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Pathology Competencies for Medical Education and Educational Cases.

Current medical school curricula predominantly facilitate early integration of basic science principles into clinical practice to strengthen diagnostic skills and the ability to make treatment decisions. In addition, they promote life-long learning and understanding of the principles of medical practice. The Pathology Competencies for Medical Education (PCME) were developed in response to a call to action by pathology course directors nationwide to teach medical students pathology principles necessary for the practice of medicine. The PCME are divided into three competencies: 1) Disease Mechanisms and Processes, 2) Organ System Pathology, and 3) Diagnostic Medicine and Therapeutic Pathology. Each of these competencies is broad and contains multiple learning goals with more specific learning objectives. The original competencies were designed to be a living document, meaning that they will be revised and updated periodically, and have undergone their first revision with this publication. The development of teaching cases, which have a classic case-based design, for the learning objectives is the next step in providing educational content that is peer-reviewed and readily accessible for pathology course directors, medical educators, and medical students. Application of the PCME and cases promotes a minimum standard of exposure of the undifferentiated medical student to pathophysiologic principles. The publication of the PCME and the educational cases will create a current educational resource and repository published through Academic Pathology.

then posted on the Association of Pathology Chairs (APC) Website in 2014, where they were available for both course directors and medical students. A website externally linked from the APC Website was maintained where anyone could leave a comment regarding the competencies. This project, the pathology competencies for medical education (PCME), was initiated and supported by the Undergraduate Medical Education Committee of the APC. 2 Most medical schools have transitioned to an integrated organ-based curriculum, 1 where individual courses are no longer taught as distinct disciplines. The manner in which medical students are taught has also changed. The lecture format has largely been replaced with multiple types of active learning, including integrated small group discussions, team-based learning exercises, and flipped classrooms. Pathology course directors have a new challenge in education that has vastly transformed from the classic 1910 Abraham Flexner module of basic science education with individual basic science and clinical skills courses followed by 2 years of clinical practice apprenticeships 3 to an integrated and interdisciplinary medical school curriculum. In this transformation, individual disciplines are no longer presented as stand-alone courses, and the exponential expanse of medical knowledge requires an everchanging and comprehensive understanding of pathobiology by the competent practicing physician. The importance of understanding pathobiology is underscored by the significant amount of questions included on the current US Medical Licensing Examination (USMLE), where pathobiology is tested in both Steps 1 and 3 of the licensing examinations. 4 Every medical student must master disease processes and therapeutics in order to become a competent intern, resident, and fully practicing physician. As stated in the current standard 7 of the Liaison Committee on Medical Education (LCME) publication "structures and functions of a medical school," 5 there are important elements that must be understood including: (1) recognize and interpret symptoms and signs of disease and (2) develop differential diagnoses and treatment plans.
Pathology has a central role to assist students and physicians in (1) understanding the mechanisms of disease that lead to the signs and symptoms that must be recognized in patients, (2) forming a differential diagnosis, and (3) applying laboratory medicine that allows physicians to rule in or out individual diagnoses and make appropriate diagnostic and treatment decisions. This is in line with the Carnegie Foundation's report calling for a new reform of learning that is "learner centered" 6 and for learning outcomes to be tied to competencies.
The goal of this endeavor is 3-fold: (1) to revise the previously Website-published pathology competencies as these must be a living document, meaning revised regularly to keep pace with current medical practice and understanding, to highlight the essential (or minimum) for all medical students to understand for the practice of medicine and remain current with medical practice; (2) to emphasize laboratory medicine, which is often not taught, or at best only superficially taught, in many medical school curricula; and (3) to develop a shared resource of pathology competencies and educational cases highlighting the competencies for pathology faculty, educators, and students, which are developed by or with pathologists, peerreviewed, and represent foundational understanding of pathobiology essential for clinical practiec that can easily be adapted into any curriculum.

Pathology Competencies for Medical Education
The PCME have detailed learning objectives under each goal that direct medical students and course directors to important facets of each learning goal that can be individually applied by learners. The competencies are divided into 3 sections-disease mechanisms and processes, organ system pathology, and diagnostic medicine and therapeutic pathology-and allow flexibility for each learning institution and learner to apply the learning goals and objectives in a way that can keep the unique design of each curriculum or learning plan. The competencies are purposefully kept broad as they represent the minimum requirements of what pathology course directors across the nation have agreed upon to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine. 1 The learning objectives of the competencies are meant to be a living document, being continually commented upon by pathologists, medical educators, and medical students, and revised accordingly after review by an editorial group. The topics, goals, and learning objectives, as well as the comments submitted on the PCME website before November 2016, have been extensively reviewed by the original editorial group to ensure the learning objectives are current with the changing and expanding medical knowledge. Compared with the original competencies, additional sections have been developed, learning objectives have been revised, the format has been standardized, and new introductions for each section have been added. The revised competencies are found in the following pages of this article.

Educational Cases
Following publication of the original PCME, the Undergraduate Medical Educators Section (UMEDS) of APC began developing educational cases for the pathology competencies that are current, peer-reviewed, and highlight the pathology competencies in learning cases that can easily be adapted to multiple types of educational modalities. Some of the original cases were posted on the PCME website.
The format of the cases has evolved from the original cases posted on the PCME website to the present format of educational cases that are presented in this special edition of Academic Pathology. The educational cases reference the PCME from the following pages, and address at least 1 primary learning objective, but may have 1 or more secondary learning objective(s). The pathology competencies and learning objectives are clearly indicated in the beginning of each case so that the focus of the educational case is evident. Key elements of the current format include clinical presentation, discussion questions or points, learning points, and references. The clinical presentation may include images or laboratory data for the patient's presentation. The discussion questions or points are questions or statements that promote clinical reasoning followed by detailed explanations of the pathology, medicine, or therapeutics brought up in the discussion point or question. The learning points at the end of the case highlight the main teaching points from the preceding discussion. Thus, the cases demonstrate the application of medical reasoning to clinical scenarios that allow the learner to understand and apply diagnostic principles, incorporating morphologic findings and laboratory values with discussion of the laboratory medicine essentials for accurate diagnosis and treatment. References are included in each case and will allow the reader to review the original sources used to create the learning case or gain additional in-depth information. Thus, the educational cases are written in a style that can be easily used or adapted to multiple educational formats, such as small group discussions or flipped classrooms.

Discussion
Development of the PCME and the educational cases that support the individual learning objectives is a tremendous undertaking. On the broadest level, this effort supports the LCME standard 7, which requires all medical school curricula to prepare the undifferentiated medical student with sufficient breadth and depth of knowledge for the contemporary practice of medicine. This very broad view is the level at which the objectives were originally created, intended to be the minimum-level objectives course directors nationally felt were needed for adequate understanding for the practice of medicine. In addition, the PCME can be used by individual medical schools to gain leverage for additional curriculum development, especially in laboratory medicine, which is often only minimally taught, and to help expose students to pathology as a clinical specialty. Having a national repository of competencies that is peer-reviewed allows use of learning objectives and educational cases in individual curricula, potentially relieving some of the load on pathology course directors to continually update curricula to keep up with the exponential expanse of knowledge, laboratory testing, and treatment options. And lastly, a national repository of learning objectives and cases can potentially be used to support pathology exposure in integrated curricula to ensure exposure to a minimum amount of pathology for all students. We invite our audience to comment on the depth and breadth of the competencies found on the following pages.
The primary audience for the educational cases is our pathology educators, especially since not all pathology course directors are pathologists. The cases are peer-reviewed, appropriately referenced, and can be used as teaching material by faculty and students. Discussions that follow each discussion point should be broad enough to give faculty who may use these educational cases a deeper understanding of the pathobiology behind the learning objectives needed to teach or explain the concepts to the students. Here we emphasize that the discussions should explain the basic science and medicine behind each objective at a deeper level than the bare minimum of the objectives. As educators, we must be able to explain and build on basic knowledge concepts for our students, tying the information together in a tightly woven fabric across disciplines.
In addition, the discussions should explain the clinical reasoning behind each of the discussion points. Thus the educational cases are not intended to be a bare-bones review, but rather a fuller discussion building on concepts and explaining the thought process that will allow our students to become critical thinkers and apply new knowledge in the future. Having said this, the cases may be adapted to different levels or types of learners during different parts of the curriculum. For example, a case may present a simple benign lesion at a basic level where the intent is to highlight histologic features that help to differentiate between benign and malignant processes, however, another case may cover that same lesion in a different scenario to highlight clinical or diagnostic aspects of that specific disease.
Examples of educational cases can be found in the following pages for a variety of objectives from the three pathology competencies. The educational cases allow for individual use of the cases as students for primary learning or inclusion in medical school curricula in an adaptable format for a variety of teaching venues including laboratories, small group discussions or Team-Based-Learning. The educational cases are intended to facilitate knowledge integration and retention essential for clinical practice. Moving forward, we invite the broader community to submit educational cases to Academic Pathology to grow this national resource.

