathology • Read government guidelines of
- select appropriate specimens for ethical autopsy practice
ancillary investigations
- select appropriate blocks for Access relevant parts of the
histology Coroner’s Act
- demonstrate a clear understanding
of the occupational health and
safety issues
- write a competent autopsy report
with appropriate clinico-
pathological correlation
of which matters are reportable to
the coroner


of the pathologist’s responsibilities
under the Coroner’s Act relevant to
the Trainee’s area.
Production of (For Anatomical Pathology, the ‘data’ • Read laboratory manual

Laboratory comprise all specimens, blocks, • Participate in daily laboratory
Data sections and other specimens which activities
are available for examination and
review) • Read NATA/NPAAC guidelines
Storage and Specimen Storage • Read laboratory manual

Retrieval of - demonstrate a working knowledge of an • Read NATA and NPAAC
Laboratory appropriate specimen storage and guidelines
Data retrieval system • Participate in daily laboratory
activities
Specimen Retrieval
- retrieve specific specimens for
examination and review

- index specimens appropriately
- retrieve records relating to specific cases
or specimens
- retrieve specimens showing examples of
specific diseases or processes
Analysis of Autopsy • Participate in the department’s • Complete Autopsy

Laboratory - describe and interpret the macroscopic autopsy programme assessment as stated in
Data findings RCPA guideline
• Present autopsy findings at a
departmental or
interdepartmental meeting
Specimen Description • Read laboratory manual • Essay question - Part I exam

- describe and interpret gross • Participate in daily laboratory • Part I special practical exam
specimens accurately and activities
concisely
Microscopic Interpretation • Participate in daily laboratory • Practical slide exams - Part I

- examine describe and interpret activities. cases and reports initially and II
sections and specimens prepared drafted/written by the Trainee Part I special practical exam
by any of the techniques described should be examined/discussed
above (e.g.: FNA, frozen section, regularly over a “double head”
imprints, routine histochemistry, microscope with the supervising
immunohistochemistry, electron pathologist on a regular basis
microscopy) • Textbook reading
- provide clinicopathological • Participate in internal and external
correlation quality assurance programmes
• Present at departmental,
Interpretation of other specimens interdepartmental and hospital wide
- examine describe and interpret meetings
specimens prepared by other
techniques described above (e.g.:
cytogenetics, microbiology, flow
cytometry, molecular studies)
- provide clinicopathological
correlation
Accessing Information Retrieval • Participate in daily laboratory • Present a departmental,
Sources of - access appropriate information to activities interdepartmental meetings
Information assist in the interpretation of • Master use of search engines and • Viva exams – part I and II
specimens databases such as Medline
• Textbook reading
• Viva exams – part I and II

Developing an Professional Opinion • Participate in daily laboratory

Opinion (this is - on the basis of all the information activities

part of the (cytology, biopsy, autopsy, etc.) available
process of in relation to a specific case, develop and
interpreting lab. record a professional opinion as to the
Data) nature, causation, severity, likely
sequelae etc. of the pathological
process(es)
Communicating Reporting • Participate in daily laboratory

an Opinion (this activities
is part of the - construct and sign off a written report • Practical exams – Part I and
process of which contains all appropriate information • Have constructed and signed off II
interpreting lab. and inferences about the case (including sufficient cases to be competent at • Viva exams – Part I and II
Data) information on the reproducibility of the the level required for each of the
findings and knowledge and use of exam phases
grading systems), together with
responses to any specific queries
received from clinicians
- produce synoptic reports where
appropriate
- provide appropriate information and
inferences about a case to referring
clinicians by oral (face-to-face or
telephone) communication
- contribute appropriately to Grand
Rounds, clinico-pathological conferences,
morbidity and mortality reviews, and other
similar meetings
Monitoring Follow-Up • Participate in daily laboratory

Patient activities, specifically clinico-
Progress - where appropriate, follow up patient pathological correlation meetings
outcomes by consultation with clinicians, routinely held by the Department
in both hospital and general practice and ensure participation in
meetings covering a range of sub-

specialty interests

C HEMICAL P ATHOLOGY
INTRODUCTION
Chemical Pathology is that branch of pathology which deals with the diagnosis and management
of disease by use of chemicals present in the body fluids and tissues. Typically, Chemical
Pathology laboratories are the largest subunits in Pathology Departments and commonly
perform measurements of many different chemicals on hundreds of patient samples each day.
Because many of these analyses are time-critical, the Chemical Pathology laboratory is usually
highly automated and uses complex analysers which are capable of performing many analyses
in a short time frame.
Chemical Pathologists are responsible for running these laboratories, ensuring the quality of the
results, and providing a diagnostic service and advice to clinicians. This requires a sophisticated
knowledge of the pathophysiology of disease, the diagnostic value of individual tests, and also of
the laboratory and its working.
Because of the complexity of the laboratory, Trainees in Chemical Pathology spend a lot of time
leading to the Part I assessment learning about the laboratory, and about the instrumentation
and procedures in the laboratory.
A significant part of the work of the Chemical Pathologist entails verbal communication with
clinical colleagues, and for this reason significant emphasis is put on verbal communication skills
both in training and in assessment.
In 2004, the RCPA established a program with the Royal Australasian College of Physicians
(RACP) for Trainees to train jointly in Endocrinology and Chemical Pathology. Joint Trainees
will be required to demonstrate the same knowledge and learning outcomes, and undertake the
same assessment as pathology only Trainees.
The Chemical Pathologist needs the following traits:

strong aptitude for, and interest in, the scientific basis of medicine and laboratory work
leadership potential is essential, as is clinical experience, and candidates should have the
ability to combine their laboratory and clinical roles seamlessly
the use of information systems is an integral part of practice in chemical pathology, where
large amounts of numeric data are analysed. Familiarity with information systems and data
analysis is a necessary skill.

At the time Trainees complete the requirements for Fellowship, they should:
Have a sophisticated understanding of pathophysiology and be able to liaise with clinicians
Know the laboratory and be able to talk to scientific staff about the laboratory and its
problems
Know about management problems and be able to deal with staff problems and manage a
budget.
Stay up-to-date with new assays and new ideas arising in Chemical Pathology and move
beyond the bounds of a written curriculum.
A guiding principle in assessing the suitability of a candidate presenting for final examination is
“can this person function at consultant level?”
Despite the major elements of the practice of Chemical Pathology being spelt out below, the list
is not exhaustive.
To gain the FRCPA in Chemical Pathology requires 5 years of accredited training, and
satisfactory completion of the assessment program detailed below. No more than 4 years in the
one institution will be allowed (including for joint Trainees), except under very special
circumstances, and then only at the discretion of the Chief Examiner. Special dispensation from
the 4 year rule should never be assumed, it must ALWAYS be applied for AT THE START OF
TRAINING.
ENTRY REQUIREMENTS
• Pathologist only – 2 years of clinical work. Encouragement to do some continuing

clinical work.
• Joint training with Endocrinology – see details below. Trainees who wish to approach
joint training from Chemical Pathology should consult the Chief Examiner to discuss how
this will be achieved.
EXEMPTIONS FROM TRAINING TIME AND EXAMINATIONS
Trainees who have trained in areas of relevance to Chemical Pathology may be given some
credit towards their 5 years of approved training. For example, completion of the FRACP or
obtaining a PhD in a discipline relevant to Chemical Pathology will usually gain a one year credit
towards the 5 years of approved training. This credit MUST be applied for, through the Registrar
of the Board of Censors.
As a general rule, only Trainees who hold a Chemical Pathology fellowship from a similar
organisation to the RCPA, will be granted exemption from the Part I exam. Again, any
exemptions MUST be applied for through the Registrar of the Board of Censors.

JOINT TRAINING IN ENDOCRINOLOGY AND CHEMICAL PATHOLOGY

A joint training program is available in Endocrinology and Chemical Pathology, supervised by a
Joint Subcommittee of the Specialist Advisory Committee (SAC) in Endocrinology of the Royal
Australasian College of Physicians (RACP), comprising representatives of the SAC and
representatives of the RCPA.
DEFINITION OF SPECIALTY
Training is in an integrated discipline encompassing the diagnosis, investigation and

management of disorders of chemistry, metabolism and the endocrine system, together with the
techniques, management and administration of a Chemical Pathology laboratory.
GENERAL PRINCIPLES
1. Trainees will usually enter the joint program following after three years of basic physician
training, including success in the FRACP Written and/or Clinical Examinations.
2. Joint training takes 4 years.
3. Joint Trainees must be registered with registered with both the RCPA and the RACP and
are supervised by the Joint Subcommittee in Endocrinology and Chemical Pathology.
4. Laboratory training in Chemical Pathology is conducted by the RCPA and leads to the
award of FRCPA, and the ability to practise as a chemical pathologist. Clinical
endocrinology advanced training is conducted by the RACP and leads to the award of
FRACP and the ability to practise as a clinical endocrinologist. Paediatric endocrine
trainees must also complete the RACP’s paediatric mandatory requirements.
For regulations applying to training with the RACP, Trainees are advised to consult the
Requirements for Physician Training Adult Internal Medicine (the “Mango Book”) available on
the RACP website at www.racp.edu.au
COMPONENTS OF JOINT TRAINING
The program comprises:

• Clinical Endocrinology: 1 required clinical year.
• 2 laboratory years, each to include 80% of laboratory work and 20% of ongoing direct patient
care. A 3rd laboratory year in Chemical Pathology will be required and this should also
include ongoing direct patient care of at least 10% full-time equivalent.
• With prior approval by the Joint Subcommittee the 3rd laboratory year may be substantially
altered to allow the commencement of a PhD or MD.
Clinical Training in Endocrinology

Trainees are expected to acquire a depth and breadth of knowledge in clinical endocrinology
and metabolism, including diabetes. They must develop a detailed understanding of the
principles of endocrine physiology, biochemistry, cellular and hormonal metabolism.

Laboratory Training in Chemical Pathology

The Chemical Pathology component of training consists of 3 years of laboratory training with
allowance being made for 20% of time being in ongoing direct patient care during each year.
Training must be undertaken in laboratories accredited with the RCPA and supervised by a
Fellow of the RCPA, unless otherwise approved by the RCPA Board of Censors.
If joint Trainees start their 4 years of training with their required clinical year, then the Part I
examination will usually be taken in their third joint training year second year of laboratory
training) and the Part II examination in their fourth and final joint training year (third year of
laboratory training).
Research
Research, either clinical and/or laboratory, is a component of both Colleges’ training and
Trainees are encouraged to enrol as Trainees for a PhD or MD. All Trainees must satisfy the
clinical and laboratory requirements of the joint program, and training beyond 4 years is usually
necessary to satisfy RACP, RCPA and PhD or MD requirements.
Evidence of participation in research activities may include peer reviewed activities such as
Quality Assurance, presentation at scientific meetings, publications and/or progress towards, or
successful completion of, a PhD or MD thesis. Evidence of adequate and appropriate
involvement in research should be presented to the Joint Subcommittee prior to entry into the
last year of Joint Training.
ASSESSMENT
ASSESSMENT OVERVIEW
The assessment process comprises:

• a pass in or exemption from Pathological Sciences exam
• Part I examination, which may not be taken until the third year of training
• Part II examination, which may not be taken until the fifth or final year of training
• submission of 4 cases relating to Chemical Pathology practice, to which the candidate
has made a substantial contribution and which might be considered of a sufficient quality
for publication as a case report or similar in a quality journal. No more than 2 of the 4
cases may be on related material, e.g. investigation of genetic disease - if Trainees are
uncertain regarding the suitability of cases, they should contact the College BEFORE
writing them up.
• a review paper of approximately 3,000 words on a topic nominated by the Chief
Examiner after the candidate has registered for the Part II exams. This review must be
satisfactorily completed prior to Fellowship.

PART I ASSESSMENT
Whilst clinical elements feature prominently in all parts of Chemical Pathology training and
examination, the underlying goal for the Part I assessment is to ensure that Trainees have spent
time in the laboratory and absorbed the information there, such that they can appropriately mix
the laboratory/scientific and clinical elements of Chemical Pathology. Management will not
feature in the Part I examination, except where there is major overlap with scientific/technical
areas, such as Quality Control.
The Part I assessment has 6 elements, 5 of which are formally examined. These are:
1. 3 hour written paper on laboratory topics
2. 3 hour written paper on pathophysiology and clinical topics
3. 90 minute, 50 Multiple Choice Question paper
4. 2 hour written paper on practical problems
5. 2 x 20 minute vivas, each with 2 examiners
DETAILS OF PART I ASSESSMENT
Sample papers for each assessment are available on the RCPA website at www.rcpa.edu.au
1. Written Paper A:
3 hour written paper on laboratory topics with 5 questions:
1. short notes on 4 topics, which are reasonably straightforward - no choice.

3. short notes on 4 of 5 listed topics - these will be a little more searching.
4. 2 parts, both of which must be answered, i.e. no choice.
5. essay question, 1 of 2 choices.
2. Written Paper B
3 hour written paper on pathophysiology and clinical topics with 5 questions:

3. short notes on 4 of 5 listed topics - these will be a little more searching.
4. 2 parts, both of which must be answered, i.e. no choice.
5. essay question - select 1 of 2 choices.

3. Multiple Choice Paper with 50 questions

o all questions comprise a stem followed by 5 choices, to be marked true or false
o approximately 20 laboratory-related and 30 clinically-related questions
o marks will NOT be deducted for incorrect answers.
4. 2 hour practical paper on written problems

Comprises 20 questions dealing with practical problems relating to the laboratory. All questions
are of equal value. However, some may be more time-consuming than others.
Pass marks
The pass mark for written papers A and B will be 50%.
The pass mark for the multiple choice questions paper and the practical problems paper will be
60%.
The multiple choice paper is held at the same time as the written papers, whilst the practical
paper is held the day before the viva examination.
5. Viva examination
The viva will comprise 2 sessions of 20 minutes, each with two examiners. Questions may be
laboratory-related or clinical. Examiners will caucus, review and select the questions, and agree
on the basic items that constitute a pass for each question. The two pairs of examiners will
confer with the Chief Examiner on completion, to determine the outcome for the individual
candidate.
Trainees must pass all sections to be invited to a viva.
P A R T II A S S E S S M E N T
The Part II exam moves from technical/scientific elements to an integration of this knowledge
with clinical and managerial elements. Again, this exam can touch on any areas listed in the
Table of Tasks, Learning Outcomes, Activities and Assessment in Chemical Pathology, and in
the listing of Knowledge and Experience to be Attained, both below, but the emphasis is clinical
with a lesser emphasis on management. The scientific/technical elements are assumed to be in
place, and will not be further examined except in the context of addressing a particular clinical
problem. For example, in interpreting a set of discordant thyroid function tests, part of the
differential diagnosis may be a heterophile antibody interference. In this context, the technical
aspects of investigation for heterophile antibodies may be discussed.
The ultimate goal of this examination is to determine whether the candidate has the knowledge,
skills and communication ability necessary to function as a consultant.
The Part II assessment has four elements. These are:

1. 3 hour written paper
2. 2 x 25 minute viva exams, each with two examiners
3. Four case commentaries

4. A critical review on a topic nominated by the Chief Examiner
DETAILS OF P A R T II A S S E S S M E N T
Sample papers for each assessment are available on the RCPA website at www.rcpa.edu.au
Written Paper
5 question, 3 hour written paper, concentrating on clinical aspects of Chemical Pathology, but
management and, where appropriate, scientific aspects may be introduced where appropriate.
The 5 questions cover:
1. short notes on 4 topics which are reasonably straightforward - there will be no choice.
2. pathophysiology on 4 topics which are reasonably straightforward - there will be no choice.
3. short notes on 4 of 5 listed topics - these will be more searching.
4. 2 part question, both of which must be answered.
5. essay question - select 1 of 2 choices.
Viva
The Part II viva is the final determinant of performance and questions may cover any material in
the Chemical Pathology syllabus, although there will be a concentration on clinical matters.
The Part II viva is similar in structure to the Part I, including the preliminary selection of
questions and defining acceptable answers, and will comprise 2 sessions of 25 minutes, each
with 2 examiners. The 2 pairs of examiners will confer with the Chief Examiner on completion,
to determine the outcome for the individual candidate.

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN CHEMICAL

PATHOLOGY
Table of Tasks, Learning Outcomes, Activities and Assessment in Chemical Pathology, below.
Details of individual topics which must be covered are listed below. Please note that while there
is considerable detail below, it is not an exhaustive list. This is particularly so in the more clinical
areas where new assays and new concepts are continually being presented. It is the
responsibility of Trainees to read widely and be up-to-date with new concepts.
The different areas and the rationale for acquiring knowledge in these areas, are summarised
below.
1. TECHNICAL ELEMENTS
The Chemical Pathology laboratory is a highly technical area, with many different pieces of
instrumentation, performing analyses using a wide variety of physio-chemical techniques. The
Chemical Pathologist must have a significant understanding of these techniques, or he/she will
be unable to understand the nature of problems that arise in the laboratory, or make informed
decisions with regard to the selection of instrumentation.
2. STATISTICAL ELEMENTS
Much of the work of the Chemical Pathologist involves data manipulation. Our assessment of
the value and reliability of the tests we provide is defined by statistical parameters.
3. M A N A G E M E N T (R E F E R ALSO TO THE GENERIC CURRICULUM)
The Chemical Pathologist is a manager. Frequently there will be a staff of a dozen or more
people working under his/her control. Besides managing these people, the Chemical
Pathologist must be fully conversant with topics as disparate as budgeting, safety, privacy,
certification and quality, as well as having to represent the department to higher authorities.
4. I N F O R M A T I O N T E C H N O L O G Y (R E F E R ALSO TO THE GENERIC CURRICULUM)
Modern laboratories are highly dependent upon computing and laboratory information systems
to function effectively and efficiently. Installation of inappropriate equipment can be potentially
disastrous for an organisation, and the Chemical Pathologist must know enough to be able to
make informed decisions.
5. PHYSIOLOGICAL BIOCHEMISTRY

Before we can understand the pathophysiology of the diseases for which we provide testing, the
metabolic interconversions in a healthy individual must be understood. This includes some
basic knowledge of chemical structures.
6. PATHOPHYSIOLOGY
This is the area that is of most direct interest to us in the practice of our profession. It is
important that Trainees understand the breadth of subject material that they must cover. Do not
think that all you are required to know is covered in your own laboratory. Think of Chemical
Pathology in the widest context and understand that you must know about endocrinology,
therapeutic drug monitoring, paediatric and metabolic medicine as well.
7. R E S E A R C H (R E F E R ALSO TO THE GENERIC CURRICULUM)
Research has a vital place in the service Chemical Pathology laboratory. It is only by
undertaking small research projects that the Trainee can come to understand the difficulties in
formulating and answering even apparently simple questions. Undertaking research enables
Trainees to read papers in the literature far more effectively, and to understand the deficiencies
in the new tests and procedures which are continually mooted in the medical and scientific
literature.
DETAILS
1. TECHNICAL
For these technical areas, candidates should learn the principles of a technique and the
elements that go with its application. For example, for photometry, candidates should learn
about:
absorbance and transmittance
Beer’s Law
spectrophotometer structure
light sources
cuvettes
spectral isolation
detectors
wavelength calibration
troubleshooting and
applications.
Where specific assays are listed, candidates should be thoroughly conversant with all the
technical details relating to the assay as it is performed in their laboratory. For some assays, e.g.
TSH, this will require learning about a technique which can be widely applied, namely
immunoassay.
spectrophotometry water quality

flame photometry waste disposal

atomic absorption spectrophotometry point of care technology
mass spectrometry interferences
turbidimetry and nephelometry assays
osmometry o glucose
electrophoresis o bilirubin
isoelectric focussing o electrolytes
western blot o creatinine
ion-selective electrodes o calcium
chromatography o AST
enzymology o bicarbonate
principles of immunoassay o cholesterol
radioactivity o porphyrins
automation o TSH
nucleic acid specific technology o cortisol
specific analyte assay o albumin
centrifugation o aluminium
buffers o arterial blood gases
units of measurement
fluorescence Note: these are the most important analytes.
phosphorescence Others are also important and candidates
should be aware of them.
weight and volume calibration
pipettes
2. STATISTICAL ELEMENTS
general statistics how to evaluate data

theory of reference intervals sensitivity, specificity and predictive value,
quality control – internal and external ROC analysis
method evaluation Bayes theorem
functional sensitivity/detection limits etc Non-parametric statistics and their use
3. MANAGEMENT
Candidates are not expected to graduate as managers, but need to understand the basics.
It should be possible to develop this knowledge by participation in regular department
management meetings, observing laboratory preparation for NATA inspections etc.
Specimen reception Conflict of interest

Sample requirement, collection and ISO and Australian standards
handling (ISO for all countries)
Specimen identification Accreditation and certification

Quality management HIC related issues (Australia only)

Laboratory safety Clinical liaison
Privacy, confidentiality, legal issues,
ethical responsibilities
4. INFORMATION TECHNOLOGY
Chemical Pathology of all the divisions within pathology is the most heavily dependent upon
instrumentation and laboratory information systems. Some knowledge of this technology is
highly desirable to function efficiently within the laboratory.
instrument interfacing requirements of a laboratory IT system

flagging of results interpretive comments
5. PHYSIOLOGICAL BIOCHEMISTRY
Knowledge of metabolic pathways is essential to understand patterns of disease, and is the

basis upon which inborn errors of metabolism can be understood. Included in this area is the
knowledge of basic chemical structures, such as amino acids, glucose and creatinine.
carbohydrates electrolytes and the kidney

lipids urine composition and analysis
enzymes blood gases and pH
amino acids and proteins basic metabolism in the adult, child and
nucleic acids neonate
nutrition, trace elements and vitamins
(including iron)
6. PATHOPHYSIOLOGY
This is the major area of day-to-day work in Chemical Pathology. A good understanding of the
value of tests in the setting of disease is essential. This should be approached as a pathologist
and not as a physician.
For example, when considering a case with high TSH concentration as well as a high free T4, an
assay interference is much more common than a TSH-secreting pituitary tumour. Thus in the
differential diagnosis an interference should be listed ahead of the pituitary tumour in the list of
possible causes.
Do not think that all you are required to know is covered in your own laboratory. Think of
Chemical Pathology in the widest context and understand that you must know about
endocrinology, therapeutic drug monitoring, paediatric and metabolic medicine as well.
Acid-Base disturbance Porphyrins

Renal function Inborn errors of metabolism

Liver function Transplantation
Cardiac Therapeutic Drug Monitoring
Gastro-intestinal function Toxicology
Tumour markers Overdose – diagnosis and management
Haematological biochemistry and Fluids (ascites, CSF, pleural fluids etc)
coagulation Lipids
Endocrinology Pregnancy
o diabetes New markers of neurological disease
o pituitary Principles of newborn screening
o thyroid Population screening
o adrenal cortex Paediatric chemical pathology
o reproduction Autoantibodies
o adrenal medulla
o calcium
7. RESEARCH
It is only by undertaking research projects that the Trainee can come to understand the
difficulties in formulating and answering even apparently simple questions. Undertaking
research enables candidates to read papers in the literature far more effectively, and understand
the deficiencies in new tests and procedures that are continually mooted in the medical and
scientific literature.
scientific method
how to formulate a research question
how to evaluate an article
scientific writing
No one text or journal will be sufficient for preparation for examination, but the textbooks and
journals below are particularly likely to be useful. None of these are compulsory, nor do they
necessarily cover all the Chemical Pathology that a trainee should know - information for
examination may come from books and journals outside this list. In addition, there are many
web-based sites which are of value.
TEXT BOOKS
Baynes J, Dominiczak MH. (eds): Medical Biochemistry. Mosby, London, 1st edition, 1999.
Besser GM, Thorner MO (eds): Comprehensive Clinical Endocrinology. Mosby, 3rd edition, 2002.

Burtis CA, Ashwood ER, Bruns DE (eds): Tietz textbook of clinical chemistry. WB Saunders,
Philadelphia, 4th edition, 2006.
Fernandes J, Saudubray J-M, van den Berghe G. (eds): Inborn Metabolic Diseases. Diagnosis
and Treatment. Springer, Berlin, 3rd edition, 2000.
Fraser CG. Biological variation: From principles to practice. AACC Press 2001
Kaplan LA, Pesce AJ. (eds). Clinical Chemistry. Theory, analysis, correlation. Mosby, St Louis,
4th edition, 2003.
Larsen, Kronenberg, Melmed, Polonsky. (eds): Williams Textbook of Endocrinology. Saunders,

10th edition, 2003
Scriver, Beaudet, Valle, Sly. (eds). The Metabolic & Molecular Bases of Inherited Diseases.
McGraw-Hill, 8th edition, 2001.
Walmsley RN and White GH. A guide to diagnostic clinical chemistry. Blackwell, 1994.
Westgard JO. Basic QC Practices.Westgard QC, Inc. 2nd edition 2001.
Zilva J, Pannall P and Mayne P. Clinical Chemistry in Diagnosis and Treatment. Hodder Arnold
1994.
JOURNALS
Clinical Chemistry
Annals of Clinical Biochemistry
Clinica Chimica Acta
Clinical Biochemistry

Lancet
British Medical Journal
Medical Journal Australia
Internal Medicine Journal
Clinical Endocrinology Diabetes

Diabetes Care
J Clinical Endocrinology and Metabolism
Therapeutic Drug Monitoring
Pathology
American Journal of Clinical Pathology


ASSESSMENT IN CHEMICAL PATHOLOGY

FUNCTIONS OF THE CHEMICAL PATHOLOGIST AS MEDICAL SPECIALIST IN THE LABORATORY
TASK LEARNING OUTCOMES LEARNING ACTIVITIES POTENTIAL ASSESSMENT METHODS
THE PATIENT • Advise clinicians and patients on • Prepare (or update) patient • Short notes – preparation of patient
preparation for specific tests, e.g. information sheet in conjunction with for OGTT
explain to patient why they must the marketing division
attend for their OGTT and required to
be fasting
• Advise clinicians on the effect of • Auditing ICU patients’ outcome in • Essay on changes in laboratory
coexistent illness, e.g. explain to direct relation to TFTs. Participate in parameters in response to severe
resident why TFTs on patient in ICU ward rounds and discussion with illness
may be of little value clinicians
• Maintain patient confidentiality and • Participate in bench work, dealing • Essay about confidentiality issues in
privacy with general inquiries and actively testing, dealing with abnormal results
learn to maintain confidentiality and or sensitive tests
yet preserve excellent customer
service. Involvement with other
discipline, particularly microbiology
where particularly the issue of HIV
result is critical.
• Research involving ethics application

also rates confidentiality highly.
• Maintain patient safety and comfort • Involvement in performing various • Essay or Short answer regarding the
whilst performing tests and tests and procedures, especially consideration of patient care, safety
procedures where safety is a major issue such as and comfort during blood testing,
Sweat tests or insulin-induced particularly dynamic procedures.
hypoglycaemia test

ACCESSION, • Apply laboratory procedures for • Participate in daily laboratory • Essay – discuss different procedures
MANAGEMENT routine, urgent and out-of-hours work activities, review the workflow on a required to handle samples coming to
AND – analyse work flow and determine particular day to assess workflow in the lab routinely, urgently and out-of-
PROCESSING OF whether procedures are optimal your laboratory and identify any hours
SPECIMENS problems
• Using expert knowledge of value of • Partake in daily biochemistry duties • Essay – discuss appropriate
tests in different disease states, such as manning phone inquiries. laboratory testing of the patient
advise clinician as to appropriateness Deliver lectures or seminars to lab admitted for investigation of
of test and clinical staffs on an existing test hypertension or the assessment of
or the preparation for the introduction patients with porphyria
of a new analyte
• Ensure the appropriate collection is
made with regard to variables such • Participate in daily biochemistry • MCQ – analytes affected by different
as choice of anticoagulant, time of duties. Review of standard operating anticoagulants
day etc, e.g. explain to requesting procedures for various tests such as • Short answer – necessary
clinicians why OGTT should only be OGTT or short Synacthen test preparation of patient for OGTT
performed in the morning and
consequences of inadequate patient
preparation
• Ensure accurate patient identification • Document examples of problems • Essay: discuss policies with regard to
is made and sample labelling is resulting from inadequate patient acceptance or rejection of samples
sufficient identification. Educational seminar to deemed to be incompletely labelled
staff about the importance of correct
patient identification and subsequent
data entry
• Ensure specimen transport is • Self performing ‘experiment’ at bench • Essay – effect of delays in handling
appropriate to guarantee integrity and level to assess for the problem with after collection, upon integrity of
timeliness glucose or homocystine and delayed results for different analytes
separation

• Using knowledge of laboratory • Observe system problems when

information system, ensure that inadequate information is available
procedures for data entry include the
recording of adequate information on
both patient and sample.
• Short answers, practical laboratory
• Ensure accurate sample labelling and • Observe system handling of examination and/or CPDP recordings
appropriate sample preparation for inadequately identified samples.
analysis Identify any samples labelling that
may affect sample analysis or the
production of report such as dynamic
tests where the times recorded (both
absolute and relative) are critical for
interpretation and reporting
• Monitor workflow within the lab to • Map the workflow and optimise it
ensure that processed samples are
presented to appropriate
instrumentation for analysis
INSTRUMENTS • Ensure that appropriate • Participate in drawing up a tender for • Essay: discuss considerations in
instrumentation is used for analysis of a new analyser in the department or choice of new laboratory general
sample based on menu, throughput, in smaller point of care devices chemistry analyser
design of assays, quality
performance, financing and
laboratory physical constraints
ANALYSIS • Apply laboratory criteria for potential • Bench work assessment of • Essay or MCQ regarding the effects
sample rejection ‘abnormal’ samples which include of haemolysis and pre-analytical
haemolysis, severe lipaemia and consideration overall
exposure of bilirubin sample to UV
lights
• Follow laboratory procedure for • Bench work activity. Be wary of the • Essay – discuss the principles of

reagent handling shelf life of various reagents slide assays for general chemistry
analytes
• Explain the relative benefits and • Bench work. Performing routine
disadvantages of the unique design chemistry analysis on daily samples
and operating characteristic of a including various POCT devices.
particular instrumentation or Explaining to staff relative benefits
platforms and disadvantages of adopting a dry
slide chemistry system • What ways do various platforms
identify out of range samples?
• Monitor results to identify and prevent • Explain to staff potential problem with Identify ways (automatic or manual)
errors due to out of range samples misreporting analyte because in which this problem can be
exceeding linearity is not identified. overcome.
• Explain to clinicians and staff why it is Document a case where this may
important to be able to clearly define present as a potential misdiagnosis
limit of detection for analytes such as and henceforth management problem • Essay – Discuss theoretical and
Troponins and beta-HCG levels practical procedures for defining the
• Bench work (inquiries duty) power of detection limit for an
• Perform calibration procedures on as • Bench work - defining the limit of analyte. Differentiate between
many platforms and analytes as detection of a new assay functional and detection sensitivities
possible • Textbook reading
• Follow up of problem cases • Short answers – explain the purpose
and fundamentals in performing a
calibration procedure
• Review of laboratory internal QC
• Apply findings of Internal and procedures and update if required.
External quality control to laboratory Review of EQAP reports and any
procedures remedial actions

• Ensure appropriate determination of • Review various RI’s and compare • Essay – Compare and contrast the
reference intervals including the with other laboratories. Read ideal and practical ways of
practicality of applying such interval manufacturers’ inserts to assess their establishing reference intervals
to a new test way of establishing RI.
• Establish reference interval to a new Formatted: Bullets and

analyte Numbering
• Implement trouble-shooting • Bench work. Familiarise with • Essay or short answers – Discuss the
procedures as required corrective activities such as internal various ways of waste disposals in
quality controls are out etc… the laboratory
• Ensure waste disposal occurs in • Identify the ways in which the

accordance with laboratory laboratory disposes of various wastes
procedures and legislative including radioactive materials,
requirements infectious wastes etc… Review the
OHS standard in your state and
national.
• Ensure water supply and purification • Identify the source of water supply in • MCQs or short answer on water
measures meet quality control your laboratory. purification methods and identify
standards Review the grading of water where water may be a potential
purification in your laboratory and its problem to the validity of the results
quality control
• Ensure regular and preventative
maintenance of existing platforms • Bench work. Review and benchmark
the performance of a platform in
terms of breakdowns, reparation
frequency as distinct from planned
preventative maintenance
LABORATORY • Comply with the regulatory • Review or assess the laboratory as if • Essay – discuss the quality cycle in
ENVIRONMENT requirements of running a laboratory a NATA or quality audit organisation the Chemical Pathology laboratory or
with regard to NATA, HIC or relevant inspector and identify any problem the general structure of Pathology
accrediting authorities areas as part of a quality audit. services in your country

Critically review the last audit

assessment reports of your
laboratory and identify any
contentious issues
• Participate in budget planning and • Take part in drawing up an annual • Essay – discuss different ways in
ongoing monitoring department budget and identifying which a budget may be given to a
the fixed, variable and discretionary department and discuss the benefits
costs and disadvantages of each
• Participate in organising staff • Bench work, identifying any scientific

recruitment, training, continuing or personnel deficiency and put in a
education etc… business case for extra staff.
Organise the scientific staff
continuing education program and
provide list of learning objectives
associated with each presentation
• Monitor the organisation of the • Perform time and motion studies in

laboratory so that required work is your own lab and visit other labs of
handled most effectively and similar size and view their procedures
efficiently
VALIDATION AND • Implement staff training to ensure • Perform literature review on reported • Viva on external QC
REPORTING OF potential causes of error are identified test sensitivity and specificity data
LABORATORY – identify and record examples where and disease prevalence, estimate
DATA training deficiencies lead to lab positive predictive value
problems
• Demonstrate a detailed appreciation • Review departmental list of analytes • Essay on test limitations in specific
of test limitations when reporting and define appropriate reporting. clinical setting
results • Viva on specific tests and their

limitations in specific clinical setting

• Implement staff training to ensure • Give seminars to scientific staff giving
that clinically significant results are examples of consequences of failing
identified and communicated in to report individual analytes at
accordance with laboratory particular decision limits
procedures
• Record and verify result in accord • Review IQC in one area of lab
with laboratory procedures relating to • Explain consequences of
QC etc inappropriate QC limits in terms of
assay out-of-control
• Use laboratory information system to • Read textbook
design algorithms for reporting –
prepare algorithms for investigation of
different clinical scenarios
• Use these algorithms, alert limits etc,

to:
- identify results which need non-
routine action
- develop protocols for reflex testing
• Use department procedures to

ensure important results are
conveyed to appropriate clinician and
extra testing is performed if indicated

• Develop policies relating to printing of

results, considering especially
incomplete requests and site of
printing (e.g. ward)
• Develop procedures to ensure that

validated results go to printing
queues
MONITORING • Where laboratory results suggest • Follow up of patients • Viva

PATIENT developing disease, appropriately • Phoning out of abnormal/critical • logbook
PROGRESS monitor patient progress using direct results
visit or surveillance via laboratory • Participate in after hours roster
information system, so as to advise
clinician when further specific testing
may be warranted, or a specific
diagnosis becomes apparent.
STORAGE AND • Comply with the guidelines for • Read guidelines • Short answer question
RETRIEVAL OF specimens storage as set out in • MCQ’s
LABORATORY NATA/RCPA, IANZ, ISO or other
DATA AND relevant requirements.
SPECIMENS
• Index specimens according to
specific systems in use.
• Retrieve specimens showing • During assay evaluation retrieve

examples of specific diseases or selected specimens
processes for examination and
review.
• Retrieve records relating to specific • Using LIS, retrieve specimens with

cases or specimens. particular abnormalities for clinical

review
• Retrieve laboratory data from
information systems.
PERFORMING Apply the principles of operation, and Perform benchwork on • logbook
SPECIFIC where appropriate either perform the • Automated general chemistry • MCQ
LABORATORY specific analysis, or use the following analyser • Essay
PROCEDURES equipment: • high performance liquid • Viva
• Automated general chemistry chromatography
analyser • serum protein electrophoresis
• high performance liquid • atomic absorption spectroscopy
chromatography • polymerase chain reaction
• serum protein electrophoresis • blood gas analysis
• atomic absorption spectroscopy • immunoassay
• polymerase chain reaction • others
• blood gas analysis
• immunoassay
• others
DYNAMIC Be able to perform, or advise clinical staff • As far as possible • MCQ

TESTING on protocols for performance of dynamic • Perform the test • Essay
tests such as: • Review the guidelines together with • Viva
• Synacthen stimulation test other clinical disciplines
• Overnight dexamethasone (endocrinology)
suppression test
• Oral glucose tolerance test
• Ischemic forearm exercise test
• Water deprivation test
• Insulin hypoglycemia test
• Glucagon stimulation test
• Others
• Interpret the results of such tests to • Discuss interpretation with consultant • Logbook
the clinician and advise on further and relevant disciplines • MCQ

testing that is appropriate to elucidate • Essay

the clinical problem in question • Viva
ACCESSING AND • Access appropriate sites for relevant • Presentation in relevant journal club • Logbook
USING information, e.g. text books, journals, • Answering phone inquiries about new
INFORMATION electronic media, PubMed etc tests • MCQ
FOR SELF- • Essay
EDUCATION AND • Demonstrate critical faculties and • Viva
RESEARCH ability to assess validity and value of
published information
• Demonstrate ability to formulate and • Specific projects from supervisor • Demonstration of specific projects by
test hypotheses conference contributions, abstracts,
publications
DEVELOPING AN • Demonstrate deep knowledge of • Acquire knowledge of testing • Essay

OPINION value of tests in investigation of methodology, laboratory results, • Viva
specific clinical problems typical results in patients with the
relevant condition and integrate these
• Combine knowledge of test value experiences
with relevant clinical information to
form and record a professional • Patient review and opinion
opinion as to nature, cause, severity • Outpatient clinic attendance
and likely outcome of clinical • Participation in ICU or other ward
condition in question rounds (weekly meetings)
COMMUNICATING • Demonstrate when it is appropriate to • Participate in signing out • Logbook

AN OPINION add comments about a set of results • Participate in developing/adapting
on a written report, and be able to expert system • MCQ
add a concise and meaningful • Participate in QAP case comments • Essay
comment • Ringing out critical results to doctors • Viva
• Talk at grand rounds
• Demonstrate when it is appropriate to • Participate in QA meetings
communicate directly with a doctor

about a set of results
• Contribute appropriately to Grand

Rounds, clinico-pathological
conferences, morbidity and mortality
reviews, quality and audit committees
and other similar meetings.

C LINICAL P ATHOLOGY
INTRODUCTION
In 2004, as a result of ongoing discussions about the need for multi-discipline trained
pathologists, the College Council determined the need for the College to offer a fellowship in
Clinical Pathology. This would be in addition to the General Pathology fellowship which includes
Clinical Pathology plus Anatomical Pathology and Cytology. The objective is to meet a growing
need for pathologists who have the necessary skills to manage clinical pathology laboratories
and to interpret and communicate laboratory tests for referring clinical doctors.

The possible roles and requirements of the clinical pathologist include:
• as a supervising pathologist in an area hospital or branch laboratory of a large private
practice.
• sharing duties with general or specialist pathologists (most commonly anatomical
pathologists) in a district hospital or medium sized private practice;
• working in a teaching hospital or large private practice, either as a clinical pathologist in one
or more departments or, with additional training and experience, as a specialist in a single
discipline or as head of a department or director of a combined grouping of departments.

The clinical Pathologist needs the following traits:
an interest in both technical and scientific laboratory matters
interpretive and report writing skills
communication and interpersonal skills
the ability to combine test data from all investigations to assist in diagnosis and ongoing
patient management
capacity to work as part of a team of medical, nursing and laboratory personnel
capacity for leadership and management
GENERAL INFORMATION
• 5 year training program.
• The training would be divided into 2 sections and undertaken in the following order:
(a) 3 years of Core Clinical Training
(b) 2 years of ancillary skill training and consolidation of all skills.

• The 3 years Core Clinical Training would generally involve one year each to be spent in
Chemical Pathology, Haematology and Microbiology. This time would be spent
learning the core competencies in the individual areas. Smaller disciplines, i.e.
Genetics and Immunology, would be included in this period of training.
For this period of training the College may need to provide teaching materials and limit
accreditation to laboratories which can provide the required experience and rotation.
• The 2 years senior training would have an emphasis on the interpretation of results and
the appropriate investigative approach to a clinical problem or patient. Skill areas
covered would include people management, quality systems, informatics and
communication. This time would be spent consolidating and using the knowledge
learnt in the clinical areas through a senior role supervising testing and communicating
results to referring doctors (with an emphasis on interpretation of results).
• Rotations through different institutions would be encouraged.
ASSESSMENT
1. A practical assessment in the discipline would take place at the end of each year. This
will comprise a combination of hands on practical and theoretical practical asessment.
These assessments would be designed to assess any areas of weakness and confirm
that the Trainee is ready to progress from that discipline.
2. At the end of the 3 years core clinical training, there would be an integrated cross-
discipline written examination and viva.
3. Completion of the Fellowship would involve 2 exit vivas, one with a clinical focus and one
with a management focus, and a casebook (which would be compiled in the senior
years).

Journal names
Broad medical Journals
NEJM –New England Journal of Medicine
Lancet
MJA – Medical Journal of Australia
NZJM – New Zealand Journal of Medicine
Pathology Journals
American Journal of Clinical Pathology
Clinical Chemistry
Blood
Haematology
Infectious Diseases
Pathology
Australasian Association Clinical Biochemists
Journal of Clinical Microbiology
Clinics North America
Books
Tietz – Textbook of clinical chemistry and molecular diagnostics/edited by Carl A. Burtis,

Edward R. Ashwood, David E. Bruns. (2006)
Carl A. Burtis, Edward R. Ashwood (2000). Tietz Fundamentals of Clinical Chemistry.
Lawrence A. Kaplan, Amadeo J. Pesce, Steven C. Kazmierczak (2003) Clinical Chemistry:

theory, analysis, correlation [edited by]

Mandell, Douglas, and Bennett’s, (2005). Principles and practice of infectious

diseases/edited by Gerald L. Mandell, John E. Bennett, Raphael Dolin; with illustrations by
George V. Kelvin.
Mayhall , C.Glen. 1999, 2nd edition. Hospital Epidemiology and Infection Control
A. Kucers, S.M. Crowe, M.L. Grayson and J.F. Hoy. 1997 5th edition. The Use of
Antibiotics, A Clinical Review of Antibacterial, Antifungal and Antiviral Drugs.
Victor Lorian. 2005, fifth edition. Antibiotics in Laboratory Medicine.
Davidson’s Principles and practice of medicine (19th edition), editors, Christopher Haslett
[et al.]; International editor, John A.A. Hunter; illustrated by Robert Britton (2002),
(20th edition due July 2006)
Jacques Wallach [7th edition, 2000], [8th edition, 2006]. Interpretation of Diagnostic Tests
R.N.Walmsley, G.H. White (1994). A guide to diagnostic clinical chemistry
John Bernard Henry. (2001). Clinical Diagnosis and management by laboratory methods
Ronald Hoffman. 2005. Haematology; Basic Principles and Practice
Williams Hematology/ editors, Marshal A. Lichtman….[et al.] (7th edition, 2006)
Practical Haematology [edition 10] by Dacie and Lewis (2006)
Barbara Bain, Rajeev Gupta (2003). A-Z of haematology
Barbara Bain (1996). Slide Atlas of Blood Cells in Haematological Malignancy
Barbara Bain (2004). Beginners Guide to Blood Cells
Barbara Bain (2006). Blood Cells, A Practical Guide
James P. Isbister (1986). Clinical Haematology, A problem oriented approach.
Vinay Kumar, Ramzi S. Cotran, Stanley L. Robbins; with illustrations by James A. Perkins
(2003). Robins Basic Pathology
Harrison’s Principles of Internal Medicine/ editors, Dennis L. Kasper (et al) (2005)
Patrick R. Murray, Ellen Jo Baron, James H. Jorgenson, Michael A. Pfaller, Robert H.

