Gastrointestinal Pathology Fellowship

Overview

The ACGME-accredited GI and Liver Pathology Fellowship at Cedars-Sinai offers comprehensive training in diagnostic GI pathology including in-depth exposure to all aspects of gastrointestinal pathology. The Medical Center has well funded centers for GI diseases including the Inflammatory Bowel Disease Center and Colorectal Cancer Center, as well as active Pancreatic and Biliary Disease, Carcinoid/Neuroendocrine tumor and Liver Transplant programs, and the Samual Oschin Comprehensive Cancer Center. These programs cover a full spectrum of adult and pediatric, medical and neoplastic diseases of the digestive system, providing over 10,000 GI biopsies, 1,000 GI resections, 600 liver biopsies, 200 liver resections, and 50 Whipple/pancreatectomy specimens annually. The fellow is provided with and given graduated responsibility for signing out cases, including consultation cases, with the five subspecialized GI and liver pathology faculty members at Cedars-Sinai. The fellow is expected to become involved in ongoing clinical or translational research in the Departments of Pathology and Laboratory Medicine and the Gastroenterology and Liver Divisions, including initiation and completion of at least one research project during the course of the year. Available diagnostic and research techniques include immunohistochemistry, in situ hybridization and other contemporary molecular techniques. The fellow also will participate in the integrated IBD and GI conferences, and education of Pathology and Gastroenterology residents. The CSMC GI and Liver Pathology fellowship is highly competitive. Therefore, interested applicants should strongly consider concurrent application for the Surgical Pathology Fellowship, as qualified candidates may be offered Surgical and Subspecialty Fellowship positions in consecutive years.

 
 
 
 
 

 

Program Structure

The program is structured to provide all needed core training over a one-year period and to assure that learning of the techniques and skills needed for excellence in practice in GI and liver pathology (morphology, immunohistochemistry, molecular diagnostics, laboratory management administration and informatics) is accomplished in a coordinated fashion. The GI/liver pathology fellow is scheduled with monthly rotations, which can be arranged in variable order to accommodate his/her personal interest and faculty's availability. In general, the year is divided into 6 months on GI (including pancreaticobiliary), 3 months on liver, and 3 months on research. Meeting and vacation times are usually arranged during research and/or GI rotations. The schedule can be flexible and overlapping. For example, one may carry on a research project(s) during GI or liver rotations, and vice versa.

The clinical responsibilities the fellow assumes during the year of training include:

During GI rotations:

  • Sign-out all/selected in-house GI and pancreaticobiliary cases
  • Sign-out all GI consult cases
  • Supervise residents grossing of complex GI, pancreaticobiliary and liver cases
  • Present GI conferences
  • Attend weekly liver conference
  • Organize weekly GI consensus conference
  • Work on research project(s)

 During Liver rotations:

  • Sign-out all in-house and consult liver cases
  • Sign-out all GI consult cases
  • Gross in selected liver resection/explant specimens
  • Supervise residents grossing of complex GI, pancreaticobiliary and liver cases
  • Present GI conferences
  • Attend weekly liver conference
  • Organize weekly GI consensus conference
  • Work on research project(s)
  • Study liver teaching sets

The fellow has administrative responsibilities as part of the program structure; this affords an opportunity to learn skills that are required for academic and private practice and are critical to master. Administrative Quality Assurance activities in which the fellow participates include:

  1. Frozen section review for cases in which the fellow has been involved;

  2. Quality control of MLH1, MSH2, MSH6 and EGFR immunostains;

  3. Participation in evaluation of new immunostains;

  4. Monitoring adequacy of lymph node dissections for resection specimens.

  5. Review of amended reports for discrepancies

  6. Review of selected cancer reports to ensure compliance with required CAP reporting elements

  7. Review of cases with inter-institutional reviews/reports

On call responsibilities are one Saturday/month in rotation with the GU and surgical pathology fellows. While on call, the fellow functions as gross room supervisor for the residents and PA grossing on Saturday, performs all frozen sections requested from 8 am to 4 pm, diagnoses all emergent biopsies and cytology silver stains (with faculty oversight), and generally functions as junior faculty. A faculty member is in house on Saturday's for back-up, if needed. 

