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CLINICAL PATHOLOGY

 

Blood Bank/Transfusion

Residents spend four months in this rotation, preceded by a two-week lecture and laboratory orientation program. They work closely with medical technologists and medical staff to learn the theory and methodology involved in serologic testing, and the steps involved in issuing blood components. They also serve as liaisons between the clinician and the laboratory, providing consultation concerning the appropriate use of blood components, investigating transfusion reactions, and correlating laboratory test results with clinical findings. Residents are very involved in the apheresis service as well, which offers both therapeutic apheresis and peripheral stem cell collection. They also have the opportunity to participate in the clinical Hematology/Oncology Consult Service on an elective basis. The overall goal of the experience is for the residents to develop knowledgeable consultative approach to patient care problems.

Faculty and laboratory managers discuss cases and important issues with residents each morning, and residents also meet with individual faculty members on a regular basis to review selected and timely topics.


Clinical Microbiology/Virology

The Clinical Microbiology/Virology Laboratory plays a vital role in patient management and hospital infection control by detecting and identifying infectious pathogens in clinical isolates and by determining the antimicrobic susceptibility of bacteria. During their core Clinical Pathology training, residents spend four months on the Microbiology/Virology/Molecular Diagnostics/Tissue Typing rotation. The first of these four months is dedicated solely to microbiology and serves as the time during which the principles, methods, and procedures of general bacteriology, mycobacteriology, mycology, parasitology, and virology are taught. Specific training in state-of-the-art molecular diagnostic methods used to identify microorganisms compliments the education provided by the separate Molecular Diagnostics aspect of the rotation.

Subsequent training months serve to complete, expand, and solidify the resident’s knowledge base in microbiology and to expose and involve the resident in laboratory management practice. In addition, residents serve as an important educational resource to the laboratory staff as well as to the Clinical Infectious Disease teams. Elective/Special Training months beyond the required core months can be arranged for those seeking to gain additional training in a specific area or to carry out a research project involving the microbiology laboratory.

Molecular Diagnostics

Residents spend approximately four weeks in the Molecular Diagnostics Laboratory. The rotation includes regular didactic contact with the laboratory director and regularly scheduled sign-out sessions. Sign-out duties include collating information from related tests (e.g. bone marrow morphology and cytogenetics) with the molecular test results. Basic instruction in Molecular Pathology concepts is taught by lectures and assigned readings.

The Molecular Diagnostics Laboratory performs over 3,000 tests in molecular pathology annually. Residents become familiar with both the techniques of the laboratory and the interpretation of these tests which include B and T cell gene rearrangement studies, bcr-abl, Factor V Leiden, prothrombin 2021 A, hereditary hemochromatosis, apoE, Fragile-X, and bone marrow engraftment analysis.

Hematopathology

Adult and pediatric bone marrow transplantation programs and active Clinical Hematology/Oncology services provide a wealth of interesting and challenging cases for the Hematopathology Division. During their core training in Clinical Pathology, residents spend six months on this service, work closely with the attending staff, senior laboratory staff, senior pathology residents, and the Hematopathology fellow.

In the first three months, residents learn the fundamentals of diagnostic bone marrow and lymph node pathology and the laboratory aspects of both benign and malignant hematology, including body fluid analysis, by reviewing diagnostic material with an attending hematopathologist. Didactic lectures, conferences, and self study complement this problem/case-based learning format. Training is also provided in the principles and methods of Cytogenetics, Flow Cytometry, Immunohistochemistry, and Molecular Diagnostics as applicable to hematopathology.

Many residents spend additional elective time in the hematopathology laboratory working individually with one of the attending hematopathologists, initiating a research project, or acquiring additional in depth training in a specific area of hematopathology.

Clinical Chemistry

The section of Clinical Chemistry consists of chemical pathology, ligand assay, drug analysis, and toxicology. During their four months on this rotation, residents are trained at the bench in basic assay methods and the operation of automated instruments. This training experience encompasses a wide variety of tests ranging from routine electrlyte analysis to highly sophisticated imunoassays. Theoretical considerations, relevant patholophysiology, test interpretation, statistical analysis, point-of-care testing, quality control, quality assurance, and management issues are addressed during regular didactic sessions with laboratory directors. Integrated into the rotation is formal instruction in laboratory informatics, which provides the resident with exposure to laboratory information systems and computer networking.

On this rotation, the resident serves as a primary resource for problems that arise on a daily basis. Problem solving often requires interaction with medical staff on patient wards, chart reviews, or literature searches. Finally, residents are also encouraged to assist in the development and introduction of new procedures.


Clinical Immunology

During their time in the Clinical Immunology laboratory, residents learn about techniques and methods in diagnostic immunology, and gain first hand experience with tissue immunogluorescence (especially as it relates to rheumatologic, renal, and dermatologic disorders), immunoenzyme assays, and protein electrophoresis. Each resident meets with a faculty member three times a week to sign out cases, and time is always available prior to sign-out for residents to preview the cases and formulate opinions. In addition, faculty meet weekly with residents, in a group forum, to discuss selected timely topics in immunopathology.

Residents may elect to spend more time in immunopathology, either to gain more experience in interpretation of tests or to pursue particular interests.