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Clinical Pathology Rotations |
CLINICAL ORIENTATION INTRODUCTION - Hartford Hospital and Clinical Laboratory Partners’ core laboratory offer a wide variety of active clinical laboratories that perform both basic and specialized procedures. Training in Clinical Pathology is accomplished through a combination of practical experience, didactic teaching sessions, Clinical Pathology Laboratory Rounds, and one-on-one interaction with attending faculty and staff members. Through review talks, case presentations, journal clubs, and discussion of current controversies the entire field of laboratory medicine is explored.
This training begins with a two-month Introductory to Clinical Pathology structured around the proposed Curriculum Content and Evaluation of Resident Competency In Clinical Pathology (Laboratory Medicine) by the Academy of Clinical Laboratory Physicians and Scientists. The introductory core is intended to familiarize the resident with all the branches of Clinical Pathology (blood banking and transfusion medicine, microbiology, hematology, clinical chemistry, and molecular pathology and cytogenetics) and provide the resident with overview of the laboratories prior to the scheduled bench rotations. During the orientation, the resident will be required to attend the three-week Hartford Hospital Medical Technology training in Blood Bank/Transfusion Medicine and initiate a program of learning the vast technical and clinical knowledge in Clinical Pathology.
CLINICAL CHEMISTRY ROTATION - After the Clinical Pathology Introduction, the resident will rotate with the Clinical Chemistry Division for 2 months (8 weeks). During the rotation, the resident will develop technical and interpretive expertise in the following areas: blood gases, electrolytes, proteins, enzymes, endocrinology, laboratory management/administration, laboratory statistics, instrumentation, immunoassays, quality control and quality assurance, therapeutic drug monitoring and toxicology. Educational activities include:
- Discussions based on pre-assigned reading material with doctoral staff members (held approximately 3 times per week),
- Schedule rotation through the laboratory to observe specific laboratory procedures and learn about clinical chemistry instrumentation.
- Clinical Pathology Weekly Laboratory Rounds: Residents present clinical cases with emphasis on clinical interpretation of laboratory tests, patient management, and appropriateness.
- Serum and urine protein electrophoresis and immunofixation electrophoresis sign-out responsibility
- Developmental projects: All residents have the opportunity to complete research and developmental projects. These projects have specific short-term objectives that can be reasonably met during the course of their rotations. Projects are resident-directed at areas of interest.
Consultative activities: All resident will be expected to respond to inquiries about the availability and significance of most common clinical test
- Toxicology rounds: Emphasis will be placed on interesting cases and involve one-on-one discussion of screening and confirmatory test modalities including gas chromatography/mass spectrometry.
HEMATOLOGY/HEMATOPATHOLOGY ROTATION - After the Clinical Pathology Introduction, the resident will rotate with the Hematology Division for five months. The resident is expected to obtain an in-depth knowledge of the basic science and applied clinical science of Hematology and Coagulation and gain an understanding of the Main Hematology/Coagulation and Special Hematology laboratories.
The residency training also focuses on diagnostic aspects of Hematopathology, which occur during the daily sign-out of case materials with the attending staff. All aspects of Hematology/Hematopathology are integrated under one division at Hartford Hospital and include:
- Routine Hematology - complete blood counts with differential cell counts, abnormal peripheral blood smear review, reticulocyte counting, erythrocyte sedimentation rate, and related tests, hemoglobin electrophoresis testing.
- Coagulation - prothrombin time and partial thromboplastin time, thrombin time, fibrinogen, and fibrin split products, clotting factor assays, and tests for hypercoagulable states including factor V Leiden, prothrombin G20210A, lupus anticoagulants.
- Body fluids - morphological assessment of cerebrospinal, pleural, peritoneal and joint fluids.
- Special Hematology – wide variety of flow cytometry applications including immunophenotypic analysis of leukemia/lymphoma, immunodeficiency evaluations and DNA ploidy/cell cycle analysis.
- Hematopathology- daily sign-out with the attending staff of all abnormal peripheral blood /body fluid slides, hemoglobin electrophoresis testing, bone marrow aspirates and biopsies, surgical hematopathology, and flow cytometry and molecular genetic applications.
- Additional educational activities include: Surgical Pathology/Hematology unknown conference, Hematology laboratory administrative meetings, Intercity lymphoma conference, Pediatric tumor board / Hematopathology conference, Clinical Pathology core curriculum series, weekly Clinical Pathology working rounds and journal club.
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MICROBIOLOGY ROTATION - Following the completion of the Introduction to Clinical Pathology, the resident will be assigned for a 2 months (8 weeks) rotation with the Division of Clinical Microbiology. During this rotation, the resident will increase their individual clinical expertise through the interactions with the technical staff in each section of the laboratory and through interactions with clinical colleagues, particularly infectious disease clinicians, and at the same time gain fundamental technical and interpretive expertise in the science of Microbiology.
The learning objectives in Microbiology include:
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Knowledge: specific bacteria, fungi and parasites, viral classification and identification, practical knowledge of infectious disease pathogenesis, common infectious diseases as they relate to body sites, normal microbiologic flora and pathogens common at various infection sites and a working knowledge of newer molecular diagnostic methodologies (including molecular fingerprinting, resistance determination, and the detection of pathogens).
