The goals of the surgical pathology rotations are to train residents to become competent surgical pathologists with excellent skills in microscopic and gross specimen diagnosis; to impart competency in the required technical skills including specimen prosection frozen section preparation and photomicrography; to have the resident achieve an understanding of the application of the associated special procedures including molecular pathology, immunopathology, and electron microscopy; and to impart a knowledge of anatomic pathology laboratory management and the technical skills upon which these laboratories are dependent. Additional goals are to develop in the residents a strong knowledge base with emphasis upon the disease processes and patient management that rely upon tissue examination and to achieve facility in communication with clinicians including the authorship of surgical pathology reports.
The surgical pathology rotation consists of 12 month with a total of more than 17,000 cases of a wide variety of body sites and pathologic processes. There is a three-day rotation system were the resident performs frozen sections, gross and microscopic evaluation.
Residents are trained in surgical pathology in the classic “apprenticeship” method and are responsible for their own cases from accessioning to sign-out. In the beginning, residents learn the essentials of prosection from the chief residents and faculty, with the Surgical Pathology manual as a guide. The first step in increasing responsibility is independent prosection. The staff pathologist is available throughout training for consultation and guidance. Microscopic evaluation of the glass slides in all cases is performed first by the resident and then together with the attending from the beginning of the training. Although residents are not responsible for final diagnostic decisions, the requirement for them to produce a written diagnosis or a differential diagnosis on each case lays the foundation for assuming increased responsibility to discuss their cases with the submitting physician. Residents are additionally responsible for independent prosection of increasing complex cases and communication of results to clinicians, especially during intraoperative consultation. Residents are responsible for taking the initiative in requesting special stains, including immunohistochemical stains, increased interaction with clinicians, as well as instructing younger trainees in prosection and diagnosis.
Residents also experience increased responsibility in case presentation for interdepartmental conferences and outside conferences (regional pathology society). Senior residents serve on Temple University Hospital committees. Residents present cases at the hospital oncology (weekly) and radiology (monthly) conferences.
Residents are encouraged to write up case reports for journal publication. They are also encouraged to work with faculty on research projects for presentation at national meetings.
The anatomic pathology faculty, on a rotating basis, provides didactic conferences once a week (Wednesdays at 8 a.m.). These topics include subspecialties in surgical pathology, laboratory management, immunohistochemistry, photomicroscopy, gross photography and others.
Autopsy experience is obtained on the following rotations: 6 months at Temple University Hospital and 1 month at the Office of the Medical Examiner of Philadelphia. While on the forensic pathology rotation, residents receive instruction and perform autopsies under the supervision of staff pathologists of the Medical Examiner’s Office.
Instruction of residents in the performance of post-mortem examinations, in gross description, in selection of tissue for microscopy, in interpretation of post mortem findings, and in completion of autopsy reports is the direct responsibility of attending pathologists assigned to the autopsy service. Senior residents may also assist in resident instruction. Attending pathologists rotate autopsy coverage on a weekly basis. The majority of autopsy attending coverage is by 3 anatomic pathology-certified pathologists, one of whom is the renal pathologist. Instruction of residents on autopsy service is closely monitored by the director, who reviews gross findings on all adult cases at a conference usually held once or twice a week, and serves as autopsy attending 40-50% of the year.
Residents assigned to the autopsy service review requests for autopsies, preliminary review of the clinical history of the circumstances of death, ascertain next of kin, review chart and discuss specifics of each case with the clinical staff and autopsy attending pathologist, and perform post mortem examinations (external and internal gross examination) including review of microscopic and toxologic findings under the supervision of an attending pathologist and with the assistance of a morgue technician. Gross findings are then reviewed with the attending pathologist. The resident then prepares a provisional anatomic diagnosis which is finalized with the staff pathologist and submitted for distribution within two working days. Sections for microscopic examination are submitted by the resident, who examines them and formulates a draft of a list of final diagnoses and opinion regarding the cause of death. The final report is reviewed with the resident and autopsy attending. There is at least one intradepartmental case presentation each month, and the residents are responsible for case presentations at extra-departmental conferences as well. The attending staff supervises these presentations.
The autopsy rotation is designed to provide graded resident responsibility. Attending pathologists perform post-mortem exams with each new resident on the autopsy service until the autopsy attendings and director of the autopsy service are confident in each resident’s ability to perform the autopsy prosection with no direct staff presence or assistance. Graded responsibility on autopsy service is reflected in the progressive independence of the resident in performing his/her requisite duties. While all activities of the resident on autopsy service are supervised by the attending pathologist assigned to each case, residents are expected to show initiative in performing their autopsy duties (e.g. discussion with clinical staff, formulation of provisional diagnoses, dissection, selection of tissues for histology, etc.) with progressively less frequent and/or intense consultation with the attending.
For more information, also refer to the section on Neuropathology.
The cytopathology rotation is designed for the resident to learn the basic and advanced concepts of cytology, the diagnostic procedures performed in the cytology laboratory, the fine needle aspiration (FNA) techniques and applications, and the quality assurance/quality control aspects in cytology.
