Elective Rotations

This rotation is designed to allow an upper level resident to sign-out the biopsy specimens. It is intended for the beginning of the academic year to allow the first year residents to concentrate on gross examination and diagnosis of the large specimens. A pathology assistant will gross the small specimens.

The biopsy resident will be expected to preview all of the biopsy cases for the day and create preliminary diagnoses on these cases to be signed out with the attending staff. When indicated, the upper level resident is expected to order special stains, request further sampling of tissues and research pertinent literature. In general, he or she is responsible for preparing the case for final review and sign-out by the attending. He or she is expected to maintain a log of incomplete or unsigned-out cases and to expedite their completion. A collection of current interesting cases or teaching examples is to be maintained by the upper level resident in preparation for the weekly Surgical Pathology conferences.

This rotation encompasses not only the gross and microscopic pathology of breast disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the breast cancer patient. In addition to daily review of breast aspirates, biopsies, lumpectomies, and resections, the resident is expected to assume primary responsibility for the Multidisciplinary Breast Conference which is held weekly. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with Dr. Metcalf (or designee), and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

The Dermatopathology rotation is intended to provide the Pathology resident with an in-depth exposure to gross and microscopic diagnosis of cutaneous diseases. The resident will be expected to attend the sign-out sessions, which occur every afternoon. After completion of the sign-out, the Pathology resident will be responsible for grossing in specimens for the following day. This duty will be shared with the Dermatopathology fellow and the Dermatology resident rotating on the service. The Pathology resident will also be responsible for dictating the reports of a portion of the cases received from within the institution.

Because it is important for the Pathology resident to understand the clinicopathologic correlation between gross and microscopic aspects of cutaneous diseases, he or she is expected to attend the Dermatology outpatient clinics at the Veterans Administration Hospital on the appropriate mornings. Initially, the Pathology residents will be precepted by Senior Dermatology residents until their skills are appropriate for seeing patients independently. In addition, the Pathology resident should plan to attend all morning Dermatology teaching conferences. If there is a Pathology teaching conference that conflicts with the Dermatology teaching conference, then the Pathology resident may be exempted from the Dermatology conference on that day. The Dermatopathology conference is held every Monday morning at 7:30 am. and is a required aspect of the rotation. Mornings when not in clinic, are intended for individual study. Teaching sets are maintained in the Dermatopathology reading room, which should be utilized extensively during the rotation.

The frozen section rotation is of variable duration. The resident will be expected to examine all frozen section specimens delivered for intra-operative consultation. He or she will also train younger residents and to instruct them in the art of gross examination. They will be responsible for interacting with surgical residents and faculty concerning frozen section diagnoses. He or she is also responsible for the transmittal of information from the frozen section room to the grossing room (information concerning special treatment of margins). This resident will also be prepared to render his/her frozen section diagnosis to the surgical faculty/residents after approval of the pathology faculty. Additionally, the resident will be responsible for all ultra-rush specimens and all neuropathology specimens (if there is no resident on the neuropathology elective rotation).

This rotation includes surgical pathology of the gastrointestinal tract and liver. The resident will assume primary responsibility for tumor board and biopsy conference cases.

Daily review of surgical pathology biopsies and large gastrointestinal and liver specimens will be performed after sign-out. The resident will get re-cuts of all interesting cases and add them to the appropriate study sets. All gastrointestinal and liver consultations will be previewed and a preliminary diagnosis and dictation performed. The resident will be expected to spend at least one day in the endoscopy suite, to see the process of obtaining gastrointestinal specimens. Additionally, review of study sets and reading is expected. For rotations greater than one month, a research project is expected.

The resident will prepare and preview all of the conference and tumor board cases with Dr. Lewin. The resident will then present the appropriate cases at the conference. The list of conferences is as follows:

• Liver biopsy conference
• Digestive Disease Case Conference: pathology is presented for the case if appropriate.
• Liver Transplant Selection Committee
• Thoracic Tumor Board (Esophageal tumors are discussed)
• GI Tumor Board (Pathology of discussed patients is presented)
• Liver Tumor Board

This rotation is designed to allow an upper level resident to teach and help first year residents in their grossing of surgical specimens. It is intended for the beginning of the academic year. The gross room supervisor will also help the frozen section resident when the frozen section resident gets overwhelmed.

This rotation encompasses not only the gross and microscopic pathology of urologic disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the urologic cancer patient. In addition to daily review of GU biopsies, and resections, the resident is expected to assume primary responsibility for the GU Tumor board which is held weekly. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with Dr. Smith (or designee), and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

This rotation encompasses not only the gross and microscopic pathology of gynecologic disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the gynecologic cancer patient. In addition to daily review of Gyn biopsies, and resections, the resident is expected to assume primary responsibility for the GYN Tumor board which is held weekly. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with Dr. Richardson (or designee), and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

This rotation encompasses not only the gross and microscopic pathology of head and neck disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the ENT cancer patient. In addition to daily review of ENT biopsies, and resections, the resident is expected to assume primary responsibility for the Head and Neck Tumor board which is held weekly. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with Dr. Richardson (or designee), and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

This rotation includes both surgical and autopsy neuropathology. Surgical neuropathology includes brain biopsies for neoplastic and non-neoplastic disease, muscle biopsies, and nerve biopsies. Autopsy neuropathology includes disease processes that affect the brain, spinal cord, peripheral nerves or muscle. The evaluation of these specimens frequently includes immunohistochemistry and electron microscopy.

The resident will assume primary responsibility for case evaluation and diagnosis. This includes gross description, microscopic description, and clinicopathologic correlation. Interesting case material may be presented at conferences.

