Review of the clinical areas in the resident rotations.
Pennsylvania Hospital is a major treatment center for complex surgical cases, with emphasis on breast, gynecologic, head and neck, gastrointestinal, and genitourinary oncology. Residents gain experience in gross dissection, frozen section interpretation and microscopic diagnosis. The department has adopted an “oligo-specialty” model of sign out, in which faculty members cover their area(s) of expertise.
A core rotation in cytopathology exposes residents to all aspects of gynecologic and nongynecologic cytology including interpretation of fine needle aspiration biopsies. Residents review all types of specimens with the attending cytopathologist at the teaching microscope, which also include body fluids, and ultrasound/ CT-guides aspirations. The trainees are also involved in rapid on-site evaluations (ROSE). The cytopathology rotations take place at both Pennsylvania Hospital and the Hospital of University of Pennsylvania.
Autopsy experience is integrated into the program during all levels of a resident's training. The trainee performs both adult and pediatric/ fetal autopsies at Pennsylvania hospital. An autopsy conference follows all cases, and is attended by all residents and faculty members, thereby maximizing exposure to clinical-pathologic problem solving and gross diagnosis. Our program includes supplemental autopsies at Albert Einstein Hospital in Philadelphia.
Residents spend one month during their residency in the Philadelphia Medical Examiner's Office to learn the essentials of forensic pathology. For interested senior residents, additional elective months are available.
Clinical Pathology / Laboratory Medicine:
A core rotation of up to five months exposes residents to important aspects of transfusion medicine. Hands-on experience is received in the blood bank laboratory where residents meet regularly with the laboratory director to discuss topics in transfusion medicine. Residents are involved in clinical problem solving and patient care. The training includes 1-month mandatory rotation at the HUP, which emphasizes the fundamentals of tissue typing and apheresis.
The emphasis in clinical chemistry (four months) is on test interpretation and utilization. Laboratory experience exposes residents to the technical aspects of the tests performed, including test validation. Residents are also encouraged to participate in quality assurance initiatives and projects.
Residents spend a core rotation of five months in hematopathology. During this rotation residents review all unusual blood smears, bone marrow aspirates/biopsies and lymph node biopsies with the attending, receive tutorials in hematologic interpretation, learn about the instrumentation in the hematology laboratory, and learn to interpret and coagulation studies. The residents are also trained at evaluating flow cytometry, immunohistochemistry and molecular methods. The trainees also spend 3-months of mandatory hematopathology rotations at the HUP. They are also exposed to complicated Consult Hematopathology cases during their HUP rotation.
During this four month core rotation, residents gain practical experience in identifying microorganisms including bacteria, fungi, viruses and parasites, by conventional phenotypic analysis and modern technologies, such as Maldi-TOF, genetic sequencing, etc. Residents attend conferences given in conjunction with the hospital's Section on Infectious Diseases and are involved in clinical-pathologic studies. These rotations are divided between Pennsylvania hospital and HUP (one month).
Residents gain experience with molecular pathology techniques during a core rotation in the molecular biology laboratory at the HUP (one month).
Given the growing importance of molecular methods in the practice of medicine, all residents receive extensive training in cytogenetics, targeted molecular diagnostics, as well as the emerging field of genomics.
Penn Medicine’s Center for Personalized Diagnostics (CPD) became operational in 2013 and is actively analyzing patient specimens and affecting clinical treatment decisions. The focus of the CPD's initial efforts has been toward developing two cancer gene sequencing panels: a custom hematologic malignancy panel and a solid tumor panel. The primary targets include leukemias, lymphomas and solid tumors, beginning with brain, melanoma, and lung tumors. The goal is to identify genomic alterations that allow clinicians to design and implement optimal treatment plans. As part of their training in genomics, residents will rotate at the CPD. It is important to note that the rotation at the CPD offers a wide range of opportunities for resident research projects.
The residents are also offered elective rotations at the Hospital of the University of Pennsylvania in various anatomic pathology and clinical pathology subspecialties, including but not limited to Dermatopathology, GI pathology, neuropathology, liver pathology, medical renal pathology, among others.
- Ocular Pathology: A month-long elective in ocular pathology is available at Wills Eye Hospital for interested senior residents.
- Pediatric Pathology: Residents can spend time at The Children's Hospital of Philadelphia for experience in pediatric surgical pathology biopsy and resection specimens, and also for pediatric autopsy.
- Others: The residents are also offered elective rotations at other national/international institutes in their areas of interest, subject to availability and approval by the Department of Graduate Medical Education.
Residents cover evening (after 5PM) and weekend on call service under the supervision of a senior resident and staff pathologist. Call duties include frozen section, and gross dissection of a few select surgical pathology specimens over the weekend.