Residency Program

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Curriculum & Residency Structure

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The Department of Pathology offers comprehensive training in all aspects of pathology.  Although we are a large and diverse department, there is a strong emphasis on cohesiveness in both providing service and resident training.  The majority of our clinical and anatomic pathology facilities are housed in the University Hospitals and the adjacent Medical Science complex.  Our research faculty are located in the adjacent Cancer Center and Medical Science Complex and, a few steps away in the Biomedical Sciences Research Building.  This allows for ready communication and collaboration between faculty and residents working on different aspects of patient care or on research projects.

Our program provides training in clinical pathology (CP), anatomic pathology (AP), and research.  Clinical training encompasses either a combined AP/CP program or exclusive training in AP or CP.  Research training is available and can be linked to clinical training or exclusively as post-doctoral fellowship training.

The goal of our training program is to provide a comprehensive educational experience ensuring that our residents have a strong foundation in the knowledge base, interpretive skills and clinical interface skills required of a practicing pathologist.  Increasing resident responsibility in the day-to-day aspects of tissue diagnosis and laboratory problem solving are emphasized along with participation in laboratory administration and medical informatics programs.  Involvement in laboratory and clinically based research is strongly encouraged as an integral component of training.   Teaching opportunities include clinical conferences and medical student pathology laboratories.

Training Pathways

Training programs are personally designed and formulated to meet individual professional goals allowing our graduates to pursue multiple career paths including clinical practice, clinical academic careers and research investigator academic careers.


Application Checklist

The following documents are required from ERAS to complete your application:

  • ERAS common application form
  • Curriculum vitae (CV)
  • Personal statement
  • Medical school transcript(s)
 
  • Medical student performance evaluation (also referred to as the "dean's letter")
  • Three letters of recommendation
  • USMLE scores (allopathic medicine students)

Structure & Design

Rotations are structured in 2 week blocks, although many rotations including autopsy and clinical pathology are grouped into 4 week increments. The frequency of rotations emphasizes and reinforces concepts learned on complementary services. Additionally, exposure to rotations at different levels of training helps naturally increase gradation of responsibilities and education. This design also helps routinely expose residents to most sub-specialty areas before fellowship applications are due.

 

Anatomic Pathology Required Rotations

Autopsy 12 weeks
Cytology 10 weeks
Surgical Pathology 74 weeks (approx. 18 months)
 

 

Surgical Pathology Sub-Specialty Signout Services

Breast Pathology 8 weeks
Dermatopathology 6 weeks
Gastrointestinal Pathology 8 weeks
Genitourinary Pathology 8 weeks
Gynecologic Pathology 8 weeks
Neuropathology 2 weeks
Pediatric and Placenta Pathology 4 weeks
Renal Pathology 2 weeks
Room 1/Frozen sections
(Soft tissue, head and neck, thoracic)
14 weeks

 

Residents Training only in Anatomic Pathology have additional specific rotations

Cytogenetics 2 weeks
Hematopathology (includes Flow Cytometry) 8 weeks
Molecular Diagnostics 6 weeks

 

Clinical Pathology Required Rotations

CP rotations are usually organized into block rotations of slightly longer duration, particularly for Hematopathology (4-8 weeks) and the first time on Transfusion Medicine (8 weeks). The remaining CP rotations are typically in 2 or 4 week blocks within individual laboratory disciplines. This program is designed to increase longitudinal exposure to various CP disciplines and facilitate interdisciplinary approaches to complex clinical problems. Residents will have graded responsibility with first and second year residents focusing on acquiring basic skills and upper level residents refining their knowledge and interpretive skills and serving as a liaison for clinicians, laboratory supervisors and technologists.

 

Clinical Pathology Rotations

Chemistry/Toxicology/Informatics 12 weeks
Cytogenetics 2 weeks
Hematopathology/Flow Cytometry 20 weeks
Microbiology 12 weeks
Molecular Diagnostics/Immunopathology/HLA and Tissue typing 10 weeks
Transfusion Medicine, including Apheresis/Coagulation 16 weeks

 

Elective Rotations

Residents will have 24 weeks (almost 6 months) of elective rotations available during their core AP/CP 48 month training program. Numerous electives are available, including subspecialty consultation services in each field, and elective time can also be utilized as protective research time. Novel electives may be pursued with an identified mentor and approval by the Residency Program Director. This is to ensure the overall quality of the training experience and that the experience meets American Board of Pathology (ABP) requirements.

 

Additional Requirements

The Department of Pathology has recently created a Division of Quality and Health Improvement (DQHI), which will support projects aimed at quality improvement and assurance. This includes resident initiated projects of wide-ranging scope. Participation in quality improvement is an ACGME requirement and the department is well positioned to support such work.

The Department provides free access to ASCP’s Lab Management University, online learning modules which complement existing didactics. Completion of the online program is required prior to graduation and results in a program certificate.

