Molecular Genetics Pathology Fellowship Program
Molecular Genetics Fellowship
The ACGME accredited Molecular Genetics Pathology Fellowship at Cedars-Sinai offers comprehensive training in all areas of molecular pathology including in-depth exposure and experience in molecular test strategies, decisions on application of testing, test interpretation and communication with other physicians and patients regarding test results. Fellows may come from a background in pathology or internal medicine, and on completion of the fellowship are competent to perform as junior staff in either a community or academic setting. The CSMC Molecular Genetics Pathology fellowship is highly competitive. Therefore, interested applicants with a pathology background should strongly consider concurrent application for the Surgical Pathology Fellowship, as qualified candidates may be offered Surgical and Subspecialty Fellowship positions in consecutive years. The Medical Center has many sources of excellent adult and pediatric cases and material, including the Medical Genetics Institute, the Samuel Oschin Comprehensive Cancer Center and a busy hematopathology laboratory service.
The program is provides experience in the practice and administration of molecular genetics pathology including learning how to select, apply and interpret molecular studies and create cogent and integrative reports in a variety of areas including hematopathology, infectious diseases, solid tumors, inherited diseases, pharmacogenomics, genetics, cytogenetics, and biomedical genetics, and in the HLA Laboratory. In addition, molecular genetics pathology fellows who are pathologists will spend one month in the Medical Genetics Clinical rotation, while those boarded by the ACMG will spend this time in Anatomic Pathology.
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 of practice in and administration of molecular genetics pathology (MGP) is accomplished in a coordinated fashion. The MGP fellow participates in learning how to select, apply and interpret molecular studies and create cogent and integrative reports in a variety of areas including hematopathology, infectious diseases, solid tumors, inherited diseases, pharmacogenomics, genetics, cytogenetics, and biomedical genetics, and in the HLA laboratory. In addition, MGP fellows who are pathologists will spend one month in the Medical Genetics Clinical rotation, while those boarded by the ACMG will spend this time in Anatomic Pathology. An overview of rotation specifics is provided below.
Molecular Hematopathology provides a background to the non-random mutations and gene rearrangements associated with leukemias and lymphomas. The MGP fellow will become familiar with the technologies used to perform the molecular tests (quantitative PCR etc.) as well as gain experience in running the test and trouble-shooting in the lab.
Molecular-Infectious Disease provides experience with numerous molecular technologies used in the identification of viruses, bacteria, and other microorganisms. The fellow also learns how to identify and investigate and control nosocomial infections in the hospital in collaboration with the infectious disease department and epidemiology. The MGP fellow will become familiar with repetitive PCR sequence analysis as part of the epidemiologic work-up.
In Molecular-Solid Tumors, the fellow reviews the morphologic evaluation of solid tumors and the non-molecular testing used to classify these specimens, and becomes familiar with the non-random mutations and gene rearrangements that occur in different classes of solid tumors, and their use in diagnosis and prognosis. The fellow is involved in the development and implementation of new tests based on knowledge of the current scientific literature. In the future, expression micorarrays may become part of the testing menu.
In the inherited disease rotation, the fellow learns to recognize clinical, inherited disorders and to evaluate a family history. The fellow will work with researchers in the institution to help translate findings in the research lab into clinical tests for rare disorders followed at our institution and identified in specific, local ethnic populations. The fellow will become familiar with the concepts of genetic heterogeneity and variable expressivity and be able to use their understanding of these phenomenon to individualize testing for particular families. It is planned by the department to introduce Comparative Genomic Hybridization arrays and have the MGP fellow participate in their validation and implementation for CLL, AML, and other hematopoietic malignancies.
The new field of pharmacogenomics will give the fellow the opportunity to be at the forefront of individualized medicine by learning to use genetic information about drug activation and metabolism to help predict the appropriate dose of a drug. They will learn about drug metabolism, the various enzyme pathways involved and the genetic variation in these pathways that exist in different populations and families. The fellows will be involved in the development of new tests related to drug selection and dosing, and be involved in the process of educating community physicians about the value of this approach.
In cytogenetics and molecular cytogenetics the fellow learns different methods of cell culture, banding and karyotyping and molecular cytogenetic (FISH) techniques. The fellow is involved in the writing reports and interpretation of results for prenatal diagnosis, evaluation of congenital abnormalities and reproductive problems, as well as cancer cytogenetics.
The HLA laboratory allows the fellow to learn methods and relative merits of serological and molecular typing using the variety of methodologies available in they lab for matching donors and recipients experiencing transplantation of bone marrow, liver, kidney, heart, lung, pancreas and other tissues.
In the anatomic pathology and autopsy services, the fellow becomes familiar with autopsies of dysmorphic fetuses and still born infants or others with identified genetic disorders, malformations, and other inherited disorders and learns to identify anatomic features that are associated with genetic diseases. In addition, the department of pathology offers subspecialized surgical pathology, and the fellow will have the opportunity to choose an area of interest in which to develop a translational research project.