Yoken. (2003). Manual of Clinical Microbiology (8th edition)

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN CLINICAL PATHOLOGY

Table of Tasks, Learning Outcomes, Activities and Assessment in clinical Pathology, below.

TASK LEARNING OUTCOMES LEARNING ACTIVITIES POTENTIAL

ASSESSMENT
Core Functions of the Clinical Pathologist as Medical Specialist in the Laboratory
Preanalytical • Advise clinicians on the appropriate • Providing advice to • Written/Viva.

Consultation choice and selection of tests and requesting clinicians (e.g. Describe the principles
samples, their relative diagnostic incoming phone calls) for and pitfalls of
strengths and the limitations of any test selection. appropriate test
proposed investigation • Preparation or updating a selection.
patient information sheet.
• Preparation of
information sheets for
referring doctors.
• Advise clinicians on the relevant samples
and preservatives required for specific • Participation in laboratory
tests: e.g. blood specimens, bone marrow testing protocols
aspirate & trephines, buccal swabs, CVS • Review/update current
biopsies, amniotic fluid, products of laboratory protocols and
conception, skin biopsy, muscle biopsy, collection room protocols
lymph node biopsy etc for handling and
preparing specimens
• Advise clinicians regarding appropriate prior to the specimen
specimen transport conditions for the arriving in the laboratory.
dispatch of samples, including timeliness
and temperature • Review of laboratory
manuals for consistency
between NPAAC
requirements and
laboratory protocols

Accession, • With reference to the relevant laboratory • Work in specimen reception

Management and procedure manual, apply the principles area
Processing of of:
Specimens - appropriate receipt, integrity and
validation of specimens in the laboratory
- specimen identification and laboratory • Evaluate turn-around times in
accession time critical tests e.g. APTT,
- appropriate specimen transport, identifying any source of non-
handling, storage, retention and conformance.
subsequent disposal
• Written/Viva
• Apply laboratory-specified work flow How does your
procedures to routine, urgent and out of laboratory select out-of-
hours work and determine whether they • Review documentation and hours procedures?
are optimal. practice. How do you assure
laboratory performance
of time critical tests?
• Select appropriate samples for integrity
and intended assay. • Supervisors report
and/or short essays on
• Evaluating different testing principles for
selection methods and acceptance of
technologies. specimens for analysis.
• Written/Viva.
Case scenarios
advising clinicians as to
appropriate testing
strategies.

Instrumentation &
• Apply the principles of test method • Work in laboratory areas. • Written/Viva.
automation
selection with reference to the Your laboratory is to
systems requirements for: implement a new test.
specimen analysis • Review internal and external What considerations do
performance QA/QC with senior scientists you take into account
- quality control and pathologists. for your patient
- calibration set up, including the population and work
development of normal and therapeutic practices?
reference ranges
- trouble shooting
- training
- reagent usage
- waste disposal
- costs
- service issues
- maintenance
- record keeping.
Microscopy and
• Set up and maintain laboratory • Undergraduate and scientist • Microscopy exam.
related skills
microscopes. teaching.
• Use light and other microscopy

appropriately.
• Record images for • Review of presentation

retention/teaching/manuscripts, etc, e.g. • Preparation of teaching by Supervisor
digital photography. materials.
• Casebook and/or
• Presentation at clinical posters
meetings

Production,
• Design, trouble-shoot and validate in • Specific projects to establish • Essay
Validation,
house, manual or automated tests or update validation materials What are the principles
Analysis and for all tests to the standard by which lab tests are
Reporting of required for regulatory validated?
Laboratory Data compliance
• Case book report of the
performance
characteristics of a new
• Ensure appropriate determination of test
reference intervals including the
practicality of applying such interval to a • Review various RI’s and • Essay
new test compare with other Compare and contrast
laboratories. Read the ideal and practical
manufacturers’ inserts to ways of establishing
assess their way of reference intervals
establishing RI.
• Record, verify, interpret and report
laboratory test results. • Establish reference intervals
for a new analyte
• Oral examination
• Participation in everyday questions on validation
laboratory duties. of laboratory tests
• Supervisor assessment
and feedback on reports
• Review test procedures and prepared by trainee.
prepare a report with
recommendations for future
local usage based on
literature review and analysis
• Identify potential causes of variation in of all methods and data
results including specificity, • Written /Viva.
- clinical sensitivity and predictive Describe the preanalytic
- non-clinical. values. variables which affect

the results of tests.

• Review causes of variation.
Discussions with
Supervisor
• Use the laboratory information system to

develop algorithms for Viva
production/validation of results, Assessment of use and
interpretative comments and knowledge of your
recommendations for further tests. laboratory IT systems
• Retain examples of reports and awareness of
• Apply the principles of action limits with commented on and validated alternative systems
regard to: by you.
- their development • Review action limits,
- application in the laboratory documentation and
- notification of abnormal results to compliance. • Written/Viva
pathologists and/or requesting What are the action
clinicians. limits for test reporting
in your laboratory and
• Maintain staff training to ensure that • Review training manuals. how are they
potential causes of laboratory error are implemented and used?
identified – identify and record examples
where training deficiencies lead to lab
problems. • Written/Viva
How do you ensure
• Maintain staff training to ensure that that your
clinically significant results are identified • Review and develop with laboratory staff
and communicated in accordance with Supervisors laboratory are suitably
laboratory procedures. procedures to identify and trained?
communicate clinically
• Demonstrate a detailed appreciation of significant results
test limitations when reporting results
• Perform literature review on • Discussions with
reported test sensitivity and Supervisor
specificity data and disease
prevalence, estimate positive

predictive value
• Record and verify results in accordance Written/Viva

with laboratory procedures relating to QC Discuss how you
etc evaluate a new test with
• Review departmental list of regard to its limitations.
tests and define appropriate
• Use department procedures to ensure QC/reporting. • Discussions with
that important results are conveyed to Supervisor
appropriate clinician and extra testing is
performed if indicated • Give seminars to scientific • Written/Viva.
staff explaining significance How do you as a
and consequences of clinical pathologist get involved
reporting. in the development,
implementation and
• Involvement in subsequent auditing of compliance
actions. E.g. Telephoning with action limit
Monitor workflow within the lab to ensure that requesting clinician with procedures in your
samples are processed and analysed in a recommendation for further laboratory?
timely fashion investigation.
• Participation in laboratory
testing programs and • Oral examination
turnaround time monitoring. question on appropriate
use of laboratory staff
resources to meet
patient/clinician
expectations
Storage And • Retrieve specimens showing examples • Retrieve specimens for

Retrieval Of of specific diseases or processes for review as part of daily work
Laboratory Data examination and review. practice.
And Specimens
• Retrieve laboratory data from information
systems.
• Using LIS retrieve reports

with particular abnormalities

for clinical review.
Developing an
• On the basis of all the information • Daily laboratory duties • Written/Viva
Opinion
available in relation to a specific case,
develop and record a professional opinion
as to the nature, causation, severity, likely
sequelae etc of the pathological
process(es).
• Seek further expert opinion as

appropriate • Preparation under
supervision of consultative
reports.
Communicating
• Construct and sign off a written report • Preparation under • Written/Viva.
an Opinion
which contains all appropriate diagnostic supervision of consultative Prepare a consultative
information and recommendations to the reports report/give a
requesting clinician in a timely fashion. consultative opinion on
various test
• Provide appropriate information and abnormalities and
inferences about a case to referring clinical conditions
clinicians by oral (face-to-face or
telephone) communication.
• Performance of daily • Discussions with
• Contribute appropriately to Grand laboratory and supervised Supervisor.
Rounds, clinico-pathological conferences, on-call duties.
morbidity and mortality reviews, quality
and audit committees and other similar
meetings.
Monitoring Patient
• Where laboratory results suggest • Follow up of patients • Discussions with

Progress developing disease, advise clinician Supervisor

when further specific testing may be • Ringing out of
warranted, or when a specific, abnormal/critical results
unexpected diagnosis or development
becomes apparent. • Participate in Supervised
after hours roster
• Predict and where possible assist in
prevention of adverse events.
• Review or implement systems for chronic

disease management programs.
Design a recall system for follow- • Supervisor assessment

up monitoring of patients with
e.g. diabetes mellitus
Discipline Specific Functions of the Clinical Pathologist as Medical Specialist in the Laboratory
CHEMICAL PATHOLOGY
Analysis • Explain the relative benefits • Bench work activity. Be wary

and disadvantages of the of the shelf life of various
unique design and reagents • Essay
operating characteristic of a Discuss the principles
particular instrumentation or • Bench work. Performing of various assays
platforms routine chemistry analysis on systems for general
daily samples including chemistry analytes
various POCT devices.
Explaining to staff relative
benefits and disadvantages
of adopting a chosen
chemistry system
• Perform calibration • What ways do various
procedures on as many • Bench work (inquiries duty) platforms identify out of
platforms and analytes as range samples?
possible • Bench work- defining the limit Identify ways (automatic

of detection of a new assay or manual) in which this

problem can be
• Textbook reading/ Journals overcome.
• Follow up of problem cases • Essay

Bench work. Discuss theoretical and
practical procedures for
defining the power of
detection limit for an
analyte. Differentiate
between functional and
detection sensitivities
• Short answers – explain

the purpose and
fundamentals in
performing a calibration
procedure
• Viva exams in
commenting on an end
of cycle report
• Ensure water supply and • Identify the source of water • MCQs or short
purification measures meet supply in your laboratory. answer on water
quality control standards Review the grading of water purification methods
purification in your laboratory and identify where
and its quality control water may be a
potential problem to
the validity of the
results
• Apply the principles of • Perform benchwork on

Performing Specific operation, and where o Automated general • MCQ
Laboratory Procedures appropriate either perform chemistry analyser

the specific analysis, or use o high performance liquid • Essay

the following equipment chromatography
o Automated general o serum protein • Viva
chemistry analyser electrophoresis
o high performance liquid o atomic absorption
and other spectroscopy
chromatography o polymerase chain reaction
o serum protein o blood gas analysis
electrophoresis o immunoassay
o atomic absorption o others
spectroscopy
o polymerase chain
reaction (PCR)
o blood gas analysis
o immunoassay
o point of care testing
(POCT)
o others
Dynamic Testing • Be able to perform, or As far as possible • MCQ

advise clinical staff on • Perform the test
protocols for performance of • Essay
dynamic tests such as: • Review the guidelines
o Synacthen stimulation together with other clinical • Viva
test disciplines (endocrinology)
o Overnight
dexamethasone
suppression test
o Oral glucose tolerance
test
o Water deprivation test
o Insulin hypoglycemia
test • Discuss interpretation with
o Glucagon stimulation consultant and relevant
test • MCQ
disciplines

o Others • Essay
• Interpret the results of such • Viva

tests to the clinician and
advise on further testing
that is appropriate to
elucidate the clinical
problem in question
HAEMATOLOGY
Perform Specific Clinical

• Perform sterile procedures • Perform procedures as part • Supervisors report to
Procedures
including bone marrow of daily laboratory and document candidate’s
aspiration, trephine training activities. May skill and experience in
biopsies, cannulation and require attendance and clinical procedures, e.g.
phlebotomy (including performance at other bone marrow trephine
venesection) with due laboratories. biopsy.
consideration of: • Be able to perform a clinical Trainees should undertake
- the individual patient’s assessment of a patient’s 50 bone marrow biopsies
condition and clinical suitability for a procedure
history • Supervisor Assessment
- benefits and potential • Satisfactory performance at a
risks CPR teaching session. • Written/Viva.
- clinical indications e.g. Discuss indications
- informed consent for and potential
- resuscitation procedures complications of bone
marrow collection
Performance and • Interpret and perform, where • Perform tests as part of daily
Interpretation of Specific appropriate, the following laboratory and training
Haematology Tests laboratory tests: activities. May require
o Full Blood Count attendance and performance • Written/Viva
- Morphology at other laboratories. e.g. Describe principles
o Special stains and pitfalls of testing of
o Bone marrow morphology various technologies
o Genotype studies • Retention of reported and

- Cytogenetics signed out cases Morphological Practical

- Molecular genetics exam including blood
o Erythrocyte studies films, bone marrow
o Haemolysis studies aspirate/trephine
o Coagulation studies biopsies and flow
o Blood transfusion studies cytometry cytogenetics
- Phenotype studies results on both
o Flow cytometry paediatric and adult
o Paediatric studies specimens excluding
o Miscellaneous studies • Performance of daily rare conditions
laboratory duties.
• Prepare and examine,
describe and interpret blood • Select and present slides to
and marrow aspirate and clinicians.
trephine films prepared by
any of the techniques
described in the
Haematology checklist.
• Select, perform and interpret

routine and special stains,
and detect and correct
errors in these processes.
Transfusion-related Skills
• Identification of donor and • Daily laboratory duties. • Written/Viva
recipient and pre Questions in relation to
transfusion testing. • Answering transfusion clinical and laboratory
• Donation/storage/transport/ related queries from clinician transfusion practice.
issues and scientists.
• Indications for blood
products (including
modification). • Wet transfusion
• Detailed knowledge of practical exam
storage and patient delivery
of blood and blood

products.
• Specification of blood • Instigating the investigation
products. of transfusion reactions and
preparing reports.
• Risk and Complications of • Perform all tests; include
transfusion training exercises at ARCBS
and other relevant labs.
• Laboratory testing, reporting
and documentation.
• Attend and contribute to
• Monitoring efficacy of Transfusion Committee
transfusion. meetings
• Provide clinical advice on

the appropriate selection of
blood and blood products • Transfusion exercises set
and their administration. within the laboratory.
• Perform blood transfusion

studies as listed in the
• Interpret blood bank results.
• Recognise, investigate and

manage transfusion
reactions and other
transfusion related adverse
events.
• Provision of urgent blood

and blood product support
• Participate in disaster and

emergency management

training
MICROBIOLOGY
Public health and preventive • Provide appropriate advice • Regular interaction with Public
medicine regarding detection, Health Units (or equivalent) • Formative assessment -
surveillance and specific item in formative
intervention with respect to assessment process;
infectious diseases of satisfactory participation
public health importance. prior to final
examination.
• Participate in regular
meetings with public health • Summative assessment
units (or equivalent) - a short question as part
of the exam. This
• Formulate strategies to means at least part of
investigate and manage the practical needs to
outbreaks of infectious include a notifiable
disease disease process.
• Notification of the detection of
• Ensure compliance with infectious agents in • Submission of a project
notification requirements accordance with local statutes which investigates a
substantive outbreak of
an infectious disease
• Provide immunisation
advice
Use of Antimicrobial Agents • Provide appropriate advice • Access relevant drug policies • Formative assessment -
on selection and use of in training institution supervisor’s reports
antimicrobial agents to
patients, colleagues and • Supervised clinical liaison e.g. • Summative assessment

institutional bodies telephone consultations or – compulsory questions

ward rounds
• Participate in institutional • Involvement in drug

drug committee activities committee activities
e.g. audits and meetings
• Implement, support and • Possible on-line tutorial (to be

develop antimicrobial developed)
control policy in training
institution • Attendance at relevant
session RCPA Update.

Infection Control • Provide appropriate advice • Access relevant infection

on infection control control policies in training • Supervisors report
measures to patients, institution
colleagues and institutional • Practical examination
bodies • Involvement in infection
control committee activities • MCQs
• Ensure compliance with
legislative and regulatory • Access state and national • Practical examination
framework in geographic guidelines, regulations and
area of practice legislation
• Participate in institutional
infection control committee
activities e.g. audits and
meetings
• Implement, support and

develop infection control
policies in training institution
• Implement, support and • Ensure practice of the

develop procedures for safe procedure to a level of
laboratory practice competency
• Liaise between laboratory

practice and infection control
requirements e.g. outbreak
surveillance, subtyping
• Prepare articles for

sterilisation by various
methods
• Operate an autoclave safely

and effectively
• Detect faults in heat-

sterilising apparatus
Perform specific clinical • Perform collection

procedures procedures including
o Urethral swabs
o Skin scrapings
o Blood cultures
o Dark field microscopy
o Naso-pharyngeal aspirate
o Others
Performance and Prepare and use routine stains Access relevant sections of the Questions in the written and
interpretation of specific appropriately laboratory manual practical examination on
microbiological tests critical specimens, e.g.,
Prepare specimens for CSF or urine.
microscopy
Participate in relevant • Ensure practice of the • Supervised satisfactory

laboratory activities procedures to a level of execution of each type
including, but not limited to: competency of staining procedure
- preparation of faecal and microscopy
stains and concentrates
- identification of ova cysts
and parasites
- preparation and
examination of skin
scrapings and other tissues
for fungal examination
- preparation and
examination of specimens
by Gram’s, acid-fast,

toluidine blue, India ink,

Giemsa and fluorescent
antibody stains
- preparation and
examination of blood films
for blood-borne parasites. • Access relevant sections of
the laboratory manual
• Select media appropriately
for specimen inoculation • Ensure practice of the
procedures to a level of
• Process specimens competency
appropriately
• Access relevant sections of
the laboratory manual
• Participate in relevant
sections of the laboratory, • Ensure practice of the
including but not limited to: procedures to a level of
- preparation of culture competency
media and agar plates
- plating out clinical
specimens
- setting up anaerobic
cultures and obtaining pure
cultures
- maintenance and
inoculation of tissue culture
for virus isolation
- detection of viral • Work-based
replication in tissue culture assessment by
- determination of TCID supervisor
values for viral isolates
- preparation of mycological • Practical examination
slide cultures
¾ Mycobacterial culture • Access relevant sections of • Practical examination
the laboratory manual using real time PCR
• Correctly identify organisms read outs.

by culture Ensure practice of the

procedures to a level of
• Participate in relevant competency
sections of the laboratory,
including but not limited to:
- performance and
interpretation of tests
commonly used to identify
microorganisms
- determination of viable
counts in bacterial
suspensions
- use of automated
apparatus to detect • Practical examination
bacteraemia
- identification of medically • Oral examination.
important fungi
• Identification of
mycobacteria
Satisfactorily execute and

interpret antibiotic
susceptibility tests
Satisfactorily execute and

interpret antifungal
Participate in relevant sections

of the laboratory, including
but not limited to:
- preparation and
interpretation of antibiotic
- detection of beta-

lactamases
- determination of the
bactericidal activity of
antibiotics or antibiotic-
containing serum
- determination of synergy
between combinations of
antibiotics
- performance of
antimicrobial assays on
blood and body fluids by
bioassay or other methods
Participate in relevant sections

of the laboratory, including
but not limited to:
- preparation and
interpretation of antifungal
antifungal agents
• Satisfactorily prepare
Storage, use and maintenance specimens, bacterial, fungal • Access relevant sections of
of laboratory equipment and viral isolates and the laboratory manual
mammalian cells for
retention and preservation • Participate in relevant
sections of the laboratory
• Use and maintain laboratory • Satisfactory
equipment, including but not • Ensure practice of the participation in relevant
limited to: procedures to a level of laboratory activities
- incubators competency
- centrifuges
- safety cabinets
- refrigerators

Performance and • Satisfactorily execute • Access relevant sections of Written exam, e.g. what
interpretation of specific serologic assays, the laboratory manual factors are important in
immunological and serological demonstrating familiarity deciding on a serology
tests with automated systems analyser
• Satisfactorily execute Ensure practice of the

molecular biologic assays, procedures to a level of
demonstrating familiarity competency
with automated systems
which should include, but is
not limited to:
- preparation, reading and
interpretation of assays for
the detection of antigens
and antibodies (including
methods such as
- agglutination
- precipitation
- immunoassay including
coeliac antibody testing
- complement fixation
- immunofluorescence
- tissue and nuclear
antibodies
-direct fluorescent
antigen(DFA) testing
Measurement of specific
immunoglobulins and other
proteins
- RAST testing
- immunoperoxidase

- immunoblotting
- extraction of nucleic acids
from specimens
- set-up of a PCR assay
- preparation and reading
of gels

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN CLINICAL PATHOLOGY

The following knowledge and experience requirements are to be read in conjunction with
the Table of Tasks, Learning Outcomes, Activities and Assessment in General Pathology,
above.
2. CHEMICAL PATHOLOGY
TECHNICAL
about:
Beer’s Law
light sources
cuvettes
spectral isolation
detectors
troubleshooting and
applications.
technical details relating to the assay as it is performed in their laboratory. For some assays,
e.g. TSH, this will require learning about a technique which can be widely applied, namely
immunoassay.


osmometry o glucose
electrophoresis o electrolytes
isoelectric focussing o creatinine
western blot o calcium
ion-selective electrodes o LFT
chromatography o Lipids
enzymology o troponins
principles of immunoassay o TSH
radioactivity o cortisol
automation o protein
nucleic acid specific technology o amylase
specific analyte assay o Drterial blood gases
centrifugation
buffers Note: Whilst these are the most important
analytes, others are also important and
units of measurement candidates should be aware of them.
fluorescence
phosphorescence
pipettes
STATISTICAL ELEMENTS

theory of reference intervals sensitivity, specificity and predictive
quality control – internal and external value, ROC analysis
M A N A G E M E N T (R E F E R ALSO TO GENERIC CURRICULUM)

management meetings, observing laboratory preparation for NATA / IANZ or other relevant
inspections etc.



Quality management Clinical liaison
Laboratory safety Intellectual property
Privacy, confidentiality, legal issues, Credentialing and Privileging
Regulatory compliance
I N F O R M A T I O N T E C H N O L O G Y (R E F E R ALSO TO GENERIC CURRICULUM)

Of all the divisions within pathology, Chemical Pathology is the most heavily dependent upon
instrumentation and laboratory information systems. Knowledge of this technology is
essential to enable the laboratory to function.

PHYSIOLOGICAL BIOCHEMISTRY

(including iron)
PATHOPHYSIOLOGY
Acid-Base disturbance Inborn errors of metabolism

Renal function Therapeutic Drug Monitoring
Liver function Toxicology
Cardiac Overdose – diagnosis and management
Gastro-intestinal function Fluids (ascites, CSF, pleural fluids etc)
Tumour markers Lipids
Haematological biochemistry and Pregnancy
coagulation Paediatric chemical pathology
Endocrinology Autoantibodies
o diabetes
o pituitary
o thyroid
o adrenal cortex
o reproduction

o adrenal medulla
o calcium
3. HAEMATOLOGY
Candidates for the examination must satisfy the training requirements of RCPA. They are
expected to have knowledge and understanding of the principles and practice of
haematology including but not confined to the following:
A. Laboratory Management
1. Organisation and work flow (Refer also to generic curriculum)
See chemical pathology section above.
2. Instrumentation and automation systems
Assessment of appropriate technology. This includes applying the principles

of selection of instrumentation with reference to:
light microscopy
phase contrast microscopy
automated cell counter
automated staining machine
automated or semi-automated coagulation instruments
electrophoresis (serum proteins, haemoglobin and for molecular studies)
pH meter
weighing machines
centrifuge (including cyto-centrifuge)
spectrophotometer
calibration and use of diluters and pipettes
flow cytometer technologies
point-of-care instrumentation
automated and semi-automated blood grouping and antibody screening
machines
3. Reagent and inventory control (Refer also to generic curriculum)
stock control, including monitoring of expiry dates

solutions preparation
4. Laboratory safety (Refer also to generic curriculum)
See above (chemical pathology).
5. Test repertoire and scope (Refer also to generic curriculum)
On the basis of current evidence, regularly review and replace tests in

use, or introduce new tests as appropriate.

B. Laboratory Technical Procedures
1. Morphology and Phenotype Studies:

Performance of sterile procedures including bone marrow aspiration,
trephine biopsies, cannulation and phlebotomy, including therapeutic
venesection, with due consideration of
- the individual patient’s condition and clinical history
- clinical indications
- benefits and potential risks
- informed consent
- resuscitation procedures
Preparation of blood films
Preparation of bone marrow aspirate films
Staining of blood and bone marrow aspirate and trephines including
special stains
Staining of blood and bone marrow aspirate with myeloperoxidase, Sudan
Black, PAS, specific esterase, non specific esterase, acid phosphatase
and NAP stains
Preparation of supravital stained blood films
Differential count on blood and bone marrow aspirate films
Preparation of comprehensive and systematic descriptive reports of blood
films, bone marrow aspirate films and trephines, including relevant
diagnostic features and interpretation, with summary and
recommendations for appropriate further testing.
Preparation and interpretation of thick and thin blood films for
demonstration of malarial parasites
Performance and interpretation of other malarial detection systems, e.g.
ICT
Selection of blood films for review and/or retention according to laboratory
guidelines
Manual leucocyte count
Manual platelet count, using phase contrast microscopy
Calculation of red cell “absolute values”
Haemoglobin estimation
Spun micro-haematocrit
Erythrocyte Sedimentation Rate
Immunophenotype or flow cytometry

Acute leukaemia
Lymphoproliferative disorders
CD34 cells
PNH
Platelet antibody studies
DNA ploidy studies
Foeto-maternal haemorrhage
Red cell membrane disorders
2. Genotype Studies

Cytogenetics
Karyotyping
Fluorescence In-Situ Hybridisation (FISH) studies
Molecular Genetics
Nucleic acid preparation
Restriction endonuclease analysis
Southern, northern and western blotting
Polymerase chain reaction, including quantitative estimation
Gene sequencing
Other relevant techniques as applied to the diagnosis and monitoring of
disorders encountered in haematological practice
3. Erythrocyte Studies
Serum iron, total iron binding capacity and ferritin measurements

Soluble transferrin receptor studies
Serum vitamin B12 assay and B12 binding
Serum and red cell folate assays
Intrinsic factor antibody measurement
Red cell mass / plasma volume
Erythropoietin measurement
Genotype testing for haemochromatosis
4. Haemolysis Studies
Plasma haptoglobin measurement

Examination of urine for haemosiderin, differentiation between
haemoglobulinuria, myoglobulinuria, and haematuria
Reticulocyte count – manual and automated
Screening tests for Glucose 6-phosphate dehydrogenase (G6PD) and
other enzyme deficiencies
Tests for red cell membrane disorders, including osmotic fragility,
autohaemolysis, acidified serum and others
Tests for PNH
Cold agglutinin titre, thermal amplitude, i/I specificity
Tests for haemoglobin stability, including heat and isopropanol
precipitation test
Haemoglobin electrophoresis as assessed by cellulose acetate
electrophoresis and quantitation by acid elution method or
High performance liquid chromatography assay
Quantitative assessment of foetal haemoglobin
Tests for haemoglobinopathies /thalassaemia, including Hb
electrophoresis series, quantitative assessment of foetal haemoglobin,
HbA2 assay, other abnormal haemoglobins and molecular studies as
above
Quantitative assays for red cell enzymes
Tests for Hb S
Heinz body preparation

Donath-Landsteiner test
Test for methaemoglobin and sulphaemoglobin
Oxygen dissociation curve measurement (P50)
5. Coagulation Studies
Coagulation testing using point-of-care instrumentation

Prothrombin time and international normalised ratio
Activated partial thromboplastin time
Thrombin time, heparin reversal and reptilase
Plasma fibrinogen measurement
Fibrin/ogen degradation products and cross-linked fibrin assays
D-dimer assays
von Willebrand factor studies
Antiphospholipid antibody testing (eg. Lupus anticoagulant, anticardiolipin
antibodies)
6. Blood Transfusion Studies
Blood grouping and antibody screening by manual, semi-automated and

automated techniques
Red cell phenotyping
Antibody detection, identification and titre
Direct antiglobulin test using “broad spectrum” and mono specific reagents
Indirect antiglobulin test using “broad spectrum” and mono specific
reagents
Elution of antibodies from red cells
Auto and allo-antibody absorption
Crossmatching procedures
Antenatal serology
Methods for detection of white cell and platelet antibodies
Histocompatibility testing, including tests for selection of donors for
transplantation
Tests for Hepatitis B, HIV and Hepatitis C detection, and other transfusion
transmissible diseases
Selection and preparation of blood components for transfusion purposes
Transfusion reaction studies
HLA – Antibody testing
7. Paediatric Studies
Practical and theoretical differences to laboratory management and

technical procedures when dealing with neonatal and paediatric samples.
This includes:
o Understanding the significance of age related reference ranges
o Small volume sample integrity and sample processing
o Crossmatching/provision of blood products for neonates
o Differing significance of morphological features in paediatric blood
films compared to adults.

Be able to apply the appropriate diagnostic investigations, from those

listed, to specific circumstances in neonates and children. For example:
o Neonatal jaundice
o T activation
o Haemolysis in children
o Megaloblastosis of infancy
o The bleeding child
o Childhood leukaemia
o Anaemia during infancy
8. Obstetric Studies
Be aware of the alteration observed through pregnancy in reference

ranges of haematology tests including peripheral blood indices
coagulation tests and Vitamin B12 levels
Be able to advise on
o transfusion requirements of pregnant women
o Allo-antibody detection and significance (red cells & platelets)
o Intra-uterine blood sampling
o Prevention of haemolytic disease of the newborn
o Antenatal testing e.g., for haemoglobinopathies including
choriovillous sampling and amniocentesis
o Principles of genetic counselling as related to hematologic disease
Be familiar with the laboratory aspects of pregnancy related conditions

including
o Hypercoagulability
o Thrombocytopenia, including HELLP and pre-eclampsia
o Recurrent foetal loss
9. Other Studies
Immunoelectrophoresis and immunofixation of serum and urine proteins

Cryoglobulin and cryofibrinogen detection
Viscosity measurements
B2 microglobulin
Serum lysozyme measurement
Infectious mononucleosis testing
4. MICROBIOLOGY
Taxonomy and biology of human pathogens
Taxonomy and biology of human pathogens, including ecology, evolution, metabolism

and replication
Pathogenesis of infectious diseases
How pathogens cause disease, host susceptibility and host responses.

Virulence mechanisms
Public health and preventive medicine
Epidemiology of infectious diseases
Demography and its influence on infectious diseases
Public health interventions in infectious diseases
Public health surveillance
Investigation of outbreaks of infectious diseases
Immunisation
Use of Antimicrobial Agents
Principles of pharmacokinetics and pharmacodynamics and their application to the use of

antimicrobial agents
Issues relevant to antimicrobial use and control in the context of institutional drug
committee activities
Ecological issues
Infection Control
Principles of infection control construed in its broadest sense
Legislative and regulatory framework
Role of laboratory in supporting infection control initiatives
Principles of safety with specific reference to the microbiology laboratory, including use of
sterilisation procedures
Pre-analytic phase: specimen selection, collection and transport
How the biology of microorganisms and pathogenesis of infection influences the optimal
sampling of human tissue for diagnosis
Regulatory framework surrounding the collection and transport of specimens and

microbiological materials
Pre-analytic phase: selection of tests
The principles, methodology and performance of tests which are available in a large

diagnostic laboratory
Analytic phase: microscopy
Principles of staining and microscopy
Analytic phase: culture
Principles of microbial culture, including selection and composition of culture media and
incubation conditions as applied to bacteria, fungi, viruses and parasites and
mycobacteria
Analytic phase: identification of microorganisms to a species level
Principles of identification and speciation of human pathogens, including bacteria, fungi,
viruses and parasites and mycobcteria
Analytic phase: non-culture detection of microorganisms (excluding microscopy)
Principles of serologic diagnosis of infection
Principles of molecular biologic diagnosis of infection

Analytic phase: susceptibility testing
Principles of susceptibility testing

Analytic phase: management of specimens, laboratory equipment and laboratory data
Principles underlying the storage and preservation of specimens and isolates
Regulatory framework governing retention of specimens and isolates
Quality controls for every method and reagent used in the laboratory
Operation and maintenance of equipment
Principles and regulatory requirements for storage and retrieval of laboratory data
Post-analytic phase: report generation
Principles involved in the formulation of an opinion and generation of a laboratory report,
including review, synthesis and interpretation of all relevant clinical and laboratory
information
Relevant regulatory framework

Post-analytic phase: report delivery
Principles involved in the delivery of test results.

F ORENSIC P ATHOLOGY
Please refer also to the general requirements for training and examinations set out at the
front of this Handbook, the Generic Curriculum and relevant parts of the Anatomical
Pathology chapter.
INTRODUCTION
Forensic Pathology is the subspecialty of Pathology that focuses on medicolegal

investigations of sudden or unexpected death. Forensic pathologists have a critical and
pivotal role in death investigation, examining the body of the deceased to define the cause of
death, factors contributing to death and to assist with the reconstruction of the circumstances
in which the death occurred. As with all medical consultations the diagnostic process
involves the forensic pathologist integrating evidence from the deceased’s medical history,
the supposed circumstances surrounding the death, the findings of post-mortem medical
examination (autopsy) and the results of laboratory investigations undertaken as part of the
autopsy. A post-mortem examination typically involves careful examination of the external
appearances of the body of the deceased, and dissection of internal organs and structures.
A sound knowledge of anatomical pathology is essential, particularly as microscopic
assessment of body tissues is often needed to enable a precise diagnosis. Forensic
pathologists work closely with other death investigators including Coroners, police and
forensic scientists; they may be required to attend scenes of death and are often required to
testify in court.
A forensic pathologist needs the following:

• broad medical experience, preferably including post-graduate experience in paediatrics,
anaesthetics and obstetrics/gynaecology
• sound knowledge in anatomical pathology
• good communication and interpersonal skills
• a methodical and analytical approach
• ability to practise as part of a team as well as autonomously
• a high level of self-motivation
• ability to formulate and articulate well-balanced views
• patience (as it is often slow, painstaking work)
• emotional stability
• an understanding of aspects of bereavement
• enjoyment of the scientific basis of medicine
• teaching skills
• an inquiring mind, to initiate ethical research

The “Outcomes of Training” and the “Knowledge and Experience to be Attained” are
elucidated in the RCPA Forensic Pathology Curriculum (see below).
In brief, at the time Trainees complete the requirements for Fellowship they should:
• have a sophisticated understanding and perspective of Forensic Pathology and its role in
death investigation
• be able to independently examine and report macroscopic and microscopic findings at

post-mortem examination of all types of Coroners cases
• be able to integrate subjective (i.e. history) and objective (i.e. post-mortem findings and
laboratory investigation results) information about cases, to provide a well-balanced
opinion to Courts, the Coroners and authorised investigators
• be able to clearly distinguish observation of fact from interpretation and opinion
• have sound knowledge of the legislative basis and ethical issues of forensic medical
practise, being an effective advocate on behalf of the deceased
• be able to liaise with other medical and scientific specialists, with a clear understanding
of their expertise
• understand, and regularly reflect upon, the limitations of forensic medical practise
• understand and promote the value of post-mortem examination of the deceased in the
provision of quality health care
• have a working knowledge of mortuary and laboratory management, particularly

recognising and advocating maintenance of Quality and OH+S procedures
• participate in, and be an advocate for, continuing professional development of all staff
• participate in teaching to trainees in Forensic and Anatomical Pathology.
At the final assessment (Part II) in Forensic Pathology, candidates should be aware that they
are required to convince the Board of Censors, through the panel of examiners, that they
have sufficient knowledge and experience for “the safe and unsupervised practise of forensic
pathology”, and that they are ready for appointment to a position as a specialist medical
consultant.
FORENSIC PATHOLOGY CURRICULUM

The practice of contemporary forensic pathology demands a life-long commitment to
continuing professional education and development. This curriculum provides a basis to that
commitment. An up-to-date knowledge of medical practice, each of the forensic sciences and
all of the pathology disciplines is needed to practise as a forensic pathologist, but a sound
knowledge of anatomical pathology is an essential prerequisite. Accordingly a substantial
part of a trainee’s initial training time is to be spent in accredited departments of Anatomical

Pathology (AP). Before commencing a training program, trainees and supervisors should
ensure that the required training in an accredited AP laboratory can be undertaken.
There are 3 streams available to practice as a forensic pathologist: 2 of the streams provide
Fellowship in Forensic Pathology; the third is post-Fellowship Diploma. Trainees should
consider carefully which of the streams is most suited to them – the choice could greatly
impact on any future wish to change career direction (eg a forensic pathologist who achieved
Fellowship in the FP1/FP2 stream should expect to require more re-training than the other
streams if wishing to later practice as an anatomical pathologist).
The 3 streams are:
1. FP1 and FP2. Trainees are required to spend at least 18 months of training in an
accredited department of Anatomical Pathology. The curriculum for this stream emphasises
knowledge of gross and light microscopic diagnosis in anatomical pathology and forensic
pathology but does not require the depth of knowledge that a practising anatomical
pathologist requires in more specialised areas of anatomical pathology (such as
cytopathology, needle biopsy diagnosis, molecular pathology, interpretation of
immunohistochemistry and electron microscopy). However, some knowledge is expected,
particularly of the indications for the techniques, the methods used and interpretation of
findings, especially with respect to tumour diagnosis.
2. AP1 and FP2. Trainees are required to spend at least 30 months of training in an
accredited department of Anatomical Pathology. The curriculum for this stream does require
depth of knowledge in more specialised areas of anatomical pathology – refer to Knowledge
and Experience to be Attained in Anatomical Pathology elsewhere in the Handbook.
3. Post-Fellowship Diploma in Forensic Pathology. Fellows in Anatomical

Pathology or General Pathology may sit the Dip For Path. Twelve (12) months of post-
Fellowship training in an accredited forensic pathology facility is required, together with
success in the Dip For Path examination (which is the same as the FP2 examination).
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN FORENSIC PATHOLOGY
the Table of Tasks, Learning Outcomes, Activities and Assessment in Forensic Pathology,
below:
Forensic Pathology1 AND Forensic Pathology2 STREAM
1. PRE FP1
Trainees are required to spend at least 18 months of training in an accredited department of

Anatomical Pathology. It is expected that most trainees will sit the FP1 examination in their
third year of training and will therefore have at least 18 months of accredited AP
training and approximately 12 months of accredited FP training prior to this examination.
During this time the trainee will be expected to have:
o paid attention to the requirements of the Generic Curriculum

o studied for and passed the Basic Pathological Sciences (BPS) examination
o studied General and Systemic Anatomical Pathology to a level that will enable
satisfactory completion of the FP1 examination (see below)
o studied introductory Forensic Pathology to a level that will enable satisfactory
completion of the FP1 examination (see below)
The following gives some guidance as to the topics to be studied and understood. The list is
not intended to be a complete of exhaustive syllabus, but is a guide to the breadth of
knowledge required. In particular it does not indicate the depth to which an individual trainee
will need to understand the field of knowledge.
1.1. General Anatomical Pathology
Much of this part of the curriculum will have been studied and understood in preparation for
the BPS examination:
1.1a Cellular adaptations, injury and death
1.1b Acute and chronic inflammation
1.1c Tissue renewal and repair: regeneration, healing and fibrosis
` 1.1d Haemodynamic disorders, thromboembolic disease and shock
1.1e Genetic disorders
1.1f Diseases of immunity
1.1g Neoplasia
1.1h Infectious diseases
1.1i Environmental and nutritional pathology
1.1j Introduction to diseases of infancy and childhood
1.2. Systemic Anatomical Pathology

Comprehensive and detailed knowledge and understanding of the pathology of organs and
regions is required, including congenital, inflammatory, degenerative, toxic, infectious,
proliferative and neoplastic disorders. Trainees should be fully conversant with all aspects of
aetiology, pathogenesis, classification, epidemiology, gross and microscopic pathology and
clinical features of the various disorders. For further guidance as to the scope of conditions
that may be expected to be encountered see Forensic Histopathology Curriculum below.
1.2a Vascular system
1,2b Heart
1.2c Haematological disorders
1.2d Lung and pleura
1.2e Head and neck
1.2f Gastrointestinal tract

1.2g Liver and biliary tract

1.2h Pancreas
1.2i Kidneys
1.2j Lower urinary tract
1.2k Male and female genitalia
1.2l Breast
1.2m Endocrine system
1.2n Skin
1.2o Musculoskeletal system
1.2p Central and peripheral nervous systems
1.2q Eye
1.3. Introductory Forensic Pathology

Trainees should have a sound practical knowledge of standard topics in forensic pathology,
such that the trainee could make well-considered and accurate consideration, approach and
diagnosis of a typical Coroners’ case. These topics include:
1.3a Coronial and non-Coronial post-mortem examinations
1.3b Cause, mechanisms and manner of death
1.3c Post-mortem changes
1.3d Estimation of time of death (post-mortem interval)
1.3e Sudden natural death
1.3f Blunt and sharp injuries
1.3g Asphyxia
1.3h Immersion/Drowning
1.3i Fires
1.3j Electrocution
1.3k Gunshot injuries
1.3l Hypothermia and hyperthermia
1.4 Office, Laboratory and Mortuary Procedures

1.4a Office Procedures, including
- Quality documentation for NATA accreditation
- mechanism for ensuring confidentiality

- documentation
1.4b AP and FP Laboratory Procedures, including
- methods of routine fixation, slide preparation and staining
- special stains
- immunohistochemistry (commonly used antigens)
- other procdures (eg EM)
1.4c Mortuary Procedures, including
- mechanism for ensuring confidentiality
- continuity of forensic specimens
- post-mortem procedures (see below)
2. POST FP1 and PRE FP2
It is expected that trainees will continue to deepen their knowledge of Anatomical Pathology
and broaden their understanding of Forensic Pathology during the 2 years that will ordinarily
separate the FP1 and FP2 examinations. By the time of the FP2 examination the trainee will
be expected to be able to give sophisticated consideration of diagnostic dilemma’s and
important medico-legal issues, formulating precise and well-considered judgements. In
addition to the topics listed above in the pre-FP1 curriculum, other topics that the trainee
should have a high level of competence in include. :
2a Sudden deaths in infancy, including
o use of death investigation protocols
o SIDS findings and investigations
o other types of infant deaths
2b Perinatal deaths and post-mortem examination
2c Non-accidental injury in children
2d Scene of death examination
2e Legal systems and Courts
2f The role of the expert witness and the second autopsy
2g Deaths during anaesthesia, medical procedure
2h Deaths in care of the State
2i Deaths in the workplace
2j Barotrauma and dysbarism, including

o air crash investigation

o investigation of death whilst diving
2k Explosive injuries
2m Disaster victim identification (DVI) and disaster preparedness, including
o mortuary design and preparedness
o 5 phases of DVI
2n Toxicology, including
o sample selection and preservation
o interpretation of measured levels in post-mortem samples
o toxicology of alcohol, cannabis, prescription drugs, non-prescription drugs and poisons of all
types
2o Forensic anthropology and odontology
2p The relevance of other pathology disciplines, particularly post mortem microbiology
and chemistry
2q Deaths in high profile people
2r Deaths in obscure circumstances
2s Deaths in suspicious circumstances
2t Homicide
2u Deaths with negative post-mortem examination findings, including
- subsequent investigations and actions
2v Maternal deaths
2w Injuries and deaths associated with sexual offences
2x Human rights investigations, including
o mass grave recovery procedures
o war crime investigation and the role of the pathologist and anthropologist
2y Investigation of transport and workplace deaths, including reconstruction of an
incident (eg motor vehicle crash)
2z Identifying, evaluating and discussing patterns of injury
2aa Bloodstain pattern interpretation
2bb Exhumation
The trainee will require specific experiences during the 5 yr period of training:
o an average of 150 to 200 Coronial post-mortem examinations (PME) annually
o PME of at least 5 homicide victims

o attendance at at least 15 scenes of death

o at least 30hrs of instruction in a forensic toxicology laboratory
o 3 to 6 months training in paediatric pathology
o experience in forensic neuropathology
o instruction in clinical forensic medicine
o at least 15hrs of instruction in a forensic DNA laboratory
o at least 15hrs of instruction in a field forensic science facility
o attendance at Court on at least 15 occasions
During training the trainee should understand the principles and work with experts in
a. Clinical pathology (e.g. microbiology, immunology, clinical biochemistry) to a
reasonable level applicable to forensic practice
b. Forensic anthropology
c. Forensic odontology
d. Forensic entomology
e. Forensic radiology
f. Forensic science
i. handling of evidence,
ii. ballistics,
iii. blood spatter,
iv. DNA/Molecular biology
v. Fingerprints
Advanced trainees should be proficient in the following dissection techniques
g. Evisceration and block dissection including head and neck
h. Organ by organ dissection
i. Removal of the brain & spinal cord in continuity
j. Dissection of the brain, fresh and fixed
k. Vertebral artery dissection
l. Facial dissection
m. Removal of the orbital contents (anterior & posterior approach)
n. Dissection of the middle ear
o. Anterior & posterior layer by layer neck dissection.

