Organization of rotations
The fellow spends approximately 10 months in the Automated Chemistry and Special Testing sections of Clinical Pathology and 4 weeks in the area of Molecular Pathology. Time is available for vacation as well as attendance at one national meeting (1 week). If the fellow is presenting a paper/poster, meeting time can be extended.
Initial 3 months
These are spent in the Automated Chemistry and Special Testing sections, becoming familiar with the general organization of the Department laboratories and with supervisory and technologist staff. During this period regular discussions are held with the pathologists and clinical chemists in the major areas of chemical pathology, with special emphasis on instrumentation (general principles and departmental instrumentation), method evaluation, statistics and test interpretation. If a resident is rotating in Clinical Chemistry, discussions are held with both resident and fellow. Also during this initial period, the fellow starts to review methods and instrument systems listed in detail in the lab rotations. Test interpretations include:
- serum and urine protein electrophoreses
- serum and urine immunofixation
- hemoglobinopathy evaluations (chromatography, electrophoresis)
- glucose tolerance tests
- alkaline phosphatase isoenzymes
- hydrogen breath tests
- endocrine stimulation/suppression tests
Specific rotations - 7 months
The fellow rotates through the following lab areas.
- Stat lab (4 weeks)
- Point of care testing (during stat lab rotation)
- Automated chemistry - main lab (5 weeks)
- Urinalysis (2 weeks)
- Special testing - 1st floor/special chemistry (4 weeks)
- Special testing - 2nd floor/immunology (5 weeks)
- Toxicology (6 weeks)
- Lab administration and informatics (4 weeks)
- Outreach, send-out lab, quality assurance, phlebotomy (1 week)
During lab rotations the fellow rounds and interacts on a daily basis with the appropriate clinical chemist and/or pathologist in order to experience developments and problems within the section. The fellow is expected to assist in investigations that may be necessary, whether laboratory - or patient - related. The approach to such investigations is gradual, the intent being for technologists/supervisors to eventually contact the fellow directly, rather than going through a pathologist/clinical chemist. This graduated level of responsibility is ultimately achieved based upon repeated direct observations by the faculty. However, all decisions are reviewed with the appropriate senior staff.
During assigned rotations, time is also spent at work-stations to learn about methods and instruments used in different areas of the lab. Specific goals and activities for each lab rotation are listed under the appropriate lab section. In addition, a General checklist (includes items such as method comparisons, CAP proficiency problem review) is included. Items on the latter checklist should be completed during the year’s training.
During lab rotations, the trainee is expected to assist with test interpretation. This occurs on a regular basis, but is scheduled such that the trainee has sufficient time to work on assigned projects. The clinical chemist or pathologist is responsible for discussing other relevant laboratory issues that arise during rotations.
Molecular Pathology (4 weeks)
This period of training is placed at an appropriate time during the final 6 months of the program.
During the first three months, daily teaching sessions will be held with the pathologist and/or clinical chemists in the major areas of chemical pathology, with special emphasis on instrumentation (general principles and departmental instrumentation), pathophysiology and test interpretation. In the subsequent months teaching sessions will be individualized. The fellow is expected to attend the biweekly Clinical Pathology conference where residents and fellows are scheduled to give presentations, and selected grand rounds given by other hospital departments (e.g. Internal Medicine, Pediatrics).