The first three years of the training program are focused on core training in anatomic pathology (AP) and clinical pathology (CP). The curriculum is organized to intermingle AP and CP core rotations within each of the first three years of training. This facilitates early recognition of special interests, which the resident may wish to pursue in greater depth during the fourth year of residency or in a post-residency fellowship.

The fourth year of the Program permits the trainee great flexibility. The year includes six months of elective rotations in anatomic pathology, clinical pathology or basic research, so that the trainee can concentrate on his or her particular interests. Overall, there are nine months of elective rotations interspersed within the four-year training program.

Cytopathology

Goals and Objectives: In Cytopathology, the resident will gain basic knowledge and skills in the collection, processing, and interpretation of cytologic material, both gynecologic and non-gynecologic. The resident will also acquire skills and experience in fine needle aspiration.

Duration: 1 month in the second year, 2 months in the third year, and 1 month in the fourth year.

Faculty: Drs. Budwit, Livasy, Maygarden, Singh and Volmar; Cytopathology fellow.

Forensic Pathology (Medical Examiner's Service)

Goals and Objectives: The resident will gain familiarity with the operation of a medicolegal death investigation system and the vital role that pathologists play in such operations. By assisting in and performing forensic autopsies, the resident will learn how to perform forensic autopsies. The resident will also gain insight into alternate methods of dissection and be exposed to dissection procedures more akin to those encountered in the private practice of pathology. The resident will also accompany staff pathologists to court and observe expert witness testimony to better understand the role of the physician as expert witness.

Duration: 1 month in the third year.

Faculty: Drs. Butts, Clark, Gaffney-Kraft, Gardner, and Radisch; Forensic Pathology fellow.

Hematopathology

Goals and Objectives: The goals of the core rotation in the hematology and coagulation laboratory are as follows: (1) Develop proficiency in normal and abnormal peripheral blood cell morphology; (2) Develop intermediate level proficiency in bone marrow and lymph node morphology; (3) Gain familiarity with procedures, principles, and quality assurance in analytical hematology; (4) Gain exposure to urinalysis and body fluid examination; (5) Gain experience in clinical consultation, primarily through clinical case presentations and slide reviews with the medical staff; and (6) Develop an approach to clinical and laboratory evaluation of patients with disorders of thrombosis or hemostasis.

Duration: 2 months in the first year and 1 month in the third year.

Faculty: Drs. Dent, Dunphy, Smith, and Whinna; Hematopathology fellow.

Microbiology/Immunology

Goals and Objectives: The purpose of the 3-month rotation for second year residents is to enable the resident to gain the scientific information, laboratory bench and management skills, and knowledge of resources necessary to understand the operation and management of a clinical microbiology/immunology laboratory. The specific objectives of the rotation are as follows: (1) Familiarize the resident with the performance of, and rationale for, accepted technical procedures; (2) Develop the resident's skill in clinical consultations and interpretation of laboratory data for patient care; and (3) Provide experience with relevant management skills, such as cost accounting, budget preparation, personnel relations, quality control, and planning of laboratory services.

Duration: 1 month in the first year and 2 months in the second year.

Faculty: Drs. Gilligan, Miller and Schmitz; Immunology/Microbiology fellows.

Molecular Diagnostics and Cytogenetics

Goals and Objectives: The goal of the month-long Molecular Diagnostics/Cytogenetics Course is to instill expertise in molecular diagnostics and cytogenetics so that trainees become competent clinical consultants on the use of genetic technology in a wide variety of clinical settings. Trainees develop technical, clinical, communication, management, and judgment skills. A fundamental understanding of genetic technologies prepares them to comprehend the medical literature now and as new probe hybridization procedures are introduced in future years. Training is provided in a structured environment via didactic seminars; experience with laboratory procedures; preparing clinical cases for sign out under the supervision of expert faculty; interaction with clinicians, counselors, and laboratory scientists; and research on a topic of their choosing. Specific Objectives of the rotation are as follows: (1) Gain a working knowledge of molecular technology including Southern blot, in situ hybridization, polymerase chain reaction, arrays, protein truncation test, and sequencing; (2) Learn about clinical applications in patients with cancer, inherited disease, and infectious disease, and learn about applications in HLA typing, parentage, and forensics; (3) Gain a working knowledge of cytogenetics such as terminology, karyotypes, and FISH; (4) Learn how to design and carry out validation studies aimed at bringing new analytic tests into the clinical laboratory; (5) Interpret molecular and cytogenetic data from clinical cases and compose diagnostic reports, in correlation with clinical, morphologic, and immunophenotypic findings; and (6) Discuss quality assurance, ethics, and lab administration related to molecular technology.

