Rotations

While the following goals are flexible and certainly should not be considered final, the context of these goals is defined by the time and resource constraints of pathology practice and by the fundamental principle that our efforts must always serve the patient.

1. Learn to use gross inspection, routine histology, cytopathology and special investigations to formulate differential diagnoses, arrive at diagnoses, and solve clinical problems.
2. Learn to communicate your findings and conclusions clearly, in a manner useful to all appropriate audiences, especially clinicians. Skill in both oral and written communication is critical.
3. Learn to constantly update and expand your knowledge of facts, terminology, and classifications of disease. Clinical correlations are often key to meaningful diagnosis, problem solving, prognostication and thus effective pathology consultation. Furthermore, understanding limits of knowledge is essential to obtaining assistance in difficult situations.
4. Maintain enthusiasm for continued learning. Nurture your familiarity with bibliographic resources. Learn how to critically evaluate literature. Recognize and apply self-motivation in your work. Prepare yourself for assumption of major responsibility.
5. Explore the possibility of being involved in a research project with a faculty member and/or other residents.

Length of Rotation: 4 months
Faculty: Robert Stoppacher, MD, Director Autopsy Service Chief Medical Examiner and Anne Hoffa, MD, Medical Examiner Examiner

The autopsy service is run by the Medical Examiner's Office (MEO) at the Wallie Howard Jr. Center for Forensic Science. As part of University Hospital, it provides a medical service to the physicians who refer their patients, as well as to members of the patient's family. It is also an educational component of the Medical Center, providing opportunities for learning not only to pathology residents, but also to other medical and paramedical students, pathology faculty and staff physicians and residents from all specialties. The VA Hospital autopsy service is under the direction of Dr. Yiran Dai and staffed by VA attending pathologists.

The overall goal of the autopsy rotation at the Medical Examiner's Office is to develop a competent pathologist who can perform a complete autopsy procedure independently and has a basic skill set to understand the pathology observed in the context of the circumstances of death and the clinical history. This competency includes dissection, retrieval of specimens for specialized testing, and microscopic analysis.

Length of Rotation: 3 months
Faculty: Kamal K. Khurana, MD, Director, Qun Wang MD, Rana Naous, MD, Ola El-Zammar MD

The main goal of this rotation is to provide residents with the necessary tools to deal effectively with most cytopathology cases encountered in a general pathology practice. This rotation will also serve as a basic foundation for those interested in pursuing cytopathology as a subspecialty. This rotation provides an intense and diverse exposure to gynecological and non-gynecological exfoliative cytology and fine needle aspirations (FNA). The latter includes aspirations from superficial and palpable lesion performed by the Cytopathologist Team (attending, fellow, and rotating resident) at the FNA Clinic or at the bedside and aspirations from deep-seated lesions obtained under imaging guidance (percutaneous CT or ultrasound guided or endoscopic ultrasound).

Length of Rotation: 12 months
Faculty: Gustavo de la Roza, MD, Ola El-Zammar, MD, Co-Director, Christopher Curtiss, MD, Co-Director, Alfredo Valente, MD, Shengle Zhang, MD, Rana Naous, MD, Kerry Whiting, MD,Qun Wang, MD, Rohin Mehta, MD, Daniel Zaccarini, MD

The goal of this rotation is for the resident to develop into an outstanding surgical pathologist with strong skills in gross and microscopic diagnosis and the knowledge and ability to utilize ancillary immunohistochemical and molecular techniques as well as current literature in formulating diagnoses. Our surgical pathology laboratory sees a great diversity of common and highly complex specimens from all specialties with a significant number of cases in the following areas: gastrointestinal pathology, neoplastic and non-neoplastic lung disease, head and neck pathology, endocrine pathology including thyroid, parathyroid, and adrenal gland, musculoskeletal pathology with great emphasis on bone and soft tissue tumors, and pediatric pathology with a significant number oncologic cases. This division houses a comprehensive immunohistochemistry laboratory with two daily runs of tests and a complete molecular diagnostic section dedicated to solid tumors. There is a general, non-specialized signout with attending pathologists with special interests in most subspecialty areas. The surgical pathology service is divided into a Biopsy Service and Routine/Frozen Section Service covered by three residents and three attending pathologists. A same-day service using a microwave-based system is available for rush biopsies. The biopsy cases are usually available from the lab at about 8:00 AM the morning after they are grossed, and the biopsy resident is expected to review them before signing out with the attending, usually starting by 10:30-11:00. The routine slides are available before noon, and the routine resident has the rest of the day (between frozen sections) to review them and prepare for signout the next day in the morning right after the morning teaching conference.

