Pathology Residency Program
Medical College of Wisconsin
Overall Program Description, Goals, and Objectives
The overall goal of the Pathology Residency Program is to provide comprehensive training in the practice of pathology and laboratory medicine. The Medical College of Wisconsin Affiliated Hospitals (MCWAH) and other associated training facilities provide a diversity of practice settings, faculty skills and interests, patient populations, and specimen types to allow for both well-rounded general training and establishment of subspecialty expertise. The training program explicitly seeks an appropriate balance between service obligations and educational opportunities. By design, no single service is dependent on the presence of residents to function, but when residents are present on a service they are expected to take ownership of patient case material and function as integral members of the health care delivery team. The approach to pathology practice that is stressed and modeled is one of pathologist as clinical consultant, as a critical member of the clinical team. This role is encouraged by the sub-specialty surgical pathology signout system and a robust, structured CP curriculum that stresses clinical consultation. The environment that is fostered is one of collegiality, teamwork, patient centricity, academic inquiry, and continuous quality improvement. The Pathology Training Program seeks to provide training that allows graduates to be highly competitive for fellowship programs and be prepared to enter either community-based or academic practice, with a target of roughly equal placement of our trainees in each of these two practice settings.
Institutional GME Policies
The institutional GME office [also know as Medical College of Wisconsin Affiliated Hospitals (MCWAH)] posts complete, updated policies on its website and can be found here. In addition, all MCWAH policies will be delivered electronically to all residents and faculty on at least an annual basis.
Residency Committee and Quality Improvement Process
The residency committee is chaired by the Program Director, and consists of select faculty from various areas of AP and CP. The chief residents serve as ex officio members. The residency committee meets on an ad hoc basis to address new and ongoing issues in the residency program, as well as conduct annual recruitment functions. At least once annually, the residency committee will perform a systematic evaluation of the program, including but not limited to resident in-service performance, board passage rate, success at obtaining fellowship and job placement, resident survey, faculty survey, personal observations of committee members, and individual resident feedback provided during semiannual review. The output of this review is an annual document detailing perceived deficiencies, action plan for remediating each deficiency, and target dates for implementation. After one year, a progress report is developed for each of the proposed action plans. Any incomplete goals that remain pertinent will roll over to the following year’s QI goals.
Two chief residents will be selected each year by the residency committee. The term of appointment for the chief residents runs from April 1 to March 31. One chief will be initially assigned as AP chief, the other as CP chief, and they will switch these positions halfway through their term of service. The chief residents are expected to perform the following tasks: 1) Develop the resident rotation and conference schedules in consultation with the program director, 2) participate in the residency committee as ex officio members, 3) coordinate resident participation in the resident, fellow, and faculty recruitment processes, 4) function as a liaison between the residents and faculty and administrative and technical staff, facilitating bidirectional movement of information, 5) advocate for and represent the residents regarding educational, operational, and administrative issues, and 6) set an example of professionalism for other residents to emulate.
Core AP/CP Curriculum
The core curriculum involves 22 months of required AP rotations, 19 months of required CP rotations, and 7 months of elective time. Elective time may be spent performing additional months of core rotations, free-standing elective rotations, or research (up to 6 months). The 4-year rotation schedule (see attachment) entails 9 months of required AP and 3 months of required CP in PGY1, 3 months of required AP and 9 months of required CP in PGY2, and a more flexible and balanced admixture in PGY3 and PGY4. Chemistry, microbiology, and hematopathology are organized as 3-month blocks during the PGY2 year, in order to provide an opportunity for intensive, longitudinal exposure to core CP areas, with one additional advanced rotation month in each area as a senior resident. Surgical pathology rotations are similarly organized as 3-month blocks to the extent possible.
