Stephen Peiper, MD
Peter A. Herbut Professor
Department of Pathology, Anatomy & Cell Biology
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.
The Department has formed affiliations with the Department of Pathology at AIfred I. Dupont Hospital for Children, the Children's Hospital of Philadelphia, and the Medical Examiner's Office in Philadelphia. These 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.
Hematology & Coagulation Service
The following represents a typical forty-eight month combined program in Anatomical and Clinical Pathology. The actual time spent in any area is approximate and largely dependent on the acquisition of requisite competencies and the particular interests of the resident.
|Anatomic Pathology Requirements:||22 months total|
|Surgical Pathology||9 months|
|Autopsy and Neuro-pathology||5 months|
|Electron Microscopy and Biopsies||1 month|
|Pediatric Pathology||1 month|
|Forensic Pathology||1 month|
|Surgical Pathology Chief||1 month|
|Clinical Pathology Requirements:||18 months|
|Lab Management/Informatics||1 month|
|Molecular Pathology||1 months|
|Transfusion Medicine||4 months|
Elective Rotations in Anatomic Pathology:
Advanced subspecialty areas, including: Frozen section analysis, Genitourinary Pathology, Gynecologic Pathology, Gastrointestinal Pathology, Hepatic Pathology, Pulmonary Pathology, Renal Pathology, Immunopathology
Elective Rotations in Clinical Pathology:
Advanced training in core rotation subspecialty
Madalina Tuluc, MD is the director of surgical pathology. Full-time staff includes: Jeffrey Baliff, MD, Joanna Chan, MD, Rossitza Draganova-Tacheva, MD, John Farber, MD, Susan Iniss, MD, Wei Jiang, MD, Jianhong Li, MD, PhD, Peter McCue, MD, Brian O’Hara, MD, Juan Palazzo, MD, and Anthony Prestipino, MD.
All members of the staff are committed to active and interactive residency training in this key discipline. The senior residents assist the junior residents in the examination and preparation of diagnostic material. Four pathologist assistants are assigned to surgical pathology. The basic surgical pathology experience is nine months with an opportunity to extend this time during electives.
Patient cases are signed out and reported each morning. 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 adequare 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.
Lawrence Kenyon, MD, PhD is the director of the autopsy service, additional staff consists of Mark Curtis, MD, PhD, John Farber, MD, and David Strayer, MD, PhD . Residents and staff members participate in a bimonthly 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 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 include performance of the autopsy under supervision of the staff pathologist and the director of the autopsy service, presentation of cases at bimonthly autopsy conference, analysis of the histological findings, and 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.
Residents also have exposure to neuropathology while on their autopsy rotations. The cases include neurosurgery pathology cases, neurosurgery/ENT pathology cases, nerve biopsies and muscle biopsies. The director of the neuropathology division is Mark Curtis, MD, PhD. Lawrence Kenyon, MD, PhD is Assistant Director
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. 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 involved in preparation of intra-operative "touch preps" and frozen sections on neurosurgical cases.
Because of the large number 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 residents.
Charalambos Solomides, MD is the director of the cytopathology service, with staff Marluce Bibbo, MD, Rossitza Draganova-Tacheva, MD, and Kim Hookim, MD. 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.
During this one-month rotation, under the direction of Lindsay Simon, 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
Residents generally receive their Pediatric Pathology training at the Alfred I Dupont Hospital for Children under the direction of Katrina Conard, MD. An alternate rotation in Pediatric Pathology is also available at the Children's Hospital of the University of Pennsylvania. 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 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 breadth of pediatric pathology concepts rather than a list of facts. The rotation is one 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 and Biopsies Rotation
The electron microscopy and biopsies rotation is under the direction of John Farber, MD. During the rotation the resident is exposed to the use of electron microscopy with renal biopsies, as well as other special biopsies, such as lung, liver, and heart. The rotation is one month long. The residents have the opportunity to preview all cases and are involved in 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 Chemistry Laboratory
The director of the clinical chemistry laboratory is Douglas Stickle, PhD. The rotation is three 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. 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 HPLC and electrophoresis. In addition, the residents are responsible for evaluating special test requests by clinicians, and miscellaneous inquiries by clinicians related to the chemistry laboratory in patient care. Each resident prepares a didactic presentation for the Clinical Pathology resident conference.
