During each rotation in the clinical pathology core, emphasis is placed on the important consultative role of the resident in clinical pathology (CP) practice. In several rotations, the residents round with clinical consultation services, lending important insight from the clinical pathology viewpoint at the crucial interface between laboratory and physician/patient.
The CP core curriculum consists of 18.5 four-week blocks and includes:
- Clinical pathology basic training (1 block)
- Transfusion medicine (3 blocks)
- Hematopathology/Lymph node pathology (3.5 blocks)
- Flow cytometry/coagulation (1 block)
- Clinical chemistry (3 blocks)
- Microbiology/serology, including virology (3 blocks)
- Molecular pathology (1 block)
- Cytogenetics (0.5 block)
- Informatics (1 block)
- Introduction to quality improvement and patient safety (0.5 block)
- General pathology practice with laboratory management (1 block)
Clinical pathology basic training
This four-week (1 block) orientation to clinical pathology occurs in the first block of the PGY-2 year. It is a didactic training experience, acquainting the resident with the technological basics of clinical pathology. This "basic training" prepares the resident for his/her primary role, that of being a clinical consultant.
This is an intensive, service-oriented rotation in a busy, comprehensive transfusion service and laboratory. Time is divided between learning bench procedures and techniques and developing the skills of a consultant in transfusion medicine and component therapy. The resident spends considerable time in the patient care areas, advising clinical colleagues on the proper use of blood components. In transfusion medicine the resident gains experience and confidence in handling acute operating room problems and bleeding emergencies, transfusion reactions, and therapeutic aphereses.
In hematopathology, the resident responds to inquiries concerning coagulation problems, is responsible for signing out all bone marrows and hematologic disorders, and interprets phenotypic flow cytometric data on new hematologic malignancies.
The resident education in clinical chemistry emphasizes both analytical and interpretive skills. Residents are introduced to the specific methodologies and principles of instrumentation used and are trained in the use of basic laboratory equipment. During this rotation they are exposed to endocrinology, therapeutic drug monitoring, toxicology, and a broad range of special testing in obstetrics and pediatrics. Residents are actively involved in daily rounds and weekly supervisory meetings where they participate in discussions and decisions concerning quality assurance, proficiency testing, personnel management, budgeting, and instrument and procedure evaluations.
The rotation is comprised of 3 blocks covering all areas in the clinical microbiology laboratory. This is a comprehensive introduction to aspects of the clinical microbiology laboratory, covering general bacteriology, mycobacteriology, mycology, parasitology, virology, serology, molecular diagnosis of infectious disease, and automation. The resident is introduced to microbiological procedures. Topics include the interpretation of growth on different media, interpretation of smears, and using automated instrumentation. There is also extensive introductory exposure to antibiotic sensitivity testing, quality assurance in microbiology, and serologic testing. Daily laboratory rounds with the Medical Director or Supervisor cover interesting findings in the laboratory and questions requiring follow-up with the clinical team. The resident interacts regularly with the clinical infectious disease consultation team.
The Molecular Pathology rotation provides residents with didactic exposure to the basic techniques associated with nucleic acid-based diagnostic testing. Residents gain experience in interpreting clinical test results for infectious diseases, genetic diseases, hematology/oncology, pharmacogenomics, and identity testing. Additional time is also available to rotate through this laboratory to gain more extensive hands-on experience and to engage in a research project.
In this 2 week rotation, the resident learns the general principles of clinical cytogenetics and gains a brief hands-on introduction to technical aspects, including experience reading and interpreting karyotypes. Emphasis is placed on diagnostic and prognostic value of chromosome analysis for genetic disorders and neoplastic diseases. If the resident wishes to gain additional experience in this field or work on a project, elective rotation block(s) may be spent in cytogenetics.
Informatics includes didactic instruction and hands-on experience in computer science, decision analysis, and biostatistics. It is intended to familiarize residents with the essential role electronic information systems play in medical and laboratory practice. The multidisciplinary staff prepare pathology residents to be intelligent users of medical information systems and provide the skills and experience necessary to interact with these systems to capture and extract vital information and control necessary functions.
Introduction to quality improvement and patient safety
This 2 week rotation will serve as an introduction to quality improvement and patient safety with continual improvement in health care focusing on laboratory medicine. The focus will be on understanding errors, the pre-analytic, analytic and post analytic phases of a test, understanding the importance of patient identification and the requisition form follow up on the continuous improvement tools learnt in the yellow belt course completed during CP basic training and applying them to a process in the laboratory.
General pathology practice with laboratory management
A final portion of the core curriculum is a senior rotation in general pathology practice with laboratory management at the nearby VA Medical Center, White River Jct., a progressive general hospital with Dartmouth faculty. This rotation affords simultaneous responsibilities in laboratory management and consultation pathology across the spectrum of clinical and anatomic pathology sub-disciplines. Residents experience interdepartmental and regional administrative interactions at the VA, an experience similar to that of practicing general pathology in a community hospital.