Required AP Rotations (22 months)
Autopsy 3 months
Surgical Pathology (FMLH) 11 months
Surgical Pathology (VA) 1 month
Cytopathology 3 months
Pediatric Pathology 2 months
Forensic Pathology 1 month
Required CP Rotations (19 months)
Chemistry 4 months
Hematopathology 4 months
Microbiology 4 months
Transfusion Medicine 3 months
Coagulation 1 month
Cytogenetics 1 month
Molecular Diagnostics 2 months
Elective Time (8 months)
In addition to extra months in core rotations, available electives include: flow cytometry, frozen sections, and research.
The MCW Pathology Residency Program has no research requirement for graduation from the program. However, research is strongly encouraged, and the department is committed to promoting an atmosphere of active academic inquiry, as well as satisfying ACGME program requirements and MCWAH benchmarks regarding academic participation for residents. The goal is to have 50% or more of residents participate in and present research during their training.
Resources available to support clinical and translation research are as follows: 1) consultative and technical support through the department’s Translational Core Research Facility, 2) discretionary funds for research available through individual faculty members, 3) research administrative support through the department research coordinator, 4) ready access to clinical database searches using a dedicated departmental server that mirrors the data in the Dynacare LIS, 5) support of travel expenses to present abstracts at National meetings.
Residents may use up to 6 months of elective time to pursue research projects. For all such research elective months, a faculty supervisor must be identified. The faculty supervisor will be responsible for ensuring that the resident is appropriately guided and engaged in their project during a given elective month, and will be responsible for performing the end of rotation evaluation.
Rotation Specific Goals and Objectives
Each rotation has a set of rotation-specific goals and objectives organized around the core competencies, including training level-specific competencies. All residents will receive the entire complement of rotation documents at the beginning of each academic year. Additionally, at the beginning of each rotation, the rotation director will provide the goals and objectives to the resident and discuss them face-to-face in order to clearly establish expectations for the rotation. A sign-off process ensures that this process occurs consistently.
Residents are evaluated formally at the completion of each rotation using a standardized electronic evaluation organized around the six core competencies. Each evaluation is discussed face to face with the resident, as well, with opportunity for written response. During multi-month rotations, a mid-rotation informal written and face-to-face evaluation is conducted to assess progress, provide constructive criticism, and provide suggestions for weak areas that require special attention.
On a semiannual basis, written evaluations of residents are performed by technical and support staff who interact with residents regularly, via aggregate evaluations by managers in several areas of the department and laboratory. Additional, anonymous semi-annual peer evaluations are accomplished via an anonymous web-based survey mechanism. Finally, rotating medical students will be asked to provide written evaluations of residents with whom they have worked at the end their rotations through the department.
Objective evaluation is accomplished by the annual Resident In-Service Examination, in which all residents participate, and by rotation-specific quizzes and exams. These primarily address medical knowledge, with lesser components of the other core competencies.
Teaching faculty are evaluated electronically and anonymously by residents at the completion of each rotation. These evaluations are provided to each faculty person at the end of the academic year. They also inform, along with feedback from the program director, the teaching evaluation portion of the annual written faculty reviews conducted by the pathology chair.
The conferences described below comprise the required departmental educational sessions for residents. The conference attendance policy (see attached) delineates which conferences are required for which residents. Attendance is monitored through sign-in sheets that are removed 10 minutes into the conference, and compiled in New Innovations. An overall conference attendance of 80% is required of each resident. Various other conferences (e.g., journal clubs, multidisciplinary conferences, CPC) are strongly encouraged but not required. The structure of the didactic and conference schedule is designed to provide continuous gains in knowledge and skills in the various content domains over the sometimes prolonged gaps between rotations in some areas.
Core Didactic Sessions
The core didactic curriculum is organized as daily 7:30 AM lectures, Tuesday through Friday, for the majority of the academic year, two CP and two AP sessions each week. Both the AP and CP curricula are designed to provide a comprehensive, annually repeating (or biannually in the case of microbiology) exposure to the entire spectrum of AP and CP content areas. CP lectures are organized either as traditional PowerPoint-based didactic lectures or structured interactive discussion sessions. AP sessions in most cases are organized as topical slide reviews with interactive discussion around a multi-headed microscope. The intent of the AP microscope sessions is to ensure resident exposure to essentially the entire range of neoplastic and non-neoplastic surgical pathology cases, including rarely encountered entities.
