Residency – Anatomic Pathology Rotations

Autopsy

The Autopsy division provides medical examiner services to 23 adjoining counties and, in 2023, performed 630 medical examiner autopsies and nearly 550 external examinations. In addition, the Autopsy division provides autopsy services to ECU Health Medical Center and several of her sister hospitals in the region. In this role, approximately 40 hospital autopsies were performed in 2023. Hospital autopsies are on an upward trajectory in 2024. Residents interact directly with clinicians, medical students, law enforcement, and others on this busy service. The residents perform both hospital and medical examiner autopsies during the three required blocks which are spread over the first three years of training. Residents learn the technical elements of autopsy performance, tissue preparations, gross and microscopic analysis, and report writing, assuming increasing responsibility as their skill levels improve. All residents are introduced to the key legal and social aspects of the autopsy, from the rights of families to requirements of the legal system and elements and rules of the medical examiner statutes. Opportunities to participate in death scene investigation are also available. Neuropathology is a significant component of the autopsy and residents are encouraged to sign out the brain slides with the neuropathologist. Journal clubs, gross conferences and didactics round out the educational experience on service. Electives in forensics are available to upper level residents. A forensic pathology fellowship is available to residents after completion of their anatomic and/or clinical pathology residency.

Cytopathology

Cytopathology is a fast-paced rotation for PGY2 residents and above. Over the course of training, residents will complete four required blocks of cytology. Elective and away rotations are also available. Residents stay busy assisting with and interpreting rapid on-site evaluations, fluids, and fine needle aspirations. Recent annual statistics show the department interprets approximately 4700 gynecologic specimens and 3023 non-gynecologic specimens, with about 1100 fine needle aspirations. A broad spectrum of non-gynecologic and gynecologic specimens is seen with a particularly busy pulmonary service. The variety of educational cases is supplemented with lectures, glass-slide conferences, and journal clubs. Residents regularly engage directly with clinicians in obtaining clinical information, explaining diagnoses, and providing results. They are also exposed to the technical side of cytology and the regulatory and management aspects, including cytology laboratory inspections.

Intro to Pathology

All residents begin their PGY1 year with Introduction to Pathology. The rotation provides an intensive, systems-based pathology review, focused on practical knowledge for residents. Through daily lectures augmented with gross specimens demonstrating specific disease processes, regular glass slide review, hands-on gross room experience, and reading, the beginning residents will develop a strong knowledge base to utilize in their subsequent rotations. Other topics pertinent to incoming residents are also included, such as introductions to the clinical laboratories, regulatory agencies, quality improvement, and research. The primary goal of the rotation is to ensure that all incoming residents have a foundational level of knowledge and experience which will set them up for success in their rotations. In addition, the introductory month will provide residents with an understanding of the components and the expectations of the residency program.

Surgical Pathology

The Surgical Pathology rotations provides an excellent, learning-focused experience with exposure to a variety of specimens ranging broadly in complexity. New residents can expect a supportive environment with an early emphasis on building a strong foundation in this challenging area. Multiple full time pathology assistants work with upper level residents and faculty to supervise and teach the more junior resident. Responsibility in gross and microscopic examination progresses with post-graduate year and increasing ability. The rotation schedule is structured to provide adequate time for residents to review their cases and prepare reports. Increasing resident autonomy and case ownership is expected over the fourteen required blocks. Recent annual statistics show the department interprets over 24,000 surgical pathology cases each year. Case-based learning is supplemented with regular didactics, consensus conference, and glass slide and unknown conferences. Residents, as much as they are able, are encouraged to stretch themselves and teach co-residents, medical students, rotating residents and other observers in our department in order to consolidate their own knowledge. In addition, residents on service cover a subset of Tumor Boards, reinforcing the clinically relevant aspects of the cases presented. The goal of the Surgical Pathology division is to produce competent surgical pathologists, who are able to communicate effectively with clinicians and confidently enter fellowship and practice.

Frozen Section/Tumor Board

Residents rotate on Frozen Section/Tumor Board one block each year. The rotation provides an excellent opportunity for an intensive frozen section experience, with the resident covering the frozen section service every day. Residents, based on their capabilities and level of training, are encouraged to assume responsibility rapidly on this fast-paced service. The concentrated frozen section exposure promotes learning of this essential skillset and challenges the resident to manage competing interests in the frozen room. Evaluation of common frozen section specimens repeatedly over the month long rotation facilitates consolidation of knowledge. The resident on service also covers a subset of Tumor Boards and this provides an opportunity to review and learn from clinically relevant cases in a multi-disciplinary setting. Residents, based on their abilities, are encouraged to present the cases for cancer conferences, which cover a broad range of disciplines. Tumor Board cases are reviewed by the resident and faculty with the focus on the clinically relevant aspects of the case which drive patient care. This experience helps residents anticipate and resolve clinical questions, and provide clear communication in reporting and presenting cases. Faculty feedback helps residents rapidly improve their presentation skills. Frozen Section/Tumor Board rotation prepares residents to interact confidently with clinicians and to step into their roles as future fellows and practicing pathologists with ease.