Appendix A

Syllabus for ICPT and Histopathology Higher Specialty Training

This syllabus document is an adjunct to the curriculum and is to guide aspects of learning
expected to be covered during Integrated Cellular Pathology Training (ICPT) and
histopathology higher specialty training. The syllabus is not designed to be prescriptive or
exhaustive as indicative content may quickly become out of date. The document is a guide
for trainees and trainers. Whilst trainees are expected to encounter common specimen types
in most hospital settings, it is recognised that due to centralisation of some services, not all
centres will be able to provide experience in all the organ systems mentioned in the syllabus.
However it is expected that the trainees will have access to most of the specimen types
during some part of their five-year training programme. Trainees are expected to refer to and
follow the most up-to-date Cancer Datasets and Tissue Pathways documents, which are
available on the RCPath website. Learning is an incremental process and as such the
trainees will gradually undertake more complex specimen types and techniques as they
progress through their training, particularly in years 3–5.

Broad topic areas included in the syllabus are as follows:

• Deeper understanding of undergraduate medical pathology, the pathological basis of
disease and anatomy
• Macroscopic and microscopic appearance of disease processes in organs, samples
of tissues and cellular specimens, across all organ systems
• The autopsy process
• The role of the history and associated clinical information in interpreting pathological
findings
• Evolving ways of working: digital pathology, molecular pathology and digital autopsy
• Report production: quality aspects, writing, recording and working with IT systems
• Laboratory organisation, accreditation and management
• Generic skills relating to health and safety, legal and ethical frameworks, education
and supporting research
• General principles of working in the cellular pathology smaller specialties

Syllabus overview for histopathology higher specialty training:

• Working with systems-specific members of the multidisciplinary team
• Pathology relating to all the adult organ system excluding the nervous system

I. Integrated Cellular Pathology Training Syllabus

This is a competency-based curriculum and as such there are no absolute minimum

numbers. However, it is anticipated that most trainees will achieve the competencies
required with the indicative minimum practical experience detailed below (per Whole Time
Equivalent (WTE) training year):

Year 1
Surgical histopathology – 500 cases
Cytopathology – 150 cervical and 150 non-cervical cytology cases, which may either be new
cases or be seen in the context of teaching sets with appropriate structured feedback from
an experienced trainer.

Year 2
Surgical histopathology – 750 cases
Cytopathology – 200 cervical and 200 non-cervical cytology cases, which may either be new
cases or be seen in the context of teaching sets with appropriate structured feedback from
an experienced trainer.

The table below is a non-exhaustive list of further syllabus information. It is recognised that
indicative content may quickly become out of date.

Areas of learning Knowledge Skills

Basic knowledge Demonstrates sufficient generalDevelops the ability to solve
(CiPs: 1, 2, 3, 4, 5, clinical knowledge including complex clinical and research
9, 11) major changes in trends of problems by applying sound
diagnosis and treatment knowledge of basic principles
without the requirement always
Possesses sufficient knowledge to rely on ‘pattern matching’
of normal anatomy, physiology
and pathophysiology

Surgical cut-up Understands principles of Possesses sufficient manual

(CiPs: 9, 11) specimen dissection, dexterity to perform dissection
macroscopic description and safely and accurately, without
block selection in neoplastic damage to tissues
and non-neoplastic disease

Laboratory Understands the principles of Gains experience of laboratory

processes laboratory processing within processing including section
(CiPs: 1, 2, 3, 4, 7, surgical pathology and cutting at the start of training
8, 9, 11) cytopathology
Surgical reporting Understands the principles of Demonstrates ability to set up a
(CiPs: 7, 9, 11) microscopy microscope with ergonomic
safety and operate it effectively
Demonstrates knowledge of the
microscopic features of the Demonstrates ability to
range of normality within tissues recognise the microscopic
as well as the major common features of tissue structure in
pathological processes and normality and disease
patterns of disease
Special techniques Understands principles of Understands when to resort to
(CiPs: 7, 9, 11) ‘special’ histochemical and special techniques
immunohistochemical methods
Demonstrates ability to
recognise histological features
of histochemical and
immunohistochemical stains in
normal and diseased tissues
Fundamentals of Understands principles of Demonstrates ability to
molecular biology common molecular pathology understand origins of, and
(CiPs: 1, 2, 7, 9, 11) techniques. justifications for, molecular tests

