Residency Training Program Manual and Additional Reading

Residency Training Manual 2009

Shifting Paradigms: From Flexner to Competencies

Rethinking Pathology Residency Training

Residency Training Program Overview

DEPARTMENT OF PATHOLOGY
THOMAS JEFFERSON UNIVERSITY HOSPITAL
AND JEFFERSON MEDICAL COLLEGE

RESIDENCY TRAINING IN ANATOMICAL AND CLINICAL PATHOLOGY

I. TRAINING OBJECTIVES

The major goals of our program are to provide flexible and comprehensive training for physicians planning careers in diagnostic pathology in an academic setting or in community hospital practice. In addition, the Department provides basic and clinical research opportunities for individuals who wish to combine clinical diagnostic training with current research technology in molecular biology and genetics. The program is structured in accordance with the guidelines of the ACGME and RRC pathology and provides comprehensive didactic, hands on experience designed to develop basic competencies, in all facets of anatomic and clinical pathology as well as research.  Comprehensive learning objectives, evaluation tools and outcome assessment are been derived in accordance with the ACGME outcome formatted residency program  (see http://www.acgme.org)

II. TRAINING PROGRAM

The basic program provides training necessary for certification in both Anatomical and Clinical Pathology and consists of a thirty-six month rotation (the Core Program) through all of the areas of pathology.  The fourth year is planned on an individual basis to provide rotations in the more specialized areas of Anatomic and Clinical Pathology, and to concentrate on one or two areas of special interest. Additional training in most areas of Anatomic Pathology and Clinical Pathology is available in approved fellowship programs in Cytopathology, and Hematopathology.  All residents pursue training in both anatomic and clinical pathology.

AFFILIATED INSTITUTIONS

The Department has formed affiliations with the Department of Pathology at the Children's Hospital of Philadelphia and the Medical Examiner's Office in Philadelphia. These two affiliates provide rotations of 1-6 months in duration for training in Pediatric Pathology and Forensic Pathology, respectively. Staff Pathologists from a number of Philadelphia hospitals hold affiliate Faculty positions in our Department and all welcome Jefferson residents for "mini-rotations" with the intent of providing an opportunity to directly observe the practice of Pathology in a community in the Philadelphia metropolitan area. Opportunities to meet the affiliated faculty occur in the context of the teaching program for Jefferson medical students.

SCHEDULE

Anatomic Pathology Core Program:

Anatomic Pathology (advanced):

Anatomic Pathology Total: 24 months

Clinical Pathology Core Program:

Clinical Pathology (advanced):

Clinical Pathology Total: 24 months

Elective Rotations in Anatomic Pathology:

1. Any core [advanced level] rotation
2. Advanced Subspecialty Area

Genitourinary Pathology
Gynecologic Pathology
Gastrointestinal Pathology
Hepatic Pathology
Pulmonary Pathology
Renal Pathology
Immunopathology
Molecular Diagnostic Laboratory

Elective Rotations in Clinical Pathology:

1. Advanced training in core rotation subspecialty (E.g. Clinical Hematology/Hematopathology)
2. Informatics -- Communication technology
3. Management and Medical Administration

SURGICAL PATHOLOGY

Dr. Peter McCue, Director Surgical Pathology. Full-time staff consists of Brian O’Hara, M.D., Mary Cunnane, M.D., Juan Palazzo, M.D., John Farber, M.D., Raphael Rubin, M.D., Agnenieszka Witkiewicz, M.D., Moira Wood, M.D., Anthony Prestipino, M.D., Madalina Tuluc, M.D.

All members of the staff are committed to active and interactive residency training in this key discipline.  In addition, the surgical pathology fellow and senior residents participate in work assignments and assist the junior residents in the examination and preparation of diagnostic material.  Two Pathologist Assistants are assigned to Surgical Pathology.   The basic Surgical Pathology experience is 12 months with an opportunity to extend this time during electives.

Patient cases are signed out and reported each morning and/or as required.  A scheduled rotation permits each resident to participate in the preparation and diagnosis of all types of cases.  Experience will be gained in a variety of techniques including frozen section, diagnosis and interpretations of special stains, immunostains, electron micrographs and molecular.  Residents are provided with an opportunity time to review the slides of cases they will sign out with a Staff Pathologist the following morning. 