Conclusion
The educational cases highlight principles of the 3 competencies-(1) disease mechanisms and processes, (2) organ system pathology, and (3) diagnostic medicine and therapeutic pathology-and are presented in a way to help the development of clinical reasoning and the application of basic science into medicine, as well as increase the diagnostic acumen and treatment of disease. Continuing to build and review the PCME and create educational cases to highlight what we as a pathology education community feel is essential knowledge for the practice of medicine requires broader input.
We encourage readers to comment on the pathology competencies to further shape what we as pathologists feel is essential for medical education. Comments regarding the PCME can be sent to Jen Norman, in the APC office, at jnorman@apcprods.org. As stated above, the competencies are a living document requiring periodic updates. Comments will be reviewed and revised competencies will be published. In addition, we invite readers to submit educational cases directly to Academic Pathology, following the submission guidelines found on the Academic Pathology website.
We are grateful to Academic Pathology that the PCME and educational cases will be published as an easily accessible resource for educators and students.

Competency 1 Disease Mechanisms and Processes
A foundational knowledge of mechanisms of disease including the etiology, local or systemic responses to disease, consequences of disease, and cellular events involved in disease or adaptive changes is essential for understanding disease processes in organ system pathology and in patients.
There are 10 topics within this competency area. Each topic includes general learning goals and specific objectives that students should be able to meet before step 1 of the USMLE. Table 1 lists the topic areas and reference codes and shows the number of goals and objectives for each.

Topic: Genetic Mechanisms (GM)
This topic includes a basic knowledge of genetic mechanisms of disease including inherited and somatic disorders with the resulting consequences leading to disorders of development, metabolism, aging, stem cell biology, immunology, and the development of cancer.

Learning Goal 1: Genetic Mechanisms of Developmental and Functional Abnormalities
Apply knowledge of the genetic mechanisms of disease to discuss how changes in the genome can cause developmental and functional abnormalities at the cellular, tissue, and organism levels.
Objective GM1.1: Types of Mutations. Describe different types of mutations that can occur in human disease, and discuss how each of these can produce abnormalities in DNA transcription and/or alterations in the type or amount of protein produced.

Topic: Neoplasia (N)
This topic includes a basic understanding of characteristics of benign and malignant neoplasms, epidemiologic and environmental factors that influence neoplastic change, as well as an understanding of the molecular basis of neoplasia including oncogenes, tumor suppressor genes, carcinogenic agents, and host defense.

Learning Goal 1: Genetic Basis of Neoplasia
Apply knowledge of the genetic basis of neoplasia to explain how genetic changes are acquired, how functional alterations in these mutated genes lead to the development of cancer, and how these alterations can be exploited with therapy.

Learning Goal 3: Characteristics of Neoplasia
Apply knowledge of the characteristics of neoplasia to discuss the morphologic appearance, classification, biological behavior, and staging of neoplasms.

Topic: Environmental Mechanisms (EM)
Etiologies including physical damage resulting from trauma, particles, extreme temperature, and radiation and chemical exposures to small molecules and biologic toxins. The mechanism of injury usually causes direct damage that initiates a host response that can lead to a range of results from the process of resolution to a chronic complicated pathologic state.

Learning Goal 1: Cell Injury
Apply knowledge of biochemistry and cellular physiology to describe the mechanisms leading to cell injury induced by exposure to external agents including radiation, environmental toxins, drugs of abuse, and therapeutic agents.

Learning Goal 2: Physical Injury
Apply knowledge of biochemistry, anatomy, physiology, and mechanisms of cell injury to describe the pathogenic mechanisms of physical injury.
Objective EM2.1: Mechanical Force Injury. Compare and contrast the types of injuries associated with mechanical force (blunt vs. penetrating) with respect to effects on skin, blood vessels, and the directly affected organs and discuss systemic response to massive trauma.
Objective EM2.2: Thermal Injury. Discuss thermal injuries, comparing and contrasting the direct and systemic effects of thermal burns, hyperthermia, and hypothermia and mechanism of injury at the cellular level.

Topic: Metabolic and Nutritional Mechanisms (MN)
This topic includes the etiologic mechanisms, host responses, and disease processes leading to impairment of absorption, transport, and utilization of nutrients and oxygen, storage disorders, and disposal of waste products.

Learning Goal 1: Nutrient Deprivation or Toxicity
Apply knowledge of biochemistry and cellular physiology to explain the pathogenic mechanisms resulting from nutrient deprivation or nutrient toxicity, and the resulting pathology at the cellular, tissue, and organism levels.

Topic: Inflammatory Mechanisms (FLAM)
This topic includes the understanding of acute and chronic inflammation, patterns of inflammation, the cellular components, mediators, and systemic effects.

Learning Goal 1: Mechanisms of Inflammation
Apply knowledge of the biochemistry and cellular physiology to describe pathogenic mechanisms of acute and chronic inflammation, and the resulting pathology at the cellular, tissue, and organism levels. Objective FLAM1.6: Morphologic Patterns of Inflammation. Recognize and classify the major types of inflammatory lesions that can be present in histologic sections, and identify the cellular and protein constituents in these lesions.
Objective FLAM1.7: Acute, Chronic, and Granulomatous Inflammation. Compare and contrast acute, chronic, and granulomatous inflammation with respect to the major cell type(s) involved in the processes, the types of etiologic agents that produce each of these, and the mechanisms of tissue injury seen with these different types of inflammation.
Objective FLAM1.8: Extravascular Fluids Associated With Injury. Classify types of extravascular fluids associated with injury based on their cellular and protein content, know the terminology used to define these, and provide examples of pathologic conditions in which these can be found.

Topic: Immunological Mechanisms (IM)
This topic includes the understanding of normal and dysregulated innate and adaptive cellular immune responses resulting in inflammation, resolution, and disease.

Learning Goal 1: Immune Dysfunction
Apply knowledge of basic mechanisms of immunology to explain how dysfunction can produce cellular injury, acute and chronic inflammation, autoimmunity, allergic reactions, and susceptibility to infection; how these changes affect organ function and the health of the organism; and how therapeutic intervention can mitigate these effects.
Objective IM1.1: Innate and Adaptive Immunity. Compare and contrast innate and adaptive immunity with respect to the molecules and cells involved in the immune response, and the role of these systems in host defense. Objective IM1.5: Complement. Discuss how the complement cascade is activated, the role its activation plays in both inflammation and cellular cytotoxicity, and how abnormalities in complement function can produce disease.
Objective IM1.6: Immune Tolerance. Define immunological tolerance, and describe the role that failure of tolerance plays in the development of autoimmune diseases.
Objective IM1.7: Human Leukocyte Antigen (HLA). Discuss the structure and function of human histocompatibility antigens and describe the role of this system in both transplantation and susceptibility to certain diseases.
Objective IM1.8: Transplantation. Discuss the consequences of tissue transplantation, including mechanisms and pathophysiology of graft vs. host organ rejection, and the possible therapeutic interventions that can mitigate these effects.
Objective IM1.9: Immunodeficiencies. Compare and contrast the genetic basis and inheritance patterns of the well-defined primary immunodeficiency syndromes, discuss the pathogenesis and clinical sequelae of these disorders, and describe therapeutic interventions that can mitigate or correct them.
Objective IM1.10: Secondary Immune Deficiencies. Describe the etiology, mechanisms of action, and possible clinical consequences of secondary immune deficiencies.

Topic: Infectious Mechanisms (FECT)
This topic includes the mechanisms by which microorganisms, viruses, and parasites cause disease including virulence factors produced by microorganisms and host response.

Learning Goal 1: Mechanisms of Infection
Apply knowledge of biochemical and cellular physiology to describe the pathogenic mechanisms of infectious diseases including both pathogen and host factors, the resulting pathology at the cellular, tissue, and organism levels, and clinical manifestations. This topic includes an understanding of the pathogenesis of cellular proliferation for regeneration of cells, including of stem cells, and tissue and signal mechanisms for the repair process.

Learning Goal 1: Mechanisms of Tissue Regeneration, Renewal, and Repair
Apply knowledge of biochemistry and cellular physiology to describe the pathogenic mechanisms of tissue regeneration, renewal, and repair, the resulting pathology at the cellular, tissue, and organism levels, and describe clinical manifestations. Objective RRR1.6: Wound Healing. Describe the phases of cutaneous wound healing, the mechanisms of healing by first intention (primary union) and second intention (secondary union) and possible clinical consequences of abnormal wound healing.
Explain the effects of anti-inflammatory medications on wound repair.

Topic: Hemodynamic Disorders and Thromboembolic Disease (HDTD)
This topic includes a basic knowledge of edema, congestion, and shock as well as a basic understanding of the coagulation cascade to understand the pathogenesis of thromboembolic disorders.

Learning Goal 1: Hemodynamics and Shock
Apply knowledge of the biochemical and cellular physiology to discuss the pathogenic mechanisms resulting in alterations in hemodynamics and shock. Describe the resulting pathology at the cellular, tissue, and organism level and describe clinical manifestations associated with these pathologic changes.

Learning Goal 2: Clotting and Disruption of Blood Flow
Apply knowledge of the biochemical and cellular physiology to discuss pathogenetic mechanisms that result in alterations in blood clotting or other disruptions to blood flow. Describe the resulting pathology at the cellular, tissue, and organism level and the clinical manifestations associated with these pathologic changes.

Topic: Adaptation and Cell Death (ACD)
This topic includes a basic understanding of the cellular responses to cellular stress, mechanisms of cellular injury, and differentiating necrosis and apoptosis.

