Core Rotations

The first month of residency is an orientation rotation in surgical pathology which covers frozen sections, grossing, read out, and signout at both Main and ART hospitals. All the first year residents are on three day schedules at alternating hospitals (for a grand six day schedule covering all of surgical pathology). Upper level residents are also on each of these rotations (along with appropriate faculty) to give the first year residents an orientation, direct supervision, and substantial preliminary experience in all facets of surgical pathology.

During the resident's time on ART surgical pathology, they will examine, dissect and submit tissue blocks from surgical specimens, microscopically examine slides produced from those tissue blocks, and finally review slides with an attending surgical pathologist at the time of sign-out. Residents are also expected to actively participate in intra-operative consultations including examination of fresh tissues, selection of samples for frozen section and/or other studies, sectioning of frozen section blocks, and examination of frozen section slides. These consist primarily of GI, liver, lung/thorax, and breast cases.

The ART surgical pathology rotation is on a three day cycle and three residents are on the rotation in any one month. The resident's responsibility each day is as follows:

• Day 1: (Grossing and Frozen Sections at ART) - The resident is to cut and signout all frozen sections. The resident is expected to gross all of the large breast, GI, liver, and lung/thorax specimens. A Pathology Assistant handles biopsy specimens.
• Day 2: (a.m. GI and Lung Smalls Sign-out/ p.m. Read-out) - All duties occur at Main Hospital. The resident is to sign out GI and lung biopsies with the attending pathologist after morning conference. When slides become available (usually by 1:00 p.m.), the resident is expected to examine all specimens grossed in and dictate a preliminary diagnosis for each case.
• Day 3: (a.m. Large Specimen Sign-out (At ART) / p.m. Derm Sign-out & Derm Grossing (At Main Hospital)) - The resident is to sign out the cases with the attending pathologist at ART after morning conference. At 1:30 p.m., the resident is to sign out the derm cases with the dermpath attending pathologist at Main hospital. The resident is to gross the derm biopsies at Main Hospital after dermpath sign-out.

The basic premise of the autopsy is to provide more definitive information regarding natural diseases, treatment, trauma, and/or cause of death to provide beneficial information to clinicians, families, coroners, law enforcement, and those interested in the biology of disease. Furthermore, exposure to forensic autopsies will introduce residents to medicolegal death investigation. Gaining knowledge from the autopsy is maximized when specific questions are asked, and proper steps are taken to address those questions (special dissections, ancillary tests, etc). Developing one's ability to assess which tissues should be sampled, to what extent, and for what tests or assays is an important objective. It is the responsibility of the entire autopsy pathology staff including the faculty, residents and autopsy assistants to follow this general principle. Oversight of dissections of tissues and organs and of the ultimate final reports should be viewed as an essential positive ingredient in internal and, ultimately, external quality control.

The residents will assume graduated responsibility during their autopsy experience. Residents in their first autopsy block will primarily focus on medical autopsies and atraumatic forensic autopsies while developing their technical skills and understanding of death certification. Residents in their second autopsy block will be expected to help teach the less experienced residents while also performing their own autopsies, which should be of greater complexity and variety than during the first block. By the end of the second rotation the resident should be able to complete more than one autopsy per day and be able to prosect an autopsy without aid from an autopsy technician. All resident autopsies will be performed under the direct supervision of a staff pathologist.

Additionally, residents on the autopsy service will also be responsible for neuropathology specimens from surgical pathology. The resident will be responsible for previewing and signing out the daily neuropathology specimens before or after their autopsy responsibilities are completed. Residents are also expected to attend the weekly brain tumor board and brain cutting sessions.

The rotation in cytopathology in designed to provide you with baseline experience in interpreting cellular specimens from gynecologic and non-gynecologic sites, including body fluids, brushings, and needle aspirations. During this time you are expected to learn the specific cytologic criteria that permit definitive diagnosis, to learn preparatory techniques in cytopathology, become familiar with regulatory and management issues in cytology, and to appreciate the role that cytology plays in effective patient management. Three months time are allocated during the core experience in cytology.

During the resident's time on surgical pathology at the Main Hospital, they will examine, dissect and submit tissue blocks from surgical specimens, microscopically examine slides produced from those tissue blocks, and finally review slides with an attending surgical pathologist at the time of sign-out. Residents are also expected to actively participate in intra-operative consultations including examination of fresh tissues, selection of samples for frozen section and/or other studies, sectioning of frozen section blocks, and examination of frozen section slides.

The Main Hospital surgical pathology rotation is on a three day cycle and three residents are on the rotation in any one month. The resident's responsibility each day is as follows:

• Day 1: (Grossing) - The resident is expected to gross all of the large specimens (excluding breast, GI, liver, and lung/thorax cases). A Pathology Assistant handles biopsy specimens.
• Day 2: (a.m. Frozen Section / p.m. Read-out) - The resident is to cut and sign out all frozen sections that come to the lab until 1:00 p.m. When slides become available (usually by 1:00 p.m.), the resident is expected to examine all specimens grossed in and dictate a preliminary diagnosis for each case.
• Day 3: (a.m. Sign-out / p.m. Frozen Section) - The resident is to sign out both the biopsy and large cases with the attending pathologist after morning conference. At 1:00 p.m., the resident is to cut and sign out all frozen sections that come to the lab until 5:00 p.m..

