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and Beth Israel Medical Center Residency Program in Anatomic and Clinical Pathology
FOREWORD The St. Luke's-Roosevelt Hospital Center, in collaboration with Beth Israel Medical Center offers a concentrated program, which provides training in clinically-oriented diagnostic Anatomic and Clinical Pathology. Attending staff based at St. Luke's-Roosevelt are faculty members of the Columbia University College of Physicians and Surgeons, and at Beth Israel are faculty members of the Albert Einstein College of Medicine of Yeshiva University. Residents have access to many of the facilities at both institutions. The department interacts closely with clinical departments through a variety of inter-departmental conferences and rounds. The curriculum of the residency program is oriented toward integrated human pathology, with the faculty working as a closely-knit group of general pathologists, each with a special field of expertise. The core curriculum consists of supervised training with emphasis on increasing resident responsibility in autopsy and surgical pathology, cytology, cytogenetics, hematopathology, clinical chemistry, serology, microbiology and blood banking/transfusion medicine. Specialized training is offered in laboratory management and computer applications. GOALS AND OBJECTIVES The goal of the program is to graduate pathologists and laboratory directors with superior technical competence, clinical acumen, and intellectual depth. By developing these characteristics, the graduates will be able to bring the methods and scientific principles of current and developing pathology practice to the aid of the clinician. The objectives of the program are to instill and develop in the residents the competencies (as defined by the American Board of Pathology) required for the practice of pathology and medicine in general: A. Patient Care: Demonstrates a satisfactory
level of diagnostic competence and the ability to provide appropriate
and effective consultation in the context of Pathology services including:
effective communication with patients and families; ability to gather
essential and accurate information about the patient from all available
sources; makes informed decisions based on current scientific evidence
and clinical judgment; uses information technology to support patient
care decisions and education of patients and other health care workers;
performs competently all technical and invasive procedures essential for
the practice of pathology; develops appropriate diagnoses or differential
diagnoses; works with other health care professionals to provide patient-focused
care. Residents have intense experience and gradually increasing responsibility
in the various disciplines of anatomic and clinical pathology. Close daily
contact with the attending staff, often one-on-one, assures close supervision
and continuing evaluation. Residents are expected to attain the basic
and practical knowledge of pathology and to gradually develop expertise
and partake in increasing responsibilities in service practice (including
analyzing data, initiating case-based studies, managing the services,
and interacting with clinicians). Each rotation includes a curriculum,
which defines the educational goals of the rotation and provides guidance
for training technical aspects of the laboratory’s operation, management
and quality control. This occurs under direct supervision of attending
pathologists and senior management. Laboratory management and statistical
techniques for managing data are stressed, particularly in clinical pathology.
Intellectual and scientific aspects of pathology, including pathogenic
mechanisms and clinico-pathologic correlation, are emphasized in didactic
conferences, autopsy conferences and clinical pathology conferences. Residents The faculty evaluates the residents in each of the six core competencies
by electronic completion of a standard form at the end of each rotation.
These evaluations are supplemented by evaluations provided by the directors
of elective or specialty rotations. A permanent record of the evaluations
is maintained by the residency coordinator and is accessible to the resident
or authorized personnel. The evaluations are reviewed with the residents
biannually by the program director. The program director also reports
to the Education Committee on findings from these reviews, with recommendations
for further action (promotion, development, remediation), as appropriate.
Program The program is evaluated on a regular basis. The residents formally evaluate
the attending staff and the training program annually. These evaluations
are reviewed by the chairman and the program director, discussed by the
program director with the Education Committee, and discussed by the chairman
with the individual pathologists. The St. Luke’s-Roosevelt GME Committee
also conducts a periodic internal review of the program. Matters of staff
performance, material and budget issues, program content, rotation changes
and planning, policy and procedure are discussed at regular Education
Committee meetings, which are attended by the chief residents. Through
regularly scheduled, ad hoc, and informal meetings with the program director,
the residents provide their input, including critique(s), regarding the
program. SAMPLE ROTATION SCHEDULE BY POST-GRADUATE YEAR
SURGICAL PATHOLOGY Approximately 50,000 cases are examined each year in state-of-the-art
facilities at St. Luke’s-Roosevelt Hospital and Beth Israel Medical
Centers. These cases cover a wide variety of disease processes, and range
from routine to complex and unusual disease entities. Over the course
of training, the resident will develop into an independent diagnostician
through a combination of ‘hands-on’ experience and formal
study. Under the guidance of an attending pathologist, the resident examines,
describes, and sections surgical pathology specimens. Initially, the attending
pathologist provides detailed instruction, but as training progresses,
the resident will independently evaluate specimens and present a plan
to the attending pathologist. For some specimens, this will be relatively
simple and routine; for others it will be detailed and uniquely tailored
to the specimen. Following preparation of the microscopic slides by the
histology laboratory, the resident examines them independently prior to
reviewing them with the attending pathologist. At the outset of training,
the emphasis is on differentiating normal from abnormal and making distinctions
among a wide variety of disease processes. As the residents become more
experienced, they take an increasingly active and independent role in
the planning, ordering, and interpreting of diagnostic studies such as
histochemical, immunohistochemical, electron microscopic, and molecular
diagnostic analyses. The process stresses that the evaluation of a given
specimen extends well beyond the diagnosis itself to include details that
will help to determine patient management and define prognosis. CYTOPATHOLOGY Cytopathology is the practice of pathology concerned with the study and diagnosis of human disease manifested in cells. The goal of the three-month cytopathology rotation is for the resident to obtain the medical knowledge, the ability to utilize this knowledge to solve medical problems in cytopathology, and the patient care skills, including diagnostic competence and the ability to interpret test results, required to perform fine needle aspiration and to participate with the laboratory and clinical teams in the provision of patient-focused care. The resident spends two months at Roosevelt Hospital, where cytopathology processing and reporting is performed for the St. Luke’s Roosevelt Hospital Center, and one month at Beth Israel Medical Center, where the resident participates in the Fine Needle Aspiration (FNA) service located at the Phillips Ambulatory Care Center. During these rotations, the resident is expected to participate in patient care as a diagnostic and clinical consultant who has (a) the communication skills required for constructive interactions with referring physicians; (b) the medical knowledge to interpret specimens submitted for cytologic examination; (c) the practice-based learning and improvement skills required to maintain current knowledge in cytopathology and to locate and apply scientific evidence to the care of patients; and (d) the interpersonal and communication skills, professionalism and understanding of systems based practice required to be a successful laboratory director. AUTOPSY PATHOLOGY In teaching autopsy pathology, the resident is encouraged to approach
the autopsy in much the same way as a clinician approaches a new patient.