p. Cardiac dissection, standard, line of flow and conduction system

q. Dissection of Superior vena cava, subclavian and jugular veins
r. Subcutaneous dissection of trunk and limbs for occult bruising
s. Subcutaneous dissection for intravenous needle marks
t. Dissection of lower limbs and pelvis for deep vein thrombosis
u. In situ dissection of the vagina/rectum for sexual assault
v. Special paediatric and neonatal techniques
And should have a broad knowledge of the principles of Medicine relating to
a. Forensic Medicine
b. Medicine, medical treatment and procedures particularly cardiology
c. Surgery, procedures and complications, particularly cardiothoracic and
neurosurgery
d. Paediatrics particularly SIDS, congenital (including genetic) disease and child
abuse
e. Anaesthetics particularly death during anaesthesia
f. Obstetrics relating to maternal and perinatal death
g. Emergency medicine particularly acute treatment of trauma
h. Psychiatry in relation to suicide, mental illness and death in care
i. Occupational & Public medicine in relation to death & injury prevention.
And should have a though knowledge of artefacts which can be mistaken for ante and
peri-mortem injury or disease
And should have a high level of knowledge regarding workplace health and safety in the
mortuary in relation to infection control, and adverse psychological reactions in mortuary
staff.
And should be competent to advise police, forensic scientific staff and the coroner at
death scene examination in regard to
• Time since death including limitations
• Recovery of trace evidence on the body
• Re-creation of the circumstances of death
• DVI procedure
• Exhumation
• Handling the remains and related material
And should have a high level of knowledge of the law relation to forensic medicine
particularly
• The Coroners Act

• Human Tissue Act (or relevant act)

• Criminal law, including structure of the legal system, principles of criminal
law including mens rea and actus reus, homicide law (including child
destruction and abortion) together with the relevant defences, the law
relating to assault
• Courts
• Rules of expert evidence
• Report writing
And should have a strong grounding in ethical principles relating to
• Consent
• Organ retention
• Privacy
• Investigation of deaths in custody
• Provision of second opinions
• Investigation of war crimes, politically motivated deaths & crimes against
humanity.
And should understand the importance of interaction with the family of the deceased in
regard to
• Counselling in relation to bereavement
• Understanding loss and grief
• Providing relevant information arising from the autopsy, and
• Critical incident stress reactions
The Trainee must recognise their importance in death and injury prevention
The Trainee must learn to use information technology systems to store and retrieve data
and information for case related and research purposes and to educate the coronial
system, the courts, families and the public.
The Trainee should be committed to the advancement of ethical research in Forensic

Pathology and Medicine.
FORENSIC HISTOPATHOLOGY CURRICULUM
This list gives some guidance to conditions that may be expected to be encountered in
forensic pathology practice, and in RCPA examinations in forensic pathology. It should not

be considered to be exclusive: candidates for examinations should therefore not limit their
preparation to only these conditions. Practitioners and candidates should be familiar with the
full range of the microscopic morphology of these conditions.
ALL ORGANS/TISSUES
Infections - bacterial (eg TB, suppurative. Clostridia)

- viral (eg CMV, Herpes, Varicella)
- fungal (eg Aspergillus, Mucor, Candida)
- parasitic (eg Hydatid, Schistosoma)
Amyloidosis
Sarcoidosis
Neoplasia - leukamic infiltrate
- metastases
- common mesenchymal tumours
- Langerhans cell histiocytosis (Histiocytosis X)
Vasculitis
Infarction/Ischaemia
Systemic disease (eg Scleroderma, SLE)
Radiotherapy effect
Storage diseases (eg Gauchers)
HEART (additional to generic conditions above)
Valves - infective endocarditis

- myxoid/sclerotic degeneration
- chronic rheumatic fever
- papillary fibroelastoma
Pericarditis (eg fibrinous; carcinomatous)
Myocarditis (eg lymphocytic, eosinophilic, granulomatous, infective)
Muscular dystrophy
Sarcoid heart disease
Endocarditis and Pancarditis (eg Rheumatic fever)
SA node/AV node pathology
Neoplasia (eg Cardiac myxoma; rhabdomyoma)
Cardiac transplant rejection
Cardiomyopathy (eg ARVD, HCM)
Coronary arteries - dissection
- vasculitis
- aneurysm
- thrombosis
BLOOD/LYMPHATIC VESSELS (additional to generic list)
Vasculitis (eg PaN; Temporal arteritis, Syphilitic aortitis)

Aneurysm (eg Mycotic, Syphilitic, Dissection)
Common tumours (eg glomus, lymphangioma, kaposi’s, bacillary angiomatosis,
angiosarcoma)

LUNGS/PLEURA (additional to generic list)
Pneumonia (eg aspiration, lentil, CMV, Herpes, Adenovirus, Cryptococcal, Apergillus, Mucor,
Pnemocystis)
Lung abscess (eg fungal)
COPD and complications (eg mucoid impaction)
Pulmonary hypertension (with grading)
Embolism (eg amniotic fluid, neoplastic, bone marrow, fat,
cerebral)
Interstitial lung disease (acute and chronic – eg ARDS, asbestosis, cryptogenic organising
pneumonia)
Wegener’s granulomatosis
Sarcoidosis
IVI microgranulomatosis
Haemorrhagic disorders (eg Goodpasture’s)
Pneumoconioses (eg Anthraco-silicosis)
Transplant rejection
Common tumours (eg chondroadenoma, carcinoid, SCC, adenoCa, bronchoalveolar, Oat
cell, large cell anaplastic, mesothelioma, metastases)
Benign pleural plaque
HEAD AND NECK (additional to generic list)
Mouth
Ulcers (eg HSV, fungal infection, Wegener’s)
Tongue - muscular dystrophy
- amyloidosis
Crohn’s disease
Pyogenic granuloma
Neoplasia (eg SCC, melanoma)
Pharynx/Larynx
Pharyngeal infection/abscess (eg Actinomycetes, fungi, fusospirochatees)
Neoplasia (eg embryonal rhabdomyosarcoma, olfactory
neuroblastoma, nasopharygeal Ca)
Rhinocerebral mucormycosis
Angioedema
Neck
Branchial cyst
Thyroglossal duct cyst
Paraganglioma
Sialadenitis (eg CMV)
Salivary gland tumour (eg pleomorphic adenoma, adenoid cystic carcinoma, acinic cell
tumour)
Tonsils
Lymphoid hyperplasia
Actinomycetes
Suppurative tonsillitis
Neoplasia (eg lymphoepithelial tumour; non-Hodgkins lymphoma)

OESOPHAGUS (additional to generic list)
Oesophagitis, erosions, ulcers (eg Candida)

Varices
Barrett’s oesophagus
Muscular dystrophy
PSS
Neoplasia (eg SCC, adenoCa)
STOMACH (additional to generic list)
Acute gastritis (eg erosive, and variants such as emphysematous)

Chronic gastritis (eg eosinophilic, granulomatous)
Gastric erosions/ulcers (benign and malignant)
Wischnewsky spots
Hypertrophic gastropathy
Neoplasia (common epithelial tumours; MALT lymphoma; GIST)
INTESTINE (additional to generic list)
Infectious enteritis/colitis/enterocolitis (eg erosive, Amoebic)

Duodenitis/atrophy (eg Giardiasis)
Whipples disease
Pseudomembranous colitis
Crohn’s disease
Ulcerative colitis
Infestation (eg Enterobius vermicularis; Giardia)
Appendicits (eg Amoebic)
Diverticulitis
Neoplasia (eg adenoma, carcinoid, Ca, MALT lymphoma, GIST)
PERITONEUM/MESENTERY (additional to generic list)
Peritonitis
Torsion of appendix epiploicae
Fat necrosis
Decidualisation
LIVER (additional to generic list)
Hepatitis (eg alcoholic, Hep C, CMV)

Chronic active hepatitis
Massive hepatic necrosis (eg paracetamol)
Hydatid disease
Fibrosis/Cirrhosis (eg Alpha 1AT, haemosiderin, biliary)
Steatosis (eg Reye’s syndrome; pregnancy)
Cholangitis
Sinusoidal ectasia/peliosis hepatis

Veno-occlusive disease/central vein thrombosis

Nodular hyperplasia
Neoplasia (eg adenoma, HCC – common types, cholangiocarcinoma)
GALL BLADDER (additional to generic list)
Cholecystitis
Neoplasia
PANCREAS (additional to generic list)
Cystic fibrosis
Haemochromatosis
Acute and chronic pancreatitis
Ectopic pancreas in duodenum/Meckel’s
Neoplasia (eg Adenocarcinoma; endocrine tumours)
KIDNEY (additional to generic list)
GN (acute – common forms, and CGN)

APN/CPN
Malakoplakia
Tubular conditions (casts – eg myoglobin, Armanni- Ebstein lesion, ARTN)
Arteriosclerotic nephrosclerosis
Hypertensive nephrosclerosis
Diabetic nephrosclerosis
Cholesterol microemboli
Infarction
Infections (eg CMV, fungal)
Polyarteritis nodosa
Neoplasia (eg fibroma, Wilms’, RCC – common types, angiomyolipoma, oncocytoma, TCC)
Oxalate deposits (eg oxalosis, ethylene glycol toxicity)
Polycystic/multicystic disease
Tubulointerstitial disease (eg urate nephropathy, nephrocalcinosis)
Amyloidosis
Myeloma kidney
Microangiopathy (eg HUS)
LOWER URINARY TRACT (additional to generic list)
Cystitis (eg acute, suppurative, follicular,)

Schistosoma
Malakoplakia
Cystitis glandularis and cystica
Nephrogenic metaplasia
Neoplasia (eg TCC)
Testicular atrophy
Orchitis/epididymitis (eg TB)
Infarction of testis (eg torsion)

Neoplasia testis (eg germ cell tumours)

Prostatitis (eg suppurative, granulomatous,TB)
Prostatic abscess
Benign hyperplasia (+/- infarction, squamous metaplasia)
Neoplasia prostate
Neoplasia cervix, uterus and ovaries (common tumours)
Cervicitis
Endometritis, salpingitis (eg acute, chronic, TB)
Pregnancy
Tubal ectopic pregnancy
Pelvic vein thrombosis
Hydatidiform mole
BREAST (additional to generic list)
Mastitis (eg Acute, granulomatous)

Fat necrosis
Duct ectasia
Fibrocystic disease (common variants)
Lactating adenoma
Radial scar
Intraduct papillary lesions
Fibroadenoma
Phyllodes tumour
DCIS
LCIS
Invasive carcinoma (common types)
Pagets disease
Angiosarcoma
Gynaecomastia
PITUITARY (additional to generic list)
Rathke cleft cyst

Necrosis/infarction
Adenoma (+/- haemorrhage)
Craniopharyngioma
THYROID (additional to generic list)
Difffuse hyperplasia
MNCG
Thyroiditis (eg Lymphocytic, Hashimotos, De Quervain’s)
Adenoma – Follicular (and Hurthle cell)
Carcinoma (common types, including micropapillary)
PARATHYROID (additional to generic list)
Hyperplasia
Neoplasia – adenoma, carcinoma

ADRENAL (additional to generic list)
Adrenalitis
Adrenal haemorrhage
Cortical hyperplasia
Atrophy (Addison’s disease)
TB
Common tumours (eg cortial adenoma, carcinoma, myelolipoma, phaeo, neuroblastoma)
SKIN (additional to generic list)
Electrical injury
Bruise (age)
Gunshot injury
Common lesions – fibroepithelial polyp, seborrhoeic keratosis,
BCC, SCC, dermatofibroma, DFSP, naevi, viral lesions
Leukocytoclastic vasculitis
Infestations (eg scabies, dermatophytoses, insect bite)
Psoriasis
Eczema
Leprosy
Mycosis fungoides
Injection site
MUSCULOSKELETAL (additional to generic list)
Gout tophus
Nodular fasciitis
Fibromatoses
Common soft tissue tumours (eg lipoma, common sarcoma’s)
Osteoporosis
Renal osteodystrophy
Paget disease
Healing fracture (age of fracture)
Osteonecrosis
Osteomyelitis (eg suppurative, TB)
Common benign and malignant tumours of bone
Muscular dystrophy
Polymyositis
Rhabdomyolysis
Costochondral junction (infant)
BRAIN AND NERVE (additional to generic list)
Meningitis (eg acute, TB)

Encephalitis (eg HSV)
Cerebral abscess (eg fungal)
Rhinocerebral mucormysosis
Rabies

HIV-related menigoencephalitis
Spongiform encephalopathy (CJD)
Hypoxic-ischaemic encephalopathy
Fat/bone marrow embolism
Congophilic angiopathy
Demyelination (eg multiple sclerosis)
Tuberous sclerosis
Storage diseases
Subdural haemorrhage (age)
Traumatic axonal injury
Common tumours (eg meningioma, glial tumours, metastases)
EYE (additional to generic list)
Retinal haemorrhage
Meningitis
Common tumours
SPLEEN (additional to generic list)
Infarct
Septicaemia/splenitis
Perisplenitis
Mycobacterium avium-intracellulare infection
Angioma
Neoplastic infiltrate (eg leukaemia, NHL)
Storage disorder
LYMPH NODES (additional to generic list)
Epithelial cell inclusions

Follicular hyperplasia
Sinus histiocytosis and paracortical hyperplasia
Dermatopathic lymphadenopathy
Lymphadenitis (eg suppurative, granulomatous,
lipogranulomatous)
Sarcoidosis
Hodgkin’s lymphoma (variants)
NHL (common types)
BONE MARROW (additional to generic list)
Myeloproliferative disease
Multiple myeloma
Leukaemia
THYMUS (additional to generic list)
Hypoplasia
Thymoma
NHL/Hodgkin’s disease

PERINATAL (additional to generic list)
Periventricular leukomalacia
Chorioamniitis
Funisitis
Hyaline membrane disease
Necrotizing enterocolitis
Placental infarction
TORCH infections (myocarditis, encephalitis, hepatitis, etc)
TABLE OF LEARNING OUTCOMES, ACTIVITIES AND ASSESSMENT

See over. This table must be read in conjunction with the Generic Curriculum, at the front of
this Handbook, and Knowledge and Experience to be Attained, above.

Learning Outcomes Suggested Learning Potential Assessment

Tasks Activities Methods
Unless otherwise noted, For all tasks the
activities for all tasks will components of the Part
include: I and Part II RCPA
exams, the Casebook
• Seek and read legislation,
and the Autopsy are
codes, guidelines,
important assessment
policies, manuals and
tools.
literature (eg. NATA,
NPAAC, NCEAP Code)
• Participate in daily
departmental activities,
including all aspects of
forensic practice.
Discipline - Specific Functions of the Forensic Pathologist as Medical Specialist
Case selection/ Case selection/acceptance Refer to Coroners Act or Work based

acceptance and
• Advise clinicians and Coroner on appropriate equivalent. assessment
management
selection/acceptance of cases.
Case Accession For all outcomes below,

• Evaluate and monitor a reliable method for case/body refer to e.g., Australian
identification, mortuary accession and body discharge. Mortuary Managers’
Association Guidelines;
Case management NPAAC Guidelines or
• Manage bodies/cases through the entire process including equivalent.
associated procedures.
• Liaise with Coroner about level of death investigation and
associated procedures.
• Implement all OH&S requirements relevant to Trainee’s
involvement in death investigation practices and his/her
obligations to others.

Specimen Storage and Retrieval

• Ensure that specimens are stored according to an appropriate
system
• Access this system to retrieve specific specimens for
examination and review
• Ensure that specimens are sealed and marked to preserve the
integrity of evidence so that the Legal requirements for “chain of
custody” are fulfilled

• Index specimens appropriately
• Retrieve records relating to specific cases or specimens
• Retrieve specimens showing examples of specific diseases or
processes
Death investigation
• Participate in and evaluate death scene examination to provide Attend as many death scenes Work based
advice to police & coroner, etc. under supervision as assessment
• Review & evaluate medical records and other material relevant practicable.
to the death investigation. Arrange attendance at police
• Collaborate with medical and scientific colleagues and other crime scene investigation unit
death investigators. and/or death scene
simulations.
Autopsy
• Perform sufficient macroscopic adult and paediatric autopsies to
attain:

o high level of expertise in general procedures, including

- external and internal examinations
- evisceration, dissection and reconstruction procedures
- detection and objective description of macroscopic
abnormalities
o competence in special procedures, including:

- photography Exams
- estimation of time since death,
-evaluation of taphonomic processes
- appropriate use and evaluation of forensic radiology Comply with current RCPA
- detection and evaluation of neuropathology requirement for special
- spine, vertebral artery and neck dissection paediatric, neuropathology
- detection and evaluation of cardiac pathology and cardiac pathology
- detection and evaluation of obstetric pathology experience.
- sexual assault examinations
- handling and evaluating osteological /anthropological
specimens
- subcutaneous dissection.
o competence in performance of all types of forensic autopsy,

including homicide and special types such as: Exams
- aviation deaths
- diving deaths Work based
- deaths in custody assessment
- paediatric deaths
- maternal deaths
- high profile autopsies
- adverse medical events
- sudden unexpected death in infancy
- high risk infectious cases
- workplace death
- decomposed or skeletal remains, etc. Refer to Australasian DVI
Standards Manual and local
o competence in identification techniques and multi-fatality counter-disaster plan

incidents such as: manuals.

- terrorism and chemical, biological or radiological incidents http://www.interpol.int/Publ
- principles and aspects of the practice of odontology ic/DisasterVictim/forms/def
- disaster victim identification (DVI) procedures, DNA and ault
X-rays
Microscopy/Histology
• Undertake sufficient forensic histopathology to demonstrate a
high level of expertise in areas such as: Review and learning via
o sample selection multi-header microscope with
o tissue fixation consultants and other
o embedding and sectioning Trainees.
o staining
• Undertake sufficient forensic histopathology (i.e. histopathology

relevant to forensic practice) to demonstrate competence in
areas such as:
o histochemistry
o frozen sections
o relevant cytology and fine needle aspiration
• Demonstrate a high level of expertise in the interpretation of

forensic autopsy histopathology, including: Exams
o injuries: evaluation, healing and complications
o approaches to ageing injuries (skin, skeletal, visceral)
o cardiac histopathology of forensic significance
o neurohistopathology of forensic significance
o pneumonias
o identification of micro-organisms of forensic significance
o histopathology of IV and other drug use
o histopathological approaches to decomposition.
Other sampling
• Take and preserve appropriate samples from suitable sites for
toxicology and other investigations, with cognisance of

contamination and post-mortem processes, such as Organised interaction with

redistribution. toxicology laboratory.
• Apply medical science to death investigation, including:

o osteology and anthropology
o microbiology Organised interaction with
o biochemistry relevant laboratories.
o genetics, molecular biology
o haematology, etc.
• Apply forensic science to death investigation, including :

o general aspects (principles, procedures, continuity, etc)
o photography Organised interaction with
o at scene (photography, blood spatter, trace evidence, local forensic science
archaeology, exhumation procedures etc) facilities/courses.
o at autopsy (DNA, toxicology, ballistics, physical evidence,
entomology etc)
ommunication Reporting Consider Expert Evidence Work based

specific to the • Objectively record macroscopic and microscopic findings, Course (National Institute of assessment
Forensic Pathologist including relevant photography, so that another person at Forensic Science) or
another time can independently evaluate the autopsy/death equivalent.
investigation and come to their own conclusions. Exams
• Collate reports of other ancillary investigations. Access National Coroners
• Identify and evaluate relevant publications and similar cases Information System
from the archives of the institution or databases, implementing
the principles of evidence based practice. Review colleagues’ reports;
• Describe, summarise and interpret these reports, with positive interaction with toxicology
and negative findings, in the light of the circumstantial and facility.
clinical history, and with special attention to histological and
toxicological interpretation.
• Discuss these findings and/or reports with the supervising
pathologist

o at the time of autopsy

o at the review of histology and/or
o at the finalising of the report.
• Record a professional opinion about the cause of death, factors
contributing to the death and relevant aspects of the
circumstances of the death.
• Communicate relevant findings, reports and opinions in a timely

fashion to, inter alia, coroners, police, families, colleagues,
conferences, journals, courts and lawyers.
Attend pre-trial conferences
• Observe and evaluate discussions and expert evidence and courts.
provided by colleagues, demonstrating an understanding of the
rules of evidence and the role of the expert.
• Provide expert evidence as required; have performance Colleague/supervisor attend

reviewed and evaluated. to hear and evaluate
evidence provision
• Communicate orally and in writing at the level of the target
audience. Consider attending relevant
courses.
• With regard to the health implications of the death investigation,
communicate as appropriate with families, counsellors, Organised interaction with
clinicians and/or other relevant persons counselling services., families
• Participate in the provision of second opinions by senior

Prepare draft second
colleagues, demonstrating an understanding of the related
opinion(s).
special obligations and ethics.
• Refer and adhere to the law, relevant ethical codes and Refer to RCPA Position Work based
Professional Statement on Autopsies; assessment
guidelines relating to death investigation, provision of reports,
obligations specific National Code of Ethical
opinions and evidence, tissue and organ removal and retention,
to the Forensic Autopsy Practice; Human Exams
confidentiality, etc.
Pathologist Tissue Act or equivalent.

• Promote the value of the death investigation/autopsy and Cases presentations at

further its application in relation to: hospital rounds.
o public health and safety, including disease monitoring and Organised interaction with
prevention tissue bank/organ donation
o quality health care provision and quality control facilities.
o ethical provision of human tissue for transplantation
o teaching and research, etc.
• Promote the application of forensic pathology and related “The Missing”: ICRC website.
disciplines to circumstances of humanitarian need and abuses Minnesota Protocol
of human rights.
• Contribute to interagency planning and management of multi-

fatality disasters.

To gain Fellowship as a specialist Forensic Pathologist requires 5 years of accredited training in
the discipline, which includes a full-range of autopsy practise, histopathology and exposure to
the forensic sciences.
Depending on the stream selected by the trainee the training program must include at least 18
months (FP1/FP2) or 30 months (AP1/FP2) of training in accredited departments of Anatomical
Pathology. During this period of AP training trainees and supervisors are to ensure that
experience is gained in non-Coronial autopsies, a wide range of biopsy examinations and
reporting, and laboratory management: this experience should include a total of at least 6-12
weeks each of neuropathology, neonatal/paediatric pathology and gynaecologic/obstetric
pathology. There should be exposure to specialised techniques of histopathology, including
electron microscopy and immunohistochemistry.
The remainder of the training program is spent in accredited departments of Forensic Pathology.
Specific experiences during this time are detailed above.
ASSESSMENT
1 Formative Assessments
Training is monitored by annual approval of the training program and accreditation of each
completed year following receipt of a satisfactory Supervisors’ report.
A logbook (ie, a record of case work and learning oppurtunities and outcomes) is proposed; the
details are under review. In the meantime trainees are encouraged to maintain their own record
of activities and experiences.
2 Summative Assessments
The examination process includes:
Basic Pathological Sciences (BPS), any time prior to FPII
Anatomical Pathology Part 1 (AP1), which may not be taken until the third year of training
or Forensic Pathology Part 1 (FP1), which may not be taken until the third year of training
Forensic Pathology Part 2 (FP2), which may not be taken before the fifth year of training.
These durations refer to full-time training (or part-time equivalent) in accredited laboratories.
Each of the examinations should be considered as equal hurdles leading to Fellowship in the
discipline of Forensic Pathology. Briefly:
The BPS examination tests knowledge of the science that underpins disease processes (see
relevant section in this handbook)
The Part 1 examination may be the Forensic Pathology Part 1 examination (FP1) or the
Anatomical Pathology Part 1 examination (AP1) , depending on the stream of training selected
by the trainee. It is again emphasised that trainees should make this selection carefully, in the
full knowledge that the FP1/FP2 stream places a significant limitation on later scope of practice
(limitation to Forensic Pathology) and that lengthy re-training will be required if a later career
change is considered. Trainees who are uncertain should seek extensive counsel (eg
Supervisor; other Fellows; State Councillor; Trainees Mentor).
The AP1 examination tests knowledge of morbid anatomy (autopsy pathology), surgical and
medical pathology, and may include introductory forensic pathology. The examination is broad
164
based and could be expected to include a test of understanding of disease processes, the ability
to recognise and describe gross and microscopic lesions, competence in clinico-pathological
correlation, and knowledge of laboratory techniques, including occupational health and safety
related issues.
The FP1 examination similarly tests knowledge of all aspects of anatomical pathology, to the
extent that anatomical pathology underpins the practice of forensic pathology, but with lesser
emphasis on more specialised aspects (such as cytopathology, needle biopsy diagnosis,
molecular pathology, interpretation of immunohistochemistry and electron microscopy). The
examination will also test knowledge of introductory forensic pathology. The practical
examination of 20 histopathology slides will include a wide range of autopsy and large biopsy
cases (see Forensic Histopathology Curriculum above, for an indication of the scope to be
expected).
Trainees at FP2 level must show continued development and enhancement of their professional
skills and expertise in forensic fathology and anatomical pathology. The FP2 examination tests
the trainees ability to formulate and present diagnostic opinions on the full-range of issues and
cases encountered by a specialist forensic pathologist in daily practice.
Anatomical Pathology Part 1 Examination (AP1)
The examination comprises (see AP chapter):
Phase 1
A 3 hour essay-type written paper
A 4 hour practical examination of 20 cases that will consist entirely of histopathology slides
(biopsy, surgical and autopsy pathology). Full details are available on the RCPA website.
Phase 2
A 3 hour (plus changeover time) practical examination in which candidates progress through
a series of stations. This may comprise the following in any combination:
- Frozen sections
- Cytology cases (e.g. exfoliative and/or effusion fluid cytology and fine-needle
cytopathology)
- Histopathology (biopsy, surgical and autopsy pathology)
- Special stains
- Immunoperoxidase slides
- Photographs of immunofluorescence examination
- Electron micrographs
- Macro photographs, which may include forensic-based material.
Some cases might consist of multiple components (e.g. biopsy slides + immunofluorescence
photographs + electron micrographs).
Two 20-minute oral examinations.

A U T O P SY A S S E SS M EN T ( AL S O A P PL I ES T O FP1 E X A M IN AT I ON , B E L OW )
All candidates taking the API examination will be required to complete the Autopsy Assessment,
in order to demonstrate competency in autopsy technique and pathology.

• is a component of the AP1examination
• may be completed at any time after 15 months of training
• must be completed in addition to performance of a Coronial autopsy required as part of
the FP2 examination
Procedure
The full procedure and form for the assessment is available on the RCPA website (from the
Members site go to Publications and Forms/Document Library/Training and Exams – Exam
information).
The procedure will include:
- an introductory session with the assessors and candidate during which the candidate
could be expected to demonstrate adequate knowledge of relevant OH&S matters,
knowledge of correct completion of paperwork (consent etc.) and relevant knowledge
of any legislative requirements pertinent to the autopsy process or specific case being
examined
- the actual performance of an autopsy including demonstration of any required specialised
dissection of the main organ system involved in causation of death
- the interpretation of the macroscopic findings
- the selection of appropriate specimens for ancillary investigations
- the selection of appropriate blocks for histology
- the examination and interpretation of histological sections
- the submission of a written report including macroscopic findings, histological
interpretations and clinicopathological correlation.
It is strongly advised that the decision as to when to present for the autopsy assessment be
made by the candidate in consultation with his/her supervisor. Candidates should ensure they
have sufficient experience in autopsy performance before they present for the assessment. No
specific number of autopsies is required to be performed prior to presenting for the assessment
as the requisite number for competency to perform autopsies may vary from candidate to
candidate. However, it is suggested that the candidate have personally performed a minimum of
10 autopsies before presenting for the assessment.
Forensic Pathology Part 1 Examination (FP1)
The examination comprises:
Phase 1
A 3 hour essay-type written paper on Anatomical Pathology and introductory Forensic

Pathology which may include short answer-type questions.
A 4 hour practical examination of 20 cases that will consist entirely of histopathology slides
(large biopsy and autopsy pathology - see Forensic Histopathology Curriculum above, for an
indication of the scope). The answers will require a brief description of the morphology with
a diagnosis or preferred diagnosis; the conclusion may require a comment of further
investigations that may be necessary (eg special stains; immunohistochemistry) to enable a
precise diagnosis.

Phase 2
A 90 minute practical examination of introductory forensic pathology and anatomical

pathology that may include, in any combination:
- Gross specimens (museum preparations)
- Macro photographs of AP specimens and forensic pathology conditions
- Histopathology sections, including special stains
Some cases might consist of more than one component (eg gross and histopathology)
• Two 20-minute oral examinations
A U T O P SY A S S E SS M EN T
All candidates taking the FP1 examination will be required to complete the Autopsy Assessment,
in order to demonstrate competency in autopsy technique and pathology, in the same way as for
the AP1 examination (see detail, above). The assessment my be on a Coronial or non-Coronial
case.
Outcomes For Unsuccessful Candidates In AP1 and FP1

See table at end - Guidelines for Exemption and Progression in Forensic Pathology
As a guide, for the written paper, a fail grade is considered to be <46%, a borderline result as 46
to 50%, a clear pass as > 51% and a meritorious pass as > 60%.
It should also be noted that:

no candidate having obtained a fail grade in any component of the examination will ordinarily
ordinarily a candidate re-sitting the second special practical will be required to also attend
the oral examinations
a candidate cannot proceed to the FP2examination until all components of the AP1 or FP1
examinations have been completed successfully
The AP1 and FP2 examinations must ordinarily be sat in separate years, with the exception
of candidates in their 5th year of training who, having previously been unsuccessful at the
AP1 or FP1 examinations, pass the APl in their 5th year – these candidates may then attempt
the FP2 as an “exit” examination in the November round of examinations if the Chief
Examiner in FP agrees that these examinations will proceed.
• a candidate with any exemptions must pass all components of the AP1 and FP1
examinations within 5 years of the first attempt; otherwise the candidate will ordinarily be
required to re-sit the full examination.
Forensic Pathology Part 2 Examination (FP2) and Diploma in Forensic Pathology (Dip For
Path)

The examination comprises:

Phase 1
• A Casebook of 8 cases (or alternative, see below)

• An autopsy assessment (see below)
• A 3 hour essay-type written paper (see below)
• A 4 hour practical of 3 cases (see below)
Phase 2
• A 2 hour practical examination of forensic pathology and anatomical pathology,

comprising macro-photographs, possible gross specimens and histopathology (see
below)
• A 2 hour practical examination of 10 cases that will consist entirely of histopathology
slides (large biopsy and autopsy pathology – see Forensic Histopathology Curriculum
above, for an indication of scope). The answers will require a brief description of the
morphology with a diagnosis or preferred diagnosis; the conclusion may require a
comment of further investigations that may be necessary (eg special stains;
immunohistochemistry) to enable a precise diagnosis.
•
• Two 20 minute oral examinations
C A SE B O O K R EQ U I R EM EN T S
The Casebook comprises 8 cases. The aims are to produce for each case:
• a succinct presentation of no more than 10 pages (single spaced type) with the
discussion, clinicopathological correlation, at least twice as long as the remainder of the
presentation
• a bibliography of approximately 15 to 30 references and including recent peer-reviewed
literature
• a comprehensive and critical but selective appraisal of the cited literature
• high quality photomicrographs/illustrations
• expensive binding and production are not necessary and will not affect outcomes
The 8 cases presented in the Casebook should cover:
• the history surrounding the death

• the macroscopic and microscopic findings at autopsy
• the results of associated findings, such as toxicology, radiology, etc
• a discussion of the findings, and the mechanisms and cause of death

Repetition is to be avoided. The 8 cases should be chosen from the following categories (only
one case per category):
• sudden unexpected natural death due to natural cause

• obstetric death
• drug toxicity or asphyxiation
• accidental or sudden unexpected death in an infant
• homicidal firearm or stabbing death
• homicidal battering or homicidal asphyxial death;
• motor vehicular collision or pedestrian death;
• death from environmental exposure, starvation or immersion;
• death associated with fire or immersion,
• electrocution or lightning death
• death during medical procedure or associated with medical therapy
• death from injury, where injury interpretation assisted the investigation
• death in custody
• death in obscure circumstances
• unexplained death requiring comprehensive examination
• examination of skeletalised remains
PREPARATION OF THE C A SE B O O K :
• cases must have been handled personally by the Trainee as part of their supervised
training
• at least 2 cases must have been handled in the 12 months immediately preceding the
submission date
• the cases must not be used in any other Casebook at any time, or by any other Trainee
To this end, the Trainee will be expected to make the following signed and dated declaration at
the beginning of the Casebook:
I certify that the cases which comprise this Casebook were examined and
reported by me as part of my personal supervised practice during my
accredited training in Forensic Pathology. None has been used by any
other Trainee for any other Casebook. Cases …. and …. were reported by
me during the last 12 months. The case reports are original and have not
been reported in any other Casebook.
The Supervisor needs to make the following signed and dated declaration at the beginning of the
Casebook:
As the supervisor for Dr. …………………, I certify that I have audited the
cases that form this Casebook. Each case was examined and reported
personally by Dr. ……………….. during his/her training in Anatomical

Pathology, and Cases ….. and ….. were reported by him/her during the last
12 months. The case reports are original and have not been reported in any
other Casebook.
Alternatives to the Casebook
Trainees are encouraged to share their learning experiences, to the advantage of all
Forensic Pathologists. Accordingly each paper published in a peer-reviewed journal
or each oral or poster presentation at national/international meetings involving
forensic pathologists (e.g.: RCPA Pathology Update; IAP; ANZ Forensic Science
Society; Australasian Coroners Conference) can be substituted for 3 of the 8 cases
in the Casebook. The Trainee is required to be the principal author, the oral/poster
presenter, and had significant input into the publication/presentation. If the
presentation is a Case Report then the case must have been reported by the Trainee
in his or her practise during the period of training. A copy of the journal article or
presentation is to be included as part of the Casebook.
Candidates undertaking and completing a PhD thesis directly related to forensic

pathology during the training period may be exempt from up to 5 of the 8 cases in
the Casebook, providing the remaining 3 cases or publications are on subject matter
other than the topic of the thesis. The number of cases exempted will depend on the
breadth of the topic covered and will be at the discretion of the Chief Examiner.
SUBMISSION OF THE CASEBOOK
• Casebooks must be received at the College by 31 March each year, so that they can be
assessed in advance of the practical and oral examinations.
• two hard copies plus an electronic copy on CD must be submitted. Hard copies may be
spiral bound.
• Casebook results are ordinarily released when Trainees are notified of their progress to
the oral examination.
• revised Casebooks must be received at the College by 31 October each year, so that
the results are available for ratification at the November Board of Censors meeting.
• if revised Casebooks are not received by the due date, results may be held over until
the next year, in which case two new cases may be required to ensure at least two
cases were reported during the 12 months before the submission date.
• in exceptional circumstances, the Board of Censors may allow a candidate to sit a
three-hour essay-type written paper in place of the Casebook.
A S S ES S M E N T OF THE CASEBOOK
• Casebooks will be assessed as satisfactory or unsatisfactory.

• Trainees who satisfactorily complete the Casebook, but are unsuccessful in the practical
or oral components of the examination, will receive a Casebook exemption when they re-
sit FPII.
• Trainees whose Casebooks are assessed as unsatisfactory, will be exempt the
successfully completed components of the examination and allowed to revise and re-
submit the Casebook. The FP2 examination will not be complete until a satisfactory
standard is attained in the Casebook.

• Trainees who produce particularly good reports may be approached with regard to the
inclusion of selected cases in a case-based teaching collection e.g., College website, or
for publication in the RCPA journal Pathology.
Autopsy Assessment
All candidates taking the FP2/Dip For Path examination will be required to complete the
Autopsy Assessment, in order to demonstrate competency in Coronial autopsy technique and
pathology. Candidates who have previously successfully completed a Coronial autopsy
assessment as part of the AP1 or FP1 examination may be granted an exemption for this part of
the examination.

• is a component of the FP FP2/Dip For Path examination
• may be completed at any time after completion of the A1/FP1 P examinations
The procedure is the same as the Autopsy Assessment undertaken as part of the AP1/FP1
examinations.
Written Paper
The paper is the same format as that in the AP1/FP1 examination but with emphasis on on
more advanced topics and concepts in Forensic Pathology rather than Anatomical Pathology.
Practical Examination: Long Cases
The candidate will be asked to consider findings (history, examination and investigations) from 3
cases, and prepare a report to the Coroner, Court or authorised investigator.
Practical Examination: Short Cases
The candidate will be required to examine illustrated colour photographs of forensic cases, and
histopathology slides of forensic and medical post mortem significance. This may include a
series of photographs, museum preparations and a series of cases.
Oral Examinations
Two 20 minute examinations will assess the Trainees knowledge in Forensic Pathology and
capacity to logically discuss with peers issues of forensic significance. The focus will be
assessment of the Trainee’s integrative skills and ability to formulate and express an opinion.
As part of this examination Trainees may be presented with findings in one or more selected
Coronial post mortem examinations: the findings may include fixed organs and tissues;
histological slides; photographs - macroscopic or microscopic , including scene depictions;
radiological findings; test results; and statements concerning the circumstances of death.
G U I D E L I N ES FOR EXEMPTION AND P R O G R E S SI O N IN F O R E N SI C P A T H O L O G Y
See over.

AP1 and FP1 WRITTEN PAPER: MERITORIOUS PASS >60%; PASS >51%;
B/LINE 46-50%; FAIL <46%
See Anatomical Pathology section

PHASE 1 COMPONENTS PHASE 2 COMPONENTS
WRITTEN SLIDE OUTCOME PHASE 1 SPECIAL VIVA OUTCOME PHASE 2

PRACTICAL PRACTICAL
Pass Pass Proceed to Phase 2
Pass Pass Proceed to Forensic Pathology 2
Borderline Pass Proceed to Forensic Pathology 2
Fail Pass Resit 2nd phase – special practical and viva only
Pass Fail Resit 2nd phase – special practical and viva only
nd
Fail Fail Resit 2 phase – special practical and viva only
Pass Borderline Proceed to Phase 2
Pass Pass Proceed to FP 2
Borderline Pass Resit 1st and 2nd phase, exempt written
Pass Fail Resit 1st and 2nd phase, exempt written

nd
Fail Pass Resit 1st and 2 phase, exempt written
Fail Fail Resit 1st and 2nd phase, exempt written
Borderline Pass Proceed to Phase 2
Pass Pass Proceed to FP 2
Pass Fail Resit 1st and 2nd phase, exempt slides

nd
Fail Pass Resit 1st and 2 phase, exempt slides
Fail Fail Resit 1st and 2nd phase, exempt slides
Meritorious Fail Resit 1st phase,

pass exempt written

WRITTEN SLIDE OUTCOME PHASE 1 SPECIAL VIVA OUTCOME PHASE 2

PRACTICAL PRACTICAL
Pass Fail Resit 1st phase,

no exemptions
Fail Pass Resit 1st phase,

no exemptions
Borderline Borderline Resit 1st phase,

no exemptions
SPECIAL SITUATIONS AT PART I

Pass or 2nd fail Resit 1st phase,
previous exempt written on 3rd
pass attempt
Pass or 3rd fail Invite to 2nd phase Pass Pass Resit phase 1 slides, exempt written
previous with advice
pass
Borderline or Borderline Candidate for counselling/discussion with supervisor

fail or fail
Meritorious pass on Exempt phase 2

subsequent attempt special practical and/or
viva if previous clear
pass on special
practical and/or viva
respectively.
Otherwise, proceed to
phase 2

Borderline x 2nd fail Resit 1st phase

2 - current &
previous

AS THIS IS AN EXIT ASSESSMENT THERE IS NO BORDERLINE CATEGORY FOR FP2/Dip For Path EXAMINATION
PHASE 2
FP 2/Dip For Pathology COMPONENTS
PHASE 1 COMPONENTS
WRITTEN CORONIAL LONG CASES OUTCOME SHORT VIVA OUTCOME

AUTOPSY PRACTICAL PHASE 1 CASES
PRAC
Pass Pass Pass Proceed Pass Pass Recommend for Fellowship if Casebook
satisfactory
Pass Pass Fail Fail N/A N/A Resit 1st phase – exempt written and autopsy
Pass Fail Pass Proceed N/A N/A Resit Coronial inquest
Fail Fail Fail Fail N/A N/A Resit 1st phase– exempt autopsy and long prac
Pass Pass Pass Proceed Pass Fail Resit phase 2
Fail Pass Resit phase 2


See Anatomical Pathology section
Kumar V, Abbas A and Fausto N 2005. Robbins and Cotran Pathological Basis of Disease.
Elsevier Saunders (7th ed)
Key Texts in Forensic Pathology
Byard RW 2004. Sudden Death in Infancy, Childhood and Adolescence

(2nd ed) Cambridge
Byers, S.N. 2002. Introduction to Forensic Anthropology. Boston: Allyn and Bacon, Boston.
Cox, M. and Mays, S. 2000 (eds.) Human Osteology in Archaeology and Forensic Science.
London: Greenwich Medical Media
Di Maio, VJM 1999. Gunshot Wounds: Practical Aspects of Firearms, Ballistics, and Forensic
Techniques, (2nd ed). CRC Press Inc.
Di Maio, V.J.M. and Di Maio D. 2001, Forensic Pathology

(2nd ed) CRC Press Inc.
Dodd M 2006. Terminal Ballistics: a Text and Atlas of Gunshot Wounds. CRC Taylor and
Francis
Dolinak D, Matshes EW, 2002, Medicolegal Neuropathology: A Color Atlas. CRC Press
Drummer OH, Odell M 2001, The Forensic Pharmacology of Drugs of Abuse

Arnold Publishing
Henssge C, Knight B, Krompecher T, Madea B and Nokes L (eds) 1995, The Estimation of
the Time Since Death in the Early Postmortem Period, Arnold Publishing.
Karch SB 2001Karch's Pathology of Drug Abuse, (CRC Press)

Third Edition,
Krogman, W.M., Iscan, M.Y. 1986. (2nd ed.) The Human Skeleton in Forensic Medicine.
Springfield, Ill: Charles C. Thomas.
Mason JK, Purdue BN, eds.2000, The Pathology of Trauma, (3rd ed), Arnold Publishing
Payne-James J., Busuttil A., Smock W., (Eds) Forensic Medicine: Clinical and Pathological
Aspects. 2003. London: Greenwich Medical Media Ltd
Payne-James J., Byard R., Corey T., Henderson C., (Eds) 2005. Encyclopaedia of Forensic
and Legal Medicine. 4 Vols. London: Elsevier.
Ranson D., 1996. Forensic Medicine and the Law: An introduction. Melbourne: Melbourne
University Press
Saukko P Knight B, 2004. Knight's Forensic Pathology

(3rd ed ), Arnold Publishing.
Vanezis P., 1989. Pathology of Neck Injury. Butterworths.