Length of Rotation: 5 months
Faculty: Yiran Dai, MD, Director, Henry Friedman, MD, Seena Kumar, MD, Shridevi Karikehalli, MD

The rotation at the VA gives residents the opportunity to experience a general pathology practice. Residents are exposed to a variety of scenarios that integrate anatomic pathology, clinical pathology, and laboratory administration. While residents mainly concentrate on surgical pathology, they are also exposed to hematopathology and cytology, including a fine needle aspiration service. Since there is only one resident rotating at the VA at a time, residents benefit from working with three different pathologists in a short period of time and are able to participate in daily departmental consultation conferences and interdepartmental conferences. The relatively smaller and less complex case load in surgical pathology at the VA gives residents the opportunity to master their skills in routine cases and spend more time reviewing and learning from them. Residents see a fair amount of skin, lung, prostate, GI, and bladder biopsies at the VA.

Length of Rotation: 2 weeks plus one month in a combined Special Hematology/Chemistry rotation. 
Faculty: Zhimin (Tim) Cao, MD, PhD, Director

Our Clinical Pathology Core Laboratory is a comprehensive and fully-automated lab with rapid turn-around that operates 24 hours a day 7days a week. Resident will learn about the technical and functional aspects of the lab, the rational use of diagnostic clinical chemistry tests, the interpretation a broad spectrum of assays and their pathophysiologic correlation, and to effectively communicate with consultating clinicians. They participate in realistic problem-solving and in directing and managing the clinical laboratory. Increasing levels of responsibility are given to residents in additional rotations during their 3rd year of residency, where a combined Chemistry/Special Hematology takes place for 2 months. Resident also participate in the teaching of Medical Technology students from our College of Health Professions and in the in service education for the technical staff. This rotation also includes exposure to Andrology and optional Forensic Toxicology.

Length of Rotation: 2 weeks
Faculty:  Scott C. Smith, PhD, FACMG; Elizabeth Ruckdeschel, MD, PhD

This Cytogenetics rotation provides the residents with an overview of Medical Genetics, including exposure to standard karyotype analysis, prenatal diagnosis, cancer genetics, and molecular cytogenetics (FISH). The resident will gain an appreciation for the basic techniques in cytogenetics including tissue culture, cell harvest, slide preparations, banding, special staining, microscopy, and computer assisted karyotyping. By the end of the rotation, the resident will be expected to be able to interpret the clinical data and correlate laboratory findings with various clinical outcomes in unknown case studies.

Length of Rotation: 6 months 
Faculty: Katalin Banki, MD, Sylva Bem, MD, Elizabeth Ruckdeschel, MD, PhD, Michel Nasr, MD

There are 3 different rotations in Hematopathology: Bone Marrow Service, Hematopathology Consultations and Flow Cytometry Service, and Special Hematology. Residents rotate one month in each service in their first year (3 months total), two months in the second year (one in Bone Marrow and one in Consultation/Flow Cytometry), and one month (Bone Marrow only) in the third year. During the third year, they also spend two additional months in a combined Special Hematology/Chemistry rotation.

These rotations prepare residents to interpret a wide range of hematologic abnormalities; to communicate findings and serve as a consultant to clinicians; and to constantly appraise laboratory tests in a changing environment. Residents are exposed to a wide range of diagnostic and consultative services that include diagnoses of hematologic malignancies, systemic disorders affecting bone marrow, lymph nodes and other organs; bleeding abnormalities and thrombotic conditions; hemoglobinopathies, thalassemias, anemias; and a varied array of other hematologic abnormalities. During these rotations, residents are also exposed to specific cytogenetic and molecular testing routinely applied in this field. Residents attend and present cases at the Hematopathology-Oncology Conference on a weekly basis and also participate in the teaching of students in our Medical Technology Program.

Length of Rotation: 2 weeks

Faculty: Elizabeth Ruckdeschel, MD, PhD - Director of Flow Cytometry, Sylva Bem, MD - Director of Clinical Immunology

During this rotation resident are exposed to a wide array of serological and immunodiagnostic tests, and in the management of an Immunology Laboratory. Residents will acquire a base of knowledge, skills, experience and understanding of the principles and applications of methods used in contemporary clinical testing involving Immunology testing applied to rheumatological/autoimmunity, immunodeficiency, and paraprotein related disorders. The latter includes but it is not limited to immunofixation and quantitative immunoglobulin analyses, Antinuclear Antibody and ANCA analysis, Hepatitis/HIV Serology, Immunodeficiency Syndromes, Diagnosis, Analysis and treatment of transplant rejection, Flow Cytometric Immune cell enumeration. They also exposed to tissue immunopathology that includes direct Immunofluorescence and rheumatological pathology. During this rotation, residents will attend renal pathology sign-outs, lab staff meeting, and two conferences intimately related to this service: Rheumatological Pathology and Renal pathology Conferences.

