Anatomic/Clinical Pathology Track
Years 1 and 2 introduce fundamentals in Anatomic and Clinical Pathology. Years 3 and 4 serve as a time to consolidate and integrate skills. AP/CP residents will start with either a full year of anatomic or clinical pathology, followed by a full year in the remaining discipline.
In the first year of anatomic pathology training (either PGY1 or PGY2), residents train in both Surgical (~75% of the work time) and Autopsy Pathology (~25%). The first year of AP also includes a one-month rotation in Cytopathology. In Surgical Pathology, residents are exposed to different organ systems and the broad range of specimens, both small and large. Of note, in our program subspecialty signout rotations are of one or two week duration rather than one or two month blocks. We believe this provides a significant training advantage as residents are continually exposed to disease entities in each organ system throughout the year, thereby reinforcing learning. Importantly, to promote optimal acquisition of diagnostic skills, we give residents ample time to study and diagnose their slides prior to signing out their cases with attending staff pathologists.
In the first year of clinical pathology training (either PGY1 or PGY2), the first eight months of the year are divided into four 2-month rotations in the core disciplines: Chemistry; Hematology/Coagulation/Hematopathology; Microbiology; and Transfusion Medicine. This sequence allows repeat, advanced, one month rotations in each of the core laboratories in the last four months of the academic year and exposes residents optimally to all of the laboratories while allowing consolidation of the entire laboratory medicine experience. Our laboratory management curriculum (including quality control, quality assurance and utilization review) includes not only lectures but exercises such as a mock laboratory inspection to help residents better understand key concepts. We also recently developed and implemented a new Informatics curriculum based on the national Pathology Informatics Essentials for Residents (PIER) resources (https://apc.memberclicks.net/pier). In CP, we emphasize clinical context and the laboratorian serving as a clinician and consultant. Furthermore, we integrate residents within greater hospital teaching conferences (e.g., “Firm” case sessions involving internal medicine faculty, residents and students).
Integration of AP and CP starts at the beginning of training with residents attending both AP and CP conferences, regardless of their year in training. In this way, they develop a multi-disciplinary knowledge base and deeper appreciation for pathological issues that often optimally require insights from both arms of our discipline. In addition, they maintain skills obtained during their training in AP while in their CP years and vice versa. Years 3 and 4 are divided between Anatomic and Clinical Pathology. The schedule also includes a formal one month rotation in Molecular Diagnostics and Cytogenetics. Genomic pathology is also integrated into this month.
Five months of additional clinical pathology experience are required. Three months involve an advanced rotation in one of the core laboratories. The residents are given additional responsibility in regard to leading rounds and teaching junior residents and often pursue research projects with our faculty. The two remaining months can also be in the core labs, a subspecialty rotation (e.g., stem cell processing laboratory) or residents can design their own novel rotations under the guidance of a faculty member. In addition to required surgical and autopsy pathology rotations, year 3 and 4 rotations in Anatomic Pathology include Cytopathology (2 months), Pediatric Pathology (4 weeks) and Forensic Pathology (2 weeks). For residents who have demonstrated proficiency in core requirements, three months of elective time may be spent in one-month advanced subspecialty surgical pathology rotations. Years 3 and 4 serve as a time for assumption of greater responsibility. Residents play a more important role in conference preparation and presentation and often participate in research projects. Furthermore, they act with greater autonomy during clinical consultations.
All of our rotations occur at BIDMC with two exceptions. Residents learn pediatric pathology during a rotation at Children's Hospital Boston, in a large, well-organized department with an excellent faculty and educational resources. The Forensic Pathology rotation occurs at the Massachusetts Medical Examiner's Office in Boston with a large volume of medical-legal autopsies.
Upon graduation from this pathway, a large proportion of our AP/CP residents pursue subspecialty fellowship training in one of the many fellowships offered by our department before going on to faculty positions, often at major academic medical centers. (See Graduate Destinations for information regarding post-residency placement.)