Educational Goals and Philosophy

The major educational goals of the Beth Israel Deaconess Medical Center Selective Pathology Fellowship Training Program are to provide an environment for rigorous diagnostic training in surgical pathology (with particularly high exposure to gastrointestinal and breast, genitourinary, gynecologic, soft tissue, lung and head and neck pathology), to offer the opportunity for graduated sign-out responsibilities and to encourage scholarly activity in clinical and basic research. Our aim is to train Fellows who will develop a life-long interest in learning, will exhibit the highest professional and technical behavior and will become integral members of the Pathology community as consultants, clinician researchers, mentors and teachers. We provide the professional staff, the diversity of clinical material and experiences and the intellectually stimulating environment necessary to fulfill these objectives.

Organization of the Selective Pathology Fellowship Program

At the BIDMC, we have a high volume of in-house surgical pathology specimens (over 58,000 in 2018), as well as complex external consults, providing the Selective Pathology Fellows the opportunity to spend the year refining their diagnostic skills at the microscope. The beginning of the Fellowship year is spent on the surgical pathology, gastrointestinal/liver or breast pathology rotation schedule so that the Fellows can act as a resource to the junior residents as well as polish their own grossing skills and integrate their gross diagnostic impressions with the microscopic findings. Once the Fellows have demonstrated competence in the grossing and diagnosing of a broad range of organ specimens, they are advanced in responsibility to "junior signout." In this way, the Fellows more fully develop their clinical skills prior to becoming an independent pathologist including learning how to manage a larger caseload and concurrently hone their teaching skills.

There is the opportunity for one of the Fellows to have subspecialty training in breast and two in gastrointestinal and liver pathology. In addition, there are two General Surgical Pathology Fellows. At BIDMC, we have a large volume of these types of specimens, both in house and in the form of consultation materials, and have leaders in these fields (both nationally and internationally) within our department.

Description of Assignments

For the first two months, the Selective Pathology Fellows are on a modification of the routine surgical pathology service (usually subspecialty specific) to allow for polishing of grossing skills and integration of gross diagnostic impressions with microscopic findings in addition to other responsibilities (primarily reviewing consult cases and presenting at interdepartmental conferences). The Fellows do so through acting as a resource to junior residents in the grossing room who have questions regarding grossing and processing of surgical specimens with the availability of attending back-up for more complex resections.

When having demonstrated competency in the above, subsequent months are spent in the role of “junior signout,” wherein the Fellow is responsible for his or her own cases when teamed with a resident and attending pathologist for a given number of days per week. In the role of “junior attending,” the Fellow is expected to be available to answer team resident questions in the grossing room on accessioned specimens and to work up the case to completion (ordering levels, special studies and obtaining in-house consultations as needed) before passing the case onto the attending pathologist. Selective Pathology Fellows are also responsible for the appropriate billing for each case and diagnostic coding of these cases. The attending will ultimately review the case prior to releasing the official report and then provide timely feedback to the fellow in regards to not only diagnosis but in refining the wording of said diagnoses to foster the communication skills essential for a practicing pathologist in either an academic or community environment.

As part of a tertiary care medical center with multiple referral hospital associations, as well as having experts in pathology on staff, the department also receives a large number of internal and external consult cases. The Selective Pathology Fellows each have responsibility for the daily preparation of these challenging and interesting cases that will be reviewed with the corresponding subspecialty attending.

Fellows also cover the frozen section service when possible, acting as the "senior" to the resident on operating room coverage. Each frozen section is also reviewed by an attending prior to rendering the intraoperative diagnosis, providing the opportunity for real time feedback regarding decision making regarding sampling of specimens for frozen section, wording of frozen section diagnoses and intraoperative communication with the surgical staff.

Lastly, the Fellow provides services presenting as a teacher and/or consultant at a variety of subspecialty specific departmental and interdepartmental conferences and also provides supervision of junior residents acting as teachers/consultants in these venues. The Fellow is responsible to the attending pathologist assigned to the conferences that will provide support and assistance as needed and allow for graduated independence.

Completed applications should be received by August 31 of the year prior to the fellowship training.

For application materials and information, please contact:

Program coordinator
Joan Allin 
Phone: (617) 667-7284
Email: jallin@bidmc.harvard.edu