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.

Core Training Rotations in AP & CP

Autopsy Service

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.

Duration: 2 months in the first year and 1 month in the second and third years (4 months total).

Faculty: Bouldin, Dent, Homeister, Jennette, Jones, Kaufman, Moylan, Nickeleit, and Thorne.

Clinical Chemistry

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.

Duration: 1 month in the first year and 2 months in the second year (3 months total).

Faculty: Hammett–Stabler, Korpi–Steiner, and Willis; Clinical Chemistry fellows.

Cytopathology

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.

Duration: 1 month in the second year, 2 months in the third year, and 1 month in the fourth year (4 months total).

Faculty: Drs. Budwit, DiFurio, Dodd, Greene, Hertel, Maygarden, O'Connor, and Scanga; Cytopathology fellows.

Dermatopathology/Neuropathology

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.

Duration: 1 month in first year and 1 month in third year (2 months total).

Resident Duties and Responsibilities: The resident will attend the daily dermatopathology sign-out conference and the weekly Dermatopathology Conference. The resident will also attend the daily neuropathology sign-out conference and the weekly Brain Conference. 

Faculty: Zedek (Dermatopathology) and Bouldin, Miller, and Trembath (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.

Duration: 1 month in the third year.

Faculty: Drs. Nichols, Radisch, and Simmons.

Hematopathology/Coagulation

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.

Duration: Two months in the first year, one month in the third year, and one month in the fourth year (4 months total).

Faculty: Dent, Fedoriw, Mathews, Rollins–Raval, Whinna, and Williams; Hematopathology fellow.

Microbiology

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.

Duration: 2 months in the second year.

Faculty: Drs. Gilligan, Miller, and Schmitz; Immunology/Microbiology fellows.

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.

Duration: 1 month course in the second or third year and 1 month rotation in fourth year (2 months total).

Faculty: Booker, Coleman, Farber, Fried, Friedman, Funkhouser, Gilligan, Gulley, Kaiser–Rogers, Miller, Muenzer, Nelson, Perou, Powell, Rao, Schmitz, Shaheen, Skrzynia, Thorne, Weck, Molecular and Cytogenetics fellows, technologists, and others.

Surgical Pathology

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.

Duration: 4 months in first year, 4 months in the second year, 4 months in the third year, and 3 months in the fourth year (15 months total).

Faculty: Bouldin, Budwit, DiFurio, Dodd, Funkhouser, Greene, Groben, Hertel, Lininger, Maygarden, Miller, O'Connor, Scanga, Smith, Trembath, and Woosley; Fellows in Surgical Pathology.

Transfusion Medicine

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.

Duration: 2 months during the first year and one month during the fourth year (3 months total)

Faculty: Mazepa, Park, Raval, and Whinna; Transfusion Medicine fellow and supervisors.

Elective Training Rotations in AP

Cytopathology

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will be responsible for selected cases from the Cytopathology Service, study slides from the teaching file, attend cytopathology sign-outs, review interesting cases, and participate in cytopathology conferences.

Faculty: Budwit, DiFurio, Dodd, Greene, Hertel, Maygarden, O'Connor, and Scanga; Cytopathology fellows.

Dermatopathology

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will study slides from the dermatopathology teaching file, attend dermatopathology sign-out, review interesting cases from Moses Cone Hospital (weekly), and attend the weekly Dermatopathology Conference.

Faculty: Zedek.

Electron Microscopy

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will learn how to operate a transmission electron microscope and how specimens are prepared for electron microscopic examination. Electron micrographs will be reviewed and correlated with light microscopic and other pertinent findings. Additionally, electron micrographs on file in the laboratory are available for review.

Faculty: Singh.

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will be responsible for working-up the muscle and nerve biopsies. The resident will learn to interpret lab results in view of the patient's illness, as well as gain familiarity with the many procedures involved in the preservation of enzymatic activities, ultrastructural anatomy, and biochemical integrity of tissues. The resident will also be responsible for attending the muscle and nerve biopsy conferences held in conjunction with the Department of Neurology.

Faculty: Chahin (muscle); Bouldin (nerve).

Neuropathology

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will review teaching sets to acquire further diagnostic skills. He or she will also participate in evaluation of frozen sections, surgical specimens, autopsy service specimens, and the work-up of Medical Examiner consultations in forensic neuropathology.

Faculty: Bouldin, Miller, and Trembath.

Ophthalmic Pathology

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will attend ophthalmic pathology gross and microscopic sessions. Additionally, the resident will study slides in the ophthalmic pathology study set, take responsibility for adding current interesting cases to the study set, and do reading in the area of ophthalmic pathology.

Faculty: Drs. Wright, Trembath, and Bouldin.

Oral Pathology

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will become familiar with, and participate in, the examination and preparation of gross oral specimens, as well as gain experience in microscopic diagnosis.