The first four Mondays of each month at 8 AM are dedicated to rotating unknown conferences: 2 surgical pathology, 1 hematopathology, and 1 cytopathology unknown conference per month. A pediatric pathology unknown conference occupies 5th Mondays (when they occur) on an ad hoc basis. Unknown slides are available several days in advance in most circumstances, allowing ample time for intensive study. Residents are expected to come to the conference prepared to discuss the following for each case: 1) pathologic features, 2) differential diagnosis, 3) appropriate ancillary studies for further evaluation, 4) clinical features of the various entities, 5) optimal format for communicating the salient information to the ordering physician. The process of preparing for these conferences, whereby residents identify gaps in knowledge and skills, and locates resources to remediate these gaps, builds habits for lifelong learning and improvement.
Peer Review Conference
Daily peer review conference for surgical pathology is held around the Chairman’s multiheaded microscope and is moderated by the chairman. This provides an opportunity for faculty and residents to review challenging or interesting surgical pathology cases. This serves both an educational and a quality assurance function for surgical pathology. Furthermore, the format, whereby attending staff bring cases for consultation with their peers, models one mode of lifelong learning and improvement.
CP Case Conference
This weekly, one-hour conference is divided into two parts. The first half of the hour is devoted to reporting of resident CP calls taken in the previous week. These are presented in a Powerpoint format as case vignettes with chronological details of the way events transpired. In involved cases, the residents often append small topical didactic presentations to a given call discussion. The call presentations are used as a springboard for interactive discussion of the salient issues involved in the call and, when appropriate, constructive criticism of the way a call was handled. This portion serves both an educational and quality assurance function. The second half of the conference is devoted to a resident case presentation. These rotate among residents and between the various CP areas, the latter in proportion to the annual resident-months in each respective area. These Powerpoint presentations typically involve presentation of a recent case with a fairly in-depth, didactic presentation that requires critical review and summary of relevant literature. Preparation requires the use of a variety of online resources. This learning experience addresses all of the six core competencies.
The Institutional Policy adopted by the Graduate Medical Education Council (GMEC) on 2/21/2005 states that “Each program will conduct a review of the work hours over 4 weeks at least twice a year by monitoring duty hours for all the residents/fellows. The data will be reported to MCWAH.” This is performed via New Innovations. Additionally, residents may report duty hour violations anonymously on the resident survey. Any deviations of duty hours from ACGME guidelines will be investigated by the program director, and remediation instituted.
Recognizing the limits imposed by law and ACGME requirements on the degree of autonomy permissible for a trainee, pathology faculty will strive to provide as much independence and responsibility as possible, commensurate with the abilities and progress of a given resident. The pace of this increasing autonomy will vary from resident to resident, depending on individual progress, and to some extent on the comfort level of individual faculty. However, by completion of training, all residents are expected to have attained the capacity to function entirely independently (although all cases will ultimately be reviewed by a member of the faculty).
Philosophically, from day one, residents are encouraged to take ownership of the case material for which they are responsible, i.e., shepherd cases from accession to completion, ensure that high standards of quality are met at every stage of the process, and think of themselves as integral parts of the health care delivery team. Residents are encouraged to “act like attendings,” during their training, thus building habits of thought and behavior to enable a smooth transition to post-training practice.
The following is an example of a reasonable sequence of acquisition of progressive autonomy in the context of surgical pathology. Note that the stages are not intended to directly correspond to PGY year.
