PROGRAM STATEMENT

PHILOSOPHY

The residency program's mission is to provide strong basic training in anatomic and clinical pathology and its subspecialties. The program's philosophic objective is to develop a sturdy medical knowledge/skill base and professional attributes that allow a resident/fellow to independently and competently practice pathology with a life-long commitment to continued learning and excellence. In-depth training is offered in Anatomic and Clinical Pathology as a combined AP/CP 4 year program. Programs are available for new graduates, as well as to those with post-doctoral experience. Training is offered at two sites: an academic, tertiary care referral center (West Virginia University) and a large community hospital (Charleston Area Medical Center). Although the program is geared to produce well-rounded community hospital pathologists, residents are encouraged to explore a career in academic pathology as well.

Training in anatomic pathology encompasses surgical pathology, cytopathology and autopsy pathology. Embedded in these rotations is a spectrum of patients with diseases in the areas of dermatopathology, pediatric pathology, nephropathology, neuropathology, immunohistochemistry, and forensic pathology. Electron microscopy is part of the surgical pathology curriculum at CAMC. Clinical pathology training includes hematology and coagulation, lymph nodes/bone marrows/flow cytometry, blood banking and transfusion medicine, clinical chemistry and immunology, medical microbiology, cytogenetics and molecular pathology, and laboratory management. Residents also participate in the outreach activities of a reference laboratory/outreach program that serves small, rural West Virginia hospitals. 

The department is highly computerized with advanced digital imaging systems and numerous opportunities to develop expertise in the use of information technology. Opportunities for teaching and research are also available and encouraged, with emphasis on clinically related topics. 

Residents are expected to develop competencies in the six areas mandated of the new practitioners by the ACGME , as outlined below. In order to foster self-improvement and practice-based learning, residents are provided with several forms of evaluations, including practice-based portfolios in surgical pathology, autopsy, cytopathology, and hematopathology rotations, faculty rotation evaluations, semiannual global evaluations and yearly 360 degree evaluations.

EDUCATIONAL GOALS AND OBJECTIVES OF THE PATHOLOGY RESIDENCY:

The goals and objectives of the pathology residency experience are to prepare and enable residents to:

• Demonstrate competency in the work-up and diagnosis of anatomic and clinical pathology specimens in order to effectively practice pathology independently.
• Demonstrate professional behaviors in all situations.
• Demonstrate a commitment to reviewing and improving practice patterns and to life-long learning.
• Demonstrate the concepts associated with the scientific basis of pathology, the ability to utilize the medical literature and the ability to utilize modern techniques to provide optimum patient care and to contribute to the education of their clinical colleagues.
• Communicate effectively in verbal and written form with clinical colleagues, administrative personnel, technical personnel, and clerical personnel and demonstrate respectful and caring behaviors when interacting with patients and their families.
•  Discuss the policies and regulations affecting health care (i.e., CAP laboratory accreditation, HIPAA, compliance with Medicare and billing regulations, etc.)

REQUIRED COMPETENCIES

Patient Care

• Residents must be able to provide patient-centered pathology care that is appropriate and effective for the diagnosis of health problems, and communicate effectively with their clinical colleagues to provide the important therapeutic and prognostic information. Residents are engaged in providing pathology services that promote health, such as interpretation of lipid panels and Pap smears.
• Residents are expected to:
• Gather accurate and essential information about their patients when performing autopsies, surgical pathology, cytopathology, and bone marrow examinations and interpreting laboratory results.
• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families during provision of direct patient care such as phereses.
• Make informed decisions about diagnostic and prognostic results based on patient information and preferences, up-to-date scientific evidence, and clinical judgement
• Develop and carry out case management plans.
• Counsel and educate clinicians, patients, and families about disease processes they diagnose.
• Perform competently all medical procedures such as fine-needle and bone marrow biopsies and all pathologic procedures such as autopsy prosection, and surgical pathology dissection necessary for provision of patient care.
• Provide health care services, such as Pap smear screening and interpretation and the consultative interpretation of other screening tests aimed at preventing health problems or maintaining health.
• Work with other health care professionals, including those from other disciplines to provide patient-centered care.

Medical Knowledge

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to:

• Demonstrate an investigative and analytic thinking approach to the work-up of anatomic pathology cases and laboratory consultations.
• List and apply the basic and clinically supportive sciences, which are appropriate to the modern practice of pathology.