Duration: 1 month in third year.

Faculty: Drs. Bagnell, Banks, Basinger, Billings, Booker, Callanan, Coleman, Dunphy, Evans, Farber, Fiscus, Friedman, Funkhouser, Gilligan, Gulley, Johnson, Kaiser-Rogers, Keelean-Fuller, Miller, Orton, Perou, Petch, Powell, Rao, Schmitz, Shaheen, Thorne, and Weck; molecular path fellows, technologists, and others.

Surgical Pathology

Goals and Objectives: In Surgical Pathology the resident will learn the basic techniques of gross and microscopic interpretation of tissue specimens. In addition to classical light microscopy, the resident will have the opportunity to learn a variety of modern diagnostic techniques, including electron microscopy, immunohistochemistry, flow cytometry, and molecular diagnostics. In addition to developing diagnostic skills, the resident will learn to make clinicopathological correlations, develop consultative skills with medical colleagues, and to generate a useful and informative surgical pathology report.

Duration: 3 months in first year, 5 months in the second year, 4 months in the third year, and 3 months in the fourth year.

Faculty: Drs. Bouldin, Budwit, Funkhouser, Groben, Jennette, Lininger, Livasy, Malouf, Maygarden, Miller, Rubinas, Singh, Smith, Thorne, Volmar, Weinstein, and Woosley; Fellows in Surgical Pathology.

Transfusion Medicine

Goals and Objectives: The goals and objectives of the transfusion medicine rotation are as follows: (1) Master the fundamental concepts, procedures, and protocols in immunohematology; (2) Learn the organizational aspects of a hospital-based transfusion service; (3) Obtain a working knowledge of the laboratory's procedures and policies; (4) Display sound clinical and technical judgment; and (5) Develop self confidence and effective communication skills with all health-care personnel.

Duration: 3 months during the first year.

Faculty: Drs. Afenyi-Annan, Bandarenko and Brecher; Transfusion Medicine fellow and supervisors.

Gastrointestinal Pathology

Goals and Objectives: The GI pathology elective offers the opportunity to increase diagnostic skills in GI pathology. Depending on individual interests, the resident can prepare a case report, case series, or other brief report related to GI pathology.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will study slides from the teaching file and assist in developing teaching material from the surgical pathology archives. The resident will attend the signout of GI biopsies and excisions, and attend weekly GI conferences.

Faculty: Drs. Rubinas and Woosley.

Muscle And Nerve Pathology

Goals and Objectives: This elective offers an introduction to the pathobiology of muscle and nerve diseases. A common unit is proposed for both tissues, since many pathological processes involve both organs in a cause and effect relationship. Special emphasis will be placed on the interpretation of biopsy material in order to understand the diseases of muscle and nerve. A multidisciplinary approach will be offered, which includes light and ultrastructural microscopy and the interpretation of special laboratory procedures used in diagnosis of muscle and nerve diseases.

Duration: 1-3 months.

Resident Duties and Responsibilities: The resident will be responsible for working-up the muscle and nerve biopsies. The resident will learn to interpret lab results in view of the patient's illness, as well as gain familiarity with the many procedures involved in the preservation of enzymatic activities, ultrastructural anatomy, and biochemical integrity of tissues. The resident will also be responsible for attending the muscle and nerve biopsy conferences held in conjunction with the Department of Neurology.

Faculty: Drs. Malouf and Thorne (muscle); Dr. Bouldin (nerve).

Neuropathology

Goals and Objectives: The neuropathology elective offers the opportunity to acquire more in-depth training in one or more selected areas of neuropathology, to review gross and microscopic neuropathology of common CNS diseases, and to become acquainted with the role of the neuropathologist in the work-up of neurologic diseases.

Duration: 1-3 month.

Resident Duties and Responsibilities: The resident will review teaching sets to acquire further diagnostic skills. He or she will also participate in evaluation of frozen sections, surgical specimens, autopsy service specimens, and the work-up of Medical Examiner consultations in forensic neuropathology.

Faculty: Drs. Miller and Bouldin.