Upon starting in surgical pathology as a PGY1, preview time will be relatively limited, as extended preview time is of limited value without a foundation of surgical pathology knowledge. Required special studies will be communicated to the resident by the faculty in the course of signout. Residents will essentially be expected to transcribe what their attending staff communicates regarding the microscopic description and diagnosis, and will be expected to proofread their reports to ensure accuracy.
As a foundation is gained, residents begin to preview at greater length, and begin to formulate differential diagnoses and impressions, and come prepared to provide those to the attending. The attending transitions to conveying the salient features of a case without giving specific word-for-word dictation of the wording of the microscopic description, diagnosis, or comment. Special studies continue to be discussed and ordered in the context of signout.
Residents dictate descriptions and diagnoses during preview, and make corrections following signout based on discussion during joint review. Basic special studies are ordered during preview.
Residents perform a complete work-up independently. Completed cases are delivered to the attending staff. As appropriate, at the discretion of both the attending staff and the resident, signout can be abbreviated to focus on cases in which the attending staff substantially modifies the trainees report and/or there are specific teaching points the attending would like to discuss or specific questions the resident would like answered.
In accordance with the new duty hour requirements, first year residents do not take call, they are assigned shifts. When a first year resident is scheduled for a night shift, it counts against their duty hours and they are given the appropriate amount of time off. Second through fourth year residents take call. This is at-home, beeper call for both Anatomic and Clinical Pathology. To the degree possible, residents handle calls independently, although obviously their ability to provide independent consultation is tied closely to their stage of training and progress in achieving competence and autonomy in the various content domains. A detailed weekly discussion of CP calls in the context of CP conference helps to establish the proper responses to various common types of CP calls, essentially building a collective memory amongst the residents for how to handle various situations. At all times, faculty covering each of the lab areas are available for phone consultation or, as necessary, for on site assistance handling difficult situations.
General Goals and Objectives for Pathology
The resident will acquire competency in the technical methods of production, interpretation, and effective delivery of laboratory results across the following areas: surgical pathology (including all subspecialty areas), autopsy pathology, cytopathology, forensic pathology, electron microscopy, hematopathology and hematology, microbiology, clinical chemistry, cytogenetics, molecular diagnostics, immunopathology, coagulation, and transfusion medicine. The resident will be proficient in the synthesis of data from diverse sources, including the electronic medical record, verbal communication with clinicians, other extant laboratory data, and targeted ancillary studies, to generate complete, accurate interpretations. The resident will also learn to produce concise, well-organized, and accurate reports that convey salient diagnostic information in a format that enables clinicians to efficiently deliver quality patient care. The resident will appreciate the pathologist’s role in rigorously assuring the quality of all laboratory results, in order to safeguard patient welfare. The resident will learn to work collaboratively within a multidisciplinary health care team, participating as clinical consultant and informing evidence-based decision-making and clinical management. In those situations where the resident has direct interaction with patients, families or donors, the resident will perform such interviewing, examination and counseling as may be required with caring and respect.
The resident will acquire knowledge of established and evolving biomedical, clinical, and epidemiologic sciences as applied to and relevant to the practice of pathology, understand their relationship to basic pathologic processes, and apply this knowledge to patient care. This includes specific knowledge of the current state of the art in pathology (e.g., detailed knowledge of the histopathology across the spectrum of human disease) and laboratory medicine practice, but also general medical knowledge in various clinical and basic disciplines that informs consultative pathology practice. Residents must also be familiar with management principles relevant to the operation of clinical laboratories, including quality assurance, regulatory and compliance issues, and patient safety.
Practice Based Learning and Improvement
The resident will develop skills and habits of continuous self-evaluation and improvement that will ultimately enable effective life-long earning. This includes developing an ability to critically evaluate and assimilate literature data, and incorporate this into practice to facilitate evidence-based care; effectively use information technology for managing data; apply research and statistical methods to laboratory data; analyze his/her practice using quality improvement methods; effectively internalize evaluation and criticism to improve practice; realistically appraise one’s strengths and weaknesses; and appropriately identify learning opportunities to remediate gaps in knowledge and skills.
