College of American Pathologists
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CAP Today




February 2009

Residency training in pathology Residency training in pathology

Thank you for reporting on the important topic of residency training within pathology residency programs (“First-year residents—let’s start from the very beginning,” December 2008). In the article, UT Memphis program director John Duckworth, MD, describes the month of introductory training that he and others have implemented to review basic histology, gross anatomy, and microscopy for incoming pathology residents. To the knowledge of Dr. Duckworth and his colleagues, their program is the only such training program around, the story says, and Dr. Duckworth says comments about the orientation have been uniformly favorable.

As the program director of the pathology residency at Dartmouth-Hitchcock Medical Center, I would like to share our experience with new resident training. We began our dedicated training months in 1995, under the leadership of our former program director, James AuBuchon, MD, and we have continued with an expanded format since that time.

According to our program coordinator, Susan Hawk, the training began as a two-week histology and gross bench “primer” and expanded quickly to two months (now two four-week blocks). We have experimented with one and two months, but with feedback from the staff and residents, we have settled on a productive and popular eight-week training period. The Accreditation Council for Graduate Medical Education does not require training for incoming pathology residents, but we believe more open dialogue among programs with experience in specialized training could change the state of pathology training in the United States.

Our new residents attend mandatory hospital courses (including but not limited to OSHA and HIPAA training) along with all new incoming house staff of various specialties. After the general house staff orientation, they begin their in-depth training in the practice of pathology. Our eight weeks of training consist of morning didactic lectures by staff subspecialists on normal histologies of their subspecialty as well as the proper approach to gross bench specimens in their subspecialty. For example, our breast pathologists instruct the residents in how to navigate the electronic medical record for radiographic images and reports. Multi-headed scope sessions with reviews of normal histology and commonly encountered variants follow these lectures. Afternoons are split between gross bench instruction, with staff, PA, and senior residents; autopsy lectures given by our staff autopsy director; and, if a postmortem case comes through, then step-by-step instruction through the dissection. Our first year of residency is heavily weighted with anatomic pathology.

In addition, we offer a single four-week introduction to clinical pathology before the first month of clinical pathology rotation. This month includes introductions to all of the clinical labs, including basics in instrumentation. It includes an introduction to informatics and evidence-based medicine.

Incoming trainees to our program report feeling less anxious and more oriented to their new positions after this training period, and after 14 years of training, we have had uniformly positive feedback from residents and staff. Our intensive training has been a popular recruitment draw and has lowered grossing errors, including specimen sampling errors and clinical-pathology correlation discrepancy rates. Before our formal training months, new residents were routinely sent “back to the bucket” on cases from their first month. That has been virtually eliminated. We feel strongly about the success of this program and hope it can serve as an educational model for other pathology training programs.

Candice C. Black, DO
Associate Professor of Pathology
Residency Program Director—Anatomic
and Clinical Pathology
Dartmouth-Hitchcock Medical Center
Norris Cotton Cancer Center
Lebanon, NH