Our Combined Anatomic Pathology (AP) and Clinical Pathology (CP) Training Program is focused on core training rotations in AP and CP as well as ample elective time (eight months total of both AP elective rotations and CP elective rotations) for focusing on particular sub-specialty areas. Intermingling the AP/CP core rotations throughout the four years facilitates recognition of special interests that the resident may wish to pursue in greater depth, during the elective rotations or in a post-residency fellowship, as well as easing board preparation. All of our residents are exposed to the majority of sub-specialty areas in time for the fellowship application process. Our curriculum contains the structure and flexibility that prepares our graduates for any type of practice environment, including both private and academic settings. The 2013–2014 rotation schedule is given below.
Goals and Objectives: The Resident will learn to perform autopsies (including the neuropathological aspects), write reports, trim blocks, review gross and histopathological findings, and analyze clinical problems. Additionally, through various conferences, residents participate in education of medical students, residents, and faculty.
Goals and Objectives: The goals of the clinical chemistry rotation are to provide the resident with a general analytical and clinical knowledge base in clinical chemistry, and an overview of the operation and management of a clinical chemistry laboratory. Upon completion of the rotation, the resident will be familiar with how various types of tests are performed, the interpretation and correlation of results with patients' conditions, and communication of the latter to requesting physicians.
Goals and Objectives: In Cytopathology, the resident will gain basic knowledge and skills in the collection, processing, and interpretation of cytologic material, both gynecologic and non-gynecologic. The resident will also acquire skills and experience in fine needle aspiration.
Goals and Objectives: The dermatopathology/neuropathology rotation provides the resident with an opportunity to gain basic knowledge and skills in diagnostic dermatopathology and in diagnostic surgical and autopsy neuropathology.
Forensic Pathology (Medical Examiner's Service)
Goals and Objectives: The resident will gain familiarity with the operation of a medicolegal death investigation system and the vital role that pathologists play in such operations. By assisting in and performing forensic autopsies, the resident will learn how to perform forensic autopsies. The resident will also gain insight into alternate methods of dissection and be exposed to dissection procedures more akin to those encountered in the private practice of pathology. The resident will also accompany staff pathologists to court and observe expert witness testimony to better understand the role of the physician as expert witness.
Goals and Objectives: The goal of the core rotation in hematopathology and coagulation is to develop an approach to clinical and laboratory evaluation of benign and malignant hematologic diseases. The resident trainee is an essential member of the diagnostic team, and in conjunction with the Hematopathology fellow, is responsible for efficient workflow of the service. Trainees gain experience in the management and medical supervision of a high volume hematology laboratory the evaluation of peripheral blood smears, bone marrow and lymph node biopsies, and are fully engaged in the laboratory testing for disorders of thrombosis and hemostasis. Trainees additionally gain exposure to urinalysis and body fluid examination, as well as in clinical consultation, primarily through clinical case presentations and slide reviews with the medical staff.
Goals and Objectives: The purpose of the two-month rotation for second year residents is to enable the resident to gain the scientific information, laboratory bench and management skills, and knowledge of resources necessary to understand the operation and management of a clinical microbiology laboratory.
Molecular Diagnostics, Cytogenetics, and Immunology
Goals and Objectives: This curriculum is divided into two month long rotations: (1) A month long didactic and systematic course in Molecular Diagnostics and Cytogenetics and (2) A month long rotation with practical and patient care experience in the form of consultations in the areas of Molecular Diagnostics, Cytogenetics and Immunology. The goal of the month-long Molecular Diagnostics and Cytogenetics Course is to instill expertise in molecular diagnostics and cytogenetics so that our trainees become competent clinical consultants on the use of genetic technology in a wide variety of clinical settings. Trainees develop technical, clinical, communication, management, and judgment skills. A fundamental understanding of genetic technologies prepares them to comprehend the medical literature now and as new probe hybridization procedures and other genetic technologies are introduced in future years. Training is provided in a structured environment via didactic seminars; experience with laboratory procedures; preparing clinical cases for sign out under the supervision of expert faculty; interaction with clinicians, counselors, and laboratory scientists; and research on a topic of their choosing. The purpose of this one-month rotation for third or fourth year residents is to provide medical practice for all the concepts and skills learned during the month long Molecular Diagnostics and Cytogenetics Course. In addition, two mornings per week (Monday, Thursday) are spent in core Immunology training. The resident gains scientific knowledge, laboratory bench and management skills, experience delivering patient care through laboratory medicine (interpretation of raw data, compose reports, review with staff and faculty) and consultation, and learning about resources necessary to understand the operation and management of clinical molecular and immunology laboratories.