Interpersonal and Communication Skills
The resident will develop interpersonal and communication skills, both formal and informal, written and oral, that result in the effective exchange of information and expertise with other health care providers, patients, patients’ families, and the public. Residents will learn to behave and interact with others in ways that promote a team approach to patient care and create a pleasant and productive working environment. Residents will learn to be willing, available, and informed clinical consultants.
The resident will develop a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population of patients and health care providers. He/she will learn to behave in a patient-centric fashion, putting the welfare of patients above personal concerns, and develop a work ethic appropriate to a profession that exists to serve others. Residents will learn the importance of accountability, transparency, altruism, and self-regulation as components of professionalism.
Systems Based Practice
The resident will develop knowledge and experience in laboratory management, in order to develop operational systems that deliver optimal patient care in an economic fashion. The resident will cultivate an awareness and responsiveness to the place of the laboratory in the larger context and systems of health care, and the ability to call on resources within the system to provide pathology services that are of optimal value. The resident will become aware that for healthcare processes to function properly, individuals must learn to work within and through the system to achieve goals.
Structure and Design of Program By Year With Training-Level Specific Goals and Objectives
At the beginning of the academic year, new residents receive a series of introductory lectures covering histopathology, basic grossing techniques, and orientation to the various clinical laboratory sections, focusing on issues likely to be encountered on call. After the introductory sessions, the core didactic curriculum begins. The first year curriculum consists of 6 months of surgical pathology, organized as two 3-month blocks, three months of autopsy, one month of molecular diagnostics, one month of coagulation, and one month of transfusion medicine. The six months of surgical pathology include one month on each of the surgical pathology subspecialty rotations at FMLH (GI; breast/GYN; GU/kidney/lung; bone/soft tissue/ENT/endocrine; derm) and one month of general surgical pathology at the VA hospital.
In surgical pathology and autopsy/neuropathology during the first year, residents learn basic gross and histopathology skills, along with skills for obtaining appropriate clinical histories from clinicians and the medical record, and communicating results verbally and through written reports. They also begin to learn to apply and interpret the results of ancillary tests (immunohistochemistry, cytogenetics, molecular diagnostics) in the work-up of patient specimens. The autopsy rotation also provides an opportunity to develop skills for integrating gross, microscopic, clinical, and laboratory information into cohesive pathophysiologic narratives. Initial rotations in Coagulation and Transfusion Medicine introduce the resident to the clinical laboratories and permit the resident to begin functioning as a clinical consultant. Through the preparation of intra- and inter-departmental presentations, the resident begins to polish his/her communication skills and proficiency in utilizing library and internet resources. Residents take evening and weekend call for both AP and CP beginning in the fall or early winter of their first year, which allows them to begin independent (but supervised) activity as a consultant in the medical center.
Medical Knowledge: Build foundational knowledge in basic histology, histopathology, and pathobiology; begin to be introduced to topics and illustrative cases in all subspecialty surgical pathology areas; begin to acquire depth of knowledge in coagulation and transfusion medicine; be introduced to molecular diagnostic as a critical ancillary technique in pathology and clinical medicine.
Patient Care: Acquire basic techniques for gross examination of surgical specimens and become proficient at autopsy prosection; begin to develop interpretive skills on slides, smears, and clinical laboratory test results; gain skills in obtaining relevant historical information for patient care from charts and other sources.
Interpersonal Skills and Communication: Begin to interact with clinicians and other health-care providers to obtain history and deliver results and interpretations; begin to learn modes of effective interaction within the laboratory and physician hierarchy; begin to compose effective autopsy, surgical, and clinical laboratory consultation reports; begin to give oral presentations.
Professionalism: Observe and begin to emulate professional behavior modeled by attending staff and colleagues; learn basic concepts of compliance, confidentiality, and ethics as applied to medicine; learn to recognize the importance of adhering to cultural and professional norms in the workplace; learn to be sensitive to diverse patient populations and co-workers.
