Gynecologic and Breast Pathology Fellowship

Rotations include:

Breast pathology (5 months)

On the breast service, the fellow manages the subspecialized breast pathology service, supervising a junior resident . The fellow reviews slides on half of in-house cases and on consults, which includes pre-dictating cases, coordinating ancillary testing and communicating preliminary diagnoses to clinical staff as needed. The fellow meets daily with the assigned attending for case review and sign-out. Because of the vital importance of gross examination in breast pathology, the breast pathology fellow completes competency-based grossing of selected large cases during a credentialing period and is excused from grossing once competencies are met. The breast pathology fellow presents at a weekly tumor board.

Obstetric and gynecologic pathology (5 months)

On OB/GYN , the fellow is paired with a junior resident to cover this subspecialized service. The fellow reviews half of current surgical cases as well as all outside consults, signing them out with an assigned staff pathologist. The fellow will gross cases initially to become familiar with local practice and to ensure competency. Once educational objectives are met, they are excused from further grossing. The fellow participates in a daily consensus conference and presents at the weekly gynecologic oncology tumor board.

Frozen section (1 month)

On the frozen section service, the fellow alternates daily between the North (Parkview) and South (Peters) frozen section area and is partnered with an accessioner, technician and/or PA. This team provides both gross intraoperative consultations and frozen sections (approximately 30/day across both sites). The fellow has direct attending pathologist supervision during the day. As part of graduated responsibility, the fellow reads frozens at night and on weekends with indirect supervision, with direct supervision available as necessary.

Research/elective (1 month)

Each fellow has approximately four weeks of elective time in which to pursue research or other special projects. Fellows in this program are expected to complete a QI/QA project as well as to undertake a hypothesis-driven research project with the intent of publication. The department will support travel to present at a national meeting. The gynecologic and breast fellow is expected to rotate for one week with either gynecologic oncology or breast surgery, or both if resources permit.

Each fellow is asked to give one didactic session and two unknown conferences over the year. There is a monthly journal club specific to the gynecologic and breast pathology fellowship.

The surgical pathology fellowship at WashU Medicine is one of the oldest and most successful programs of its kind. In 2018, the Department of Pathology & Immunology completed a transition to a fully subspecialized sign-out model. Under the leadership of Richard Cote, MD, named department head in 2019, the department has embarked on the next stage of this evolution by creating opportunities for subspecialty anatomic pathology training. The Gynecologic and Breast Pathology Fellowship has been ACGME-accredited since its launch in 2020.

Fellows must have an MD or DO degree (or foreign equivalent with ECFMG certification) and be board-certified or board-eligible in anatomic pathology. Applicants must be legally authorized to work in the United States. The department will sponsor J-1 visas.

This single-site fellowship occurs in state-of-the-art facilities at WashU Medicine and Barnes-Jewish Hospital. The surgical pathology laboratory is located in the 680,000-square-foot BJC Institute of Health (BJCIH) on the WashU Medicine campus.