The ACGME-accredited one-year surgical pathology fellowships at Washington University are highly immersive, 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.
The fellowship (five positions) is divided into six core rotations as described below. These include a variable period of elective time for each fellow, depending on the available coverage and depending on the interests of fellows for the given year. The fellowship provides training in all the major areas of surgical pathology, preparing graduates for academic, private practice or industry careers.
Major strengths of the surgical pathology fellowship include a diverse and abundant case mix, the availability of nationally regarded faculty mentors, graduated responsibility for clinical cases (particularly in the area of frozen section diagnosis) and opportunities for clinical research.
The fellowship was approved by Accreditation Council for Graduate Medical Education (ACGME) in July 1, 2002. The first fellow began on July 1, 1990. To date over 130 128 fellows have graduated from the program.
The frozen section fellow supervises a team composed of a second-year pathology resident and the gross room fellow. Together, the team provides gross intraoperative consultations and performs all frozen sections requested at the South Campus of Barnes-Jewish Hospital (approximately 30/day). Primary diagnostic responsibility rests with an assigned faculty member during the day. In the evenings and at night, fellows render diagnoses independently, with faculty backup as needed.
The consult fellow reviews outside surgical pathology material for patients referred to Barnes-Jewish Hospital (“inside/outside” cases) as well as directed consults (“outside” cases) sent to specific faculty members. The mixture of inside/outside cases includes GU, GI, head and neck, bone and soft tissue, cardiovascular and pulmonary pathology. Directed consults are focused in the areas of soft tissue and pediatric pathology.
The breast fellow manages the subspecialized breast pathology service, supervising a first-year resident. He/she reviews slides on half of in-house cases and on consults, communicates preliminary diagnoses to clinical staff and takes phone calls relating to these cases. He/she grosses in a subset of large cases. In addition, the breast pathology team performs more complex intraoperative evaluations on cases from the Barnes-Jewish North Campus operating rooms.
The OB/GYN fellow manages the subspecialized pathology service in this area, supervising a second-year resident. The fellow reviews half of the current surgical cases on this service, as well as all inside/outside consults, signing them out with an assigned staff pathologist. The fellow also grosses approximately one half of cancer cases and a subset of noncancer cases, 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.
Although there is a separate liver/GI pathology fellowship, general surgical pathology fellows rotate on this service for 3-4 weeks. During this time they work closely with the rotating second-year resident on service, reviewing a proportion of the daily in-house liver and GI surgical specimens, reviewing inside/outside hepatobiliary and pancreatic consult cases with the assigned attending and performing the gross examination of approximately 1/2 of pancreatic and hepatic resections. They also review outside (directed) liver consults and present at two interdepartmental conferences relating to liver/GI pathology.
Head and neck
Although there is a separate head and neck fellowship, general surgical pathology fellows rotate on this service for 3-4 weeks. During this rotation, the fellow signs out all relevant consult cases, participates in preparation, reading and communication of multipart head and neck frozen sections, prosects and signs out every third in-house tumor resection specimen and sits for sign-out with the head and neck rotating resident as time permits. They help advise the rotating resident on grossing and case handling and present at interdepartmental head and neck and endocrine tumor boards.
Each fellow has approximately 4 weeks of elective time in which to pursue subspecialty interests within surgical pathology, special study in areas outside of “general” surgical pathology (e.g., neuropathology, dermatopathology, hematopathology, cytopathology), basic, translational, or clinical research and quality assurance projects.
Training for the fellowship occurs in state-of-the-art facilities at Washington University School of Medicine/Barnes-Jewish Hospital/St. Louis Children’s Hospital. The Surgical 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
Applications for the 2022-2023 academic year will be accepted starting June 1st, apply at fellowships.path.wustl.edu.
For general questions, please contact Kim Green at firstname.lastname@example.org or 314-747-8159.
Department of Pathology & Immunology
Washington University School of Medicine
660 S. Euclid Ave., Box 8118
St. Louis, MO 63110