Training in clinical pathology (CP) is integrated with that in anatomic pathology (AP) throughout the 4-year general pathology (AP/CP) program in this department. Residents are actively involved with AP in all 4 years, and the on-call resident covers both AP and CP.
Pathology residents usually start their major formal CP experiences by taking the annual spring graduate course in 1 of the 4 CP divisions, and a 2-month rotation in clinical chemistry.
All second-year residents will take the 6-month didactic Program in Medical Laboratory Science (PMLS) course, which covers the basic principles, methods and instrumentation of the clinical laboratory. This course is divided into 4 6-week sections:
- Blood banking
The CP resident will attend all lectures, perform all laboratory assignments, and take all examinations with the PMLS students. This course will be a full-time assignment for the resident, and, except for call and conference responsibilities, the resident will be free of all service obligations. Satisfactory completion of the course will be a prerequisite to the subsequent clinical laboratory rotations.
The PMLS course sequence is given July through December, and the second-year resident will generally take the course in that 6-month block, but because the course is modular, scheduling is flexible. During the later 2-month rotations through the 4 major laboratory sections, the CP resident is expected to become knowledgeable in result interpretation and will assist the laboratory section director in problem solving, quality control (QC) and quality assessment (QA), laboratory management and clinical interactions. There are also 10 months of CP elective time in which the individual resident may pursue other clinical laboratory interests.
In addition to the requirements above, the program includes other formal CP training beginning on the first day. The orientation period starts the residents on what they need to cover the laboratories when on 24-hour call. The responsibilities undertaken will involve the resident with such things as sign-out of problem blood films, investigation of transfusion reactions, consultation with other services regarding testing, and consultation with the technical staff on current problems in laboratory administration.
During each year there is a formal, graduate-level course in one of the 4 CP disciplines, presented in each winter/spring semester. All residents must take these and pass.
The regular clinical pathology conferences involve the residents from the very beginning of their programs. In the monthly hematology conference, residents interpret 5 sets of bone marrow/peripheral blood findings using the slides from actual cases and a brief summary of the case.
The residents submit written diagnoses to the faculty member conducting the conference, and the tabulated results are discussed at the conference. Residents are assigned to cases in alphabetical rotation. That resident obtains and reviews the clinical record, follows up on the patient's status at the time of the conference and does the photomicrography of all pertinent material.
The weekly clinical pathology problems conference requires residents to present and discuss in Socratic fashion any interesting and unusual cases encountered while on call or during rotations in the clinical laboratories. In addition, the residents attending the conference are expected to do such things as interpret for the group red-cell reagent panel results, electrophoretic patterns, unusual cells in blood and body fluids, and patterns of lab results seen in current patients.
During this half-hour, informal sessions are also presented on topics that require resident knowledge but are not considered to require hands-on laboratory rotations at the present time (e.g. cytogenetics techniques, HLA testing, and RIA principles).
The purpose of the program in clinical pathology is to provide the AP/CP resident with sufficient training and experience in the methods, applications, and interpretation of clinical laboratory analyses and of the organization and administration of the clinical laboratory to allow effective function as a general pathologist and laboratory director.
In all laboratory sections or disciplines, residents are expected to:
In each CP discipline, residents are responsible for:
- Detailed objectives of the PMLS program's didactic course
- Objectives for each clinical laboratory section rotation.
Residents should master these objectives and expand on the basic objectives already mastered in the didactic portion of the clinical pathology course for Program in Medical Laboratory Science students and pathology house officers.
A. Julian Garvin, MD, PhD
Department Chair, Pathology
Beth Gaither, MBA, MT(ASCP) SM
Director, Program in Medical Laboratory Science
Instructor, Microbiology and Special Studies