Understand principles of Demonstrates ability to retrieve

electron microscopy relevant data from public
sources
 Demonstrates understanding of Demonstrates ability to
the origins and consequences undertake the appropriate
of germ-line variation and sample collection, retrieval and
somatic mutations, including preparation for the common
DNA methylation and gene molecular tests, whether
expression changes performed on extracted nucleic
acid or in situ
Demonstrates knowledge of
basic molecular databases
Demonstrates knowledge of
Demonstrates knowledge of sequencing, PCR, microarrays
how histological samples are (DNA and RNA), in situ
taken, prepared and of how hybridisation and mutation
nucleic acids are extracted from detection
them
Demonstrates ability to assess
Understands the principles of the demand for molecular tests
the most up-to-date molecular and the modes of supply
methods

Demonstrates knowledge of
molecular tests currently
performed on histological
samples, including the
limitations of these tests and of
tests that are anticipated in the
near future

Areas of learning Knowledge Skills

General pathology Correctly identifies patient Sets up a microscope correctly
(CiPs: 7, 9, 11) details relevant to each
specimen Recognises normal histology
and normal variations of
Demonstrates understanding of common tissue types
normal anatomy and histology
Selects/identifies appropriate
Demonstrates understanding of histochemical stains for
the pathological basis of glycogen, fat, mucins, amyloid,
disease etc

Demonstrates understanding of Demonstrates familiarity with

common pathological basic immunohistochemical
abnormalities markers for major tissue and
tumour types and interpretation
Demonstrates understanding of of a basic panel of
lymph node anatomy and immunohistochemical markers
dissection in cancer specimens on an undifferentiated tumour

Correctly orientates specimens

Opens fresh specimens

Correctly obtains fresh tissue

 for touch preparation, freezing,
electron microscopy, genomic
studies, etc

Areas of learning Knowledge Skills

Breast pathology Demonstrates understanding of Demonstrates ability to apply
(CiPs: 1, 2, 4, 7, 9, the NHS Breast Screening the appropriate NHSBSP
11) Programme’s (NHSBSP) categories (B1–B5) on needle
guidelines for pathology core biopsy
reporting in breast cancer
screening and The Royal Describes, dissects and reports
College of Pathologists’ dataset mastectomy or wide local
for breast cancer excision specimens

Demonstrates understanding of Demonstrates the ability to

commonly encountered assess wide local excision for
neoplastic and non-neoplastic macroscopic tumour and
disease processes. For sample appropriately
example:
• ductal carcinoma in situ Demonstrates the ability to
• invasive carcinoma of no assess and sample axillary
special type (NST) lymph node dissection
• invasive lobular appropriately
carcinoma
• fibrocystic change Demonstrates the ability to
• fibroadenoma screen the specimen for
• other common benign microcalcification
breast lesions

Areas of learning Knowledge Skills

Upper Demonstrates understanding of Able to interpret and report
gastrointestinal various specimens obtained for endoscopic biopsies
tract example via:
(CiPs: 7, 9, 11) • oesophagectomy Recognises common diseases;
• gastrectomy e.g. Helicobacter-associated
• antrectomy gastritis, oesophageal and
• polypectomy gastric malignancy, etc
• EMR
Describes, dissects and reports
Demonstrates understanding of oesophageal and gastric
commonly encountered resection specimens
neoplastic and non-neoplastic
disease processes. For
example:
• Helicobacter-associated
gastritis
• reactive gastritis
• Barrett’s oesophagus
• oesophageal carcinoma
• gastric carcinoma
 • coeliac disease
• duodenitis
• GIST
• neuroendocrine tumours

Areas of Learning Knowledge Skills

Lower Demonstrates understanding of Able to interpret and report
gastrointestinal the NHS Bowel Cancer endoscopic biopsies
tract Screening Programme’s
(CiPs: 1, 2, 4, 7, 9, (NHSBCSP) guidelines for Recognise and report colorectal
11) pathology reporting in bowel carcinoma on biopsy
cancer screening and The
Royal College of Pathologists’ Identify presence of
dataset for colorectal cancer inflammatory bowel disease and
attempt to classify type on
biopsy
Demonstrates understanding of
specimens obtained for Distinguish serrated from
example via: adenomatous polyps
• colectomy/proctectomy
for cancer or Recognise low- and high-grade
inflammatory bowel dysplasia
disease
• appendicectomy Describe, dissect and report
• polypectomy colorectal carcinoma and non-
• EMR neoplastic resection specimens

Demonstrates understanding of
commonly encountered
neoplastic and non-neoplastic
disease processes. For
example:
• appendicitis
• inflammatory bowel
disease.
• Not otherwise specified
(NOS)
• hyperplastic polyp
• sessile serrated lesion
• adenomatous polyp
• high-grade dysplasia
• colorectal carcinoma
• neuroendocrine tumours