Practice-based Learning and Improvement: Observe and participate in quality assurance activities such as peer review conference, autopsy conference, and CP conference; observe and participate in quality control and quality assurance activities in coagulation and transfusion medicine; review and refine basic skills in the practice of evidence-based medicine and review of relevant literature through journal club and independent use of library and Internet resources; become comfortable receiving constructive criticism; learn to self-identify gaps in knowledge and skills and begin developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Begin to learn appropriate utilization of testing through managing the work-up of autopsies and uncomplicated surgical specimens and through oversight of ordering of blood products in transfusion medicine; begin to appreciate how the laboratory interfaces with other service lines and hospital system in the delivery of cost-effective, timely, high-quality care.
The resident further receives a comprehensive overview of pediatric pathology, as well as refining skills and knowledge in surgical pathology through a two month block rotation at the Children’s Hospital of Wisconsin. The resident is expected to assume progressively greater responsibility for his/her surgical cases during this time. The remainder of the second year curriculum consists of three-month blocks on hematopathology, microbiology, and clinical chemistry. The resident will also have one month free for an elective. Unless the resident has strong interest in other areas, it is encouraged that they rotate in Cytology during this elective month. Overall, the intensive longitudinal experience in the clinical lab in the second year provides not only a thorough exposure to those areas of the laboratory, but also includes integrated instruction in laboratory management, both through didactic instruction and participation in real-time activities such as management meetings, trouble-shooting, instrument evaluation, quality control, QA/QI activities, proficiency testing, and preparation for accreditation visits. On the CP rotations, the resident also helps serve as a consultant to the send-out area of the laboratory, helping to ensure appropriate utilization of unusual tests, locations and requirements for testing, and interpretation of received results. During hematopathology, the resident learns basic and intermediate skills in interpretation of peripheral blood smears, and bone marrow samples. Also during this rotation, residents hone their skills in gathering clinical data from diverse sources and integrating this information with the results of morphologic and other laboratory analyses. Residents refine and expand skills in the application of ancillary testing to diagnostics, including an introduction to flow cytometry. Communication skills are further polished as the resident gives increasing numbers of presentations and literature reviews. The majority of residents begin to participate in clinical or translational research projects, although this is not a requirement. The resident continues to take AP and CP call for the clinical laboratories.
Medical Knowledge: Gain additional knowledge of histopathology and pathobiology through further exposure to surgical cases in the context of the pediatric pathology rotation; acquire depth of knowledge in microbiology, clinical chemistry, and hematopathology; begin to understand the principles, application, and interpretation of flow cytometry in hematopathology; further develop an understanding of the use of ancillary techniques in diagnostic pathology; learn basic principles of lab management as applied to the clinical laboratory; learn the basics of preparing research protocols and conducting clinical and translational research projects (optional).
Patient Care: Continue to develop skills in gross examination of surgical specimens; continue to develop interpretive skills on surgical slides; continue to develop skills in the application of appropriate and efficient workups to diagnostic specimens; develop intermediate-level skills in interpretation of laboratory test results in the areas of microbiology, clinical chemistry, and hematology; begin to learns interpretations of flow cytometry; refine skills in obtaining and integrating information from diverse sources in the develop of pathology interpretations.
Interpersonal Skills and Communication: Continue to interact with clinicians and other health-care providers to obtain histories and convey results and interpretations; continues to learn modes of effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; further develop skills in composing effective surgical and clinical laboratory consultation reports; enhance presenting skills; begin to develop teaching and mentoring skills by helping orient and teach first year residents and medical students.
Professionalism: Continue to develop concepts of professional behavior and begin acting as a role model for beginning residents and students; practice basic concepts of compliance, confidentiality, and ethics as applied to medicine; reinforce the importance of adhering to cultural and professional norms in the workplace; continue to develop sensitivity to diverse patient populations and co-workers.
