The first year of the fellowship is comprised of rotations in hospital-based surgical neuropathology. There are three distinct services that comprise these rotations: Surgical Neuropathology; Muscle and Nerve Biopsy and Autopsy Neuropathology.
In this rotation, fellows will be involved in the diagnostic work-up of all surgical neuropathology cases accessioned into the University of Michigan pathology department. These include specimens generated from in-house procedures, transfer cases from outside institutions, and consultations sent to the neuropathology service from outside physicians. Fellows will examine the gross specimen, perform and interpret squash and touch preparations of fresh tissue, perform and interpret frozen sections, review microscopic slides from fixed material, develop a differential diagnosis, master the work-up for cases, generate appropriate final diagnoses, and communicate results in a timely manner to clinicians. Fellows will be given graded responsibility appropriate for their level of training with the goal of ensuring high-quality patient care. Junior fellows will receive direct supervision in all aspects of this rotation. As their training progresses, fellows will be encouraged to write complete reports and to communicate preliminary results to clinicians; the faculty will subsequently review and verify all cases. In this way, the fellow and the program will be able to assess the fellow’s ability to function independently while maintaining an adequate level of supervision.
Muscle and Nerve Biopsy:
Fellows will concurrently rotate on the muscle and nerve biopsy service. Here they will be involved in the diagnostic evaluation of all skeletal muscle and peripheral nerve biopsies accessioned into the University of Michigan pathology department. These include specimens generated from in-house procedures along with a robust consultation service. Fellows will participate in freezing fresh tissue, preparing fixed tissues, reviewing microscopic slides, developing a differential diagnosis, mastering the work-up for cases, generating appropriate final diagnoses, and communicating results in a timely manner to clinicians. The evaluation of this material will include the use of an array of histochemical and immunohistochemical stains, Epon embedded sections and electron micrographs. As with the rotation on surgical neuropathology, fellows will be given graded responsibility appropriate for their level of training with the goal of ensuring high-quality patient care.
Fellows are responsible for gross and microscopic evaluation of the neuropathology on all autopsies performed at the University of Michigan Hospital, including perinatal, pediatric and adult cases from the in-patient services and dementia patients followed by the Michigan Alzheimer’s Disease Center. Fellows will master brain and spinal cord removal, lead gross evaluation of specimens at brain cutting conference, block in specimens, review microscopic slides, master the work-up for cases and generate appropriate final diagnoses. As with the rotation on surgical neuropathology, fellows will be given graded responsibility appropriate for their level of training. Four weeks of this rotation will include CNS examination of forensic autopsies conducted at the University of Michigan Hospital, site of autopsies for the Washtenaw County Medical Examiner’s Office.
Surgical Neuropathology and Neuromuscular Pathology:
Eight weeks of the fellow’s second year of training will be spent on the surgical neuropathology and muscle and nerve biopsy service. The fellow’s interest will help determine the breakdown of time spent on surgical versus muscle and nerve service, but a minimum of 4 weeks on surgical neuropathology is expected. During this time, senior fellows who have demonstrated appropriate diagnostic acumen will take a lead role in running the service, mentoring junior fellows on service and teaching rotating residents. Fellows will be expected to write complete reports and to communicate results to clinicians; the faculty will subsequently review and verify all cases.
During this one-week rotation, fellows will study slide sets to review normal and disease cytology of the CNS. During the rotation week, fellows will also participate in screening and signout of CNS cytology cases including fluids and FNAs. Fellows will augment this focused experience on cytopathology. While rotating on surgical neuropathology, fellows will review CNS cytology specimens from patients with brain tumors and correlate findings with surgical biopsy specimens. If desired by the fellow, this cytopathology rotation can be taken during the first year of training.
Based on the increasing use of molecular tests in diagnostic surgical neuropathology and in the evaluation of neurogenetic diseases, fellows will rotate on the Molecular Diagnosis service. The length of this rotation will depend on the trainee’s prior experience with molecular techniques. Emphasis will be placed on gaining familiarity with tests used in neurogenetic screens (e.g. mutational analysis) and surgical neuropathology, including, but not limited to, FISH, PCR-based screens for chromosomal rearrangements, and tests for gene amplification. The length of this rotation will be 2-4 weeks, as determined by the director and fellow.
A wide range of clinical and basic research opportunities exist within the division, the pathology department and the medical school. Neuropathology faculty will mentor fellows and assist them in identifying an appropriate project so as to develop an area of investigational expertise using state of the art approaches to clinical, translational or cell and molecular questions. During this time, fellows will further develop their abilities to critically evaluate the literature, generate hypotheses and design experiments to answer clinically important questions. The goal of this experience is to generate scholarly work that will be presented at a national or international meeting and will be submitted for publication in a peer-reviewed journal; if appropriate, this work should also serve as the foundation for an application for extramural funding. While on this rotation, it is expected that fellows will continue to attend the twice-weekly neuropathology consensus conference and neuromuscular conference to assure continuity of clinical training.