Anatomic and Clinical Pathology (AP/CP) Track
The anatomic and clinical pathology (AP/CP) residency program is a four-year training track. Anatomic and clinical pathology rotations are distributed throughout the four years. The first three years consist mainly of “core” rotations, along with dedicated elective and research time. This is done to provide early exposure to as many fields of anatomic and clinical pathology as possible, allowing residents the time to decide what fellowships or career paths they are interested in pursuing. The fourth year of training is more individualized, allowing residents to tailor their schedule and electives toward their interests and future career.
Anatomic Pathology Curriculum:
The Anatomic Pathology curriculum is structured around subspecialty modules, which consist of: Breast pathology, Gynecologic pathology, Cytopathology, Hematopathology, Pediatric pathology, Molecular pathology, Genitourinary pathology, Gastrointestinal pathology, Bone and soft tissue pathology, Cardiothoracic pathology, Neuropathology, Head and Neck pathology, and Dermatopathology. Residents also rotate on Autopsy, with the majority of the rotation spent performing medical autopsies, and additional experience at the St. Louis Medical Examiner office. After their first year of training, Anatomic Pathology residents help run the Intraoperative Consultation service, learning to provide frozen and gross diagnoses to surgical teams intraoperatively. There is designated elective time scheduled throughout the residency for research projects and selective study. Residents are expected to assume graduated responsibility throughout their training, with coverage of some fellow-level rotations in their third and fourth years.
Clinical Pathology Curriculum:
Laboratory medicine is continuously being challenged by an ever-increasing range and complexity of laboratory tests, automation, computerization, and new methodologies. Clinical laboratories rely on medical directors who can evaluate tests and technologies objectively within the proper clinical context, ensuring that treating physicians have access to the latest and most accurate information to guide patient care decision making. The Clinical Pathology curriculum at Washington University is rooted in five 3-month-long core rotations in each of the major areas of laboratory medicine: 1) Transfusion Medicine, 2) Clinical Chemistry Toxicology, 3) Microbiology, Virology, Serology, 4) Molecular Biology, Immunology, Cytogenetics, Informatics, and Histocompatibility, and 5) Hematopathology and Hematology/Hemostasis. These rotations are distributed evenly over the four-year residency for AP/CP residents (or during the first 15 months for CP residents). Residents learn the fundamental principles of operation in these laboratories, including the test methodology and instrumentation, as well as obtain experience in the proper selection of tests and the interpretation of data. Residents are closely involved with patient care teams through an on-call system set up in each clinical laboratory, where trainees provide direct consultative and interpretive services for treating physicians. Trainees also work closely with fellows and faculty throughout their clinical pathology training, regularly attending multidisciplinary conferences, participating in high-complexity testing oversight and management, and completing a quality improvement project. In addition to these core rotations, advance elective rotations are available in each of these core areas, as well as in informatics and laboratory management.
Conferences are an integral part of the training process. Both Anatomic and Clinical Pathology have thoughtfully constructed conference schedules designed to promote trainee education through interaction from both faculty and peers. Many of the conferences are resident-driven, giving the opportunity to develop presentation and teaching skills. Lunch is provided at all noon conferences.
Anatomic Pathology Conferences:
Anatomic Pathology-specific didactics and unknown conferences occur daily at noon, with the exception of autopsy conference and first-year unknowns, which occur at 8 am. During these didactics, residents are taught the fundamentals of anatomic pathology from faculty experts.
Anatomic and Molecular Pathology Conference:
The Anatomic and Molecular Pathology Conference is a biweekly conference during which residents present to faculty and peers about a specific disease process or testing modality related to the field of anatomic pathology. Presentations are typically attended by all anatomic pathology faculty and trainees. This is often a resident’s opportunity to showcase their own research or quality improvement projects.
Anatomic Pathology Journal Club:
The Anatomic Pathology Journal club is a biweekly conference during which time residents critically review pertinent anatomic related journal articles. Articles are evaluated as a group with faculty leading the discussion.