Areas of learning Knowledge Skills

Respiratory Demonstrates understanding of Describes, dissects and reports
pathology specimens obtained for resection specimens such as
(CiPs: 7, 9, 11) example via: segmental resection, lobectomy
• bronchial biopsies and pneumonectomy
• open biopsy of lung
• pneumonectomy or Recognises the presence of the
 lobectomy common subtypes of primary
• pleural biopsy lung cancer in biopsies and
resection specimens
Demonstrates understanding of
commonly encountered Recognises the presence of
neoplastic and non-neoplastic metastatic cancer in the lung
disease processes, for
example: Recognises common patterns
• squamous cell of interstitial lung disease
carcinoma
• small cell carcinoma
• adenocarcinoma
• metastatic carcinoma
• vasculitis
• interstitial pneumonia
• mesothelioma

Areas of learning Knowledge Skills

Skin Demonstrates understanding of Able to diagnose basic skin
(CiPs: 7, 9, 11) commonly encountered cancer types including
neoplastic and non-neoplastic squamous cell carcinoma, basal
disease processes, for cell carcinoma and typical
example: cases of melanoma
• basal cell carcinoma
• squamous cell Recognises common naevi and
carcinoma presence of atypical features in
• melanoma naevi
• melanocytic naevi
• haemangioma Demonstrates adequate
• seborrhoeic keratosis morphological description of
• actinic keratosis features seen in common
inflammatory skin lesions
• chronic dermatitis NOS
• epidermal inclusion
Demonstrates accurate gross
cysts
description of skin lesions
• dermatofibroma,
• acantholytic diseases Demonstrates appropriate
• vesiculobullous handling of orientated or
disorders, complex skin specimens
• cutaneous infections

Areas of learning Knowledge Skills

Lymphoreticular Demonstrates understanding of: Able to describe, dissect and
pathology • reactive lymphadenitis report lymph node, splenectomy
(CiPs: 7, 9, 11) including follicular specimens
hyperplasia, sinus
histiocytosis, Able to screen lymph node
dermatopathic change, dissections for metastatic
etc tumour
• high-grade lymphoma
• common types of low- Able to screen lymph node for
grade lymphoma neoplastic and non-neoplastic
 • Hodgkin’s lymphoma disease
• granulomatous diseases
• metastatic carcinoma, Recognises common reactive
etc node patterns including follicular
hyperplasia and sinus
histiocytosis

Able to diagnose high-grade

lymphoma, common types of
low-grade lymphoma and
Hodgkin’s lymphoma in lymph
node specimens and bone
marrow biopsies

Gains experience of examining

bone marrow trephine biopsies,
where locally available

Demonstrates the ability to

sample tissue for
supplementary techniques (e.g.
flow cytometry and molecular
studies)

Areas of learning Knowledge Skills

Head and neck Demonstrates understanding of Able to describe, dissect and
pathology specimens obtained for report tonsillectomy,
(CiPs: 7, 9, 11) example via: polypectomy, salivary gland
• mucosal biopsy biopsies and resections, lymph
• tonsillectomy node excisions, neck
• nasal polypectomy dissections, biopsies from the
• salivary gland tumour pharynx, larynx and upper
resections respiratory tract
• radical neck dissection
Recognises reactive changes in
Demonstrates understanding of tonsils and distinguishes from
commonly encountered high-grade lymphoma
neoplastic and non-neoplastic
disease processes, for
example:
• simple nasal polyps
• reactive, benign and
malignant conditions of
the tonsils
• salivary gland tumours
such as pleomorphic
adenoma,
adenocarcinoma,
Warthin’s tumour
• tumours of the
nasopharynx and larynx
Areas of learning Knowledge Skills
Gynaecological Demonstrates understanding of Recognises leiomyomata,
pathology specimens obtained for secretory and proliferative
(CiPs: 7, 9, 11) example via: endometrium, and endometrial
• hysterectomy and/or and cervical carcinoma
salpingo-oophorectomy
for malignant or benign Describes, dissects and reports
disease hysterectomy and/or salpingo-
• cervical loop/cone oophorectomy specimens, etc
biopsy

Demonstrates understanding of
commonly encountered
neoplastic and non-neoplastic
disease processes, for
example:
• common uterine
conditions such as
leiomyoma, secretory
and proliferative
endometrium,
endometrial atrophy and
endometrial carcinoma
• common cervical
conditions such as
cervical carcinoma and
chronic cervicitis
• common ovarian
conditions such as
ovarian cystic
follicles/theca cysts,
ovarian cystadenoma
and ovarian
cystadenocarcinoma