Learning Goal 1: Cellular Response to Injury
Apply knowledge of membrane physiology, metabolism, signal transduction, and macromolecular synthesis to discuss cellular responses to injury at the cell, tissue, and organism levels; how these responses affect morphologic appearance; and how they can be used for diagnostic, prognostic, and therapeutic purposes.
Objective ACD1.1: Adaptation. Discuss the pathogenesis of hyperplasia, hypertrophy, atrophy, and metaplasia, and compare and contrast their possible physiologic and pathologic causes.
Objective ACD1.2: Necrosis. Define necrosis and compare and contrast the forms of necrosis produced in response to different etiologic agents with respect to their variable clinical and morphologic features.
Objective ACD1.3: Ischemia. Compare and contrast ischemia and hypoxia and discuss the time course of the molecular events that occur in a cell in response to lack of oxygen, emphasizing the events that distinguish reversible from irreversible injury.
Objective ACD1.4: Reperfusion Injury. Summarize the cell's response to reperfusion injury emphasizing how reperfusion can exacerbate injury produced by ischemia.

Learning Goal 2: Cell Death
Apply knowledge of biochemistry and cellular physiology to differentiate between pathogenic and physiologic mechanisms of cell death, the resulting morphologic appearance, and the physiologic and clinical settings in which these mechanisms are activated.
Objective ACD2.1: Apoptosis. Contrast the etiology, mechanisms, and morphologic changes of apoptosis with those of necrosis. Discuss the circumstances in which dysregulation of apoptosis can produce disease, and circumstances that determine why cells undergo apoptosis vs. necrosis.

Learning Goal 3: Sublethal Injury
Apply knowledge of cellular physiology, metabolism, and macromolecular synthesis to discuss cellular and subcellular responses to sublethal injury or stress on cells; how these responses affect morphologic appearance at the cell and tissue level; and how they can affect organ function.
Objective ACD3.1: Cellular Response to Environmental Changes. Discuss, with examples, the changes that occur in cellular organelles or cytoskeletal proteins of different cell types in response to environmental alterations.
Objective ACD3.2: Intracellular Accumulations. Describe the mechanisms of intracellular accumulations and the morphologic and clinical consequences of these accumulations.

Competency 2 Organ System Pathology
Once the student has mastered the fundamental mechanisms and processes for causing, sustaining, extending, or resolving injury, this knowledge can be integrated to understand how pathology in each organ system affects the initial pathologic site, multi-organ systems, and the overall function of the patient. There are 23 topics within this competency area. Each topic includes general learning goals and specific objectives that medical students should be able to meet upon graduation from medical school. Table 2 lists the topic areas and shows the number of goals and objectives for each.
Topic: Cardiovascular-Blood Vessels (CBV) Cardiovascular disorders resulting from abnormal development, hypoxia, immune dysregulation, infections and smooth muscle changes as they relate to the blood vessels are enumerated.

Learning Goal 1: Mechanisms of Atherosclerosis
Apply knowedge of immunologic principles, inflammation, and tissue repair to explain atherosclerosis and its complications.

Learning Goal 2: Vascular Damage and Thrombosis
Apply knowledge of the cellular response to injury and basic hemodynamic principles to explain how defective or excessive inflammatory and reparative processes damage blood vessels and how this damage results in thrombus formation.
Objective CBV2.1: Thrombus Formation. Discuss the steps in thrombus formation and its predisposing factors.
Objective CBV2.2: Aortic Aneurysm and Dissection. Compare and contrast aortic aneurysms and aortic dissections in terms of their predisposing factors, the sites of involvement, and patient populations likely to be affected.

Learning Goal 3: Vasculitis
Apply knowledge of microbiological principles and mechanisms of immunologically mediated disease to discuss the pathogenesis, clinical presentation, morphological features, and laboratory diagnosis of the different vasculitides.
Objective CBV3.1: Drug-induced Vasculitis. Describe how a druginduced vasculitis depends on a functioning immune system.
Objective CBV3.2: Autoimmune Vasculitis. Compare and contrast the mechanisms by which an autoimmune disease can appear as a vasculitis in 1 specific organ or as a generalized disease in many organs.
Objective CBV3.3: Categories of Vasculitis (Vessel Size). Describe the vasculitides that occur in large, medium, and small vessels.
Topic: Cardiovascular-Heart (CH) Cardiovascular disorders resulting from abnormal development, hypoxia, immune dysregulation, infections and intrinsic muscle disease as they relate to the heart are enumerated.

Learning Goal 1: Heart Failure
Apply knowledge of anatomy, physiology, and general pathophysiologic principles to describe the clinical presentation associated with heart failure.
Objective CH1.1: Right-and Left-Sided Heart Failure. Compare and contrast right heart versus left heart failure in terms of clinical features, pathologic features, and the short-term and long-term consequences.

Learning Goal 2: Atherosclerosis in Heart Disease
Apply knowledge of anatomy, physiology, and general pathophysiologic principles to explain how atherosclerosis leads to heart disease and death.
Objective CH2.1: Ischemic Heart Disease. Explain how ischemic heart disease can progress while remaining entirely free of symptoms for many years.
Objective CH2.2: Angina. Contrast the clinical, physiologic, and histologic differences between exercise-induced angina and unstable angina.
Objective CH2.3: Reperfusion Versus Ischemic Injury. Contrast the behavior of the myocardium that has been subjected to chronic ischemia alone from that of reperfused myocardium following therapy for infarction.
Objective CH2.4: Timing of Changes in Myocardial Infarction. Compare and contrast the gross and microscopic features of acute myocardial infarction and remote myocardial infarction, and at what point gross or microscopic pathology appears.
Objective CH2.5: Histopathology of Myocardial Infarction. Describe the histologic features of acute myocardial infarction and explain the pathophysiology underlying the histologic changes from initial infarction through fibrosis and relate to the laboratory diagnosis of myocardial infarction.
Objective CH2.6: Complications of Myocardial Infarction. Identify short-term and long-term complications of myocardial infarction.

Learning Goal 3: Cardiovascular Malformation
Apply knowledge of embryologic principles to describe how improper development of the heart and blood vessels leads to cardiac dysfunction.
Objective CH3.1: Congenital Heart Disease. Name the most common forms of congenital heart disease and outline their clinical presentation, natural history, and long-and short-term complications.
Objective CH3.2: Congenital Heart Disease Associated with Genetic Disorders. Name several common genetic disorders associated with congenital heart disease, and describe the clinical presentation.
Objective CH3.3: Paradoxical Embolism. Describe a paradoxical embolus in terms of congenital heart disease.
Objective CH3.4: Cardiac Shunts. Define the concepts of left to right shunt, right to left shunt, and shunt reversal, and correlate with clinical presentation.

Learning Goal 4: Cardiac Infection
Apply knowledge of immunological and microbiological principles to explain the role of infectious agents in myocardial dysfunction and describe the related clinical presentations.
Objective CH4.1: Rheumatic Fever. Describe the major manifestations of rheumatic fever and its effect on the endocardium, myocardium, and pericardium.
Objective CH4.2: Rheumatic Fever and Endocarditis. Compare the effects of rheumatic fever and bacterial endocarditis on the endocardium, myocardium, and pericardium.
Objective CH4.3: Infective Endocarditis. Describe the 2 major patterns of infective endocarditis and the pathologic changes seen in the cardiac valves.
Objective CH4.4: Noninfective Endocarditis. Discuss the pathologic features of noninfective endocarditis on the cardiac valves.
Objective CH4.6: Pericarditis. Summarize the common causes of pericarditis and their pathophysiologic features.

Learning Goal 5: Valvular Dysfunction
Apply knowledge of the anatomy and physiology of heart valves to explain how valvular dysfunction leads to heart failure and describe the related clinical presentation.

Learning Goal 6: Hypertension and the Heart
Apply knowledge of the mechanism of response of cardiac muscle to increased resistance to describe the clinical and pathologic changes seen in systemic and pulmonary hypertension.

Topic: Hematopathology-Red Cell Disorders (HRC)
Red blood cell disorders resulting from abnormal development, nutritional derangements, inherited disorders, and intrinsic disease as they relate to anemia are enumerated.

Learning Goal 1: Anemia
Apply knowledge of nutritional biochemistry, erythropoiesis, and red blood cell structure and function to a discussion of the behavioral, hereditary, developmental, and chronic causes of anemia.
Explain the contribution of iron to red blood cell development and function. Describe behaviors and conditions that lead to iron deficiency and contrast the morphology and laboratory parameters of normal red cells versus iron-deficient cells. Objective HRC1.5: Anemias of Red-Cell Destruction. Explain the mechanisms by which anemia is produced on the basis of shortened red cell survival, distinguishing between intrinsic and extrinsic causes of red cell destruction.
Objective HRC1.6: Aplastic Anemia. Compare and contrast congenital and acquired forms of aplastic anemia.
Objective HRC1.7: Hemoglobinopathies and Thalassemia. Describe the structural alterations and regulatory abnormalities associated with hemoglobinopathies and thalassemia, and discuss how these abnormalities give rise to the clinical manifestations of these diseases.
Topic: Hematopathology-White Cell Disorders, Lymph Nodes, Spleen, and Thymus (HWC) White blood cell disorders resulting from abnormal development, genetic mutations, infections, and intrinsic disease as they relate to reactive and neoplastic abnormalities are enumerated.

Learning Goal 1: Development of White Blood Cells and Nonneoplastic Causes of Neutropenia
Apply knowledge of anatomy and physiology to describe the normal development of white blood cells and nonneoplastic conditions leading to increased or decreased numbers of white blood cells.