 A case review conference is held daily at which difficult and/or interesting cases are presented to the entire surgical pathology attending and resident staff for review.  In addition, there is a weekly didactic seminar, which reviews some aspect of surgical pathology.  Senior residents actively participate in these sessions as well as the numerous interdisciplinary clinical conferences in which the pathology department plays an integral part.

The progress of resident learning of diagnostic surgical pathology is both evaluated and assisted by the participating staff.  The hands-on learning of the residents is supported by the conferences and seminars noted above.  The involvement of virtually all residents during recent years in clinical related research projects in collaboration with the Surgical Pathology Staff reflects the active nature of the residency training.

AUTOPSY SERVICE

Lawrence Kenyon, M.D., Ph.D. Director Autopsy Service, additional staff consists of John Farber, M.D., David Strayer, M.D., Ph.D., Renato Iozzo, M.D., Fred Gorstein, M.D., Raphael Rubin, M.D., Tina Edmonston, M.D., Moira Wood, M.D., William Kocher, M.D., and Mark Curtis, M.D. Residents and staff members participate in a weekly interdisciplinary Autopsy Conference where gross and microscopic findings of current autopsy cases are presented.

Residents rotate on the Autopsy Service for a total of five months in 1-2 month blocks during the first two years of the residency program.  Additional opportunities to perform autopsies are present throughout the four years of residency in the context of the weekend on-call schedule.  In addition, senior residents gain further experience supervising junior residents in the performance and evaluation of autopsy examinations.  Additional experience in autopsy pathology is gained during the forensic pathology rotation at the Medical Examiner’s Office (see Forensic Pathology description).  Autopsies are performed in a state-of-the-art facility for isolation of infectious, communicable cases.  Photographic equipment for documentation of gross findings is present within the autopsy room.

Resident responsibility during this rotation includes:

1. Performance of the autopsy under supervision of the staff pathologist and the Director of the Autopsy Service;
2. Presentation of the case with clinical correlation at a weekly gross conference;
3. Analysis of the histological findings;
4. Correlation of the clinical history, gross, and histopathologic findings in the creation of a comprehensive autopsy report under the supervision of the staff pathologist.

Resident performance is based on an evaluation of the accuracy of gross and microscopic examination, as well as the quality and timely completion of autopsy reports.

CYTOPATHOLOGY

Marluce Bibbo, M.D., Director, Moira Wood, M.D., Associate Director. The basic rotation is 3 months in duration. The principal goal is to provide basic and advanced training in all aspects of cytopathology including fine needle aspiration and research techniques applied to cytopathology in preparation for diagnostic proficiency in this discipline. 

Residents are actively involved in the sign-out of current cases with attending cytopathologists.  In addition, 4000 glass slide study sets are available for review with emphasis on correlation of cytology findings and surgical pathology diagnoses.  Residents review all consultation cases referred to the Department.

Residents are actively involved in the procurement and on-site evaluation of fine needle aspiration biopsies.  The cytology fellow assists in the training of residents.

Opportunities for research experience in collaboration with Staff Cytopathologists are available for additional elective time following the mastering of the basic cytopathology principles during the initial three-month rotation.

NEUROPATHOLOGY

The members of the Neuropathology division are Dr. Mark Curtis and Dr.
Lawrence Kenyon.  The Director of the Neuropathology division is Mark Curtis,
M.D., Ph.D.   Lawrence Kenyon, M.D., Ph.D. is assistant director.   The
Neuropathology rotation is one month in duration.

The resident on the Neuropathology rotation manages all neuropathology cases including neurosurgery pathology cases, neurosurgery/ENT pathology cases, nerve biopsies and muscle biopsies. Residents are instructed in diagnostic approaches to neoplastic, infectious, inflammatory and degenerative central nervous system processes. Residents review the case including immunohistochemical stains and special studies prior to review of case with the attending pathologist. Residents are responsible for obtaining pertinent clinical information and information on imaging studies prior to daily sign-out. The residents participate in daily case sign-out. Interpretation of nerve biopsies involves ultra-structural analysis of biopsy material. Interpretation of muscle biopsies involves interpretation of enzyme based histochemical stains in addition to standard stains. The resident covering neuropathology is also responsible for preparation of intra-operative "touch preps" and frozen sections on Neurosurgical cases. A comprehensive lecture covering multiple aspects of neuropathology including CNS trauma, Central Nervous System vascular pathology, CNS infectious disease, Degenerative Disorders of the Brain and spinal cord and on regarding congenital CNS disorders is also available.