 

Program Advantages: A List Compiled by the Residents

Rotation Structure

  • Integrated AP & CP rotations throughout all 4 years
  • 2-week rotation blocks, sometimes grouped together for 4 to 6 weeks for continuity when appropriate (generally CP rotations, first blood bank rotation, first autopsy rotation)

 

AP Rotation Design

  • Subspecialty surgical pathology model – Services include:
  • Breast, Dermatopathology, Gastrointestinal, Genitourinary, Gynecologic, “Room 1” (combined Head & Neck, Bone & Soft tissue, Thoracic and Frozen section service)
  • Dedicated preview time every afternoon/evening
  • Residents prepare reports to completion within the LIS (simulation of independent practice)
  • Daily sign-out with the attending on service
  • Sign-out, previewing and grossing each done every day (no all-day grossing)
  • Strong PA support provides training in grossing, and maximizes educational grossing opportunities

 

Unique Autopsy Rotation Design

  • Combined hospital and forensic services
    County medical examiner’s office is integrated into U of M hospital morgue, providing much greater variety and experience
  • Residents easily achieve 50 required autopsies without sharing and first-time residents are always paired with a senior resident

 

CP Rotation Design

  • Individual lab rotations – Services include:
    Chemistry/Toxicology, Hematopathology, Cytogenetics, Molecular/HLA/Immunology, Microbiology, and Transfusion Medicine
  • Rotations includes daily sign-out of tests requiring pathologist interpretations with attendings
  • Dedicated management elective available
  • ASCP’s Lab Management University
    Residency pays for access and curriculum is integrated into four years of residency

 

Additional Perks

  • Daily protected didactic conference from 8-9 am, with coffee and light breakfast served
  • Salary: Current salaries remain consistently competitive due to the House Officers Association collective bargaining. The most updated salary listing is available here. Additionally, an annual “lump sum” payment to encourage savings is made during the November pay period, generally equivalent to an extra month’s salary.
  • Education and travel fund:  $1500 per year for books/travel/educational resources, as well as an additional $1500 for travel if you are presenting an abstract at a national meeting, up to 3 separate meetings. (Potential total education fund: $10,500)
  • 4 weeks of protected vacation time, not scheduled while on service (no requirement to find coverage)
  • ASCP’s PRISE: Residency pays for access to hundreds of practice questions for rotation and Board preparation
  • Laptop and iPad provided for the duration of residency
  • Wide spectrum of housing options, including the opportunity to buy condos/houses  or rent close to the hospital
  • Close-knit resident group: Lots of planned get-togethers, impromptu hangouts and happy hours, pathology kickball team and a great overall work environment

Education Series (Conferences)

Each morning from 8-9 am is protected time for resident education, primarily with didactic talks given by faculty, fellows and residents. Resident presentation skills are developed through regular presentations including AP grand rounds (annually) and CP case conferences (3-4/year). The didactic lecture content will include fundamental and advanced topics generally repeated every 2 years, such that over 4 years a resident will have experienced these sessions twice at different stages of training. Additional regularly scheduled conferences at other times include Frozen section review, Autopsy gross findings, Forensic pathology, Molecular pathology and Surgical pathology journal clubs. As an added bonus, coffee and a light breakfast are served each day with morning conference.

 

Typical Weekly Schedule (8-9am Conference)

Monday AP didactics/Grand rounds
Tuesday AP didactics/Professional development
Wednesday Unknown slide and thematic microscope sessions
Thursday AP didactics, monthly hands-on Gross Pathology conference
Friday CP case conference or CP faculty didactic

How many positions are there in the program?

There are 28 total residents, with the number of positions varying between 6 and 8 each year. Most residents are in the AP/CP track, but AP only, CP only and AP/NP are also offered.

How many fellowships are offered?

18 different fellowships are available, some of which have multiple positions available. Many residents choose to stay for fellowships at University of Michigan. Additional info can be found here.

When do applications start getting reviewed? Can I contact the program education office to inquire on the status of my application?

Completed ERAS applications are reviewed shortly after they become available from ERAS from applicants registered for the NRMP match. Invitations for candidate interviews are sent starting in mid-to-late September, and continued on a rolling basis as ERAS applications are completed.

Applicants are encouraged to contact the program coordinator, Pam Howard, regarding the scheduling of interviews, application questions, and any other inquiries. 

What’s the interview day like?

We work hard to make the interview day a smooth, relaxed, and fun experience to facilitate candidates, residents, and faculty to get to know each other. The interview day typically lasts from 7:30 am to 3:00 pm. 4-6 residents are interviewed per day, each with one-on-one interviews with the program director and associate program director, as well as a variety of faculty from both AP and CP divisions, including faculty tailored to the specific interests of the resident (a short survey is sent prior to interview in order to optimally tailor the interview day to each candidate’s interests and career goals). In additional to individual interviews, candidates attend morning conference and an AP signout session to gain more insight into daily resident life and diagnostic activities.

