Year by Year Design of the Residency Program
The AP/CP curriculum at the Medical College of Wisconsin follows an integrated approach, with both AP and CP rotations in each of the four years of residency, although not evenly balanced in each year (the first year is weighted toward AP, while the second is weighted toward CP). The first two years of the curriculum are entirely structured, with rotations through each area of both AP and CP. This ensures that residents have a broad grounding across the spectrum of pathology sub-disciplines in order that 1) they achieve basic competencies necessary to function as autonomous clinical consultants in an on-call capacity, and 2) they can make an informed subspecialty choice if they choose to apply for post-residency fellowship training. The third and fourth years provide much more flexibility in rotation scheduling, as well as ample elective time.
At the beginning of the academic year, new residents receive a series of introductory lectures covering histopathology, basic grossing techniques, and orientation to the various clinical laboratory sections, focusing on issues likely to be encountered on call. After the introductory sessions, the core didactic curriculum begins.
The first year curriculum consists of 6 months of surgical pathology, organized as two 3-month blocks, three months of autopsy, one month of molecular diagnostics, one month of coagulation, and one month of transfusion medicine. The six months of surgical pathology include one month on each of the surgical pathology subspecialty rotations at FMLH (GI; GYN/Placenta; Lung/Breast; Bone/Soft Tissue/Head and Neck/Endocrine; Derm).
In surgical pathology and autopsy/neuropathology during the first year, residents learn basic gross and histopathology skills, along with skills for obtaining appropriate clinical histories from clinicians and the medical record, and communicating results verbally and through written reports. They also begin to learn to apply and interpret the results of ancillary tests (immunohistochemistry, cytogenetics, molecular diagnostics) in the work-up of patient specimens.
Initial rotations in Coagulation and Transfusion Medicine introduce the resident to the clinical laboratories and permit the resident to begin functioning as a clinical consultant. The introductory molecular rotation focuses on molecular techniques, but also includes didactic sessions devoted to molecular application in various areas of anatomic and clinical pathology.
The autopsy rotation also provides an opportunity to develop skills for integrating gross, microscopic, clinical, and laboratory information into cohesive pathophysiologic narratives. This rotation includes time at the Milwaukee Medical Examiner’s Office receiving in-depth training in autopsy techniques. Initial rotations in Coagulation and Transfusion Medicine introduce the resident to the clinical laboratories and permit the resident to begin functioning as a clinical consultant.
Through the preparation of intra- and inter-departmental presentations, the resident begins to polish his/her communication skills and proficiency in utilizing library and internet resources. Residents do not take call during the first year, but are asked to begin taking extended duty shifts in the fall of the first year, as permitted by ACGME duty hours and supervision requirement. On these shifts, they are first in line to address both AP and CP issues that come up in real time, which allows them to begin independent (but supervised) activity as a consultant in the medical center.
During the second year, each resident engages in the first of two required months of rotation at the Children’s Hospital of Wisconsin. This rotation provides structured, organ system-based exposure to pediatric surgical pathology. A two-month rotation in cytopathology introduces the resident to the preparation and interpretation of gynecologic and non-gynecologic cytologic specimens, as well as administrative and quality assurance aspects in cytopathology. In addition, the resident participates in and attains competency in the performance of FNAs. The remainder of the second year curriculum consists of three-month blocks on hematopathology, microbiology, and clinical chemistry.
Overall, the intensive longitudinal experience in the clinical lab in the second year provides not only a thorough exposure to those areas of the laboratory, but also includes integrated instruction in laboratory management, both through didactic instruction and participation in real-time activities such as management meetings, trouble-shooting, instrument evaluation, quality control, QA/QI activities, proficiency testing, and preparation for accreditation visits.
On the CP rotations, the resident also helps serve as a consultant to the send-out area of the laboratory, helping to ensure appropriate utilization of unusual tests, locations and requirements for testing, and interpretation of received results. During hematopathology, the resident learns basic and intermediate skills in interpretation of peripheral blood smears, and bone marrow samples.
