Department of Pathology

RESIDENCY PROGRAM OVERVIEW

The combined anatomic pathology/clinical pathology (AP/CP) "core" curriculum consists of 108 weeks of AP, 76 weeks of CP, and 24 weeks of additional AP/CP electives.

The department handles a large volume of surgical specimens, with approximately 70,000 accessioned per year. Because of the specialized nature of the cancer center and high volume of specimens, the department utilizes subspecialty sign out; residents are exposed to a wide variety of common and rare specimens. Glass slide exposure is emphasized during the surgical pathology rotations, which is supplemented by selected grossing of complex specimens. The residents rotate on a five day cycle within their 4-week AP subspecialty (two days of biopsies signout and "regs" previewing, two days of "regs" signout and grossing of one specimen, and one day of all-day grossing). Specimens are assigned based on level of experience and increasing degrees of difficulty, and there is an experienced group of pathology assistants and technicians available for answering questions and teaching. Computer workstations with guidelines and dictation templates are available for all standard specimens at each of the grossing stations. Medical related autopsies are performed on site at our Regional Autopsy Center in addition to a one month rotation at the Franklin County Medical Examiner’s Office during third year for exposure to forensic pathology. Residents also rotate through the busy cytopathology division where there is an opportunity to perform fine-needle aspiration procedures on patients. A teaching collection of glass slides with examples of classic and rare entities are available for the residents. There are also numerous digital slides and study sets available from the personal collections of various faculty members, as well as a growing in-house collection of cases scanned at our new Digital Pathology Scan Center.

During the clinical pathology rotations, residents are exposed to various laboratory testing methods, laboratory management techniques, and many other aspects of clinical pathology. Dedicated clinical pathology rotations include chemistry/toxicology, microbiology, cytogenetics, molecular pathology, transfusion medicine/apheresis, flow cytometry, coagulation and hematopathology. During these rotations, time is split between experience in the laboratory, one-on-one didactic sessions, clinical conferences, departmental meetings and self-directed reading and learning modules. The hematopathology rotation offers the opportunity for residents to get comfortable with a variety of fluid specimens, along with working up complex tissue and bone marrow cases and reviewing consultation cases from outside institutions. During the transfusion medicine rotation, residents serve as a focal point for triaging clinical questions and issues that arise in the blood bank, and are also given the opportunity to participate in the management of patients on the apheresis unit. Additionally, blood donor experience is provided at the American Red Cross Central Ohio Blood Service, located in Columbus.

Conferences are held from 8:00-9:00 AM daily, with an average of two anatomic pathology conferences and two clinical pathology conferences per week, with an unknowns or informatics conference held on Fridays. The conferences include didactic sessions, unknown slide conferences and journal clubs. Also, there is a dedicated biannual informatics lecture series. Interdisciplinary conferences are held in various disciplines throughout the week in the areas of dermatopathology, gynecologic pathology, bone and soft tissue pathology, head & neck pathology, gastrointestinal and hepatobiliary pathology, breast pathology, medical kidney and transplant pathology, hematopathology, and neuropathology. Additionally a general interesting case conference is held biweekly for faculty and residents to share interesting cases with the department from their sub-specialties.

For all first year residents (PGY-1), a 4-week introductory block provides a review of basic histology using glass and virtual slides, as well as instruction on the basics of grossing specimens from different organ systems, performing frozen sections and autopsies, and familiarizing themselves with different information systems that will be used throughout their residency. The remainder of the year, the PGY1 residents rotate for 36 weeks in surgical pathology (including 4 weeks of Cytopathology) and 12 weeks in the autopsy rotation. Surgical pathology consists of rotations in subspecialty areas including GI, GU, Breast, Gyn, Bone and Soft Tissue/Thoracic, and Head & Neck.

The PGY-2 year residents rotate through clinical pathology, on hematopathology/lymph nodes (14 weeks), transfusion medicine (8 weeks), clinical chemistry (4 weeks), medical microbiology (8 weeks), molecular pathology (4 weeks), cytogenetics (4 weeks), flow cytometry (2 weeks), and AP/CP electives (8 weeks). During this time the residents are given individual instruction and introduced, via graded responsibility to sign out and management duties on each clinical service. A regular two year cycle of didactic lectures covering all the major topic areas in CP is conducted weekly, as well as a weekly unknown case conference, a CP journal club, and a review of on-call cases. There is also a regular two year cycle of Business and Laboratory Management lectures covering legal, economic, ethical and social issues related to laboratory management.

Anatomic pathology rotations include a gross room rotation (4 weeks), cytopathology block (8 weeks with the option of rotating an additional 4 week block or an AP elective), dermatopathology (8 weeks), forensic pathology at the Franklin County Coroner's Office (2 weeks), neuropathology (4 weeks), renals/transplant pathology (4 weeks), pediatric anatomic pathology at The Nationwide Children's Hospital (4 weeks), and AP subspecialty (4 weeks). Rotations on clinical pathology include the completion of higher-level structured rotations in hematopathology/lymph nodes (8 weeks), benign hematology (2 weeks), transfusion medicine (8 weeks), pediatric clinical pathology at The Nationwide Children's Hospital (4 weeks), chemistry/toxicology (4 weeks), chemistry (4 weeks), medical microbiology (2 weeks), flow cytometry (2 weeks) and AP/CP electives (12 weeks), which can be used to revisit any rotation, or complete special projects and research.

PGY-1 residents are assigned to the Autopsy service for Saturdays and holidays. Autopsies are not performed on Sundays, Christmas Day, Thanksgiving Day, and New Years Day. Monday through Friday the resident on autopsy service is located in the autopsy area and covers autopsies. For Saturday and holiday assignments, the resident on call must be available for any case that is ready for autopsy by 1:00 pm. An attending pathologist will be available to provide direct supervision or indirect supervision with direct supervision immediately available for the duration of the resident's presence on site.

PGY-2 through PGY-4 residents take AP/CP weekday and weekend call. During the weekdays, the resident begins call at 5:00 pm and ends at 7:00 am the following morning. The call may consist of clinical pathology questions, frozen sections, acute leukemia, transplant biopsy support, renal biopsies, among others. The resident is on weekday call approximately 2-3 times per month and weekend call approximately one weekend every six weeks. At the end of their training the residents will have gained a tremendous amount of experience in dealing with many of the routine and challenging clinical pathology questions from clinicians as well as a breadth of experience in frozen section consultations. Residents are always assigned with a faculty member while on call.

Evaluations of residents performance are carried out at the end of each rotation and are based on the competency standards set by the ACGME. Evaluations are performed by the faculty and staff, and are reviewed with the resident by the Program Director or Associate Program Director for AP and CP semi-annually. In addition to the faculty evaluation, residents' performance and progress is also objectively evaluated at the end of major rotations. A well-defined set of criteria for remediation, disciplinary action or probation is delineated in the Residency Program Statement and Resident handbook which is provided to all residents at the beginning of their training. The residents evaluate the faculty, rotations and conferences anonymously.

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