Because of the large number of cases and interesting range of cases,
opportunities for the generation of case reports are frequent. Residents also attend clinical conferences in the Departments of Neurology and Neurosurgery.

Opportunities for research in Neuroscience at Jefferson, is available to the Resident.

FORENSIC PATHOLOGY

During this one month rotation, under the direction of Samuel P. Gulino, MD, Medical Examiner of City of Philadelphia, the Pathology resident has the opportunity to determine the cause of death and the circumstances surrounding the deaths of persons coming under the jurisdiction of the Medical Examiner. This includes scene investigations and the instruction in the performance of the forensic autopsy. When needed to complete the cause and manner of death, the resident participates in evaluating microscopic slides of toxicology reports. The residents participate in morning "rounds" where all cases are discussed, and under staff supervision, assist in the medico legal autopsy. Forensic toxicology is emphasized. In addition, residents are expected to attend all conferences held by the Medical Examiner and staff of five forensic pathologists and attend court where sessions deal with forensic pathology. Opportunities for additional elective time at the Medical Examiner's office with involvement in research projects are readily available.

PEDIATRIC PATHOLOGY

Residents generally receive their Pediatric Pathology training at the Childrens Hospital of Philadelphia (CHOP) under the direction of Drs. Bryan Wolf and Eduardo Ruchelli. An alternate rotation in Pediatric Pathology is also available at the AI Dupont Hospital for Children. The specific goal of the Pediatric Pathology rotation is to develop an appreciation in the resident for the uniqueness of pediatric pathology and the significant differences between the disorders of adults and children. The major emphasis is on learning the specific approach to the diagnostic challenges of pediatric autopsies. The resident would also become familiar with classic surgical lesions of the pediatric population. Following the rotation on both surgical and autopsy services, the goal is to convey a sense of the breath of pediatric pathology concepts rather than a list of facts. The rotation is one to two months in duration. Residents are actively involved in examination of surgical specimens and performing autopsies under the supervision of the attending staff. The attending staff directly involved with the trainees, monitors the residents progress and performance.

ELECTRON MICROSCOPY ROTATION

The Electron Microscopy Laboratory is under the direction of Renato V. Iozzo, M.D. The EM rotation for residents is four weeks long. During the first week, basic principles of electron microscopy including fixation, processing, thick and thin sectioning, and the operation of a modern transmission electron microscope. The residents are subsequently involved in scoping the cases personally, interpreting the electron micrographs and finally writing up the reports under the supervision of the Attending Pathologist. The clinical, anatomical and immunohistochemical data are generally integrated with the ultrastructural findings. During this rotation, therefore, the residents are exposed to a wide variety of ultrastructural pathology that is crucial to the development of their diagnostic skills.
CLINICAL IMMUNOLOGY

CLINICAL IMMUNOLOGY

The Clinical Immunology Laboratory is under the direction of Laura McCloskey, PhD. As part of the Microbiology rotation, the laboratory provides the resident with a basic understanding of the technology and instrumentation utilized in the evaluation of wide range autoimmune serology procedures, their underlying principles and clinical application. The laboratory staff directly supervises the residents in mastering the knowledge base and competence in performing the components of the above program.

MOLECULAR PATHOLOGY ROTATION

The Molecular Pathology Laboratory and rotation is under the direction of Tina Bocker Edmonston, MD. The laboratory performs approximately 2,100 assays per year comprised of 1,100 oncology assays (of which 800 are PCR or RT-PCR based and 300 are FISH studies) and 1,000 special microbiology studies. All clinical molecular studies are performed in a central laboratory site. Additionally, the microbiology lab performs molecular studies of various microorganisms.

The goals of this rotation are to provide the resident with a fundamental of the clinical interpretation and physiologic basis of nucleic acid-based testing in genetics, oncology and infectious disease; the genetic, molecular and instrumental principles underlying nucleic acids-based testing, and principles of quality control, emphasizing specific issues in nucleic acid- based testing.