Areas of learning Knowledge Skills

Liver and Demonstrates understanding of Demonstrates appropriate
pancreatobiliary specimens obtained via: handling and reporting of liver
pathology • liver biopsy biopsies
(CiPs: 7, 9, 11) • resections for metastatic
tumour Able to describe, dissect and
• cholecystectomy report cholecystectomies, liver
resections and in later years
Demonstrates understanding of complex pancreatobiliary
commonly encountered resections specimens
neoplastic and non-neoplastic
disease processes, for Recognises normal liver on
example: needle biopsy
• chronic cholecystitis
• cholesterolosis Appropriate use of special
• steatosis stains and
• cirrhosis NOS immunohistochemistry
 • chronic hepatitis NOS
• metastatic carcinoma Identifies presence of cirrhosis,
• chronic pancreatitis and hepatitis or metastatic tumour in
pancreatic neoplasia needle biopsy

Areas of learning Knowledge Skills

Cardiovascular Demonstrates knowledge of Recognises inflammation in
pathology blood vessels, including temporal artery specimens
(CiPs: 7, 9, 11) temporal artery biopsy

Demonstrates knowledge of
temporal arteritis and atheroma

Areas of learning Knowledge Skills

Renal and Demonstrates understanding of Assesses deviation from normal
urological pathology specimens obtained for histology
(CiPs: 7, 9, 11) example via:
• renal biopsies Recognises the presence of
• bladder biopsies dysplasia and cancer in bladder
• nephrectomy specimens biopsies
• cystectomy specimens
Recognises glomerular changes
Demonstrates understanding of that might indicate
commonly encountered glomerulonephritis; e.g.
neoplastic and non-neoplastic hypercellularity, crescent
disease processes, for formation
example:
• bladder carcinoma Describes, dissects and reports
• renal cell carcinoma nephrectomy and bladder
• pyelonephritis resection specimens

Understands the value of

immunohistochemistry and
electron microscopy in the
diagnosis of glomerulonephritis

Areas of learning Knowledge Skills

Male genital tract Demonstrates understanding of Reports normal vas deferens
(CiPs: 7, 9, 11) specimens obtained via:
• prostate biopsies and Recognises presence of PIN
chippings and cancer in prostatic needle
• orchidectomy and if biopsies
available prostatectomy
specimens Describes, dissects and reports
orchidectomy specimens
Demonstrates understanding of
commonly encountered Recognises seminoma,
neoplastic and non-neoplastic embryonal carcinoma and other
disease processes, for testicular tumours
example:
 • prostatic
adenocarcinoma
• benign prostatic
hyperplasia
• testicular tumours such
as germ cell tumours

Areas of learning Knowledge Skills

Endocrine Demonstrates understanding of Recognises normal thyroid,
pathology specimens obtained for parathyroid and adrenal tissue
(CiPs: 7, 9, 11) example via:
• thyroidectomy Recognises goitre
• parathyroidectomy
• adrenalectomy Describes, dissects and reports
biopsy and excision specimens
Demonstrates understanding of from the thyroid, parathyroid,
commonly encountered and – in later years – adrenals
neoplastic and non-neoplastic and paragangliomas
disease processes including:
• benign and malignant
conditions of the thyroid,
parathyroid and adrenal
glands
• paragangliomas

Areas of learning Knowledge Skills

Soft tissue Demonstrates understanding of Recognises morphological
pathology the correlation of pathologic soft
features suggestive of main
(CiPs: 7, 9, 11) tissue lesions with their clinical
subtypes of tumours (i.e.
and radiological appearances lipomatous, fibromatous,
myomatous, neural, vascular
Demonstrates understanding of characteristics)
commonly encountered
neoplastic and non-neoplastic Recognises inflammatory
disease processes, for lesions and mimics
example:
• lipoma Recognises high-grade
• angiolipoma sarcoma
• neurofibroma
• dermatofibroma
• inflammatory pathology
• other benign,
hamartomatous,
indeterminate and
malignant soft tissue
lesions

Demonstrates knowledge of
immunohistochemical
techniques to apply
 Understands the value of
cytogenetics