British Medical Association, 2001. The Medical Profession and Human Rights: Handbook for
a changing agenda. Zed Books in association with the BMA.
Code of Practice and Performance Standards for Forensic Pathologists. Home Office Policy
Advisory Board for Forensic Pathology and The Royal College of Pathologists. November
2004.
Guidelines for the Facilities and Operation of Hospital and Forensic Mortuaries. NPAAC.
Commonwealth of Australia 2004.
Guidelines on Autopsy Practice. Report of a working group of The Royal College of

Pathologists. The Royal College of Pathologists. September 2002
Sudden Unexpected Death in Infancy. A multi agency protocol for care and investigation.
The report of a working party convened by The Royal College of Pathologists and The Royal
College of Paediatrics and Child Health. Chair: The Baroness Helena Kennedy QC.
September 2004
Journals
American Journal of Forensic Medicine & Pathology
Journal of Forensic Sciences
Forensic Science International
Meetings and Conferences:
RCPA Pathology Update
RCPA Short course in Forensic Pathology (Hobart)
RCPA Introduction to the Mortuary and the Autopsy (Glebe)
ANZ Forensic Science Society
Australasian Coroners Conference
Other Learning Resources
http://www.rcpath.org/index.asp?PageID=455
http://www.rcpath.org/index.asp?PageID=38

G ENERAL P ATHOLOGY
INTRODUCTION
General Pathology is a composite branch of pathology. It deals with the diagnosis and
management of disease by use of every component of laboratory medicine and every diagnostic
technique, including examination of the patient. General Pathologists are often responsible for
managing these laboratories, ensuring the quality of the results, and providing a diagnostic
service and advice to clinicians. This requires a sophisticated knowledge of the pathophysiology
of disease, the diagnostic value of individual tests and also of the laboratory and its workings.
General Pathologists must be familiar with the theoretical basis of investigation and the scientific
principles of anatomical, biochemical and physiological processes of the healthy human body
and the mechanisms that fail during disease. They must also have knowledge and experience
of the limits of investigative processes, pitfalls in measurements and in interpretation of
diagnostic techniques.
As much as any member of single specialties, the General Pathologist must be fully aware of
his/her limits of knowledge and prepared to consult. The corollary of this is that a General
Pathologist has a very broad basis of knowledge. The training is difficult and examination is
exhaustive, but the reward is much because it is possible to have a fuller understanding of the
patient and his disease, to be much more fully in touch with diagnostic possibilities.
The possible roles and requirements of the general pathologist include:
• as a supervising pathologist in a small area hospital or branch laboratory of a large private
practice.
• sharing duties with other general or specialist pathologists in a district hospital or medium
sized private practice;
• working in a teaching hospital or large private practice, either as a general pathologist in one
or more departments or, with additional training and experience, as a specialist in a single
discipline or as head of a department or director of a combined grouping of departments.

The General Pathologist needs the following traits:
the ability to combine test data from all pathology subspecialties to assist in diagnosis and
ongoing patient management

A consultant General Pathologist would be expected to:

• acquire basic training in all disciplines up to the ability to function as a consultant pathologist
in all disciplines
• appreciate when and how to refer and/or seek other opinions regarding problems in diagnosis
• deal with enquiries, handle immediate problems in the running of a department and authorise
the issuing of results and reports
• develop an overview of the inter-relationship between the varying pathology disciplines.
GENERAL INFORMATION
General Pathology Trainees must complete the equivalent of five years of full-time pathology
laboratory training, with no rigid requirements as to the time spent in individual disciplines. The
minimum training time required for any single discipline is the need to obtain a supervisor's
report showing adequate training and experience and demonstrating proficiency in practical
assessments. The majority of Trainees will spend a year each in Chemical Pathology,
Haematology and Microbiology and two years training in Anatomical Pathology.
The General Pathologist is expected to practise in a multidisciplinary capacity and to achieve

skills in all four major disciplines of pathology (Anatomical Pathology, Haematology, Chemical
Pathology and Microbiology). Periods spent in training in Immunology, Cytology or in approved
multi-disciplinary training in district hospitals or private laboratories are acceptable.
ASSESSMENT
The examination system normally consists of:
the examination in Pathological Sciences;
an examination in Morphological Pathology;
an examination in Clinical Pathology; and
individual Practical Assessments in Anatomical Pathology, Chemical Pathology,
Haematology and Microbiology. Relevant Immunology, Genetics and Molecular Pathology
will be included in each of these assessments.
Alternatively, the Trainee may apply to the Board of Censors to take:

the Pathological Sciences Examination; and
Part I examinations in any two of the single disciplines of Anatomical Pathology, Chemical
Pathology, Haematology, Immunology and Microbiology;
a viva voce exit exam to assess the candidate’s understanding of management issues and
quality systems as they apply to the pathology laboratory
OR
any one of the single discipline examinations and the examination in morphological
pathology or clinical pathology, together with the relevant practical assessments.

If a Part I examination is undertaken in Anatomical Pathology then training in General

Pathology must include the examination in Clinical Pathology and practical assessments
in Haematology, Chemical Pathology and Microbiology.
If a Part I examination is undertaken in a clinical discipline, then training in General

Pathology must include the examination in Morphological Pathology and the practical
assessment in Anatomical Pathology.
MORPHOLOGICAL PATHOLOGY AND CLINICAL PATHOLOGY EXAMINATIONS
For each of these there is a written examination and an oral examination each year.
Trainees may sit for the written examinations in whichever sequence they choose, and the
majority of Trainees will take them in their fourth and fifth years of training. Consideration will be
given to Trainees who request permission to sit one examination in their third year of training.
The examinations will be multi disciplinary.
Morphological Pathology
This exam will involve Anatomical Pathology, Cytology and Morphological Haematology. In
each of these disciplines a pathologist needs to recognise and describe abnormalities, to make
a diagnosis, and may need to fulfil a consultative role regarding further investigation and
therapy. The written examination will assess the Trainee’s ability to satisfy these requirements,
their depth of knowledge, perspective and capacity to present information clearly and concisely.
Clinical Pathology
The examination involves Chemical Pathology, non- morphological Haematology, Immunology
and Microbiology. The written examination will assess depth of knowledge, ability to function in
a consultative role and the capacity to organise and supervise in these disciplines.
The Clinical Pathology oral examination will reinforce these assessments and ensure Trainees
have adequate communication skills to function as both consultant and laboratory supervisor.
Material similar to that used in the practical assessments (see below) may be used as part of the
oral examination. Other material presenting diagnostic problems may also be included to check
the Trainees ability to assess such material.
THE PRACTICAL ASSESSMENTS
The intention of the practical assessments is to ensure Trainees can observe and recognise
abnormalities and that they are sufficiently familiar with basic routine laboratory procedure and
microscopy, so they are able to expand their knowledge and adapt to continuing change.
Practical assessments include material seen in a routine laboratory, or to be so characteristic or

of sufficient clinical importance that Trainees should be able to recognise it. The assessment
covers a wide range of material that will be clearly diagnosable and will include relevant
immunological material.
The assessment may take a number of forms. These may be a series of slides and sections
supplied to each Trainee at a single microscopy station, multiple choice examinations, or a
series of examination stations through which Trainees rotate. These individual stations can
involve calculations, collecting materials, data interpretation, laboratory equipment, laboratory

testing materials, microscopy, photographs, quality control material, and quality assurance
material. Hand calculators, slide rules and mathematical tables may be taken into these
examinations.
Credit for passing the examination in Morphological Pathology will be linked with passing the
practical assessments in Part I Anatomical Pathology and Haematology. Credit for passing the
examination in Clinical Pathology will be linked with passing the practical assessments in Part I
Chemical Pathology, Haematology and Microbiology.
Trainees may elect to sit for practical assessments from the first year of training onwards and
must present for practical assessments no later than the year after sitting the relevant multi-
disciplinary written and oral examinations. Failure in a single practical assessment undertaken
in the same year as successful written and oral examinations will not mean undertaking the
written and oral examinations again. However, repeated failure in an assessment, or failure in
more than one assessment, may result in the Trainee having to undertake the relevant written
and oral examination as well as the failed assessment or assessments.
Because the currency of an assessment is 5 years, if the relevant examination (Clinical or

Morphology) is not completed within 5 years of passing a practical assessment, it will be
necessary to either pass that assessment again or gain exemption from it.
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN GENERAL PATHOLOGY

Table of Tasks, Learning Outcomes, Activities and Assessment in General Pathology, below.
1. ANATOMICAL PATHOLOGY
STAINED TISSUE SECTIONS

principles of tissue fixation
principles of manual and automated tissue processing; detection of defects in H & E
sections; correction technical errors responsible;
stains for acid-fast bacilli, fungi and iron pigment; interpretation of stains such as those for
mucin, fat, RNA, muscle fibres, reticulin, elastin and collagen;
approximately 2,500 accessions, including biopsies from medical and gynaecological cases
as well as surgical specimens.
FROZEN SECTIONS
uses, limitations and artefacts of frozen sections
AUTOPSIES
sufficient experience in performing general and, where appropriate, special autopsies
including Coronial autopsies
detailed knowledge of autopsy pathology
CYTOLOGY
principles of exfoliative and aspiration cytology
techniques of collection and methods of preparation

experience in screening gynaecological smears and assessment of no fewer than 100

abnormal gynaecological smears and 100 non-gynaecological preparations
experience in the performance, preparation and reporting of 30 fine needle aspirations.
IMMUNOLOGY AND IMMUNOHISTOCHEMICAL TECHNIQUES

basic immunopathological changes in biopsies from kidney, bone marrow, skin, blood
vessels and the lymphoid system.
principles of, and techniques used for the localisation of antigens in tissue sections eg.
immunoperoxidase, immunofluorescence, in-situ hybridisation and FISH
ELECTRON MICROSCOPY, CYTOGENETICS, FLOW CYTOMETRY AND

HISTOCHEMICAL TECHNIQUES
possible applications and proper method of tissue preservation for these special
morphological and cytological techniques
RECORD KEEPING AND DISEASE INDEXING

record keeping and disease indexing systems.
2. CHEMICAL PATHOLOGY
TECHNICAL
about:
Beer’s Law
light sources
cuvettes
spectral isolation
detectors
troubleshooting and
applications.
technical details relating to the assay as it is performed in their laboratory. For some assays, e.g.
TSH, this will require learning about a technique which can be widely applied, namely
immunoassay.


osmometry o glucose
electrophoresis o electrolytes
isoelectric focussing o creatinine
western blot o calcium
ion-selective electrodes o LFT
chromatography o Lipids
enzymology o troponins
principles of immunoassay o TSH
radioactivity o cortisol
automation o protein
nucleic acid specific technology o amylase
specific analyte assay o Drterial blood gases
centrifugation
buffers Note: Whilst these are the most important analytes,
others are also important and candidates should be
units of measurement aware of them.
fluorescence
phosphorescence
pipettes
STATISTICAL ELEMENTS

theory of reference intervals sensitivity, specificity and predictive value,
quality control – internal and external ROC analysis
M A N A G E M E N T (R E F E R ALSO TO GENERIC CURRICULUM)

management meetings, observing laboratory preparation for NATA / IANZ or other relevant
inspections etc.



Quality management HIC related issues (Australia only)
Laboratory safety Clinical liaison
Privacy, confidentiality, legal issues,
I N F O R M A T I O N T E C H N O L O G Y (R E F E R ALSO TO GENERIC CURRICULUM)

Of all the divisions within pathology, Chemical Pathology is the most heavily dependent upon
instrumentation and laboratory information systems. Some knowledge of this technology is
highly desirable to function efficiently within the laboratory.

PHYSIOLOGICAL BIOCHEMISTRY

(including iron)
PATHOPHYSIOLOGY
Acid-Base disturbance Inborn errors of metabolism

Renal function Therapeutic Drug Monitoring
Liver function Toxicology
Cardiac Overdose – diagnosis and management
Gastro-intestinal function Fluids (ascites, CSF, pleural fluids etc)
Tumour markers Lipids
Haematological biochemistry and Pregnancy
coagulation Paediatric chemical pathology
Endocrinology Autoantibodies
o diabetes
o pituitary
o thyroid
o adrenal cortex
o reproduction
o adrenal medulla
o calcium

3. HAEMATOLOGY
expected to have knowledge and understanding of the principles and practice of haematology
including but not confined to the following:
6. Organisation and work flow (Refer also to generic curriculum)
See biochemistry section above.
Assessment of appropriate technology. This includes applying the principles of

selection of instrumentation with reference to:
light microscopy
pH meter
weighing machines
spectrophotometer
machines
8. Reagent and inventory control (Refer also to generic curriculum)

9. Laboratory safety (Refer also to generic curriculum)
See above (biochemistry).
10. Test repertoire and scope (Refer also to generic curriculum)
On the basis of current evidence, regularly review and replace tests in use, or
introduce new tests as appropriate.
10. Phenotype Studies

Morphology
- informed consent
Staining of blood and bone marrow aspirate with Romanowsky stains
Staining of blood and bone marrow for Iron
Black, PAS, specific esterase, non specific esterase, acid phosphatase and
NAP stains
films, bone marrow aspirate films and trephines, including relevant diagnostic
features and interpretation, with summary and recommendations for
appropriate further testing.
Preparation and interpretation of thick and thin blood films for demonstration
of malarial parasites
Performance and interpretation of other malarial detection systems, eg. ICT
guidelines

Acute leukaemia
CD34 cells
PNH
DNA ploidy studies

11. Genotype Studies
Cytogenetics
Karyotyping
Molecular Genetics
Gene sequencing

Serum vitamin B12 assay and B12 binding

Screening tests for Glucose 6-phosphate dehydrogenase (G6PD) and other
enzyme deficiencies
Tests for PNH
Tests for haemoglobin stability, including heat and isopropanol precipitation
test
Tests for haemoglobinopathies /thalassaemia, including Hb electrophoresis
series, quantitative assessment of foetal haemoglobin, HbA2 assay, other
abnormal haemoglobins and molecular studies as above
Tests for Hb S



Prothrombin time and international normalised ratio
D-dimer assays
antibodies)

Indirect antiglobulin test using “broad spectrum” and mono specific reagents
Antenatal serology
transplantation
Practical and theoretical differences to laboratory management and technical

procedures when dealing with neonatal and paediatric samples. This
includes:

Be able to apply the appropriate diagnostic investigations, from those listed,

to specific circumstances in neonates and children. For example:
o Neonatal jaundice
o T activation
o The bleeding child
Be aware of the alteration observed through pregnancy in reference ranges of

haematology tests including peripheral blood indices coagulation tests and
Vitamin B12 levels
o Antenatal testing e.g., for haemoglobinopathies including choriovillous
sampling and amniocentesis

including
18. Other Studies

B2 microglobulin

4. MICROBIOLOGY
Taxonomy and biology of human pathogens, including ecology, evolution, metabolism and
replication
Immunisation

Issues relevant to antimicrobial use and control in the context of institutional drug committee
activities
Ecological issues
Infection Control


incubation conditions as applied to bacteria, fungi, viruses and protozoa
viruses and parasites

Principles of antibiotic susceptibility testing
Principles of antifungal susceptibility testing
Principles of antiviral susceptibility testing

Quality controls for every method and reagent used in the laboratory


information
TABLE OF LEARNING OUTCOMES, ACTIVITIES AND ASSESSMENT.


TASK LEARNING OUTCOMES LEARNING ACTIVITIES POTENTIAL

ASSESSMENT
Core Functions of the General Pathologist as Medical Specialist in the Laboratory
Preanalytical • Advise clinicians on the appropriate choice • Providing advice to • Written/Viva.

Consultation and selection of tests and samples, their requesting clinicians (e.g. Describe the principles
relative diagnostic strengths and the incoming phone calls) for and pitfalls of
limitations of any proposed investigation test selection. appropriate test
• Preparation or updating a selection.
patient information sheet.
• Preparation of
information sheets for
• Advise clinicians on the relevant samples and referring doctors.
preservatives required for specific tests: e.g.
blood specimens, bone marrow aspirate & • Participation in laboratory
trephines, buccal swabs, CVS biopsies, testing protocols
amniotic fluid, products of conception, skin • Review/update current
biopsy, muscle biopsy, lymph node biopsy laboratory protocols and
etc collection room protocols
for handling and
• Advise clinicians regarding appropriate preparing specimens
specimen transport conditions for the prior to the specimen
dispatch of samples, including timeliness and arriving in the laboratory.
temperature
• Review of laboratory
manuals for consistency
between NPAAC
requirements and
laboratory protocols

Accession, • With reference to the relevant laboratory • Work in specimen reception

Management procedure manual, apply the principles of: area
and Processing - appropriate receipt, integrity and validation
of Specimens of specimens in the laboratory
- specimen identification and laboratory
accession
- appropriate specimen transport, handling, • Evaluate turn-around times
storage, retention and subsequent disposal in time critical tests eg.
APTT, identifying any source
• Apply laboratory-specified work flow of non-compliance.
procedures to routine, urgent and out of
hours work and determine whether they are
optimal. • Written/Viva
How does your
• Review documentation and laboratory select out-of-
• Select appropriate samples for integrity and practice. hours procedures?
intended assay. How do you assure
laboratory performance
of time critical tests?
• Evaluating different • Work based

testing selection methods assessment – short
and technologies. essays on principles for
acceptance of
specimens for analysis.
• Written/Viva.
Case scenarios
advising clinicians as to
appropriate testing
strategies.

Instrumentation
• Apply the principles of automated test • Work in automated area. • Written/Viva.
& automation
method selection with reference to the Your laboratory is to
systems requirements for: implement a new
specimen analysis automated analysis.
performance What considerations do
- quality control • Review internal and external you take into account
- calibration set up, including the QA/QC with senior scientists for your patient
development of normal and therapeutic and pathologists. population and work
reference ranges practices?
- trouble shooting
- training
- reagent usage
- waste disposal
- costs
- service issues
- maintenance
- record keeping.
Microscopy
• Set up and maintain laboratory microscopes. • Undergraduate and scientist • Microscopy exam.
and related
teaching.
skills
• Use light and other microscopy
appropriately.
• Record images for

retention/teaching/manuscripts, etc, eg. • Review of presentation
digital photography. • Preparation of teaching by Supervisor
materials.
• Casebook and/or
• Presentation at clinical posters
meetings

Production,
• Design, trouble-shoot and validate in house, • Specific projects to establish • Essay
Validation,
manual or automated tests or update validation materials What are the principles
Analysis and for all tests to the standard by which lab tests are
Reporting of required for regulatory validated?
Laboratory Data compliance
• Ensure appropriate determination of • Review various RI’s and • Case book report of the
reference intervals including the practicality compare with other performance
of applying such interval to a new test laboratories. Read characteristics of a new
manufacturers’ inserts to test
assess their way of
establishing RI. • Essay
Compare and contrast
• Record, verify, interpret and report • Establish reference intervals the ideal and practical
laboratory test results. for a new analyte ways of establishing
reference intervals
• Participation in everyday
laboratory duties.
• Oral examination
• Review test procedures and questions on validation
prepare a report with of laboratory tests
recommendations for future
local usage based on • Supervisor assessment
literature review and analysis and feedback on
of all methods and data reports prepared by
including specificity, trainee.
sensitivity and predictive
values.
• Written /Viva.
• Identify potential causes of variation in • Review causes of variation. Describe the
results preanalytic variables
- clinical which affect the results
- non-clinical. of tests.

Discussions with
Supervisor
Viva
• Use the laboratory information system to • Retain examples of reports Assessment of use and
develop algorithms for production of results, commented on and validated knowledge of your
interpretative comments and by you. laboratory IT systems
recommendations for further tests.
• Review action limits, • Written/Viva
• Apply the principles of action limits with documentation and What are the action
regard to: compliance. limits for test reporting
- their development in your laboratory and
- application in the laboratory how are they
- notification of abnormal results to implemented?
pathologists and/or requesting clinicians. • Review training manuals.
• Maintain staff training to ensure that Written/Viva

potential causes of laboratory error are How do you ensure that
identified – identify and record examples your laboratory staff are
where training deficiencies lead to lab suitably trained?
problems. • Review and develop with
Supervisors laboratory • Discussions with
• Maintain staff training to ensure that procedures to identify and Supervisor
clinically significant results are identified and communicate clinically
communicated in accordance with significant results
laboratory procedures.
• Perform literature review on • Written/Viva
• Demonstrate a detailed appreciation of test reported test sensitivity and Discuss how you
limitations when reporting results specificity data and disease evaluate a new test
prevalence, estimate positive with regard to its
predictive value limitations.
• Discussions with
• Record and verify results in accordance with • Review departmental list of Supervisor
laboratory procedures relating to QC etc tests and define appropriate
QC/reporting.

• Use department procedures to ensure that • Give seminars to scientific • Written/Viva.

important results are conveyed to staff explaining significance How do you as a
appropriate clinician and extra testing is and consequences of clinical pathologist get involved
performed if indicated reporting. in the development,
implementation and
• Involvement in subsequent auditing of compliance
actions. Eg. Telephoning with action limit
requesting clinician with procedures in your
recommendation for further laboratory?
investigation.
• Participation in laboratory • Oral examination

testing programs and question on appropriate
turnaround time monitoring. use of laboratory staff
• Monitor workflow within the lab to ensure resources to meet
that samples are processed and analysed in patient/clinician
a timely fashion expectations
Storage And • Retrieve specimens showing examples of • Retrieve specimens for

Retrieval Of specific diseases or processes for review as part of daily work
Laboratory Data examination and review. practice.
And Specimens
• Retrieve laboratory data from information • Using LIS retrieve reports
systems. with particular abnormalities
for clinical review.
Developing an
• On the basis of all the information available • Daily laboratory duties • Written/Viva
Opinion
in relation to a specific case, develop and
record a professional opinion as to the
nature, causation, severity, likely sequelae
etc of the pathological process(es).
• Seek further expert opinion as appropriate

• Preparation under
supervision of consultative
reports.
Communicating
• Construct and sign off a written report which • Preparation under • Written/Viva.
an Opinion
contains all appropriate diagnostic supervision of consultative Prepare a consultative
information and recommendations to the reports report/give a
requesting clinician in a timely fashion. consultative opinion on
various test
• Provide appropriate information and abnormalities and
inferences about a case to referring clinical conditions
clinicians by oral (face-to-face or telephone)
communication.
• Performance of daily • Discussions with
• Contribute appropriately to Grand Rounds, laboratory and supervised Supervisor.
clinico-pathological conferences, morbidity on-call duties.
and mortality reviews, quality and audit
committees and other similar meetings.
Monitoring
• Where laboratory results suggest • Follow up of patients • Discussions with
Patient
developing disease, advise clinician when Supervisor
Progress further specific testing may be warranted, or • Ringing out of
when a specific, unexpected diagnosis or abnormal/critical results
development becomes apparent.
• Participate in Supervised
• Predict and where possible assist in after hours roster
prevention of adverse events.
• Review or implement systems for chronic

disease management programs.

Design a recall system for follow- • Supervisor assessment

up monitoring of patients with
e.g. diabetes mellitus
Discipline Specific Functions of the General Pathologist as Medical Specialist in the Laboratory
ANATOMICAL PATHOLOGY
Accession, Specimen Cut-Up • Read laboratory manual

Management - photograph specimens (and indicate • Participate in daily laboratory
and Processing sites of block selection) when appropriate activities
of Specimens • Read textbooks
- cut up specimens, and select blocks,
appropriately
- know how to handle fresh specimens and
how to triage when ancillary tests are
required
- understand the occupational health and
safety issues of dealing with specific • Read laboratory manual
tissues • Spend sufficient time (minimum
of a week on at least three
Tissue Fixation separate rotations) in the
- select appropriate fixation regimes, and be able pathology laboratory learning
to detect and correct errors in this process about and being involved in
Embedding and Sectioning tissue fixation, embedding,
- select appropriate embedding and sectioning sections, staining (including
techniques, and detect and correct errors in special stains, histo- and
these processes immuno-histochemistry) sections
Staining
- perform and interpret routine stains, and detect
and correct errors in these processes
- select, perform and interpret appropriate
special stains, and detect and correct errors in
these processes
Histochemistry
Written and/or viva

- select appropriate fixation, preparation and examinations

staining techniques, and detect and correct
errors in these processes Practical and viva
examinations
Immunology, Immunofluorescence and
Immunohistochemistry
- select appropriate preparative techniques for
the localisation of antigens in tissue sections,
and detect and correct errors in these processes
• Read laboratory manual
Frozen Sections • Regularly accompany
- prepare frozen sections when pathologists to frozen sections –
appropriate, detect and correct technical attend sufficient frozen sections
errors and artefacts to achieve learning outcomes
safety issues
- report frozen section results to surgeons
via ‘phone or in theatre and convey any
limitations of the
information/interpretation conveyed • Read laboratory manual.
• Textbook reading.
Cytology
- select appropriate techniques for collection and
specimen preparation, and detect and correct
errors in these processes • Participate in daily laboratory
activities- including attendance
Fine Needle Aspiration at FNAs
- select appropriate preparative
techniques, and detect and correct errors
in these processes
safety issues
- perform per-cutaneous fine needle
aspirations
- assess specimen adequacy • Participate in laboratory
teaching program for electron
microscopy.

Electron Microscopy • Read laboratory manual Autopsy assessment -

- select appropriate fixation, embedding, • Textbook reading perform a minimum of 20
sectioning and staining techniques, and • Participate in daily laboratory autopsies
detect and correct errors in these activities. Practical and/or viva
processes examinations
- interpret results of commonly used • Participate in laboratory
electron microscopy (esp. renal EM) teaching program for
cytogenetics and flow cytometry
Cytogenetics • Read laboratory manuals.
- demonstrate a working knowledge of • Textbook reading.
appropriate fixation, preparation and • Participate in daily laboratory
staining techniques for samples sent for activities related to selecting of
cytogenetic analysis tissue for cytogenetics and flow
- know which units/consultants to contact cytometry
for expert advice
Flow Cytometry
- select appropriate specimen preparation
techniques, and demonstrate a working
knowledge of interpretation/correlation of
results
Autopsies
- perform sufficient hospital and coronial • Read laboratory autopsy
autopsies to be competent at these manual.
procedures and gain a good knowledge • Textbook reading
of anatomy and macroscopic pathology • Participate in the department’s
- select appropriate specimens for autopsy programme
ancillary investigations • Read government guidelines of
- select appropriate blocks for histology ethical autopsy practice
- demonstrate a clear understanding of the
occupational health and safety issues Access relevant parts of the
- write a competent autopsy report with Coroner’s Act
appropriate clinico-pathological
correlation
- demonstrate a clear understanding of
which matters are reportable to the

coroner
- demonstrate a clear understanding of the
pathologist’s responsibilities under the
Coroner’s Act relevant to the Trainee’s
area.
• Read laboratory manual Formatted: Bullets and

Production of (For Anatomical Pathology, the ‘data’ Numbering
Laboratory Data comprise all specimens, blocks, sections • Participate in daily laboratory
and other specimens which are available activities
for examination and review)
• Read NATA/NPAAC or other
relevant guidelines
Autopsy • Participate in the department’s • Complete Autopsy
Analysis of - describe and interpret the macroscopic findings autopsy programme assessment as stated in
Laboratory Data RCPA guideline
• Present autopsy findings
(Read in at a departmental or
association with interdepartmental meeting
other specific
guidelines Specimen Description • Read laboratory manual • Written, practical and/or
above) - describe and interpret gross specimens • Participate in daily laboratory viva examinations
accurately and concisely activities
Microscopic Interpretation • Participate in daily laboratory

- examine describe and interpret sections activities. cases and reports
and specimens prepared by any of the initially drafted/written by the
techniques described above (e.g.: FNA, Trainee should be
frozen section, imprints, routine examined/discussed regularly
histochemistry, immunohistochemistry, over a “double head”
electron microscopy) microscope with the supervising • Practical slide exams
- provide clinicopathological correlation pathologist on a regular basis • • Special practical exam
Textbook reading
Interpretation of other specimens • Participate in internal and
- examine describe and interpret external quality assurance

specimens prepared by other techniques programmes

described above (e.g.: cytogenetics, • Present at departmental,
microbiology, flow cytometry, molecular interdepartmental and hospital
studies) wide meetings
- provide clinicopathological correlation
Communicating Reporting • Participate in daily laboratory Formatted: Bullets and
an Opinion (this - construct and sign off a written report activities Numbering
is part of the which contains all appropriate Have constructed and signed of
process of • Practical and viva
information and inferences about the sufficient cases to be competent
interpreting lab. examinations
case (including information on the at the level requires for each of
Data) reproducibility of the findings and the exam phases
knowledge and use of grading systems),
together with responses to any specific
queries received from clinicians
- produce synoptic reports where
appropriate
- provide appropriate information and inferences
about a case to referring clinicians by oral (face-
to-face or telephone) communication
- contribute appropriately to Grand Rounds,
clinico-pathological conferences, morbidity and
mortality reviews, and other similar meetings
CHEMICAL PATHOLOGY
Analysis • Explain the relative benefits and • Bench work activity. Be wary
disadvantages of the unique design and of the shelf life of various
operating characteristic of a particular reagents
instrumentation or platforms • Essay
• Bench work. Performing Discuss the principles
routine chemistry analysis on of slide assays for
daily samples including general chemistry
various POCT devices. analytes

Explaining to staff relative

benefits and disadvantages
• Perform calibration procedures on as many of adopting a dry slide
platforms and analytes as possible chemistry system
• What ways do various
• Bench work (inquiries duty) platforms identify out of
range samples?
• Bench work- defining the limit Identify ways (automatic
of detection of a new assay or manual) in which this
problem can be
• Textbook reading overcome.
• Follow up of problem cases • Essay

Bench work. Discuss theoretical and
practical procedures for
defining the power of
detection limit for an
analyte. Differentiate
between functional and
detection sensitivities
• Short answers – explain

the purpose and
fundamentals in
performing a calibration
procedure
• Ensure water supply and purification

measures meet quality control standards
• Viva exams in
• Identify the source of water commenting on an end
supply in your laboratory. of cycle report
Review the grading of water
purification in your laboratory • MCQs or short
and its quality control answer on water

purification methods
and identify where
water may be a
potential problem to
the validity of the
results
• Apply the principles of operation, and • Perform benchwork on • MCQ

Performing where appropriate either perform the o Automated general
Specific specific analysis, or use the following chemistry analyser • Essay
Laboratory equipment o high performance liquid
Procedures o Automated general chemistry analyser chromatography • Viva
o high performance liquid and other o serum protein
chromatography electrophoresis
o serum protein electrophoresis o atomic absorption
o atomic absorption spectroscopy spectroscopy
o polymerase chain reaction (PCR) o polymerase chain reaction
o blood gas analysis o blood gas analysis
o immunoassay o immunoassay
o point of care testing (POCT) o others
o others
Dynamic • Be able to perform, or advise clinical staff As far as possible • MCQ

Testing on protocols for performance of dynamic • Perform the test
tests such as: • Essay
o Synacthen stimulation test • Review the guidelines
o Overnight dexamethasone suppression together with other clinical • Viva
test disciplines (endocrinology)
o Oral glucose tolerance test
o Water deprivation test
o Insulin hypoglycemia test
o Glucagon stimulation test
o Others • MCQ
• Essay

• Interpret the results of such tests to the

clinician and advise on further testing that is • Discuss interpretation with • Viva
appropriate to elucidate the clinical problem consultant and relevant
in question disciplines
HAEMATOLOGY
Perform
• Perform sterile procedures including bone • Perform procedures as part • Supervisors report to
Specific Clinical
marrow aspiration, trephine biopsies, of daily laboratory and document candidate’s
Procedures cannulation and phlebotomy (including training activities. May skill and experience in
venesection) with due consideration of: require attendance and clinical procedures, e.g.
- the individual patient’s condition and performance at other bone marrow trephine
clinical history laboratories. biopsy.
- benefits and potential risks Trainees should
- clinical indications • Be able to perform a clinical undertake 50 bone
- informed consent assessment of a patient’s marrow biopsies
- resuscitation procedures suitability for a procedure
• Supervisor Assessment
• Satisfactory performance at a
CPR teaching session. • Written/Viva.
e.g. Discuss indications
for and potential
complications of bone
marrow procurement
Performance • Interpret and perform, where appropriate, • Perform tests as part of daily
and the following laboratory tests: laboratory and training
Interpretation of o Full Blood Count activities. May require
Specific - Morphology attendance and performance
Haematology o Special stains at other laboratories.
Tests o Bone marrow morphology • Written/Viva
o Genotype studies e.g. Describe principles
- Cytogenetics • Retention of reported and and pitfalls of testing of
- Molecular genetics signed out cases various technologies
o Erythrocyte studies

o Haemolysis studies Morphological Practical

o Coagulation studies exam including blood
o Blood transfusion studies films, bone marrow
- Phenotype studies aspirate/trephine
o Flow cytometry biopsies and flow
o Paediatric studies cytometry cytogenetics
o Miscellaneous studies results on both
paediatric and adult
• Prepare and examine, describe and • Performance of daily specimens excluding
interpret blood and marrow aspirate and laboratory duties. rare conditions
trephine films prepared by any of the
techniques described in the Haematology • Select and present slides to
checklist. clinicians.
• Select, perform and interpret routine and

special stains, and detect and correct errors
in these processes.
Transfusion-
• Identification of donor and recipient and pre • Daily laboratory duties. • Written/Viva
related Skills
transfusion testing. Questions in relation to
Donation/storage/transport/ issues • Answering transfusion clinical and laboratory
Indications for blood products (including related queries from clinician transfusion practice.
modification). and scientists.
Detailed knowledge of storage and patient
delivery of blood and blood products.
Specification of blood products.
• Complications of transfusion • Instigating and investigating

transfusion reactions and
• Laboratory testing, reporting and preparing reports.
documentation. • Perform all tests; include
training exercises at ARCBS
• Monitoring efficacy of transfusion. and other relevant labs.
• Provide clinical advice on the appropriate • Attend and contribute to

selection of blood and blood products and Transfusion Committee • Wet transfusion practical
their administration. meetings exam
• Transfusion exercises set
• Perform blood transfusion studies as listed within the laboratory.
in the Haematology checklist.
• Interpret blood bank results.
• Recognise, investigate and manage

transfusion reactions and other transfusion
related adverse events.
• Provision of urgent blood and blood product
support
• Participate in disaster and emergency

management training
MICROBIOLOGY
Public health • Provide appropriate advice regarding • Regular interaction with Public
and preventive detection, surveillance and intervention Health Units (or equivalent)
medicine with respect to infectious diseases of
public health importance.
• Participate in regular meetings with public

health units (or equivalent)
• Formulate strategies to investigate and • Formative assessment -

manage outbreaks of infectious disease specific item in formative
assessment process;
• Ensure compliance with notification • Notification of the detection of satisfactory participation
requirements infectious agents in prior to final
accordance with local statutes examination.

• Summative assessment
- a short question as part
of the practical. This
• Provide immunisation advice means at least part of
the practical needs to
include a notifiable
disease process.
• Submission of a project
which investigates a
substantive outbreak of
an infectious disease
Use of • Provide appropriate advice on selection • Access relevant drug policies • Formative assessment -
Antimicrobial and use of antimicrobial agents to patients, in training institution supervisor’s reports
Agents colleagues and institutional bodies
• Supervised clinical liaison eg. • Summative assessment
telephone consultations or – compulsory questions
• Participate in institutional drug committee ward rounds
activities eg. audits and meetings
• Involvement in drug
• Implement, support and develop committee activities
antimicrobial control policy in training
institution
• Possible on-line tutorial (to be
developed)
• Attendance at relevant
session RCPA Update.
Infection • Provide appropriate advice on infection • Access relevant infection

Control control measures to patients, colleagues control policies in training • Part of project
and institutional bodies institution
• Practical examination

• Ensure compliance with legislative and • Involvement in infection

regulatory framework in geographic area of control committee activities • MCQs
practice
• Access state and national • Practical examination
• Participate in institutional infection control guidelines, regulations and
committee activities eg. audits and legislation
meetings
• Implement, support and develop infection

control policies in training institution
• Implement, support and develop procedures

for safe laboratory practice
• Liaise between laboratory practice and

infection control requirements eg. outbreak
surveillance, subtyping • Ensure practice of the
procedure to a level of
• Prepare articles for sterilisation by various competency
methods
• Operate an autoclave safely and effectively
• Detect faults in heat-sterilising apparatus
Perform specific • Perform collection procedures including

clinical o Urethral swabs
procedures o Skin scrapings
o Blood cultures
o Dark field microscopy
o Naso-pharyngeal aspirate
o Others
Performance Prepare and use routine stains appropriately Access relevant sections of the • Questions in the

and laboratory manual written and practical

interpretation of Prepare specimens for microscopy examination on critical
specific specimens, e.g., CSF
microbiological Participate in relevant laboratory activities or urine.
tests including, but not limited to:
- preparation of faecal stains and • Ensure practice of the
concentrates procedures to a level of • Supervised satisfactory
- identification of ova cysts and parasites competency execution of each type
- preparation and examination of skin of staining procedure
scrapings and other tissues for fungal and microscopy
examination
- preparation and examination of
specimens by Gram’s, acid-fast, toluidine
blue, India ink, Giemsa and fluorescent
antibody stains
- preparation and examination of blood
films for blood-borne parasites.
• Select media appropriately for specimen

inoculation
• Process specimens appropriately
• Participate in relevant sections of the • Access relevant sections of

laboratory, including but not limited to: the laboratory manual
- preparation of culture media and agar
plates • Ensure practice of the
- plating out clinical specimens procedures to a level of
- setting up anaerobic cultures and competency
obtaining pure cultures
- maintenance and inoculation of tissue • Access relevant sections of
culture for virus isolation the laboratory manual
- detection of viral replication in tissue
culture • Ensure practice of the
- determination of TCID values for viral procedures to a level of
isolates

- preparation of mycological slide cultures competency
• Correctly identify organisms by culture
• Participate in relevant sections of the

laboratory, including but not limited to:
- performance and interpretation of tests
commonly used to identify microorganisms
- determination of viable counts in bacterial
suspensions
- use of automated apparatus to detect
bacteraemia
- identification of medically important fungi
Satisfactorily execute and interpret antibiotic

susceptibility tests • Work-based
• Access relevant sections of assessment by
Satisfactorily execute and interpret antifungal the laboratory manual supervisor
Ensure practice of the • Practical examination
Participate in relevant sections of the procedures to a level of using API strips
laboratory, including but not limited to: competency
- preparation and interpretation of antibiotic • Practical examination
susceptibility tests using real time PCR
- detection of beta-lactamases read outs.
- determination of the bactericidal activity
of antibiotics or antibiotic-containing serum
- determination of synergy between
combinations of antibiotics
- performance of antimicrobial assays on
blood and body fluids by bioassay or other
methods
Participate in relevant sections of the

- preparation and interpretation of
antifungal susceptibility tests

- determination of synergy between

combinations of antifungal agents • Practical examination
• Oral examination.
Storage, use • Satisfactorily prepare specimens, bacterial, • Access relevant sections of • Written exam, e.g. what
and fungal and viral isolates and mammalian the laboratory manual factors are important in
maintenance of cells for retention and preservation deciding on a serology
laboratory • Participate in relevant analyser.
equipment • Use and maintain laboratory equipment, sections of the laboratory
- incubators • Ensure practice of the • Satisfactory
- centrifuges procedures to a level of participation in relevant
- safety cabinets competency laboratory activities
- refrigerators
Performance • Satisfactorily execute serologic assays, • Access relevant sections of Written paper.
and demonstrating familiarity with automated the laboratory manual
interpretation of systems
specific
immunological • Satisfactorily execute molecular biologic
and serological assays, demonstrating familiarity with Ensure practice of the
tests automated systems procedures to a level of
competency
laboratory, which should include, but is not
limited to:
- preparation, reading and interpretation of
assays for the detection of antigens and
antibodies (including methods such as
- agglutination
- precipitation
- immunoassay including coeliac antibody
testing

- tissue and nuclear antibodies
-direct fluorescent antigen(DFA) testing
Measurement of specific immunoglobulins and

other proteins
- RAST testing
- immunoperoxidase
- immunoblotting

- extraction of nucleic acids from
specimens
- preparation and reading of gels
Performance • Provide appropriate clinical advice and • Exposure to Genetics lab

and referral to a Geneticist if required
Interpretation of
Specific Genetic
Tests • Interpret and perform, in consultation with
the Geneticist where appropriate, the • Participation in laboratory • Work-based
*Practice in this following types of laboratory tests testing programs assessment by
area is limited, supervisor
but familiarity • Cytogenetic analysis of
with the use and - blood • Practical (“interpret”)
application of - amniotic fluid cells • Participation in laboratory
these procedures - chorion villus samples testing programs • Oral (“interpret”)
is important. - products of conception
- normal tissues for fibroblast cytogenetics • Work-based
Knowledge of - bone marrow and other malignant tissues assessment by
interpretation of supervisor
the most • Molecular genetic studies
common genetic - standard and allele restricted PCR • Practical (“interpret”)

tests is expected. - modified PCR for methylation studies

- modified PCR for mutation screening • Oral (“interpret”)
- quantitative PCR methodologies • Participation in laboratory
- Hybridisation based testing (Southern testing programs
analysis) • Work-based
- DNA sequencing assessment by
- denaturing HPLC supervisor
- linkage studies
- microsatellite based studies • Practical (“interpret”)
- microarray based studies
• Oral (“interpret”)
• FISH analysis
- gene amplification
- aneuploidy
- microdeletion
- translocation
- chromosome painting
- M-FISH/SKY
Biochemical genetics studies. • Participation in laboratory

testing programs
• Work-based
assessment by
supervisor
• Practical (“interpret”)
• Oral (“interpret”)

G ENETICS
this Handbook.
INTRODUCTION
Laboratory geneticists are members of a team of professionals involved in the diagnosis,

counselling and management of patients and families with genetic disease. They are trained in
cytogenetics, the study of the structure of chromosomes, biochemical genetics, the study of
genetics in terms of the chemical events involved, and molecular genetics, the study of the flow
and regulation of genetic information between DNA, RNA, and protein molecules.
Much of the work revolves around:

1. Prenatal diagnosis: the examination of cells for possible abnormalities in the foetus,
usually in families where single gene disorders have been identified by DNA analysis.
2. Carrier testing: risk assessment for identifying presymptomatic individuals at risk from
single gene disorders.
3. Confirmation of diagnosis.
The Laboratory Geneticist needs the following traits:

the ability to work as part of a multidisciplinary team
interest in keeping up to date with scientific advances
ability to keep up with new knowledge daily
good oral and written communication skills
expertise in bioinformatics
excellent interpretive skills.
The training program will enable the pathologist to practise as a specialist in laboratory genetics.
Skills would also be developed to enable the pathologist to participate in research/professional
activities in genetics and the RCPA's continuing professional development requirements.
The laboratory, managerial and research/professional development skills acquired by the end of
the training period should allow the pathologist to undertake supervision and leadership in a
genetics laboratory.
The clinical skills acquired by the end of the training period should enable the pathologist to
participate as a member of a team in the diagnosis, counselling and management of patients
and families with genetic disease.