The specific competencies that the resident will achieve include,

Patient care, medical knowledge and practice based learning: Interpretation of all studies conducted routinely in the laboratory (PCR for micro-satellite analysis, IgH and TCR gamma gene rearrangement, unequal X inactivation analysis, RT-PCR for BCR/ABL, hybrid capture analysis for HPV, and FISH studies for chromosomal rearrangements, deletions and Her2/neu amplification, quantitative PCR for HBV, HCV and CMV. Understanding pre-analytic and analytic variables affecting each of the assays. Understanding the sensitivity and specificity of molecular tests and FISH compared to light microscopy, flow cytometry, and karyotyping.

Communication skills and professionalism: Interaction with lab director and staff, as well as colleagues in pathology and clinical disciplines. Presentation and discussion of results and topics in molecular pathology.

System based practice: Understanding of workflow, Utilization of resources to improve lab services, Participation in QC/QA/QI, awareness of legal and ethical issues in molecular diagnostics.

The resident will have daily exposure to performance and interpretation of all tests currently conducted in the laboratory with emphasis on clinical relevance and appropriateness, test interpretation, methodological principles, quality control, and management. The resident will have the opportunity to extract DNA from blood and perform a DNA amplification control PCR. The PCR products can be run on an Agarose gel and/or by capillary electrophoresis.

The resident is required to read the following:

Clinical Diagnosis and Management by Laboratory Methods, 20th ed., Henry, 2001, chapter 56, 58-68, Principles of Molecular Pathology, Killeen, 2003, SOPs for all current tests.

The resident will attend the following conferences:

Weekly laboratory meetings (Director and staff), weekly Clinical Pathology lecture series, weekly Monday CP rounds, weekly HemeOnc Cardeza conference, monthly quality assurance/improvement conferences. Presentation to laboratory staff of a topic of interest, presentation at CP rounds and presentation of cases at Cardeza conference.

CYTOGENETICS

Residency training during the one-month rotation in the Cytogenetics Laboratory consists of direct participation in the analysis and interpretation of cytogenetic and FISH studies. Competencies for resident training are detailed in the Resident Manual and include cytogenetic analysis of amniotic fluid, chorionic villi, peripheral blood, solid tissue biopsies, and bone marrow samples. Additional molecular biology studies include in-site hybridization and FISH on appropriate clinical material.

Pathology residents participate in the review of all abnormal cases and are given the opportunity to write descriptive reports in selected cases. Each resident on a personal blood sample performs the technical aspects of all culturing and karyotype evaluation. The rotation acquaints the resident with the principles of interpretation of cytogenetics studies such as the differential diagnosis of pseudo-mosaicism and true mosaicism in prenatal studies and clonal aberrations of a variety of neoplasms. The importance of quality control is stressed and familiarity with the quality assurance program of the laboratory is required. Opportunities for further elective research projects in the Cytogenetics laboratory are available following successful completion of the Cytogenetics rotation.

HEMATOPATHOLOGY

The Hematopathology Laboratory is under the direction of Drs. William Kocher and Eric Behling. The duration of this rotation is four months, including two mandatory months in coagulation service, with opportunity to extend this period during elective rotation.

During the Hematology rotation, the residents initial exposure to the service will consist of two consecutive months of training during either the first or second year of residency. During these first two months, the emphasis will be on general principles of Hematology, including the structure and function of the hospital Hematology Laboratory (including Urinalysis and Body Fluid analysis), and basic morphology of blood, bone marrow, and lymph nodes and the diseases that affect these tissues. In the remaining two mandatory months (usually taken during the third and fourth years of residency), the resident will be given increased responsibility and the emphasis of the rotation will shift to development of diagnostic skills and clinicopathologic correlation. Integration of routine morphology, cyto/immunohistochemistry, flow cytometry, molecular diagnostics, and cytogenetics in the diagnostic process will be stressed. Recommended is an additional month (fifth month), during which the resident will rotate through the clinical Hematology service and Cardeza Special Coagulation Laboratory. This rotation will allow the resident to observe and perform bone marrow aspiration and biopsy, as well as improve their understanding of coagulation.

