Surgical Pathology Fellowship

Surgical Pathology Fellowship

Overview

The Surgical Pathology Fellowship at Cedars-Sinai offers comprehensive training in diagnostic surgical pathology including in-depth exposure to all subspecialty areas of general surgical pathology. Fellows are expected to enter the year with a strong general background in diagnostic pathology, and to emerge from it as polished attending pathologists who can quickly adapt to the role of and competently perform as junior staff in either a community or academic setting, or enter into and excel at further subspecialty fellowship training. The Medical Center has many sources of excellent surgical pathology material, including the Samual Oschin Comprehensive Cancer Center, Breast, Prostate, Ovarian and Colorectal Cancer Centers, Inflammatory Bowel Disease Center, and active surgeons in many other areas. These programs cover a full spectrum of medical and neoplastic diseases, providing over 50,000 surgical pathology specimens annually.

The fellow will be provided with and given graduated responsibility for signing out cases including consultation cases with the large fully subspecialized surgical pathology faculty at Cedars-Sinai. The fellow is expected to become involved in ongoing clinical or translational research in the Department of Pathology and Laboratory Medicine, 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 conference presentations, anatomic pathology administration, education of Pathology residents, Quality Improvement projects and have the opportunity to participate in CAP inspections. While not ACGME accredited, the fellowship meets the American Board of Pathology criteria for Maintenance of Certification credit.
 

 
 
 
 
 

 

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 surgical pathology (morphology, immunohistochemistry, molecular diagnostics, laboratory management administration and informatics) is accomplished in a coordinated fashion. The surgical pathology faculty at Cedars- Sinai is fully subspecialized; therefore, the surgical pathology rotations are structured in a subspecialized manner.

The year is divided as follows:
4 months - surgical pathology (includes grossing responsibilities 2-3 times/week)
4 months - surgical pathology (without grossing)
2 months - frozen sections
2 months - research/electives

During the year while on surgical pathology with grossing, the surgical pathology fellows rotate through 7 subspecialties in 2-week rotational blocks; the last 2 week block may be done in an area of the fellow's interest. The subspecialty areas include Derm/Bone/Soft Tissue, GI, GU/Endocrine, Gyn, Lung/Liver, Breast, Head and Neck/Placenta. Days are structured with biopsy sign-out in the subspecialty area every morning, and alternating subspecialty grossing and large case sign-out in the afternoon. During the 4 months of surgical pathology without grossing, fellows sign out all consultation cases in all subspecialty areas and evaluate a portion of biopsies and large cases. The volume at Cedars is such that residents and fellows have their own cases even when on similar specialty services.
In addition to their day-to-day service work responsibilities, Fellows will participate in additional departmental and interdepartmental activities listed below.
 

Fellow Responsibilities

  1. Case editing, preparation and sign out

  2. Sign out of outside consultation cases during non-grossing months

  3. Rotation as Gross Room Supervisor (GRS)

  4. Grossing duties required up to 2-3 days/wk during 4 grossing months

  5. Consultant for junior residents on grossing (and where possible slide preview) for all major soft tissue and bone tumor resections

  6. Late coverage (until 6PM) of breast research tissue collection on rotational basis with other AP Fellows

On call responsibilities are one Saturday/month in rotation with the GU and surgical GI 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 - 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.

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. Review (under supervision) of monthly surgical pathology monitors; collate and present data

  2. Surgical pathology turnaround time

  3. Frozen section-final diagnosis correlation

  4. Completeness of tumor reports reports to ensure compliance with required CAP reporting elements

  5. Review of amended reports for discrepancies

  6. Correlation of inter-institutional review case diagnoses

  7. Assist/conduct daily review of histology slide quality
     

Conference Schedule

During the year, the Surgical Pathology Fellow mandatory conferences include:

  1. Surgical pathology consensus conference (daily)

  2. General oncology tumor board (weekly)

  3. Specialty-specific tumor boards on rotation (e.g. GI)

  4. Thyroid Center of Excellence (COE) conferences when cases are presented (quarterly)

  5. Performance Improvement in Surgical Pathology (PIP) conference

  6. AP Journal Club (monthly)

  7. Molecular Pathology Journal Club (monthly)

  8. AP fellow conference to review of interesting/educational cases (monthly)

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. Fellows may attend other departmental and interdepartmental conferences and educational endeavors to maintain competence in general pathology.

 

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 are:

  1. Consultation/supervision of junior residents in grossing room

  2. Supervision of and assisting junior residents in grossing all soft issue/bone tumor cases

  3. PIP conference (per above)

  4. Unknown slide conferences for residents

  5. Gross conferences for residents
     

Research

The fellow is expected to initiate or participate in one or more research projects related to any area of surgical pathology, to present the research data at national meetings, and to publish the data in pathology/biomedical journals. In addition, 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 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 acquire necessary medical knowledge, diagnostic skills and experience to
practice as an outstanding surgical pathologist, to gain research experience and skills with the option of developing a successful academic career, and to become an outstanding educator for pathology colleagues and clinicians. 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 in surgical pathology, 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 surgical pathology specimens.

  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.

 

Surgical Pathology Faculty

Bonnie Balzer, MD, PhD, and Xuemo Fan, MD, PhD, Surgical Pathology Program Directors

 

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.