Areas of learning Knowledge Skills

Neuropathology Demonstrates knowledge of Observes or performs a range
(CiPs: 3, 7, 9, 10, basic neuroanatomy and of examinations, and
11) histology and basic entities and documents activities with
disease processes affecting the reflective notes, including:
nervous system: • an indicative 10 fresh
• basic neuroanatomy and brain examinations with
histology demonstration of basic
• basic pathophysiology neuroanatomy as part of
(e.g. cellular reactions to general autopsy training
injury, cerebral oedema, • an indicative 2 fixed
raised intracranial brain examinations with
pressure and herniation, demonstration of basic
and hydrocephalus) neuroanatomy and
• trauma macroscopic
• cerebrovascular abnormalities, as
diseases appropriate
• infections • an indicative 2 post-
• human prion diseases mortem brain histology
(very basic knowledge cases following
with emphasis on health neuropathological
and safety examination and
considerations) representative sampling
• demyelinating diseases
• degenerative diseases Demonstrates observation of or
• genetic, toxic and participation in adult neuro-
acquired metabolic oncology multidisciplinary
diseases (basic meetings, the clinical
knowledge) neuroscience Grand Round or
• epilepsy and the equivalent clinical neuroscience
concept of sudden and encounter
unexpected death in
epilepsy (SUDEP)
• tumours (e.g. primary
versus metastatic,
paraneoplastic
syndromes, and familial
tumour syndromes)

Areas of learning Knowledge Skills

Paediatric and Demonstrates understanding of Recognises common
perinatal pathology common paediatrics tumours: inflammatory and neoplastic
(CiPs: 3, 7, 9, 10, • neuroblastoma conditions occurring in
11) • nephroblastoma childhood
• rhabdomyosarcoma
• acute lymphoblastic Description and processing of
leukaemia/lymphoma biopsy specimens
• Burkitt lymphoma
Demonstrates examination,
 • Hodgkin’s lymphoma description and sampling of
placentas
Demonstrates awareness of
special stains in paediatric Demonstrates examination,
pathology description and sampling of
other specimens only under
Understands value of direct consultant supervision
cytogenetics

Demonstrates awareness of
perinatal pathology including:
• normal development of
the placenta
• early pregnancy loss (1st
and early 2nd trimesters)
• syndromes associated
with common
aneuploidies (T13, T18,
T21, X0)
• common cardiac
malformations (septal
defects, truncus
arteriosus, tetralogy of
Fallot, coarctation of the
aorta and transposition
of the great arteries)
• observation/assistance
in at least 2 perinatal
post-mortem
examinations with
reflective notes
Autopsy Pathology
It is envisaged that trainees will perform an indicative minimum of 20 autopsies during each
year of training. ST1 trainees should begin to understand the level of certainty with which
macroscopic features can be interpreted at autopsy and when histological examination of
autopsy tissues is important. They should begin to recognise histological changes that occur
due to a post-mortem artefact.

This section of the syllabus incorporates the basic autopsy practice competencies that all
trainees will acquire. It will come from apprenticeship training, reading, formal tuition and the
practical experience from the indicative minimum 20 adult autopsies per annum and 2
paediatric/perinatal autopsies that all trainees will undertake until satisfactory completion of
ICP training.

Areas of learning Knowledge Skills

General Demonstrates understanding of Applies basic standard of
(CiPs: 1, 2, 3, 7, methods for identification of the practice in the techniques used
9, 10, 11) patient for identifying morphological
abnormalities at autopsy
Describes the pathological examination
basis of disease and the
macroscopic/microscopic Demonstrates manual dexterity
pathology of various types of sufficient to perform autopsies
death safely and to demonstrate the
Describes the anatomy, major abnormalities
macroscopic features of major
Operates with the APTs to
disease processes and
common tissue dissection maximise the autopsy learning
techniques relevant to autopsy opportunities
practice
Able to demonstrate findings to
clinicians and medical students,
Recognises the training
undertaken by anatomical with clear clinicopathological
pathology technologists (APTs) correlation
and the role that they can
appropriately play within all Demonstrates the ability to
aspects of the mortuary function interrogate the clinical and
(see www.aaptuk.org) laboratory records and
understand the utility and
Identifies the use of clinical limitations associated with
information and the health various types of investigation
record in autopsy examination including imaging, microbiology,
biochemistry and toxicology
Demonstrates knowledge of the
main side effects of common Identifies issues to be
treatments and the major addressed by the autopsy
complications of most surgical examination
procedures

Demonstrates awareness of the

principles and practice of digital
autopsies
Areas of learning Knowledge Skills
Autopsy technique Demonstrates knowledge of, Able to perform full evisceration
(CiPs: 2, 7, 9, 10, and the ability to perform, and dissection of the internal
11) autopsies in a variety of clinical organs
situations, such as:
• cardiac disease of Describes the appearances
uncertain cause accurately and succinctly
• endocrine/metabolic
death Interprets the findings in the
• hepatic disease of light of the clinical information
unknown cause available
• intra-abdominal disease
of unknown cause Summarises the findings to
• neurological disease of clinicians either immediately or
unknown cause later at a clinical meeting
• renal disease of
unknown cause
• respiratory disease of
unknown cause
Areas of learning Knowledge Skills
Deaths in the Describes and explains the Demonstrates the ability to
community aims of the autopsy and perform a full post-mortem
(CiPs: 2, 7, 9, 10, investigations required where examination and take relevant
11) death occurs in the community samples for histology if
and there are no suspicious appropriate consent is in place
circumstances
Areas of learning Knowledge Skills
Microbiology Identifies microbiological Demonstrates the ability to take
(CiPs: 3, 7, 9, 10, processes that are relevant to appropriate samples
11) autopsy practice; e.g. sepsis,
meningitis, pneumonia,
endocarditis, tuberculosis and
viral hepatitis

