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Anatomic Pathology Rotations |
AUTOPSY & PEDIATRIC PATHOLOGY SERVICE - Beginning residents will learn all the elements of the autopsy during this rotation. Experienced dieners will assist the resident in organ removal and provide technical assistance. Senior attendings supervise and instruct the resident in chart abstraction/formulation, prosection, gross pathology, microscopic anatomy and pathology, development of provisional/final diagnosis with cause of death, and communication of these results with clinicopathological correlations to staff and peers.
Concurrent with the comprehensive autopsy training the resident will enjoy a core Pediatric pathology experience. A full time pediatric pathologist instructs the PGY-1 resident in the special requirements of the pediatric and prenatal autopsy, and examination of the placenta and surgical pathology specimens from the Connecticut Children’s Medical Center, with emphasis on the diagnostic workup of small round blue cell tumors.
PGY-1 residents spend three one-month rotations on autopsy/pediatric pathology during the first 6 months and during the second half of the academic year continue autopsy training by joining the senior housestaff on a rotating “next up” schedule for all nonsurgical residents. Additional autopsy training includes a weekly brain cutting attended by neuropathologists and neurology housestaff. A one-month rotation at the Chief Medical Examiner’s Office in Farmington supplements monthly forensic lectures at the same site. Residents will have many opportunities to present autopsy findings at monthly CPC’s for the medical attendings and housestaff.
SURGICAL PATHOLOGY SERVICE - Residents on the Surgical Pathology Service at Hartford Hospital are given increasing responsibility as their knowledge base and diagnostic skills develop.
Our “Anatomic Pathology Orientation” consists of an intensive one-month program where residents learn the basic approach to surgical specimens from the time they are accessioned until slides are delivered to the surgical pathology team for the formulation of a final diagnosis. This includes instruction in the basics of histology laboratory processing, the department and hospital computer systems, gross specimen evaluation, and frozen section assessment of active surgical cases. Under the guidance of the Department’s three pathology physician assistants, residents will be instructed in the proper dictation and sectioning of surgical pathology cases and will be given a broad cross section of specimen types to process, with an emphasis on tumor pathology. At the end of the rotation, the resident is well prepared to participate as the junior member on one of the surgical pathology teams.
The second step in surgical pathology training is the “Intensive Surgical Pathology” rotation. Residents spend their time between the frozen section service and processing and signing out large surgical pathology specimens to solidify the knowledge gained in the introductory rotation. The emphasis is on the evaluation of major cases and cancer specimens with instruction in the preparation of detailed reports containing the essential information necessary for optimum patient care. The Department utilizes a standard reporting format, which is outlined in the “Tumor Template Manual” that helps direct residents to the key information they need to focus on.
After completion of the “Intensive Surgical Pathology” module, subsequent rotations are as a member of the general surgical pathology teams, with graduated responsibility as the resident gains in experience and competence.
The essential components focused on during the surgical pathology training are:
- gross examination and description of surgical pathology specimens,
- microscopic review of case material prior to sign-out,
- development of an independent morphologic diagnosis or appropriate differential diagnosis,
- preparation of timely and quality intraoperative consultations,
- effective and professional communication with clinical colleagues and support personnel
- organization skills to acquire and incorporate information from multiple diverse sources
The standard Surgical Pathology rotation consists of a four-day cycle. There are four surgical pathology teams, each composed of a junior resident, a senior resident or Surgical Pathology fellow, a pathology physician assistant (PA) and Surgical Pathology attending(s).
- On day #1, the team staffs the frozen section room and is responsible for grossing in all of the cases, both inpatient and outpatient, which enter the Department that day. The frozen section room is located in the OR and team members dress in surgical scrubs and interact directly with the surgeon requesting an intraoperative consult. This face-to-face interaction is ideal for discussing difficult cases and promotes optimal patient care. PAs assist in the OR as well as processing routine specimens in the surgical pathology cutting room, located in the pathology department. As residents master the processing of small and routine specimens, they spend a greater portion of their time handling the larger and more complex cases.
- On the morning of day #2, the housestaff previews biopsy case material and generates a provisional diagnosis prior to sign out with the attending. The biopsy cases are generally completed by early afternoon and then the slide trays from the major resections and small routine specimens are divided among the housestaff for review and preparation of provisional diagnoses. Residents are expected to put their cases in final form with all necessary information for accurate staging. If a final diagnosis cannot be made, the resident should develop a differential diagnosis and a plan for workup of the case.
- On day #3, the housestaff and attending work together at a multi-headed microscope and residents presents their cases to the attending on service. Even though a resident may not have previewed a case the evening before, he/she will still review the microscopic findings when it is finalized with the attending.
- Day #4 is reserved to “clean up” cases which were held for fixation, or those requiring cut downs or special stains. This is also the day when housestaff are expected to do the bulk of their reading, conference preparation, and follow-up cases that involved other subspecialties (hematopathology, neuropathology and pediatric pathology). On the following day, the team is once again in the OR.
Over the 4-year training period, residents will be scheduled for 15 months of Surgical Pathology. They also spend one month on each of the following subspecialty rotations:
- Dermatopathology at the University of Connecticut
- Renal Pathology & Electron Microscopy at the University of Connecticut
- Combined Neuropathology and Pulmonary Pathology at Hartford Hospital
A variety of intradepartmental and interdisciplinary conferences supplement the residents’ experience on the surgical pathology teams. They include:
- A weekly core curriculum conference in anatomic pathology in which, over the course of three years, the major topics in surgical pathology and cytopathology are presented in a didactic fashion to the housestaff.
- A weekly surgical pathology unknown conference.
- Multiple interdisciplinary tumor boards (general surgery, GYN oncology, urology, thoracic surgery and pediatrics).
- Multiple interdisciplinary clinical conferences (GI pathology, transplant pathology, and radiology correlation conference).
- A variety of intradepartmental conferences (journal club, cytology interesting case review, surgical pathology problems conference, gross pathology conference).
CYTOPATHOLOGY ROTATION - The Cytopathology Division is a state-of-the-art laboratory offering comprehensive gynecologic and nongynecologic diagnostic services, education and research. Cytopathology resident training consists of four one-month rotations and includes a balanced emphasis between gynecologic, non-gynecologic and aspiration specimens with emphasis on diagnostic criteria, accurate reporting and communication of diagnostic interpretations, and ancillary techniques applicable to cytopathology (automated screening devices, immunocytochemistry, flow cytometry, and molecular studies). The resident participates in FNAs and FNA adequacy assessments.
Teaching of cytopathology occurs primarily at sign out when residents and fellows review slides and discuss provisional diagnoses with the Cytopathology attending. In addition to sign out at the multi-headed microscope, organized teaching sets as well as current cases are utilized for resident education. These activities are supplemented by didactic lectures and independent study of textbooks and journal articles. Other educational activities include quality assurance, laboratory management, cytopreparatory techniques, and cytology/surgical pathology correlation.
Pathology residents work very closely with the cytopathology fellow and attending, receiving extensive one-on-one education during sign outs. They are integrated into all services of the laboratory, providing a well-rounded educational experience.
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