Pathology Residency Program
The Pathology Residency training program consists of 22 months of Anatomic Pathology (AP), 21 months of Clinical Pathology (CP) and five months of electives. AP rotations include Surgical Pathology, Cytology, and Forensics; and CP rotations include Chemistry, Microbiology, Hematology, Molecular Genetics, Cytogenetics, Laboratory Management, Transfusion Medicine, and a one-month introduction to CP course at the University of Washington. A typical rotation schedule would be as follows:
- First Year Five months Surgical Pathology (including histology training), one month Cytology, one month Hematology, two months Transfusion Medicine, one month of Chemistry, one month of Microbiology, and a one-month introduction to CP course at University of Washington.
- Second Year Five months Surgical Pathology, one month Cytology, one month Microbiology, one month Chemistry, one month Hematology, one month CP elective, and two months of General Elective.
- Third Year Three months Surgical Pathology, one month Cytology, two months Forensic Pathology, two months Hematology, one month Molecular Pathology, one month of Transfusion Medicine, and two months General Elective.
- Fourth Year Three months Surgical Pathology, one month Cytology, two weeks Laboratory Management, two weeks Cytogenetics, one month Chemistry, one month Microbiology, one month Transfusion Medicine, one month AP Elective, and one month General Elective.
Each AP rotation consists of a four-day rotation which includes separate days for grossing surgicals, preview day, signing out with staff, and frozen sections. As the resident progresses through the residency, more independence is given. Fourth year residents function as junior staff completely working up their own cases prior to staff review. Autopsies are done on a rotating basis among all residents on AP and CP throughout the residency. All residents who have graduated from our program have performed the adequate number of autopsies required by the American Board of Pathology. Training in immunohistochemistry, fine needle aspiration is given throughout the four years.
The Transfusion Medicine rotation provides training in transfusion practices, immunohematology, donor center operations, blood component preparation, and consultation services. The Hematopathology rotation provides training in peripheral blood, bone marrow, and lymph node pathology and interpretation, body fluid analysis, coagulation, hemoglobin electrophoresis, flow cytometry, and consultation services. Training in performing bone marrow aspirates and biopsies is also given during this rotation. The Microbiology rotation provides training in bacteriology, mycology, mycobacteriology, parasitology, virology, serology, and clinical infectious disease. The Chemistry rotation provides training in all aspects of clinical chemistry including blood gas interpretation, electrolyte and enzyme assays, immunochemistry, protein electrophoresis, and therapeutic drug monitoring. Graded responsibility is also given on CP. The resident functions as acting Medical Director during their third and fourth year CP rotations. In the last rotation on hematopathology, the resident completely works up the cases independently prior to staff review.
Most training takes place at Madigan. Mandatory outside rotations include an introduction to Clinical Pathology course (University of Washington) during July of the first year, Forensic Pathology (Pierce County Medical Examiner), Soft tissue and Neuropathology (University of Washington), and one Surgical Pathology rotation at Oregon Health Sciences University, Portland, Oregon. Elective rotations can be done in any area of AP or CP.
Fourth-year residents are the Chief Residents. Responsibilities include: Creating the academic year rotation schedule and call schedule, coordinating the daily teaching conference schedule, inviting guest consultants and lecturers, teaching junior residents, as well as medical and podiatry students.
Teaching conferences are scheduled each day. The curriculum follows an organ system-based outline that incorporates topics within AP and CP. This is a two-year schedule which will give each resident exposure to each organ system two times during residency.
The teaching conference formats include:
- AP unknown slide conference
- CP topics conference
- AP/CP lectures
- Journal Club
- Molecular pathology conference
- Ethics and Professionalism discussions
- Interesting case conference
Each year there are one to three invited guest consultant visits. These are two conferences given by nationally known experts in various areas of Pathology. There is also a quarterly consultant visit by a pediatric pathologist from the Seattle Children’s Hospital. Other pathologists at the University of Washington and the surrounding areas occasionally give lectures throughout the year.
Resident call is rotated among second to fourth year residents. Call is taken from home for one week at a time. Call consists of both administrative and medical responsibilities with blood bank issues predominating. There is staff coverage at all times. The resident investigates and handles problems as they arise and reports these situations to the staff pathologist on call as appropriate. Calls are discussed in morning one time per week. This gives all residents a chance to learn from the wide variety of calls. All residents and staff pathologists attend morning report.
During residency, each resident is encouraged to complete an original investigative project in either clinical or anatomic pathology. The project may involve submission of a research protocol with subsequent collection and correlation of data or preparation of a case report. Residents will prepare their project for publication and submit it to a peer-reviewed medical journal. Presentations at local or national meetings are also encouraged. Residents also have the opportunity to collaborate with clinicians from other services on research projects and case reports. A departmental research meeting is held quarterly.
The Department of Clinical Investigation (DCI) here at Madigan provides support for research endeavors. They have resources to assist with planning, data collection, and statistical analysis. DCI is also a fully equipped molecular biology/protein chemistry lab and animal research lab with technicians available to help with bench research.
There are many opportunities for residents to teach. As residents progress in the residency, they teach the more junior residents. Several medical and podiatry students rotate through the department each year and are assigned to a Pathology resident. The residents give occasional pathology conferences to various clinical services and show cases monthly in tumor boards. Individual case teaching for clinical residents occurs throughout the residency. Residents on Clinical Pathology rotations give a monthly 15-minute teaching session on a topic of their choice. First year residents help teach the normal histology for the organ system of the month.
Each year, every resident is assigned a staff mentor who provides guidance and a friendly ear. The program director is always available to discuss problems and concerns. Residents evaluate each rotation when it ends. Residents formally evaluate the pathology staff and the residency program annually. An annual program evaluation committee meeting coordinated by the 3rd year residents, which includes catered food and a fun off-site activity, is held each year. These meetings lead to many changes and improvements in the residency program. The pathology staff and residents work closely together to continuously improve the residency program and to ensure it meets all accrediting requirements, as well as the needs of the residents.