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Role standards

Laboratory

Pathologists' assistant

What a newly certified pathologists' assistant must do safely under a pathologist's direction: examine and sample surgical and autopsy specimens so the diagnosis can be made on the right tissue from the right patient, describe what they did truthfully, and bring anything unexpected to the pathologist the same day. Drawn from the NAACLS curriculum requirements for pathologists' assistant programmes and the AAPA scope of practice.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
6
Sources
3
Version
1

Built from National Accrediting Agency for Clinical Laboratory Sciences, American Association of Pathologists' Assistants, US Government Publishing Office, Electronic Code of Federal Regulations. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent pathologists' assistant does on day one, dimension by dimension.

Clinical skills

  • Orients, measures, inks, dissects and samples a specimen so that every feature the pathologist must report, including margins, depth and lymph nodes, can be assessed on the slides.
  • Handles and fixes tissue so that every study the diagnosis may need is still possible, including fresh tissue for ancillary tests.

Workflow and tools

  • Writes a gross description that records what was received, what was found and exactly what was done and submitted, accurately enough that the pathologist and any later reviewer can reconstruct the specimen.
  • Maintains the checks that keep grossing reliable: cassette reconciliation, fixation logs, reagent checks and bench cleanliness.

Patient communication

  • Brings an unexpected or time-critical finding to the pathologist the same day, directly, and confirms it has been received and acted on.
  • Writes clinical summaries, notes to the pathologist and messages to clinical teams that are factual, specific and useful to the reader.

Compliance and safety

  • Confirms that container, requisition and accession match on at least two identifiers and on site and laterality before opening, works one case at a time, and holds any mismatch until the submitting service resolves it.
  • Works with formalin, xylene, infectious tissue and prion risk under the controls each requires, and responds to spills and exposures by procedure.

Role knowledge

  • Works under the direction of a pathologist, leaves diagnosis to the pathologist, and does not begin or extend an autopsy beyond what is legally authorised.
  • Teaches residents, students and technicians to gross safely and accurately, and keeps the patient's specimen protected while doing it.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Cuts into a resection specimen before establishing orientation and inking the margins, or samples so that the relationship of the tumour to its closest margin cannot be assessed.

    Margin status decides whether a patient has more surgery or radiation; once the specimen is cut without orientation and ink, that answer is lost for good.

  • Grosses a specimen whose container, requisition or accession do not match on identifiers, site or laterality, or corrects the label themselves, instead of holding it for the submitting service to resolve; or works with more than one patient's specimen open at the bench at once.

    A mislabelled or swapped specimen gives one patient another's diagnosis, and can lead to surgery or chemotherapy on the wrong person or the wrong side.

  • Records measurements, margin distances or sections they did not take, lets a template's pre-filled text stand for what was actually done, or alters a gross description after sign-out without a dated addendum.

    The pathologist reports margins and staging from the description; a false one produces a false report, and altering a signed record is misconduct.

  • Leaves a finding that needs same-day action - such as no chorionic villi in products of conception, a specimen that does not match the operation, or an unexpected mass - to routine slide review, or records it only in the gross description, instead of telling the pathologist directly now.

    Absent villi can mean an ectopic pregnancy that may rupture, and a mismatched specimen can mean the intended tissue is still in the patient; delay is the harm.

  • Gives a surgeon or clinician a diagnosis or final margin status on their own authority, including during a frozen section.

    Surgery is decided on what the surgeon is told; a diagnosis from someone not qualified to make it can lead to an unnecessary or inadequate operation.

  • Begins or extends an autopsy beyond the consent's restrictions, without valid authorisation from the legal next of kin, or on a death that falls under the medical examiner's jurisdiction and has not been released.

    An unauthorised examination is unlawful and a grave harm to the family, and a hospital autopsy on a medicolegal death can destroy evidence the medical examiner needs.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not render a diagnosis, interpret a frozen section, or sign out a case.Prepares the specimen and sections, describes what they see, and brings the pathologist in for every interpretation and communication of a diagnosis.
  • Does not begin an autopsy without verified authorisation, or examine beyond its stated restrictions.Confirms the consent, the authorising person and any restrictions with the pathologist before starting, and stops to consult when something is unclear.
  • Does not perform a hospital autopsy on a death within medical examiner or coroner jurisdiction unless the case has been declined or released.Raises the concern with the pathologist so the death is reported, and performs medicolegal work only under the direction of the forensic pathologist.
  • Does not work outside the direction and supervision of a pathologist.Practises under a licensed anatomic pathologist, as the AAPA scope of practice defines, and brings any case beyond their training to that pathologist.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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