Each resident will rotate for 3 months. The resident is expected to gain familiarity with the procedures and technical preparation of cytology slides, as well as becoming competent in smearing techniques. By the end of their rotation, they are expected to be competent screeners capable of performing FNAs with adequate evaluation and able to issue a formal cytology report.
Resident responsibilities gradually increase from studying of normal and abnormal cytology cases using teaching materials (glass slides teaching sets, 35 mm kodachrome slides and cytology atlases) to screening of gynecologic (GYN) cases and independent review of all non-GYN and abnormal GYN cases before their daily sign out sessions with the attending.
Residents will perform rapid adequacy evaluation in the Radiology, Surgery and Gastrointestinal Departments during CT and ultrasound-guided FNAs. In addition, residents will participate in FNA of superficial, palpable masses at the department’s FNA clinic, in the hospital out-patient or in-patient areas, and present cytologic findings to individual clinicians as well as at inter- and intradepartmental conferences. The residents will participate in the FNA procedure during their rotation with the goal of performing 15-25 procedures under direct supervision.
Extensive participation in quality assurance/quality control activities and cytohistologic correlation studies is expected. The residents will also study cases from CAP interlaboratory comparison of GYN and non-GYN programs in which the cytology lab participates. Periodically, the surgical specimens and cytologic specimens from the same patient are identified through computer search and the diagnosis of both specimens is reviewed by the cytopathologist and the resident rotating in cytology.
The overall progress of a resident is monitored by the director of cytology according to the rotation schedule. Their daily performance is continually evaluated by the cytology supervisor and the attending cytopathologist on service.
At the end of the rotation, each resident is evaluated by addressing their motivation and commitment, the knowledge gained during the rotation, their problem solving ability and thought processes when dealing with cytologic specimens, their laboratory (especially FNA) skills, and their interpersonal skill (including working with cytotechnologists and communicating with clinicians). Additionally, each resident is given a test consisting of 40 unknown slides that include GYN and non-GYN cases to assess their diagnostic skills. Residents that score less than 80% are advised to spend an additional elective month in cytopathology.
The Oral Pathology Biopsy Service is a part of the Department of Pathology and Laboratory Medicine at Temple University, located within surgical pathology. The service receives mail-in biopsy specimens from offices of oral surgeons, periodontists and endodontists throughout the Delaware Valley and is one of the largest such services in the country. The attending oral pathologists are Dr. S-Y. Chen (Director) and Dr. G.A. Pringle, both diplomates of the American Board of Oral and Maxillofacial Pathology.
Neuropathology Elective at Temple University Hospital
An understanding of the pathologic basis of neurologic diseases is essential for understanding both the clinical manifestations of the disease, as well as the potential treatment paradigms.
A pretest will be given at the beginning of the rotation and a post test will be taken at the end of the rotation to document the progress made by the resident during the rotation.
- Brain cutting at TUH morgue: Tuesdays 9-10 am
- Autopsy confererences at Multiheaded scope: Tuesdays 8-9 am
- Monthly neuropathology lecture/ slide conference:
The primary aim of the molecular pathology laboratory is to provide clinical diagnostic/prognostic services for the molecular analysis of clinical material submitted to the anatomical and clinical laboratories of the Temple University Hospital. The goal of the molecular pathology rotation is to provide a comprehensive understanding of the role of molecular pathology in clinical and anatomic pathology. Residents rotating through the molecular pathology laboratory are given extensive handouts on the theoretical basis underlying the principle of the polymerase chain reaction (PCR). In addition, these handouts also include topics such as real-time PCR, FRET (fluorescence resonance energy transfer) analysis, cDNA microarrays, etc. They are trained to perform as well as interpret the molecular diagnostic test results. The primary testing in the molecular diagnostics laboratory are viral loads and genotyping for HIV-1 and HCV and HPV genotyping. Other assays include hypercoagulation assays for Factor V Leiden and prothrombin gene mutation analysis. In this one calendar year, the molecular pathology laboratory will perform approximately 1,500 HIV-1 and HCV viral loads, 200 HIV-1 and HCV genotyping, 2,000 HPV genotyping and 300 Factor V Leiden and Prothrombin (Factor II) gene mutation analysis.
During this week, the resident will be given ample opportunity to observe the techniques being utilized in the molecular pathology laboratory to enable them to understand and correlate the theoretical with the practical. During the second week, the resident will be trained in the various methods of extraction of nucleic acids from various tissue sources. They will extract and isolate RNA and DNA from tissues. During the third week, the residents will set up PCR and RT-PCR reactions using the nucleic acid isolated in week two. During this week, emphasis will be placed on understanding the various criteria used for selection of the primers for amplification, concentration of the various components of the PCR reaction and the method used at the back end for identification of the amplified template. During the fourth week, the residents will spend time on interpretation of the results obtained by amplification. They will also be exposed to some unusual cases that have been obtained in the laboratory during the past years. Future assays for consideration of development include CMV quantitation as well as EGFR, Kras, Jak2 and Bcr/Abl gene mutation analysis.
Department of Pathology and Laboratory Medicine Residency Program
Residency Program Director:
Yajue Huang, MD
Room 346 Outpatient Bldg.
Philadelphia, PA 19140