There are two RCPA training options in Genetics:

1. A 5 year program in one of three areas in genetics i.e. cytogenetics, biochemical genetics or
molecular genetics ("subspecialty stream").
2. A 5 year general program leading to the development of skills in the above three areas of
genetics ("general stream").
Applicants are strongly advised to consider carefully which of the two options would be more
appropriate for their future needs. The option to undertake the FRCPA through the successful
completion of two Part I examinations is available within the Genetics program (e.g. AP1 and GT1)
although this would lead to the trainee being credentialed as a General Pathologist. An alternative
pathway to develop or demonstrate additional skills is possible through the Post Fellowship
Diploma in Molecular Pathology (Dip Mol Path) which can only be undertaken post-FRCPA (and is
therefore not available to Fellows of overseas Medical Colleges).
TRAINING FOR PART I
The knowledge and practical skills required of the trainee pathologist at the time of the Part I
examination are briefly summarised below in the section on Knowledge and Experience to be
Attained. Laboratory components and standards should be considered comparable to those which
would be required for a senior hospital scientist who undertakes these activities in a genetics
laboratory.
TRAINING FOR P A R T II
The 2 years of advanced training will continue the single subspecialty option or a program which
is more general in content. The post-part I years are designed to allow the candidate to make
the transition from trainee to consultant pathologist and expert. The focus is therefore on
training the candidate to take the role of consultant pathologist and gaining expert knowledge
rather than on accumulating sufficient basic knowledge in genetics to pass examinations.
ASSESSMENT
Pathological Sciences All trainees are required to undertake or apply for apply for exemption
from the Pathological Sciences examination.
PART I ASSESSMENT
The Part I examination is considered the barrier examination in Genetics and is comprised of
written, practicals and a viva examination. Trainees must have completed at least 24 months of
accredited training time to be eligible to sit the Part I.
Written Papers:
The written component will consist of two examination papers.

1. a two hour general Laboratory Genetics paper comprised of essays, short answer questions and
worked problems which assesses the Trainee's knowledge of the scientific, diagnostic and
managerial aspects of laboratory genetics practice. It is intended to be more general than the
subspecialty paper and will require the candidate to demonstrate general knowledge of
important issues in genetics practice from the fields of biochemical genetics, cytogenetics and
molecular genetics. Although the scope of this examination is wider, the focus remains on
diagnostic human genetics. The examination cycle in 2009 will include biochemical genetics in
this examination for the first time
2. a three hour subspecialty Genetics paper, comprised of essays and short answer questions
specific to the discipline in which the Trainee is training (ie either biochemical genetics,
cytogenetic or molecular genetics).
Practical Examinations:
All trainees who sit the Part I written paper will be invited to proceed to the Practicals and the Viva
examinations. There are two practical examinations, the first practical assessment is to be
performed in the trainee’s laboratory over an appropriate time frame. The second practical
examination is 3 hour ‘dry’ practical to be performed at the College examination venue prior to the
Viva examination
1a. First Practical in Molecular Genetics

This assessment consists of tasks to be completed using the usual resources of the laboratory. The
objective is to test the ability of the trainee in molecular genetics to perform specific tasks where the
time frame is too long to fit into a conventional practical assessment, or where each laboratory uses
different algorithms, software, preferred websites etc. Examples of the types of tasks that may be
included are:
• design of PCR primers to amplify a specified segment of DNA,
• identification, analysis and interpretation of DNA sequences for mutations
• mutation screening of provided PCR products
• mutation screening of a provided blood sample
This assessment will be supervised by the trainee’s supervisor and an appropriate time frame
allocated for the return of results (ordinarily 1 week).
1b. First Practical in Cytogenetics

This examination consists of tasks to be completed using the usual resources of the laboratory. The
objective is to test the ability of the trainee in cytogenetics to identify, interpret and report cytogenetic
anomalies when presented with a fixed cell suspensions or a biological sample. Trainees will be
expected to be able to culture and harvest samples, make slides, perform banding, analyse,
interpret and report the results. This examination will be supervised by the trainee’s supervisor and
an appropriate time frame allocated for the return of results (ordinarily 1 week)..
1c. First Practical in Biochemical Genetics

This assessment consists of tasks to be completed using the usual resources of the laboratory. The
objective is to test the ability of the trainee in biochemical genetics to perform specific tasks where
the time frame is too long to fit into a conventional practical assessment, or where each laboratory
uses different algorithms, software, preferred websites etc. Examples of the types of tasks that may
be included are:
• analysis of a provided patient sample for a specific enzyme activity
• mutation screening of provided PCR products

• mutation screening of a provided blood sample

This assessment will be supervised by the trainee’s supervisor and an appropriate time frame
allocated for the return of results.
2. Second Practical Examination

The Dry Practical Examination consists of a three hour session of laboratory data interpretation and
reporting. The material for this examination will be standard diagnostic material collected from the
Examiners’ laboratories and will be representative of the range of materials handled by a routine
diagnostic laboratory in the sub-discipline in which the candidate is training. It is expected that in the
majority of cases there will be a single correct answer or a clear differential diagnosis indicated by
the problems posed.
Viva Examinations:
The Viva will consist of two 50 minute sessions in which the trainee's ability to interpret laboratory
data will be assessed. Each of the two sessions will be conducted by a different team of two
examiners. Ordinarily the starting point for each discussion will be the interpretation of one or more
items of laboratory data, and may include material seen in the practical examination. In some
instances there may be no single correct answer to the question posed to the candidate, in which
case the approach to the diagnosis is being examined.
Successful completion of the Part I examination will be based on the aggregate mark achieved
in the various components of this examination, i.e. written paper and the practical/viva.
Candidates may be allowed to proceed to advanced training if a deficit in knowledge or
experience is identified in the part 1 – however this will be brought to the candidate’s attention
for remediation prior to the Part II examination and will be assessed in the Part II examination by
means of a special dry practical examination which will include the area in which the deficit has
been identified and other areas of laboratory practice.
P A R T II A S S E S S M E N T
The form of the Part II examination, which is taken at the end of advanced training, will depend on
the type of training undertaken, the laboratory's accreditation status and other considerations which
may arise (including performance in specific areas raised during the Part I examination). As a
minimum, the assessment at the end of the Part II laboratory and clinical training will involve a viva
examination. A practical examination may be included based on the performance of the trainee
during the Part I examination in which case a clear pass in this will be required. The form of the Part
II practical may vary from year to year according to the sub-discipline in which the candidate is
training. Appropriate post-graduate or research qualifications e.g. a PhD or MD in a directly relevant
field, may be considered suitable for part or all of the Part II laboratory training requirements.
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN GENETICS
Table of Tasks, Learning Outcomes, Activities and Assessment in Genetics, below.
This list provides examples of issues that are viewed as elements of knowledge for a genetics
trainee. It is not intended to be a complete or exhaustive syllabus, but as a guide to the breadth

of knowledge required. In particular it does not indicate the depth to which an individual trainee
will need to understand a field of knowledge.
GENETIC SCIENCES
Genome and Genetic structures

DNA structure and variation
Epigenetics and DNA methylation
Chromosome structure, morphology and variation
Structure and organisation of the human genomes, & comparisons with other phyla
Structure, variation, function and identification of genes and functional DNA elements
Mapping, linkage disequilibrium and haplotypes in the human genome
Various types of repeats in human genome
Molecular and cellular physiology

DNA replication and repair
Gene expression I; RNA transcription and processing
Gene expression II; Translation and post translational processing
Mitosis and the cell division cycle
Meiosis, recombination and chromosomal segregation
Fertilisation, early embryogenesis and malformation
Mosaicism and chimerism
Twins and twinning
Mutation / polymorphisms
Mutation and polymorphism
Microdeletions & microduplications
Biological basis of non-disjunction & aneuploidy
Segregation of chromosomal structural anomalies
Types of polymorphisms in the human genome
Inheritance
Standard patterns and modifiers of inheritance
Complex, multifactorial and quantitative traits
Population genetics & Hardy Weinberg equilibrium
Cancer genetics
The biological basis of cancer
Inherited cancer predisposition
Molecular aberration in cancer
Principles of genetic testing
Direct and indirect laboratory testing
Clinical:molecular correlates. Phenotype/genotype relationships
Calculation of conditional probability and genetic risk
Bayesian probabilities
Relevant aspects of epidemiology and statistics
Population screening
Regulatory issues for diagnostic laboratories
The laboratory as a safe workplace
Medical physics

Diagnostic uses of ionising radiation
MUTATION AND METHODS FOR ANALYSING MUTATIONS
Cytogenetics
Uses of karyotyping
Chromosomal preparations and banding techniques
Karyotyping techniques
Cytogenetic nomenclature
FISH mutations
CGH microarrays
Molecular techniques with direct relevance to cytogenetic analysis
Assessment of chromosome breakage
Karyotyping systems in clinical cytogenetics
Methods of mutation analysis

Mutations and polymorphisms
Mutation scanning techniques for unknown variants

Heteroduplex/SSCP/DGGE based techniques
MLPA/Oligonucleotide ligation
Mismatch methods, RNAse and Chemical cleavage of mismatch
Protein Truncation Testing
DNA Sequencing, chemistry & electrophoretic methods
CGH microarrays
Assays for known variants

Allele specific amplification
Allele specific hybridisation techniques
Southern Blotting and RNA hybridisation
DNA Sequencing, chemistry & electrophoretic methods
CLINICAL CYTOGENETICS
Clinical relevance of constitutional and acquired chromosome abnormalities
Constitutional chromosomal disorders

autosomal and sex chromosome aneuploidy
polysomies
structural abnormalities of chromosomes
cryptic chromosomal translocations
Microdeletion syndromes
Uniparental disomy
abnormal segregation of structural anomalies
Pregnancy
Fertility and infertility
First trimester screening
Prenatal testing by amniocentesis
Prenatal testing by CVS
Mosaicism and pseudomosaicisim

Cytogenetics of spontaneous miscarriage
Development
Embryogenesis and malformations
Sex determination & differentiation
Chromosome causes of intersex
Chromosome breakage syndromes
Cancer cytogenetics
Significance of karyotype in leukaemia
Significance of karyotype in solid tumours
CLINICAL MOLECULAR GENETICS

The stated topics are included to indicate the breadth of the examination. Items that do not
appear in this list are still eligible to be included in an examination
Cardiovascular genetics
Congenital Heart Disease
Ischaemic heart disease
Cardiomyopathies
Arrhythmias
Hypertension
Pre-eclampsia
Haematological genetics
Haemoglobinopathies
Thalassaemias
Red cell disorders
Haemophilias
Thrombophilias & Coagulation
Leukaemia and proliferative disease
Iron metabolism
Porphyrias
Gangliosidoses and lipid storage disease
Immunogenetics
Primary Immunodeficiencies
Complement defects
HLA complex and transplantation genetics
Neurogenetics
Neural tube defects
Congenital malformations of CNS
The epilepsies
Basal Ganglia disorders
Hereditary Ataxias and paraplegias
Autonomic and sensory genetic disorders
Hereditary motor and sensory neuropathies
The Phakomatoses
Demyelinating disorders
Alzheimer syndrome and other dementias

Neuromuscular genetics
The muscular dystrophies
Congenital myopathies
Spinal muscular atrophies
Periodic paralyses
Myotonic dystrophy
Inherited myasthenias
Motor neurone disease
Neurosensory genetics
Colour blindness
Optic atrophy and congenital blindness
Retinal and choroidal degenerations
Glaucoma
Defects of the lens and cornea
Strabismus
Congenital and inherited deafness
Respiratory genetics
Cystic fibrosis
Asthma
Emphysema
Surfactant abnormalities
Cancer genetics
Inherited Breast Cancer
Inherited ovarian cancer
Genetic causes of colorectal carcinoma
Primary CNS tumours
VHL and pheochromocytoma
Retinoblastoma
Inherited thyroid cancer
Genetic susceptibility for skin cancer
Pharmacogenetics
Gastrointestinal genetics
Developmental anomalies of the GI tract
Inflammatory bowel disease
Iron metabolism and hepatic iron overload
Pancreatic enzyme abnormalities
Endocrine genetics
Genetic causes of types 1 and 2 Diabetes
Genetic disorders of the pituitary
Genetic causes of non-malignant thyroid disease
Parathyroid, calcium and mineralisation disorders
Genetic diseases of the adrenal
Sex determination and differentiation
Obesity, body size and body proportion

Dermatology
Epidermolytic diseases of the skin
Ectodermal dysplasia
DNA repair defects and skin disease
Icthyoses
Renal genetics
Congenital disorders of the genitourinary system
Renal cystic disease
Nephrotic disease
Intellectual and Behavioural genetic disorders

Fragile X and other X-linked causes of Developmental disability
Autism
Dyslexia and defects of language
Schizophrenia and bipolar disorders
Addictive disorders
Connective Tissue genetics

Marfan syndrome and disorders of fibrillin
Ehlers danlos syndrome
Pseudoxanthoma elasticum, Cutis laxa and disorders of elastin
Musculoskeletal, craniofacial and joint genetics

Chrondrodysplasias
Disorders of bone density, volume and mineralisation
Abnormalities of bone structure
Dystoses
Arthrogryposes
FGFR & TWIST related craniofacial disease
Rheumatoid arthritis
Hereditary non-inflammatory arthropathies
Pregnancy and development

Sex determination & differentiation
First trimester screening
Embryogenesis and malformation syndromes
BIOCHEMICAL GENETICS
Disorders of amino acid metabolism

Organic acidurias
Mitochondrial respiratory chain disorders
Urea cycle defects
Fatty acid β-oxidation disorders
Common carbohydrate and glycogen metabolic disorders
Purine and pyrimidine metabolism
Lipid metabolism
Porphyrias

Oligosaccharidoses
Copper metabolism
Mucopolysaccharidoses
Gangliosidoses and lipid storage disease
Peroxisomal disorders
Vitamin D metabolism
Molecular Genetics
Brown T. Genomes III. Wiley
Strachan & Read. Human Molecular Genetics. Garland Publishing
Lewin B. Genes Oxford
Jobling, Hurles Tyler-Smith. Human Evolutionary Genetics: Origins, peoples and
disease. Garland Science.
Cotton R, Edkins E, Forrest S (1998) Mutation Detection. IRL Press
PCR Primer – A laboratory manual (2nd ed) Dieffenbach, Dveksler. Cold Spring Habour
Press
King, Rotter, Motulsky Genetic Basis of Common Disease II (2002). Oxford
Cytogenetics
Gardner & Sutherland. Chromosome Abnormalities and Genetic Counselling (3rd Edition,
2004). Oxford University Press
Gersen & Keagle. The Principles of Clinical Cytogenetics Humana Press
Heim & Mitelman. Cancer Cytogenetics. Wiley
Jaffe ES, Harris NL, Stein H, Vardiman JW (Eds). WHO Classification of Tumours:
Tumours of Haematopoietic and Lymphoid Tissues IARC Press 2001
D. Rooney & B. Czepulkowski (Eds) Human Cytogenetics (Vols 1 & 2 IRL Press 3rd
Edition
Clinical Genetics/Laboratory Interface

Trent RJ. Molecular Medicine. Churchill Livingstone
Read and Donnai, The new clinical genetics. Scion
Young. Medical Genetics. Oxford University Press
Rimoin, Connor, Pyeritz (Eds). Principles and Practise of Medical Genetics. Churchill
Livingstone
Scriver. The Metabolic and Molecular Bases of Inherited Disease. McGraw Hill
Bridge P. The calculation of genetic risks (2nd Edition). Johns Hopkins University Press
Milunsky. Genetic Disorders and the Foetus (4th edition). Johns Hopkins University
Press
Biochemical Genetics
Scriver. The Metabolic and Molecular Bases of Inherited Disease. McGraw Hill
N. Blau. Physician's Guide to the Laboratory Diagnosis of Metabolic Diseases.
Chapman & Hall Medical.
JOURNALS
Nature Genetics

American Journal of Human Genetics

Nature Medicine
Human Molecular Genetics
Journal of Medical Genetics

European Journal of Human Genetics
Genetics in Medicine
Genetic Testing
Trends in Genetics
Human Mutation
Molecular Genetics and Metabolism
Cancer Journals
Blood
Leukaemia
British Journal of Haematology
Genes Chromosomes and Cancer
Cancer Research


FUNCTIONS OF THE LABORATORY GENETICIST AS MEDICAL SPECIALIST IN THE LABORATORY
TASKS LEARNNG OUTCOMES SUGGESTED LEARNING POTENTIAL ASSESSMENT

ACTIVITIES METHODS
Clinical
consultation Advise clinicians on the appropriate Preparation or updating of patients Written or oral examination question
choice and selection of tests, given investigation algorithms for given on test selection for a given disorder
the clinical question to be answered, symptoms or laboratory results eg colorectal carcinoma, DMD,
and the relative diagnostic strengths investigation of hyperammonemia,
and the limitations of any proposed metabolic acidoses etc
investigation.
Advise clinicians on the relevant Preparation of information sheets Inclusion in case reports/oral
samples and preservatives required for referring clinicians and examinations of justification of sample
for specific tests: eg blood in heparin, laboratories selection
blood in EDTA, blood in
cyclohexamide, bone marrow aspirate
& trephines, buccal swabs, CVS
biopsies, amniotic fluid, PoC, skin
biopsy, muscle biopsy, lymph node
biopsy etc
Advise clinicians regarding

appropriate
- requirement for duplicate samples, Oral examination requestion relating to
- positive and negative control Participation in laboratory testing discordant results between sample
samples protocols test results and between mutation and
- specimen transport conditions for linkage results.
the dispatch of samples, including Review/update current laboratory
timeliness and temperature protocols
Advise clinicians on the formal

consent procedures for genetics

testing for NPAAC Class 1 and 2 Written examination question on the
genetics tests, including pre-test evidentiary basis for improved patient
counselling, formal documentation of Review of laboratory manuals for outcomes with genetic testing plus
Consent under State Government consistency between NPAAC counselling versus testing alone
regulations where relevant, and the requirements and laboratory
requirements for post-test protocols
counselling.
Request provision of pedigree

information for familial conditions
Practical examination question of

linkage studies in DMD and the
calculation of genetic risks from
Trainee to attempt to perform pedigrees incorporating pedigree
linkage analysis with and without information and mutation screening
pedigree information results
Maintain patient safety and comfort

whilst performing sample collections Essay question on safety standards in
and procedures the laboratory
Maintain patient confidentiality and

privacy Trainee participation in collection
of bone marrow samples Written examination questions on
Conduct patient testing programs that content of ALRC documents
are consistent with the ethical and
legal principles and structures in the Assessment by supervisor
jurisdiction Familiarity with ALRC documents
on this subject
Familiarity with relevant ethical

standards documents

Communication with referring

practitioners when test is
requested that is inconsistent with
appropriate pre-test, testing or
post test ethical standards
Accession,
Management With reference to the relevant Perform rescue of samples Workplace-based assessment
and Processing laboratory procedure manual, ensure transported under incorrect
specimen transport time and conditions or collected in an
of Specimens
conditions have been appropriate to incorrect preservative
guarantee specimen integrity and
timeliness
Apply the principles of appropriate

specimen receipt, identification and Administrative and laboratory
laboratory accession. protocols to resolve sample Oral examination questions on
identity resolution of sample identity
Using knowledge of laboratory
information system, ensure
procedures for data entry include the Review of laboratory protocols for
recording of adequate information on accuracy and currency. Workplace-based assessment
both patient and sample for repeat
future family testing.
Apply principles of safe sample

handling, storage, retention and

subsequent disposal
Review of laboratory protocols for

accuracy, currency and regulatory
Apply laboratory-specified workflow compliance. Workplace-based assessment
procedures to prioritise routine, urgent
and out of hours work.
Oral examination question on

specimen and staff management
Production,
Validation, Apply the principles of test method Participation in laboratory existing Practical/Oral question eg “Here is a
Analysis, selection with reference to the testing programs request form. What test will you
requirements for: select? Explain why”
Reporting and
- specimens
Storage of - performance Specific projects to set up new Written paper: Design and validate a
Laboratory Data - quality control tests protocols for the laboratory laboratory test
- calibration set up, including the
development of normal ranges Specific project to select a referral
- sources of patient and lab laboratory based on information
variation provided regarding test
- trouble shooting performance
- training
- reagent usage
- waste disposal
- costs
- service issues
- maintenance
- record keeping
Specific projects to establish or
update validation materials for all
Design, trouble-shoot and validate in tests to the standard required for
house laboratory tests regulatory compliance Essay: What are the principles by

which lab tests are validated?
Participation in laboratory testing Oral examination questions on

programs validation of laboratory tests
Analyse, interpret, record, report, Practical exam: Cytogenetics/FISH

compile and check morphological test result
results in the context of the clinical Participation in laboratory testing
question programs
Analyse, interpret, record, report,

compile and check qualitative test Practical exam: Mutation screen or
results in the context of the clinical hybridisation result
question Participation in laboratory testing
programs
Analyse, interpret, record, report,
compile and check quantitative test
results in the context of the clinical Practical exam: qPCR result/MLPA
question result
Participation in laboratory testing
Analyse, interpret, record, report, programs
compile and check linkage test results
in the context of the clinical question
Monitor workflow within the lab to Participation in laboratory testing Practical exam. DMD linkage studies
ensure that samples are processed programs in a prenatal test.
and analysed in a timely fashion
Oral examination question on

appropriate use of laboratory staff
resources to meet patient/clinician
expectations

Instrumentation Apply the principles of automated Work in an automated area. Written/Viva.

& Automation systems for sample preparation, PCR
Systems setup, post-PCR analysis/automated Review QA/QC with senior “Your laboratory is to implement
karyotype analysis with reference to scientists and pathologists. automation in a sector of the
the requirements for: laboratory. What considerations do
- specimens you need to take into account for your
- performance patient population and work
- quality control practices?’
- calibration set up, including the
development of normal ranges and
demonstrating accuracy at critical
decision thresholds
- trouble shooting
- training
- reagent usage
- waste disposal
- costs
- service issues
- maintenance
- record keeping.
Biochemical genetics
- HPLC
- GC-MS
- Tandem MS
- Enzyme assays

Performance Interpret and perform, where

and appropriate, the following types of
Interpretation of laboratory tests:
Specific Genetic
Tests Cytogenetic analysis of
- blood Participation in laboratory testing Work-based assessment by
- amniotic fluid cells programs supervisor
- chorion villus samples
- products of conception
- normal tissues for fibroblast Practical (“interpret”)
cytogenetics
- bone marrow and other malignant Oral (“interpret”)
tissues
Molecular genetic studies

- standard and allele restricted PCR Participation in laboratory testing Work-based assessment by
- modified PCR for methylation programs supervisor
studies
- modified PCR for mutation Practical (“interpret”)
screening
- quantitative PCR methodologies Oral (“interpret”)
- Hybridisation based testing
(Southern analysis)
- DNA sequencing
- denaturing HPLC
- linkage studies
- microsatellite based studies
- microarray based studies
FISH analysis
- aneuploidy
- microdeletion
- translocation
- chromosome painting

- M-FISH/SKY
Participation in laboratory testing Work-based assessment by
programs supervisor Casebook
Biochemical genetics studies: Practical (“interpret”)

(Interpretation of results of the
following laboratory investigations) Oral (“interpret”)
- Plasma Amino acid
- Blood Carnitine profile
- Urine organic acid Participation in laboratory testing Work-based assessment by
- Plasma ammonia programs supervisor
- Lactic acid
- Principles of enzyme assays Practical (“interpret”)
- Fibroblast culture
Oral (“interpret”)
Storage and Ensure that specimens are selected Participation in the laboratory Work-based assessment by
Retrieval of and stored appropriately in quality system supervisor
Laboratory Data compliance with NATA/RCPA, IANZ,
and Specimens ISO or other relevant requirements. Review of laboratory protocols for Oral examination sub-question
regulatory compliance
Index specimens according to Participation in laboratory testing

specific systems in use. programs Work-based assessment by
supervisor
Retrieve specimens showing Participation in family studies

examples of specific diseases or using archival samples Work-based assessment by
processes for examination and supervisor
review.

Retrieve records relating to specific

cases or specimens. Participation in family studies
using archival samples Work-based assessment by
Retrieve laboratory data from supervisor
information systems. Participation in laboratory testing
programs Work-based assessment by
supervisor
Prenatal testing Understand the principles and Participation in laboratory testing Workplace based assessments by
practice of prenatal genetic diagnosis programs supervisor
by cytogenetics, molecular genetics
and biochemical genetics Practical examination questions based
on prenatal diagnosis test data
Viva examination questions on

standards for prenatal testing
Cytogenetics Initiate, maintain and harvest in vitro Participation in laboratory testing Work-based assessment by
microscopy and culture for diagnostic human programs supervisor
related skills specimens
Prepare cytogenetic spreads Participation in laboratory testing Work-based assessment by

according to laboratory guidelines. programs supervisor
Select, perform and interpret routine Participation in laboratory testing Work-based assessment by
and special stains, and detect and programs supervisor
correct errors in these processes.
Set up and maintain laboratory

microscopes. Work-based assessment by
Participation in laboratory testing supervisor
Use light and inverted microscopy programs
appropriately.
Participation in laboratory testing Work-based assessment by

Examine, describe and interpret programs supervisor

normal and abnormal metaphases
spreads Participation in laboratory testing Practical examination
programs
Molecular Prepare nucleic acids as required for Participation in laboratory testing Work-based assessment by
Genetics Skills testing programs, including cDNA programs supervisor
and modified / substituted DNA, to
an appropriate purity standard. Oral: “Explain possible causes of the
following test result”
Design oligonucleotide primers to
maximise PCR sensitivity and Written/Oral examination on PCR
specificity Participation in laboratory testing optimisation/ discuss possible causes
programs for false negative and positive PCR
results
Establish PCR reagent mixes for Oral questions on technical solutions

different PCR applications to optimise staff resources
Participation in laboratory testing
Perform standard, multiplex, allele programs Written question on use of,
restricted, methylation sensitive, modifications to and differences
quantitative and sequencing PCRs Participation in laboratory testing between PCR applications
programs
Perform sample analytical methods
for
- known mutations
- common mutation screens Participation in laboratory testing
- mutation screens in genes without programs
a known mutation
- identification of mutation bearing
haplotypes by linkage
Perform hybidisation based analyses

such as Southerns, ASO

Use instrumentation for Casebook and practical questions

- large scale extraction of nucleic Participation in laboratory testing
acids programs
- establishing nucleic acid quantity
and purity,
- robotic workstations for large scale Participation in laboratory testing
PCR set-up programs
- sample analysis by PCR product
sizing, sequencing and denaturing
HPLC
Accessing Access appropriate information to Systematic use of reference

Sources of assist in the interpretation of data. websites and reference texts
Information
Seek further expert opinion as
appropriate
Developing an On the basis of all the information Workplace based experience

Opinion available in relation to a specific
case, develop and record a Assignment: “Construct an Practical Examination
professional opinion as to the extended analysis of the ‘nature,
nature, causation, severity, likely causation, severity, likely sequelae Oral examination
sequelae etc of the pathological etc of the pathological
process(es). process(es)’ in respect of a given
patient ...”
Communicating Construct and sign off a written Workplace based assessments, Written: “Write a report in response to
an Opinion report which contains all appropriate for example: a request on a patient with X, in the
diagnostic information and Specific task - Write a report in light of the following data / results …”

recommendations to the requesting response to a request on a patient

clinician in a timely fashion. with X, given the following data /
results…
Provide appropriate information and Workplace based assessments

inferences about a case to referring monitored by supervisor Oral: “Respond to an enquiry from a
clinicians by oral (face-to-face or clinician about a patient …”
telephone) communication.
Contribute appropriately to Grand

Rounds, clinico-pathological Workplace based assessments
conferences, morbidity and mortality monitored by supervisor and
reviews, quality and audit senior medical staff
committees and other similar
meetings.
Monitoring Where appropriate, follow up patient Workplace based assessment
Patient outcomes by consultation with
Progress clinicians, in both hospital and general
practice.
Laboratory Comply with the regulatory Review or assess the laboratory Written examination question, e.g. an
environment requirements of running a laboratory as if a NATA or quality audit essay on regulatory requirements or
with regard to current ISO, NPAAC organisation inspector and identify safety in the laboratory
and HIC Standards or other relevant any problem areas as part of a
authorities. quality audit. Critically review the
last audit assessment reports of
your laboratory and identify any
contentious issues
Take part in drawing up an annual

department budget and identifying
the fixed, variable and
Participate in budget planning and discretionary costs Oral examination question on
ongoing monitoring implementation of new testing

Participate in continuing education programs

programs for pathologists,
scientists and other staff and
Participate in organising staff, associated with each presentation. Part 2 oral examination questions on
continuing education etc… management and on-going
Attend unit management meetings professional development
Participation in staff selection

committees
Supervisor and senior medical staff

assessment
Supervisor and senior medical staff

assessment

H AEMATOLOGY
front of this Handbook and the Generic Curriculum.
INTRODUCTION
Haematology encompasses both clinical and laboratory aspects of primary disorders of the
blood as well as how other diseases affect the blood. Primary haematological diseases
include the various forms of leukaemia and lymphoma, some forms of anaemia and diverse
blood clotting disorders. Transfusion medicine also falls into the specialty of haematology.
Training in Haematology may be undertaken fully according to the RCPA Fellowship program
(FRCPA) or under a joint training program with the Royal Australasian College of Physicians
(RACP). Trainees in both strands undertake the same examinations.
Training for dual Fellowship of the RCPA and the RACP is under the auspices of the
Haematology Joint Specialist Advisory Committee (JSAC), with separate JSACs for Australia
and New Zealand. Candidates may enter the joint program when their training is eligible to
be accredited by the RACP as advanced training. Normally this means having passed the
RACP Fellowship examination. The subsequent examinations in Haematology are solely
under the control of the RCPA Board of Censors.
The Haematologist needs the following traits:

sound clinical skills
ability to follow through from diagnosis to prognosis to treatment
RCPA F E L L O W S H I P A L O N E
The aim of the Haematology training program offered by the RCPA is to equip Trainees with
the knowledge, skills and professional attitudes necessary to function as a specialist in the
practice of laboratory Haematology. They will then have the authority and expertise to
organise and ensure a high quality Haematology laboratory service and advise on the
diagnosis, investigation and monitoring of primary haematological disorders and blood-
related problems in other clinical disciplines. An additional responsibility may be the safe
provision of donor blood and blood components throughout a hospital or community.

JOINT TRAINING PROGRAM – DUAL FELLOWSHIPS
The aim of the RCPA and RACP Joint Training Program is to equip Trainees with the
knowledge, skills and professional attitudes to specialise in both laboratory and clinical
Haematology practice.
They will be responsible for providing high quality Haematology laboratory services (including
the safe provision of donor blood and blood components) and will offer comprehensive
clinical management of patients with primary haematological disorders and haematological
manifestations of other disease states.
There are two paths for training in Haematology:

a 5 year training program undertaken fully according to the RCPA Fellowship
requirements (FRCPA)
a joint training program with the Royal Australasian College of Physicians (RACP),
under the management of the Haematology Joint Specialist Advisory Committee
(JSAC) for Australia or New Zealand. Candidates may enter the joint program when
their training is eligible to be accredited by the RACP as advanced training. Normally
this means having passed the RACP Fellowship examination. Trainees are granted,
on formal application, one year’s retrospective accreditation for their basic physician
training.
All Haematology training must be undertaken in accredited laboratories and under

supervision approved by the Board of Censors. Trainees need to discuss in detail with their
supervisors how to achieve a sound knowledge of all aspects of laboratory Haematology and
transfusion medicine. If the Trainee is not exposed to specific specialised techniques in their
laboratory it is their responsibility, in conjunction with their supervisor, to ensure techniques
are understood. If possible, visits should be organised to departments where specialised
investigations are performed.
Trainees in both strands undertake the same examinations, which are solely under the
control of the RCPA Board of Censors.
Fellowship is granted on the basis of the Trainee having a sound foundation in the basic
medical sciences, a thorough understanding of the patho-physiology of haematological
disorders and awareness of the latest advances in the field.
Training is for a minimum of five years, with a major emphasis on laboratory practice,
including a period of at least two years devoted to acquiring detailed knowledge and practical
experience. On completion of the Part I examination, Trainees may continue in any general
or sub-specialty area of Haematology, e.g. haematological cytogenetics or blood transfusion
medicine. One year of the five may be spent in a branch of laboratory medicine other than
Haematology and Trainees must not spend more than four years in any one laboratory.
A period devoted to a research project in Haematology is desirable (although not mandatory,

however, see requirements for Part 2 examination dissertation) during training. Other
educational activities such as case presentations, preparation of case reports or subject

reviews, participation in utilisation review studies, quality and audit activities and attendance
at intra- and extra-mural scientific meetings are regarded as essential components of the
program.
The RCPA and RACP Joint Training Program involves a minimum of four years of accredited
training in laboratory and advanced clinical Haematology practice. One year of clinical
training undertaken before entering the dual fellowship program is accredited by the RCPA
towards its five year Fellowship training program.
The Haematology component will include at least two years gaining detailed knowledge and
practical experience in laboratory Haematology practice closely related to clinical
haematological problems. Training will also include all aspects of laboratory medicine such
as safety, quality assurance, and management.
The remaining two years will centre on inpatient and outpatient work to achieve competence
in managing clinical haematological problems without supervision. A period devoted to a
research project in Haematology is also desirable during training.
Other educational activities such as case presentations, preparation of case reports or

subject reviews, participation in utilisation review studies, quality and audit activities and
attendance at intra- and extra-mural scientific meetings are regarded as essential
components of the program.
POLICIES AND PROCEDURES FOR JOINT TRAINING
The Joint Training Program is managed by a Joint Specialist Advisory Committee

(Haematology) comprising representatives of the RCPA and RACP. Training is monitored
through annual training program approval and accreditation after submission of the
supervisor's reports each year (please refer to the section on Forms and Submissions at the
front of this Handbook regarding the submission of forms to the JSAC and the RCPA).
The JSAC will normally approve training programs in Haematology departments of hospitals
fully accredited for RACP basic physician training or of other institutions, including university
departments headed by a senior haematologist who is a Fellow of either College. Other
programs will be considered on application. Programs must be under the supervision of a
senior haematologist who is a Fellow of either College (or of equivalent status), and the
laboratory component undertaken in an RCPA accredited laboratory, supervised or co-
supervised by a Fellow of the RCPA (or equivalent).
RCPA policy is that Trainees must spend at least one year of their five year program in a
separate institution (please refer to Training Limitation in the Registration and Training
section of this Handbook). JSAC Trainees may not complete both their clinical and
laboratory training entirely within one service of an institution. Alternative employment may
occur either in the laboratory or the clinical component of JSAC training.
Trainees are strongly advised to consult the RACP handbook "Requirements for Physician
Training" for JSAC regulations governing retrospective accreditation of training and other
information concerning the Joint Training Program.
With joint training, the FRCPA and FRACP are awarded on completion of the combined
program.

ASSESSMENT
Pathological Sciences All trainees are required to undertake or apply for apply for
exemption from the Pathological Sciences examination.
PART I EXAMINATION
The Part I examination may be taken by RCPA only Trainees during or after their third year
of training, or by Joint Trainees after a minimum aggregate of 18 months of accredited
laboratory training.
The Part I examination is a comprehensive, searching and rigorous examination and

Trainees must convince the examiners they have a sound knowledge base and a mature
problem-solving approach to Haematology and transfusion medicine.
The examination consists of the following components:

Phase 1 – held in June at local venues
A three hour written paper - essay and short answer questions
A three hour haematological morphology examination - peripheral blood and marrow
(aspirates and trephines)slides
At a time to be notified, usually mid-July
A "wet" transfusion practical in the Trainee's own laboratory, under the supervision of
his/her supervisor
Phase 2 – held in August, currently in Melbourne
A “dry" Haematology (practical examination
An oral examination comprising 2 x 20 minute standardised vivas.
In broad terms the examination is a test of the Trainee's knowledge and comprehension in
the following areas:
Anatomy, physiology, biochemistry and molecular biology of the cellular and protein
elements of blood and of the haematopoietic, lymphatic, vascular and reticuloendothelial
systems
Pathophysiology of haematological and related disorders
Theoretical and practical knowledge of the full range of haematological laboratory
investigations performed in and referenced from a tertiary referral hospital
Laboratory organisation and management, laboratory safety, equipment selection and
maintenance, quality control, assurance and improvement
Test selection and interpretation of laboratory data in relation to clinical problems
Transfusion Medicine, including aspects of donor selection, blood product collection,
preparation, storage and distribution, pre-transfusion testing and aspects of transfusion
safety.
The Trainee is expected to have considerable hands-on laboratory experience, exposure to

problem solving in laboratory Haematology, experience in setting up new methodologies and

an understanding of quality systems. Examination in these aspects of Haematology and

transfusion medicine are central to the Part I examination. Trainees should ensure that they
are at the centre of their work area’s activities and not just observers. Trainees who have
spent most of their time studying books and observing laboratory Haematology will rarely
satisfy the examination requirements.
Not only are Trainees expected to have a detailed knowledge of mainstream Haematology
investigations, they also need knowledge of the principles and interpretation of tests
performed in other laboratories of relevance to Haematology practice. These would include:
methodologies in molecular biology, immunology and biochemistry relevant to Haematology
such as cytogenetics, tissue typing, and Haematology investigations in nuclear medicine
(e.g. red cell mass, plasma volume, chromium studies, iron kinetics).
Trainees are not expected to be fully-fledged consultants in the area of interpreting data from
these tests in relation to clinical problems, but they are expected to show considerable
maturity in understanding of the principle, application, interpretation and limitations of the
tests, and in their approach to clinical problems.
The Trainee should have an extensive understanding of the activities of a blood supply
agency, including knowledge of screening, testing, product selection and preparation, and
supply issues. They should also have comprehension of clinical/laboratory liaison issues in
Transfusion Safety including patient/specimen identification and diagnosis and management
of adverse transfusion-related events.
Full details of Knowledge and Experience to be Attained by Part I are set out below.
Part II Examination
The Part II examination may not be attempted until the final year of approved training. The
examination assesses the Trainee's suitability as a consultant specialist in Haematology and
consists of an oral examination and review of training, original work and publications. In their
application for the Part II examination, Trainees are encouraged to provide details (including
reprints and/or typescripts, if available) of research and special educational activities
undertaken during training.
The Part II examination includes preparation of a five to ten thousand word dissertation on a
particular Haematology topic of the Trainee’s choice. Three copies of the dissertation (spiral
bound) must be submitted to the College by 30 June of the year in which the Part II
examination is being undertaken.
Trainees awarded a relevant PhD/MD may be exempted from submitting a dissertation but
should submit a copy of their thesis. Trainees enrolled in a PhD/MD by research in a topic of
direct relevance to Haematology are eligible to apply for an exemption from the Dissertation,
but are required to submit a research plan and summary of work to date. The due date for
the research summary is the same date as the dissertation.
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN

HAEMATOLOGY
the Table of Tasks, Learning Outcomes, Activities and Assessment in Haematology, below.