Weekly conferences in which interesting autopsy cases with important teaching points are presented. Conference occurs in the morgue, allowing for group examination and discussion of gross pathology. Conference is led by the autopsy resident, though faculty are also present to help drive discussion and emphasize teaching points.
Clinical Pathology Conferences:
Each clinical pathology rotation has its own uniquely tailored educational content. By offering clinical pathology rotations in uninterrupted 3-month blocks, the lectures, bench rotations, and other activities are distributed in a comprehensive and progressive fashion.
LGM Case Conference:
Laboratory and Genomic Medicine Case Conference is held weekly. During this conference residents present an interesting case and focus on details regarding the differential diagnosis and the pertinent laboratory tests. Residents engage attendees in building a differential diagnosis and recommending additional testing. The focus of the talk is typically on the relevant laboratory testing, including discussion on both utility and methodology. This also includes a review of pertinent literature.
Laboratory and Genomic Medicine Grand Rounds:
Laboratory and Genomic Medicine division-wide grand rounds provide a weekly forum for residents to review the latest advances relevant to the diagnosis of a particular disease. These are intended to be critical evaluations of controversial topics. Examples include evaluating the utility of a new test, the utilization of a current test, or a general issue of pertinence to laboratory medicine (e.g. ethical dilemmas, management of lab medicine-related therapeutics or patient management challenges). Through this exercise, residents have the opportunity to develop expertise in a controversial aspect of laboratory medicine and take on the hypothetical role of a medical director who is tasked with making the decision on this debatable laboratory testing issue.
Common AP/CP Conferences:
Throughout their training residents attend several conference series covering topics relevant across both AP and CP disciplines. These include a dedicated conference series on informatics, in which residents are taught the fundamentals of clinical informatics and are asked to use those fundamentals to address a quality improvement initiative. There is also a Computational and Digital Pathology Seminar Series, in which residents are taught about evaluation and implementation of cutting edge technologies. Another shared conference is the Management Lecture series which covers various management related topics, ranging from laboratory accreditation to risk management.
Residents partake in teaching medical students throughout their training. This includes mentoring and teaching students on their pathology electives, as well as interacting with medical students through the Pathology Interest Group. Residents with a strong interest in teaching are encouraged to serve as formal Pathology Interest Group Liaisons. Residents also have ample opportunity to teach their peers. Senior residents on anatomic electives serve as “senior buddies” to more junior residents, a system designed to teach grossing and basic sign-out skills. They also have the opportunity to more formally teach each other through the “Resident Report” conference, a conference designed for residents, by residents, with a focus on review of boards-related material.
Two Anatomic Pathology chief residents and one clinical pathology chief resident are typically selected from among the outstanding residents in the program. Responsibilities include setting up schedules for the residents, helping to organize collaborative clinical services, and acting as liaisons between the residents, faculty, and administration.
Residents wanting to exercise leadership early in their training are encouraged to join our Trainee Leadership Committee, a resident-run group with a charge of continual assessment and improvement of our training program. Representatives from each PGY year are elected to represent their class’ concerns at quarterly meetings. In the past, the Trainee Leadership Committee has successfully petitioned to increase the trainee book fund and expanded the length of resident orientation.
During the entirety of their training, trainees are encouraged to pursue research opportunities, in concert with faculty members. Research can be in the basic sciences or in translational areas and typically is done in an area of interest to the trainee. Many projects arise organically, usually sparked by an interesting case or idea for quality improvement. Residents are also encouraged to approach faculty in their area of interest to explore ways in which they can become involved with ongoing research. Through participation in research projects, residents learn the elements of hypothesis testing, nuances of IRB preparation, elements of study organization, and art of manuscript preparation. These are essential for those residents considering an academic career and are also important in learning to evaluate the scientific literature with a discerning eye. Residents are strongly encouraged to present their research at local and national conferences. To help support this, a yearly $2,500 travel fund is available for first author presentations of research projects at conferences.