Opportunities for research in clinical chemistry under the supervision of the director are numerous.
The cytogenetics laboratory is under the directorship of Jinglan Lui, PhD. 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 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 has the opportunity to perform the technical aspects of culturing and karyotype evaluation on a personal blood sample. 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. Each resident prepares a didactic presentation for the clinical pathology resident conference.
The hematopathology laboratory is under the direction of Jerald Gong, MD and Guldeep Uppal, MD. The duration of this rotation is four months and includes exposure to hematology and hematopathology.
The four months are structured to emphasize graduated responsibility. During the first two months, the emphasis will be on general principles of hematology, including the structure and function of the hospital hematology laboratory, and basic morphology of blood, bone marrow, and lymph nodes and the diseases that affect these tissues. In the remaining two months, 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, immunohistochemistry, flow cytometry, molecular diagnostics, and cytogenetics in the diagnostic process will be stressed.
Throughout all four months, the resident actively participates in the diagnostic daily work conference over multiple-headed microscopes. The residents prepare a didactic presentation for the clinical pathology resident conference each month. They may also present at the weekly hematology/oncology conferences as they progress through the rotation. The residents’ performance and progress is monitored by the attending staff directly involved in the residents’ training.
The clinical immunology laboratory is under the direction of Laura McCloskey, PhD. The two week rotation in 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. Each resident prepares a didactic presentation for the clinical pathology resident conference. The laboratory staff directly supervises the residents in mastering the knowledge base and competence in performing the components of the above program.
The coagulation laboratory is under the direction of Jerald Gong, MD and Jay Herman, MD. The duration of the coagulation rotation is two weeks.
The goals of this rotation are to acquire experience in the technical aspects of a variety of test procedures including routine and special coagulation tests, such PT, PTT, fibrinogens, D-dimers, lupus inhibitors, and platelet assays. Each resident prepares a didactic presentation for the clinical pathology resident conference.
The Lab Management/Informatics rotation is under the direction of Julie Karp, MD. It is one month in duration, with two weeks emphasizing informatics under the direction of Robert Stapp, DO.
This area of residency training is presented in the form of didactic lectures, shadowing and multiple hands-on computer sessions. Faculty involve in this program include 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 and administrative activities and decision-making in each rotation, are expected to engage in the evaluation of options in relation to laboratory operations, resource utilization and quality assurance activities. .
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. State of the art digital imaging equipment is available on site for resident use.
The microbiology laboratory is under the direction of Amity Roberts, PhD. 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. Introduction to new technologies by using probes in our laboratory including PCR.
4. Serving as consultants to clinicians regarding unusual tests requests and results.
5. Examining patients and procuring pertinent medical history data.
6. Reviewing results from reference laboratories.
7. Presenting cases at infectious disease conference and clinical pathology 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.
Molecular Pathology Rotation
The molecular pathology laboratory is under the direction of Zi-Xuan Wang, PhD. The laboratory performs oncology assays (PCR or RT-PCR based) and special microbiology studies. All clinical molecular studies are performed in a central laboratory site.
The goals of this rotation are to provide the resident with a fundamental understanding 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:
1) 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, 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; and understanding the sensitivity and specificity of molecular tests and FISH compared to light microscopy, flow cytometry, and karyotyping.
2) 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.
3) 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 will attend the following conferences: weekly laboratory meetings with the director and staff, weekly clinical pathology lecture series, weekly conference with the hematology/oncology staff, and monthly quality assurance/improvement conferences. The resident will give a presentation to laboratory staff on a topic of interest, and a presentation at CP conference for the residents and CP attendings.
Transfusion Medicine (Blood Banking)
Transfusion Medicine/Blood Banking is under the directorship of Jay Herman, MD, and Julie Karp, MD. The rotation is four months in duration, 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. When scheduled for 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.
Mark Curtis, MD, PhD
Director, Residency Program
1020 Locust Street
Philadelphia, PA 19107
We participated in the National Residency Match Program and utilize the Electronic Residency Application Service (ERAS).