Residency – Clinical Pathology Rotations

Blood Bank/Transfusion Medicine

The Blood Bank experience consists of three blocks, usually scheduled early in training, on this very busy service. In 2018, the Blood Bank handled over 26,000 blood product transfusions in support of hospital services, such as our neonatal intensive care unit, our kidney and pancreas transplant program, our busy cardiovascular surgery service, and one of the largest sickle cell clinics in the U.S., all at this Level-1 trauma center. During rotations, residents are exposed to a wide variety of transfusion-related issues. With the assistance of experienced faculty and staff, residents on service act as the first point of contact for transfusion reactions and are responsible for all patients with positive antibody screening. Through assigned readings and clinical interactions, residents acquire in depth knowledge of the full range of transfusion medicine. Residents rotate through the apheresis unit in our hospital and also visit a major blood collection center. They also participate in weekly rounds, making presentations every week about interesting or difficult cases. Numerous opportunities for research and quality improvement projects can be found on this popular rotation. Further experience can be obtained through Blood Bank electives or Research electives.

Chemistry

Chemistry rotation orients you toward biochemical analysis of various fluids and basic management of the laboratory for 3 blocks over the first 3 years of residency training. The setting for the rotation is our busy Chemistry laboratory, which, in 2018 performed over 3,900,000 tests. The rotation provides an introduction to laboratory issues such as test selection, analytic variable, quality control, instrument selection and validation, and point of care testing. Residents solidify their chemistry knowledge through interpretation of serum and urine electrophoresis, hemoglobin electrophoresis, and immunofixation. Recognition of common electrophoretic patterns and triaging cases requiring immunotyping and immunofixation is emphasized. Sign out with faculty takes the form of practical, short discussions of cases which are boards oriented. The rotation provides ample opportunity to develop research projects and investigate and report unusual cases. Development of resident management skills and increasing their responsibility for troubleshooting laboratory issues is a significant aspect of the rotation. Residents participate in managerial and other administrative meetings as well as quality improvement efforts and reporting. Elective in Chemistry or Research are available to further enhance the resident’s Chemistry experience.

Hematopathology

Four Hematopathology rotations are required for PGY2 residents and above, with opportunities for additional electives available. While on service, residents learn to interpret a broad range of bone marrow and flow cytometry cases, lymph node biopsies, and abnormal peripheral blood smears. Residents also gain experience in other areas, including coagulation, hematology and urinalysis. Recent annual statistics reveal the department interprets approximately 600 bone marrow cases and 700+ flow cytometry cases each year, encompassing a broad range of complexity and diagnoses. Hematopathology lectures, case-based discussion, glass slide conference and Hematopathology Tumor Board round out the learning experience. Interested residents can also learn proper bone marrow aspiration technique while on rotation. In addition to the diagnostic skills gained on service, residents troubleshoot quality assurance and laboratory management issues according to their abilities.

Histocompatibility Laboratory

Residents spend four weeks in the Histocompatibility (HLA) Laboratory, which supports our kidney and pancreas transplant program. During the rotation, residents rapidly advance from a review of immunology to more complex transplantation related issues and immunogenetics. Residents learn through engagement in the critical procedures for transplantation, such as DNA isolation from lymphocytes, real-time qPCR, solid phase flow cytometry (Luminex) and crossmatch. This hands-on training, guided by independent study, lectures from faculty, and research into a cutting-edge topic related to transplantation. At the end of the rotation, residents provide a presentation based on their research. The one on one teaching and exceptional faculty and staff makes HLA a popular choice for electives.

Informatics

Informatics rotation is provided annually and is primarily directed towards PGY3 residents. All residents are provided an informatics review during the four week block with informatics lectures during scheduled clinical pathology teaching time. The group rotation is a nice change of pace and allows residents to benefit from the questions and perspectives of their peers. The rotation is led by informatics faculty and the content spans a core set of materials which is fine tuned to the residents’ interests during the block. Content is delivered in a variety of ways, including traditional didactics, questions and answer sessions, and demonstration sessions. Selected reading and video materials are also utilized. Topics covered during the block include digital pathology, image analysis, data analysis, clinical data sets, LIS configuration, middleware, networking, hardware, enterprise interoperability, interfaces, standards, and more. The rotation provides an excellent foundation for understanding many aspects of the laboratory. There are opportunities to pursue informatics projects during the rotation and also during elective rotations.

Laboratory Management

Laboratory Management is a PGY4 rotation led by clinical pathology faculty which serves as a great opportunity to consolidate laboratory management principles gleaned from all prior rotations. Residents attend management meetings for various aspects of the laboratory and also visit community hospitals in our hospital system. Residents fill any gaps in their management knowledge base through assigned readings, focused discussion, and resolving day to day issues. The scope of this rotation is broad and covers everything from regulations and finance to equipment selection and validation to personnel management. The major goal of this rotation is to demonstrate the various administrative functions of the pathologist and to help the upper level residents develop the skills necessary to successfully fulfill those roles.

Microbiology

The Medical Microbiology rotation is part of our Clinical Pathology core requirements. Residents rotate for 3 blocks over the first 3 years of training; however it is such a popular rotation, many residents rotate on microbiology electives as seniors. The rotations are structured to maximize the learning environment. Residents focus on clinical management of difficult cases, including coordination and consultation with laboratory clinical staff. Close communication with the primary care teams is emphasized as residents increasingly become active members of the infectious disease diagnostic and therapeutic team. Issues addressed by residents include interpretation of specialized assays, the diagnostic approach to and specimen collection for unusual infectious cases and the discussion of unusual test results. Residents progress through an instruction and practical laboratory experience for all aspects of infectious disease diagnostics: bacteriology, mycobacteriology, virology, serology, parasitology, molecular diagnostics and emerging technologies such as MALDI-TOF-MS. Learning on this rotation is complemented by weekly multidisciplinary conferences addressing unusual pathogens and treatment methods as well as research opportunities in new identification methods and treatment modalities. Residents in Microbiology are actively engaged in multiple microbiology-related hospital committees and quality initiatives which provide a robust systems-based experience.

Molecular Pathology/Cytogenetics

The goal of the required Molecular Pathology/Cytogenetics rotation is to introduce residents to basic molecular and cytogenetic techniques, teach them how to interpret these tests in a clinical setting and be an effective consultant. The rotation includes hands-on learning, a didactic component, and observation at a commercial laboratory. Case-based learning with assigned reading and hands on learning in the genomics core laboratory is also part of the experience the Teaching Residents In Genomics (TRIG) curriculum is also part of the rotation.