Curriculum

EDUCATIONAL OBJECTIVES:

• This fellowship is designed to provide advanced training in diagnostic genitourinary (GU) pathology.
• It provides fellows with junior staff responsibilities, including a large case volume and clinical and basic science research opportunities in GU pathology, thus enabling them to function independently as an academic genitourinary surgical pathologist.

The educational objective of this experience is to ensure that the trainee becomes competent in the broad area of genitourinary pathology, including urologic oncology with an emphasis on diseases of the prostate, bladder, kidney, testis and other urinary tract, understanding the medical and surgical management of GU malignancies and patient materials derived from the cystoscopic and GU surgical services, as well as in the administrative and regulatory aspects of this discipline.

CORE CURRICULUM:

Genitourinary Pathology Fellowship Outline

1. Pathology of Prostate:

• The trainee will develop an expertise in the recognition and pathological diagnosis of prostate cancer utilizing a combination of clinical information, routine histopathological examination, as well as specialized immunohistochemical studies. The trainee will also learn the potential applications of the emerging biomarkers in the diagnosis and prognosis of the prostate cancer. 
• Strong emphasis will be laid on the Gleason scoring system, pathological staging (TNM) and their implication on the clinical decision-making.
• The trainee will develop expertise in identifying the various morphological variants of prostate cancer as well as understanding the prognostic implications of these less common variants: influence on therapy, outcome, and the follow-up. 
• The trainee will learn to properly identify the potential pitfalls in the morphological diagnosis of prostate cancer, in particular in being able to amply differentiate from the benign mimickers like atrophy, post-atrophic hyperplasia, partial atrophy, basal cell hyperplasia, sclerosing adenosis, etc. 
• The trainee will become knowledgeable in the effects of radiation and /or hormonal therapy on histopathology of prostate cancer. 
• Additionally, the GU pathology fellow will prosect and harvest tissue from the male patients died of advanced hormone refractory prostate cancer participating in the IRB-approved posthumous tissue donor program (Rapid Autopsy Program).

2.  Pathological Conditions of Urinary Bladder and Urethra: 

• The trainee will develop proficiency in the basic concepts of urinary bladder and urethral pathology, including evaluating the more complex gross specimens like radical cystoprostatectomies (prostate and bladder resection) for deeply invading bladder cancer, neo-bladder, transplanted urinary bladder, etc. 
• The trainee will develop proficiency in the area of bladder cancer, its various histological types, and their prognostic implications. A strong emphasis will be placed on the thorough understanding of the evolution of the various grading schemes as well as the new ISUP grading system for bladder neoplasia. 
• The trainee will develop proficiency in the cytological aspects of urinary bladder cancer by closely coordinating with the cytopathologists; histopathological and cytological correlation of bladder cancer; and knowledge of more sophisticated techniques like image analysis, morphometry, flow cytometry, DNA ploidy analysis, UroVision FISH and their application in diagnostic evaluation of urinary bladder cancer.
• The trainee will become proficient in the non-neoplastic, inflammatory, and pre-malignant conditions of urinary bladder, such as interstitial cystitis.

3. Diseases of Kidneys and Ureters:

• The trainee will become proficient in the diagnosis of adult epithelial and non-epithelial neoplastic diseases of kidney and ureter. 
• The trainee will become proficient in evaluating nephrectomies performed for non-neoplastic diseases (laparoscopic, partial and total, and donor).

4. Pathology of Testes and the Male Genital System: 

• The trainee will evaluate orchiectomy specimens mainly for primary testicular neoplastic disorders and also as a part of management of advanced prostate cancer. 
• The trainee will evaluate secondary tumors involving testes. 
• The trainee will evaluate non-neoplastic disorders of testes. 
• The trainee will evaluate biopsies for infertility and impotence in conjunction with other lab data and clinical information. 
• The trainee will become proficient in the diagnosis of both neoplastic and non-neoplastic disorders of the external male genitalia.

5. Frozen Sections:

• The fellow will interpret frozen sections as related to genitourinary pathology with staff supervision and support from the division of surgical pathology. He/she will act as a liaison with the clinicians, eager to receive preliminary diagnosis for GU cases.

6. Administrative and Regulatory Aspects of Genitourinary Pathology

• The fellow will serve as the primary contact for all urologists and pathologists at the participating institutions. 
• The trainee will develop proficiency in the day-to-day genitourinary sign-outs involving coding (SNOMED) and billing information, especially for the multiple needle biopsies of prostate. 
• The trainee will develop enhanced proficiency in the area of lthe aboratory informatics system and the web-based clinical information system. 
• The trainee will develop proficiency in maintaining adequate records and documentation of all the sign-outs performed. 
• The trainee will become knowledgeable about the role of the Institutional Review Board (IRB) in clinical research. 