Learning Goal 2: Genetic Mutations in Hematologic Malignancy
Apply knowledge of general concepts of neoplasia to explain how genetic mutations can produce hematologic malignancies and how the clinical behavior of different malignancies can be explained by different mutations.

Learning Goal 3: Classification of Leukemia and Lymphomas
Apply knowledge of hematopoiesis to discuss the pathophysiologic basis for the classification of leukemia and lymphomas.
Describe the morphologic features that characterize typical cases of acute leukemia and lymphoma.
Objective HWC3.2: Myeloid Neoplasia. Compare and contrast myelodysplastic syndromes, myeloproliferative neoplasms, and acute myeloid leukemia with respect to morphologic appearance, clinical features, and underlying pathophysiology.
Objective HWC3.3: Categories of Lymphoma. Compare and contrast low-grade or indolent lymphomas and high-grade or aggressive lymphomas with respect to underlying pathophysiology that yields specific morphologic features and clinical behavior.
Discuss the morphologic appearance of a blast and be able to distinguish acute myeloid leukemia from chronic myelogenous leukemia.
Objective HWC3.5: Morphology of Lymphomas. Describe the histologic appearance of typical cases of follicular lymphoma, diffuse large B-cell lymphoma, small lymphocytic lymphoma/ chronic lymphocytic leukemia, and Hodgkin lymphoma.
Objective HWC3.6: Hodgkin and Non-Hodgkin Lymphoma. Compare and contrast Hodgkin lymphoma with at least 2 non-Hodgkin lymphomas with respect to age and clinical symptoms at presentation, sites and pattern of spread of disease, cell of origin, histologic appearance, and prognosis and response to therapy.

Learning Goal 4: Clinical Features of Hematolymphoid Neoplasms
Discuss the clinical manifestations of hematolymphoid neoplasms including age distribution of different tumors, presenting symptoms and signs, disease complications, natural history, and response to therapy. Describe the morphologic and molecular changes that take place within a lymph node in response to B-cell activation and explain how these changes relate to different types of B-cell non-Hodgkin lymphoma.

Learning Goal 6: Thymus
Thymus Apply knowledge of the anatomy and function of the thymus to summarize how developmental anomalies, immune disorders, and malignant transformation of epithelial and lymphoid cells lead to immune dysfunction.
Objective HWC6.1: Thymoma. Compare and contrast thymoma from lymphoma and describe the clinicopathologic features of thymic neoplasms.
Objective HWC6.2: Thymic Development. Explain how deficits in particular stages of thymic development can produce specific types of disease.

Learning Goal 7: Spleen
Apply knowledge of the anatomy and function of the spleen to explain how developmental anomalies, immune, and metabolic disorders neoplasia lead to splenic dysfunction.
Objective HWC7.1: Splenic Function. Explain the contribution of normal splenic function to nonneoplastic diseases.
Objective HWC7.2: Splenomegaly. Describe the clinicopathologic features of neoplastic and nonneoplastic disorders leading to splenomegaly.

Topic: Hematopathology-Platelets and Coagulation Disorders (HPCD)
Platelet disorders resulting from abnormal development, inherited disorders, immune, and infectious diseases and their central role in blood clotting as they relate to coagulation and hemostasis abnormalities are enumerated.

Learning Goal 1: Platelets
Apply knowledge of platelet structure and function to discuss qualitative and quantitative disorders leading to abnormal bleeding.

Topic: Respiratory System (RS)
Respiratory disorders resulting from abnormal development, genetic mutations, immune, infections, and intrinsic disease as they relate to lung abnormalities are enumerated.

Learning Goal 1: Vascular Diseases of the Lung
Apply knowledge of the structure and function of blood vessels to explain the pathogenesis, clinical manifestations, and pathologic findings in pulmonary embolism, pulmonary hypertension, and diffuse pulmonary hemorrhage syndromes.

Learning Goal 3: Lung Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of lung neoplasms.

Topic: Head and Neck (HN)
Head and neck disorders resulting from abnormal development, genetic mutations, immune, and intrinsic disease as they relate to salivary and upper respiratory abnormalities are enumerated.

Learning Goal 1: Nonneoplastic Salivary Gland Disorders
Apply knowledge of the structure and function of the salivary glands to an understanding of the clinicopathologic features associated with disorders presenting with gland enlargement.
Objective HN1.1: Salivary Duct Obstruction. Describe the potential causes for obstruction of the salivary gland duct.
Objective HN1.2: Lymphocytic Sialadenitis. Discuss disorders arising from lymphocytic infiltration of the salivary glands and discuss their potential neoplastic complications.
Objective HN1.3: Sjögren Syndrome. Describe Sjögren syndrome and discuss how it relates to salivary gland dysfunction, its effect on multiple organ systems, complications, and long term risks.

Learning Goal 2: Head and Neck Neoplasia
Apply knowledge of the etiology, pathogenesis, morphological appearance; and classification of neoplasms involving the salivary glands, oral cavity, upper airways, and larynx to their diagnosis; and prediction of biological behavior, prevention, and treatment.

Learning Goal 2: Anatomy and Blood Supply of the Gut
Apply knowledge of the gross anatomy of the GI tract and hemodynamic principles to discuss vascular disorders.
Objective GT2.1: Ischemic Disorders of the Gut. Explain the pathogenesis and clinicopathological features for common disorders of the GI tract that arise from hypoxia or ischemia.
Objective GT2.2: Necrotizing Enterocolitis. Compare and contrast the pathophysiology of necrotizing enterocolitis from bowel infarction due to shock and atherosclerosis.

Learning Goal 3: Gastrointestinal Neoplasia
Apply knowledge of the molecular basis of neoplasia to explain the clinical presentation, inheritance risk, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of gastrointestinal neoplasms.

Learning Goal 4: Features of Gastrointestinal Neoplasms
Apply knowledge of the gross anatomy of the GI tract and its blood supply to describe presenting signs and symptoms and pattern of spread of gastrointestinal neoplasms.

Learning Goal 7: Bowel Infections
Apply knowledge of common pathogens and principles of immunity to describe the morphological features and clinical presentation of infectious diseases affecting immunocompetent and immunocompromised patients.
Objective GT7.1: Bowel Infections. Compare the underlying mechanism and clinicopathologic features of GI tract involvement by common bacterial, fungal, and parasitic pathogens.
Objective GT7.2: Helicobacter Infection. Relate the clinicopathologic features of Helicobacter to chronic gastritis and ulcer formation.

Learning Goal 8: Mechanical Disorders of Bowel
Apply knowledge of GI anatomy and physiology to explain the clinicopathologic features, diagnostic criteria, and therapy of disorders resulting in acid reflux, abnormal GI motility, and gastrointestinal tract obstruction. Objective GT8.4: Appendicitis. Describe the clinicopathologic features of acute appendicitis and discuss the clinical differential diagnosis and potential complications of this disorder.

Topic: Hepatobiliary (HB)
Hepatobiliary disorders resulting from abnormal development, genetic mutations, immune, infections, toxins, and intrinsic disease as they relate to liver and biliary abnormalities are enumerated.

Learning Goal 1: Hepatitis
Apply knowledge of pathogenic organisms infecting the liver and their transmission, natural history, pathogenesis, laboratory profiles, and histopathological patterns of injury to the prevention and diagnosis of hepatitis.

Learning Goal 2: Liver Toxins
Apply knowledge of the cellular response to injury, the pathogenic mechanisms leading to disease and the biochemical alterations of hepatic function to explain the clinicopathologic features, prognosis, and treatment of disorders resulting from ethanol and other drugs and toxins.
Objective HB2.1: Steatosis. Describe the clinicopathologic features of excessive ethanol ingestion, focusing on biochemical pathways and short-and long-term complications, and compare and contrast alcoholic with nonalcoholic fatty liver disease.
Objective HB2.2: Acetaminophen Toxicity. Describe the clinicopathologic features of excessive acetaminophen ingestion focusing on biochemical pathways and short-and long-term complications.
Objective HB2.3: Hemochromatosis. Discuss the clinicopathologic features of excessive iron absorption, focusing on biochemical pathways, genetic factors, and short-and long-term complications.

Learning Goal 3: Hepatic Neoplasms
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of hepatic neoplasms. Objective HB3.4: Radiology of Cirrhosis. Identify the major spaceoccupying lesions that may be seen on radiographic imaging of the normal and cirrhotic liver, and discuss the complications of cirrhosis.
Objective HB3.5: Metastasis to the Liver. Describe the factors that lead to metastasis to the liver and the features of metastatic disease that distinguish it from primary neoplasms.

Learning Goal 4: Inflammatory and Congenital Hepatobiliary Disorders
Apply knowledge of the cellular response to injury, the pathogenic mechanisms leading to disease and the biochemical alterations of hepatic function to describe the clinicopathologic features, prognosis, and treatment of intrahepatic and extrahepatic biliary tract diseases.
Objective HB4.1: Inflammatory Disorders of the Liver. Outline how autoimmune hepatitis, primary and secondary biliary cirrhosis, and primary sclerosing cholangitis differ regarding associated conditions, incidence, sex predilection, etiology, laboratory features, clinical features and prognosis.
Objective HB4.2: Congenital Disorders of the Liver. Compare and contrast the etiology and treatment of biliary atresia and neonatal hepatitis.

