The Washington University School of Medicine and Barnes-Jewish Hospital gynecologic and breast pathology fellowship will matriculate its first fellow in 2020. This 12-month program will build 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. This fellowship is a highly immersive program in which trainees 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 seven gynecologic pathologists and five 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 eight gynecologic oncologists and six breast surgeons on the faculty, ensuring a steady stream of surgical material.

History

The selective (surgical) pathology fellowship at Washington University is recognized as one of the oldest, largest 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 is embarking on the next stage of this evolution by creating opportunities for subspecialty anatomic pathology training. The department is currently applying for ACGME accreditation for the program. We anticipate that the program will be accredited by the time the first fellow graduates in 2021.

Curriculum

Rotations include:

Breast pathology (4 months)

The breast pathology fellow manages the subspecialized breast pathology service, supervising a junior resident (usually PGY-2). 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 (4 months)

The ob/gyn pathology fellow is paired with a PGY-1 resident to cover this subspecialized service. The fellow reviews half of current surgical cases as well as all inside/outside consults, signing them out with an assigned staff pathologist. Similar to the breast service, the ob/gyn pathology 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. Medical students often rotate on this service and are supervised by either the fellow or resident.

Frozen section (1 month)

The frozen pathology fellow is posted to either the North (Parkview) or South (Peters) frozen section area and is partnered with an accessioner and technician or PA. This team provides both gross intraoperative consultations (often in the operating room) 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 invoked only as necessary.

Liver/GI, head and neck, cardiothoracic, and GU pathology (1 month total)

The gynecologic and breast pathology fellow cross-rotates on some or all of these services in order to gain a balanced exposure to surgical pathology and in recognition of the fact that disease processes can cross traditional organ system boundaries.

Research/elective (1 month)

Each fellow has approximately 4 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 specific to the gynecologic and breast pathology fellowship, and a joint monthly journal club for subspecialty AP fellows. The department also conducts a Pathology Management Series, an interesting case conference series, and numerous other educational activities.

Facilities

This is a single-site fellowship that occurs in state-of-the-art facilities at Washington University School of Medicine and Barnes-Jewish Hospital. The section of surgical pathology is located in the 680,000 square foot BJC Institute of Health (BJCIH) on the Washington University School of Medicine campus. This centrally located, 11-story building houses both clinical and research laboratories. The gross room has 28 grossing bays and is staffed by a team of six pathologist assistants. The department uses Voicebrook voice recognition, Copath lab information system, Epic electronic medical record and has a tradition of excellence in clinical informatics, including use of live-mode telepathology and whole-slide imaging.

Application

NOTE: A 2020-2021 position is still available. Please email Kim Green at greenkd@wustl.edu to inquire.

Applications are being accepted for 2021-2022 via our applicant portal, fellowships.path.wustl.edu.

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 a form and provide their CV, photograph, USMLE scores (step 3 optional), ECFMG certificate if applicable and personal statement. Please be sure to provide contact information for three individuals who will be asked to write letters of recommendation.

Ian S. Hagemann, MD, PhD
Program Director
Washington University School of Medicine
425 S. Euclid Ave., Campus Box 8118
St. Louis, MO 63110
314-747-8924
hagemani@wustl.edu

For general questions, please contact Kim Green at greenkd@wustl.edu or 314-747-8159.

Faculty and trainees

Faculty


Contact information

Kim Green
Fellowship Coordinator
Department of Pathology & Immunology
Washington University School of Medicine
660 S. Euclid Ave., Box 8118
St. Louis, MO 63110
Phone: 314-747-8159
greenkd@wustl.edu