Practice-based Learning: Continue to participate in quality assurance activities such as case reviews; observe and participate in quality control and quality assurance activities in microbiology, clinical chemistry, and hematology; continue to develop skills in the practice of evidence-based medicine and review of relevant literature through journal clubs, independent use of library and Internet resources, in depth literature reviews for research projects and through serving as a consultant to clinical services; continue developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Further develop appropriate utilization of testing through management of patient specimens; continue to develop an appreciation of how the laboratory interfaces with other service lines and hospital system in the delivery of cost-effective, timely, high-quality care; develop an appreciation of the importance of development and adherence to rational systems and processes for quality assurance and effective use of limited resources.
During year three, residents perform three months of cytopathology. This introduces the resident to the preparation and interpretation of cytologic specimens, as well as administrative and quality assurance aspects in cytopathology. In addition, the resident participates and attains competency in the performance of FNAs. A second, intermediate-level rotation through transfusion medicine allows residents to assume greater responsibility in the management of component therapy, transfusion work-ups, and therapeutic apheresis. An advanced rotation in coagulation consolidates knowledge of the laboratory work-up of bleeding and clotting disorders, and allows further refinement of quality assurance and management issues related to the clinical laboratory. A required cytogenetics month allows hands on exposure to the techniques of karyotyping and FISH analysis, as well as practical and didactic exposure to the application of cytogenetics to constitutional and acquired disorders. Additional months on surgical pathology (3-4) allow continued, in-depth refinement of subspecialty area expertise, as residents rotate through subspecialty areas for a second time. The majority of residents complete their Medical Examiner rotation in the third year, providing additional training in autopsy prosection and introducing them to the specialized aspects of the forensic autopsy, crime-scene investigations, and courtroom experiences for criminal cases. Advanced rotations in microbiology and/or chemistry may be taken in the third year. These allow reinforcement of previously acquired knowledge in these areas, opportunity for developing additional depth of knowledge, further refinement of skills as a clinical consultant, and honing of knowledge and skills related to laboratory management. The residents may also do a final pediatric month at Children’s Hospital of Wisconsin. Finally, the third year provides elective time, which can be used to obtain additional expertise in areas of interest or work on clinical or translational research projects. Residents continue to take AP and CP night and weekend call.
Medical Knowledge: Learn basic and intermediate concepts in interpretation of cytopathologic preparations from various organ systems; gain knowledge in techniques for obtaining and preparing cytopathology slides; deepen knowledge of histopathology and pathobiology through further exposure to topics and illustrative cases in subspecialty pathology areas; reinforce and deepen knowledge to a level of basic proficiency in microbiology and chemistry (if advanced rotations are taken during third year); become familiar with the techniques employed in generating and interpreting cytogenetic tests, and understand how these are applied to diagnostic pathology and clinical medicine; enhance autopsy prosection skills and gain basic knowledge regarding forensic sciences; learn the basics of preparing research protocols and conducting clinical and translational research projects.
Patient Care: Refine skills in basic and more specialized techniques in autopsy prosection and gross examination and microscopic interpretation of surgical specimens; develop interpretive skills on cytologic preparations; continue to build knowledge regarding the use of ancillary studies in diagnostic pathology and achieve greater autonomy in the work-up of cases; refine skills in interpreting and providing clinical consultation regarding laboratory test results, especially in chemistry, microbiology, and cytogenetics; continue taking service call for surgical pathology and the clinical laboratories, further developing comfort and skills in the role of independent consultant.
Interpersonal Skills and Communication: Refine skill in interacting with clinicians and other health-care providers to function as an integral part of the healthcare delivery team and provide optimized patient care; refine effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; refine skills in composing effective autopsy, surgical, and clinical laboratory consultation reports; refine skill in giving oral presentations through additional practice; continue to develop teaching skills through orientation and teaching of new residents and medical students.