PART I
expected to have knowledge and understanding of the principles and practice of
haematology including but not confined to the following:
1. Organisation and work flow
specimen collection, identification, acceptance criteria, storage and

disposal
work flow procedures related to ‘routine’, urgent and out-of-hours work
contingency plans and laboratory backup procedures
assessment of appropriate technology. This includes applying the

principles of selection of instrumentation with reference to:
- requirements for specimen analysis
- performance
- quality control
- calibration
- setup (including the development of normal and therapeutic reference
ranges)
- trouble shooting
- training
- reagent usage
- waste disposal
- cost
- service issues
- maintenance and
- record keeping.
light microscopy
electron microscopy
photo electric colorimeter
pH meter
weighing machines
spectrophotometer
immuno assays
high pressure liquid chromatography
instruments for molecular techniques
radioactivity counters

platelet function testing machines
machines
3. Reagent and inventory control

4. Laboratory safety
control of chemical, physical, microbiological and radiation hazards

fire safety
disaster management plans – internal and external
training and documentation
5. Quality Systems
Continuous quality monitoring

- notification, documentation, analysis of and action on incidents, errors
and adverse events
- governance in relation to quality systems
Quality control - pre-analytical

- sample handling, including collection, identification, acceptance,
storage and disposal
Quality control - internal

- reference ranges and applications- principles and usage of SI units
- basic statistics as applied to quality control
- measurement of uncertainty
External quality assurance

- laboratory accreditation as specified by NATA/RCPA, IANZ, ISO or
other relevant body
- adverse reaction reporting
- audit and quality improvement
6. Laboratory Computer System
Laboratory information system

Recording and reporting systems (including back-up)
7. Human Resource Management
Organisational policies relating to personnel management

Orientation of new registrars and scientific staff
Training and continuing education
Performance assessment

8. Test repertoire and scope
On the basis of current evidence, regularly review and replace tests in

use, or introduce new tests as appropriate.
9. Phenotype Studies
Morphology
- informed consent

Staining of blood and bone marrow aspirate with Romanowsky stains
Staining of blood and bone marrow for iron
Black, PAS, specific esterase, non specific esterase, acid phosphatase
and NAP stains
films, bone marrow aspirate films and trephines, including relevant
diagnostic features and interpretation, with summary and
recommendations for appropriate further testing.
Preparation and interpretation of thick and thin blood films for
demonstration of malarial parasites
Performance and interpretation of other malarial detection systems, eg.
ICT
guidelines

Acute leukaemia
CD34 cells
Paroxysmal nocturnal haemoglobinuria

DNA ploidy studies

10. Genotype Studies
Cytogenetics
Karyotyping
Molecular Genetics
Gene sequencing

Serum vitamin B12 assay and B12 binding, other relevant tests to
investigate for B12 deficiency
Schilling test

Screening tests for Glucose 6-phosphate dehydrogenase (G6PD) and
other enzyme deficiencies
Tests for paroxysmal nocturnal haemoglobinuria
Tests for haemoglobin stability, including heat and isopropanol
precipitation test

Tests for haemoglobinopathies/thalassaemia, including Hb electrophoresis

series, quantitative assessment of foetal haemoglobin, HbA2 assay, other
abnormal haemoglobins and molecular studies as above
Tests for Hb S

Prothrombin time and International Normalised Ratio
Anti-Xa assay
Coagulation factor assays and inhibitor studies
Echis time
D-dimer assays
Platelet aggregation studies
Protein C, Protein S, Antithrombin
antibodies, etc.)
Euglobulin clot lysis time
Tests for Heparin associated thrombocytopenia
Molecular testing, eg. Factor V Leiden, Prothrombin G20101A gene
mutation, methyl tetrahydrofolate reductase
Plasma homocysteine

Indirect antiglobulin test using “broad spectrum” and mono specific
reagents
Antenatal serology
transplantation

Practical and theoretical differences to laboratory management and

technical procedures when dealing with neonatal and paediatric samples.
This includes:
Be able to apply the appropriate diagnostic investigations, from those

listed, to specific circumstances in neonates and children. For example:
o Neonatal jaundice
o T activation
o The “bleeding child”
Be aware of the alteration observed through pregnancy in reference

ranges of haematology tests including peripheral blood indices
coagulation tests and Vitamin B12 levels
o Antenatal testing e.g., for haemoglobinopathies including
choriovillous sampling and amniocentesis

including
17. Other Studies

B2 microglobulin
Tdt (Terminal deoxynucleotidyl transferase) assays

Red cell survival and platelet survival studies

Bone marrow colony assays
Labelling indices – plasma cell and other
C. Clinical Interface
Discuss with clinicians the appropriate selection of tests and samples with regard
to their relative diagnostic strength in the clinical context and the limitations of
any proposed investigation.
Part II
All candidates sitting Part II, including those doing research, are expected to show continued
development and enhancement of their professional skills and expertise.
1. MAJOR TEXT BOOKS
Bain BJ, Clark DM, Lampert IA Bone Marrow Pathology - 3rd edition.
Bain BJ Haemoglobinopathy Diagnosis – 2nd edition
Bain BJ Blood Cells - 3rd edition
Dacie and Lewis Practical Haematology -10th edition
Hoffbrand V, Tuddenham E & Catovsky D Postgraduate Haematology – 5th edition
Hoffman’s Hematology: Basic Principles & Practice – 4th edition
Wintrobe’s Clinical Haematology –11th edition
2. JOURNALS
American Association of Blood Banks – Technical Manual 15th edition
Hematology, the American Society of Hematology Annual Education Program Book
Review Articles from:

American Association of Blood Banks – Transfusion Journal
American Association of Blood Banks – All About Blood
Blood
British Journal of Haematology (BJH)
New England Journal of Medicine (NEJM)

Journal of Thrombosis and Haemostasis
3. WEBSITES
UpToDate – comprehensive evidence-based clinical information resource:

www.uptodate.com
ANZSBT – Australian & New Zealand Society of Blood Transfusion:

www.anzsbt.org.au
ARCBS – Australian Red Cross Blood Services:

www.arcbs.org.au
BSCH - British Committee for Standards in Haematology:

www.bcshguidelines.com

FUNCTIONS OF THE HAEMATOLOGIST AS MEDICAL SPECIALIST IN THE LABORATORY
Tasks Learning Outcomes Learning Activities Potential Assessment Methods
Accession, • Advise clinicians on the appropriate choice and • Providing advice to requesting • Written/Viva.
Management and selection of tests and samples, their relative clinicians (e.g. incoming phone Describe the principles and pitfalls
Processing of diagnostic strengths and the limitations of any calls) for test selection in of current molecular testing
Specimens proposed investigation conjunction with haematologists. strategies, eg. PCR.
• With reference to the relevant laboratory procedure • Work in reception area

manual, apply the principles of:
- appropriate receipt, integrity and validation of
specimens in the laboratory
- specimen identification and laboratory accession
- appropriate specimen transport, handling, storage,
retention and subsequent disposal
• Evaluate turn-around times in time • Written/Viva
• Apply laboratory-specified work flow procedures to critical tests eg. APTT identifying How does your laboratory select
routine, urgent and out of hours work and determine any source of non-compliance. out-of-hours procedures?
whether they are optimal. How do you assure laboratory
performance of time critical tests?
• Review documentation and
• Select appropriate samples for integrity and practice. • Work based assessment – short
intended assay. essays on principles for
• Evaluating different testing acceptance of specimens for
• Using expert knowledge of value of tests in different selection and technologies. analysis.
disease states, advise clinician as to
appropriateness of test. • Written/Viva.
Case scenarios advising clinicians
as to appropriate testing
strategies.
Instrumentation &
• Apply the principles of automated test method • Work in automated area. • Written/Viva.
automation
selection with reference to the requirements for: Your laboratory is to implement a
systems - specimen analysis new automated analysis. What
– performance • Review QA/QC with senior considerations do you take into
- quality control scientists and pathologists. account for your patient population
- calibration set up, including the development of and work practices?
normal and therapeutic reference ranges
- trouble shooting
– training
- reagent usage
- waste disposal
– costs
- service issues
- maintenance
- record keeping.
Production and
• Record, verify, interpret and report laboratory test • Participation of ‘normal’ laboratory • Supervisor assessment and
Analysis of
results. duties. feedback on reports prepared by
Laboratory Data
trainee.
• Review test procedures and
prepare a report with
recommendations for future local • Supervisor assessment.
usage based on literature review
and analysis of all methods and
data including specificity, sensitivity
and predictive values.
• Review causes of variation.
• Identify potential causes of variation in results • Written /Viva.

- clinical Describe the preanalytic variables
- non-clinical. which affect the results of
coagulation tests.
• Explain the use of the laboratory information system • Discussions with Supervisor
to develop algorithms for production of results, • Review action limits, documentation
interpretative comments and recommendations for and compliance.
further tests.
• Apply the principles of action limits with regard to: • Written/Viva

- their development What are the action limits for
- application in the laboratory haemoglobin reporting in your

- notification of abnormal results to pathologists laboratory and how is this
and/or requesting clinicians. implemented?
Validation and
• Implement staff training to ensure that potential • Review training manuals. • Written/Viva
Reporting of
causes of laboratory error are identified – identify How do you ensure that your
Laboratory Data
and record examples where training deficiencies laboratory staff are suitably
lead to lab problems. trained?
• Implement staff training to ensure that clinically • Review and develop with • Discussions with Supervisor
significant results are identified and communicated Supervisors laboratory procedures
in accordance with laboratory procedures. to identify and communicate
clinically significant results
• Demonstrate a detailed appreciation of test • Perform literature review on • Written/Viva

limitations when reporting results reported test sensitivity and Discuss how you evaluate a new
specificity data and disease test with regard to its limitations.
prevalence, estimate positive
predictive value
• Record and verify result in accord with laboratory • Review departmental list of tests • Discussions with Supervisor
procedures relating to QC etc and define appropriate
QC/reporting.
• Use laboratory information system to design
algorithms for reporting – prepare algorithms for • Give seminars to scientific staff
investigation of different clinical scenarios explaining significance and
consequences of clinical reporting.
• Use these algorithms, action limits etc, to identify • Review and preparation of action
results which need non-routine action limit documentation. • Written/Viva.
How do you as a pathologist get
• Use department procedures to ensure that • Involvement in subsequent actions. involved in the development,
important results are conveyed to appropriate Eg. Telephoning requesting implementation and auditing of
clinician and extra testing is performed if indicated clinician with recommendation for compliance with action limit
further investigation. procedures in your laboratory?
Monitoring Patient
• Where laboratory results suggest developing • Follow up of patients • Discussions with Supervisor
disease, appropriately monitor patient progress

Progress using direct visit or surveillance via laboratory • Ringing out of abnormal/critical
information system, so as to advise clinician when results
further specific testing may be warranted, or when a
specific diagnosis becomes apparent. • Participate in Supervised after
hours roster
Storage And • Comply with the guidelines for specimen’s storage • Read guidelines and study local • Discussion with Quality Officers,
Retrieval Of as set out in NATA/RCPA, IANZ, ISO or other practice for monitoring laboratory scientists and
Laboratory Data relevant requirements. documentation for NATA-ISO Supervisor
And Specimens assessment
• Index specimens according to specific systems in • Retrieve specimens for review as

use. part of daily work practice.
• Retrieve specimens showing examples of specific

diseases or processes for examination and review.
• Using LIS retrieve reports with
• Retrieve laboratory data from information systems. particular abnormalities for clinical
review.
Laboratory
• Comply with the regulatory requirements of running • Review or assess the laboratory as • Written/Viva.
Environment
a laboratory with regard to NATA, HIC or other if a NATA or quality audit Discuss the quality issues in your
relevant authorities. organisation inspector and identify laboratory with regards to
any problem areas as part of a production of full blood
quality audit. Critically review the examination result.
last audit assessment reports of
your laboratory and identify any
contentious issues
• Participate in budget planning and ongoing • Take part in drawing up an annual • Written/Viva
monitoring department budget and identifying
Discuss the budgetary implications
the fixed, variable and discretionary
costs of implementing a new technology
into your laboratory.
• Participate in organising staff, continuing education • Participate in continuing education
etc… programs for pathologists,
scientists and other staff and
associated with each presentation.

• Attend unit management meetings
Perform Specific
• Perform sterile procedures including bone marrow • Satisfactory performance at a CPR • Oral and observed practical oral
Clinical
aspiration, trephine biopsies, cannulation and teaching session. assessment by Supervisor before
Procedures
phlebotomy (including therapeutic venesection) with credentialing to perform test ‘solo’.
due consideration of:
- the individual patient’s condition and clinical • Written/Viva.
history Discuss indications for and
- benefits and potential risks potential complications of bone
- clinical indications marrow procurement
- informed consent
Performance and Interpret and perform, where appropriate, the following • Perform tests as part of daily
Interpretation of laboratory tests as listed in detail in the Haematology laboratory and training activities. • Written/Viva
Specific check list: May require attendance and Describe principles and pitfalls of
Haematology
performance at other laboratories. testing of various technologies
Tests
• Full Blood Count
• Phenotype studies
- Morphology
- Immunophenotype or flow cytometry
• Genotype studies
- Cytogenetics
- Molecular genetics
• Erythrocyte studies
• Haemolysis studies
• Coagulation studies
• Blood transfusion studies
• Paediatric studies
• Other studies.
• Ensure that specimens are selected and stored • Critically review the last reports for
appropriately in compliance with NATA/RCPA, any compliance irregularities.
IANZ, ISO or other relevant requirements.
• Prepare a report on storage • Discussions with Supervisor.
Storage and • Index specimens according to specific systems in systems.

Retrieval of use.
Laboratory Data • Exercises set in laboratory
and Specimens • Retrieve specimens showing examples of specific
diseases or processes for examination and review.
• Retrieve records relating to specific cases or

specimens.
• Retrieve laboratory data from information systems.
Microscopy and
• Prepare blood and bone marrow films according to • Performance daily laboratory • Microscopy exam.
related skills
laboratory guidelines. duties. Select and present slides to
clinicians. Undergraduate and
• Select, perform and interpret routine and special scientist teaching.
stains, and detect and correct errors in these
processes.
• Set up and maintain laboratory microscopes.
• Use light and other microscopy appropriately.
• Examine, describe and interpret blood and marrow

films prepared by any of the techniques described
in the Haematology checklist.
• Review of presentation by
• Record images for retention/teaching/manuscripts, • Preparation of teaching materials. Supervisor
etc eg. Digital photography.
Transfusion-
• Identification of donor and recipient and pre • Daily laboratory duties.
related Skills
transfusion testing.
- Donation/storage/transport/ issues • Answering transfusion related • Wet Transfusion Practical
- Indications for blood products (including queries from clinician and
modification). scientists. • Written/Viva
- Specification of blood products. Questions in relation to clinical
and laboratory transfusion
• Complications of transfusion • Instigating and investigating practice.
transfusion reactions and preparing

• Laboratory testing, reporting and documentation. reports.
• Monitoring efficacy of transfusion. • Perform all tests; include training

exercises at Red Cross Blood
• Provide clinical advice on the appropriate selection Service or other relevant labs.
of blood and blood products and their
administration. • Attend and contribute to
Transfusion Committee meetings
• Perform blood transfusion studies as listed in the
• Transfusion exercises set within the
• Interpret blood bank results. laboratory.
• Recognise, investigate and manage transfusion • Discussions with Supervisor and

reactions and other transfusion related adverse Blood Bank Scientist.
events.
• Provision of urgent blood support
Accessing
• Access appropriate information to assist in the • Use textbooks, journals, internet, • Written/Viva
Sources of
interpretation of specimens. etc. Testing all components of
Information
curriculum and current knowledge.
Developing an
• On the basis of all the information available in • Daily laboratory duties • Written/Viva
Opinion
relation to a specific case, develop and record a .
professional opinion as to the nature, causation, • Preparation under supervision of
severity, likely sequelae etc of the pathological consultative reports.
process(es).
Communicating
• Construct and sign off a written report which • Preparation under supervision of • Morphology Written/Viva.
an Opinion
contains all appropriate diagnostic information and consultative reports Refer to recommended format for
recommendations to the requesting clinician in a answering morphology questions.
timely fashion. (RCPA website).
Prepare a consultative report/give

• Provide appropriate information and inferences • Performance of daily laboratory and a consultative opinion on various
about a case to referring clinicians by oral (face-to- supervised on-call duties. haematological test abnormalities
face or telephone) communication. and clinical conditions
• Contribute appropriately to Grand Rounds, clinico- • Discussions with Supervisor.

pathological conferences, morbidity and mortality
reviews, quality and audit committees and other
similar meetings.
Monitoring Patient
• Where appropriate, follow up patient outcomes by • Performance of daily laboratory and • Discussions with Supervisor.
Progress
consultation with clinicians, in both hospital and supervised on-call duties.
general practice.

I MMUNOLOGY
front of this Handbook and the Generic Curriculum.
INTRODUCTION
Immunology training under the auspices of the Royal College of Pathologists of Australasia
(RCPA) is designed to prepare specialists to provide expert medical care for patients with
immune disorders as clinicians and pathologists, and who can serve as consultants,
educators, and physician scientists in the diagnosis and investigation of such conditions.
Fellows of the RCPA trained in Immunology will be able to direct services specialising in the
diagnosis and monitoring of diseases of immune function, including immunodeficiency,
autoimmunity, lymphoid malignancy and allergy, and the diagnosis and monitoring of other
medical conditions that depend on identification of abnormalities of immune function or on
the results of tests based on immunological methodology.
The Immunopathologist needs the following traits:

scientific curiosity
interest in keeping up to date with advances in basic science
ability to work as part of a team
good oral and written communication skills
ability to use on-line databases and familiarity with computers
By the end of the training program, immunopathologists will be able to:

1. Demonstrate a detailed knowledge of the structure and function of the normal
immune system and the pathogenesis of abnormal immune responses
2. Demonstrate knowledge in choice of investigations (including relevant benefits, costs
and risks), interpreting generated data, and providing advice on further patient
management
3. Demonstrate a detailed knowledge of the tests listed in the syllabus, including their
performance, interpretation and analysis, and quality control
4. Appreciate the different methods that are available for performance of tests listed in
the syllabus and be competent in choosing between them depending on specific
circumstances and requirements
5. Provide advice to medical practitioners and patients about the selection,
interpretation and clinical utility of relevant tests
6. Demonstrate competence in the management of a pathology service, including the
understanding of financial and legislative requirements, resource allocation and
equipment and instrument maintenance
7. Demonstrate a capacity for continued learning, an ability to generate and interpret
new data, and an ability to apply new developments in the field as appropriate in the
improved diagnosis and management of immune diseases
8. Demonstrate other skills and proficiencies as described in the Generic Curriculum.

The objectives of training are to be met by the Trainee’s participation in the work of a
diagnostic immunopathology laboratory, with involvement in the total cycle of testing offered
by the laboratory, from specimen receipt to release of results, and including:
• selection and validation of test methods
• performance of assays
• interpretation of results
• investigation and resolution of assay problems
• reporting of results
• quality management
• laboratory audits
• teaching
• consumer liaison
A training program is also offered conjointly with the Royal Australian College of Physicians
(RACP) leading to Fellowships of both Colleges for trainee Immunologists who wish to
provide patient care as well as laboratory services. The RACP also offers a program for
immunologists whose primary responsibility is for patient care only.
This is a five-year program supervised by a senior immunopathologist in a laboratory

accredited by the RCPA Board of Censors. The Trainee is required to seek prospective
approval for every year of training, with accreditation being granted on receipt of a
satisfactory supervisor's report towards the end of that year.
Training may include one year in General Pathology, or in one of the pathology specialties,
or part of an Immunology research project. The major part of the training program must be
taken in laboratories providing a comprehensive Immunopathological Diagnostic Service.
This program is jointly supervised by the RCPA and the Royal Australasian College of
Physicians (RACP) through a Joint Specialist Advisory Committee (JSAC). One year of
clinical Training undertaken before entering the dual fellowship program is accredited by the
RCPA towards its five-year fellowship training program.
Candidates may enter the joint program when they are eligible to enter advanced training as
determined by the RACP, generally following completion of the FRACP written and clinical
examinations. Subsequent examinations in Immunopathology for all trainees are under the
jurisdiction of the RCPA Board of Censors.
Training requirements apply, as detailed under general policies and procedures of the Board
of Censors of the RCPA.
LABORATORY ROTATION
Training can be undertaken only in laboratories approved by the College. RCPA policy is that
Trainees must spend at least one year of their five-year program in a separate institution

(please refer to Training Limitation in the Registration and Training section of this
Handbook). JSAC Trainees may not complete both their clinical and laboratory training
entirely within one service of an institution. Alternative employment may occur either in the
laboratory or the clinical component of JSAC training. Change of supervisor to another
member of an integrated clinical/laboratory service will not qualify; nor will a change to a
different geographical site of an integrated service. Training overseas may be approved as
part fulfilment of the requirements.
ASSESSMENT
Pathological Sciences All trainees are required to undertake or apply for exemption from
the Pathological Sciences examination.
FORMATIVE ASSESSMENTS
Training is monitored via annual approval of the training program and accreditation of
each completed year following receipt of a Supervisor's report.
SUMMATIVE ASSESSMENTS
PART I EXAMINATION
Trainees in either the RCPA-only or Joint Training Program may sit the Part I Immunology
Examination after at least 12 months training in an approved Immunopathology laboratory.
They must have satisfied the laboratory supervisor of their proficiency in the techniques
listed under Knowledge and Experience to be Attained in Immunopathology, below.
The Part I examination consists of written, practical and oral examinations.

Each component is an integral part of the total examination and cannot, except under
unusual circumstances, be taken alone. The examination is, therefore, graded in its entirety
with each component contributing an equal part to the final assessment.
Written examination
The written examination consists of a three-hour question paper that is designed to test
theoretical knowledge of basic immunology and applied clinical and diagnostic
immunopathology.
The question paper comprises:

a choice of two essay questions that account for one third of the allocated marks
twenty ‘short-answer’ questions that make up the remainder of the marks.
Practical examination
The practical examination tests proficiency in laboratory procedures, the ability to solve
clinical case problems and problem-solving capacity in laboratory practice. Trainees are
expected to demonstrate knowledge of laboratory procedures in Immunology, and
interpretation of results.
The examination comprises 6 stations each of 30 minutes duration.
Oral examination
The Oral examination consists of interviews with two sets of examiners each of 20 minutes
duration.

Upon completion of the Part I examination, the Trainee may continue training in any field in
Immunology, provided the program is approved by the RCPA and RACP.
This is usually undertaken in the final year of training. At this stage the Trainee must be able
to direct a routine Immunopathology laboratory and act as a consultant in Immunopathology
in a major hospital or regional health service. Assessment is by two oral examinations with a
pair of examiners.
The Part I and II examinations cannot ordinarily be undertaken in the same year.
Dissertation
Trainees are required to submit a dissertation to JSAC (for dual fellowship trainees) or the
BOC (for RCPA only trainees) in their penultimate year of training. In either case, the
requirements are outlined under the “Project requirements of the JSAC in Clinical
Immunology and Allergy”, and the timing of submission and nature of the dissertation are
outlined in the relevant document held by the RACP.
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED
Table of Tasks, Learning Outcomes, Activities and Assessment in Immunology, below.
CORE BODY OF KNOWLEDGE IN FUNDAMENTAL IMMUNOLOGY
Organisation of the Immune System:

− lymphoid tissues and organs: anatomy and function
− cells of relevance to the immune response, ontogeny, characteristics and functions
− molecules of relevance to the immune response: MHC, cytokines, chemokines,
receptors, signalling pathways, vasoactive mediators, prostaglandins, leukotrienes
− genes of relevance to the immune response, including genes for above molecules and
MHC, gene rearrangement in generation of antigen receptors
Structure and function relationships between the organs, tissues and cells that participate in
immune responses
Cellular and molecular correlates of immune function
Malignancies of the immune system:

− B cell and plasma cell neoplasms
− T cell neoplasms
− Monocyte/macrophage neoplasms
Comprehensive understanding of the ontogeny of the immune system and the relationship
between the development of immune function to development of allergic diseases,
autoimmunity, vasculitides and immunodeficiencies.
IMMUNE MECHANISMS
Innate immunity:
− NK cells
• Activation and inhibition

• Cytotoxicity mechanisms
• Cytokines relevant in NK cell development and function
− Macrophages
− Granulocytes
− Receptors:
• Pattern recognition molecules (e.g. TLRs, MMR), pathogen-associated molecular
patterns;
− Proteins
• Complement
• Acute phase proteins
• Mannose-binding lectin
• Anti-microbial peptides
Specific immunity:
− MHC
Molecular structure
Function
Tissue typing
− Antigen-presenting cells
• Dendritic cells
• Antigen processing and presentation
• Superantigens
− T cell mediated immunity

• T cells (αβ & γδ) and subsets (CD4/CD8, Helper, CTL, Th1/Th2, memory T cells,
regulatory T cells)
• T cell receptor epitope recognition (αβ & γδ), activation and co-stimulation
• Cytokines relevant in T cell development and function
• Cytotoxicity mechanisms
• Activation-induced cell death
− B cell mediated immunity

• Antibodies: structure, function (neutralisation, opsonization, complement fixation,
antibody dependent cell mediated cytotoxicity)
• B cells and subsets (transitional B cells, memory B cells)
• Plasma cell differentiation
• Immunoglobulin production
• B-cell receptor epitope recognition, activation and co-stimulation
• Cytokines relevant in B-cell development and function
• Isotype switching and affinity maturation
− Allergic responses
Cells of the allergic reaction (mast cells, basophils, eosinophils)
Generation of Th2 responses
Cytokines / chemokines relevant in allergic responses
IgE and receptor interactions
IgE-mediated acute-phase and late-phase reactions
− Hypersensitivity responses (types II – IV)

• Antibody-mediated cytotoxicity responses
• Immune complexes - immunologic properties and mechanisms of clearance
• Cell-mediated immunity

− Immunoregulatory mechanisms
• Tolerance and autoimmunity
• Idiotypic networks
• Apoptosis
− Mucosal immunity
• Mucosal epithelium and specialised cells
• IgA biology and transport
• Oral tolerance
• Role in vaccine responses
− Transplantation Immunology
• Allograft rejection
• Graft versus host reactions (GVHR)
• Maintenance of tolerance
− Tumour immunology
• Tumour specific and tumour associated antigens
• Immune surveillance
− Immune response to infections

Parasites, Helminths
Extracellular bacteria
Viruses
Intracellular bacteria (Mycobacteria)
Protozoa
− HIV biology
• HIV life cycle (entry, latency, mechanisms of replication)
• Pathogenesis of immunodeficiency
Cellular and molecular mechanisms of immune function
Relationships and links between different immunological processes
P A T H O P H YS I O L O G Y
Pathophysiology, including the molecular basis, of immunodeficiency diseases
Primary immunodeficiency diseases:

− Combined immunodeficiencies
− Predominantly antibody deficiencies
− Other well defined immunodeficiency syndromes
− Complement deficiencies
− Congenital defects of phagocytic number and/or function
Acquired immunodeficiency disorders:

− HIV-related
− nutrition and metabolic related
− associated with malignancy and cancer therapies
Pathophysiology, including the molecular basis, of autoimmune/rheumatic diseases and

systemic vasculitides

Pathophysiology, including the molecular basis, of inherited disorders of immune regulation

including:
− IPEX syndrome
− Autoimmune lymphoproliferative syndrome (ALPS)
− Familial haemophagocytic lymphohistiocytosis syndromes.
Pathophysiology, including the molecular basis, of autoimmune diseases including:

− collagen-vascular diseases (connective tissue disease)
− immune endocrinopathies
− autoimmune liver diseases
− coeliac disease
− inflammatory bowel diseases
− immunologic neuromuscular diseases
− immunohaematologic diseases
− ocular diseases.
Pathophysiology, including the molecular basis, of vasculitis including:

− small medium and large vessel diseases
− pulmonary and renal immune disease.
Normal physiology of the upper and lower airways.
Pathological effects of allergic and other immunologic diseases on airway physiology.
Pathophysiology, including the molecular basis, of allergic diseases.
Pathophysiology, including the molecular basis, of upper airway diseases including:

− rhinitis,
− sinusitis,
− nasal polyposis,
− otitis (bacterial and serous)
Pathophysiology, including the molecular basis, of lower respiratory tract disease including:
− asthma and related disorders:
o wheezing disorders of early childhood,
o exercise-induced,
o allergic
o bronchopulmonary aspergillosis,
o sulfite-related,
o aspirin- induced,
o occupational,
o menstrual cycle related,
o infection-related, and
o intrinsic.
Pathophysiology, including the molecular basis, of allergic eye diseases including allergic
and vernal conjunctivitis, iritis, and iridocyclitis.

Pathophysiology, including the molecular basis, of allergic dermatologic diseases including:

− urticaria,
− angioedema,
− dermatographism,
− atopic dermatitis,
− contact dermatitis,
− urticaria pigmentosa,
− bullous disease,
− drug rashes,
− erythema multiforme and toxic epidermal necrolysis,
− erythema nodosum, and
− other immunologic skin diseases.
PRINCIPLESO F I M M U N O L O G I C A L A S S A YS , O P E R A T I O N O F I N S T R U M E N T S A N D
THE REAGENTS USED IN IMMUNOLOGICAL TESTING
Antigen-antibody reactions
Separation of molecules in gels
Use and applications of fluorochromes
Cell proliferation and cell cycle analysis
Molecular techniques
Cellular techniques
Use of automated instruments
Radioactivity and isotopes
Production of antibodies
Microscopy
SPECIFICTESTS, INCLUDING PERFORMANCE CHARACTERISTICS OF THE TESTS,

ALTERNATIVE METHODS, TEST USAGE AND CLINICAL UTILITY
Electrophoresis of proteins and DNA

Measurement of immunoglobulins
Measurement of complement proteins and function
Detection of autoantibodies
Detection of IgE-specific antibodies
Lymphocyte analysis
Lymphocyte function
Demonstration of monoclonality
Granulocyte function tests

Recognising the evolving nature of the discipline, no texts for training in Immunopathology
are stipulated. However, the following books and journals give a general idea of texts that
may be useful to trainees preparing for Fellowship in Immunology:
BOOKS
1. Abbas AK, and Lichtman AH (2005). Cellular and Molecular Immunology (5th edition)
ISBN 1416023895. Saunders, Philedelphia
2. Janeway CA, Travers P, Walport M and Shlomchik M (2004) Immunobiology: The
Immune System in Health and Disease, 6th edition, ISBN 0443073104 Churchill
Livingstone
3. Paul WE (2003) Fundamental Immunology 5th Edition ISBN: 0-7817-3514-9. Lippincott,
Williams and Wilkins
4. Rose NR, Hamilton RG and Detrick B (2004). Manual of Clinical Laboratory Immunology,
(6th Edition) ISBN: 1-55581-215-5 ASM Press
5. Paul WE, Fathman CG and Glimcher LH. Annual Reviews of Immunology. Published
annually by Annual Reviews, Palo Alto, California
JOURNALS
The following journals have many useful articles on Immunological topics:

Clinical Chemistry
Journal of Clinical and Diagnostic Immunology
The Lancet
Nature
Nature Medicine
Nature Immunology
Trends in Immunology
Nature Reviews Immunology
CONFERENCES AND MEETINGS
Trainees are encouraged to attend Pathology Update, the annual scientific meeting of the
RCPA which is held annually in Sydney in March. A discipline stream for Immunopathology
runs concurrently and in association with the other pathology disciplines and covers topical
and novel aspects of practice.
The RCPA also supports the ICPMR Immunopathology Course, an annual program in the
principles and practice of Immunopathology at which Immunopathologists from laboratories
in Australia give interactive tutorials and lectures on current topics in Basic and Applied
Immunology and Immunopathology. The meeting is organised by the Department of
Immunology at the ICPMR and is held at Westmead Hospital, Sydney. The program includes
the opportunity for participation in a simulated practical and clinical examination that may
assist trainees in their approach to formal summative assessments.
The Annual Scientific meeting of the Australasian Society for Immunology and Allergy
(ASCIA) is held usually in September at different venues around Australia and New Zealand
and often includes a satellite meeting devoted to immunopathology.


ASSESSMENTS IN IMMUNOLOGY

Learning Outcomes Learning Activities Potential Assessment Methods

Tasks
Discipline-Specific Functions of the Immunologist as Medical Specialist in the Laboratory
Accession, Identify the need and use laboratory • Providing advice to requesting • Written/Viva.
Management tests/clinical procedures for: clinicians for test selection For example:
and Processing o prevention, diagnosis, treatment and Describe the tests you would
of Specimens monitoring of primary and secondary • Work in reception area recommend for monitoring
immunodeficiency SLE.
o diagnosis and assessment of How does your laboratory
autoimmune/rheumatic disease and • Participation in laboratory select out-of-hours
systemic vasculitides management meetings procedures?
o diagnosis and monitoring of relevant How do you assure laboratory
sensitisations in the patients with allergic • Evaluate turn-around times in performance of time critical
symptoms (including skin testing and time critical tests eg. Anti-GBM tests?
measurement in the serum of allergen antibodies, identifying any Case scenarios
specific IgE) source of non-compliance.
o diagnosis of myelo- and lymphoproliferative
disorders • Review documentation and • Work based assessment –
o tissue typing for disease risk assessment practice. short essays on principles for
and for transplantation acceptance of specimens for
Advise clinicians on the appropriate selection of • Evaluate different testing analysis
investigations, tests and samples, and their selection and technologies
relative diagnostic strengths and limitations • Supervisors’ reports.
With reference to the relevant laboratory
• Own study.
procedure manual, apply the principles of:
o appropriate receipt, assessment of integrity
and validation of specimens in the
laboratory
o specimen identification and laboratory
accession
o appropriate specimen transport, handling,
storage, retention and disposal


Tasks
Apply laboratory-specified work flow procedures
to routine, urgent and out of hours work and
determine whether they are optimal
Know the appropriate techniques for the
processing and storage of specimen submitted
to laboratories for analysis including processes,
indications and diagnostic uses for serum,
plasma, urine, CSF, pleural and peritoneal
fluids DNA and RNA.
.
o Ensure washing, sterilisation and care of • Laboratory orientation • Written/Viva.

General glassware and other equipment in accordance program For example:
Laboratory with laboratory manuals. How do you prepare a
Skills o Make up solutions accurately from written • Participation in laboratory suspension of cells from a
formulae activities including performance lymph node?
o Apply scientific principles to prepare buffered of laboratory assays
solutions
o Calculate solution concentrations and make • Work based assessment –
isotonic solutions • Set up and alignment of short essays on principles of
o Deal with potential hazards in accordance with microscope handling biologically
laboratory manuals, in particular: hazardous materials
o human sera
o infectious agents • Supervisors’ reports.
o radioisotopes
o potentially explosive materials • Practical examination
o poisons
Maintain safe practice in relation to radioactivity
and carcinogens
o Apply principles and procedures to culture of
cells and lines and their maintenance
o Prepare cell suspensions and separate cell
populations, e.g. by density centrifugation, or


Tasks
antigen- or antibody-coated beads or columns.
o Assessment of cell viability and concentration.
o Perform procedures under sterile conditions,
including cells in culture
o Use and maintenance of microscope.
o Aliquoting and dilution of specimens and
reagents
Test method
• Ability to select test methods and instruments • Written/Viva.
selection and
taking into account factors such as: • Participation in activities of the Your laboratory is to
evaluation
o potential for automation laboratory including test implement a new automated
o performance characteristics of test evaluation analysis. What considerations
methods do you take into account for
o quality control your patient population and
o calibration set up, including the work practices?
development of normal and therapeutic • Review QA with senior
reference ranges scientists and pathologists. • Practical examination
o trouble shooting E.g.: Compare performance
o training • Calibration and maintenance of characteristics of different
o reagent usage instruments and equipment assays.
o waste disposal Interpret QA reports
o costs and remuneration
o service issues
o maintenance
o record keeping
• Ability to compare performance of different
methods
o statistical analysis
o QA
• Ability to assess test usage and clinical utility


Tasks
Storage And • Recognise how requirements for specimen • Read guidelines and study • Discussion with Quality
Retrieval Of storage as set out in NATA/RCPA, IANZ, ISO local practice for monitoring Officers, laboratory scientists
Laboratory guidelines are applied in the laboratory. documentation for NATA-ISO and Supervisor
Data And • Ensure that specimens are selected and stored assessment • Exercises set in laboratory
Specimens appropriately in compliance with NATA/RCPA, • Retrieve specimens for review • Viva Examination
IANZ, ISO or other relevant requirements. as part of daily work practice. • Practical examination
• Index specimens according to specific systems • Using LIS retrieve reports with
in use. particular abnormalities for
• Retrieve specimens showing examples of clinical review
specific diseases or processes for examination • Prepare a report on storage
and review. systems..
• Retrieve records relating to specific cases or
specimens
• Retrieve laboratory data from information
systems.
Laboratory
• Comply with the regulatory requirements of • Review or assess the • Written/Viva.
Environment
running a laboratory with regard to NATA, HIC laboratory as if a NATA or Discuss the quality issues in
or other relevant authorities. quality audit organisation your laboratory with regards to
• Participate in budget planning and ongoing inspector and identify any detection of autoantibodies.
monitoring problem areas as part of a
• Participate in organising staff, rosters, training quality audit. Critically review • Written/Viva
continuing education etc… the last audit assessment Discuss the budgetary
reports of your laboratory and implications of implementing a
identify any contentious issues new technology into your
• Take part in drawing up an laboratory.
annual department budget and
identifying the fixed, variable
and discretionary costs • Viva.
• Participate in continuing For example: How would you
education programs for ensure that laboratory staff
pathologists, scientists and


Tasks
other staff and provide list of are qualified to perform a
learning objectives associated test?
with each presentation.
• Participate in laboratory
management meetings
Assay Understand the principles of assays, operation of • Participation in activities of the • Written/Viva.
techniques instruments and use of reagents in the following laboratory including test For example:
test methods: evaluation Explain the principles of
o Antigen-antibody reactions for analyte Rayleigh scatter
detection
o Immunoassays (ELISA and its • Own study
modifications, RIA) • Work based assessment –
o Immunoprecipitation • Tutorials short essays, for example, on
o Nephelometry and Turbidimetry principles of nephelometry
o Separation of molecules in gels
o Electrophoresis • Practical examination.
o Immunodiffusion assays For example: Interpret the
o Western blotting results of assay
o Flow cytometry
o Use in immunophenotyping and function Decide on actions to take with
of cells and in cell selection and sorting, aberrant results
cell cycle analysis and DNA ploidy
o Detection of analytes and antibodies by • Supervisors’ reports.
addressable bead assays
o Direct and indirect immunofluorescence
o Chemiluminescence
o Assessment of functions of immunologically
relevant proteins
o Cell proliferation, function and cell cycle
analysis
o Molecular techniques


Tasks
o DNA and RNA extraction, polymerase
chain reaction, molecular hybridisation
assays, sequencing
o Cellular techniques
o tissue and cell freezing, e.g. in liquid
nitrogen
o Use of automated instruments
o Radioactivity and isotopes
o Production of antibodies
o Microscopy
o Spectroscopy
Understand the calibration, operation and

maintenance of the equipment used in the
performance of the techniques listed.
Understand the historical and technical

development of assays in use in Immunology
laboratories and other assays that use
immunological principles that are in use in other
disciplines of pathology
Appreciate differences in assays for the

measurement of analytes in use in diverse
laboratories, particularly with their strengths and
weaknesses and the reasons for their selection.
Understand the reasons why some methods and

tests have been replaced or are no longer in use.
Microscopy and
• Prepare tissue sections (others?) according to • Performance daily laboratory • Viva;
related skills
laboratory guidelines. duties. Select and present Explain the principles of


Tasks
• Set up and maintain laboratory microscopes. slides to clinicians. immunofluorescent
• Use light, immunofluorescent and other Undergraduate and scientist microscopy
microscopy appropriately. teaching. • Microscopy exam.
• Record images for • Practical examination:
retention/teaching/manuscripts, etc eg. Digital • Preparation of teaching Interpret stained tissue
photography. materials. sections
• Review of presentation by
Supervisor
Performance
• Interpret serum protein electrophoresis, • Perform tests as part of daily
and
immuno-electrophoresis and isoelectric laboratory and training • Written/Viva
Interpretation of
focussing. activities. May require Describe principles and pitfalls
Specific
o cryoglobulin quantitation and attendance and performance at of testing of various
Immunology
characterisation other laboratories. technologies
Tests
• Interpret CSF protein electrophoresis,
immunoelectrophoresis and isoelectric Explain what you would
focussing advice a clinician seeking to
• Interpret serum immunoglobulin levels exclude a diagnosis of …….
• Interpret and explain molecular methods for
diagnosing monoclonality. • Practical
• Use laboratory tests/clinical procedures for Fro example: Interpret the
prevention, diagnosis, treatment and monitoring following test results
of primary and secondary immunodeficiency.
• Interpret (including an understanding of the
physiological changes with age) tests of
immune function, including:
o enumeration of lymphocyte subsets,
immunophenotype of cells in peripheral
blood, bone marrow and biopsy
specimens,
o proliferation assays,
o neutrophil function tests,


Tasks
o measurement of immunoglobulins, IgG
subclasses,
o antibody responses to immunisations,
o tests for innate immune function
including: measurement of complement
components, CH50, AH50, and
mannose binding lectin.
• Interpret (including age-specific interpretation)
laboratory tests used routinely in the diagnosis
of autoimmune conditions.
Perform skin prick, intradermal and patch
testing for physical urticaria/angioedema and
autologous skin testing.
Interpret direct and indirect immunofluorescent
tests.
Diagnose and interpret allergic triggers using
skin prick testing, including appropriate
selection of allergens, and controls.
Interpret allergen-specific IgE testing.
Assay Perform, analyse, interpret and report the following • Participation of laboratory • Supervisor assessment and
applications tests: duties. feedback on reports prepared
o Assessment of immunoglobulins and other by trainee.
immunologically relevant proteins
o Measurement of complement proteins and • Review test procedures and • Written /Viva.
function prepare a report with Describe the pre-analytic
o Detection of autoantibodies recommendations for future variables that affect the
o Detection of allergen-specific IgE local usage based on literature results of antibody tests.
o Immunophenotyping of cells and tissues review and analysis of all
o Lymphocyte function methods and data including • Practical examination.
o Granulocyte function specificity, sensitivity and other Report the results of a test
o HLA typing performance characteristics.


Tasks
o Tests for the diagnosis and monitoring of HIV •
infection
o Direct immunofluorescence of tissue samples
Validation and
• Record and verify results in accordance with • Review training manuals. • Written/Viva
Reporting of
Laboratory
laboratory procedures relating to QC etc • Review causes of variation. What are the action limits for
Data • Identify potential causes of variation in results • Prepare and review action immunoglobulin levels
• Use and explain the use of the laboratory limits, documentation and reporting in your laboratory
information system to develop algorithms for compliance. and how is this implemented?
production of results, interpretative comments • Review and develop laboratory
and recommendations for further tests. procedures to identify and Discuss how you evaluate a
• Develop and use action limits as they apply to communicate clinically new test with regard to its
the tests in the laboratory and the rules for significant results limitations
notification of abnormal results to pathologists • Perform literature review on
and/or requesting clinicians. reported test sensitivity and • Practical Examination
• Ability to recognise and rectify causes of error specificity data and disease Interpret the results of tests
in the laboratory prevalence, estimate positive provided as data from an
• Demonstrate a detailed appreciation of test predictive value instrument
limitations when reporting results • Implement staff training to
• Use laboratory information system to design ensure that potential causes of Write a report for a result
algorithms for reporting – prepare algorithms laboratory error are identified –
for investigation of different clinical scenarios identify and record examples Comment on action limits for
• Use these algorithms, action limits etc, to where training deficiencies lead results of quality control
identify results which need non-routine action to laboratory problems. specimen
• Ability to recognise important results that need • Implement staff training to
to be conveyed to appropriate clinicians ensure that clinically significant
• Identify when additional testing is indicated results are identified and • Discussions with Supervisor
communicated in accordance
with laboratory procedures.
• Review departmental list of
tests and define appropriate
QC/reporting.


Tasks
• Give seminars to scientific staff
explaining significance and
consequences of clinical
reporting.
• Involvement in subsequent
actions. Eg. Telephoning
requesting clinician with
recommendation for further
investigation.
Monitoring
• Where laboratory results suggest developing or • Follow up of patients as part of • Discussions with Supervisor
Patient
Progress
established disease, appropriately monitor duties in the laboratory • Viva/Practical
patient progress so as to advise clinician when • communication of
further specific testing may be warranted, or abnormal/critical results
when a specific diagnosis becomes apparent. • Participate in supervised after
• Advise on selection of tests when used for hours roster
diagnosis compared to monitoring
• Where appropriate, follow up patient outcomes
by consultation with clinicians, in both hospital
and general practice.
Perform
• Perform procedures including cannulation, • Satisfactory performance at a • Oral and observed practical
Specific Clinical
venesection, skin prick testing and CPR teaching session. by Supervisor before
Procedures
plasmapheresis with due consideration of: • Participation in the clinical credentialed to perform test.
- the individual patient’s condition and clinical activities
history • Written/Viva.
- benefits and potential risks Discuss indications for and
- clinical indications potential complications of skin
- informed consent prick tests


Tasks
Accessing
• Access appropriate information to assist in the • Use textbooks, journals, • Written/Viva
Sources of
interpretation of specimens. internet, etc. Testing all components of
Information
curriculum and current
knowledge.
• Practical/viva
Interpret information from a
provided published source
Developing an
• On the basis of all the information available in • Daily laboratory duties • Written/Viva
Opinion
relation to a specific case, develop and record
a professional opinion as to the nature, • Preparation under supervision • Dissertation
causation, severity, likely sequela etc of the of consultative reports. .
pathological process(es).
Communicating
• Construct and sign off a written report that • Preparation under supervision • Written/Viva.
an Opinion
contains all appropriate diagnostic information of consultative reports
and recommendations to the requesting Prepare a consultative
clinician in a timely fashion. • Performance of daily laboratory report/give a consultative
• Provide appropriate information and inferences and supervised on-call duties. opinion on various test
about a case to referring clinicians by oral abnormalities and clinical
(face-to-face or telephone) communication. conditions
• Contribute appropriately to Grand Rounds, • Discussions with Supervisor.
clinico-pathological conferences, morbidity and • Dissertation
mortality reviews, quality and audit committees
and other similar meetings.