In the medical genetics clinical rotation, the fellow sees a wide variety of pediatric and adult patients with inherited disorders in conjunction with the genetics residents and faculty. The CSMC medical genetics institute has an international reputation for skeletal dysplasia, as well as dysmorphology, prenatal diagnosis, metabolic and adult onset disorder clinics. The MGP fellow will be involved in non-directive genetic counseling with patients from a wide variety of socio-economic and ethnic backgrounds.
In the biochemical genetics laboratory rotation, the fellow is exposed to the primarily protein-based methodologies used to test for different inherited enzyme and metabolic deficiencies, and discuss them with their attending. The focus will be on understanding the relative merits of
biochemical versus molecular testing for genetic disease.
Yearly Rotation Schedule
The fellow may be assigned on call responsibilities including 2 weeks on genetic call and 2 weeks in molecular pathology call from home.
|Molecular Hematopathology||1.5 months||Hematopathology (South Tower 4th Floor)|
|Molecular Infectious Disease||1.5 months||Microbiology (South Tower 7th Floor|
|Molecular Solid Tumors||1.5 months||Molecular Pathology Laboratory (Spielberg Bldg)|
|Molecular Genetics/ Pharmacogenomics||1.5 months||Molecular Pathology Laboratory (Spielberg Bldg)|
|Cytogenetics||1 month||Cytogenetics (Spielberg Bldg)|
|HLA||2 weeks||HLA lab (Spielberg Bldg)|
|Medical Genetics or Anatomic Pathology||1 month||Medical Genetic Institute or Anatomic Pathology (South Tower 8th Floor)|
|Biochemical genetics||2 weeks||Biochemical Genetics Laboratory (CHOP)|
|Elective/R&D||2 months||Molecular Pathology (Spielberg Bldg/other)|
Fellows participate in departmental and interdisciplinary conferences with Genetics and Oncology, including clinical case conferences and case reviews.
During the year, the Molecular Genetics Pathology Fellow mandatory conferences include:
- Molecular Pathology Journal Club (monthly)
- CSMC genetics research seminars (weekly)
- UCLA human genetics research seminars (weekly)
- CSMC genetics rounds (weekly)
- CSMC Cytogenetics laboratory meetings (weekly)
- CSMC Prenatal conferences (weekly)
- HemeOncGenetics Conference (monthly)
- FLICS seminar series
- Molecular Development Meeting (bimonthly)
- Molecular Pathology interesting case conference (monthly)
The fellow is expected to prepare for and present at many of the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference. Fellows are encouraged to attend other departmental and interdepartmental conferences and educational endeavors to maintain competence in general pathology.
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:
- Supervision of and assisting residents during their molecular pathology and cytogenetics rotations.
- Presenting molecular didactic conferences for residents and other fellows.
- Supervision of and teaching residents in molecular techniques, applications and
interpretations during hematopathology and anatomic pathology rotations.
The fellow is expected to initiate or participate in one or more research projects related to an area of molecular genetics pathology, to present the research data at national meetings, and to publish the data in appropriate journals. In addition, the fellow is required to bring a new test on-line. This includes researching patient needs and laboratory protocols, and the implications of various mutations, population incidence and clinical features of the disorder being evaluated. The fellow will develop and QC the test strategy, devise a reporting strategy and work with the technical personal to start up the procedure. In addition, there will be consultation with the genetics faculty to evaluate the ethical and population concerns associated with test implementation. Finally, he fellow will be involved in marketing and pricing of the test and communication with physicians in other disciplines who would benefit from test use.
There are a number of local research competitions and awards for which the fellow can compete. More information about research opportunities may be found at our housestaff research site. 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.
The overall goals are for the fellow to acquire necessary medical knowledge, diagnostic skills and experience to practice as an outstanding molecular pathologist, to gain research experience and skills with the option of developing a successful academic career, and to an outstanding educator for pathology colleagues and clinician.
Specific goals and objectives include:
- Patient Care - Be able to accurately select appropriate lab testing based on diagnosis or clinical findings, interpret laboratory reports and predict phenotype and impact for patients, describe to a patient the steps necessary to obtain lab results, and, function as a consultant to clinical physicians.
- Medical Knowledge - Have an extensive knowledge of and understand the various types of chromosome abnormalities and their clinical impact, know the procedures for different cytogenetic tests and the significance of the results, and be able to describe karyotypes based on ICSN nomenclature.
- Interpersonal and Communication Skills - Be able to obtain clinical information to assist the lab in appropriate test selection, be able to explain clinical findings and their significance to laboratory staff, be comfortable discussing test results and sensitive issues with clinicians, patients and their families, design and deliver effective presentations/instructions for residents, co-fellows and faculty, and create cogent correct and timely molecular pathologic reports.
- Professionalism - Display and promote ethical and respectful behavior to all, be sensitive to issues of diversity, and demonstrate respect for patient confidentiality.
- 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, work effectively with various members of the clinical and laboratory team to facilitate accurate and appropriate patient testing and reporting of results, be aware of the costs and risks/benefits of obtaining samples and providing testing in molecular pathology.
- Practice-based Learning - Be involved in quality assurance/quality improvement, independently engage in furthering life-long learning. review the literature to obtain information on rare chromosome aberrations.
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.