HEMATOLOGY AND COAGULATION SERVICE

The Hematology Laboratory is under the direction of Drs. William Kocher, Eric Behling, and Gene L. Gulati, who comprise the senior staff. The duration of the Hematology rotation is two months.

The goals of this rotation are to acquire factual experience in the technical aspects of a variety of test procedures:

1. Routine hematology instrumentation
2. Morphologic hematology - peripheral smears, bone marrow aspirates, and biopsies
3. Coagulation tests, routine and special - PT, PTT, fibrinogens, Dimes, and lupus inhibitors
4. Serum and hemoglobin electrophoresis

In addition, residents receive instruction in laboratory management and quality control appropriate to Hematology Laboratory operations.

Flow cytometry laboratory experience  serves to acquaint the resident with the principles and interpretation of this technique as applied to hematologic disorders. Residents on the Hematopathology Service spend two weeks in the flow cytometry service laboratory under the supervision of Drs. Kocher, Behling and the technical staff. During this time the resident is expected to gain a basic understanding of the technical and interpretational aspects of  flow cytometric as well as an understanding of the limitations of flow cytometry as an ancillary technique, and correlating flow cytometry findings with other hematologic assays. The areas covered include the following:

1. Principles of the optical and fluidic components of a flow cytometer
2. Calibration of the machine
3. Aspects of quality control and quality assurance
4. Preparation and staining of cell suspensions for flow cytometric analysis
5. Application of interpretational software for surface marker and DNA analysis
6. Interpretation of histograms obtained from malignant and non-malignant hematologic disorders
7. Knowledge of commonly used diagnostic markers, understanding the applications of the CD classification

Under the supervision of a Clinical Hematologist, each resident performs 5-10 bone marrow aspirations/biopsies during the rotation.  The resident actively participates in the diagnostic daily work conference over multiple-headed microscopes.  The residents’ performance and progress is monitored by the Attending Staff directly involved in the residents’ training.

The director of the Clinical Chemistry Section is Saleh Ayache, M.D. The rotation is four months with opportunities to expand this period of training during subsequent electives.

The goal of the rotation is the teaching of basic and advanced Clinical Chemistry by daily interaction with the Supervising Directors and Clinical Chemistry Fellow. The residents are formally oriented in the use of computerized data bases, research and laboratory management issues in Clinical Chemistry and legal aspects of Clinical Chemistry.

The residents have daily responsibilities of serum, urine, and CSF protein electrophoresis and hemoglobin electrophoresis. In addition, the residents have call Responsibilities of evaluation of special test requests, and miscellaneous inquiries by clinicians related to the chemistry laboratory in patient care. A one-week elective toxicology rotation has been established.

Opportunities for research in Clinical Chemistry/Endocrinology under the supervision of the Director are available.

Donald Jungkind, Ph.D., who is directly responsible for the Residency Training Program in clinical microbiology, directs the Clinical Microbiology Laboratory.

The rotation in Microbiology, three months in duration, is organized as a series of bench stations supervised by the Attending Staff and laboratory personnel, supplemented by multiple additional educational experiences including:

1. Daily rounds with Staff where unusual cases, susceptibility pattern and laboratory management are discussed.
2. Weekly didactic sessions with staff covering a variety of topics.
3. Identification of unknown specimens and proficiency specimens.
4. Introduction to new technologies by using probes in our laboratory including PCR.
5. Serving as consultants to clinicians regarding unusual tests requests and results.
6. Examining patients and procuring pertinent medical history data.
7. Reviewing results from reference laboratories.
8. Presenting cases at infectious disease conference.

The above spectrum of activities and responsibilities are outlined in a schedule presented to the resident at the beginning of the rotation. The Staff directly supervising the residents throughout the rotation evaluates the performance and progress of the resident.

TRANSFUSION MEDICINE (BLOOD BANKING)

Transfusion Medicine/Blood Banking is under the Directorship of Drs. Jay Herman and Saleh Ayache. Three or four months are usually spent on this rotation, allowing adequate exposure to all aspects of Transfusion Medicine. TJUH has its own Blood Donor Program, a busy Therapeutic Apheresis Service, and transfuses over 60,000 blood products annually. Regular hours are Monday through Friday, 8:00 a.m. to 5:00 p.m., with some call from home during rotation months.