Goals and Objectives: In Surgical Pathology the resident will learn the basic techniques of gross and microscopic interpretation of tissue specimens. In addition to classical light microscopy, the resident will have the opportunity to learn a variety of modern diagnostic techniques, including electron microscopy, immunohistochemistry, flow cytometry, and molecular diagnostics. In addition to developing diagnostic skills, the resident will learn to make clinicopathological correlations, develop consultative skills with medical colleagues, and to generate a useful and informative surgical pathology report. For one-half a month in the third year and a full month in the fourth year of this time, the resident will be assigned to the Conference/Consultation Service. On this service, the resident will learn the techniques of review of outside pathology cases for patients seeking care, and presentation of cases to many of our multidisciplinary treatment teams, at UNC Hospitals. This allows the resident to work on their microscopic interpretation of cases processed in multiple different laboratories, as well as making decisions on additional testing that may be necessary prior to treatment decisions. In addition to developing diagnostic skills, the resident will learn to make clinicopathological correlations, develop consultative skills with medical colleagues, and to generate a useful and informative surgical pathology reports. The case load includes both pediatric and adult cases, so that the resident has the opportunity to see a wide range of diseases affecting children and adults.
Goals and Objectives: The resident is responsible for determining appropriateness of blood product requests from clinical teams, evaluating requests for therapeutic apheresis, and investigating transfusion reactions. The resident will also be involved with component coordination, daytime technical call, daily rounds, review of daily worksheets and reference cases, and making in-service presentations. The final month of the rotation will include 1 week in the HLA typing lab and 1 week in the hematopoietic progenitor cell laboratories. At the end of these rotations the resident will have (1) Mastered the fundamental concepts, procedures, and protocols in immunohematology; (2) Learned the organizational aspects of a hospital-based transfusion service; (3) Obtained a working knowledge of the laboratory's procedures and policies; (4) Come to display sound clinical and technical judgment; and (5) Developed self-confidence and effective communication skills with all health-care personnel.
Elective Training Rotations in AP
Goals and Objectives: The cytopathology elective offers an opportunity to increase diagnostic skills in cytopathology. Depending on individual interests, the resident can prepare a case report, case series, or other brief report related to cytopathology.
Goals and Objectives: The dermatopathology elective offers an opportunity to increase diagnostic skills in dermatopathology. Depending on individual interests, the resident can prepare a case report, case series, or other brief report related to dermatopathology.
Goals and Objectives: The resident will obtain experience in the use of the electron microscope and the utilization of ultrastructural information in the diagnosis of various diseases, predominantly neoplastic disorders.
Muscle And Nerve Pathology
Goals and Objectives: This elective offers an introduction to the pathobiology of muscle and nerve diseases. A common unit is proposed for both tissues, since many pathological processes involve both organs in a cause and effect relationship. Special emphasis will be placed on the interpretation of biopsy material in order to understand the diseases of muscle and nerve. A multidisciplinary approach will be offered, which includes light and ultrastructural microscopy and the interpretation of special laboratory procedures used in diagnosis of muscle and nerve diseases.
Goals and Objectives: The neuropathology elective offers the opportunity to acquire more in-depth training in one or more selected areas of neuropathology, to review gross and microscopic neuropathology of common CNS diseases, and to become acquainted with the role of the neuropathologist in the work-up of neurologic diseases.
Goals and Objectives: The goals of the ophthalmic pathology elective are to acquire a basic understanding of the pathology of diseases of the eye commonly presented to the pathologist, to become acquainted with the gross and microscopic findings of common ocular diseases, and to become acquainted with the role of the pathologist in evaluating ophthalmic pathology specimens.