Learning Goal 5: Molecular Basis of Biliary Neoplasia
Apply knowledge of the molecular basis of neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of neoplasms involving the biliary tree.

Topic: Pancreas (P)
Pancreas disorders resulting from abnormal development, genetic mutations, immune, infections and intrinsic disease as they relate to the exocrine pancreatic abnormalities are enumerated.

Learning Goal 1: Nonneoplastic Disorders of the Exocrine Pancreas
Apply knowledge of the structure and function of the pancreas to an understanding of the clinicopathologic features and diagnostic criteria of disorders resulting from cellular injury to the exocrine pancreas.

Topic: Kidney (UTK)
Kidney disorders resulting from abnormal development, genetic mutations, immune, infections, and intrinsic disease as they relate to renal abnormalities are enumerated.

Learning Goal 1: Renal Neoplasia
Apply knowledge of the molecular basis of neoplasia to explain the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of renal neoplasms.

Learning Goal 2: Structure and Function of the Nephron
Apply knowledge of kidney structure and function to summarize how acquired and hereditary abnormalities of the renal tubules and interstitium cause acute and/or chronic renal dysfunction.
Objective UTK2.1: Tubulointerstitial Diseases. Describe the clinicopathological features and pathogenesis of tubulointerstitial diseases and discuss how their pathogenesis relates to treatment and outcomes.
Objective UTK2.2: Nephritis. Compare and contrast acute pyelonephritis, drug-induced interstitial nephritis, and lupus nephritis in terms of pathogenesis, clinical presentation, histopathological appearance, and treatment.
Objective UTK2.3: Acute Tubular Injury. Compare and contrast ischemic and nephrotoxic forms of acute tubular injury, including typical clinical contexts, pathogenesis of renal failure, microscopic appearance, and expected outcome.
Objective UTK2.4: Chronic Inflammatory Injury. Compare and contrast chronic pyelonephritis and reflux nephropathy, including the organisms commonly associated with each.

Learning Goal 3: Renal Vascular Dysfunction
Compare and contrast the common causes of renal vascular dysfunction in terms of size and types of vessels involved, characteristic gross and microscopic morphology, pathogenesis, and clinical presentation.

Learning Goal 4: Congenital Disorders of the Kidney
Apply knowledge of the embryologic principles of kidney and lower urinary tract development to explain developmental anomalies.
Objective UTK4.1: Inherited Renal Disorders. Compare autosomal dominant and autosomal recessive polycystic kidney disease in terms of pathological anatomy, molecular pathogenesis, and clinical presentation.

Learning Goal 5: Renal Syndromes
Apply knowledge of the structure and function of the kidney to describe the pathogenetic mechanisms, diagnostic criteria, and clinicopathologic features of glomerular diseases presenting with asymptomatic proteinuria, nephrotic and nephritic syndrome.

Topic: Bladder (UTB)
Bladder disorders resulting from abnormal development, genetic mutations, infections, obstructions and intrinsic disease as they relate to urothelial abnormalities are enumerated.

Learning Goal 1: Bladder Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of bladder neoplasms.

Learning Goal 2: Bladder Infection
Apply knowledge of innate and adaptive immunity, pathogenic organisms infecting the bladder and their transmission to explain the natural history, pathogenesis, diagnosis, laboratory profiles, histopathological features, and prevention of cystitis.

Learning Goal 3: Urinary Obstruction
Apply knowledge of the anatomy and physiology of the kidney to describe how disorders may lead to obstruction of urinary outflow.

Topic: Male Reproductive-Prostate (MP)
Prostrate disorders resulting from genetic mutations, infections, and intrinsic disease as they relate to prostate abnormalities are enumerated.

Learning Goal 1: Prostate Neoplasia
Apply knowledge of the molecular and cellular origins of prostate cancers, specifically adenocarcinoma, to summarize the epidemiology, clinicopathological features, natural history, and treatment strategies for this disease.
Objective MP1.1: Prostate Adenocarcinoma. Outline the cellular phenotype of the typical adenocarcinoma cell and describe its molecular and immunohistochemical characteristics.
Objective MP1.2: Histopathologic Criteria for Prostate Adenocarcinoma. Define the histopathological diagnostic criteria for the diagnosis of adenocarcinoma.

Objective MP1.3: Epidemiology of Prostate Adenocarcinoma.
Explain the epidemiology of prostate cancer with respect to age, race, and family history.

Learning Goal 2: Nonneoplastic Disorders of the Prostate
Apply knowledge of the molecular and cellular origins of nonneoplastic disorders of the prostate, specifically prostatitis and nodular hyperplasia, to explain the epidemiology, clinicopathological features, natural history, and treatment strategy for these diseases.
Objective MP2.1: Nodular Hyperplasia. Explain the molecular and hormonal origins of nodular hyperplasia, the area of the prostate affected, the natural history of the disease, various treatment strategies, and anticipated outcomes of treatment.
Objective MP2.2: Prostatitis. Describe the pathophysiologic basis for inflammatory conditions affecting the prostate, including the organisms causing this condition.

Topic: Male Reproductive-Testes (MT)
Testicular disorders resulting from abnormal development, germ cell lesions, infections, and intrinsic disease as they relate to testes abnormalities are enumerated.

Learning Goal 1: Nonneoplastic Disorders of the Testes
Apply knowledge of the molecular and cellular origins of nonneoplastic disorders of the testis to explain the epidemiology, clinicopathological features, natural history, and treatment strategy for these diseases.

Learning Goal 2: Testicular Neoplasia
Apply knowledge of the molecular and cellular origins of the common types of testicular cancer to explain the epidemiology, clinicopathological features, natural history, and treatment strategies for this disease.

Topic: Breast (BR)
Breast disorders resulting from abnormal development, genetic mutations, immune mediated, infections, and intrinsic disease as they relate to breast abnormalities are enumerated.

Learning Goal 1: Nonneoplastic Disorders of the Breast
Apply knowledge of the embryology, cellular responses to injury, underlying etiology, and biologic and molecular alterations to describe the clinical presentation, inheritance risk, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and therapy of nonneoplastic disorders of the breast.

Learning Goal 2: Nonneoplastic Uterine Disorders
Apply knowledge of uterine physiology, endocrinology, and anatomy to compare and contrast the clinical presentation and pathology of common nonneoplastic uterine disorders.

Learning Goal 3: Cervical Disorders
Apply knowledge of cervical physiology and anatomy to compare and contrast the clinical presentation and pathology of common cervical disorders.
Objective FU3.1: Clinical Features of Cervical Dysplasia and Neoplasms. Discuss the common human papillomavirus (HPV) types that affect the cervix and discuss the pathogenesis of cervical dysplasia and neoplasia, and cervical screening methods and prevention.

Learning Goal 4: Female Genital Tract
Apply knowledge of physiology and anatomy to compare and contrast the clinical presentation and pathology of common female genital tract disorders.
Objective FU4.1: Clinical Features of Pelvic Infections. Discuss the common pelvic infections including those affecting the vulva, vagina, cervix, and fallopian tubes, and describe the pathogenesis of pelvic inflammatory disease, common organisms involved, and its complications.

Topic: Female Reproductive-Ovary (FO)
Ovarian disorders resulting from abnormal development, genetic mutations, infections, immune, and intrinsic disease as they relate to the ovary are enumerated.

Learning Goal 1: Ovarian Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of ovarian neoplasms

Topic: Female Reproductive-Disorders of Pregnancy (FDP)
Pregnancy disorders resulting from abnormal implantation, genetic mutations, hemodynamic, immune, infections, and intrinsic disease as they relate to gestational disease abnormalities are enumerated.

Learning Goal 1: Disorders of Pregnancy
Apply knowledge of embryology, cellular responses to injury, hemodynamics, and molecular alterations to summarize the clinical presentation, morphologic appearance, classification, diagnosis, biologic behavior of and therapy for disorders of pregnancy. including potential consequences and/or subsequent risks, treatment, and prognosis for each.
Objective FDP1.7: Gestational Diabetes. Describe the pathophysiologic effects of diabetes mellitus on the mother and fetus.

Topic: Endocrine (EN)
Endocrine disorders resulting from abnormal development, genetic mutations, immune, infections, and intrinsic disease as they relate to multiple endocrine organ abnormalities are enumerated.

Learning Goal 1: Hyper-and Hypopituitarism
Apply knowledge of pituitary physiology to describe the pathophysiology and clinicopathologic features of disorders associated with hyperpituitarism and hypopituitarism.

Learning Goal 2: Hyper-and Hypothyroidism
Apply knowledge of thyroid physiology to explain the pathophysiology and clinicopathologic features of disorders associated with hyperthyroidism and hypothyroidism.

Learning Goal 3: Autoimmune Thyroiditis
Apply knowledge of immune system dysregulation to summarize immune-related disorders of the thyroid.

Learning Goal 4: Hyper-and Hypoadrenalism
Apply knowledge of adrenal physiology to describe the pathophysiology and clinicopathologic features of disorders associated with adrenocortical hyperfunction (hyperadrenalism) and adrenocortical insufficiency.

Learning Goal 5: Endocrine Neoplasms
Apply knowledge of the molecular basis of neoplasia to explain the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of endocrine neoplasms.