They are expected to gather and interpret clinical data available in the
patient’s medical record, including clinical history, laboratory
and radiological data, hospital course, clinical diagnosis and terminal
event, with the intent of performing a patient focused post-mortem examination.
This begins with their external examination of the body as received. A
key component of post-mortem examinations involves making decisions when
planning the gross dissection and the collection of appropriate samples
for ancillary studies (e.g., microbiologic analysis, toxicology, immunohistochemistry,
electron microscopy, etc.). While residents are closely supervised by
attending pathologists, following an initial phase of direct oversight,
residents assume graduated responsibility, functioning more independently
as their fund of knowledge and their ability to actively utilize this
knowledge to solve problems increases. While an attending and/or senior
resident is always available to discuss any unexpected findings encountered
during the post-mortem examination, as the resident becomes increasingly
independent, routine attending oversight may be limited to a discussion
of the clinical history prior to initiating the examination. The ability
of the resident to progressively assume responsibility for the post-mortem
examination is a useful assessment tool for the attending staff in evaluating
their diagnostic competence, medical knowledge and professionalism in
anatomic pathology. Immediately following the post-mortem examination,
the findings are reviewed with an attending pathologist, a written description
of the gross findings is prepared by the resident, and appropriate preliminary
sections submitted to the histology laboratory. Based on the gross findings
and clinical history, a Preliminary Anatomic Diagnosis (PAD) is issued
within 24 to 48 hours. When the microscopic slides are available, the
resident reviews them with ancillary studies, such as toxicology results,
and senior residents prepare a written description of their observations. CLINICAL PATHOLOGY The goal of training in clinical pathology is to provide the residents with the case material, practical experience, formal instruction, and guidance to develop into a pathologist capable of handling all aspects of the modern practice of clinical pathology. There is an emphasis on diagnostic competence, research, evaluation of evolving medical knowledge and new procedures, management and quality assurance issues, and effective communication with clinicians and other members of the healthcare community. While direct patient contact is limited, the program is committed to developing clinical pathologists who recognize and appreciate their role as part of the clinical team in the provision and advancement of patient-focused care. It is the intent of the program that this should occur in an environment based on the acquisition of progressive knowledge, superior diagnostic competence, clinical acumen, and professional responsibility. The rotation schedule requires a minimum duration in each of the four major specialties (hematopathology/hematology, blood bank/transfusion medicine, microbiology, and clinical chemistry). Additional rotations are spent in laboratory management/informatics and cytogenetics. Throughout training, the resident develops skills and acquires competence through graduated responsibility in each of the 6 competencies noted above. RESEARCH Research opportunities are available in anatomic and clinical pathology, and the residents are encouraged to complete projects in one or more disciplines. In anatomic pathology, the projects may consist of case reports, analyses of series of cases from a primarily pathologic perspective, collaborative correlative studies with clinical colleagues, and/or incorporation of basic science techniques (e.g., immunohistochemistry, in-situ hybridization, polymerase chain reaction, comparative genomic hybridization, etc). The resident works closely with the attending pathologist and other investigators in all stages of the process, including planning, execution, and reporting. Research projects require a range of organizational, analytical, and communication skills; the attending pathologists evaluation of the resident is based on an assessment of these skills, and ultimately on the finished product which is submitted for presentation in abstract or paper form. The department encourages residents to present their findings at local, national and international meetings and provides financial support so that they may do so. PROGRAM APPLICATIONS Interested candidates may apply to the program through the Electronic
Residency Application Service (ERAS), beginning early September and preferably
prior to December 31st of each year. Due to the anticipated high volume
of applicants, only a small percentage of qualified candidates can be
invited for interview.
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