Areas of learning Knowledge Skills

Histology Describes the post-mortem Demonstrates the ability to
(CiPs: 3, 7, 9, 11) histological appearances of select appropriate tissue blocks
various common fatal conditions
Areas of learning Knowledge Skills
Other investigations Describes those areas of Demonstrates the ability to
(CiPs: 3, 7, 9, 11) haematology, biochemistry, select appropriate tissue/fluid
medical genetics and other samples
investigative modalities that are
relevant to autopsy practice
Areas of learning Knowledge Skills
Consent Is conversant with current policy Demonstrates understanding of
(CiPs: 1, 2, 3, 4, 7) in relation to consent for the principles and process of
autopsies and for tissue or obtaining consent for autopsies
organ retention and for further investigation of
tissue or whole organs
Is conversant with current policy
 in relation to tissue or organ
donation

Identifies the legal basis of

consent to autopsy examination
and the circumstances for which
consent is not required
Areas of learning Knowledge Skills
Health and safety Describes relevant protocols Demonstrates the ability to work
(CiPs: 1, 2, 3, 4, 7) and documentation of in the mortuary in a safe way
departmental working practices
and the practicalities of
mortuary practice

Describes and explains

regulatory aspects of health and
safety issues

Summarises the following

documents: Safe Working and
Prevention of Infection in the
Mortuary and Autopsy Suite
(Health Services Advisory
Commission) Guidelines on
Autopsy Practice
Areas of learning Knowledge Skills
Coroner’s/Procurat Demonstrates familiarity with Demonstrates a working
or Fiscal Service the duty to report deaths to the knowledge of the law of the
Regulations appropriate legal authority appropriate legal authority
(CiPs: 1, 2, 3) within the four countries of the within the four countries of the
UK UK relating to death, the
investigation of death and
Understand the preliminary disposal of the dead
enquiries that may take place
via the coroner or procurator
fiscal
Areas of learning Knowledge Skills
Autopsy report Demonstrates familiarity with Able to write a final gross and
(CiPs: 1, 2, 3) the RCPath Guidelines on microscopic report with suitable
Autopsy Practice and Best summaries, according to the
Practice Scenarios RCPath Guidelines on Autopsy
Practice

Includes the cause of death in

the Office of National Statistics
format

Areas of learning Knowledge Skills

Teaching Explains the value of the Demonstrates appropriate
(CiPs: 1, 2, 3, 6) autopsy as a teaching aid teaching skills
Areas of learning Knowledge Skills
Demonstration of Demonstrates awareness of the Demonstrates the
autopsy findings value of communicating communication skills required to
(CiPs: 3, 7, 10) relevant autopsy findings to inform clinical colleagues and
clinicians other non-clinical professionals
involved in inquiries into deaths
and assist in multidisciplinary
mortality review

Complex Post-mortem Examinations

These autopsies and special techniques are part of the higher autopsy training curriculum.
However, ICPT trainees may take the opportunity to observe or assist in these examinations
should the opportunity arise.

• Assessment of traumatic injury, e.g. after road traffic accident

• Methods of sampling for toxicology, e.g. in suicide, drug overdose
• HIV-, HCV- and tuberculosis-infected persons
• Maternal deaths
• Removal of eyes and dissection of middle ear
• Removal of spinal cord
• Post-mortem examination in haematological malignancy, including sampling of bone
marrow from iliac crests and femur
• Post-mortem examination of a decomposed body
• Post-mortem examination in a case of suspected drowning
• Post-mortems in patients dying after complex cardiothoracic surgery
• Assessment of the changes following complicated gastrointestinal surgery

Cytopathology
Cervical and non-cervical cytology will be part of the histopathology curriculum and
assessment processes for ICPT training. Subsequently, cervical cytology will be available as
an optional training package, equivalent to three months of training. Histopathology relating
to cervical screening and non-cervical cytology will continue to be part of the higher
histopathology training curriculum and assessment processes.