The resident will be available and on-call as for any surgical pathology or autopsy rotation. He/she will receive specimens in the operating room for frozen tissue diagnosis, review the neuroimaging studies, and obtain a clinical history from the neurosurgeon. Following frozen section diagnosis, the resident will carry the case through to final diagnosis.The resident will be responsible for all neuropathology surgical pathology specimens, dictation, and sign-out with the appropriate attending. The resident will perform electron microscopy as indicated.

The purpose of this rotation is to familiarize the resident with the scope of oral and maxillofacial pathology. The resident will take part in the daily sign-out of cases in the Oral Pathology Laboratory. In addition, interesting cases from study sets of oral, head, and neck lesions will be reviewed. Depending on the particular cases available at the time of the rotation, the resident may also have the opportunity to work on forensic dental cases and to evaluate clinical patients with oral disease. Reading of texts and journals is encouraged and expected.

This rotation encompasses not only the gross and microscopic pathology of pediatric disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing pediatric diseases. In addition to daily review of pediatric specimens, the resident is expected to assume primary responsibility for the pediatric tumor board. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with Dr. Caplan (or designee), and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

This rotation encompasses not only the gross and microscopic pathology of placental disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the mother and newborn. In addition to daily review of placenta specimens, the resident is expected to assume primary responsibility for the fetal board. This will entail obtaining the conference agenda (in advance), reviewing previous as well as current pertinent pathology reports and slides, reviewing the findings with the attending pathologist, and presenting them at the conference. Following the conference, reviewed cases will be recorded as part of the ongoing AP quality assurance program.

The rotation is geared toward familiarizing the resident/fellow with the common histopathologic and clinical disease entities in pulmonary pathology. Special emphasis will be given to the management implications of the pathologic diagnosis and the tools and studies at hand to reach this diagnosis. Review of current as well as archival or study set material would be included. Independent reading and review of the current literature in the field is expected. Attendance to the weekly thoracic tumor board and the weekly pulmonary medicine conference is imperative during the month.

This rotation is set up to allow upper level residents to read out and signout all the large specimens in one month, assisting the junior residents. The junior residents will gross the majority of the specimens. The read out resident will be expected to preview all of the large cases for the day with the junior resident and create preliminary diagnoses on these cases to be signed out with the attending staff. The upper level resident will assist the attending staff in the supervision and training of the first year residents. He or she will be expected to review all of the day's Surgical Pathology slides and dictate diagnoses and, where appropriate, microscopic descriptions of those slides. When indicated, the upper level resident is expected to order special stains, request further sampling of tissues and research pertinent literature. In general, he or she is responsible for preparing the case for final review and signout by the attending. He or she is expected to maintain a log of incomplete or unsigned out cases and to expedite their completion. A collection of current interesting cases or teaching examples is to be maintained by the upper level resident in preparation for the weekly Surgical Pathology conferences.

During the resident's one month on the Roper rotation, they will work with the Roper hospital pathologists. Roper Hospital is a closely located private hospital. The pathology department has 8 private practice pathologists and does approximately 25,000 surgical pathology cases/year. The residents will be primarily responsible for surgical pathology signout (the majority of the grossing is done by pathology assistants) with the appropriate attending pathologist. This rotation allows the resident to experience a private practice pathology setting and a difference surgical pathology case mix.

This rotation encompasses not only the gross and microscopic pathology of bone and disease, but also the role of the surgical pathologist as a part of the multidisciplinary team managing the cancer patient. Daily review of bone and soft tissue biopsies and resections with Dr. Smith. Additionally, the resident will be expected to read pertinent material and review study sets. Interesting current cases should be added to the appropriate study sets.

This rotation is set up to allow upper level residents to preview and sign-out all the consultation specimens (excluding dermatopathology), and present cases at the variety of tumor boards. This will allow the resident to see interesting and difficult cases as well as interact with the clinicians at the various tumor boards.

The resident will preview the consultation cases, order special stains, and create preliminary diagnoses to be signed out with the appropriate attending pathologist that same day. If appropriate, the resident will be expected to call the referring physician.

The resident is expected to help collect and present cases at the following tumor boards:

• Breast Correlation Conference (Dr. Metcalf)
• Head/Neck Tumor Board (Dr. Richardson)
• Liver Conference (Dr. Lewin)
• Thoracic Tumor Board (Drs. Lewin/Bilic/Riemer)
• Pediatric Tumor Board (Dr. Welsh)
• GI Tumor Board (Dr. Lewin)
• Brain Tumor Board (Dr. Welsh)
• Gynecology Tumor Board (Dr. Madory)
• Liver Tumor Board (Dr. Lewin)

The rotation through the HLA laboratory is to provide an introduction to this high-complexity laboratory and the testing done within. During your time in the lab, you will be shown the different techniques that are used to perform tissue typing and anti-HLA antibody analysis. You will learn serological and molecular methods. Unless laboratory workload prohibits, you will be allowed to perform an HLA typing of yourself. You will also learn about the crossmatch.

This elective rotation in lymph node pathology is designed to provide the resident with a more in depth examination of lymph node morphology. The resident will be expected to view study sets and all lymph node and flow cytometry specimens that come in to the department for the month.

With the increasing demands on a pathologists daily schedule in the anatomic and clinical laboratories there must be effective methods of providing the data needed by clinical colleagues and researchers. By utilizing information technology resources available in most laboratories the pathologists should be able to provide the information when needed.

The department of Pathology and Laboratory Medicine has a team of Laboratory Information specialists operating within the Laboratory Information Services (LIS) department. Their role is to provide service within the department and integration with hospital wide clinical systems. Integration of the pathologist with the LIS team is essential for design and maintenance of an effective laboratory information system. The role of this rotation is a brief introduction into the role of the pathologist.