Also during this rotation, residents hone their skills in gathering clinical data from diverse sources and integrating this information with the results of morphologic and other laboratory analyses. Residents refine and expand skills in the application of ancillary testing to diagnostics, including an introduction to flow cytometry.
Communication skills are further polished as the resident gives increasing numbers of presentations and literature reviews. The majority of residents begin to participate in clinical or translational research projects, although this is not a requirement.
The resident begins to take formal AP and CP call for the clinical laboratories.
Residents often complete an additional required month of cytopathology in year 3, although this may be deferred to year 4, if desired. This allows the resident to further refine and deepen the skills and knowledge obtained during two-month cytopathology rotation in the second year.
A second, intermediate-level rotation through transfusion medicine is also often performed in year 3, although again this may be deferred to year 4. This allows residents to assume greater responsibility in the management of component therapy, transfusion work-ups, and therapeutic apheresis.
A required cytogenetics month allows hands on exposure to the techniques of karyotyping and FISH analysis, as well as practical and didactic exposure to the application of cytogenetics to constitutional and acquired disorders.
Additional months on surgical pathology (3-4) allow continued, in-depth refinement of subspecialty area expertise, as residents rotate through subspecialty areas for a second time.
Residents may complete their Medical Examiner rotation in either the third or fourth year, providing additional training in autopsy prosection and introducing them to the specialized aspects of the forensic autopsy, crime-scene investigations, and courtroom experiences for criminal cases.
Advanced rotations in microbiology and/or chemistry may be taken in the third year. These allow reinforcement of previously acquired knowledge in these areas, opportunity for developing additional depth of knowledge, further refinement of skills as a clinical consultant, and honing of knowledge and skills related to laboratory management.
A two-month advanced rotation in molecular diagnostics allows reinforcement of basic knowledge and techniques, but also an opportunity to keep pace with the cutting edge applications for clinical diagnosis and translational research. Additionally, it allows the opportunity to engage in and complete a translational research or method development project in the Clinical and Translational Research Core Lab.
A second required pediatric pathology month at the Children’s Hospital of Wisconsin provides the opportunity to deepen and broaden
skill and knowledge related to the unique aspects of pediatric organ system pathology, as well refine general surgical pathology skills.
Finally, the third year provides elective time, which can be used to obtain additional expertise in areas of interest or work on clinical or translational research projects.
Residents continue to take AP and CP night and weekend call.
and participate in quality control and quality assurance activities in clinical pathology rotations; continue to develop skills in the practice of evidence-based medicine and review of relevant literature through journal clubs, independent use of library and Internet resources, in depth literature reviews for research projects and through serving as a consultant to clinical services; continue developing a plan for ongoing learning through the residency and on a lifelong basis.
hospital systems in the delivery of cost-effective, timely, high-quality care; further develop an appreciation of the importance of development and adherence to rational systems and processes for quality assurance and effective use of
In the final year of training, residents take final required rotations in the surgical pathology subspecialty areas (2-3 months). Having spent at least two months on each of the 6 surgical pathology subspecialty rotations, residents should achieve competence in all major subspecialty areas of surgical pathology.
A senior rotation in hematopathology allows reinforcement of material learned on the second year rotation, but also allows increase in depth and breadth of these knowledge and skills, including more intensive exposure to flow cytometry.
If not performed during the third year, advanced rotations in microbiology and chemistry allow reinforcement of previously acquired knowledge in these areas, opportunity for developing additional depth of knowledge, further refinement of skills as a clinical consultant, and honing of knowledge and skills related to laboratory management.
A senior transfusion medicine elective (if not performed during the third year) allows further development of independent competency in the management of component therapy, transfusion work-ups, and therapeutic apheresis, as well as exposure to more esoteric testing during two-weeks spent at the Blood Center of Wisconsin’s downtown facility.
Finally, additional elective months are used to obtain expertise in areas of interest or work on clinical or translational research projects. Residents continue to take AP and CP night and weekend call.