Ophthalmic Pathology

Goals and Objectives: The goals of the ophthalmic pathology elective are to acquire a basic understanding of the pathology of diseases of the eye commonly presented to the pathologist, to become acquainted with the gross and microscopic findings of common ocular diseases, and to become acquainted with the role of the pathologist in evaluating ophthalmic pathology specimens.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will attend ophthalmic pathology gross and microscopic sessions with Dr. Bouldin. Additionally, the resident will study slides in the ophthalmic pathology study set, take responsibility for adding current interesting cases to the study set, and do reading in the area of ophthalmic pathology.

Faculty: Drs. Wright and Bouldin.

Oral Pathology

Goals and Objectives: The goals of the oral pathology elective are to familiarize the resident with pathology peculiar to the oral and perioral regions, including odontogenic, salivary, and jaw lesions.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will become familiar with, and participate in, the examination and preparation of gross oral specimens, as well as gain experience in microscopic diagnosis.

Faculty: Drs. Curran, Murrah, and Padilla.

Pediatric Pathology

Goals and Objectives: This elective offers a more intensive exposure and perspective into the pathology of diseases of childhood.

Duration: 6-12 months.

Resident Duties and Responsibilities: The resident can rotate through various labs involved in pediatric pathologic diagnosis, including cytogenetics, molecular pathology, autopsy service (concentrating on pediatric materials), and surgical pathology. Interested residents will be able to identify interesting cases through these various rotations and present the pathologic findings to clinicians in the form of a weekly conference.

Faculty: Drs. Malouf, Smith, and faculty of various subspecialties.

Renal Pathology

Goals and Objectives: The resident has the opportunity to develop a general knowledge of diagnostic renal biopsy pathology.

Duration: 1 month or more.

Resident Duties and Responsibilities: The resident will examine renal biopsy case material (teaching cases, filed cases, and/or active cases) including light, immunofluorescence, and electron microscopy data. The resident will attend renal biopsy review conferences.

Faculty: Drs. Jennette, Nickeleit and Singh.

Other Electives in Anatomic Pathology

In addition to the anatomic-pathology electives listed above, residents can arrange to spend additional time in any of the core areas, such as Surgical Pathology, Cytopathology, and Forensic Pathology. Special opportunities are also available to study applications of recombinant DNA technology, as well as to participate in a wide variety of research projects.

Blood Gas/Clinical Care And Pediatric Metabolic Screening

Goals and Objectives: A major goal of this elective is to provide residents with sufficient practical lab experience and responsibility to enable them to serve effectively as acting director of those areas; enable them to actively participate on a daily basis as a consultant to attending/housestaff as well as to direct lab operations. The resident will interact daily with other areas of pathology and other medical center departments regarding patient care. The resident will also develop skills in evaluating efficacy of lab methodology.

Duration: 1-2 months.

Resident Duties and Responsibilities: Includes evaluation of critical patient data, interpretation of data, follow-up consultation, physician-patient related laboratory concerns, and quality assurance monitoring. The resident will help evaluate new procedures and develop specific protocols for such evaluations. By playing an active role in lab management, the resident will gain valuable insights into lab direction and operation, including budgetary and personnel matters.

Faculty: Clinical Chemistry Faculty.

Clinical Chemistry

Goals and Objectives: The goals of the advanced elective Clinical Chemistry are to provide an opportunity for in-depth assumption of clinical responsibility or research in a particular area.

Duration: 1-6 months.

Resident Duties and Responsibilities: Resident duties and responsibilities are to actively participate with faculty in assuming responsibility for an area, or in undertaking and completing a research project.

Faculty: Drs. Chapman and Hammett-Stabler.

Coagulation

Goals and Objectives: This advanced elective in coagulation offers an opportunity for increased responsibility in the administration and supervision of the core and/or special coagulation laboratories. Residents will also gain additional in-depth experience with the Division of Hematology Clinical Coagulation Consult team.

Duration: 1 month.

Resident Duties and Responsibilities: The trainee will build on the fund of knowledge gained in the core rotation and assume greater responsibility in the laboratory regarding clinical, technical, and administrative issues in the core and/or special coagulation laboratories. The trainee will be the initial contact for any questions from the clinicians or technologists in the area of coagulation. The trainee will be expected to develop a plan of action and then present the consult issues and plan to the laboratory director for discussion and approval.

Faculty: Dr. Whinna.

Flow Cytometry

Goals and Objectives: To provide an opportunity for the residents to expand their knowledge and experience in flow cytometry by working on a special project. The project will consist of either a research project or development of a new procedure. The project also may involve evaluation of a new monoclonal antibody and include clinical correlations.

Duration: 3 months (negotiable).