Cervical cytology
Areas of learning Knowledge Skills
General principles Applies rationale, methodology Demonstrates the ability to
and cancer and organisation of the CSP source information on the CSP
screening
programme (CSP) Demonstrates a basic Demonstrates understanding of
(CiPs: 1, 2, 3, 7, 9, understanding of the roles of the difficulties in producing rigid
11) component organisations, criteria for adequacy
failsafe
Identifies features to determine Ability to recognise inadequate
the adequacy of a cervical specimens
sample
Areas of learning Knowledge Skills
Technical aspects Demonstrates basic knowledge Demonstrates awareness of
(CiPs: 1, 2, 3, 7, 9, of automated screening devices sampling devices used and the
11) and HPV testing fixation of specimens
 Demonstrates awareness of the Demonstrates a basic knowledge
process involved in approving of the range of methods for
new technologies for use in converting a raw sample into a
cervical screening slide
Areas of learning Knowledge Skills
Normal and benign Identifies normal cellular Recognises typical morphological
changes components in cervical appearances of specific
(CiPs: 4, 7, 9, 11) specimens organisms commonly seen in
cervical specimens; e.g.
Identifies features of infections trichomonas, candida, herpes
in cervical samples simplex, HPV, actinomyces
Areas of learning Knowledge Skills
Borderline nuclear Demonstrates understanding of Recognises the morphological
changes (BNC) criteria for diagnosis of BNC features of BNC
(CiPs: 4, 7, 9, 11)
Areas of learning Knowledge Skills
Dyskaryosis Demonstrates understanding of Recognises typical examples of
(CiPs: 4, 7, 9, 11) criteria for diagnosis and mild, moderate and severe
grading of squamous and squamous dyskaryosis and
glandular dyskaryosis endocervical cellular
abnormalities
Areas of learning Knowledge Skills
Quality assurance Demonstrates awareness of QA Recognises QA procedures
(QA) including internal quality control involved in cervical screening,
(CiPs: 1, 2, 4, 8) (IQC), external quality including internal quality control
assurance (EQA) and audit (IQC), external quality assurance
(EQA) and audit

Recognises current national

quality standards and indicators

Non-cervical cytology
Areas of learning Knowledge Skills
Technical aspects Demonstrates knowledge of Recognises faults and artefacts
(CiPs: 7, 9, 11) preparation and staining of preparation; e.g. air-drying
techniques for common
specimen types Describes panels of antibodies
for particular diagnostic
Demonstrates knowledge of use applications; e.g. mesothelioma
of special techniques; e.g.
immunocytochemistry
Areas of learning Knowledge Skills
Morphology Demonstrates knowledge of cell Recognises normal cell
(CiPs: 7, 9, 11) components populations

Demonstrates knowledge of Recognises the differences in cell

various stains used in air-dried morphology in air-dried and fixed
 and fixed preparations preparations

Identifies the nuclear features Demonstrates the ability to

used to diagnose malignancy diagnose malignancy with
confidence in specimens from
Identifies features of breast, gastrointestinal tract,
malignancy in sites commonly respiratory tract, urinary tract,
investigated with cytopathology head and neck, lymphoreticular
system, serous fluids and thyroid
Identifies features of specific
non-malignant diagnoses; e.g. Demonstrates the ability to
infection integrate clinical information and
histology or other investigations
into diagnosis

Demonstrates the ability to

recognise when definitive
diagnosis is beyond capability
Areas of learning Knowledge Skills
Report writing Identifies requirements for a Demonstrates the ability to write
(CiPs: 1, 2, 3, 4, 10) report an accurate report that gives
clinicians the information they
Demonstrates ability to recall need
relevant datasets

Identifies nationally recognised

coding systems

Demonstrates knowledge of the

likely outcome in terms of
further investigation or
management of the patient

Molecular Pathology
This section lists the required basic knowledge in molecular methods and their applications,
both potential and actual, within histopathology. The section is focussed on DNA- and RNA-
based techniques.

Areas of learning Knowledge Skills

Fundamentals of Identifies the origins and Demonstrates the origins of and
molecular biology consequences of germline justifications for molecular tests
(CiPs: 7, 9, 11) variation and somatic
mutations, including DNA
methylation and gene
expression changes
Areas of learning Knowledge Skills
Fundamentals of Identifies the structure of genes Recognises the factors affecting
genetics including translation and transcription and translation
(CiPs: 7, 9, 11) transcription, factors affecting
gene expression and
inheritance patterns
Areas of learning Knowledge Skills
Molecular Identifies molecular techniques Demonstrates awareness of
techniques principles, practical knowledge of
(CiPs: 7, 9, 11) sequencing, PCR, microarrays
(DNA and RNA), in situ
hybridisation and mutation
detection
Areas of learning Knowledge Skills
Molecular tests Describes molecular tests Interprets the common molecular
(CiPs: 7, 9, 11) currently performed on tests
histological samples