Practice-Based Learning and Improvement

Residents must be able to appraise and assimilate scientific evidence, investigate and evaluate their diagnostic acumen in regard to provision of care via anatomic pathology diagnoses and laboratory consultations. Residents are expected to:

Analyze practice experience utilizing statistical analysis of their concordance with staff on surgical pathology and autopsy gross examinations and microscopic diagnoses, and cytopathology and bone marrow biopsy diagnoses from CoPath (Anatomic Pathology Computer System) reports, and perform practice-based improvement activities using a systematic methodology.

Demonstrate ability to locate, appraise, and assimilate evidence from scientific studies related to patients’ health care problems, including:

• Perform literature search and review to find relevant scientific references to aid in the workup of surgical pathology, autopsy, bone marrow, and laboratory consultative cases (computer-based searches).
• Obtain and incorporate information about their patient population (via COPATH computer searches and medical records chart review) for clinicopathologic study of selected diseases.
• Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

Demonstrate competency in the use of information technology to manage information, access on-line medical information, and support their own education, including:

•  Accessing of patient clinical information and previous pathology accessions via Medsite (on-line hospital information system – website) and Copath.
• Performance of computer searches of the medical literature.
• Utilize digital imaging technology.
• Accessing web sites pertaining to specific pathologic diagnoses (grading systems for tumors, etc.).
• Actively participate in the teaching of medical students and other health care professionals, including teaching medical students as lecturers (senior residents only), leaders in small groups and laboratory sections and teaching clinicians and other health care professionals during inter- and intradepartmental conferences and tumor boards.

INTERPERSONAL AND COMMUNICATION SKILLS

Residents demonstrate effective communication with other health care providers, patients, and patients’ families by:

• Presenting cases at in-house tumor boards and conferences under direct faculty supervision.
• Interacting with clinicians and patients during performance of anatomic pathology procedures and clinical pathology consultations and by providing support to clinicians and patients during on-call assignments.

PROFESSIONALISM

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest with prompt response and accountability to calls from faculty and clinicians for anatomic and clinical pathology consultation, and while on-call.
• Exhibit a commitment to excellence and on-going professional development by utilizing study materials within the department including the slide file, the image database, books and journals for their own professional advancement.
• Demonstrate a commitment to ethical principles pertaining to the practice of pathology, confidentiality of patient information, informed consent, and business practices.
• Demonstrate appropriate behavior with the faculty, clinicians, peers, and the administrative, technical and clerical staff of the hospital.
• Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.

SYSTEMS-BASED PRACTICE

Residents must demonstrate an awareness and responsiveness to the larger context of the system of health care and the ability to call on system resources to provide pathology services that are of optimal value. Residents are expected to:

• Understand how their pathology diagnoses and consultations affect health care decisions for patients and the health care system.
• Discuss how the various types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
• Immunohistochemistry and other adjunct techniques.
• As senior residents attend QA committee meetings to discuss how to partner with the administrative and technical staff to assess, coordinate, and improve health care and know how these activities affect system performance.
• Residents may also inspect a pathology laboratory section during a CAP inspection.

Program Overview

The Department provides four years of combined anatomic and clinical and three years of anatomic or clinical pathology only residency training to physicians who continually make successful academic progress towards the independent practice of laboratory medicine and pathology. In order to ensure uniform basic training, combined anatomic and clinical and anatomic or clinical pathology only trainees must successfully complete the appropriate anatomic and/or clinical pathology core rotation series to graduate from the Program (see below). In addition to the rotation requirements, all combined anatomic and clinical and anatomic only trainees must successfully complete 50 autopsies in accordance with the Program's autopsy policies by the time of graduation. Trainees are also required to satisfactorily present a formal 45 minute Departmental Grand Rounds on a current topic of pathology or a research project they completed. While not mandatory, trainees are highly encouraged to participate in clinical and/or basic pathology related research. Residents, with the assistance of a pathology faculty mentor, may apply for Department sponsored funds to help partially cover the cost of their project and travel to present their research at a national meeting.

Combined Anatomic and Clinical Pathology Graduation Requirements:
Four-Year Training Program: 

Core Training: (36 months), generally carried out in PGY1-3:

It is strongly recommended that residents complete core training by the end of PGY3. However, occasionally residents transfer from programs in which core training is not completed and provisions will be made to ensure that program requirements are met.