Learning Goal 6: Endocrine Pancreas
Apply knowledge of the structure and function of the endocrine pancreas and biochemical principles of carbohydrate metabolism to summarize the clinicopathologic features, diagnostic criteria, and therapy of disorders resulting from excess or decreased production of insulin and other islet cell hormones.

Topic: Skin (SK)
Skin disorders resulting from abnormal development, genetic mutations, immune, infections, and intrinsic disease as they relate to dermal abnormalities are enumerated.

Learning Goal 1: Classification of Skin Disease
Apply knowledge of histology, cell biology, inflammation, and neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, and classification of diseases of the skin.
Objective SK1.1: Pathophysiology of Changes in the Skin. Describe the pathophysiologic basis for changes in the color, surface texture, swelling, temperature, and sensitivity of skin.

Learning Goal 2: Infections of the Skin
Apply knowledge of the anatomic and immunologic structure of the skin to discuss the role of skin in protecting against direct invasion of skin and appendages by pathogens.
Objective SK2.1: Barrier Function of Skin. Explain the anatomic basis for the skin as a barrier and the role of normal flora that colonize the skin in this function.
Objective SK2.2: Cutaneous Infections. Describe common bacterial, viral, fungal, and parasitic agents that may cause cutaneous infections and the particular sites that they infect, and morphologic features and complications of these infections.

Learning Goal 3: Immune-Related Disorders of the Skin
Apply knowledge of basic concepts in immunopathology and the key immunologic functions of components of the skin to understand the pathologic basis of disease caused by reactivity to exogenous agents versus immunologically driven disease with a genetic component.
Objective SK3.1: Manifestations of Exogenous Antigens. Describe the clinical features and pathologic basis for skin manifestations to exogenous antigens including infectious organisms, drugs, chemicals, and environmental agents.
Objective SK3.2: Immune Diseases of the Skin. Describe the clinical features and pathologic basis for the following immunologically driven diseases with a genetic component: eczema, psoriasis, and vitiligo.

Learning Goal 4: Inherited Disorders of the Skin
Apply knowledge of genetics, skin structure, and function and basic principles of pathology to an understanding of nonneoplastic inherited disorders of the skin.
Objective SK4.1: Inherited Blistering Diseases. Describe the genetic basis for blistering diseases affecting the skin.

Learning Goal 5: Skin Neoplasia
Apply knowledge of the molecular basis of neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and therapy of benign and malignant skin neoplasms.

Topic: Musculoskeletal System (MS)
Musculoskeletal disorders resulting from abnormal development, genetic mutations, nutritional, immune, infections, and intrinsic disease as they relate to lung abnormalities are enumerated.

Learning Goal 1: Bone Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of bone neoplasms.

Learning Goal 2: Nonneoplastic Disorders of the Musculoskeletal System
Apply knowledge of histology, immunology, microbiology, and biological and molecular alterations to discuss clinical presentation, biological behavior, morphological appearance, and natural history of nonneoplastic disorders of bones, joints, and skeletal muscle. Topic: Nervous System-Central Nervous System (NSC) Nervous system disorders resulting from abnormal development, genetic mutations, vascular, immune, infections, and intrinsic disease as they relate to central nervous system (CNS) abnormalities are enumerated.

Learning Goal 1: CNS Neoplasia
Apply knowledge of the pathological and molecular basis of common brain tumors to describe their clinical behavior, effects on the nervous system, and therapies.
Objective NSC1.1: Features of Brain Tumors. Explain the pathophysiology underlying the signs and symptoms associated with brain tumors.
Objective NSC1.2: Classification of Brain Tumors. Compare and contrast the common types of brain tumors that affect the cerebrum, the cerebellum, the meninges, and the cranial nerves in adults and children; and outline their molecular basis and clinicopathologic features.
Objective NSC1.3: Hereditary Tumor Syndromes. Describe the major hereditary tumor syndromes of the central nervous system, the genes responsible for each syndrome, and the spectrum of tumors associated with each syndrome.
Objective NSC1.4: Grading of Brain Tumors. Explain the pathophysiologic basis for grading primary brain tumors and discuss how grading relates to prognosis and governs patient management.
Objective NSC1.5: Complications of Brain Tumors. Describe several complications of brain tumors and give specific examples.
Objective NSC1.6: Carcinomas Metastasizing to the CNS. Discuss carcinomas that commonly metastasize to the central nervous system and describe the locations in which metastases may be seen.

Learning Goal 2: Infection
Apply knowledge of clinical features, neuroimaging studies and location of lesion(s) to develop a differential diagnosis for CNS infection. Objective NSC2.4: Suppurative Meningitis and Abscess. Describe the gross and microscopic features of acute suppurative meningitis and brain abscess; and name the organisms most commonly associated with each.

Learning Goal 3: Spinal Cord Disorders
Apply knowledge of neuroanatomy, pathogenesis, and biologic behavior to develop differential diagnoses and determine appropriate therapy for disorders of the spinal cord.
Objective NSC3.1: Ependymoma. Describe the importance of distinguishing ependymoma from infiltrative astrocytoma intraoperatively and list the histologic features of each.
Objective NSC3.2: Spinal Findings in Demyelinating and Neuromuscular Disorders. Explain how examination of a spinal cord at autopsy is important for the diagnosis and classification of demyelinating and/or neuromuscular diseases.
Objective NSC3.3: Multiple Sclerosis. Describe the pathogenesis, clinical presentation, and gross and microscopic pathologic features of multiple sclerosis.

Learning Goal 4: Neuromuscular Disorders
Apply knowledge of clinical, anatomic, and neuropathologic principles to the diagnosis of neuromuscular disorders.
Objective NSC4.1: Amyotrophic Lateral Sclerosis. Describe the etiology, pathogenesis, and clinical features of amyotrophic lateral sclerosis.
Objective NSC4.2: Mitochondrial Disorders. Describe the etiology, pathogenesis, and clinical features of 2 types of mitochondrial diseases affecting muscle, and explain why it may be important to obtain fresh frozen muscle to aid diagnosis.

Learning Goal 5: Dementia
Apply knowledge of structure and function and general pathologic concepts to describe disorders where dementia is a component.
Objective NSC5.1: Amyloid and Tau in Dementia. Define the essential underlying abnormalities of amyloid and tau proteins in the most common causes of dementia in the United States.
Objective NSC5.2: Abnormal Protein Processing in Neurodegenerative Disease. Describe the protein processing abnormalities responsible for multiple neurodegenerative diseases.
Objective NSC5.3: Alzheimer's Disease. Describe the clinical features, gross pathology, and histopathology of Alzheimer's disease and name 3 regions of the brain that are usually involved.
Objective NSC5.4: Genes Implicated in Alzheimer's Disease. Discuss 3 genes in which mutations have been identified in patients with early onset Alzheimer's disease.
Objective NSC5.5: Disorders of the Basal Ganglia. Describe several diseases which involve the basal ganglia and describe how to distinguish among the diseases in terms of gross, microscopic, and clinical pathology.

Learning Goal 6: Demyelinating Disorders
Apply knowledge of the structure and function of the brain and general immunopathology concepts to summarize disorders that result in demyelination in terms of their etiology, pathogenesis, clinical and morphologic features, natural history, and therapeutic options.
Objective NSC6.1: Autoimmune Mechanisms in MS. Describe the autoimmune mechanism mediated by CD4þ T cells that react against self myelin antigens in multiple sclerosis and outline the clinicopathologic features of the disease.

Learning Goal 7: Ischemia of the Brain
Apply knowledge of the structure and function of the brain and general pathology concepts to discuss disorders resulting from altered blood supply and hypoxia to the brain.
Objective NSC7.1: Stroke. Compare and contrast the 2 major mechanisms for stroke and how treatment differs for each.
Objective NSC7.2: Traumatic Brain Injury. Describe the pathologic findings seen in the most common causes of traumatic brain injury.
Objective NSC7.4: Hypertensive Hemorrhage. Describe the mechanism of hypertensive hemorrhage and name 3 common locations in which this occurs.
Objective NSC7.5: Embolic Infarction. Describe how embolic infarcts differ from atherothrombotic infarcts in pathologic appearance and name 3 sources of emboli.
Objective NSC7.6: Acute Versus Chronic Brain Injury. Compare and contrast the gross and histopathologic appearance of acute versus remote brain infarction.

Topic: Nervous System-Peripheral Nervous System and Eye (NSP)
Nervous system disorders resulting from abnormal development, genetic mutations, vascular, immune, infections and intrinsic disease as they relate to peripheral nervous system (PNS) and ocular abnormalities are enumerated.

Learning Goal 1: Peripheral Nerve Disorders
Apply knowledge of the structure and function of the peripheral nerves and general pathology concepts to discuss peripheral nerve disorders.

Learning Goal 2: PNS Neoplasia
Apply knowledge of the pathological and molecular basis of common PNS tumors to describe their clinical behavior, effects on the nervous system, and therapies.
Objective NSP2.1: Hereditary Tumor Syndromes. Describe the major hereditary tumor syndromes of the peripheral nervous system, the genes responsible for each syndrome, and the spectrum of tumors, including the histology associated with each syndrome.
Objective NSP2.2: Tumors of the Peripheral Nervous System. Compare and contrast the common benign from malignant PNS tumors, and outline their molecular basis and clinicopathologic features.