II. Histopathology Higher Specialty Training Syllabus

Following completion of the ICP training, trainees will continue to consolidate their
knowledge and skills within the relevant areas of learning, mapped out in the syllabus
for ICPT. They will be expected to take increased responsibility for specimen types and
techniques included in the ICPT syllabus including independent reporting of cases. In
addition, they will get an opportunity to develop their skills in histopathology as below. This
period of higher specialist training in histopathology will typically be in years 3–5 of training.
This is a competency-based curriculum and as such there are no absolute minimum
numbers. However, it is anticipated that most trainees will achieve the competencies
required with the indicative minimum practical experience detailed below (per WTE training
year):

Year 3
Surgical histopathology – 1000 cases
Cytopathology – 300 non-cervical cytology cases, which may either be new cases or be
seen in the context of teaching sets with appropriate structured feedback from an
experienced trainer.

Year 4
Surgical histopathology – 1000 cases
Cytopathology – 300 non-cervical cytology cases, the majority of (approximately 70%)
should be new diagnostic cases.

Year 5
Surgical histopathology – 1500 cases (dependent on specialist interest), most of which in the
latter half of the year should be independently reported.
Cytopathology – 300 non-cervical cytology cases, the majority of (approximately 80%)
should be new diagnostic cases.

Areas of learning Knowledge Skills

General Demonstrates sufficient general Demonstrates the ability to solve
(CiPs: 1, 2, 3, 4, 5, clinical knowledge including complex clinical (and research,
7, 8, 9, 11) major changes in trends of when applicable) problems by
diagnosis and treatment applying sound knowledge of
basic principles without the
Demonstrates sufficient requirement always to rely on
knowledge of normal anatomy, ‘pattern matching’
physiology and pathophysiology
 Demonstrates the knowledge
contained in and be able to
operate within the tissue
pathways and datasets
documents produced by
RCPath and any updates of
these documents
Areas of learning Knowledge Skills
Specimen Explain the principles of Demonstrates sufficient manual
dissection specimen dissection, dexterity to perform dissection
(CiPs: 1, 7, 9, 11) macroscopic description and safely, accurately and
block selection in neoplastic independently, without damage to
and non-neoplastic disease tissues

Explain and describe the

principles of dissection of all
major cancer resection
specimens and tissue sampling
to enable completion of
RCPath’s Standards and
Datasets for Reporting Cancers
Areas of learning Knowledge Skills
Special interests Develops a special interest in Uses RCPath’s Standards and
(CiPs: 1, 5, 7, 9, 11) one or more diseases or organ Datasets for Reporting Cancers
systems and Tissue Pathways for
reporting most cases

Molecular Pathology
This section describes the required practical knowledge and application of molecular biology.
While many of these competences could be achieved by spending time attached to a
specialist molecular biology laboratory, it is not essential that trainees do so. It is anticipated
that for most trainees much of their experience in molecular pathology will be integrated with
relevant specialist histopathology training.

Areas of learning Knowledge Skills

General Describes the origins and Demonstrates the origins of and
(CiPs: 7, 9, 11) consequences of germline justifications for molecular tests
variation and somatic
mutations, including DNA
methylation and gene
expression changes
Areas of learning Knowledge Skills
Fundamentals of Demonstrates ability to recall Summarises the use of data and
databases and the basic molecular identify relevant data from public
bioinformatics databases sources
(CiPs: 7, 9, 11)
Areas of learning Knowledge Skills
Use of histology Describes how histological Demonstrates practical
samples samples are taken and understanding of undertaking the
(CiPs: 7, 9, 11) prepared, and how nucleic appropriate sample collection,
acids are extracted from them retrieval and preparation for the
common molecular tests, whether
performed on extracted nucleic
acid or in situ
Areas of learning Knowledge Skills
Technology Outlines the principles and Demonstrates practical
(CiPs: 7, 9, 11) limitations of the most up-to- knowledge of sequencing, PCR,
date molecular methods microarrays (DNA and RNA), in
situ hybridisation, mutation
detection
Areas of learning Knowledge Skills
Molecular tests Describes molecular tests Demonstrates the demand for
(CiPs: 7, 9, 11) currently performed on molecular tests and the modes of
histological samples, including supply
the limitations of these tests
and of tests that are Describes and explains common
anticipated in the near future molecular tests including some of
the common pitfalls and how to
avoid them

Illustrates the significance of

common molecular tests