• Eighteen months of Anatomic Pathology Core Requirements:

 Surgical pathology: 9 months

Autopsy pathology including forensic pathology: - 6 months

Cytopathology: 3 months

Eighteen months of Clinical Pathology Core Requirements:

Blood bank/transfusion medicine: 3 months

 Microbiology: 3 months

Clinical chemistry/immunology: 3 months

Hematology/coagulation: 3 months

Lymph nodes/bone marrows/flow cytometry: 3 months

Cytogenetics and molecular pathology: 2 months

Management: 1 month

While training sites may vary slightly at the Program Director's discretion, the rotation site composition is basically that outlined in the rotation sections of the Program manual.

Electives (12 months): generally carried out in PGY 4:

At least five months of additional training in Surgical Pathology and one to two months of cytology are strongly recommended for most residents, because these are the areas where the new practitioner will face the greatest challenges immediately. Some residents will choose to focus more on Clinical Pathology, and we will normally be able to accommodate this. However, on occasion due to recommendations for remediation from the faculty in any of the core areas, additional training in either AP or CP disciplines may be assigned. 

Additional Anatomic Pathology:

• Additional surgical pathology training (strongly recommended), at least 5 months 
• Additional cytopathology training, one to two months
• Dedicated forensic pathology training (arranged with Dr. Matrina Schmidt))
• Anatomic pathology research

Additional Clinical Pathology:

• Additional training in any of the rotations outlined above
•  Additional management/senior project
• Clinical Pathology research

Anatomic or Clinical Pathology Only- THREE-YEAR Training Program: 

Completion of the corresponding two year anatomic or clinical pathology core requirements, and a year of approved pathology research or advanced rotations relating to the specific discipline as described above.

RESIDENT OPPORTUNITIES FOR TEACHING AND RESEARCH

As laboratory medicine and pathology involves continual learning and the sharing of knowledge with colleagues, the residents and fellows regularly participate in multiple inter- and intradepartmental conferences and medical student teaching. Residents participate fully in the teaching of sophomore medical students, by participating in small group sessions either aiding the faculty or as a more senior resident, as a small group leader. Residents also teach medical students rotating through surgical pathology and with presentations of autopsies and elective teaching. Our residents are intimately involved with inter- and intra-departmental conferences. Each resident must present one 45-minute formal presentation for Pathology Grand Rounds yearly. In addition residents present to each other during Autopsy Conference and once per month residents present to a combined audience of medicine and Pathology residents at a joint autopsy conference. More senior residents (PGY2+) present cases under direct faculty supervision at interdepartmental conferences such as ENT Tumor board, Tumor Board, OB/GYN, Hematology Oncology teaching and patient care conferences, Pulmonary, Multidisciplinary Lung Cancer Conference, and Multidisciplinary Breast Cancer Conference.

While not required, the residents and fellows are encouraged to explore and participate in clinical, basic and/or translational research with a faculty mentor. The research program in Pathology at West Virginia University is emerging with several new faculty engaged in clinical, basic and translational research and with a new commercially funded tissue bank. All residents are required to submit at least one case report per year to our web-based “Case of the Month” series, which is both internally and externally peer reviewed. 

website: http://www.hsc.wvu.edu/som/pathology/cases

RESIDENT AND PROGRAM EVALUATION

Residents are evaluated at the completion of each rotation, semiannually and annually:

Rotation specific evaluations include:

• Statistical analysis of a practice based portfolio (ex. Grading of individual gross and microscopic reports in surgical pathology as “agree, partially agree, or disagree.” Resident results are compared to the overall and PGY means.
•  A rotation specific semi-objective evaluation tied to the required competencies for each rotation. A mean score for each competency as well as overall mean for each resident is tabulated and compared to the overall and PGY means.
• A semi-annual global evaluation is tied to our overall program competencies with statistical evaluation of resident means versus overall and PGY means.
• Annual evaluations are completed using a 360o evaluation form.

The residency advisory committee meets at least quarterly to review resident evaluations. Residents experiencing difficulties will be placed on a remediation program as quickly as possible. All residents are informed of their evaluations at least on a yearly basis.

The residents evaluate the program and faculty at least yearly. Statistics will be tabulated for this evaluation and monitored by the residency advisory committee at least yearly.

SUPERVISION OF RESIDENTS

The on service teaching faculty members are physically present during standard operating hours; faculty members not physically present are rapidly available by phone or pager. At all times, a supervising faculty member is on-call for evening and weekend questions. No diagnosis or consultative interpretation is communicated to the clinicians before a faculty member has evaluated the case.