Conference Schedule

During the year, the GI and Liver Fellowship mandatory conferences include:

  1. Colorectal cancer conference (monthly)

  2. Pancreatic/biliary conference (monthly)

  3. GI neuroendocrine conference (monthly)

  4. IBD conference (monthly)

  5. Liver tumor board (bimonthly)

  6. Surgical pathology journal club (monthly)

  7. Molecular pathology journal club (monthly)

  8. Pathology Grand Rounds (monthly)

  9. Liver conference (during liver rotations, the fellow also is expected to attend these weekly conferences)

The fellow is expected to prepare for and present at the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference. Attending autopsy conferences with cases related to digestive disorders also is expected.

Other conferences and educational endeavors in which the fellow may want to participate to maintain competence in GI, liver and general pathology are:

  1. Surgical pathology consensus conference (daily)

  2. Tumor board (weekly)

  3. Participation in developing, reviewing and modifying GI gross manual, diagnosis templates, and synoptic reports (for GI tumors) 

Teaching Responsibilities

Cedars-Sinai Medical Center has an anatomic and clinical pathology residency program with 20 residents. The fellow is expected to take an active role in resident education, honing teaching skills during the year. The fellow teaching activities include:

  1. Supervision of residents in GI rotations in the Gross Room;

  2. Organizing weekly conference of interesting GI cases for GI faculty, rotating residents, and GI fellows;

  3. Giving 2 unknown slide conferences for residents during the year of training;

  4. Being available to residents for review of microscopic GI, pancreaticobiliary and liver surgical and autopsy slides;

  5. Assisting residents with conference presentation preparation, as indicated.
     

Research

The fellow is expected to initiate or participate in one or more research projects
related to GI, liver and pancreaticobiliary pathology, to present the research data at national meetings, and to publish the data in pathology/biomedical journals. More information about research opportunities may be found at our research website. The department provides funds for purchasing books and attendance at a national meeting. If an abstract is presented at a meeting, additional funds and time off are provided.

 

Goals and Objectives

The overall goals are for the fellow to acquiring necessary medical knowledge, diagnostic skills and experience to practice as a subspecialty expert in GI, liver and pancreaticobiliary pathology, to gain research experience and skills to develop a successful academic career, and to become an outstanding educator for fellow pathologists, clinicians and researchers in the field. Specifically, goals and objectives include:

  1. Patient Care - Be able to gross specimens without supervision, Independently work-up and complete the majority of cases, including ordering and interpreting ancillary studies, and independently perform frozen sections, present cases at conferences, and function as a consultant to clinical physicians.

  2. Medical Knowledge - Have an extensive knowledge of neoplastic and non-neoplastic disorders that either primarily or secondarily affect the luminal GI tract, liver and pancreas, including the clinical aspects of these disorders.

  3. Interpersonal and Communication Skills - Be comfortable discussing problem cases and sensitive issues with clinicians, design and deliver effective presentations/instructions for residents, co-fellows and faculty, and create cogent correct and timely pathologic reports for GI, liver and pancreaticobiliary disorders.

  4. Professionalism - Effectively communicate case processing with technical personnel (PAs, histology, special laboratories, transcriptionists), display ethical and respectful behavior to all and be sensitive to issues of diversity.

  5. Systems-based Practice - Learn about and become able to manage administrative and technical functions involved in the operation of a pathology department and its interactions with the medical center.

  6. Practice-based Learning - Be involved in quality assurance/quality improvement and independently engage in furthering life-long learning.

Faculty in GI and Liver Pathology

Maha Guindi, MD, Program Director
Deepti Dhall, MD
Melissa Kahn, MD
Richard Mertens, MD
Shefali Chopra, MD

All Pathology Department Faculty

GME Information

 Information regarding stipends, benefits, contracts, etc. may be found at the Cedars-Sinai GME website.

Prior Fellow Placements

 Past fellows in the program have gone on to academic positions at major institutions and into private practice. 

Application Process

 Applicants must be board eligible in AP or AP/CP and licensed to practice medicine in the State of California by the time their fellowship begins. We encourage those interested to apply 20 months in advance. For application information, please visit our Fellowship General Information page.

Android app on Google Play