M ICROBIOLOGY
INTRODUCTION
The discipline of Microbiology involves the use of laboratory techniques to diagnose infectious
diseases, recommend antibiotic therapy and to advise, correlate, coordinate and educate
clinicians regarding aspects of the pathogenesis, epidemiology, prevention and management of
infection. Clinical microbiologists work in diagnostic medical /pathology laboratories. The work
focuses on the collection, analysis, reporting and interpretation of results to aid in the diagnosis,
treatment and surveillance of infectious diseases. There are opportunities to carry out research
in the subspecialties of bacteriology, virology, mycology and parasitology.
The Clinical Microbiologist needs the following traits:

ability to make sound clinical judgements
good computing skills and organisational ability
ability to work as part of a team of medical, nursing and laboratory staff
leadership skills
need to be patient, inquiring, accurate, listening, persistent, self motivated
good interpretation and report writing and observation skills.
teaching and presentation skills
research
1. Ability to competently use a microscope to examine specimens and write a relevant

report
2. Ability to competently examine cultures, interpret antimicrobial susceptibility results and
write a relevant report
3. Ability to competently perform and interpret serological and molecular microbiology
techniques and write a relevant report
4. Apply and interpret laboratory information relevant to clinical care
5. Apply clinical information to cost effective laboratory practice
6. Learn the skills necessary to supervise and manage a microbiology laboratory safely
7. Learn the skills necessary to participate in an infection control team.
8. Develop skills necessary to function effectively as a team member
9. Develop and apply relevant communication skills as a clinician teacher

Training in Microbiology is of five years duration. Trainees must spend a minimum of four years
under the supervision of a medical microbiologist in laboratory accredited by the RCPA. The
fifth year of training may involve clinical practice in infectious diseases or in another pathology
discipline. Trainees are not permitted to spend more than four years in one institution.
RESEARCH STREAM
Trainees who complete the Part I examination may opt to take a research stream for Part II
training. They need to apply to the Board of Censors for approval of their application, project,
laboratory and supervisor, and the research plan must be relevant and lead to a Doctorate by
thesis. During the years spent on the thesis, Trainees are expected to maintain competence in
clinical general Microbiology. The Doctorate, when granted, will be accepted in lieu of a written
Part II examination and the Trainee will then be examined orally on the thesis.
JOINT TRAINING PROGRAM IN MICROBIOLOGY AND INFECTIOUS DISEASES
As of 2005, a joint training program is available with the Royal Australasian College of
Physicians (RACP). Joint training is a five-year training program combining clinical training in
Infectious Diseases and laboratory training in Microbiology. Candidates may enter the joint
program when their training is eligible to be accredited by the RACP as advanced training.
Normally this means having passed the RACP Fellowship examination. Joint trainees must be
registered with and supervised by the Joint Sub-committee in Microbiology and Infectious
Diseases and registered with the Board of Censors, RCPA.
Joint trainees are required to sit the same examinations as RCPA trainees in Microbiology and
to attain the same standard. Joint trainees who have passed the FRACP Part I examinations
should apply to the Board of Censors for exemption from the examination in Pathological
Sciences.
At the completion of the 5-year joint training program, trainees will be eligible for FRCPA and
FRACP.
Components of Joint Training

The training period of 5 years is expected to encompass 2 years of core training in Infectious
Diseases and 3 years in Laboratory Microbiology. These years can be undertaken in any order
or, in some cases; trainees may occupy joint laboratory/clinical positions. In this case trainees
will be required to nominate the breakdown of time sought for approval for each of the core
Infectious Diseases or Microbiology training.
Core Training in Infectious Diseases (2 years): The required 2 clinical years must be a
comprehensive and structured program, prospectively approved the Specialist Advisory
Committee. Exposure to inpatients and outpatients with a broad range of Infectious
Diseases is required.
Laboratory Training in Microbiology (3 years): Training in Microbiology may only be

undertaken in laboratories accredited with the RCPA Board of Censors and under approved
supervision. It is expected that only a small proportion of time (approx. 10%) would be
spent in direct patient care during this time.

Trainees will be expected to develop comprehensive knowledge and practical skills in all
facets of Microbiology and to be proficient at collection and handling of specimens and
identifying the range of organisms expected to be encountered in a tertiary care hospital,
with attention to safety and quality assurance.
The requirement to undertake three clinical projects will continue, as for Infectious Diseases
training. Two of these must be commenced and relate to work undertaken in the two core
clinical years of training, but the third project may also be suitable for submission as part of
the requirements of the microbiology component of conjoint training.
Policies and Procedures for Joint Training
The Joint Training Program is managed by a Joint Subcommittee of the Infectious Diseases
Specialist Advisory Committee, comprising representatives of the RCPA and RACP. Training is
monitored through annual training program approval and accreditation after submission of the
supervisor's report each year (please refer to the section on Forms and Submissions at the front
of this Handbook regarding the submission of forms to the JSAC and the RCPA).
RCPA policy is that Trainees must spend at least one year of their five year program in a
separate institution (please refer to Training Limitation in the Registration and Training section of
this Handbook). Joint Trainees may not complete both their clinical and laboratory training
entirely within one service of an institution. Alternative employment may occur either in the
laboratory or the clinical component of joint training.
Trainees are strongly advised to consult the RACP handbook "Requirements for Physician
Training" (the Mango Book) for regulations governing retrospective accreditation of training and
other information concerning the Joint Training Program.
ASSESSMENT
Pathological Sciences Examination
All Trainees are required to undertake or apply for exemption from the Basic Pathological
Sciences examination. Whilst JSAC Trainees are exempt from the Basic Pathological Sciences
Examination, they must formally apply for exemption and pay the appropriate fee. Assessment
in Microbiology is in the form of the Part I and Part II examinations, each consisting of written,
practical and oral examinations as determined by the Board of Censors. There are no automatic
exemptions given to any Trainee for any component of the examinations.
PART I EXAMINATION
The Part I Microbiology Examination is taken after at least 18 months of training in diagnostic
and clinical Microbiology. Trainees should discuss in detail with their supervisors how to
achieve a sound knowledge of all aspects of the discipline.
The Part I examination has an emphasis on the theoretical, practical and interpretative aspects
of investigations in all fields of clinical Microbiology and has the following components:
a 3 hour written paper
a 3 hour multiple choice examination

a “wet practical” examination, testing practical ability to identify unknown organisms such as
those in the RCPA QAP, which is held in the Trainee’s own laboratory in July.
Only those who pass the written paper and the first practical examination are invited to the
second phase, which consists of:
a 1.5 hour practical examination
an oral examination.
Based on the examiners’ assessment at the oral examinations, some Trainees may receive a
provisional pass in the Part I examination. This implies that the Trainee should continue to study
general Microbiology during the later period of training, and that the Part II examination may
cover information normally tested only in Part I.
The Part I examination will address such issues as, but not necessarily limited to:
• the epidemiology, pathogenesis and prevention of infectious diseases
• sterilisation and disinfection, media production, QC and laboratory safety
• basic microbial structure and metabolism and genetics
• host-pathogen relationships
• specimen collection, processing, identification and further testing (e.g. antimicrobial
susceptibility) of the full range of likely samples and pathogens to be experienced at the
tertiary care level hospital, including bacteriology, mycology, virology and parasitology
• contemporary issues in Microbiology, including for example, emerging pathogens,
bioterrorism
• Molecular Biology techniques relevant to diagnostic Microbiology, Microbiology research and
Molecular epidemiology.
Trainees who pass Part I are eligible to sit for Part II, usually in the final year of training. This
more advanced training encourages diversity, specialisation and investigation within fields of
Microbiology and trainees will have sufficient choice to be examined in an area of sub-
specialisation (e.g. Virology). However, knowledge of the wide field of Microbiology and in
particular, recent issues in Microbiology is still expected. The final assessment consists of:
a 3 hour written examination

a consideration of the Trainee’s ability to plan and present the results of a scientific
investigation in medical Microbiology
an oral examination and
a research stream (optional).
The written examination must be passed in order to progress to the oral exam. Both the Part I
and II written examinations are held in June of each year and the viva and practical in August.
A repeat examination, held in November, may be offered to unsuccessful Part II candidates only,
at the discretion of the Board of Censors.

Written and Oral Examinations

If requested by the Trainee, the written examination can be slanted towards the Trainee's
special interests. Those not declaring a special interest, or who were given a provisional pass in
the Part I examination, are examined in General Microbiology, including laboratory management.
The oral examination consists of an interview conducted by two panels of examiners and will
focus primarily on the research project, but may address areas of weakness identified previously
in the exam papers. If, in the opinion of the examiners, the project work is inadequate, the
Trainee will be asked to revise and resubmit the work.
Scientific Report Presentation

An important part of the assessment is the Trainee’s ability to plan and present results of
scientific investigation in medical Microbiology. As evidence of this Trainees must submit one of
the following:
the manuscript of a research project written in a style suitable for publication; or
a paper of which the Trainee is senior or sole author, published in a refereed medical
journal; or
a completed thesis for a higher degree.
The project should be a significant piece of laboratory based research work related to the
pathogenesis or diagnosis of infectious diseases. Joint Trainees should note that a solely
clinical project is not appropriate for satisfying this component of the joint training program and
such projects should be submitted to the RACP during the clinical years to satisfy their
requirements (see above).
The report must be submitted to the College by 31 July. Manuscripts not refereed must be
submitted in triplicate for perusal by both the Chief Examiner and the two oral examiners.
Candidates who have submitted a PhD thesis or MD thesis can apply for exemption from the
Part II written and, if successful in the Part II viva; will satisfy the requirements for FRCPA Part
II, subject to confirmation of PhD/MD acceptance.
KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN MICROBIOLOGY

Table of Tasks, Learning Outcomes, Activities and Assessment in Microbiology, below.

Taxonomy and biology of human pathogens, including ecology, evolution, metabolism and
replication


Immunisation
Issues relevant to antimicrobial use and control in the context of institutional drug committee
activities
Ecological issues
Infection Control
incubation conditions as applied to bacteria, fungi, viruses and protozoa
viruses and parasites

Principles of antibiotic susceptibility testing

Principles of antifungal susceptibility testing
Principles of antiviral susceptibility testing
Quality controls for equipment and every method and reagent used in the laboratory
information
Postage / International regulations for transport of specimens
Laboratory Safety
Waste Disposal

Microbiology Journals
Antimicrobial Agents and Chemotherapy
Clinical Infectious Diseases
Clinical Microbiology and Infection
Clinical Microbiology Newsletter
Clinical Microbiology Reviews
Communicable Diseases Intelligence
Infectious Diseases Clinics of North America
Internal Medicine Journal
Journal of the American Medical Association (JAMA)
Journal of Antimicrobial Chemotherapy
Journal of Clinical Microbiology
Journal of Hospital Infection
Journal of Infectious Diseases
Journal of Virology
Medical Journal of Australia
Nature
Nature Reviews Microbiology
Reviews of Medical Virology

Science
The Lancet
The Lancet Infectious Diseases
The New England Journal of Medicine
Virology
Microbiology Texts
Manual of Clinical Microbiology, Topley and Wilson
Hospital Epidemiology and Infection Control, Mayhall C Glen
Therapeutic Guidelines, Mayhall C Glen
Infectious Diseases, Christie AB
Principles and Practices of Infectious Diseases, Mandell, Douglass and Bennett
Microbiology Conferences/Workshops
Annual RCPA Pathology Update Meeting

Held Annually in March
www.rcpa.edu.au
Annual Scientific Meeting of the Australian Society for Microbiology

http://www.asm2007.org/
Annual Scientific Meeting of the Australasian Society for Infectious Diseases

http://www.racp.edu.au/asid/asm_reg.htm
Australian Society for Parasitology Annual Conference

http://www.parasite.org.au/Conference.html
Viruses in May
Dates: 3 May 2007 to 5 May 2007

Location: Carrington Hotel
Address: Katoomba
State: NSW
The focus of Viruses in May 2007 is Viral Infection, Treatment and Prevention, and includes
sessions on viral infection in the immunocompromised patient.
Contact Name: Julie Rainbow

Contact Phone: 0411 557 790

Contact Email: jules.rainbow@hotmail.com
Mycology MasterClass III: the Immunocompromised Patient

www.sapmea.asn.au/virology2007
http://www.mycology.adelaide.edu.au/Fungal_Jungle/masterclass.html
Microbiology Websites
National Pathology Accreditation Advisory Council

www.health.gov.au/npaac
Australian Society for Antimicrobials

http://www.asainc.net.au/
Expert Advisory Group on Antimicrobial Resistance (EAGAR)

http://www.nhmrc.gov.au/about/committees/expert/eagar/index.htm
Australasian Society for Infectious Diseases:

http://www.racp.edu.au/asid/asm_reg.htm
The Australian Society for Microbiology

http://www.theasm.com.au/
Discussion Group for Australian ID Physicians

http://www.racp.edu.au/asid/trainees/tools_discussion.htm
International Society for Infectious Diseases

http://www.isid.org/
The Australian Society for Parasitology

http://www.parasite.org.au/
Global Electronic Reporting System for Outbreaks of Emerging Infectious Diseases &
Toxins
http://www.promedmail.org/pls/promed/f?p=2400:1000
Other resources
Electronic version of Infection Control Guidelines

www.icg.health.gov.au
MIMS
http://www.mims.com/
The Sanford Guide

http://www.sanfordguide.com/


Functions of the Microbiologist as Medical Specialist in the Laboratory

Tasks Learning Outcomes Learning Activities Potential Assessment
(observable and assessable (range of activities which result in
behaviour) the learning outcome)
Public health and preventive • Provide appropriate advice • Formal academic study such • Formative assessment -
medicine regarding detection, as MPH, MEpi specific item in formative
surveillance and intervention assessment process;
with respect to infectious satisfactory participation prior
diseases of public health to award of part II can be
importance. awarded as complete.
• Participate in regular meetings • Regular interaction with Public • Summative assessment - a
with public health units (or Health Units (or equivalent) short question as part of the
equivalent) practical. This means at least
• Formulate strategies to part of the practical needs to
investigate and manage include a notifiable disease
outbreaks of infectious disease process.
• Ensure compliance with • Notification of the detection of • Submission of a project which
notification requirements infectious agents in investigates a substantive
• Provide immunisation advice accordance with local statutes outbreak of an infectious
disease
Use of Antimicrobial Agents • Provide appropriate advice on • Access relevant drug policies • Formative assessment -
selection and use of in training institution supervisor’s reports
antimicrobial agents to • Supervised clinical liaison eg. • Summative assessment –
patients, colleagues and telephone consultations or compulsory questions in part I
institutional bodies ward rounds and II
• Participate in institutional drug • Involvement in drug committee
committee activities eg. audits activities
and meetings
• Implement, support and • Possible on-line tutorial (to be
develop antimicrobial control developed)
policy in training institution • Attendance at relevant session
RCPA Update.
Infection Control • Provide appropriate advice on • Access relevant infection • Part of project
infection control measures to control policies in training • Practical examination
patients, colleagues and institution • MCQs
institutional bodies • Involvement in infection control • Practical examination.
committee activities
• Ensure compliance with • Access state and national
legislative and regulatory guidelines, regulations and
framework in geographic area legislation
of practice
• Prepare articles for sterilisation
• Participate in institutional by various methods
infection control committee • Operate an autoclave safely
activities eg. audits and and effectively
meetings • Detect faults in heat-sterilising
apparatus
• Implement, support and • Practise safe handling and
develop infection control disposal of biohazardous
policies in training institution materials, chemicals and
radioactive materials
• Implement, support and
develop procedures for safe
laboratory practice
• Liaise between laboratory

practice and infection control
requirements eg. outbreak
surveillance, subtyping
Pre-analytic phase: specimen • Provide appropriate advice • Supervised clinical liaison • Work-based assessment of
selection, collection and regarding the selection, • Ensure appropriate collection clinical vignette.
transport collection and transportation of and transport of specimens
specimens so as to optimise
diagnostic yield
• Refer to relevant sections of • Access relevant sections of the

the laboratory manual laboratory manual
• Resolve uncertainty in • Participate in relevant
situations not addressed by the laboratory activities
laboratory manual • Prepare specimens and
• Triage, examine and set up isolates for transport in
specimens accordance with local and
international postal and
shipping regulations
Pre-analytic phase: selection of • Provide appropriate advice • Supervised clinical liaison • Supervisor’s assessment.
tests regarding the optimal Include assessment from other
diagnostic algorithm for a given team members – laboratory
clinical problem scientists and infection control
• Refer to relevant sections of • Access relevant sections of the practitioners.
the laboratory manual laboratory manual
• Resolve uncertainty in • Participate in relevant
situations not addressed by the laboratory activities, including
laboratory manual execution of individual tests
• Participate in evaluation and
implementation of new and
existing tests
Analytic phase: microscopy • Prepare and use routine stains • Access relevant sections of the • Questions in the written and
appropriately laboratory manual practical examination on
• Prepare specimens for • Participate in relevant critical specimens, e.g., CSF or
microscopy laboratory activities including, urine.
• Effectively use a light but not limited to: • Supervised satisfactory
microscope, including bright - preparation of faecal stains execution of 500 episodes of
field, phase contrast, dark field and concentrates each type of staining
and fluorescence microscopy - identification of ova cysts procedure and microscopy.
• Interpret microscopy findings and parasites
appropriately. - preparation and examination
of skin scrapings and other
tissues for fungal examination
- preparation and examination

of specimens by Gram’s, acid-
fast, toluidine blue, India ink,
Giemsa and fluorescent
antibody stains
- preparation and examination
of blood films for blood-borne
parasites.

• Select media appropriately for • Access relevant sections of the
specimen inoculation laboratory manual
• Process specimens • Participate in relevant sections
appropriately of the laboratory, including but
• Resolve uncertainty in not limited to:
situations not addressed by the - preparation of culture media
laboratory manual and agar plates
- plating out clinical specimens
- setting up anaerobic cultures
and obtaining pure cultures
- maintenance and inoculation
of tissue culture for virus
isolation
- detection of viral replication
in tissue culture
- determination of TCID values
for viral isolates
- preparation of mycological
slide cultures]
Analytic phase: identification of • Correctly identify organisms by • Access relevant sections of the • Work-based assessment by
microorganisms to a species culture laboratory manual supervisor
level • Resolve uncertainty in • Participate in relevant sections • Practical examination using
situations not addressed by the of the laboratory, including but API strips
laboratory manual not limited to: • Practical examination using
- recognition of the colonial real time PCR read outs.
and microscopic appearance

of commonly encountered or
medically important organisms
- performance and
interpretation of tests
commonly used to identify
microorganisms
- determination of viable
counts in bacterial
suspensions
- use of automated apparatus
to detect bacteraemia
- identification of medically
important fungi
Analytic phase: non-culture • Satisfactorily execute serologic • Access relevant sections of the Written paper.
detection of microorganisms assays, demonstrating laboratory manual
(excluding microscopy) familiarity with automated • Participate in relevant sections
systems of the laboratory, including but
• Satisfactorily execute not limited to:
molecular biologic assays, - preparation, reading and
demonstrating familiarity with interpretation of assays for the
automated systems detection of antigens and
• Resolve uncertainty in antibodies (including methods
situations not covered by such as agglutination
laboratory manual - precipitation
- immunoassay
- immunoperoxidase
- immunoblotting)
• Participate in relevant sections
of the laboratory, including but
not limited to:
- extraction of nucleic acids
from specimens

- preparation and reading of
gels
• Analytic phase: • Access relevant sections of the Practical examination

susceptibility testing laboratory manual
• Satisfactorily execute and • Participate in relevant sections Oral examination.
interpret antibiotic susceptibility of the laboratory, including but
tests not limited to:
- preparation and interpretation
of antibiotic susceptibility tests
- detection of beta-lactamases
- determination of the
bactericidal activity of antibiotics
or antibiotic-containing serum
antibiotics
- performance of antimicrobial
assays on blood and body fluids
by bioassay or other methods
• Satisfactorily execute and • Participate in relevant sections
interpret antifungal of the laboratory, including but
susceptibility tests not limited to:
- preparation and interpretation
of antifungal susceptibility tests
antifungal agents
Analytic phase: management of • Satisfactorily prepare • Access relevant sections of the • Written exam, e.g. what factors
specimens, laboratory specimens, bacterial, fungal laboratory manual are important in deciding on a
equipment and laboratory data and viral isolates and • Participate in relevant sections serology analyser.
mammalian cells for retention of the laboratory Satisfactory participation in
and preservation • Use and maintain laboratory relevant laboratory activities.

• Satisfactorily execute quality equipment, including but not
controls for common tests, limited to:
reagents and media - incubators
• Recognise when quality - centrifuges
controls have failed and - safety cabinets
institute remedial action - refrigerators
• Use laboratory data proficiently
for cost-efficient laboratory
management and generation
of statistics
Post-analytic phase: report • Satisfactory report generation • Familiarity with relevant Practical exam, given a
generation • Communication and sections of the laboratory microscope, a culture plate and
• Principles involved in the interpretation of results to manual brief clinical notes and required to
formulation of an opinion and clinicians, including urgent • Participation in relevant write a report.
generation of a laboratory results sections of the laboratory,
report, including review, • Resolution of uncertainty in including but not limited to
synthesis and interpretation of situations not covered by - recording, verification and
all relevant clinical and laboratory manual interpretation of laboratory test
laboratory information results
• Relevant regulatory framework - identification of parameters
of measurement uncertainty
- development and application
of action limits
- notification of abnormal
results to pathologists and
clinicians

D IPLOMA IN C YTOPATHOLOGY
this Handbook.
INTRODUCTION
The College offers a post-Fellowship Diploma in Cytopathology (Dip.Cytopath.) for Fellows who
have successfully completed the Part II Anatomical Pathology or Haematology examinations, or
final General Pathology examinations.
AIMS OF THE DIPLOMA
The aims of the Diploma in Cytopathology are to:

1. Certify professional expertise in Cytopathology
2. Allow Fellows whose practice includes a substantial component of Cytopathology to
demonstrate further expertise in Cytopathology.
TRAINING
The Diploma course of training includes the following:

Twelve months equivalent full time experience in an institution approved by the RCPA Board
of Censors for training in Cytopathology. This could include specialised Anatomical
Pathology departments with a major service in exfoliative and fine-needle aspiration
Cytopathology and with an identifiable Cytopathology laboratory;
either full or part-time training, provided that part-time training is equivalent in aggregate to
12 months full-time training. Consideration may be given to a period of pre-Fellowship
training specifically in Cytopathology;
the reporting out of at least 1000 general (non-gynaecological) cases, 300 fine-needle
aspirates and 2000 gynaecological cases, the latter to be of the type that would ordinarily be
referred to a Cytopathologist.
Fellows who have completed the required 12-months experience are eligible for immediate
award of the Diploma on successful completion of the examination. For those who take the
examination part-way during this period, award of the Diploma is deferred until the requisite 12
months experience is complete.
ASSESSMENT
The Diploma examination will have written, practical and oral components, including:
- a three-hour written specialised examination in Cytopathology
- the presentation of a Casebook detailing 10 Cytopathology cases handled personally by
the candidate
- A practical examination consisting of 15 to 20 Cytopathology slides
- an oral examination.
The written and oral examinations are held at the same time as the Part II examinations in
Anatomical Pathology.
302
THE CASEBOOK
Each of the 10 cases detailed in the Casebook must include the history, cytological findings -
including the use of ancillary techniques where appropriate,and a review of the relevant
literature. Repetition must be avoided, and the cases must encompass a selection of both
gynaecological and non-gynaecological disorders, and tumours and non-neoplastic lesions.
Fellows may submit publications of direct relevance to Cytopathology in lieu of the Casebook.
These include books, book chapters or articles in peer-reviewed journals. Individual case
reports in peer-reviewed journals are also acceptable with each case report equal to one case in
the Casebook. Other more substantial publications will be weighed appropriately in comparison
to individual cases. As a general guide, about three to five substantive publications could
secure a Casebook exemption, but each application will be decided on its merits by the Board of
Censors.
Guidelines for presentation, certification and submission are similar to those for the Part II
Anatomical Pathology Examination Pathology (see under Anatomical Pathology Requirements).
L I M I T E D E X A M I N AT I ON FOR C YT OP A T H O L OG Y D I P L OM A
At its discretion, with the exception of the oral component, the Board of Censors may waive any
part of the examination depending on the candidate’s qualifications and experience.
G U I D E L IN E S F O R ‘O R A L O N L Y ’ E X A M I N A T IO N FOR THE D I PL O M A IN
C YT O PA T H O L O GY
On the recommendation of the Chief Examiner in Anatomical Pathology, in consultation with the
RCPA’s Cytopathology Advisory Committee Chairman, approval may be given for an oral
examination only.
Applicants for an oral examination only should be nominated by a College Fellow, or the Head of
the Department or another pathologist of equivalent status from the department in which they
work.
The applicant should:

be a Fellow of the RCPA; and
have substantial full time experience as a specialist in Cytopathology (eg full or part-time
experience as a specialist in Anatomical or General Pathology, and Cytopathology
amounting to > 10 years in aggregate, of which > 5 years shall be in Cytopathology); or
have significant experience in a senior administrative or academic post with a substantial
professional component in Cytopathology (eg full or part-time experience as a specialist in
Anatomical or General Pathology, and Cytopathology amounting to > 10 years in aggregate,
of which > 5 years shall be in Cytopathology).
Fellows with less than a total of 10 years’ specialty, senior academic or administrative
experience are unlikely to be approved unless there are exceptional circumstances. In this
situation, the applicant and sponsor should detail why they believe an exception may be
justifiable.
Approval for the oral only form of examination is most likely for those Fellows who fulfil at least
one and preferably several of the following criteria. That they:
have a national and international reputation among peers for excellence in Cytopathology;

are a major contributor to Cytopathology through publications (books; book chapters; or

papers published in peer-refereed journals); or have presented or given invited lectures at
national and international scientific meetings. Candidates with fewer than 20-30 publications
or presentations are unlikely to be successful;
are members of national or international committees related to Cytopathology;
substantially contribute to professional organisations such as learned Colleges in
Cytopathology;
consult or advise government, academic or professional bodies in Cytopathology;
have national or international awards recognising research achievements or professional
excellence, or for other contributions in Cytopathology.

Applicants and their sponsors should address these selection criteria in their applications, and
may request for one or more of these criteria to be weighted.
The RCPA Board of Censors may give each application, the applicant's curriculum vitae, and
any supporting documents to up to three referees. Because referee reports may take time, the
Fellows and their sponsors should send applications well in advance of the examination
application closing date, which is the last working day in February each year.
At its discretion, the Board of Censors may vary any of the above guidelines depending on the
circumstances and merits of a particular case.
G U I D E L I N ES F O R E X EM P T I O N O F W R I T T E N E X A M I N A T I O N O R C A S E B O O K F O R
THE DIPLOMA IN CYTOPATHOLOGY
On the recommendation of the Chief Examiner in Anatomical Pathology, in consultation with the
RCPA’s Cytopathology Advisory Committee Chairman, approval may be given for some
candidates, eg, pathologists whose professional attainments and experience in cytopathology do
not meet the requirements for award of the Diploma by oral examination only – to be exempted
from the written or Casebook components of the examination (or both).
Applicants requesting this form of examination should be nominated by a College Fellow, or the
Head of the Department or another pathologist of equivalent status from the department in which
they work.

have substantial full time experience as a specialist in Cytopathology (eg full or part-time
experience as a specialist in Anatomical or General Pathology, and Cytopathology,
amounting to 5 to 10 years in aggregate, of which >3 years shall be in Cytopathology
Applications from candidates with less experience are unlikely to be approved unless there are
exceptional circumstances. In this situation, the applicant and sponsor should detail why they
believe an exception may be justifiable.
D IPLOMA IN F ORENSIC P ATHOLOGY
this Handbook.

INTRODUCTION
The College offers a post-Fellowship Diploma in Forensic Pathology (Dip.Forens.Path.) for

Fellows who have successfully completed the Part II Examination in Anatomical Pathology
(without slant to Forensic Pathology) or General Pathology.
The Forensic Pathology Diploma is to certify professional expertise in Forensic Pathology and
may carry particular significance for testimony in various courts of law.
AIMS OF THE DIPLOMA
The aims of the Diploma in Forensic Pathology are to:

1. Certify professional expertise in Forensic Pathology
2. Allow Fellows whose practice includes a substantial component of Forensic Pathology or
who later cross over to a career in Forensic Pathology to demonstrate further expertise in
Forensic Pathology.
TRAINING
The Diploma course of training includes the following:
• Twelve months equivalent full time experience in an institution approved by the RCPA Board
of Censors for training in Forensic Pathology. Appropriate departments would include
specialised departments of Forensic Pathology and those associated with the coronial
system. If any Fellow working in a department not approved for forensic training wishes to
take this examination, he/she should ask the department head to seek Board of Censors'
approval at the earliest opportunity;
• Either full or part-time training provided that part-time training is equivalent in aggregate to
12 months full-time training. Consideration may be given to a period of pre-Fellowship
training specifically in Forensic Pathology.
Fellows who have completed the required 12 months experience are eligible for immediate
award of the Diploma on successful completion of the examination. For those who take the
examination part-way during the training period, award of the Diploma is deferred until the
requisite 12 months experience is complete. Award of the Diploma shall be at the sole
discretion of the RCPA Board of Censors.
ASSESSMENT
The examination consists of the written, Casebook, practical and oral components of the
FP II examination, including:
a 3 hr written specialised examination in Forensic Pathology
a 4 hr written-practical examination of 3 cases
the presentation of a Casebook detailing 8 coronial post mortem examinations conducted by
the candidate
a 2 hr practical examination of short cases
2 x 20 min oral examinations
assessment of a coronial post mortem examination.

The examinations will take place in 2 phases as detailed in the previous section on the FP II
examination.
WRITTEN EXAMINATION
See section on Forensic Pathology Part II Examination. This will be an essay paper of 3 hrs
duration on Forensic Pathology.
WRITTEN-PRACTICAL EXAMINATION
See section on Forensic Pathology Part II Examination. This will be required to consider the
findings on 3 cases and prepare written reports.
C A SE B O O K
See section on Forensic Pathology Part II Examination: candidates are encouraged to consider
alternatives to the Casebook as detailed in this section.
Casebooks must be received at the College by 31 March.
P R AC T I C AL E X AM I N AT I O N : SHORT CASES
See section on Forensic Pathology Part II Examination. This will be a 2 hr examination of

photographs and histopathology slides of forensic and medical post mortem significance.
ORAL EXAMINATION
See section on Forensic Pathology Part II Examination. There will be 2 x 20 minute viva voce
examinations of issues relating to the practice of forensic pathology.
L I M I T ED E X A M I N A T I O N FOR FORENSIC PATHOLOGY DIPLOMA
At its discretion, with the exception of the oral component, the Board of Censors may waive any
part of the examination depending on the candidate’s qualifications and experience.
G U I D E L IN E S FOR ‘O R A L ONLY’ E X A M I N AT I ON FOR THE D I P L OM A IN F O R E N S IC

P A T H OL O GY
On the recommendation of the Chief Examiner in Forensic Pathology, approval may be given for
an oral examination only. Applicants for an oral examination only should be nominated by a
College Fellow, or the Head of the Department, or another pathologist of equivalent status from
the department in which they work.

have substantial full-time experience as a Forensic Pathology specialist (e.g. full-time or
part-time experience as a specialist in Anatomical or General Pathology, and Forensic
Pathology amounting to > 10 years in aggregate, of which > 5 years shall be in Forensic
Pathology); or
have substantial experience in a senior administrative or academic post with a substantial
professional component in Forensic Pathology (e.g. full-time or part-time experience as a

specialist in Anatomical or General Pathology and Forensic Pathology amounting to > 10

years in aggregate, of which > 5 years shall be in Forensic Pathology).
Fellows with less than a total of 10 years’ specialty, senior academic, or administrative
experience are unlikely to be approved unless there are exceptional circumstances. In this
situation, the applicant and sponsor should detail why they believe an exception may be
justifiable.
Approval for the oral only form of examination is most likely for those Fellows who fulfil at least
one and preferably several of the following criteria. That they:
have a national or international reputation among peers for excellence in Forensic
Pathology;
are a major contributor to Forensic Pathology through publications (books; book chapters; or
papers published in peer-refereed journals); or have presented or given invited lectures at
national and international scientific meetings. Candidates with fewer than 20-30 publications
or presentations are unlikely to be successful;
have made a substantial number of appearances as an expert witness in a supreme court, or
its equivalent, or higher court proceedings, especially those of major legal or forensic
significance (e.g. > 30 such court appearances);
are members of national or international committees related to forensic science or pathology;
substantially contribute to professional organisations such as learned Colleges in Forensic
Pathology;
consult or advise government, academic or professional bodies in Forensic Pathology;
have national or international awards recognising research achievements or professional
excellence, or for other contributions in Forensic Pathology.
Applicants and their sponsors should address these selection criteria in their applications, and
may request for one or more of these criteria to be weighted.
The RCPA Board of Censors may give each application, the applicant's curriculum vitae, and
any supporting documents to up to three referees. Because referee reports may take time, the
Fellows and their sponsors should send applications well in advance of the examination
application closing date, which is 7 days before the last working day in February each year.
G U I D E L IN E S F O R E X EM P T I ON OF W R I T T E N E X A M I N AT I ON S OR C AS E B OO K FOR THE
D I PL O M A IN F OR E N S I C P A T H O L OG Y
On the recommendation of the Chief Examiner in Forensic Pathology, approval may be given for
some candidates (e.g. pathologists whose professional attainments and experience in forensic
pathology do not meet the requirements for award of the Diploma by oral examination only) to be
exempted from the written or Casebook components of the examination (or both).
Applicants requesting this form of examination should be nominated by a College Fellow, or the
Head of the Department or another pathologist of equivalent status from the department in which
they work.
have substantial full time experience as a specialist in Forensic Pathology (e.g. full or part-
time experience as a specialist in Anatomical or General Pathology, and Forensic Pathology,

amounting to 5 to 10 years in aggregate, of which >3 years shall be in Forensic Pathology.
Applications from candidates with less experience are unlikely to be approved unless there are
exceptional circumstances. In this situation, the applicant and sponsor should detail why they
believe an exception may be justifiable.

D IPLOMA IN M OLECULAR P ATHOLOGY

this Handbook.
INTRODUCTION
The College offers a post-Fellowship Diploma in Molecular Pathology (Dip.Mol.Path.), intended

to certify professional expertise in molecular biology as it is applied to the practice of pathology.
The level of expertise required to obtain the Dip.Mol.Path. would be sufficient to allow the
applicant to function independently in relation to undertaking DNA techniques primarily within the
discipline in which he obtained Fellowship. The graduate will not be expected to acquire
sufficient skills in 1 year of molecular pathology training to replace the role of a Fellow of the
RCPA in Genetics or Microbiology in providing the full range of consultant pathology services in
human or microbial genetics.
Although it is acknowledged that skills in molecular biology form an integral part of any modern
training program which leads to the FRCPA, the Diploma will allow Fellows who have particular
expertise in molecular biology to be recognised. In addition, Fellows who did not have an
opportunity to utilise molecular biology during the course of their FRCPA program, now have a
mechanism within the College which will allow these skills to develop, and be recognised.
These guidelines for the Diploma will be reviewed periodically to ensure that the Diploma
remains appropriate to College and Fellows’ requirements. Award of the Diploma will be at the
sole discretion of the Board of Censors.
The course of training and examination for the Diploma will comprise the following:
1. Core knowledge
Twelve months training is required, in an institution/department approved by the Board of
Censors. Part-time training is allowed provided it is considered by the Board of Censors to be
equivalent to 12 months of full-time training. Retrospective accreditation for training can be
given provided the applicant can show that the work was relevant to molecular pathology, and it
was carried out in a laboratory approved by the RCPA.
The laboratory in which the training is being undertaken must have an active molecular
pathology program. The range and comprehensiveness of DNA diagnostic techniques in that
laboratory will, to some extent, determine the emphasis which is given in the examination to
testing laboratory skills i.e. an applicant training in a laboratory which is actively undertaking
molecular techniques will allow less emphasis to be placed on the “hands on” component of the
examination.
Core work for the Dip.Mol.Path. will overlap all disciplines, and will predominantly relate to
commonly used techniques in molecular pathology, eg an extensive theoretical and practical
knowledge of the polymerase chain reaction (PCR) will be a key element of this work. Other
areas tested in core work will include structure/function of DNA and how this relates to molecular
technologies, DNA probes, hybridisation techniques, design of primers, DNA cloning etc.
ASSESSMENT

Examination
There are three components to the examination of core knowledge:
(1) A 3 hour written paper. The written component will consist of a three hour Molecular
Pathology paper, comprised of essays, multiple choice questions and short answer
questions (which may include worked problems) which assesses the candidate’s knowledge
of the scientific and clinical aspects of molecular pathology practice. All questions are
compulsory and there is no choice of questions provided. Approximately 45 minutes will be
allocated for each section, in which time the candidate must provide information that is
correct, relevant, complete, coherent and legible
(2) Two practical laboratory assessments

2a. An assessment of laboratory competence which consists of several tasks to be completed
using the usual resources of the laboratory in which the candidate is working. The objective is to
test the competency of the candidate at performing specific tasks where the time frame is either
too long to fit into a conventional practical assessment, or where each laboratory uses different
algorithms, software, preferred websites etc. This assessment will be supervised by an
independent Fellow and an appropriate time frame allocated for the return of results (days – 1
week).
2b. A two hour session of laboratory data interpretation and reporting to be performed at the
examination Venue. The material for this examination will be diagnostic material collected from
the examiners’ laboratories and will be representative of the range of materials handled by a
routine molecular laboratory. It is expected that in the majority of cases there will be a single
correct answer or a clear differential diagnosis indicated by the problems posed
3 An oral assessment which will predominantly focus on trouble shooting issues in molecular
pathology e.g. the examiners will present various data or work examples, and ask the
candidate to discuss reasons or explanations for these findings.
The written examination covering core knowledge will be undertaken in June at the same time
as the other FRCPA written examinations. Practical and oral components will be undertaken in
the August examination cycle. The oral component will also be used to assess specialised
knowledge described below.
.
THE CURRICULUM IN MOLECULAR PATHOLOGY
The curriculum in molecular pathology outlined below defines the extent and standards of the
competencies and knowledge base required by the candidate to pass the assessments.
1 . C OM P E T E N C IE S R EQU IR ED F O R T H E D IPL OM A IN M OL EC U L A R PAT HO L O GY

Competencies are behaviours or actions needed to successfully perform within a particular work
context. The core competencies required with respect to laboratory contexts of at the time of the
Diploma examination are summarised below.
Context Competencies required

Preanalytical consultationProvide advice on the appropriate choice and selection of tests
including their relative diagnostic strengths and limitations.
Provide advice on the relevant samples and preservatives required

to enable testing

Provide advice on the relevant sample transport conditions

including timeliness and temperature
Sample reception With reference to laboratory standard operating procedures

(SOPs) be able to apply principles of appropriate sample receipt,
validation of sample identity and integrity, specimen storage
retention, retrieval and disposal.
Apply laboratory specific work-flow procedures to routine, urgent

and out of hours work.
Select appropriate samples for intended assay.
Prepare nucleic acids to an appropriate standard from samples
Test design Review literature to determine existing knowledge
Design a testing system taking into account the characteristics of

the pathology and clinical requirements for testing
Determine the analytic and clinical validity of the test
Data production Monitor workflow in the laboratory to ensure that samples are
processed and analysed in a timely fashion
With respect to SOPs, perform and trouble-shoot in house manual

or automated tests
Identify potential causes of variation in test results
Record and verify laboratory test results
Data storage and retrieval Input and retrieve laboratory data into laboratory information
systems
Use laboratory information systems to generate meaningful

statistics
Developing an opinion On the basis of all information available for a case develop and
record a professional opinion as to the nature, cause, severity, and
likely sequelae of the genetic process
Know limitations and seek expert advice as appropriate.
Communicating an opinion Construct a written report containing the appropriate diagnostic

information and any recommendations in a timely fashion
Provide the information and inferences to a clinician by oral

communication
In accordance with the delegation system of the laboratory,

communicate results to referring clinician and advise on any
subsequent or additional testing to be performed.

Contribute to clinico-pathologic conferences, quality meetings and

audits
Monitoring disease Where lab results suggest evolving or unexpected disease advise
clinicians of your findings
Predict and where possible prevent or avoid adverse events
Laboratory equipment Perform instrument calibrations as required
Use and maintain laboratory equipment, including incubators,

centrifuges, safety cabinets, refrigerators, balances, pipettes, pH
metres, spectrophotometers, sequencers, end-point and real-time
PCR machines
Involvement in equipment selection, purchasing, installation and

commissioning
Safety Ensure compliance with institutional or regulatory requirements
Develop, implement, support and audit procedures for safe

laboratory conduct
Quality management Design and perform audits as required
Produce documents for procedures, methods and protocols.