Learning Goal 3: Ocular Disorders
Apply knowledge of the structure and function of the eye and general pathology concepts to discuss common ocular disorders.
Objective NSP3.1: Ocular Disorders. Describe the clinicopathologic features of common primary and secondary disorders of the eye including macular degeneration and uveitis.
Objective NSP3.2: Ocular Neoplasm. Describe the clinicopathologic features of common neoplasms of the eye including ocular melanoma and retinoblastoma.

Competency 3 Diagnostic Medicine and Therapeutic Pathology
Diagnosis and patient management require the student to apply their knowledge of disease mechanisms and organ system pathology to achieve efficient and effective use of clinical laboratory testing. In addition, the student should learn the proper use of blood/blood product utilization to enable optional diagnosis, treatment, and patient care. There are 10 topics within this competency area. Each topic includes general learning goals and specific objectives that medical students should be able to meet upon graduation from medical school. Table 3 lists the topic areas and shows the number of goals and objectives for each.

Topic: General Principles (GP)
Every physician should have an appreciation for the preanalytical, analytical, and postanalytical phases of laboratory testing. In addition, physicians need an appreciation of the statistical treatment of data that underlies test utilization. This includes but is not limited to the ability to choose the correct test to make a diagnosis enabling treatment selection and to employ the appropriate testing paradigm to monitor patients with chronic diseases enabling optimal clinical management.

Learning Goal 1: Laboratory Tests
Apply knowledge of clinical medicine, pathology, and statistics to determine the utility of a laboratory test in making a diagnosis and in monitoring chronic disease management. Explain the interpretation and limitations of clinical laboratory assays.
Objective GP1.1: Pre-and Postanalytical Errors. Give examples of common sources of preanalytical and postanalytical errors and categorize errors when the following procedures are not properly followed: pairing patient/specimen identification with the requisition forms, using correct specimen containers/tubes for specific tests, and timing of collection, transport, and storage.
Objective GP1.2: Sensitivity and Specificity. Evaluate the quality of an assay in differentiating disease versus nondisease states, including graphically presenting and interpreting the data. Determine the relationship between sensitivity and specificity for this assay.  Objective GP1.6: Turn-around Time. Compare and contrast appropriate uses of "stat" and "routine" test priorities with discussion of critical values and the elements of "turn-around time." Predict which elements affect turn-around time the most.
Objective GP1.7: Regulatory Issues. Explain the broad differences between Food and Drug Administration (FDA)-approved tests and laboratory-developed tests, including Clinical Laboratory Improvement Amendments (CLIA) waived and nonwaived tests, and discuss the regulatory issues involved in physicianoffice laboratories, home testing, and provider-performed microscopy.
Objective GP1.8: Point-of-Care Testing. Explain how "point-ofcare" (POC) testing in the physician office, multispecialty clinic, and hospital can enable better patient and population management of acute and chronic disease and why values generated using POC methods could differ from values generated in a high-throughput laboratory.
Objective GP1.9: Test Utilization. Create a clinical scenario that begins with a patient diagnosis and monitors a chronic disease for years, taking into account the following aspects: a laboratory testing decision tree to make the diagnosis, a protocol for monitoring the patient, the use of test panels and individual tests, the impact on healthcare cost for overutilization of laboratory testing, and the potential impact on cost for underutilization both at the diagnostic stage and in the management of chronic disease.
Objective GP1.10 Test Economics. Compare and contrast the cost of several common laboratory diagnostic tests, such as Complete Blood Count (CBC) and CBC with a manual differential. Discuss the cost of diagnostic testing and the impact on healthcare costs.

Topic: Transfusion Medicine (TM)
Every physician needs an understanding of transfusion medicine which encompasses the transfusion of red blood cells, platelets, and plasma products in order to correct deficiencies in patients or remove offending antibodies. Transfusions are not without risk and knowledge of the pathophysiology of the disease and risks of transfusion are vital for physicians for optimal patient outcomes.

Learning Goal 1: Concepts of Blood Transfusion
Apply knowledge of pathology, hematopoietic cell physiology and immunology to explain concepts of blood component transfusion and the therapeutic interventions in transfusion medicine. Objective TM1.4: HLA. Explain the HLA system and its role in both transfusion and transplantation.
Objective TM1.5: Apheresis. Explain the clinical role of therapeutic apheresis in the management of the following disorders: sickle cell anemia, thrombotic thrombocytopenia, acute and chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, antiglomerular basement membrane disease, organ transplantation, plasma cell dyscrasias, leukemia, and lymphoma.
Objective TM1.6: Paternity Testing. Explain the role of blood group testing in determining paternity identification.

Topic: Hematology (H)
Every physician needs a thorough understanding of one of the most common tests ordered from the laboratory, the complete blood count or CBC. Differentiating between tests needed for diagnosis and treatment of anemias and coagulation disorders is important for appropriate treatment and monitoring of these disorders.

Learning Goal 1: Normal Coagulation
Apply knowledge of biochemistry, pharmacology, and pathology to describe the basic cellular and molecular events associated with blood coagulation and explain laboratory tests for diagnosis and management of coagulation disorders.
Objective H1.1: Platelet Aggregation After Injury. Describe the process whereby platelets are activated and aggregate after blood vessel injury.
Objective H1.2: Platelet Inhibitors. Explain the action and the clinical use of common platelet function inhibitor drugs including, but not limited to, aspirin and clopidogrel.
Objective H1.3: Coagulation Cascade. Describe the process of fibrin formation in terms of the initiation of coagulation reactions by the exposure of tissue factor and/or "contact activation" and the subsequent proteolytic interactions that involve coagulation factor proteins.
Objective H1.4: Anticoagulants. Explain the actions and clinical use of commonly used anticoagulants including warfarin, the heparins, and the new oral direct inhibitors of thrombin and factor Xa.

Learning Goal 2: Diagnosis and Management of Coagulation Disorders
Apply knowledge of biochemistry, pharmacology, and pathology to describe the use of specific laboratory tests to diagnose and manage coagulation disorders.

Learning Goal 3: Mechanisms of Anemia
Apply knowledge of red blood cell (RBC) structure/function and nutrient metabolism, the mechanisms of anemia, and the clinical and pathological features of common causes of anemia, to develop an appropriate differential diagnosis.

Topic: Chemistry (CHEM)
Every physician needs to be able to differentiate between multiple different chemical tests in order to confirm a diagnosis or to follow disease progression. An understanding of the major chemical tests, their relationship to pathophysiology of disease progression, and understanding of limitations of such tests is essential for treatment.

Learning Goal 1: Pathogenesis, Diagnosis, and Treatment of Common Disorders
Apply knowledge of biochemistry, pharmacology, and pathogenesis of disease and clinical syndromes to describe the basic cellular and molecular events associated with diseases of specific tissues and organ systems, and the use of laboratory tests to diagnose and manage these diseases including the selection of medical/surgical interventions. Objective CHEM1.6: Lung Disease. Discuss the clinical presentation and the pathophysiologic bases of lung diseases including the efficient use of laboratory tests to make a definitive diagnosis and manage the disease.
Objective CHEM1.7: Toxicology. Determine the value of testing for drugs and toxins accounting for the routes of administration, distribution and metabolism of the agent of interest, including the specimen source, the analytes to be detected given the medical questions, and the timing constraints for specimen collection.
Objective CHEM1.8: Cancer Diagnostics. Select and interpret appropriate tests for specific cancer diagnostics, including tumor markers and serum monoclonal protein analysis.

Topic: Immunology (IMM)
Every physician needs an understanding of specific laboratory tests to differentiate between inflammatory and immunemediated diseases. Many newer techniques have been recently implemented that allow more definitive diagnosis and specialized treatment for these disorders.

Learning Goal 1: Pathogenesis, Diagnosis, and Treatment of Immunologic Disorders
Apply knowledge of immunology, biochemistry, and pathology to describe the basic cellular and molecular events associated with immune system diseases of specific tissues and organ systems and the use of laboratory tests to diagnose and manage these diseases.

Topic: Genomics (GE)
Every physician needs an appreciation of the complex field of genomics including Mendelian inheritance patterns to the ever evolving molecular techniques that are essential for diagnosing diseases as accurately as possible, and for many diseases correlated with specific targeted immune or chemotherapy to maximize effectiveness of treatment, decrease side effects, and optimize patient survival.

Learning Goal 1: Genes
Apply knowledge of genetics including the structure and organization of the human genome and regulation of gene expression, genetic variation, and inheritance patterns to basic disease processes.
Objective GE1.2: Pedigrees and Mutations. Demonstrate how to take a 3-generation family history and draw a pedigree. Distinguish between a nonpathogenic polymorphism and a pathogenic mutation, and describe the mechanisms that produce different types of mutations.
Objective GE1.3: Inheritance Patterns. Compare diagnostic testing of single-gene disorders to diseases with complex inheritance patterns and include the role of rare, high-risk variants, and common, low-risk variants.
Objective GE1.4: Linkage Analysis. Outline the principles that underlie genetic linkage analysis and association studies and how they are used to identify genes associated with diseases.
Objective GE1.5: Population Genetics. Define the concepts "founder effect" and "genetic drift" and explain how genetic variants are distributed within populations.
Objective GE1.6: Genetic Risk. Explain how genetic risk is determined by carrier status and carrier frequency of a condition and determine carrier frequencies and incidence of recessive conditions using Hardy-Weinberg Laws.
Objective GE1.7: Phenotypic Expression. Distinguish dominant and recessive phenotypes and alleles and describe how incomplete penetrance, variable expressivity, imprinting, and pleiotropy affect the phenotypic expression of diseases.
Objective GE1.8: Modifier Genes. Describe the concept of a modifier gene and its contribution to phenotypic variability.
Objective GE1.10: Mosaicism. Define mosaicism and explain how it affects the phenotype of a chromosomal disorder.

