Gynecologic and Breast Pathology Fellowship | Pathology & Immunology

The Washington University School of Medicine and Barnes-Jewish Hospital gynecologic and breast pathology fellowship matriculated its first fellows in 2020. This 12-month program builds on the strengths of the existing surgical pathology fellowship, which has been training fellows since its inception in the 1950s by Lauren V. Ackerman, MD. All of our fellowships are highly immersive, allowing trainees to gain familiarity with both common and rare surgical pathology specimens. Frozen section experience, opportunities to cross-rotate in other areas of surgical pathology and research experiences are available.

The department has a subspecialty practice model with four gynecologic pathologists and six breast pathologists. Institutional strengths include the Alvin J. Siteman Cancer Center, a nationally recognized center of excellence and member of the National Comprehensive Cancer Network. There are nine gynecologic oncologists and six breast surgeons on the faculty, ensuring a steady stream of surgical material.

History

The surgical pathology fellowship at Washington University 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.

Curriculum

Rotations include:

Breast pathology (5 months)

On the breast pathology service, the fellow reviews half of in-house breast cases and all inside/outside consults. Responsibilities include 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 (two weeks) and is excused from grossing once competencies are met. The breast pathology fellow presents at a weekly tumor board. Fellows may assist in the management of our breast consultation service (second-opinion consults).

Obstetric and gynecologic pathology (5 months)

On the OB/GYN pathology service, the fellow reviews half of current surgical cases as well as all inside/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 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 where they are 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 (direct supervision is 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 didactic series (journal club) specific to the gynecologic and breast pathology fellowship.

Facilities

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

Requirements

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.

Application

There will be two positions per year for this 12-month program. The program seeks to recruit candidates with excellent residency training in anatomic or anatomic/clinical pathology, with the primary mission of training future academic leaders in gynecologic and breast pathology.

Applicants must complete an application and provide their CV, photograph, USMLE scores (step 3 optional), ECFMG certificate if applicable and personal statement. The application portal will collect contact information for three individuals who will be asked to write letters of recommendation.

We are participating in the Surgical Pathology Unified Approach for Gynecologic and Breast Pathology Fellowship Programs for the 2025-2026 fellowship year. Applications for the 2025-2026 position will open on May 1, 2023. Please apply at fellowships.path.wustl.edu.

Surgical Pathology Unified Approach Timeline:

Online Applications available: May 1, 2023
Application review window: July 1^st – September 2023
Interview window: August 14^th – October 2023
Earliest offer date: October 2, 2023, 11 AM ET (10 AM CT, 9 AM MT, 8 AM PT)
Acceptance Terms: 24 hours for applicants to accept/decline offer

Note: All applicants will be given a 24-hour period to accept/decline from the time of offer notification.

Letters of Recommendation will be solicited via our application portal, but can also be directed to:

Ian Hagemann, MD, PhD
Program Director, Gynecologic and Breast Pathology Fellowship
Washington University School of Medicine
660 South Euclid Avenue, Campus Box 8118
St. Louis, MO 63110
hagemani@wustl.edu

For general questions, contact Kim Green at greenkd@wustl.edu.

Faculty and trainees

Faculty

Fouad Boulos, MD

Associate Professor, Pathology & Immunology
Section Head, Breast Pathology
Director, AMP Core Lab

Phone: 314-338-1292
Email: bfouad@wustl.edu

Division: Anatomic & Molecular Pathology

Erika C. Crouch, MD, PhD

Carol B. and Jerome T. Loeb Professor of Medical Education
Professor, Pathology & Immunology
Vice Chair for Education
Gateway Histology and Pathology Thread Leader
Gateway Module 2 Phase 1 Co-leader