Faculty: Drs. Curran, Murrah, and Padilla.

Pediatric Pathology

Goals and Objectives: This elective offers a more intensive exposure and perspective into the pathology of diseases of childhood.

Duration: 1 month.

Resident Duties and Responsibilities: The resident can rotate through various labs involved in pediatric pathologic diagnosis, including cytogenetics, molecular pathology, autopsy service (concentrating on pediatric materials), and surgical pathology. Interested residents will be able to identify interesting cases through these various rotations and present the pathologic findings to clinicians in the form of a weekly conference.

Faculty: Smith and faculty from various subspecialties.

Renal Pathology

Goals and Objectives: The resident has the opportunity to develop a general knowledge of diagnostic renal biopsy pathology.

Duration: 1 month or more.

Resident Duties and Responsibilities: The resident will examine renal biopsy case material (teaching cases, filed cases, and/or active cases) including light, immunofluorescence, and electron microscopy data. The resident will attend renal biopsy review conferences.

Faculty: Jennette, Nickeleit and Singh.

Surgical 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.

Duration: 1 month or more.

Resident Duties and Responsibilities: The resident will be responsible for selected cases from the Surgical Pathology Service, study slides from the teaching file, attend surgical pathology sign-outs, review interesting cases, and participate in weekly surgical pathology conferences. Each resident is also strongly encouraged to collect 2-4 cases for addition to the study set material.

Faculty: Budwit, DiFurio, Dodd, Funkhouser, Greene, Groben, Hertel, Lininger, Maygarden, O'Connor, Scanga, Smith, Trembath, and Woosley; Fellows in Surgical 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.

Duration: 1–2 months.

Resident Duties and Responsibilities: The resident must be on-site and fully devoted to this service. Duties and responsibilities are similar to that of the faculty directors and vary daily.

Faculty: Hammett–Stabler, Korpi–Steiner, Mathews and Whinna.

Clinical Chemistry

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.

Duration: 1–4 months.

Resident Duties and Responsibilities: Resident duties and responsibilities are to actively participate with faculty in assuming responsibility for an area, or in undertaking and completing a research project.

Faculty: Drs. Hammett–Stabler, Korpi–Steiner, and Willis.

Coagulation

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.

Duration: 1 month.

Resident Duties and Responsibilities: The trainee will build on the fund of knowledge gained in the core rotation and assume greater responsibility in the laboratory regarding clinical, technical, and administrative issues in the core and/or special coagulation laboratories. The trainee will be the initial contact for any questions from the clinicians or technologists in the area of coagulation. The trainee will be expected to develop a plan of action and then present the consult issues and plan to the laboratory director for discussion and approval.

Faculty: Rollins–Raval and Whinna.

Flow Cytometry

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.

Duration: 1–3 months.

Resident Duties and Responsibilities: (1) Collection of appropriate clinical material; (2) Flow cytometric analysis; (3) Evaluation of clinical usefulness or appropriateness of the project; and (4) Write-up of procedure and/or manuscript.

Faculty: Schmitz.

Hematology

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.

Duration: 1 month.

Resident Duties and Responsibilities: Duties and responsibilities will be arranged with Dr. Fedoriw in accordance with the resident's specific goals. Responsibilities will usually include signing out bone marrows and consultation on the hematopathology diagnostic service.

Faculty: Dent, Fedoriw, Mathews, Rollins–Raval and Williams.

Microbiology

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.

Duration: 1 month.

Resident Duties and Responsibilities: (1) Develop a PCR method for a selected organism using known primer sequences; and (2) Optimize laboratory conditions and initiate studies on clinical specimens.

Faculty: Gilligan, Miller and Schmitz.

Molecular Pathology

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.

Duration: 1 or more consecutive months.

Resident Duties and Responsibilities: The resident will participate in molecular diagnostic testing, in interpretation of results, and in preparing cases for sign-out. An opportunity is provided to actively participate in research and development of new molecular diagnostic tests.

Faculty: Booker, Funkhouser, Farber, Gulley, Thorne and Weck.

Pathology Informatics

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will write a request for bids (RFB) for a laboratory information system (LIS). He or she will also review with the Supervisor and Director of Laboratory Computer Services all requests for new database searches, and using the LIS software, will create database searches to provide clinical, research, or quality assurance information. Additionally, the resident will be required to solve an information management problem, such as acquiring data from a laboratory instrument with a personal computer and analyzing this data with a spreadsheet or database program.

Faculty: Laboratory Medicine Faculty.

Transfusion Medicine

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.

Duration: 1 month.

Resident Duties and Responsibilities: The resident will utilize the fund of knowledge gained in the first-year rotation, and assume greater responsibility in the laboratory regarding clinical, technical, and administrative issues in both the main laboratory and the apheresis unit.

Faculty: Mazepa, Park, Raval, and Whinna.

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.