THE KNOWLEDGE BASE IN MOLECULAR PATHOLOGY
Core Topic 1 BIOMOLECULAR SCIENCES
Minimum Standard for the post-Fellowship diploma

Genome and Genetic Structures
• Nucleic acid structure, DNA replication, mitosis Strachan & Read pp 3-17
Brown pp8-14, 467-497
• Meiosis & Recombination in humans Strachan & Read pp 40-45
Brown pp8-14, 541-549
• DNA repair Brown pp524-532
Strachan & Read pp 344-350
• Structure and organisation of the human genome Brown pp197-218, 238-239, 256-264
Strachan & Read pp 34-48, 239-70
• Haplotype structure of the human genome Gabriel et al (2002) Science, 296, 2225-9
• Gene structure Brown pp 133-162
Strachan & Read pp
• Gene expression I; Structures that regulate gene expression Brown pp 271-290
• Gene expression II; RNA transcription and processing Brown pp 295-377
• Gene expression III; Translation and post translational processing Brown pp 385-443
• Protein structure and proteomics Brown pp 18-26, 175-189
• Mosaicism and chimerism Gardner & Sutherland 394-405
Inheritance
Mendelian and non-Mendelian patterns of inheritance Strachan and Read pp 102-120
Wilkie AOM. J Med Genet 31, 89-98, 1994
Dobyns, WB (2004) Am J Med Genet 129(2),136-43
Dobyns WB (2006) Acta Paed 95(Suppl 451),11-15
Imprinting, methylation, histone tail modifications and epigenetics Gardner & Sutherland 311-335
Strachan & Read 303-305
Brown pp 285-289
Complex, multifactorial and quantitative traits Strachan & Read 111-119, 435-457
Cancer genetics
The biological basis of cancer Strachan and Read pp 488-504
Principles of genetic testing

Direct and indirect laboratory testing Burke W (2002) NEJM 347:1867-75
Population screening Khoury MJ et al (2003) NEJM 348:50-58
Godard B et al (2004) Eur J Hum Genet 11(Suppl2):S49-87
Calculation of conditional probability and genetic risk Bridge pp 2-50, 60-74,
Regulatory issues for diagnostic laboratories NPAAC documents. Standards for Nucleic Acid Detection, Standard for
validation of in house tests
The laboratory as a safe workplace On-line safety library at:
http://www.pp.okstate.edu/ehs/LINKS/Labchem.htm
Medical physics
Diagnostic uses of ionising radiation, principles of labelling Holme and Peck 193-205
Barker 313-343
• Autoradiography, phosphorimaging, scintillation counting
• Radiation safety, exposure monitoring and disposal of radioisotopes
Core Topic 2 MUTATION AND METHODS FOR MUTATION DETECTION
Topic
Basic concepts in testing Mutation Scanning Methods
Analytical validity, clinical validity, clinical utility Heteroduplex based methods
Sensitivity, specificity, positive & negative predictive power Single Strand Conformation Polymorphism based methods
Measurement of uncertainty Dideoxy nucleotide based sequencing methods
Mutation versus polymorphism Multiplex Ligation-dependant Probe Amplification
Loss of function and haploinsufficiency mutations Melt-curve analysis
Gain of function and dominant negative mutations
HGVS nomenclature Scanning for Known Mutations
Southern Blotting
Automation in the molecular laboratory PCR product presence and sizing methods
High through-put analyses Restriction enzyme site methods
Robotics in the laboratory Oligonucleotide ligation
Structuring workflow Oligonucleotide hybridisation
Data handling, validation of large results datasets Allele specific amplification methods
Sequenome Massarray, custom SNP chips
Mutation

Small scale mutations (nucleotide subs, dels, dups, ins, invs) Microsatellite/SNP based methods
Failures of mismatch repair Linkage studies for unknown mutations
Splice site mutations, exonic splicing enhancers, branch sites Methods for zygosity, identity & paternity testing
Trinucleotide repeat mutations & mRNA, poly-Glutamine toxicity Relevant population genetics
Non-homologous recombination and repeat mediated mutations Microsatellite instability
Translocations and formation of chimeric transcripts Loss of Heterozygosity
Amplification of genetic sequences
Large scale deletions; loss of heterozygosity Quantitative methods
Chromosome mutations; aneuploidy and monosomy Real-time PCR
Genome mutations; polysomy Taqman methods
General Methods Specific issues in diagnosis

Polymerase chain reaction Consent, informed versus valid
Nucleic acid hybridisation Prenatal testing and methods for result verification
Quantitative methods Predictive testing and methods for result verification
Array based methods Predictive testing for untreatable disorders
Carrier testing in childhood
General Methods
Polymerase chain reaction Mutation Scanning Methods
Nucleic acid hybridisation Heteroduplex based methods
Quantitative methods Single Strand Conformation Polymorphism based methods
Array based methods
Core Topic 3 CLINICAL MOLECULAR PATHOLOGY
Disorders
General
Conditions for which diagnostic molecular tests are provided in the candidates 1o discipline
o
Conditions for which presymptomatic testing is sought in the candidate’s 1 discipline
o
Conditions for which prenatal testing is sought in the candidate’s 1 discipline
Conditions associated with genetic mosaicism in the candidate’s 1o discipline
Hereditary cancer syndromes in the candidate’s 1o discipline
Common aneuploidies detectable by molecular techniques
Detection of chimeric transcripts in sarcoma
Inherited endocrine cancers
Role of molecular diagnosis in haematological malignancies
Detection and role of LOH in CNS tumours
Detection of HPV in cervical cancer

Genetics of malignant and non-malignant skin disorders
Detection and characterisation of infectious disease agents
Genes in pathology – classical and important examples of genetic pathology Gene(s) Reason for Inclusion
Familial breast/ovarian cancer BRCA1 & classic example of an AD cancer gene, also founder
BRCA2 mutations
Huntington disease IT15 classical AD trinucleotide repeat disease
MELAS mtDNA classical mitochondrial disorder
Duchenne and Becker Muscular Dystrophy DMD common allelic XLR disorders with complex mutational
basis
Cystic fibrosis CFTR common classical AR disorder with complex mutational
basis
Prader Willi/Angelman syndrome UBE3A example of a complex imprinted locus
Chronic myeloid leukaemia BCR/ABL example of chimeric transcript, MRD & quantitation
Spinal muscular atrophy SMN example of disorder mediated by gene deletions,
conversion and mitigated by copy number
Haemoglobin disorder – Alpha-thalassaemia HBA1; HBA2 example of gene deletion disorder
example of mismatch repair defect and microsatellite
Hereditary colorectal cancer – HNPCC MLH1, MSH2 instability
Rett syndrome MECP2 example of XLD disorder
Achondroplasia/hypochondroplasia/thanatophoric dysplasia FGFR3 AD gain of function mutations
Beckwith Wiedeman Syndrome CDKN1C/IGF2 Complex imprinted loci
Charcot Marie Tooth neuropathy – CMT neuropathy 1A and Hereditary PMP22
Neuropathy with liability to Pressure Palsies Duplication/deletion disorder due to Mariner repeats
Emery Dreifuss muscular dystrophy and laminopathies LMNA Phenotypic heterogeneity due to allelic heterogeneity
Familial retinoblastoma RB1 Classical inherited cancer syndrome
Fanconi anaemia FANCA,
FANCC Chromosome instability disorder, founder mutations
FMR1 – FRAXA, Tremor Ataxia syndrome, Premature ovarian failure FMR1
premutations RNA toxicity disorders
Friedreich ataxia FDRA AR trinucleotide repeat disorder
FSH muscular dystrophy D4Z4 Disorder influenced by position effect varigation
Gonadal dysgenesis SRY Sex reversal due to mutations in a master regulator gene
Haemochromatosis HFE Common AR condition of Fe metabolism
Haemoglobin disorder – Beta-thalassaemia HBB Common AR condition of unbalanced globin production
Hereditary colorectal cancer – adenomatous polyposis coli APC Classical inherited cancer disorder
Myeloproliferative disorders JAK2 Somatic cell disorder in heterozygous and homozygous
form
Myotonic dystrophy DMPK Classical trinucleotide repeat/RNA toxicity disorder
Noonan, Leopard, CHARGE syndromes KRAS, Example of pathway involvement in related disorders

PTPN11, SOS1
Osteogenesis imperfecta COL1A1,
COL1A2 Classical AR skeletal dysplasia
Uniparental disomy Chr 7, 14, 16 Examples of UPD
Core Topic 4 MANAGEMENT, ETHICS AND REGULATION
Topic
Quality systems in the laboratory

Laboratory accreditation
Regulatory environment for molecular pathology laboratories
Medical jurisprudence, the role of an expert witness
Staff management
Budget management
Occupational health, safety and rehabilitation
The ethical practice of molecular genetics

Aids in the acquisition of knowledge
Genetic and Genomic Sciences

*Brown T (2002). Genomes III. Wiley
*Strachan & Read. Human Molecular Genetics III (2004). Garland Publishing
*Lewin B Genes IX (2007) or Lewin B Essential Genes (2005)
PCR Primer – A laboratory manual (2nd ed) Dieffenbach, Dveksler. Cold Spring Habour
Press
King, Rotter, Motulsky Genetic Basis of Common Disease II (2002). Oxford
Jobling, Hurles Tyler-Smith (2004) Human Evolutionary Genetics: Origins, peoples and
disease. Garland Science.
Holme and Peck Analytical Biochemistry (3rd ed) Longman
*Cotton, Edkins, Forrest (1998) Mutation Detection. IRL Press
Molecular Pathology
*Trent RJ. Molecular Medicine. Churchill Livingstone
Pfeiffer JD. Molecular genetics Testing in Surgical pathology. Lippincott Williams and
Wilkins, 2006
Leonard DGB. Diagnostic Molecular Pathology, Saunders (Elsevier)
Genetics and Laboratory Interface

*Ian Young “Medical Genetics". Oxford University press,
*New Clinical Genetics by Andrew Read and Dian Donnai. Scion Publishing 2007. ISBN
10-1-904842-31-3

318
D IPLOMA IN F ORENSIC M EDICINE [UNDER REVIEW]

Please refer to the general requirements for training and examinations set out at the front of this
Handbook.
INTRODUCTION
As the Forensic Pathology Secretariat for the World Association of Societies of Pathology, the
College has international responsibilities in forensic medicine generally and more specifically in
forensic pathology. In discharging these responsibilities, one of the main contributions the
College can make is to provide the framework for training opportunities that can lead to an
appropriate qualification. It is anticipated many such trainees will come from countries where
opportunities for training in pathology are limited, but the need for forensic pathologists exists.
Such trainees may not fulfil the requirements for Fellowship of the College (Anatomical
Pathology slanted to Forensic Pathology) or for the post-Fellowship Diploma in Forensic
Pathology.
The College has therefore instituted the Diploma in Forensic Medicine as a qualification for
candidates not eligible for the Fellowship. This Diploma is set at a standard below that of the
Fellowship, to provide some assurance of competence and analytical ability in the major areas of
forensic pathology. The award of this Diploma has no implications for registration as a medical
practitioner in Australia, because it is not the equivalent of the Fellowship, or the post-Fellowship
Diploma in Forensic Pathology.
GENERAL INFORMATION
Eligibility Criteria
The Diploma in Forensic Medicine is offered to Australian and overseas medical graduates
seeking a qualification in forensic pathology but who are not eligible to undertake the Fellowship.
To be eligible for examination, the candidate:

Must hold a medical qualification acceptable to the RCPA Board of Censors.
Must have completed two years of training at a centre accredited by the College for training
in Forensic Pathology. This training must include certification of competence -- by the Head
of the Department and at the time of application for the examination -- in the following:
(a) Autopsy techniques including:
• External examination
• Opening head, chest, abdomen
• Inspection and evisceration
• Dissection and description
• Reconstitution of the body;
and
(b) Special techniques including:
319
Infant autopsies
Removal of spinal cord
Examination of the vertebral arteries
Inspection of femoral bone marrow
Removal of cervical spine
Examination of skeletal material;
and
(c) Experience in histopathology to a standard similar to that required for a pass at the
Part I examination in Anatomical Pathology -- to include numbers of autopsies
performed and biopsies reported -- and to be certified by an appropriate authority
(e.g., Head of a Department of Anatomical or Forensic Pathology).
and
(d) The writing of autopsy reports; the principles of giving evidence in court; the
principles of forensic science and the examination of scenes of death.
and
(e) Presenting and evaluating autopsy findings orally;
or
(e) Satisfies the RCPA Board of Censors that he or she has experience in forensic
pathology equivalent in aggregate and in all respects to the two years of training
outlined above. This experience must be certified by an appropriate authority (e.g.,
Head of a Department of Forensic Pathology) and must include evidence of autopsy
experience -- including forensic autopsies -- and other experience that encompasses
the same areas referred to above.
A reduction in the training time may be granted on the basis of experience in forensic
pathology that falls short of the two-year period mentioned above (i.e., fractional
experience, gained either full-time or part-time). For the assessment of pro rata
reduction in the training period for part-time experience, the RCPA Board of Censors
will use criteria equivalent to those for the evaluation of fractional training for
Fellowship candidates in Anatomical Pathology.
At its discretion, the Board of Censors may take into account other training or experience (e.g.,
post-graduate degrees) in determining an individual’s eligibility for examination. As a general
rule, a high degree of proficiency, relevance and certification must be proven for this other
training or experience, to influence a decision to bypass any of the eligibility requirements above.
Ordinarily, each candidate must be sponsored by a Fellow of the College. In circumstances
where this is impracticable, the sponsorship of the Head of Department where the candidate is
working may be accepted. Fellows sponsoring candidates for the Diploma in Forensic Medicine
are advised to seek preliminary indications from the College before accepting an overseas
graduate for training.
Those candidates who have completed the training requirements are eligible for immediate
award of the Diploma on successful completion of the examination. For those candidates who
take the examination part-way during the training period, award of the Diploma is deferred until
the training period is completed.

ASSESSMENT
The Examination
The examination consists of written, Casebook, practical and oral components including:
a three hour written essay examination in the general areas of Forensic Pathology and
Forensic Medicine (Should any Trainees be sitting at the same time for the Diploma in
Forensic Pathology, a similar examination paper may be used for both examinations);
a two-hour short answer paper of 10-15 compulsory questions covering more

specialised aspects of forensic pathology;
the presentation of a Casebook detailing 10 coronial post mortem examinations

conducted by the candidate;
a practical examination (should any Trainees be sitting for the Diploma in Forensic
Pathology, a similar practical examination may be used for both examinations.);
an oral examination; and
the conduct of a coronial post mortem examination.
The written, practical and oral components of the examination will be held at the same time as
the Part II Examinations in Anatomical Pathology.
Casebook
Guidelines covering Casebook content are similar to those appertaining to the Anatomical
pathology Part II examination slanted to Forensic Pathology (see under Anatomical Pathology
Requirements) except that as for the Diploma in Forensic Pathology, all cases are to be
orientated towards Forensic and Autopsy Pathology, and no mixture of Forensic Pathology and
general Anatomical Pathology will be allowed.
Guidelines for presentation, certification and submission are similar to those for the Part II
Anatomical Pathology Examination (see under Anatomical Pathology Requirements).
Casebooks must be received at the College by 31 March and assessment will be in line with that
for other Part II Anatomical Pathology Casebooks (see under Anatomical Pathology
Requirements).
Practical Examination
The content and format of the practical examination are similar to those for the Anatomical
Pathology Part II examination slanted to Forensic Pathology (see under Anatomical Pathology
Requirements) except that as for the Diploma in Forensic Pathology, all cases will be orientated
towards Forensic and Autopsy Pathology.
Oral Examination
The content and format of the oral examination are similar to those for the Anatomical Pathology
Part II examination slanted to Forensic Pathology (see under Anatomical Pathology
Requirements).
Limited Examination for Diploma in Forensic Medicine

There shall be no waiver of any part of the examination for any candidate.

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN FORENSIC MEDICINE

F ACULTY OF O RAL P ATHOLOGY

INTRODUCTION
The College offers a Fellowship of the Faculty of Oral Pathology (FFOP) for dental graduates
fulfilling similar criteria, but applicable to dental practice, as those applicable to medical
graduates. This is also offered for medical graduates, and for Trainees and Fellows wishing
either to gain recognition as an Oral Pathologist, or to cross over to a career in oral pathology.
It should be noted that to be recognised as a specialist by Dental Boards in Australia or Dental

Council of New Zealand, dental practitioners must also hold an approved Master’s degree (or
approved clinical Doctorate) in Oral Pathology or Oral Pathology and Oral Medicine, and a
dental qualification registrable by these Boards.

The examinations for Fellowship of the FOP are intended to certify professional expertise in oral
pathology at a level equivalent to Fellowship in other disciplines.
Enquiries and registration of Trainees follow the same guidelines set out at the front of this
Handbook. Trainees registered as dental practitioners must have practised dentistry for at least
one year full-time or part-time equivalent after qualification, in posts approved by the Board of
Censors.
Practitioners who hold specialist qualifications in oral pathology from a country other than
Australia or New Zealand may apply for admission to the FFOP. The decision about eligibility to
enter the scheme, and what (if any) exemptions from further training or examinations may be
granted, will be made by the Board of Censors.
Training involves a five year program, undertaken in at least two laboratories accredited by the
Board of Censors. The supervisor will normally be a Fellow of the Faculty of Oral Pathology.
ASSESSMENT
Examinations for the Fellowship shall comprise the following:
A. Pathological Sciences Examination

Trainees will normally be required to pass the Pathological Sciences examination. This may be
taken within the first three years of training and must be passed prior to taking the Part II
examination.
B. Logbook
Candidates in Oral Pathology are required to keep a logbook of their reports in both general and
oral pathology. A summary of the numbers of each type of case, laboratory procedure,
immunohistology, cytology, FNA etc in general and oral pathology should be appended. This is
intended to ensure that candidates have had sufficient experience in both general and oral
pathology and that any deficiencies are remedied.

The Logbook is to be submitted with the examination applications for both Part I and Part II
examinations and is to be authenticated by the candidate’s supervisor in the same way as the
Part II Casebook. (Please refer to Anatomical Pathology Requirements)
C. Part I Examination
This is intended to be the main assessment leading to the Fellowship of the Faculty. The criteria
for admission and examination requirements are broadly similar to those for Anatomical
Pathology except that:
I. The examination will be slanted towards oral pathology and

II. Experience prior to the Part I examination should comprise both general anatomical
pathology and oral pathology, with the equivalent of 18 months being spent in general
anatomical pathology.
The Part I examination will consist of a written paper and first practical examination in general
and oral pathology. Candidates passing these assessments are then invited to take a second
special practical examination in oral pathology and two 20-minute viva examinations.
Part I Oral Pathology component (Refer also to Checklist for Anatomical Pathology)
The checklist for the examinations in Oral Pathology is generally similar to that for
Anatomical Pathology, except as listed below.
Preparation, interpretation and reporting of stained tissue sections:

Of the 2,500 accession slides on which reports are made, approximately 1,250 should be
general anatomical pathology specimens and 1,250 should be oral pathology specimens,
with at least 50% of the total being original reports rather than reports on archival material.
The scope of the oral pathology reporting will include:

- Diseases of the dental hard tissues, gingivae, periodontium and jaws
- Diseases of the oral mucosa and relevant skin disorders
- Diseases of the bones and joints
- Diseases of the salivary glands
- Soft tissue disorders affecting the oro-facial region
- Lymphoid and haematological disorders involving the oro-facial region
- Genetic and acquired disorders with oro-facial manifestations
Autopsies:
Candidates will be expected to demonstrate knowledge of autopsy pathology and familiarity
with autopsy procedures and interpretation
Cytology:
Candidates will be expected to:
- Understand the principles of exfoliative and aspiration cytology and be familiar with
techniques of collection and methods of preparation.
- Show evidence of experience in the interpretation and reporting of the diagnosis of
common conditions in oral exfoliative and fine needle aspiration cytology. As a guide, the
candidate should have reported not less than 30 cases of exfoliative cytology and have
reported not less than 50 fine needle aspirations.
D. Part II Examination
The Part II examination and assessment will cater for two streams:
1. Oral Pathology OR

2. A major research component.
1. Part II Oral Pathology examination

Criteria in Oral Pathology are similar to those applying to Anatomical Pathology. The
examination will be analogous to that in Anatomical Pathology, with submission of a Casebook
(see below).
Preparation, Interpretation and reporting of Stained Tissue Sections:

As for Part I candidates but to a total of 5,000 accessions i.e., 2,500 over and above that
required for Part I.
At least 2,500 of these should be in oral pathology and 1,500 in general anatomical
pathology.
At least 50% must be original reports rather than reports on archival material.
Cytology:
Substantial further experience in both exfoliative and fine-needle aspiration cytology.
Casebook:
Candidates will be expected to produce a Casebook detailing 10 cases, including any post-
mortem examinations with which they have been involved. Each case is to include the history,
the macroscopic and microscopic findings, the results of associated findings, and a discussion of
the findings, and the pathobiological processes involved. Supplementation by a review of the
literature is to be provided. The case book should be submitted to the College by 31 March prior
to the Part II examination.
Please refer to the Casebook guidelines under Anatomical Pathology Requirements for details of
presentation.
2. Research stream
Trainees may opt for a research stream, but to gain Fellowship, the Trainee must demonstrate
competence in all aspects of Oral Pathology.
To do research rather than the more conventional training, Trainees need to apply to the Board
of Censors for project, laboratory and supervisor approval. The research must be considered
relevant and significant enough to lead to a PhD or MD by thesis.
Research Trainees will be required to undertake the Pathological Sciences Examination and
Part I and Part II examinations. At the Part II, the Trainee may be tested orally on the subject of
his/her thesis as well as being tested on gross and microscopic oral pathology. Trainees
entering the research stream can only acquire Fellowship if they demonstrate competence in
diagnostic pathology.
The Board of Censors will consider each case individually and inform applicants of what
examination process is required.
Exemptions
At its discretion, the Board of Censors may waive or vary any part of the examination - with the
exception of the viva examination - depending on the qualifications and experience of the
candidate, e.g. a Master’s degree or approved clinical Doctorate in Oral Pathology. Guidelines
for these exemptions are similar to those applicable to Anatomical Pathology and may be
obtained from the Registrar of the Board of Censors.

KNOWLEDGE AND EXPERIENCE TO BE ATTAINED IN ORAL PATHOLOGY

Table of Tasks, Learning Outcomes, Activities and Assessment in Oral Pathology, below.

Learning Outcomes Learning Activities Potential Assessment

Tasks Methods
For all tasks the
components of the
Part I and part II RCPA
exams are important
assessment tools
Discipline - Specific Functions of the Oral Pathologist in the Laboratory
Specimen Acquisition • Read laboratory • Document in Trainee

Accession, - advise clinicians on appropriate choice and selection of specimens, and the manual portfolio– signed by
Management limitations of any proposed investigation • Participate in daily supervisor or
and Processing laboratory activities designated pathologist
of Specimens once learning outcomes
are achieved
• Written Paper
Viva Parts 1 and 2
Specimen Accession • Read laboratory • Document in Trainee

- Demonstrate the knowledge required to establish and monitor a reliable manual portfolio– signed by
method for specimen identification and laboratory accession • Have a working supervisor or
- learn to “trouble shoot” if error identified knowledge of the designated pathologist
content of once learning outcomes
NATA/NPAAC or other are achieved
relevant guidelines and • Written Paper
where to access the Viva Parts 1 and 2
information
laboratory activities
Specimen Cut-Up • Document in Trainee
- photograph specimens (and indicate sites of block selection) when • Read laboratory portfolio– signed by
appropriate manual supervisor or
- radiograph specimens when appropriate • Participate in daily designated pathologist
- cut up specimens, and select blocks, appropriately laboratory activities once learning outcomes
- know how to handle fresh specimens and how to triage when ancillary • Read textbooks and are achieved
tests are required journals • Essay question Part I
- understand the occupational health and safety issues of dealing with
specific tissues
Tissue Fixation • Part I essay question,

- select appropriate fixation regimes, and be able to detect and correct • Read laboratory • Part I and Part II viva
errors in this process manual question(s) – to discuss
Tissue Decalcification • Spend sufficient time the principles and
- select appropriate decalcification regimes, and be able to detect and (minimum of a week problems with specimen
correct errors in this process on at least three processing and stains.
Embedding and Sectioning separate rotations) in • Document in Trainee
- select appropriate embedding and sectioning techniques, and detect and the pathology portfolio– signed by
correct errors in these processes laboratory learning supervisor or
about and being designated pathologist
Staining involved in tissue once learning outcomes
- perform and interpret routine stains, and detect and correct errors in these fixation, embedding, are achieved
processes sections, staining • Provide regular
- select, perform and interpret appropriate special stains, and detect and correct (including special tutorials to scientific staff
errors in these processes stains, histo- and using cases that
immuno- illustrate issues around
Histochemistry histochemistry) histochemistry and
- select appropriate fixation, preparation and staining techniques, and detect sections imunohistochemistry
and correct errors in these processes
Immunology, Immunofluorescence and Immunohistochemistry

- select appropriate preparative techniques for the localisation of antigens in
tissue sections, and detect and correct errors in these processes
Frozen Sections • Document in Trainee

- demonstrate a working knowledge of the preparation of frozen sections, portfolio– signed by
detect and correct technical errors and artefacts supervisor or
- understand the occupational health and safety issues • Read laboratory designated pathologist
- report frozen section results to clinicians via ‘phone or in theatre and manual once learning outcomes

convey any limitations of the information/interpretation conveyed • Regularly accompany are achieved
pathologists to frozen • Essay question in Part
sections – attend I exam
sufficient frozen +/- Viva – part I and II
sections by part I exam Part 1 special practical
to achieve learning Part 2 practical
outcomes
Cytology • Document in Trainee

- select appropriate techniques for collection and specimen preparation, portfolio– signed by
and detect and correct errors in these processes supervisor or
• Read laboratory designated pathologist
Fine Needle Aspiration manual. once learning outcomes
- select appropriate preparative techniques, and detect and correct errors • Textbook reading. are achieved
in these processes • Participate in daily Part 1 essay
- understand the occupational health and safety issues laboratory activities- Part 1 special practical
- demonstrate a working knowledge of the techniques involved in including attendance at Part 2 cytology practical
performing per-cutaneous fine needle aspirations FNAs
Cytogenetics • Document in Trainee

- demonstrate a working knowledge of appropriate fixation, preparation portfolio– signed by
and staining techniques for samples sent for cytogenetic analysis supervisor or
- know which units/consultants to contact for expert advice • Participate in designated pathologist
laboratory teaching once learning outcomes
Flow Cytometry program for are achieved
- demonstrate a working knowledge of specimen preparation techniques, cytogenetics and flow • +/- Essay question –
and interpretation/correlation of results cytometry part I exam
• Read laboratory
manuals.
• Textbook, journal
reading.
laboratory activities
related to selecting of
tissue for cytogenetics

Autopsies and flow cytometry • Document in Trainee
- demonstrate a working knowledge of hospital and coronial autopsies portfolio– signed by
and to show evidence of a good knowledge of anatomy and . supervisor or
macroscopic pathology • Textbook, journal designated pathologist
- demonstrate a clear understanding of the occupational health and safety reading once learning outcomes
issues • Participate in the are achieved
department’s autopsy • Present autopsy
programme findings at a
• Read government departmental or
guidelines of ethical interdepartmental
autopsy practice meeting
Access relevant parts • +/- Essay question –

of the Coroner’s Act part I exam
Complete casebook
requirements for Part 2
examination cycle
• Read laboratory • Document in Trainee

Production of (‘Data’ comprise all specimens, blocks, sections and other manual portfolio– signed by
Laboratory specimens which are available for examination and review) • Participate in daily supervisor or
Data laboratory activities designated pathologist
once learning outcomes
• Read NATA/NPAAC are achieved
guidelines
Specimen Storage • Read laboratory • Document in Trainee

Storage and - demonstrate a working knowledge of an appropriate specimen storage and manual portfolio– signed by
Retrieval of retrieval system • Read NATA and supervisor or
Laboratory NPAAC guidelines designated pathologist
Data Specimen Retrieval • Participate in daily once learning outcomes
- retrieve specific specimens for examination and review laboratory activities are achieved

- index specimens appropriately
- retrieve records relating to specific cases or specimens

- retrieve specimens showing examples of specific diseases or processes
Specimen Description • Read laboratory • Document in Trainee
Analysis of - describe and interpret gross specimens accurately and concisely manual portfolio– signed by
Laboratory • Participate in daily supervisor or
Data laboratory activities designated pathologist
once learning outcomes
are achieved
- • Essay question - Part I
exam
• Part I special practical
exam
• Document in Trainee
portfolio and,
Microscopic Interpretation • Participate in daily specifically, accurate
- examine describe and interpret sections and specimens prepared by laboratory activities. documentation of
any of the techniques described above (e.g.: FNA, frozen section, •Cases and reports “double header time, is
routine histochemistry, immunohistochemistry,) initially drafted/written required in this part of
- provide clinicopathological correlation by the Trainee should the assessment –
be examined and signed by supervisor or
Interpretation of other specimens discussed regularly designated pathologist
- examine describe and interpret specimens, as relevant to oral over a “double head” on a continuing basis
pathology, prepared by other techniques described above (e.g.: microscope with the throughout the training
cytogenetics, microbiology, flow cytometry, molecular studies) supervising pathologist period.
- provide clinicopathological correlation on a regular basis • Practical slide exams -
•Textbook & journal Part I and II
reading Part I special practical
• Participate in internal exam
and external quality
assurance
programmes
• Present at
departmental,
interdepartmental and
hospital wide meetings

Information Retrieval • Participate in daily • Document in Trainee

Accessing - access appropriate information to assist in the interpretation of laboratory activities portfolio– signed by
Sources of specimens • Master use of search supervisor or
Information engines and designated pathologist
databases such as once learning outcomes
Medline are achieved
• Textbook & journal • Viva exams – part I
reading and II
Professional Opinion Participate in daily Document in Trainee

Developing an - on the basis of all the information (cytology, biopsy, etc.) available in relation laboratory activities portfolio– signed by
Opinion (this is to a specific case, develop and record a professional opinion as to the nature, supervisor or designated
part of the causation, severity, likely sequelae etc of the pathological process(es) pathologist once
process of learning outcomes are
interpreting lab. achieved
Data) practical exams
• Viva exams – part I
and II
Reporting • Participate in daily • Document in Trainee

Communicating - construct and sign off a written report which contains all appropriate laboratory activities portfolio– signed by
an Opinion (this information and inferences about the case (including information on the Have constructed and supervisor or designated
is part of the reproducibility of the findings and knowledge and use of grading signed of sufficient pathologist once
process of systems), together with responses to any specific queries received from cases to be competent learning outcomes are
interpreting lab. clinicians at the level requires for achieved
Data) each of the exam • Practical exams – Part
- produce synoptic reports where appropriate
- provide appropriate information and inferences about a case to referring phases I and II
clinicians by oral (face-to-face or telephone) communication • Viva exams – part I
- contribute appropriately to Grand Rounds, clinico-pathological conferences, and II
morbidity and mortality reviews, and other similar meetings
Follow-Up • Participate in daily • Document in Trainee

Monitoring

Patient - where appropriate, follow up patient outcomes by consultation with clinicians, laboratory activities, portfolio– signed by
Progress in both hospital and general practice specifically clinico- supervisor or designated
pathological pathologist once
correlation meetings learning outcomes are
routinely held by the achieved
Department and
ensure participation in
meetings covering a
range of sub-specialty
interests

APPENDICES
A PPENDIX 1: R OLES AND R ESPONSIBILITIES OF

C OUNCILLORS IN R ELATION TO T RAINING
The role of the State or Regional Councillor includes, among many other things, responsibility for
Trainees in their area. The role of Corresponding Fellow or the Board of Censors Representative
for New Zealand has this as the primary responsibility.
Responsibility for Trainees may include any or all of the following:
• To assist, advise and inform prospective Trainees regarding training and examination
requirements and options, career prospects, educational programs and laboratories
approved for training.
• To participate in, or appoint a delegate for, medical career expos, information days and
other activities to encourage recruitment to training in pathology.
• To arrange educational programs at the local level through the state/regional Education
Committee.
• To assist Trainees with problems relating to training and examination, in association with
supervisors, members of the local Education Committee and the Registrar of the Board
of Censors.
• To assist supervisors in fulfilling their role, particularly in cases in which problems arise.
• To organise the conduct of written, practical and oral examinations in regional centres.
• To counsel candidates after examination, where necessary, especially after failure,
discussing areas of weakness indicated by the examiners.
• To investigate complaints from Trainees or supervisors in specific instances.
• To establish as far as is reasonably possible, the suitability of Trainees for ultimate
Fellowship of the College and to place any problems before Council.
• To encourage active participation by Fellows in the training and examination system.
Additional roles relating to the Board of Censors include:

• Participating in site visits for the purpose of laboratory accreditation.
• Monitoring and advising the College of any concerns about the quality of training in the
local area.
In order to fulfil these responsibilities, Councillors (or equivalent) are expected to be familiar with
College training requirements and policies relating to training and examinations, overseas
trained specialists and laboratory accreditation.

334
The Mentor Role (Please refer to Policy No 9/2002: Mentoring for Trainees)
Part of the role of the Councillor (or equivalent) is to be available to act as a mentor for Trainees,
to complement the role of supervisors and other trainers who have an ongoing relationship with
Trainees. The mentor role involves providing advice and support when required and acting
impartially if any situation of conflict arises. A mentor should be perceived by the Trainee as a
senior colleague aware of the discipline specialty, local circumstances and College requirements
for training, to whom he or she could turn for advice and support at any time during training.
If the State Councillor (or equivalent) is unable to fulfil this role for any reason, or for any
particular Trainee, it is the responsibility of the Councillor, in collaboration with the Trainee, to
identify a suitable alternative mentor. Interactions between a Trainee and a mentor are in
confidence, and a mentor would usually not provide information to a supervisor.
Where the Councillor has been unable to resolve disputes, the matter should be referred to the
College Ombudsman for Australia or New Zealand (please refer to College Policy: Ombudsman
for Trainees).

A PPENDIX 2: A CCREDITATION OF L ABORATORY FOR T RAINING
The accreditation of a laboratory for pathology training is granted by the RCPA Board of Censors
on the recommendation of the Registrar. Accreditation is considered after receipt of a
completed application form, available on the RCPA website or on request from the College.
Essentially it is the laboratory’s training program including adequacy of supervision that is

accredited. Its physical facilities, staffing and educational programs are also taken into account.
Laboratories are accredited for all of the major pathology disciplines and laboratories with a
unified structure under a single overall director may submit a single application with appropriate
attached sheets on each of the disciplines. Single discipline laboratories with individual directors
are welcome to submit separate applications for each discipline.
Accreditation is for training in General Pathology, single disciplines or both and a limit will be
imposed on the length of time a Trainee works in a particular laboratory - up to a maximum of
four years. General Pathology Trainees who rotate between individual departments may be
permitted, at the discretion of the Board of Censors, to undertake all of their training in a single
institution.
Similarly there may be a limit on the number of Trainees a laboratory can train at any one time,
depending on the laboratory’s resources as assessed by the Board of Censors.
The Registrar or his/her representative, the relevant State Councillor and a specialist in the
particular discipline may undertake a site visit to assess a laboratory.
Accreditation status will remain valid only while the supervisor nominated on the application form
and the function of the laboratory remain essentially unchanged. A change of either of the
above MUST be notified immediately to the Registrar.
Upon resignation of the supervisor, the laboratory must notify the Registrar, including the name
and curriculum vitae of the new supervisor. If, in the absence of a supervisor, the Trainee can
be provided with acceptable supervision, no further action is required. If not, the laboratory
cannot accept new Trainees, and its accreditation is temporarily suspended. Under these
circumstances Trainees are not penalised and they may complete their current period of training
providing it does not exceed one calendar year. Training time will not be accepted in these
circumstances beyond one year.
As accreditation of a laboratory is essentially accreditation of a training program for Trainees, the

five year laboratory accreditation is subject to audit each year. This is done via the supervisor’s
annual reports on the Trainee and a paper audit circulated by the College.
The Board of Censors may request a reapplication for accreditation of training at any time, and
reapplication must be made at least once every five years. The College will advise the
laboratory when reapplication is due.
Trainee positions are usually advertised each year by hospitals and laboratories in the Medical
Journal of Australia, the New Zealand Medical Journal and some of the Australian and New
Zealand newspapers between July and September.
Trainees should contact these institutions directly unless stated otherwise. State Councillors are
available for Trainees seeking advice.

Laboratory Accreditation Requirements
In order to gain accreditation all laboratories must conform to certain minimum requirements as
follows:
• Professional Staff: It is expected that there will be a full time specialist medical or, for
training in Oral Pathology, dental graduate on the diagnostic service of the particular
discipline. In general this person should be a Fellow of the College or, for training in Oral
Pathology, a Fellow of the Faculty of Oral Pathology. Whenever this is not so, a full
curriculum vitae of the appropriate professional staff will be required. Appropriate
qualifications will be necessary.
• Supervisor: One of the professional staff is to be nominated as the supervisor of the
Trainee. Please refer to the RCPA policy on Supervision of Training. The supervisor is
required to submit a proposed training program at the commencement of each year and to
complete a Supervisor's Report by 20 July, if the Trainee is undertaking an examination, or
with re-registration in the following year.
• Education Program: The Trainee should be exposed to all aspects of the work of the
laboratory, including clinical liaison and bench work, so that a thorough practical
understanding of the discipline is achieved. Participation in conferences and seminars in the
clinical environment of the institution should be available to the Trainee. Trainees should
also be available to attend such sessions at neighbouring institutions. Details of the
education program must be given in the prospective plan submitted to the Board of Censors
at the beginning of every year.
• Library/Internet Facilities: A reasonable number and variety of journals and up to date
textbooks should be made available in the laboratory and preferably a large medical library
with borrowing facilities should be conveniently near. Access to literature search and
internet facilities should be available.
• Equipment and Floor Space: These should be adequate for the volume of work
undertaken. Trainees must have adequate work space and facilities relevant to the
discipline.
• Accreditation: NATA/RCPA or IANZ accreditation is mandatory for laboratories in Australia
and New Zealand. In training sites outside Australia and New Zealand, accreditation to a
prescribed external standard is required.

A PPENDIX 3: S UPERVISOR ’ S R OLE AND R ESPONSIBILITIES
All pathology training must be supervised. A supervisor is usually an RCPA Fellow or someone
holding an appropriate postgraduate qualification relevant to the training. It is not necessarily the
Director or Head of Department where training occurs. If the supervisor is not a Fellow of the
College he/she must have their role approved by the RCPA Board of Censors.
Individual Trainees nominate supervisors who then sign the Trainee's annual registration form
when agreeing to the role. Sometimes more than one supervisor a year is involved, but there is
only one with overall responsibility. Trainees can nominate more than one supervisor if they
divide the year between two or more unrelated laboratories.
If a supervisor cannot perform his/her duties (see below) he/she must advise the RCPA Board of
Censors through the Registrar, and discuss the nomination of a new supervisor with the Trainee.
The Trainee must then nominate a new supervisor to the Board.
For Trainees working towards higher academic qualifications their research project supervisor
may not be suitable as a training supervisor as he/she may not be familiar with RCPA training
objectives. In this case a supervisor not involved in the research project may be nominated.
Primary Role
The primary role of a Supervisor is to provide formative assessment (feedback on performance).

To do this they should meet regularly with the Trainee; observe their laboratory performance and
interaction with scientists, peers and clinicians; and review result reporting.
Supervisors are also responsible for providing assessment reports (formal determination of
competence) to the Board of Censors at the end of each year or training period. Reports are
used to evaluate a Trainee's performance and should indicate if the approved training has been
followed satisfactorily. Supervisors should also indicate positive or negative aspects of the
Trainee's performance and any contributions they may have made. Prolonged absences must
also be detailed.
A supervisor is expected to:
provide a training program for the year - devised in collaboration with the Trainee and
submitted to the Board of Censors as soon as possible after agreeing to act as supervisor
and/or no later than the end of registration on 31 January each year (or end of February for
Trainees in new positions);
monitor the Trainee's progress by personal observation and discussion, with delegation to
other trainers where appropriate, eg on secondment to another laboratory for a segment of
training;
maintain contact with the RCPA’s State or New Zealand Education Committee,
State/Regional Councillor and Board of Censors regarding the training, availability of
education programs, and any problems;
participate in Supervisors' Workshops and/or complete the Supervisors’ Module;
teach the Trainee, and assist him/her to learn from experience;
ensure Trainees have completed the checklist requirements before presenting for
examination;

discuss the Trainee's performance with the Chief Examiner if requested;
help the Trainee to interpret and act on an examiner’s comments, particularly in cases of
failure;
notify the RCPA Regional Councillor of any problems relevant to the Trainee's suitability for
admission to Fellowship;
arrange appropriate alternative supervision during absences of more than two months;
notify the Board of Censors of any change in the proposed approved training program; and
provide a confidential Supervisor's Report on Trainee progress to the Board of Censors

when required.
Supervisors' Reports
Reports on Trainees are required:

annually
prior to examinations and
on request from the Board of Censors.
For Trainees taking examinations, reports should be submitted to the College by 20 July, prior to
the practical and/or oral examination and/or final assessment.
The deadline for annual reports for other Trainees is 31 October each year.
Supervisors must discuss the annual report with the Trainee, or give it to them for their perusal.
In either case the Trainee should be encouraged to comment on the report. If the Trainee is not
consulted, supervisors must inform the Board of Censors of the reasons why.
It is the Trainee’s responsibility to have reports completed by their supervisor. A supervisor's

report form for each discipline may be downloaded from the RCPA website.
For additional information, a Guide for Supervisors is available on the RCPA website or from the
College.
From January 2005, it is mandatory for supervisors to complete the

Supervisors’ Module, available on CD from the College.

RCPA Trainee Handbook

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RCPA Trainee Handbook

Telephone: +61 (02) 8356 5858

© October 2008 The Royal College of Pathologists of Australasia

About the College........................................................................................................................ 4

Summary of Training and Examinations................................................................................... 6

Registration and Training Requirements................................................................................ 11

Examination Requirements ...................................................................................................... 18

Faculty of Oral Pathology......................................................................................................... 24

Continuing Professional Development ................................................................................... 25

Recognition of Overseas Trained Specialists ........................................................................ 26

Forms and Submissions........................................................................................................... 27

Training and Examination Fees ............................................................................................... 34

TRAINING AND ASSESSMENT REQUIREMENTS ..................................................... 35

The Overall Aim of the Training Program ............................................................................... 35

The Pathology Curriculum ....................................................................................................... 40

Basic Pathological Sciences Examination ............................................................................. 51

Chemical Pathology .................................................................................................................. 77

Clinical Pathology ................................................................................................................... 102

Forensic Pathology ................................................................................................................. 139

General Pathology................................................................................................................... 180

Genetics ................................................................................................................................... 219

Immunology ............................................................................................................................. 264

Microbiology ............................................................................................................................ 285

Diploma in Cytopathology...................................................................................................... 302

Diploma in Forensic Pathology.............................................................................................. 304

Diploma in Molecular Pathology............................................................................................ 309

Diploma in Forensic Medicine [UNDER REVIEW] .............................................................. 319

Faculty of Oral Pathology....................................................................................................... 323

APPENDICES ........................................................................................................................... 334

Appendix 1: Roles and Responsibilities of Councillors in Relation to Training .......... 334

Appendix 2: Accreditation of Laboratory for Training........................................................ 336

Appendix 3: Supervisor’s Role and Responsibilities ......................................................... 338

© October 2008 The Royal College of Pathologists of Australasia

A BOUT THE C OLLEGE

“The objects of the College are:

© October 2008 The Royal College of Pathologists of Australasia

RCPA Royal College of Pathologists of Australasia

The College Royal College of Pathologists of Australasia

Fellows Qualified pathologists and official RCPA Members

Trainees Medical or dental graduates training as pathologists

Councillors State or Regional Councillors, also Chairmen of State or Regional

Registrar The Registrar of the Board of Censors: a Fellow of the College

© October 2008 The Royal College of Pathologists of Australasia

Board of Education An RCPA board set up to provide advice on education issues,

FRACP Fellow of the Royal Australasian College of Physicians

JSAC Joint Specialist Advisory Committee: a joint committee between

NATA/RCPA Collaboration between the National Association of Testing

IANZ International Accreditation New Zealand, the body which accredits

Overseas Trained Specialist A medical practitioner qualified as a pathologist in another country,

S UMMARY OF T RAINING AND E XAMINATIONS

© October 2008 The Royal College of Pathologists of Australasia

In addition the College offers post-Fellowship diplomas in:

© October 2008 The Royal College of Pathologists of Australasia

Fellowship of the RCPA is awarded to those applicants who have:

For further information on the Royal College of Pathologists of Australasia’s training,

The Registrar, Board of Censors

Phone: +61 (02) 8356 5858

© October 2008 The Royal College of Pathologists of Australasia

31 January Closing date for annual registration of Trainees and submission of

28 February Submission of Oral Pathology logbooks

Mid March Admission to Fellowship Ceremony for candidates completing

28 March Anatomical Pathology Casebook due - Part II & diplomas

Oral Pathology Casebook due - Part II

Final date for payment of annual registration fees

he/she is a graduate in medicine of a university situated in Australia or New Zealand or a

he/she is a graduate in medicine approved by the Board of Censors; and