Duties include reading appropriate textbooks and references for current case interpretation as well as the assigned Cytopathology text readings on a biweekly basis. The assigned residents review the teaching files in order to get a familiarization with the types and degrees of cytologic abnormalities in various body sites. Residents attend the sign-out sessions with the attending pathologist. They also attend the fine needle aspiration encounters where a request for evaluation of adequacy of the tap is made at the site of aspiration. With increasing experience and knowledge, the resident makes diagnoses in cases, which are reviewed by the attending, rather than being an observer in the sign out.
The goal of the Clinical Microbiology rotation is to develop the professional skills necessary to evaluate specimens, and work up and interpret microbiological cultures and testing, including, but not limited to, direct specimen stains, bacterial and mycobacterial culture, fungal culture, antimicrobial susceptibilities, parasitology, antigen testing, and molecular testing. While on the Clinical Microbiology rotation, residents spend much of their time learning at the bench with the laboratory technologists, on rounds and in didactics with the attending, and on their own during self-study.
The goal of molecular pathology rotation is to expose the resident to the principles and practice of diagnostic molecular pathology. The one-month rotation uses a case-based learning approach to reinforce the knowledge base gained through the year-round didactic lectures (~16 lectures per year) in molecular pathology.
The resident will be exposed to diverse applications in cytogenomic and molecular diagnosis of familial and acquired hematological malignancies and solid tumors, and hereditary diseases with constitutional abnormalities through case studies. Residents will learn how the cytogenomic and molecular biologic technologies such as FISH, karyotyping, chromosomal microarray, next gene sequencing (NGS) panel, fusion gene panels using NGS or reverse transcription- polymerase chain (RT-PCR), Sanger sequencing, quantitative RT-PCR for therapy monitoring, and immunosequencing for minimal residual disease (MRD) monitoring of multiple myeloma and B-cell clonal malignancies are being used in the clinical practice, the difference in various technologies, the interpretation and reporting of molecular testing, the classification of variants in oncology and constitutional genetic disease, nomenclatures of common cytogenomic abnormalities and nucleotide variants, quality control issues, and key points in CAP molecular pathology check list. There will be opportunities for independent research and manuscript publication. One hundred percentage of the fellows and 50% of the residents on molecular rotation during the last two years have published manuscripts/abstracts on molecular cases.
Residents on the Blood Bank (Transfusion Medicine and Hemostasis) rotation acquire a wealth of exposure to the unique transfusion needs of patients treated in our level I adult trauma center, children’s medical center, neonatal intensive care unit, solid organ and hematopoietic progenitor cell transplant programs, and National Cancer Institute-designated Comprehensive Cancer Center.
In addition, residents develop proficiency in pretransfusion compatibility testing, evidence-based blood component strategies, assessment and management of transfusion reactions, coagulation testing, and regulatory and quality aspects of transfusion medicine. They meet daily with the transfusion medicine attending physician to sign out cases and review specific patients’ transfusion strategies. To supplement formal and informal didactics, residents learn Blood Bank fundamentals at the bench with laboratory technologists, complete various practical exercises, and audit transfusion administrations. They may also participate in hemotherapy, coagulation, and therapeutic apheresis consultations. Generally, residents rotate in the Blood Bank for one month in each of their first three years. A fourth-year Blood Bank elective is also available in which the resident serves as a junior attending.
The Autopsy Service provides an opportunity for resident training in medical autopsies. Autopsies are provided to clinicians and families throughout Arizona, averaging about 150 autopsies per year. Residents in the Pathology Residency Program rotate on the Autopsy Service, performing autopsies under the supervision of three experienced attending pathologists. Situations vary in scope and include highly complex and challenging cases. Typically, junior residents are paired with more experienced prosectors, who, along with attending pathologists and morgue staff, assist and direct the post-mortem examination. The facilities for autopsy at Banner University Medical Center-Tucson are new and state-of-the-art, with advanced safety features and digital imaging capacity. Trainees become proficient in the venerated art of autopsy, meeting American Board of Pathology requirements, and acquiring the experience to perform them skillfully in any practice setting.
The surgical pathology rotation at BUMCT runs on a four day cycle, with four residents rotating at a time. On day one, the resident works in the gross room with a team of two PA’s, grossing in their assigned cases. On day two, the resident receives small biopsy cases in the morning to review and prepare for afternoon sign out. Late in the afternoon, the resident receives the slides for the larger cases to review and prepare for sign out the following day. On day three, the resident signs out these large cases. On day four, the resident covers frozen sections, and then the cycle starts again at day one. Because the faculty is subspecialized at this site, the cases are assigned to the attendings by specialty, and each day the resident signs out with multiple attendings.
The sections that come under the purview of Clinical Chemistry include Core Laboratory, Toxicology and Therapeutic Drug Monitoring, Special Chemistry, Point of Care Testing and Laboratory Information Systems. Residents on this rotation learn the analytical, technical and consultative activities that make up the clinical chemistry component of a clinical pathologist’s practice. Residents are expected to learn the role of clinical pathology in disease diagnosis and management and to become knowledgeable about how laboratory activities are coordinated with other disciplines within the hospital to accomplish the common goal of optimum patient care. Residents are also expected to serve as the first resource for the technologist when problems arise requiring consultation with the clinician and other healthcare employees. Under the guidance of the faculty, the resident ultimately will be able to manage the technical and consultative issues that arise on a daily basis in the laboratory.