beth israel deaconess medical center a harvard medical school teaching hospital

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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.

Specifically, PGY-1 is devoted entirely to Anatomic Pathology. In each month, residents train in both Surgical (~75% of the work time) and Autopsy Pathology (~25%). 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.

Year 2 is devoted entirely to Clinical Pathology. 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. This arrangement exposes residents optimally to all of the laboratories while allowing consolidation of the entire laboratory medicine experience by the end of the year. 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. Informatics, and the use of new technologies are integrated into the rotations. 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. This rotation incorporates teaching from all the clinical laboratories as well as anatomic pathology. There is also the opportunity to develop skills to critically analyze the literature and present findings. 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, flow cytometry) 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 (3 months), Pediatric Pathology (4 weeks) and Forensic Pathology (2 weeks). Three months of electives (that may be devoted to CP or AP, are available for residents who have demonstrated proficiency in core requirements.

Years 3 and 4 serve as a time for greater assumption of 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.