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Skills: common bench level methods, including manual, semi-manual, and automated systems, ability to prepare and interpret Gram, acid fast and other special stains for fungi and parasites, ability to perform and interpret fluorescent microscopy, ability to recognize common bacterial species using conventional biochemical tests and commonly used kits, ability to recognize common bacteria and parasites in human tissue, ability to utilize serologic and culture investigations for the diagnosis of common infections and the ability to perform and interpret susceptibility testing and to interpret the results.
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Communications: develop effective communications with other members of medical staff, house-staff, and other members of the healthcare delivery team and to develop awareness of appropriate timeliness, clarity, and accuracy of verbal and written microbiology related communications.
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Collaborator: learn to work effectively with other members of the laboratory team and to understand the role of the Microbiology laboratory in the public health system.
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Scholarship: gain experience in the critical review of the Medical Microbiology literature and to acquire experience presenting new knowledge to medical professionals.
The residents are expected to attain the aforementioned objectives by participating in educational activities which include: daily bench rounds, in-service for the medical technologists, Technologist Staff Meeting, weekly intercity Infectious Disease Conference (UConn Health Center), attending the infection control committee meetings, attending monthly administrative meeting, attending the CP Journal Club and participation in Clinical Pathology Lab Rounds.
IMMUNOHISTOCHEMISTRY, ELECTRON MICROSCOPY AND SPECIAL HEMATOLOGY ROTATION - This one-month combined rotation provides the resident to exposure to three important special technologies: immunohistochemistry, electron microscopy and flow cytometry in special hematology. During this rotation the resident will learn the technique and diagnostic potential/limitations of immunohistochemistry, become familiar with the immunohistochemical characteristics of selected pathologic specimens and review the daily immunohistochemical studies with the director of the laboratory for QA/QC purposes.
The resident, with proper supervision, will evaluate needle core biopsies of medical kidneys and will process them for immunofluorescence and electron microscopy. The resident will also learn the principles of the flow cytometry instrumentation participate in the triage of fresh specimens in Special Hematology and review characteristic electron microscopic images for infectious diseases, neoplasms and medical renal diseases.
MOLECULAR PATHOLOGY AND CYTOGENETICS ROTATION - The Molecular Pathology and Cytogenetics rotation is designed to provide the resident with the basic knowledge and principles in Molecular Biology and Genetics and to understand the principles of molecular genetics as applied to diagnostic testing. The resident will learn major techniques used in clinical molecular genetics, including PCR, Southern analysis, DNA sequencing, electrophoresis, and other technologies. In addition to the technical aspects, the resident will learn the clinical indications for molecular testing and the clinical implications of test results including calculating genetic risks. The Division is in the process of planning and implementing new diagnostic techniques.
The resident will assist the lab director in these activities and become familiar with reimbursement details and quality management measures necessary to manage a diagnostic laboratory. Opportunities to participate in an ongoing research activity in molecular genetics will be available. The Cytogenetics portion of the rotation includes both observation and active participation in the preparation of chromosome specimens from various tissues including blood, bone marrow and amniotic fluid.
Currently offered tests include: Identity testing on the ABI 310 system, Microsatellite Instability assay (MSI), Cystic fibrosis mutation screening and diagnosis, Ashkenazi Jewish disease, Thrombophilias, Fragile X testing, Huntington disease, Friedrich’s ataxia, Kennedy’s disease and myotonic dystrophy, Non-Syndromic hearing disorders, Infertility panel in collaboration with the Cytogenetics lab, DNA methylation and Imprinting testing of Prader willi and Angelman syndrome, Mitochondrial diseases, Fluorescent In situ Hybridization assays (FISH) on interphase nuclei for the diagnosis of urothelial cancers, AML, CML, CLL, MDS and others.
BLOOD BANKING AND TRANSFUSION MEDICINE ROTATION - After the Clinical Pathology Introduction and successful completion of the 3 week Transfusion Medicine Medical Technology course, the resident will rotation with the Blood Banking/Transfusion Medicine Division for 2 months (8 weeks). The Transfusion Service consists of compatibility testing, diagnostic testing, component distribution, and clinical consultation; I.V. Therapy/Donor Center includes care of therapeutic and autologous donors. Arrangements are also made for rotations at the regional American Red Cross in Farmington and with the dialysis, which performs therapeutic apharesis.
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Instruction in the HLA laboratory, which is under the administration of surgical research, is also provided. Educational activities include:
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Schedule rotation through the laboratory to observe specific laboratory procedures and learn about the methods of preparation, composition, action, indications, contraindications, and possible side effects of blood and its components.
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Clinical Pathology Weekly Laboratory Rounds: Residents present transfusion related cases with attention to donor selection, special testing procedures and the problem-solving techniques.
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Consultative activities: All resident will be expected to handle problems that arise in those areas pertaining to donor qualification, test results, delete transfusion reactions and the clinical management of patients with bleeding disorders, including massive transfusion in surgery.
At the end of the rotation, the resident will be able to function as a fully informed clinical liaison and consultant to the clinical services
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Working in the I.V. Donor Center, the residents will gain experience in therapeutic and autologous blood collections.
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Present an in-service to the technical staff on a special interest or to a project in development on the service.
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Blood and Blood Products Utilization Review /Transfusion Medicine Committee meetings.
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Conduct a mock inspection of Transfusion Service and I.V. Donor Center using the current College of American Pathologists checklist.
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