Program Description

The St. Luke’s-Roosevelt Hospital Center (SLRHC), in collaboration with Beth Israel Medical Center (BIMC) and in affiliation with Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, offers a concentrated program, which provides training in clinically-oriented diagnostic Anatomic and Clinical Pathology. Attending staff are faculty members of the Icahn School of Medicine at Mount Sinai at which residents have access to many of the facilities. The department interacts closely with clinical departments through a variety of inter-departmental conferences and rounds. The curriculum of the residency program is oriented toward integrated human pathology, with the faculty working as a closely-knit group of general pathologists, each with a special field of expertise. The core curriculum consists of supervised training with emphasis on increasing resident responsibility in autopsy and surgical pathology, cytology, cytogenetics, hematopathology, clinical chemistry, serology, microbiology and blood banking/transfusion medicine. Specialized training is offered in laboratory management and computer applications.

GOALS AND OBJECTIVES
The goal of the program is to graduate pathologists and laboratory directors with superior technical competence, clinical acumen, and intellectual depth. By developing these characteristics, the graduates will be able to bring the methods and scientific principles of current and developing pathology practice to the aid of the clinician. The objectives of the program are to instill and develop in the residents the competencies required for the practice of pathology and medicine in general:

A. Patient Care: Residents will acquire the skills to provide and demonstrate appropriate, compassionate and effective care for the treatment of disease. Competence will be assessed by direct observation and self-evaluation quizzes.

B. Medical Knowledge: The resident will demonstrate knowledge about established and evolving general and hematologic biomedical, clinical and cognate sciences, and the application of this knowledge to patient care. This should include an understanding of the etiology (including molecular basis of disease), epidemiology, pathogenesis, clinical manifestations, laboratory diagnosis, and differential diagnosis. Competence will be measured by the formation of appropriate differential diagnoses and treatment plans, and by annual in-service examinations.

C. Practice Based Learning and Improvement: The resident will learn the principles of practice based learning and improvement and demonstrate the ability to appropriately utilize information system technology. Residents should demonstrate the ability to identify their strengths and weaknesses and to implement strategies to improve their knowledge and skills and processes of patient care. Residents will participate in performance improvement activities, critical assessment of medical literature in support of practice patterns and patient management. Competency in these activities will be evaluated by direct observation and by documentation in the fellow’s portfolio.

D. Interpersonal and Communication Skills: The resident should gain the skills to effectively exchange information with other health professionals (e.g., attendings, fellows, residents, and laboratory staff) within the Department of Pathology and Laboratory Medicine and the clinical departments. This should include effective written and verbal communication and effective teaching and presentation skills. Competence will be demonstrated by direct observation and by the course directors.

E. Professionalism: Residents will demonstrate professional, ethical and responsive behavior in their interaction with other health professionals. They will also demonstrate a knowledge and understanding of local and national regulatory requirements, and their application to clinical and laboratory practice. Competence will be demonstrated by direct observation and by evaluation from multiple sources.

F. SystemsBased Practice: The resident will demonstrate an awareness and understanding of the need to respond to the larger context of the health care system and the ability to utilize system resources effectively. The fellow will also demonstrate the ability to utilize evidence-based, cost conscious strategies to provide laboratory services and patient care. Competence will be demonstrated by direct observation and by evaluation from multiple sources.

RESIDENT DUTIES AND RESPONSIBILITIES

Residents have intense experience and gradually increasing responsibility in the various disciplines of anatomic and clinical pathology. Close daily contact with the attending staff, often one-on-one, assures close supervision and continuing evaluation. Residents are expected to attain the basic and practical knowledge of pathology and to gradually develop expertise and partake in increasing responsibilities in service practice (including analyzing data, initiating case-based studies, managing the services, and interacting with clinicians). Each rotation includes a curriculum, which defines the educational goals of the rotation and provides guidance for training technical aspects of the laboratory’s operation, management and quality control. This occurs under direct supervision of attending pathologists and senior management. Laboratory management and statistical techniques for managing data are stressed, particularly in clinical pathology. Intellectual and scientific aspects of pathology, including pathogenic mechanisms and clinico-pathologic correlation, are emphasized in didactic conferences, autopsy conferences and clinical pathology conferences.