Length of Rotation: 1 month rotation
During this rotation residents are exposed to, understand and utilize the basic management principles required to function in the role as an administrative leader in the Department of Pathology. The Laboratory Informatics rotation's goal is to provide training, understanding and use of the varied hardware platforms and software for acquisition, storage, analysis and transmission of clinical laboratory information. Resident interact on an essentially full-time basis with various management and administrative members and senior faculty members of the Department of Pathology. Through a series of discussions, readings and interchange, the resident should obtain valuable information and exposure to a variety of topics. Residents may also be asked to attend and participate in certain meetings, as with the pathology work group and hospital administration. Laboratory management areas of training deal with general management, financial management, operations management, personnel management and marketing. Laboratory Informatics Services will include selection of a laboratory information system (LIS) and criteria, purchase specifications, security issues and system functions. Micro computing will include PC's (IBM's or clones) and Macintosh computers as tools for the physician and manager. Interface issues and specific software are presented as well as some basics in maintenance and troubleshooting.

Length of Rotation: 2 months 
Faculty: Scott Riddell, PhD- Director; Soma Sanyal, MD

The major objectives of this training rotation are to provide residents with experience in the detection, isolation, and identification of medically important microorganisms and the interpretation and application of microbiology laboratory results. The rotation is designed so that the resident receives hands-on experience in each of the various microbiology disciplines in order to gain the scientific knowledge, bench-level skills, and other resources necessary to understand the operation of a clinical microbiology laboratory. The later stages of the rotation serve to complete, expand, and solidify the resident's knowledge base in diagnostic microbiology and to expose and involve the resident in laboratory management practice, including the methods used for quality control and quality assurance. While Bacteriology represents a large componet of this rotation (four to five weeks), residents rotate through all sections of the laboratory: Virology, Mycobacteriology, and Mycology/Parasitology. Residents daily attend Laboratory Plate Rounds with Microbiology staff and Infectious Disease Lab Rounds with both the lab and the Infectious Disease Team. In addition, they attend two other interdisciplinary conferences: on a weekly basis: Infectious Disease Case Review and Infection Control Committee Meeting. During the first month of the rotation, residents spend the majority of their time within the various laboratory sections and in personal study. Once this first month is complete, technologists and/or a director will bring questions and problems to the attention of residents. During the 2nd month of the rotation, the resident will be responsible for: daily Infectious Disease Laboratory rounds, presentation of a case using appropriate stain and culture materials with correlation with other laboratory findings, including anatomic pathology when appropriate, attend didactic sessions with the laboratory directors, and present one in-service or clinical case to laboratory personnel on a topic chosen in consultation with a laboratory director. The primary focus during rotation should be overall laboratory operations, problem solving, and interpretation of results.

Length of rotation: 2 months
Faculty: Steven Sperber, PhD, FACMG; Scott C. Smith, PhD, FACMG; Michel Nasr, MD 

During this rotation, residents familiarize themselves with the principles and performance of, and gain practical experience in the use of, techniques and interpretation of currently performed molecular genetic and molecular oncology tests, and in the management of a Molecular Pathology Laboratory. Residents will also learn basic principles of molecular biology through participation in signing out of genetic and oncologic reports. By the end of this rotation, residents should be comfortable in their ability to interpret results generated using molecular techniques used in clinical laboratory testing, including: DNA isolation/preparation, restriction endonuclease digestion of DNA, gel electrophoresis, southern-blot and dot blot hybridiz ation and polymerase chain reaction (PCR) including real time-PCR.

Length of rotation: 3 months
Faculty: Matthew Elkins, MD, PhD - Director; Zhanna Spektor, MD; Yesha Sheth, MD; Reut Hod Dvorai, PhD

Residents are in involved in all three areas of this section of the clinical pathology: blood bank, HLA/tissue typing, and apherisis service. It allows residents to acquire a broad base of knowledge, skills, experience and understanding in contemporary Blood Banking and Transfusion Medicine (BB/TM) and the management in all aspects of Transfusion Medicine. At the completion of the program, the fellow should be capable of communicating/assisting clinical colleagues, solving technical and clinical problems that arise day to-day and be able to offer consultation in hemotherapy (components), progenitor (stem) cell collection/processing, respond to transfusion reactions, alloantibody identification, hemapheresis consultations, contribute to parentage analysis, interface with Bone Marrow/Peripheral Blood Progenitor Cell Transplantation Heme-Onc service and solid organ transplant surgery team, appreciate selection of organ donors (living/cadaver), assessment of waiting list, crossmatch and status of PRAs (percent reactive antibodies) including platelet refractoriness of patients. Resident attend a number of conferences, many of which are interdisciplinary, such as blood blank resident teaching conference (twice a month), clinical pathology service review, renal transplant/dyalisis conference, bone marrow/progenitor (stem cell) conference and a number of AABB/ASCP teleconferences.