The Spectrum and Nature of Material to Which the Trainee Will Be Exposed: 

• In-House Cases: GU fellow is responsible for supervising and helping the rotating pathology resident for previewing, preparation, and signing out of the in-house GU cases with the faculty.  
• Transfer Cases:  Transfer cases are cases from patients with documented GU lesions who had a biopsy or resection from an outside hospital or clinic that are now being seen at the University of Michigan.  The urology section religiously has slides reviewed prior to these appointments.  The GU Fellow will be responsible for reviewing these slides and writing or dictating a diagnosis prior to sign-out with the GU pathology faculty.  Templates need to be completed for all bladder and prostate specimens.  Any case requiring special studies or additional material (i.e. blocks or slides) should be requested prior to sign-out when possible.  Any major discrepancies should be discussed with the concerned urologist. 
• Consultations:  The GU pathology fellow reviews all outside consultations prior to sign-out with and Dr. L. Priya Kunju and other GU faculty.  These cases come from several regional hospitals requesting an expert opinion.  All efforts should be made to request additional material or perform appropriate studies prior to sign-out.  Turn-around time for these cases is important; therefore any delays require a phone call to the referring Pathologist.  Fellows should dictate the letters immediately following sign-out.  As a courtesy, the referring pathologist should be notified of the diagnosis by phone.

DIDACTIC COMPONENT: 

• GU Oncology Conference:  This weekly held teaching conference involves presentation of the pathology of selected GU cases by the GU pathology fellow.  This is followed by an open discussion of the case by the urologists, oncologists, radiation oncologists, and the pathologists.  
• GU Pathology Review:  This is a urologic pathology conference where the GU pathology attending staff and GU pathology fellow present basic pathology to the urology residents in preparation for their board examinations.  It often takes the form of presenting thematic unknown cases and having the urology resident work through the morphologic description as well as the differential diagnosis.  This has been found to be the most useful format over a straight didactic lecture.  Following each case, a few minutes of didactic material can be presented.  Occasionally, a straight didactic lecture will be given. 
• Pathology Conferences:  The pathology department has several conferences presented on weekly bases on a large number of broad surgical pathology topics involving the respective faculty. The fellow will have an opportunity to participate in these conferences to interact with other faculty. 
• Lectures/Presentations: The GU pathology fellow can share with the GU faculty a total of 1-2 didactic lectures per session to the pathology residents on topics related to GU pathology.
• GU Pathology Consensus Conference:  This is a consensus conference in which the GU fellow and faculty on service/consults share interesting and/or educational cases every Tuesday at 1:10pm (right after the regular consensus conference).  The GU fellow typically presents the cases.

LEARNING RESOURCES IN GU SERVICE:

• GU Room Folder
• GU Room Sign-Out Tools
• GU Template Folder
• Teaching Slide Box

RESEARCH OPPORTUNITIES: 

The trainee will develop proficiency in clinical research pertaining to GU pathology. The University of Michigan has an NIH-funded Specialized Program of Research Excellence in Prostate Cancer (S.P.O.R.E) and active bladder program. Fellows are required to be involved in the ongoing translational research projects usually in collaboration with the department of urology. The division of GU Pathology and Urology at the University of Michigan has a very active prostate and bladder research program complimented by a clinical and basic science investigative team. The trainee will have opportunities in maintaining an institutional and national prostate tissue bank, as well as being involved in immunohistochemistry studies, molecular diagnostics, tissue macro arrays, DNA micro arrays, florescent in situ hybridization, and a variety of other molecular techniques.

The core curriculum will keep a balance of 65% training in clinical and 35% for research activities including elective rotations in other subspecialities. The trainee will be given adequate protected time to perform and accomplish research objectives.

EXPECTATIONS FROM THE TRAINEE AT THE COMPLETION OF THE FELLOWSHIP: 

1. The trainee will achieve satisfactory clinical performance evaluation from the faculty.
2. The trainee will present at least one research project at national meetings each year.
3. Trainee will take a lead role in writing up all their projects and sending the manuscript(s) for publication before the completion of the fellowships.

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METHODS OF EVALUATION: 

1. Review of GU pathology fellowship with the fellowship program director to discuss fellowship requirements and expectations for the year.
2. Training log of supervised sign-outs to document competency.
3. Written evaluation form to be completed by the GU pathology attending staff every 6 months of training.
4. Quarterly meeting with the GU pathology faculty to evaluate whether the fellowship training is meeting the objectives outlined in the above document.

Objectives, Including Core Competencies on Which Evaluation Will Be Based: