Anatomic Pathology Rotations

Residents will gain extensive experience in the gross examination, sectioning and description of a wide variety of surgical specimens. A manual covering gross surgical techniques, as well as sample dictations, is available in the gross lab. Senior residents, pathology staff members, and pathology assistants will provide direct instruction.

A staff pathologist is always designated as the staff pathologist on Frozen-call duties for a one-week period from Friday-Friday. The designated staff will be available for consultation in the gross room.

Following the initial one-month one-to-one training period (July of the academic year) and after demonstrating competence, the resident will be given the increased responsibility of examining gross specimens without direct supervision.

The daily rotation schedule includes a 3-4 day rotation to include a day of Frozen section responsibilities, followed by microscopic sign-out of all gross specimens from the prior day, to then be followed by 1-2 days of assigned responsibility to small biopsy sign-out.

Direct instruction from staff pathologists will be given which will cover the appropriate use, limitations and interpretations of frozen sections and operating room consultations. The resident and staff pathologist will go directly to the operating room to pick up specimens and discuss cases with the surgeon. As residents gain experience, they may be given the added responsibility of visiting the operating room alone to obtain specimens and communicate diagnoses to the surgeon. Based on current volume, all residents should be involved in well over 200 frozen sections during the training period.

Residents will also learn the indications for the use of special fixatives, flash freezing of tissue, preparation of imprints, microbiologic culturing and the preparation of tissue for electron microscopy, cytogenetics and flow cytometry.

The skills of microscopic examination of surgical pathology cases will be studied at the dual-headed microscope both during the sign-out of large and small surgical pathology cases with the designated staff. Additionally all cases received on the frozen–day grossing responsibility will be reviewed prior to sign-out, to include reviewing and correcting the gross description that is available in the transcription area on a daily basis.

As residents advance to Skill level II and gain experience they will be given the added responsibility of contacting clinicians to discuss cases and convey diagnoses. Also during Skill level II residents will also learn to formulate and dictate microscopic diagnoses on actual case material both during and prior to individual sign out sessions with a staff pathologist.

The number of cases signed out will be maintained in the resident’s file. Every attempt will be made to have each resident sign out a minimum of 2000 cases during the training period.

Residents will be exposed to medical informatics through the retrieval of patient’s clinical and past surgical pathology records for correlation with current case material. Pathology residents will also have the opportunity to learn how to perform data searches in anatomic pathology.

Throughout the year, there will be an Anatomic Pathology lecture series. This series will extend over a 48-month period, thus allowing two opportunities to each resident to attend the series. It will include didactic conferences given by the pathology staff and senior residents that will cover areas of surgical and autopsy pathology. Residents are encouraged to attend meetings of the Michigan Society of Pathologists, monthly clinical pathology conferences, and other hospital conferences related to pathology. Financial assistance is provided by the Medical Education Department for residents wishing to attend national meetings, provided they are presenting a scholarly activity paper.

Residents in their last six months of their 1st year, 2nd-4th year of training are assigned to attend and present weekly tumor board conferences under the supervision of the assigned staff pathologist.

Outside rotations can also be arranged in cooperation with the program director. However, the maximum allowed time is not to exceed two months per resident.

A wide variety of textbook and other educational materials are available to residents.

All residents will attend a histotechnology lectures given by the histology supervisor, which cover basic techniques and management principles. Each resident will also demonstrate proficiency in a number of basic histotechnology skills.

Residents rotate on the anatomic pathology rotation for a minimum of 21 four-week blocks. During the first 13 blocks, eight of which are in the first year, they are perfecting the Skill level 1 requirement for the autopsy rotation. They are instructed on autopsy prosection using routine techniques. Additionally, they are required to complete gross examination in a period of 3 hours for uncomplicated cases, or 4 hours for complicated ones. They should have the ability to compose a provisional anatomic diagnostic report of autopsy findings within 24 hours of completing the postmortem examination, plus compose a final autopsy report according to an approved format & within 30 days of completing the postmortem examination, including accurate and complete anatomic diagnoses, thorough gross and microscopic descriptions, and pertinent clinicopathologic correlations.

As residents progress to Skill level 2 (one 5-four-week block rotation in their 3rd and 2-four-week block in their 4th year of training) they are evaluated at this level and assume additional responsibility. They are involved in teaching junior residents, and assist Autopsy I residents in the achievement of basic skills in anatomic pathology. Senior residents are given the opportunity to remove the brain and spinal cord without causing injury to either structure. They are also instructed on how to collect blood samples and vitreous eye fluid as required for biochemical tests, and to collect those samples in the proper fashion.

Residents spend a total of two 4-week blocks in the cytopathology rotation. Resident education in cytopathology includes all aspects of specimen collection, processing, staining, screening, and diagnostic interpretation, through direct instruction, hands on experience, observation, and reading. Resident education in cytopathology is supplemented with a weekly didactic lecture to include teleconferences from national organizations (e.g. American Society of Cytopathology) & a slide review conference where residents and pathology staff review interesting and diagnostically challenging cases with follow-up when available. Resident supervision includes specimen sign-out on a daily basis with one or more of the cytopathologists, specimen preparation and staining techniques with laboratory personnel, performance of fine needle aspirations with the cytopathologist or colleagues in the Nuclear Medicine or Surgery Departments and review and discussion of study sets with the cytopathologists.

Resident experience in Electron Microscopy consists of a required one 4-week block rotation combined with review of renal medical biopsies, where the resident learns the basics of specimen processing, ultramicrotomy, thin section staining, and use of the electron microscope. The resident also reviews a combination of textbook material, a set of teaching cases, case file material, and current cases, under daily supervision of a staff pathologist. A CD ROM of EM teaching cases, developed in-house, is given to each resident, as well as a second CD ROM of Renal Biopsy teaching cases, also developed in-house, that includes an extensive collection of renal electron micrographs along with correlating light microcopy and immunofluorescence photomicrographs. The Renal Biopsy Conference supplements resident education in electron microscopy.

This one 4-week block rotation will be spent at the Wayne County Medical Examiner's Office under the supervision of the Interim Deputy Chief Medical Examiner, Dr. Omar Rayes.

The resident will obtain experience in handling the investigation of sudden unexpected deaths. The residents will learn how to carry out a thorough postmortem examination, and also learn to incorporate all relevant information regarding the circumstances of the death into a final evaluation of the cause of death. The resident will be exposed to a broad spectrum of cases including death as a result of homicide, accident, suicide and natural causes.

The resident will become familiar with the preparation of a medicolegal autopsy report.

The resident will become familiar with the elements of a forensic science team (pathologists, investigators, toxicologists, consultants, etc.)

The resident will become familiar with interpretation of routine examinations of alcohol and drug testing. The resident will also become familiar with scene investigation and court testimony (by observation).