Thomas Jefferson UniversitySidney Kimmel Medical College

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Program Overview

Core 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

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 Core Program
Surgical Pathology (basic) 9 months
Autopsy Pathology 5 months
Neuropathology 1 month
Cytopathology 3 months
Electron Microscopy 1 month
  19 months
Anatomic Pathology (advanced)
Forensic Pathology 1 month
Surgical Pathology 3 months
Pediatric Pathology 1 month
  5 months

Anatomic Pathology Total: 24 months

Clinical Pathology Core Program:
Hematology/Hematopathology 5 months
Microbiology 3 months
Chemistry/Toxicology 5 months
Transfusion Medicine 3 months
Molecular Pathology 1 month
Cytogenetics 1 month
  18 months
Clinical Pathology (advanced):
Tissue typing and Histocompatability 1 month
Immunology/Flow Cytometry 1 month
Electives in Clinical Pathology 4 months
  6 months

Clinical Pathology Total: 24 months

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Elective Rotations

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

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Surgical Pathology

Dr. Peter McCue, Director Surgical Pathology. Full-time staff consists of Brian O’Hara, MD, Jeffrey Baliff, MD, Juan Palazzo, MD, John Farber, MD,  Anthony Prestipino, MD, Madalina Tuluc, MD, Ruth Birbe, MD, Joanna Chan, MD, Wei Jiang, MD, and Lea Gordon, MD

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.

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Autopsy Service

Lawrence Kenyon, MD, PhD Director Autopsy Service, additional staff consists of John Farber, MD, David Strayer, MD, PhD, and Mark Curtis, MD. 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.

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Cytopathology

Charalambos Solomides, MD, Director, with staff Rossitza Draganova-Tacheva, MD and Marluce Bibbo, 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.

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Neuropathology

The members of the Neuropathology division are Dr. Mark Curtis and Dr. Lawrence Kenyon.  The Director of the Neuropathology division is Mark Curtis, MD, PhD. Lawrence Kenyon, MD, PhD 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.

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Forensic Pathology

During this one-month rotation, under the direction of Gregory McDonald, DO, 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.

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Pediatric Pathology

Residents generally receive their Pediatric Pathology training at the Children's 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.

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Electron Microscopy Rotation

The Electron Microscopy Laboratory is under the direction of Renato V. Iozzo, MD. 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.

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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.

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Molecular Pathology Rotation

The Molecular Pathology Laboratory and rotation 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 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 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.

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Cytogenetics

The Cytogenetics Laboratory is under the professional directorship of Dr. Barry Barnoski. 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.

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Hematopathology

The Hematopathology Laboratory is under the direction of Drs. Jerald Gong and Guldeep Uppal. 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.

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Hematology & Coagulation Service

The Hematology Laboratory is under the direction of Drs. Jerald Gong 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. 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.

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Clinical Chemistry

The director of the Clinical Chemistry Section is Douglas Stickle, PhD. 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.

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Microbiology

Amity Roberts, PhD, 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.

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Transfusion Medicine (Blood Banking)

Transfusion Medicine/Blood Banking is under the Directorship of Drs. Jay Herman and Nguyet Le, MD. 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.

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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 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 LastWord 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.

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