Pathology Residency

During the autopsy rotation, residents learn to do autopsy examinations. Additional experience in autopsy pathology is gained during the forensic pathology rotation at the Medical Examiner’s Office (see Forensic Pathology description). Autopsies are performed in a state-of-the-art facility for isolation of infectious, communicable cases. Photographic equipment for documentation of gross findings is present within the autopsy room.

During the clinical chemistry rotation, residents learn basic and advanced clinical chemistry by daily interaction with the supervising directors. The residents are formally oriented in the use of computerized databases, research and laboratory management issues in clinical chemistry, and legal aspects of clinical chemistry.

The residents have daily responsibilities of serum, urine, and CSF protein electrophoresis and hemoglobin HPLC and electrophoresis. In addition, the residents are responsible for evaluating special test requests by clinicians, and miscellaneous inquiries by clinicians related to the chemistry laboratory in patient care. Each resident prepares a didactic presentation for the Clinical Pathology resident conference.

During the coagulation rotation, residents acquire experience in the technical aspects of a variety of test procedures including routine and special coagulation tests, such PT, PTT, fibrinogens, D-dimers, lupus inhibitors, and platelet assays. Each resident prepares a didactic presentation for the clinical pathology resident conference.

During the cytogenetics rotaton, residents participate in the analysis and interpretation of cytogenetic and FISH studies. Competencies for resident training include cytogenetic analysis of amniotic fluid, chorionic villi, peripheral blood, solid tissue biopsies, and bone marrow samples. Additional molecular biology studies include in-site hybridization and FISH on appropriate clinical material.

During the cytopathology rotation, residents are actively involved in the sign-out of cytology cases with attending cytopathologists. In addition, 4,000 glass slide study sets are available for review, with emphasis on correlation of cytology findings and surgical pathology diagnoses. Residents review all consultation cases referred to the department.

Residents are actively involved in the procurement and on-site evaluation of fine needle aspiration biopsies. The cytology fellow assists in the training of residents.

Opportunities for research experience in collaboration with staff cytopathologists are available for additional elective time, following the mastering of the basic cytopathology principles during the initial three-month rotation.

During the electron microscopy rotation, the resident is exposed to the use of electron microscopy with renal biopsies, as well as other special biopsies, such as lung, liver, and heart. The rotation is one month long. The residents have the opportunity to preview all cases and are involved in interpreting the electron micrographs, and finally writing up the reports under the supervision of the attending pathologist. The clinical, anatomical and immunohistochemical data are generally integrated with the ultrastructural findings. During this rotation, therefore, the residents are exposed to a wide variety of ultrastructural pathology that is crucial to the development of their diagnostic skills.

During this one-month rotation at the Medical Examiner of the city of Philadelphia, the pathology residents have the opportunity to determine the cause of death and the circumstances surrounding the deaths of persons coming under the jurisdiction of the Medical Examiner. This includes scene investigations and the instruction in the performance of the forensic autopsy. When needed to complete the cause and manner of death, the resident participates in evaluating microscopic slides of toxicology reports. The residents participate in morning "rounds" where all cases are discussed, and under staff supervision, assist in the medical legal autopsy. Forensic toxicology is emphasized. In addition, residents are expected to attend all conferences held by the Medical Examiner and staff of five forensic pathologists, and attend court where sessions deal with forensic pathology. Opportunities for additional elective time at the Medical Examiner's office with involvement in research projects are readily available.

During the hematopathology rotations, residents learn general principles of hematology, including the structure and function of the hospital hematology laboratory, and basic morphology of blood, bone marrow, and lymph nodes and the diseases that affect these tissues. As they become more competent, the resident will be given increased responsibility, and the emphasis of the rotation will shift to development of diagnostic skills and clinicopathologic correlation. Integration of routine morphology, immunohistochemistry, flow cytometry, molecular diagnostics, and cytogenetics in the diagnostic process will be stressed.

During the immunology rotation, residents gain a basic understanding of the technology and instrumentation utilized in the evaluation of a wide range autoimmune serology procedures, their underlying principles and clinical application. Each resident prepares a didactic presentation for the clinical pathology resident conference. The laboratory staff directly supervises the residents in mastering the knowledge base and competence in performing the components of the above program.

During the laboratory management/informatics rotation, residents are introduced to various topics, including cost analysis of instrumentation, regulation compliance (CLIA, OSHA, FDA, CAP), budget preparation, personnel management and QA procedure critique. Residents are involved in management and administrative activities, and decision-making in each rotation, and are expected to engage in the evaluation of options in relation to laboratory operations, resource utilization, and quality assurance activities.   

The training of the residents in laboratory computer technology addresses the learning objectives and specific goals related to the functional knowledge and architecture of all information systems of the institution. State-of-the-art digital imaging equipment is available on-site for resident use.

During the microbiology rotation, residents learn about the etiology of infectious disease in a laboratory setting. It is organized as a series of bench stations supervised by the attending staff and laboratory personnel, supplemented by multiple additional educational experiences. Residents learn to be consultant physicians for colleagues in other departments.

During the molecular pathology rotation, residents gain a fundamental understanding of the clinical interpretation and physiologic basis of nucleic acid-based testing in genetics, oncology and infectious disease; the genetic, molecular and instrumental principles underlying nucleic acids-based testing, and principles of quality control, emphasizing specific issues in nucleic acid-based testing.

Residents can do their pediatric pathology training at either the Nemours Children's Hospital or the Children's Hospital of Philadelphia (CHOP). The specific goal of the pediatric pathology rotation is to develop an appreciation in the resident for the uniqueness of pediatric pathology and the significant differences between the disorders of adults and children. The resident would also become familiar with classic surgical lesions of the pediatric population. Following the rotation on both surgical and autopsy services, the goal is to convey a sense of the breadth of pediatric pathology concepts rather than a list of facts. The rotation is one month in duration. Residents are actively involved in examination of surgical specimens and performing autopsies under the supervision of the attending staff. The attending staff directly involved with the trainees monitors the resident's progress and performance.

During the transfusion medicine rotation, residents are exposed to all aspects of transfusion medicine. This includes, but is not limited to, pre-transfusion testing, compatibility testing, resolution of antibody problems, therapeutic apheresis, and the administration of blood and blood components to various patient populations, including Trauma, Hematologic Malignancy, Organ Transplantation, Oncology, Neonatology, Orthopaedics, Neurosurgery, Stem Cell Transplant, and Sickle Cell Disease.  

During the surgical pathology rotation, residents learn how to make histologic diagnoses from tissue specimens. Surgical pathology is a subspecialty service staffed by sub-specialty trained pathologists. The service receives more than 30,000 specimens per year.

Residents also have extensive exposure to neuropathology on their surgery pathology rotations. The cases include neurosurgery pathology cases, neurosurgery/ENT pathology cases, nerve biopsies and muscle biopsies.  

All members of the staff are committed to active and interactive residency training in this key discipline.  The senior residents assist the junior residents in the examination and preparation of diagnostic material. Four pathologist assistants assist in the grossing of specimens.