Curriculum

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 (7.5 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 2016–2017 rotation block schedule is given below, followed by a brief description of the rotations.

 

PGY 1
ROTATIONS

#
MONTHS

PGY 2
ROTATIONS

#
MONTHS

Autopsy

2

AP or CP Elective

1

Blood Bank/TMS

2

Autopsy

1

Chemical Pathology

1

Chemical Pathology

2

Cytopathology

1

Forensic Pathology

1

Dermpath/Neuropath

1

Hemepath/Coagulation

1

Hemepath/Coagulation

1

Microbiology

1

Surgical Pathology

4

Molecular Pathology Course*

1

 

 

Surgical Pathology

4

PGY 3
ROTATIONS

#
MONTHS

PGY 4
ROTATIONS

#
MONTHS

AP or CP Elective

Renal Pathology

1.5

0.5

AP or CP Elective

1

Autopsy

1

Blood Bank/TMS

1

Cytopathology

2

CP Electives

4

Dermpath/Neuropath

1

Cytopathology

1

Hemepath/Coagulation

1

Hemepath/Coagulation

1

Microbiology

1

Molecular Pathology

1

Surgical Pathology

4

Surgical Pathology

3

* The Molecular Pathology Course is offered every two years and is taken in the
Fall of the second or third year. This course alternates with an elective month.

 

CORE ROTATIONS IN ANATOMIC PATHOLOGY & CLINICAL PATHOLOGY

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

Faculty: 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: Bouldin 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 second year.

Faculty: Radisch and the associate chief medical examiners.

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: One month each in first year, second year, third year, and 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: 1 month each in the second and third year.

Faculty: 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, Schmitz, Shaheen, Skrzynia, Thorne, Weck, Molecular and Cytogenetics fellows, technologists, and others.

Renal Pathology

Goals and Objectives: The resident will participate in all aspects of the medical renal pathology service. This includes light microscopic evaluation of renal biopsies, immunofluorescence studies and electron microscopy. This is a high volume, internationally recognized medical renal biopsy service and the full spectrum of routine and unusual cases are seen. Additionally, large resection specimens for non-neoplastic renal disease such as hereditary renal cystic disease, end stage kidney disease and post transplant complications are seen on this service. Interesting cases are presented at the renal biopsy conference each Friday afternoon in conjunction with the clinical nephrology service.

Duration: 2 weeks during the second or third year.

Faculty: Jennette, Kenan, Nickeleit and Singh; renal pathology fellows.

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, Dodd, Funkhouser, Greene, Hertel, Lawton, Lininger, Maygarden, O'Connor, Sasatomi, 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 ROTATIONS IN ANATOMIC AND CLINICAL PATHOLOGY

There is 7.5 months of elective time in the residency (total of 2.5 months in second and third years, distribution depends on when the molecular pathology course is held; 5 months in the fourth year). 4 of these months must be taken in clinical pathology in order to fulfill board requirements for AP/CP residency. We purposely schedule some elective time in the second year of residency, this allows time to consider specialized areas of pathology the resident may be considering for fellowships. Most residents arrange their elective time in the fourth year immediately before the spring American Board of Pathology examination in order to allow a more flexible schedule for study purposes. Electives may be taken in any area of pathology, and up to 6 months of elective time may be taken as research time. It is strongly encouraged that all residents schedule a month of quality assurance and informatics experience; an on-line curriculum with study modules covering various aspects of quality assurance and informatics is available to residents which fulfills this requirement. This is usually taken as a fourth year elective because this material is directly relevant to board exams. Popular electives in anatomic pathology include focused study on specific organ systems, with review of study set materials available from the faculty and specialized reading related to that organ system. Popular electives in clinical pathology include molecular pathology, microbiology and hematopathology. Many elective experiences include working on projects and completing manuscripts for presentation and publication. Away electives may be taken at other medical centers, but ample time is required to complete paperwork required by other institutions to satisfy credentialing requirements at these sites, and the resident must arrange the elective with the outside institution. UNC will continue to pay the salary and benefits for residents taking elective rotations at other institutions.