Resident Duties and Responsibilities: (1) Collection of appropriate clinical material; (2) Flow cytometric analysis; (3) Evaluation of clinical usefulness or appropriateness of the project; and (4) Write-up of procedure and/or manuscript.

Faculty: Dr. Schmitz.

Hematology

Goals and Objectives: This advanced elective may be tailored to meet a specific goal, including any of the following: (1) Proficiency in normal and abnormal bone marrow and lymph node morphology; (2) Advanced experience in analytical hematology; (3) Clinical research in hematology; and (4) In-depth exposure to molecular diagnostics in hematological malignancies.

Duration: 1-6 months.

Resident Duties and Responsibilities: Duties and responsibilities will be arranged with Dr. Dunphy in accordance with the resident's specific goals. Responsibilities will usually include signing out bone marrows and consultation on the hematopathology diagnostic service.

Faculty: Drs. Dent, Dunphy and Smith.

Microbiology

Goals and Objectives: This advanced elective provides an opportunity to become familiar with a variety of molecular diagnostic techniques as they relate to clinical microbiology and infectious disease. The focus is primarily on PCR-related techniques for detecting bacteria, fungi, and viruses in clinical specimens.

Duration: 3 months (negotiable).

Resident Duties and Responsibilities: (1) Develop a PCR method for a selected organism using known primer sequences; and (2) Optimize laboratory conditions and initiate studies on clinical specimens.

Faculty: Drs. Gilligan, Miller and Schmitz.

Molecular Pathology

Goals and Objectives: To prepare our trainees to become creative leaders of anatomic and clinical pathology laboratories through acquisition of knowledge, accumulation of laboratory skills, and formulation of experimental approaches to problem solving in a modern molecular laboratory setting. Learning revolves around analytic and clinical validation of new molecular diagnostic tests and around practical experience with existing molecular tests for inherited diseases, cancer and microbial agents as well as identity testing. Research opportunities are provided.

Duration: 1 or more consecutive months.

Resident Duties and Responsibilities: The resident will participate in molecular diagnostic testing, in interpretation of results, and in preparing cases for sign-out. An opportunity is provided to actively participate in research and development of new molecular diagnostic tests.

Faculty: Drs. Booker, Funkhouser, Farber, Gulley, Thorne and Weck.

Pathology Informatics

Goals and Objectives: The elective covers the following topics: (1) How to purchase a laboratory information system; (2) The management of a laboratory information system; (3) Principles of database searching; and (4) An introduction to communications, i.e., instruments, terminals, printers, and networks.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will write a request for bids (RFB) for a laboratory information system (LIS). He or she will also review with the Supervisor and Director of Laboratory Computer Services all requests for new database searches, and using the LIS software, will create database searches to provide clinical, research, or quality assurance information. Additionally, the resident will be required to solve an information management problem, such as acquiring data from a laboratory instrument with a personal computer and analyzing this data with a spreadsheet or database program.

Faculty: Laboratory Medicine Faculty.

Toxicology

Goals and Objectives: This elective provides the resident with hands-on experience in an analytical toxicology project and experience in serving as a toxicology laboratory consultant in cases of suspected poisoning. Upon completion of the rotation, the resident will be familiar and proficient with the technique(s) used in the project, and will be competent and confident in handling toxicology consultations.

Duration: 2 months.

Resident Duties and Responsibilities: The resident will be on-site throughout the elective. Time spent on the project will be balanced with being available 24 hours per day on a weekly rotational basis with the Toxicology director to handle Toxicology calls. Written consultations will be provided and reviewed, and a written project report will be prepared.

Faculty: Dr. Hammett-Stabler.

Transfusion Medicine

Goals and Objectives: The advanced elective in transfusion medicine offers an opportunity for increased responsibility in the administration and supervision of the laboratory. Residents will also gain more in-depth experience with the apheresis department.

Duration: 1-3 months.

Resident Duties and Responsibilities: The resident will utilize the fund of knowledge gained in the first-year rotation, and assume greater responsibility in the laboratory regarding clinical, technical, and administrative issues in both the main laboratory and the apheresis unit.

Faculty: Drs. Afenyi-Annan, Bandarenko, Brecher and associates.

Other Electives in Clinical Pathology

In addition to the clinical-pathology electives listed above, residents can arrange to spend additional time in any of the core areas of clinical pathology. Special opportunities are also available to study applications of recombinant DNA technology, as well as to participate in a wide variety of research opportunities.