Approximately half of the time is spent providing service and in direct observation, and about half the time is spent in other academic pursuits. Resident training is guided by a self-administered checklist and each resident prepares a didactic presentation for the Clinical Pathology Resident Conference. The service schedule includes Clinical Pathology Residents and Hematology Fellows on rotation, and is managed by the Blood Bank Fellow. Supervision is provided by the Transfusion Medicine Attending on service that week. When scheduled to have service responsibility, the Resident is expected to be present or immediately available to the staff. The Resident acts as liaison between house physicians and the Blood Bank staff gathering medical data from charts and attends scheduled conferences, rounds, and Transfusion Committee meetings, as well as department education activities.

The curriculum includes, but is not limited to, pre-transfusion testing, compatibility testing, resolution of antibody problems, therapeutic apheresis and the administration of blood and blood components to various patient populations including Trauma, Hematologic Malignancy, Organ Transplantation, Oncology, Neonatology, Orthopaedics, Neurosurgery, Stem Cell Transplant, and Sickle Cell Disease. Past residents have readily gained experience and developed competence in Transfusion Medicine on this rotation.

MANAGEMENT/INFORMATION SYSTEMS

This area of residency training is presented in the form of didactic lectures, shadowing and multiple hands-on computer sessions; the latter primarily oriented toward the first year residents.  Faculty involve in this program include Laboratory Administrators as well as selected Departmental Directors.  Attendance at Administrative Meetings as well as accompanying faculty staff members to the Departmental and Hospital quality assurance committee meetings will provide first-hand experience in this facet of laboratory management.

Lectures address various topics including cost analysis of instrumentation, regulation compliance (CLIA, OSHA, FDA, CAP), budget preparation, personnel management and QA procedure critique. Residents are involved in management/administrative activities and decision make in each rotation, are expected to engage in the evaluation of options in relation to laboratory operations, resource utilization and quality assurance activities.  A month elective rotation in Management/Information is offered at   the senior resident level during which time the resident assumes responsibilities of the “associate director of laboratories” Residents are provided with comprehensive review of governmental regulatory programs, legal medicine, JCAHO, CAP, ACGME, RRC path, managed care, and other aspects of the “System basis for Pathology Practice”.  Residents play a key role in developing and refining basic competencies, learning objectives, evaluation tools and outcome assessment in each of the six ACGME formatted    residency program by participating in work groups and in the individual laboratory rotations.

The training of the residents in laboratory computer technology addresses the learning objectives and specific goals related to the functional knowledge and architecture of all information systems of the Institution including the Misys LIS and CoPath plus systems and JeffChart HIS.   Residents develop individual skills in PC Microsoft word processing, spreadsheet and database programs, and the operation of the departmental LAN.  Applications dedicated to resident activities are available to the residents from work areas and in addition, computers are available in multiple locations within the Department for access to the above software and in selected sites for computer library search facilities.  State of the art digital imaging equipment is available on site for resident use and encompasses a variety of input and output sources. Residents are each provided with hand held devices, which are employed for maintaining schedules, notes, and case logs.  The latter functions are currently being expanded to permit Internet access at each resident workstation.   Residents participate in hands on workshops in which the basic hardware components are dissembled and reassembled. Principles of basic maintenance are reviewed.

III. RESEARCH AND TEACHING OPPORTUNITIES

Throughout the program, residents are encouraged and expected to investigate clinical and/or laboratory problems that arise during their daily activities.  All residents engage in scholarly activities.   Advice and assistance from the Attending Staff are readily available, and residents are encouraged to prepare the results of their investigations for publication or presentation at national meetings. The residency program is structured to facilitate up to six months of dedicated research during the residency program in accordance with the recommendations of the American Board of Pathology.  However, if desired, residents may  take leave of the structured rotations for additional  periods of three to twelve months to devote full time to a research project. Departmental funding outside of the residency program is available and such extended research activities are generally not included in the basic program structure.   Most resident perform projects of a smaller scale that are conducted during elective rotations.  Prior to elective rotations, a formal proposal must be submitted to the chief resident and Director of Residency Training for approval.  All elective rotations off site require the approval of the Hospital GME Committee and Hospital Executive Director.  During the past 30 months the residents and fellows of the department have published in excess of 62 peer reviewed studies in leading medical journals. 

