Head & Neck (Selective) Pathology Fellowship

The ACGME-accredited one-year Head and Neck Pathology Fellowship at Washington University generally consists of ~6 months of training in head and neck pathology and ~6 months of general surgical pathology, including all of the other general surgical pathology fellowship rotations described below, although there is some flexibility depending on the preference of the fellow.

Major strengths of the Washington University Selective Pathology Fellowships include a diverse and abundant case mix, graduated responsibility for clinical cases (particularly in the area of frozen section diagnosis), and opportunities for clinical research. It is a highly immersive fellowship, with a large volume of specimens ranging from the most complex to the most common to many of the rarest. Fellows learn by seeing and doing and by handling, diagnosing, and pre-dictating most of their cases.

History

Fellowship approved by Accreditation Council for Graduate Medical Education (ACGME) to begin July 1, 2015. The first fellow began on July 1, 2015. The second fellow will graduate June 30, 2017.

Curriculum

Rotations Include:

Head and neck
Work up and sign out all head and neck consults, both directed and inside/outside with the head and neck attendings. The fellow has the option to review cases with the attending or not. If the cases are reviewed alone, the fellow will give all the slides and a dictated final report to the attending on inside/outside consult coverage, who will review and sign out the case.

1. Prosect every third large head and neck tumor resection case sign out with the head and neck service attending.

2. Review resident’s head and neck cases prior to sign out and sit for sign out of these cases, when available.

3. Present and describe the pathological findings of cases to Otolaryngology and Oncology clinicians who come to the department to look at their cases.

4. Participate in frozen sections at South campus when the regular South frozen section staff need assistance with multi-part ENT cases. The fellow needs to be available 7:45 am up to 5:30 pm on weekdays and will be paged to the frozen section area for all such cases.

5. Develop a strong knowledge of head and neck surgical and pathologic anatomy.

6. Educate junior residents and rotating medical students about gross prosection, how to provide accurate gross descriptions of routine and complex specimens, and about safety practices in the pathology laboratory.

7. Attend and present cases at head and neck tumor board (Wednesday 12:00 PM) and at the endocrine multidisciplinary conference (Thursday 4:30 PM x2 per month).

8. Attend the monthly Head and Neck Fellow’s Conference (last Monday of every month immediately following sign out).

Frozen section
The frozen section fellow has primary responsibility for organizing the workflow in the frozen section room, providing instruction and leadership to the second year resident and medical students rotating in the frozen section room, and carrying the frozen section pager after hours Monday through Friday.

Consults
The consult fellow is responsible for reviewing all inside/outside consultation (except GYN, derm, heme and breast cases) that are sent to this institution because the patient is being treated here. The fellow reviews the case renders a preliminary diagnosis, signs out the case with the attending, and orders any special studies that are needed. This fellow also performs a similar function for consult cases that come to attendings as personal consults.

Breast
The breast pathology fellow reviews all inside/outside breast consultation cases. They also sign out ½ of all in house breast specimens and present at the Breast Tumor Board. This fellow is also responsible for selecting the cases for the first year resident slide unknown conference and leading the discussion.

Obstetric/Gynecologic
While on this service, the fellow will have a caseload that provides a concentrated experience in all the areas of OB-GYN pathology with exposure to a wide variety of specimens including those of the cervix (biopsy, cone biopsy and LEEP specimens), endocervical and endometrial curettage specimens, benign hysterectomy specimens, hysterectomy specimens for endometrial and cervical malignancies, oophorectomy specimens for both benign and malignant disease, vulvar specimens for both cases of dysplasia and invasive malignancies, staging laparotomies for uterine and ovarian malignancies, and placental pathology. The GYN fellow will also handle all GYN consult cases and present case at the Gyn-Onc Tumor Board.

Liver/GI
The fellow will be responsible for handling adult gastrointestinal biopsies, liver biopsies, liver resections, hepatectomies, and biliary tract resections and any form of pancreatectomy. Responsibilities include gross examination or supervision of gross examination by the resident on Liver/GI, photographing gross specimens when necessary, gathering of pertinent clinical history, laboratory and imaging data, review of prior surgical pathology specimens, previewing of slides and determination of preliminary diagnosis. After sign-out w/the attending, the fellow also orders any ancillary tests and dictates the final diagnosis and microscopic of the cases. The fellow is also responsible for previewing and signing out all liver consults and select GI inside-outside consults. The fellow will be the primary presenter at the weekly CRC Conference and the monthly Hepatobiliary Oncology Conference.

Elective
This dedicated, clinical service work free time is provided specifically for the fellows to involve themselves in any (or all) of several areas, depending on their career interests, including 1) scholarly work on a research project, review article, or case report 2) work on a QA/QI/PS project or 3) clinical skills improvement in a subspecialty area of interest (for example: by case or study set review in head and neck, dermpath, neuropath etc). In addition, the fellow will be involved in reviewing CAP training in PS/QI modules. They will also be available for emergency coverage (by day) for other fellows as needed. Guidance will be from specific attendings for chosen areas of activity with the general plan and execution monitored by Fellowship Director.

Facilities

Training for the fellowship occurs in the state of the art facilities of Washington University School of Medicine/Barnes Jewish Hospital/St. Louis Children’s Hospital. The Head and Neck Pathology section is located in the 680,000 square-foot BJC Institute of Health (BJCIH) at Washington University School of Medicine which is an 11-story research building housing laboratories and support facilities and is Washington University’s largest building

Application

NOTE: A 2020-2021 position is still available. Please email Kim Green to inquire.

Applications for the 2021-2022 academic year are currently being accepted, apply here.

For general questions, please contact Kim Green, 314-747-8159.

Faculty and trainees

Head & Neck (Selective) Faculty


Current trainees


For further information please contact:
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