Learning Goal 2: Chromosomal Disorders
Apply knowledge of genetics to explain the molecular basis of single-gene and nonneoplastic chromosomal disorders.
Objective GE2.1: Testing for Genetic Disorders. Describe the genetic and epigenetic causes, pathophysiology and clinical manifestations, and optimal laboratory tests used to diagnose the following specific genetic disorders: Mendelian, autosomal disorders (dominant and recessive), X-linked disorders, chromosomal disorders, and disorders of nonclassic inheritance.

Learning Goal 3: Genetic Basis of Neoplasia
Apply knowledge of genetics to explain the genetic basis for neoplasia, and the role of genetic testing in diagnosis and treatment of diseases.
Objective GE3.2: Genetic Mechanisms of Neoplasia. Describe the molecular genetic mechanisms that underlie cancers: germline mutations; somatic mutations including point mutations, deletions, amplifications and translocations; epigenetic changes.
Objective GE3.3: Molecular Testing in Oncology. Explain the application of molecular testing for diagnosis, prognostication, and therapeutic follow-up of oncologic diseases.

Learning Goal 4: Reproductive Genetics
Apply knowledge of genetics to explain the role of reproductive genetics and population screening.
Objective GE4.1: Carrier Testing. Describe the role of preconception and prenatal carrier testing for genetic disorders depending upon family history and ethnic background.
Objective GE4.2: Newborn Screening. Describe the rationale for newborn screening for genetic diseases and explain the difference between screening and diagnostic testing.

Learning Goal 5: Diagnosis, Treatment, and Counseling
Apply knowledge of genetics to explain the role of genetic testing in diagnosis and treatment of diseases and in counseling of patients and families.
Objective GE5.1: Treatment Mechanisms. Explain the mechanisms involved in the treatment of genetic diseases: organ transplantation, manipulating metabolic pathways, correction of defective structural proteins or enzymes, modulation of RNA expression, alteration of DNA sequence, and alteration of gene expression.
Objective GE5.2: Genetic Variation in Response to Treatment. Describe how genetic variation can predict response to medications, dosing, and risk for adverse effects.

Objective GE5.3: Factors to Prevent Disease in the Genetically
Predisposed. Describe how modification of nongenetic factors can prevent or mitigate disease in genetically predisposed individuals.
Objective GE5.4: Genetic Counseling. Describe the role of genetic counselors in patient care and when to make appropriate referrals for genetics evaluations.

Topic: Autopsy (AU)
Autopsy is a division of anatomic pathology that encompasses the examination of a deceased person, either for medical or legal reasons. Understanding the value of the autopsy, both for scientific investigation of potential inherited disorders and for understanding the diseases that led to a patient's demise will allow clinicians appropriately discuss this end-of-life medical evaluation.

Learning Goal 1: Value of the Autopsy and Obtaining Consent
Apply knowledge of clinical medicine and quality management to discuss the value of the autopsy and procedures for obtaining permission for postmortem examination.
Objective AU1.1: Value of the Autopsy. Provide examples demonstrating the value of the autopsy toward improvement in clinical diagnosis and management, quality control, medical education, research, and elucidation of "new" diseases.
Objective AU1.2: Consent for Autopsy. Identify the legal next of kin or individual authorized to consent when obtaining consent for an autopsy.
Objective AU1.3: Obtaining Consent from the Family. Describe how to approach a family to request consent for an autopsy, including a discussion of the autopsy procedure in language that the patient's family can understand.
Objective AU1.4: Professionalism in the Autopsy. Discuss the psychosocial-emotional aspects of the autopsy experience, including its role in closure, and the importance of communication and professionalism among the health-care team.

Learning Goal 2: Death Certificate
Apply knowledge of quality management to discuss the utility of death certificates and proper approaches for completing them.

Learning Goal 3: Forensic Autopsy
Apply knowledge of clinical medicine and postmortem examination to discuss the indications for medical examiner referral and special procedures in the forensic postmortem examination.
Objective AU3.1: Role of the Medical Examiner. Define the role of a medical examiner in terms of public health and protection of legal rights.
Objective AU3.2: Reportable Deaths. Identify circumstances of death that need to be reported to the medical examiner/coroner.

Topic: Surgical Pathology (SP)
Surgical pathology is the area of anatomic pathology where all tissues or hardware removed from a patient is evaluated. Specimens sent to surgical pathology may range from minute endoscopic biopsies to large organ resections. Special techniques are commonly used by pathologists in evaluating these specimens that allow for definitive diagnosis and the recommendation of appropriate treatment for both benign and malignant lesions.

Learning Goal 1: Role in Diagnosis
Apply knowledge of clinical medicine and pathology to describe the roles cytology and surgical pathology play in diagnosis and treatment of benign and malignant disorders. Use specific examples from the most common diseases and forms of cancer.
Objective SP1.1: Obtaining the Specimen. Describe the procedures for obtaining a biopsy of a tissue lesion or mass in different sites, including superficial and deep soft tissues, solid organs, and tubular organs. Associate each procedure and specimen type to either cytology or surgical pathology and give examples of possible reasons and follow-up for false negative biopsies.
Objective SP1.2: Differential Diagnosis. List the major differential diagnoses for each type of cytology or surgical pathology specimen derived from a lesion or mass and describe appropriate further studies, both special stains and immunohistochemistry.
Objective SP1.3: Special Studies. After looking at slides of a tissue lesion or mass, the pathologist makes a diagnosis. List options for surgical and nonsurgical treatment and describe prognostic and therapy-guiding tests that may be performed on the tissue.
Objective SP1.4: Staging. Describe the information that the pathologist obtains from a resected tissue specimen, how this information is reported, how it is combined with clinical information to stage the tumor, and how staging information is used to guide treatment.

Learning Goal 2: Immune and Infectious Diseases
Apply knowledge of clinical medicine and pathology to describe the roles cytology and surgical pathology play in diagnosis and treatment of inflammatory disease, in particular those with immune or infectious etiologies.
Objective SP2.1: Examples of Inflammatory Conditions. Give examples of specific sites and diseases in which specific pathologic diagnoses of inflammatory and/or infectious conditions are critical to treatment and prognosis.

Learning Goal 3: Congenital Disorders
Apply knowledge of clinical medicine and pathology to describe hereditary/malformative disorders, in terms of clinically useful information that anatomic pathology diagnosis can provide.
Objective SP3.1: Terminology. Define general terminology for pathologic features that are associated with hereditary/malformative disorders.

Learning Goal 4: Interpretation of Reports
Apply knowledge of clinical medicine and communication skills to interpret pathology reports and communicate the results to patients in the context of risk assessment and patient prognosis. Determine appropriate action including additional testing and clinical evaluation.
Objective SP4.1: Explaining the Report to the Patient. Explain the results of a pathology report to a patient in language the patient can understand.

Learning Goal 5: Classification of Leukemia and Lymphomas
Apply knowledge of pathology and the application of diagnostic decision trees to discuss the classification systems of leukemia and lymphomas, and describe the relative roles of ancillary laboratory studies in classification.
Objective SP5.1: Special Studies. Describe the roles of immunohistochemistry, flow cytometry, cytogenetics, and molecular diagnostics in the diagnosis and classification of lymphoma, and explain how, with examples, different techniques are most appropriate in diagnosis, staging, and management of disease.
Objective SP5.2: Use of Special Studies. Explain how the work up of lymph nodes at the frozen section bench differs from routine frozen sections, and how examination of touch preparations of slides are used to streamline use of additional special techniques.
Objective SP5.3: Differential Diagnosis. Discuss how a pathologist can use a diagnostic decision tree to make a diagnosis efficiently, minimize the time to report results to the oncologist, and optimize treatment decisions.

Topic: Cytopathology (CYP)
Cytopathology focuses on the individual cellular components of disease. Cytopathological examination is an essential tool for its wide-ranging reach in screening, diagnostics, prognostics, and prevention of advanced disease states. Furthermore, the minimally and noninvasive nature of ascertaining most cytological specimens allows for immediate access to viable cellular material for advanced testing, molecular, and biochemical analyses.

Learning Goal 1: Cytologic Diagnosis
Apply knowledge of general and systems pathology to understand the meaning and context of cytologic diagnoses.
Objective CYP1.1: Obtaining the Specimen. Compare and contrast the 3 basic methods to obtain cytologic material for diagnosis, describe the settings in which these can be used to diagnose benign and malignant conditions, and discuss the limitations of each.

Learning Goal 2: Advantages of Cytopathology
Apply knowledge of clinical medicine, pathology, and healthcare delivery to describe the advantages cytopathologic examination offers over conventional pathologic tissue examination.
Objective CYP2.1: Screening. Describe the principles of an effective screening test and the uses and limitations of cytology.
Objective CYP2.2: Adjunct Testing (HPV). Describe how adjunct testing is used in conjunction with cytology examination.
Objective CYP2.3: Cervical Screening. Describe how to find and utilize current algorithms for management of cervical screening.