Teaching opportunities, exclusive of intra- and inter-departmental conferences, are in the context of multiple established courses in the Medical Center.  Residents are currents involved in a teaching capacity in the General Pathology course taught to sophomore medical students and three additional courses to students in Allied Health fields in the Medical Center.  Senior residents perform the majority of such teaching; however, outstanding junior residents also participate.

IV. RESIDENT EVALUATION

To monitor the progress of residents who have been accepted in the Jefferson program, formal written evaluations are completed by the Departmental Staff directly supervising each resident at the end of the rotations. The Director and Residency Training Program Advisory Committee discuss the evaluations with each resident on a regular basis, but no less than twice a year. Semiannual and annual summary evaluations are completed by the Residency Advisory Committee and the Program director, and discussed individually with each resident.

Reciprocally, the residents complete formal evaluations of the rotations they fulfill each year and submit them to the Chief Resident(s). An abstracted form of these evaluations is forwarded to the Director of Residency Training in a manner to preserve anonymity and ensure thorough feedback. Yearly, the Department administers the ASCP-sponsored in service examination. Computed scored results are made available to all participants and the material that constitutes the examination is review in regular conferences.

V. AFFILIATED INSTITUTIONS AND RELATED ACTIVITIES

The Department has formed affiliations with the Department of Pathology at the Children’s Hospital of Philadelphia and the Medical Examiner’s Office in Philadelphia.  These two affiliates provide rotations of 1-6 months in duration for training in Pediatric Pathology and Forensic Pathology, respectively.  Staff Pathologists from approximately 20 Philadelphia hospitals hold affiliate Faculty positions in the Department and all welcome Jefferson residents for “mini-rotations” with the intent of providing an opportunity to directly observe the practice of Pathology in a community in the Philadelphia metropolitan area.  Opportunities to meet the affiliated faculty occur in the context of the teaching program for Jefferson medical students.

TYPES AND NUMBERS OF APPOINTMENTS

The current staff consists of 15 residents in the AP/CP program with clinical fellows in Cytopathology, Hematopathology, and Dermatopathology. An affiliated surgical pathology fellowship program at Fox Chase Cancer Center is available. Jefferson Medical College and Thomas Jefferson University Hospital offers residency and fellowship positions in 52 specialties and subspecialties.

FACILITIES

Thomas Jefferson University is situated on six square blocks in the Center City area of Philadelphia. Separate facilities have been provided for teaching, research, and patient care. A new radiation therapy center, one of the most advanced of its kind in the country, is available. The Medical Center has a large Emergency Department facility, a new Outpatient Testing Center and an Ambulatory Practice facility that will be occupied in the near future. There is a fully equipped autopsy suite operated by the department Decedent Affairs office, modern laboratories for surgical pathology and cytopathology were recently completed, and new laboratories for immunopathology, cytogenetics, flow cytometry, and molecular pathology. The Hospital has a total of 957 beds, had 32,965 admissions in the most recent fiscal year, and had an average occupancy of 89%. Jefferson is affiliated with a number of hospitals in the Delaware Valley which constitute the Jefferson Health System, and maintains joint programs and special relationships with others. Pathology Department activities are housed in several buildings with a total of 70,000 square feet for laboratories and offices. Clinical Pathology Laboratories are located on three floors of the Foederer Pavilion. The Cytopathology and Surgical Pathology Laboratories are located on the second floor of two adjoining building. Teaching and research are done in the College Building, Jefferson Alumni Hall, Pavilion, and the Kimmel Research Center. The Alcohol Research Center and other research laboratories occupy facilities in Jefferson Alumni Hall. Each resident is provided with a dedicated computer workstation with internet access. Last year, the number of autopsies performed was 114, surgical specimens, 25,831, cytology cases, 20,586 and clinical laboratory tests over two million. The Samuel Parsons Scott Memorial Library contains approximately 140,000 volumes and 1,800 journals and periodicals. Medical School enrollment for the current year is 952.

