Within the four-year (for residents beginning in or after June 2002 in compliance with American Board of Pathology requirements) Pathology and Laboratory Medicine residency program, a core program of forty-two months leads to basic competence in both anatomic pathology and laboratory medicine. We encourage our residents to take boards in both areas [(Anatomic Pathology (AP) and Clinical Pathology (CP)] for certification by the American Board of Pathology. Residents spend six months in research or on advanced rotations (electives). A wide variety of options are possible for the elective time, including subspecialty training and basic or applied research.
We stress options that further career goals and strengthen the individual's areas of weakness. Electives include advanced rotations in cytopathology, hematology, microbiology, transfusion medicine, flow cytometry, surgical pathology, molecular diagnosis, image analysis, informatics and laboratory management.
Residents are responsible for directing and instructing second-, third-and fourth-year medical students, as well as residents and fellows from other departments who are doing rotations in pathology. They work in groups with a faculty member to teach the basic pathology course for medical students.
The first three and one half years include 24 core months of anatomic pathology and 18 core months of laboratory medicine. Within the four-year residency, a core program of three and one half years leads to basic competence in both anatomic pathology and laboratory medicine. Residents spend the other six months in elective subspecialty rotations (e.g. Dermatopathology) or doing basic or applied research.
During the anatomic pathology rotations, the residents seek to understand the pathologic basis of disease by correlating gross and microscopic findings with clinical and laboratory data and works to discover the meaning of the specific findings. The resident learns not only how to handle tissues and organs and diagnose diseases, but also how this information relates to the patient. In addition to the general department conferences, residents in anatomic pathology rotations attend the tumor board, and weekly conferences dedicated to surgical pathology unknown cases, gross and frozen section pathology, autopsy presentation, and neuropathology (brain cutting). Residents are also involved in the presentation of cases at conferences held in conjunction with clinical departments including the presentation of autopsy cases at and mortality and morbidity conference.
The core anatomic pathology rotations (24 months total-taken throughout the residency) are:
Surgical Pathology (11 months):
Residents describe and section all gross surgical specimens received in the lab, write out diagnoses prior to staff review, and learn techniques of frozen-section preparation and interpretation as well as use of special stains and studies.
Autopsy Pathology (6 months):
Residents learn to perform a complete and thorough autopsy, to properly refer cases to the medical examiners' office and to recognize the gross and microscopic appearance of the more common disease states. The resident is supervised closely by the faculty in all phases of each case: review of the gross pathologic findings, review of microscopic slides, and composition of the final report. Bone marrow aspiration and biopsy technique are taught and performed.
Cytopathology (3 months):
Residents learn how specimens are fixed, processed and stained (including preparation of liquid-based monolayer slides); how to recognize the nuclear and cytoplasmic features of malignancy; and how to make differential diagnoses for specimens of major diagnostic types, including abnormal gynecology Pap smears and specimens for all non-gynecologic sites. Senior residents may participate in fine needle aspiration procedures.
Neuropathology (taught during Surgical and Autopsy Pathology rotations):
On the autopsy service, there is immediate review of the brain and spinal cord at time of autopsy. Brain-cutting conference takes place a few weeks later after adequate fixation has been obtained. During surgical rotations, residents sign out all brain, muscle biopsy and neurological tissue with the neuropathologist.
Electron Microscopy and Special Studies (1 month):
Residents handle all renal and tumor cases, obtaining clinical information, examining specimens under the electron microscope and preparing consultative reports. They also learn the application of special diagnostic technologies and techniques such as diagnostic flow cytometry, immunohistochemical and immunocytochemical studies, image analysis and molecular pathology.
Forensic Pathology (1 month):
Residents have a one-month rotation at the Philadelphia Medical Examiners' Office, where they perform approximately 30 autopsies in cases of homicides, accidents, and deaths that occurred in obscure circumstances.
Pediatric Pathology (2 months):
Residents rotate St. Christopher's Hospital for Children, a referral hospital, where they perform pediatric autopsies, surgical pathology and laboratory medicine consultations.
Laboratory medicine training provides opportunities for regular consultation with other physicians to improve patient care by selective laboratory testing. The training program consists of sequential training segments that prepare the resident for increasing responsibilities. The first segment of each rotation consists of bench work to familiarize the residents with the work done by the lab. During later months in each lab, the resident handles all laboratory medicine consultations and conferences in that discipline (with appropriate faculty supervision.). Daily conferences in various disciplines are supplemented by teleconferences and faculty seminars and weekly didactic lecture and call conferences. The resident also will participate in clinical rounds with other medical disciplines where appropriate (e.g. infectious disease during microbiology rotation).
The core laboratory medicine rotations (18 months total - taken throughout the residency) are:
Clinical Chemistry ( 3 months):
Exercises in routine and special chemistry, endocrinology and toxicology include actual "hands-on" analysis, instrument selection, method comparison, validation, acceptance criteria and result interpretation. Central, distributed and point-of-care models in a pediatric, adult community or academic medical center will be compared.
Microbiology (bacteriology, mycobacteriology, parasitology, virology) (4 months)