The Department of Pathology and Laboratory Medicine has 20 residents in an ACGME-accredited four-year combined anatomic and clinical pathology program. Since July 2013, Cedars-Sinai Medical Center’s Pathology Residency Training Program and the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) have a combined program. The Residency Program includes training at the VAGLAHS, which has more than 8,000 surgical specimens and 4 million clinical laboratory tests annually. The program is committed to provide pathology residents with a broad range of opportunities to become skilled practitioners in general pathology. Residents rotating at VAGLAHS will have the opportunity to rotate through Surgical Pathology, Autopsy Pathology, Cytology, Molecular Pathology, Cytogenetics, and Clinical Chemistry. Many faculties are actively engaged in research projects funded by NIH, VA, and private foundations. Residents have ample opportunity to participate in various research projects. VAGLAHS is one of the largest VA Medical Centers in the United States. The Department of Pathology and Laboratory Medicine at VA Greater Los Angeles Healthcare System includes 12 faculty members, representing Anatomic, Clinical Pathology. The VAGLAHS is a 500-bed general healthcare system. Annually, the laboratory system performs approximately over 5 million clinical laboratory tests, 40 autopsies, 8,000 surgical pathology specimens, 1,000 cytological specimens, including 150 fine-needle aspirations (FNAs), and 250 bone marrow biopsies. Each resident has their own computer and microscope.
The program is structured to prepare residents for academic or community practice careers. The curriculum encompasses 27 months of anatomic pathology, 18 months of clinical pathology and three months of unspecified elective time. The core rotations include:
- Surgical Pathology (15 months)
- Autopsy Pathology (5 months)
- Cytopathology (3 months)
- Forensic Pathology (1 month)
- Neuropathology (1 month)
- Renal Pathology (1 month)
- Dermatopathology (1month)
- Hematopathology (5 months)
- Transfusion Medicine (4 months)
- Clinical Chemistry (2.5 months)
- Microbiology (2.5 months)
- Molecular Pathology (1.5 months)
- Cytogenetics (1 month)
- Coagulation (1 month)
- HLA (0.5 month)
- Laboratory Management (0.5 month)
The first two years are focused on the core elements of pathology. The first year is primarily anatomic pathology which comprises 9 or 10 months of this year, the remainder being clinical pathology. Conversely, during the second year the resident rotates for 9 or 10 months in clinical pathology rotations, the remainder spent in anatomic pathology rotations. By the end of the first two years, residents are exposed to the core areas of anatomic and clinical pathology, allowing for considered decision-making in thinking about subspecialization and future fellowships. The third and fourth years are mixed including anatomic and clinical pathology rotations, specialty rotations such as neuropathology, and electives.
In anatomic pathology, residents have early exposure to the autopsy service, which provides the study foundations of gross and histologic pathology. Biweekly autopsy conferences and monthly formal resident presentations enhance opportunities for learning. After an initial orientation during the first two months of the residency, the remainder of the surgical pathology rotations at Cedars-Sinai are structured in two-week subspecialty blocks, allowing for concentrated study by organ system. The Veteran Affairs Greater Los Angeles Health System’s (VAGLAHS) surgical pathology rotations are organized as generalized signout. The program provides a wide variety of specimens, extensive frozen section experience and a large subspecialized and available faculty. Cytopathology includes Gyn, non-Gyn and FNA specimens, and residents gain further experience by attending and giving cytology conferences.
Clinical pathology provides intensive experience in all subspecialty areas, with concentrated time during the second year. The curriculum focuses on the role of the pathologist as a clinical consultant, with residents making rounds, examining patients, and performing procedures, such as bone marrow biopsies and therapeutic apheresis. Molecular pathology and cytogenetics are coordinated with Medical Genetics. Laboratory management and informatics are included in the core rotations. The faculty includes specialists in all areas of clinical pathology.
Elective time may be taken in any area of anatomic or clinical pathology; elective time is focused at Cedars, but may be taken at another institution if academically appropriate. Many residents use elective time to undertake research projects, which are strongly encouraged.
Conferences are focused and enhance the practical education obtained during rotations. The daily surgical pathology consensus conference is a working conference providing excellent exposure to unusual and challenging cases, particularly for senior residents. There are weekly AP didactics, unknown slide conference, tumor board, and gross conference which alternates between autopsy and surgical pathology gross specimens. CP didactics and cytology conference occur several times per month. AP journal club, CP journal club, Molecular Pathology journal club, resident autopsy, CP and cytology presentations, and Grand Rounds are presented monthly. There are other subspecialty and interdepartmental conferences the resident may attend or which are required during subspecialty rotations. There are daily conferences at VAGLAHS.
All residents are required to undertake at least one research project during the four years, although most residents do considerably more research. The pathology department at Cedars-Sinai has been commended for at least three years running by the United States and Canadian Academy of Pathology, the largest academic pathology organization, for the number of resident abstracts submitted to the USCAP. In excess of 60 abstracts were presented by our housestaff members at various pathology meetings during the 2011-12 academic year. The performance of research with resulting publication is an important asset in obtaining an excellent fellowship in any subspecialty, in learning to understand and interpret the literature, and in furthering an academic career if that is the resident's chosen professional path.
Evaluations of the residents by the faculty are collated and shared with the residents two times per year. The program director reviews each resident's portfolio with them twice annually to ensure residents are on track to become competent in all areas of pathology, are making considered career choices, are appropriately involved in a research project, and are engaged with national pathology organizations.
Pathology Training Programs Graduation, June 2013