University of Michigan - Department of Pathology

RESIDENCY TRAININING PROGRAMS

ANATOMIC AND CLINICAL PATHOLOGY

Resident training in Anatomic Pathology includes core rotations in autopsy pathology, cytopathology, dermatopathology, and surgical pathology. In addition, residents also spend time in other laboratories, the intellectual domains of which cross both anatomic and clinical pathology. The Clinical Pathology curriculum utilizes a unique block system in which related areas of clinical pathology are grouped together. This provides for a more integrated and structured approach to training. With this unique block system, we believe that the CP program at Michigan represents one of the finest such programs in the country. Residents are encouraged to elect rotations in hematopathology, molecular diagnostics, and cytogenetics. Additional experience is offered on an elective basis in virtually all subspecialty areas including neuropathology, forensic pathology, molecular pathology, and renal pathology to name a few.

Residents work on an individual basis closely with the attending staff, learning how to present information in scientific forums by regularly participating in inter- and intradepartmental conferences. In addition, residents play an active role in the teaching of medical students in the basic science curriculum of the Medical School. Most residents participate in anatomic pathology rotations throughout their residency training.

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ANATOMIC PATHOLOGY

CLINICAL PATHOLOGY

ANATOMIC PATHOLOGY

Autopsy Pathology

Approximately 500 autopsies are performed annually at the University Hospitals and nearby Veterans Administration Hospital. These cases represent a wide spectrum of diseases including pediatric as well as forensic cases from Washtenaw County. Because of the forensic experience of the pathology faculty, residents have not found it necessary to take separate rotations at other facilities.

The autopsy service also serves as an initial introduction to surgical pathology for many of the residents. Residents are instructed in proper dissection techniques as well as in the interpretation of histologic sections. Finally, the autopsy service serves as a forum for the instruction of medical students and house officers from other services.

Cytopathology

Residents are assigned to cytopathology for two to three months, but they may elect to spend additional time in this area. The laboratory processes approximately 7,500 non-gynecologic and 40,000 gynecologic specimens annually. The non-gynecologic specimens are quite varied and include about 1,700 fine needle aspirates.

Residents attend the daily sign-out session usually of four hour duration. They also attend all the clinical procedures of fine needle aspirations involving deeply situated lesions. These aspirations are carried out in the Department of Radiology. Residents are taught how to prepare the aspirates for rapid, on-site evaluation. Residents also learn to carry out fine needle aspiration of superficial lesions and how to prepare and interpret the specimens rapidly.

Dermatopathology

This service has seen considerable expansion in recent years, in part due to the expansion of the Cutaneous Surgery and Oncology Clinic located in the Comprehensive Cancer Center and a large pool of referring private practice dermatologists. Over 15,000 cases are accessioned each year and range from diagnostic biopsies to full resections of larger lesions.

Dermatopathology specimens are separated from general surgical pathology and residents rotate on a dedicated dermatopathology service for 3 months during their training, with the option for additional elective experience. Supplementing the sign-out experience provided by three department dermatopathologists, is a monthly teaching conference held for all residents.

Neuropathology

At weekly brain cutting sessions under the supervision of one of the neuropathologists, resident prosectors demonstrate material from their autopsy cases to an interdisciplinary group which includes neurologists, neurosurgeons, neuroradiologists, as well as pathologists. The same group participates in a monthly clinical pathologic conference. House officers are encouraged to review the neuropathology findings from their surgical and necropsy cases with neuropathologists. In addition to this ongoing practical experience, trainees are offered a didactic course in neuropathology each year.

Surgical Pathology

The Surgical Pathology faculty in the Department of Pathology constitutes one of the strongest groups of diagnostic surgical pathologists in the world. The surgical pathology service is an active rotation in which efficiency and accuracy of specimen handling and diagnosis and "one on one" teaching are emphasized. Depending on the individual career goals, residents are assigned to surgical pathology for 14 to 18 months. Training is closely supervised by the attending staff, although house officers are expected to develop a sense of confidence and graduated independence as they progress through training. During their rotations, residents are responsible for the gross description, dissection, and microscopic review of specimens prior to “sign-out” with faculty. Approximately 60,000 specimens are processed annually by this service. The types of cases range from the uncomplicated to the highly complex specimens derived from the numerous patient referrals to this tertiary care complex. In addition, about 6,000 personal consultations referred to the faculty for expert opinion complement and augment surgical pathology material.

Approximately 6,000 frozen sections are performed each year and ancillary special studies (e.g. immunohistochemistry , FISH) are performed on a significant percentage of cases. Interesting cases are reviewed with the staff at a weekly surgical pathology conference, a bimonthly immunohistochemistry conference, and a monthly gross surgical pathology conference.

CLINICAL PATHOLOGY

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.

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.

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.

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.

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.

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.