Goals and Objectives: The goals of the oral pathology elective are to familiarize the resident with pathology peculiar to the oral and perioral regions, including odontogenic, salivary, and jaw lesions.
Goals and Objectives: This elective offers a more intensive exposure and perspective into the pathology of diseases of childhood.
Goals and Objectives: The resident has the opportunity to develop a general knowledge of diagnostic renal biopsy pathology.
Goals and Objectives: The surgical pathology elective offers residents an opportunity to increase their diagnostic skills and experience in a subspecialty area of surgical pathology to include Breast, Bone and Soft Tissue, ENT/Cardiothoracic, Gastrointestinal, Genitourinary, and Gynecologic. A resident may choose one of these areas or two areas with two weeks’ time spent in each area. Depending on individual interests, the resident can prepare a case report, case series, or other brief report related the chosen area of pathology.
Other Electives in Anatomic Pathology
In addition to the anatomic-pathology electives listed above, residents can arrange to spend additional time in any of the other core areas, such as Autopsy or Forensic Pathology. Special opportunities are also available to study applications of recombinant DNA technology, as well as to participate in a wide variety of research projects.
Elective Training Rotations in CP
Acting Medical Directorships
Goals and Objectives: An elective as an “acting medical director” (AMD) is available to PGY-4 CP residents for the purpose of fostering greater insight into daily management of the clinical laboratory. This elective is of one to two months duration and occurs in the Core Laboratory (chemistry, hematology, coagulation and sub-disciplines). Residents wishing to take this elective should discuss their interest with the Core Laboratory Director at least six months beforehand. During the elective month, the senior resident will be “apprenticed” to the medical director(s) working closely with the medical director(s), assistant administrative director, and supervisors participating in all aspects of laboratory operation. Special emphasis will be given to discussion of management issues as well as advanced development of interpretive skills.
Goals and Objectives: The goals of the advanced elective Clinical Chemistry are to provide an opportunity for in-depth assumption of clinical responsibility or research in a particular area.
Goals and Objectives: This advanced elective in coagulation offers an opportunity for increased responsibility in the administration and supervision of the core and/or special coagulation laboratories. Residents will also gain additional in-depth experience with the Division of Hematology Clinical Coagulation Consult team.
Goals and Objectives: To provide an opportunity for the residents to expand their knowledge and experience in flow cytometry by working on a special project. The project will consist of either a research project or development of a new procedure. The project also may involve evaluation of a new monoclonal antibody and include clinical correlations.
Goals and Objectives: This advanced elective may be tailored to meet a specific goal, including any of the following: (1) Proficiency in normal and abnormal bone marrow and lymph node morphology; (2) Advanced experience in analytical hematology; (3) Clinical research in hematology; and (4) In-depth exposure to molecular diagnostics in hematological malignancies.
Goals and Objectives: This advanced elective provides an opportunity to become familiar with a variety of molecular diagnostic techniques as they relate to clinical microbiology and infectious disease. The focus is primarily on PCR-related techniques for detecting bacteria, fungi, and viruses in clinical specimens.
Goals and Objectives: To prepare our trainees to become creative leaders of anatomic and clinical pathology laboratories through acquisition of knowledge, accumulation of laboratory skills, and formulation of experimental approaches to problem solving in a modern molecular laboratory setting. Learning revolves around analytic and clinical validation of new molecular diagnostic tests and around practical experience with existing molecular tests for inherited diseases, cancer and microbial agents as well as identity testing. Research opportunities are provided.
Goals and Objectives: The elective covers the following topics: (1) How to purchase a laboratory information system; (2) The management of a laboratory information system; (3) Principles of database searching; and (4) An introduction to communications, i.e., instruments, terminals, printers, and networks.
Goals and Objectives: The advanced elective in transfusion medicine offers an opportunity for increased responsibility in the administration and supervision of the laboratory. Residents will also gain more in-depth experience with the apheresis department.
Other Electives in Clinical Pathology
In addition to the clinical-pathology electives listed above, residents can arrange to spend additional time in any of the other core areas of clinical pathology, such as Immunology. Special opportunities are also available to study applications of recombinant DNA technology, as well as to participate in a wide variety of research opportunities.