Residents are considered integral members of the Department of Pathology and participate in matters related to the planning and management of the Department. Chief Residents serve on the Education Committee, and monthly meetings are held by the Program Director with all residents to discuss the planning and management of the training program. The program director ensures that residents are given reasonable call and duty assignments, are allotted at least one 24-hour period each week free of hospital duties, and have no more than one on-call assignment in three. There is scheduled back up support in the event of unanticipated increases in routine or call load.

MANNER IN WHICH RESIDENTS ARE EVALUATED

Faculty evaluate the residents in each of the six core competencies by electronic completion of a standard form at the end of each rotation. These evaluations are supplemented by evaluations provided by the directors of elective or specialty rotations. The evaluations are reviewed with the residents biannually by the program director. The program director also reports to the Education Committee on findings from these reviews, with recommendations for further action (promotion, development, remediation), as appropriate.

Advancement of residents to positions of higher responsibility occurs on the basis of their satisfactory progress of scholarship and professional growth. The rotation director, who is responsible for facilitating this advancement, evaluates this progress. The progress of the residents is monitored closely by the program director, who is in daily contact with residents at all sites on routine matters of program administration and cases of interest in both anatomic and clinical pathology, and by the chairman. The program director and the chairman are also in daily contact with the attending pathologists on administrative and patient care issues, and utilize these contacts to inquire about the progress of each resident. If an area of difficulty with a resident is observed, the resident is informed in a timely manner, with the intent of remediation of the difficulty. The Education Committee is also apprised of any issues with resident performance, and in council recommends appropriate corrective action. Discussion at the departmental level occurs only when progress is not regarded as appropriate, an event that has been rare during the past years. The program director and chair (if necessary) counsel, resolve and follow-up on any such issue(s).

When a resident completes the program, a written final evaluation is completed, which reviews the resident’s performance during the final period of training and verifies their professional ability to practice competently and independently. This final evaluation is part of the resident’s permanent record maintained by the institution.

SAMPLE ROTATION SCHEDULE BY POST-GRADUATE YEAR

PGY

1

2

3

4

5

6

7

8

9

10

11

12

1

ABI

ABI

ABI

ASL

ASL

Hem

ABI

ASL

ASL

ARH

ARH

ARH

2

Mic

Mic

Mic

ARH

BB

BB

Chm

ASL

Chm

ABI

Mic

Hem

3

ABI

ABI

Hem

ME

Elect

ARH

Cyt

Cyt

Hem

ARH

LMI

Mol

4

ASL

Cytog

Hem

Elect

FNA

ARH

Chm

Ped

BB

ASL

ARH

Hem

 

ANATOMIC PATHOLOGY (27 MONTHS)

AP Roosevelt Hospital (ARH)

8 months

AP Beth Israel Medical Center (ABI)

7 months

AP St. Luke’s Hospital (ASL)

7 months

Cytopathology (Cyt)

2 months

Fine Needle Aspiration (FNA)

1 month

Medical Examiner / Forensic Pathology (ME)

1 month

Pediatric Pathology (Ped)

1 month

CLINICAL PATHOLOGY (19 MONTHS)

Hematopathology / Hematology (Hem)

6 months

Microbiology (Mic):
Bacteriology/Virology/Immunology/Mycology/Parasitology

4 months

Blood Bank / Transfusion Medicine (BB)

3 months

Chemical Pathology (Chm)
3 months

Cytogenetics (Cytog)

1 month

Molecular Pathology (Mol)
1 month

Lab Management and Informatics (LMI)

1 month

ELECTIVE ROTATIONS (2 MONTHS) [Elect]

Electives Rotations (Elect)
Sample elective rotations:
Bone Pathology, Dermatopathology, GYN Pathology, Liver Pathology, Neuropathology, Renal Pathology

1 month each