This rotation is designed to allow an upper level resident to teach and help first year residents in their grossing and sign-out of surgical specimens. It is intended for the beginning of the academic year. The resident will rotate with the junior resident on gross, reading, and signing out of the specimens. The supervising senior resident will also help the frozen section resident when the frozen section resident gets overwhelmed.

This rotation is done at the Charleston VA Hospital. Residents will encounter a different population of patients compared to the Medical University Hospital. Residents will gross specimens, preview cases then sign them out with the attending pathologist.

The purpose of the rotation in Clinical Chemistry is to introduce the subject to residents who will practice in a community hospital. We provide you with information in a variety of ways including bench work, Pathologist-Resident review of laboratory material (electrophoresis spectrophotometric scans, chromatography patterns, etc.), projects, patient chart reviews, presentations, and conferences. We will help you prepare properly for the Chemistry portion of the American Board of Pathology examination.

Clinical Chemistry is a rapidly evolving discipline that requires the pathologist to learn how to learn for the rest of their lives. It is important that you take an active role in learning to use a wide variety of techniques and methods, and to continually to update your knowledge.

The faculty and the technical staff look forward to working with you and teaching you about the assays from a clinical and analytical point of view. We want to share our knowledge about how to run a high quality lab using state of the art equipment.

We would encourage you to get involved with interesting cases, problematic clinical assays, matters that could lead to further investigations, improvement of testing, case reports, and establishment of new methods, etc.

This rotation includes two weeks of clinical immunology including infectious serology, allergy testing, immune deficiency testing and autoimmune testing. The rotation will provide the residents with a set of tools to develop and maintain a level of expertise in clinical immunology appropriate to the professional of responsibilities assumed as a practicing pathologist.

Additionally, this rotation will include two weeks of training in informatics, providing an introduction to the field of informatics and the role of the pathologist. The rotation will include exposure to imaging systems, information systems, basic computer skills, and information gathering.

The rotation in cytopathology in designed to provide you with baseline experience in interpreting cellular specimens from gynecologic and non-gynecologic sites, including body fluids, brushings, and needle aspirations. During this time you are expected to learn the specific cytologic criteria that permit definitive diagnosis, to learn preparatory techniques in cytopathology, become familiar with regulatory and management issues in cytology, and to appreciate the role that cytology plays in effective patient management. Three months time are allocated during the core experience in cytology.

The four month core rotation in hematopathology/hemostasis is designed to provide the resident with a baseline experience in interpreting peripheral smears, bone marrow aspirates and biopsies, and lymph node morphology. In addition, the resident will be introduced to laboratory assays available to assess the coagulant, fibrinolytic, and naturally occurring inhibitor pathways to assess bleeding and thrombotic disorders.

During the Immunopathology block, residents will gain proficiency in the interpretation of light, immunofluorescence, and electron microscopy in the diagnosis of renal disease. Clinical correlation and laboratory data with renal biopsy findings will be taught on a one on one basis with the attending. The resident will learn to assess renal biopsies for adequacy by gross inspection, and given the degree of specimen adequacy coupled with the clinical and laboratory data provided, optimally divide the specimen for light, immunofluorescence, and electron microscopy.

Residents will also gain proficiency in the use of immunofluorescence microscopy in the evaluation of skin diseases and in the evaluation of Endomyocardial biopsies.

The laboratory management rotation is designed to give the residents experience in running a large laboratory including quality control and assurance, and bringing on new test. The residents will spend time working with a variety of faculty and staff on a number of projects. Didactic lecture series, audio conferences, committee meetings, specific projects, and reading assignments will all be used to present the material to the residents.

A very structured, extensive study outline is prepared for the residents in all aspects of microbiology to allow them to prepare for their board examination, on-call duties, and post residency work requirements.

The study outline includes didactic sessions, rounds and observation in the microbiology laboratory, and independent study. Additionally, the residents are expected to attend the infection control committee monthly meetings and infectious diseases weekly case conference.

The rotation in Molecular Pathology is designed to provide residents with basic training in molecular technologies and to offer baseline technical and interpretive information with respect to molecular pathology testing. During this time, residents are exposed to all major areas of molecular diagnostics including: infectious disease testing, molecular genetic testing, molecular assessment of hematologic disease, and molecular analysis of solid tumors.

The resident rotating in Transfusion Medicine will be an integral part of the Blood Bank operations. He /she will have substantial responsibilities for patient care, and usually serve as the primary link between the clinical services and Transfusion Medicine Service. The core rotation consists of four months, with one week spent in the HLA Laboratory and one week in pheresis.

The residents are to review a number of items (detailed below), present their findings at morning report, perform consultations during the day, and present at the weekly Laboratory Medicine case conference. Additionally, the resident will be required to do bench work laboratory sessions and a number of quality assurance activities. Every weekday of the rotation, the resident will review the following items:

• Problems from the night call
• Blood component inventory including RBCs, platelets, and plasma products
• Therapeutic apheresis schedule
• Laboratory values of patients scheduled for apheresis procedure
• Special requests such as HLA cross-matched platelets.
• Transfusion reactions
• Special antibody work-ups and ABO discrepancies