Catered lunch with a number of residents is capped off with a resident-guided tour of the facilities. Dinner with a couple of residents the night preceding the interview day is a great way to get to know more about the program and the resident team you may be joining. A complimentary night stay is provided at either Graduate Ann Arbor or the Belltower Hotel (depending on time of year). Transportation to and from the hotel is also provided.

What is the conference schedule?

Each morning from 8-9 am is protected time for resident education, primarily with didactic talks given by faculty, fellows and residents. The didactic lecture content will include fundamental and advanced topics generally repeated every 2 years, such that over 4 years a resident will have experienced these sessions twice at different stages of training. As an added bonus, coffee and a light breakfast are served each day with morning conference.

Additional regularly scheduled conferences at other times include Frozen section review, Autopsy gross findings, Forensic pathology, Molecular pathology and Surgical pathology journal clubs.

Typical weekly schedule for 8-9 am conference:
Monday: AP didactics/Grand rounds
Tuesday: AP didactics/Professional development
Wednesday: Unknown slide and thematic microscope sessions
Thursday: AP didactics, monthly hands-on Gross Pathology conference
Friday: CP case conference or CP faculty didactic

What research opportunities do residents have?

The research programs of the Department of Pathology are one of the many strengths of our academic mission. Our research faculty successfully compete for extramural research support, and particular areas of research strength include cancer cell biology, immunopathology and inflammation, geriatrics, developmental biology, and translational research including biomarker discovery, proteomics and bioinformatics. Clinically-based research programs include active studies in virtually all clinical sub-specialty areas.??Anatomic Pathology Research Grants are available for residents and fellows with a faculty sponsor who will oversee the project and project-related expenditures. Projects will be funded to a maximum cost of $30,000 per project with total program costs of no more than $150,000 annually.

Do residents receive money for books or travel?

The Department provides up to $1,500 annually to each resident to support travel to professional meetings and the purchase of books or other learning materials (e.g. audio, video reviews) relevant to their education with the approval of the program director. In addition, residents who have an abstract accepted for presentation at a national meeting will be supported with an additional $1,500 per meeting up to three times, an additional $4,500 of potential support during training, for a potential total Academic Fund support of $10,500 during a four year residency program. Up to $500 can be borrowed from the following year if the need arises to support the resident’s training.

There are additional grants for travel to meetings funded by the A. James French Society of Pathologists that residents may apply for should they require additional funds to those outlined above.

Are there any recent changes to the curriculum?

To fulfill the ACGME requirement of participation in Quality Improvement, the department’s recently created Division of Quality and Health Improvement (DQHI) facilitates a newly developed quality improvement curriculum, which supports projects aimed at quality improvement and patient safety of wide-ranging scope.

How much elective time do residents get?

Residents in the AP/CP program will have 24 weeks (almost 6 months) of elective rotations available during their 48 month training program. Numerous electives are available, including subspecialty consultation services in each field. Elective time can also be used as protected research time.

Does anyone have trouble reaching the required number of autopsies (50) to take Boards?

No. Residents have no struggle reaching the appropriate number of autopsies during their 12 weeks of autopsy/forensic rotations. The average total is between 55 and 70 autopsies.

How are on-call responsibilities handled?

Resident call is combined AP/CP coverage. Weekday calls last from 5 pm to 8 am the following day, and Weekend days last from 8 am to 8 pm the following day. Call coverage averages 2 call days per month for 2nd to 4th years. 1st years do not take AP/CP call.

Call coverage generally includes covering frozen section evaluations in the evening, and CP-related consultations in the evening and overnight. After frozen sections are complete, overnight call is at-home call.

How is vacation handled?

Each resident has 4 weeks of vacation annually, which may be taken in 1-2 week blocks. Vacation is scheduled separately from rotations, eliminating the requirement for seeking coverage and preventing the pressure to take vacation during less time-intensive services. In addition, every effort will be made to allow residents to present at meetings and conferences with advanced notice.

2016 marks the inaugural year for the Pathology resident’s Quality Improvement course. The lean-based curriculum introduces our residents to common and effective problem solving tools and concepts like A3 documentation, gemba walks, root cause analysis, and the PDCA cycle. Our residents put these tools to use throughout the semester, as they break into small teams and work to solve some real challenges that face our department. This year, our six teams, including one comprised of Hematopathology fellows, tackled the following problems:


Inadequate formalin fixation on Anatomic Pathology specimens

Lost and damaged Descemet’s membrane specimens


Cryostat chuck misidentification during the Frozen Section process

Non-standardized platelet refractory workflow


Hemoglobin electrophoresis utilization

Peripheral blood smear review vs. RBC morphology ordering


The teams approached these problems using the A3 framework, and by the end of the semester, each had developed, piloted, and analyzed creative and effective countermeasures to be implemented into our daily practice.

The next Resident Quality Improvement class begins in January 2017 and will feature first and second year residents.