Professionalism: Further refine concepts of professional behavior and continue to act as a role model for peers, beginning residents and students; practice basic concepts of compliance, confidentiality, and ethics as applied to medicine; reinforce the importance of adhering to cultural and professional norms in the workplace; continue to develop sensitivity to diverse patient populations and co-workers.
Practice-based Learning: Continue to participate in quality assurance activities such as case reviews; observe and participate in quality control and quality assurance activities in clinical pathology rotations; continue to develop skills in the practice of evidence-based medicine and review of relevant literature through journal clubs, independent use of library and Internet resources, in depth literature reviews for research projects and through serving as a consultant to clinical services; continue developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Further develop appropriate utilization of testing through managing of patient specimens; continue to develop an appreciation of how the laboratory interfaces with other service lines and the hospital systems in the delivery of cost-effective, timely, high-quality care; further develop an appreciation of the importance of development and adherence to rational systems and processes for quality assurance and effective use of limited resources.
In the final year of training, residents complete their required rotations in the surgical pathology subspecialty areas (2-3 months), having rotated through each of the areas at least twice, allowing development of diagnostic competence in all subspecialty areas. A senior rotation in hematopathology allows reinforcement of material learned on the second year rotation, but also allows increase in depth and breadth of these knowledge and skills, including more intensive exposure to flow cytometry. If not performed during the third year, advanced rotations in microbiology and chemistry allow reinforcement of previously acquired knowledge in these areas, opportunity for developing additional depth of knowledge, further refinement of skills as a clinical consultant, and honing of knowledge and skills related to laboratory management. An advanced rotation in molecular diagnostics allows reinforcement of basic knowledge and techniques, but also an opportunity to keep pace with the cutting edge applications for clinical diagnosis and translational research. A senior transfusion medicine elective allows further development of independent competency in the management of component therapy, transfusion work-ups, and therapeutic apheresis, as well as exposure to more esoteric testing during two-weeks spent at the Blood Center of Wisconsin’s downtown facility. Finally, additional elective months are used to obtain expertise in areas of interest or work on clinical or translational research projects. Residents continue to take AP and CP night and weekend call.
Medical Knowledge: Achieves competency in the knowledge of anatomic pathology and hematopathology through further exposure to topics and illustrative case; achieves competence in clinical pathology through additional study, call, and advanced and elective rotations; achieves competency in knowledge related to laboratory management through study and hands on involvement in advance CP rotations.
Patient Care: Achieve competency in techniques in autopsy prosection and gross examination and microscopic interpretation of surgical and cytologic specimens; achieve competency in interpretation of laboratory test results, through service and call activities; achieves competency in laboratory administration through study and hands on participation in management activities in advanced CP rotations.
Interpersonal Skills and Communication: Achieve competency in interacting with clinicians and other health-care providers to function as an integral part of the healthcare delivery team and provide optimized patient care; achieve competency in effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; achieve competency in composing effective autopsy, surgical, and clinical laboratory consultation reports; achieve competency in giving oral presentations; achieve competency in teaching skills through orientation and teaching of new residents and medical students.
Professionalism: Have fully internalized concepts of professional behavior and act as a role model for peers, junior residents and students; practice basic concepts of compliance, confidentiality, and ethics as applied to medicine; adhere to cultural and professional norms in the workplace; be sensitive to diverse patient populations and co-workers.
Practice-based Learning: Fully internalize the importance of quality assurance activities in both anatomic and clinical pathology; achieve competency in the practice of evidence-based medicine and critical review of relevant literature; solidify habits that will allow an individual program of continuous lifelong learning.
Systems-based practice: Achieve competence in the appropriate utilization of testing through managing of patient specimens; appreciate how the laboratory interfaces with other service lines and the hospital systems in the delivery of cost-effective, timely, high-quality care, and the pathologist’s role in enabling this process; appreciate the importance of development and adherence to rational systems and processes for quality assurance and effective use of limited resources.