COMMUNITY

Thomas Jefferson University Hospital is located in Center City Philadelphia, near a number of noted cultural institutions, scientific organizations, historic shrines, parks and recreation areas. These include the Philadelphia Orchestra, Pennsylvania Ballet, Independence National Historic Park (Independence Hall, the Liberty Bell, Betsy Ross House), first run theatres, and major sport teams (Phillies, Eagles, Flyers, 76ers). The Center City area has undergone substantial renewal in the past 20 years and is the regional focus for shopping, theaters, restaurants, and entertainment. Philadelphia is within a few hours of seashore resorts and mountain recreation areas for activities such as swimming, boating, skiing, fishing, and hiking. Philadelphia is a center for prominent medical institutions; located nearby are four other teaching hospitals and medically oriented commercial activities, and independent research institutes.

STIPENDS AND MAINTENANCE

First-year residents currently receive $45,500 per year with an increase for each subsequent year of training. Health insurance through Blue Cross/Blue Shield with major medical coverage is provided to house officers, spouses and dependent children at no charge. Alternatively, an approved HMO may be selected. Life insurance, travel insurance, and accident insurance are provided without charge. Laboratory coats and laundry service are provided as well. On-campus housing is available in the twenty story Orlowitz Residence Hall offering one, two, and three-bedroom apartments or in the Barringer Residence which provides efficiency one, two, or three-bedroom apartments. The Housing Information Service maintains information on non-university housing in the Philadelphia area.

STAFF

Stephen Peiper MD; Chairman; Jacob and Sophie Rubin Professor of Pathology.

Fred Gorstein, MD Director, Marluce Bibbo, MD. Scd Director, Cytopathology; John L. Farber, MD Pulmonary Pathology, Transplantation, Renal Pathology; Gene Gulati, PhD, Hematology, Laboratory Automation. Renato V. Iozzo, MD Director, Electronmicroscopy; Donald L. Jungkind, PhD, Director, Microbiology; Peter A. Mccue, MD Director Anatomic Pathology/Surgical Pathology; Renal Pathology; Juan Palazzo, MD, Breast and Gastrointestinal Pathology; Emanuel Rubin, MD, Hepatology, Alcohol Research; Raphael Rubin, MD, Director, Liver and GI Pathology; David S. Strayer, MD, PhD Autopsy Service.

Mary Cunnane, MD Surgical Pathology, Head and Neck pathology; Mark Curtis, MD, PhD, Neuropathology; Lawrence Kenyon, MD, PhD, Neuropathology, Director, Autopsy Service; Brian J. O'Hara, MD, Director of Laboratories, Surgical Pathology, Soft Tissue and Bone Pathology.

Assistant Professors

Sean Cote , DO, Director, Clinical Chemistry; Eric Behling, MD, Hematopathology, Surgical Pathology; Tina Edmonston, MD Director, Molecular Pathology, Surgical Pathology; William D. Kocher, MD, Director, Hematopathology; Laura J. McCloskey, PhD, Associate Director of Laboratories; Agnieszka K. Witkiewicz, MD, Surgical Pathology, Dermatopathology, and GYN; Anthony Prestipino, MD, Surgical Pathology, GYN/GI Pathology; Moira Wood, MD, Cytopathology, Autopsy Service; Madalina Tuluc, MD, Surgical Pathology.

Part Time Staff

Harvey J. Bellin, MD; Katrina Conard, MD; Hormoz Ehya, MD; Benjamin Gerson, MD; William V. Harrer, MD; Joseph P. Hostman, MD; Albert A. Keshgegian, MD, PhD; Geraldine Meny, MD; Markku Miettinen, MD; Arthur Patchefsky, MD; Harry Cooper, MD; Scott H. Saul, MD; Nancy A. Young, MD; Diana Corao, MD; Douglas Fleider, MD; Judith Kim, MD.

APPLICATIONS

Residency candidates must be graduates of approved medical schools in the U.S. or Canada. Graduates for foreign medical school must have an ECFMG certificate. Satisfactory references are required. Applications are received until December 31st of the year preceding the start of the residency program. The Department of Pathology participates in the National Resident Matching Program.

Address inquires to:                                                                                                           

Fred Gorstein, M.D.                                                                                                               Thomas Jefferson University Hospital
125 S. 11th Street, 204 Pavillion
Philadelphia, PA 19107

Phone: (215) 503-3876
FAX: (215) 955-2519

Email: Fred.Gorstein@jefferson.edu

Pathology Residents Directory