Curriculum

The combined anatomic and clinical pathology training program is a fully accredited four-year program, accepting 3 new residents each year.

First and second years of training

• first 7 consecutive months of the first year are devoted to anatomic pathology, allowing residents to concentrate their educational experience on general surgical pathology
  • grossing of specimens
  • frozen section evaluation
  • microscopy/sign out
  • autopsy pathology
• remainder of the first and second year introduces some of the core disciplines of clinical pathology, including
  • hematopathology
  • transfusion medicine
  • clinical chemistry
  • microbiology
  • lymph node pathology
  • flow cytometry
  • molecular pathology
  • laboratory administration
  • informatics

Third and fourth years of training

• mixture of anatomic and clinical pathology rotations, including
  • subspecialty rotations (neuropathology, hepatic/renal/transplant pathology, electron microscopy, dermatopathology, pediatric pathology, molecular pathology, Cytogenomics)
  • cytopathology
  • 3 elective rotations (1 elective in anatomic pathology, one elective in clinical pathology, and the senior elective where residents may choose any focused areas of study)

The Anatomic Pathology curriculum is supplemented by outside rotations at the Wayne County Medical Examiner's office for experience in forensic pathology, and a one-month concentrated rotation in pediatric pathology at Children's Hospital of Michigan.

Anatomic Pathology

Surgical pathology specimens currently number approximately 60,000 per year and autopsies number approximately 120 per year. Cytology specimens approximate 80,000 cases per year with over 3,100 fine needle aspirations, some of which are retrieved by pathology staff and residents. A cytopathology fellowship training program is also offered.

The laboratory is equipped to perform a full array of ancillary studies including:

• histochemistry
• immunohistochemistry
• image analysis
• molecular techniques including next generation sequencing (NGS), real time polymerase chain reaction (PCR), and fluorescent in situ hybridization (FISH), chromogenic in situ hybridization (CISH), among others

Approximately 600 specimens are processed for electron microscopy annually including over 350 renal biopsies per year. Immunofluorescence microscopy is performed on renal biopsies and on other appropriate specimens such as lung and skin. Muscle and nerve biopsies number approximately 165 annually. The cytogenetics laboratory analyzes over 3,000 cases annually utilizing state-of-the-art cytogenetic, molecular cytogenetic, and whole genomic chromosome microarray techniques. The Anatomic Pathology Advanced Diagnositics Laboratory performs over approximately 1,000 breast receptor studies, 900 Urovysion tests, 100 KRAS tests, 90 HPV genotypes, 50 DNA ploidy studies, and 20 small-round-blue-cell PCR panels annually. 

Clinical Pathology

The Clinical Pathology laboratory handles over six million tests per year in a newly constructed state-of-the-art facility. The clinical pathology component of the training program includes rotations in all major divisions of laboratory medicine including hematology, clinical chemistry, transfusion medicine, coagulation, immunology, flow cytometry, microbiology, informatics, laboratory administration, and molecular pathology. 

Current structure of the training program:

Anatomic pathology (24 months)

• 16 months core anatomic pathology
• 1 month electron microscopy/renal/liver pathology
• 1 month forensic pathology at the Medical Examiner's Office
• 1 month pediatric pathology at Children's Hospital of Michigan
• 1 month molecular anatomic pathology (solid tumor, gene rearrangement, next generation sequencing) / neuropathology
• 2 month block core cytology (with 2 additional weeks of cytology sign out offered as a block during the PGY4 year)
• 1 month dermatopathology
• 1 month elective (AP topic)

Clinical Pathology (24 months)

• 4.5 months clinical chemistry
• 1 month coagulation
• 1 month cytogenomics
• 3 months hematopathology
• 2 months lymph node/flow cytometry
• 4.5 months microbiology
• 1 month molecular pathology (inherited disorders, oncology, infectious disease and pharmacogenetics)
• 4 months transfusion medicine
• 2 months elective (CP topic and senior elective)
• 1 month informatics/laboratory administration

Didactics

Our training program offers numerous types of teaching sessions, all of which are protected learning time. Our various types of teaching sessions include:

Core didactic Series

• an hour-long lecture that occurs 4 days a week
• Monday and Tuesday lectures are dedicated to topics in anatomic pathology
• Wednesday and Thursday lectures are dedicated to topics in clinical pathology
• anatomic pathology lectures are given as organ system blocks
• the series is given on a two year cycle, allowing each resident to receive the entire series twice during their training

Weekly Anatomic Pathology Conference

• conference is attended by all anatomic pathology staff and residents and covers a variety of topics including:
  • practice based learning and improvement conference
  • gross diagnosis conferences
  • journal club
  • interesting case conferences

Weekly Unknown Slide Conference

• conference is attend by all anatomic pathology staff and residents
  
• slides are reviewed by residents prior to conference
  
• slides are projected and the cases are discussed including the microscopic description, differential diagnosis, ancillary studies that would be useful in the case work-up, etc.  

Weekly Autopsy Gross Conference

• gross autopsy findings are reviewed or interesting autopsy microscopy is reviewed at the teaching microscope

Weekly Brain Cutting

• brains from adult and fetal autopsies are sectioned and reviewed
  • if there are no cases for gross review, autopsy neuropathology is reviewed at the teaching microscope

Weekly Clinical Pathology Conferences

• involves staff, fellows, residents, and laboratory staff including call debriefing conference, unknown conference, case conference, integrative case conference, journal club, quality reports conference, and a series in laboratory administration

Interdepartmental Conferences

• a variety of conferences occur in conjunction with other disciplines including
  • morbidity and mortality conference
  • multidisciplinary tumor boards and teaching conferences