Program Description

Mount Sinai St. Luke’s/Mount Sinai West (MSSLW) in affiliation with the 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, hematopathology, clinical chemistry, serology, microbiology and blood banking/transfusion medicine.  Specialized training is offered in molecular pathology, dermatopathology, neuropathology, medical renal pathology, therapeutic apheresis and hematopoietic stem cell collection, laboratory management and computer applications.

COMPETENCY-BASED Goals and Objectives BY LEVEL OF TRAINING

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 (as defined by the American Board of Pathology and the ACGME) required for the practice of pathology and medicine in general. Progression of competencies throughout training, from the novice PGY-1 resident to the accomplished PGY-4 graduate, is tracked using the ACGME-defined pathology milestones.

  1. Patient Care: Trainees demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services including: effective communication with patients and families; ability to gather essential and accurate information about the patient from all available sources; make informed decisions based on current scientific evidence and clinical judgment; use information technology to support patient care decisions and education of patients and other health care workers; competently perform all technical and invasive procedures essential for the practice of pathology; develop appropriate diagnoses or differential diagnoses; and work with other health care professionals to provide patient-focused care.  While specific patient care goals and objectives by level of training are listed under each rotation’s curriculum, in general patient care skills should progress from basic PGY-1 skills (such as review of operating schedule and preparation of frozen sections in surgical pathology) to more advanced PGY-2 and PGY-3 pathology skills (such as performing specialty work ups on lymph nodes) and finally to the most advanced PGY-4 skills (such as surgical pathology sign out of cases).  In addition, as the resident progresses from PGY-1 to PGY-4 skills, less supervision will be necessary.
  2. Medical Knowledge: Trainees demonstrate knowledge about established and evolving biomedical, clinical and cognate (epidemiological and social-behavioral) sciences and apply this knowledge to patient care; demonstrate an investigative and analytic approach to problems; appropriately consult in complicated problems; are familiar with the pathology literature; have a sound knowledge of laboratory management including implementation of all applicable safety regulations and sound management; and are an effective consultant to clinicians. While specific medical knowledge goals and objectives by level of training are listed under each rotation’s curriculum, in general medical knowledge should progress from basic PGY-1 knowledge to more advanced PGY-2 and PGY-3 knowledge in surgical and clinical pathology and finally to the most advanced PGY-4 medical knowledge. The level of medical knowledge can be assessed by the degree of diagnostic accuracy in surgical pathology case sign out as well as competence in clinical pathology (transfusion medicine decisions, for example) and by performance on the Resident In Service Exam (RISE) or other testing method.
  3. Practice-Based Learning and Improvement: Trainees investigate, evaluate and improve laboratory and medical practice and medical knowledge on an ongoing basis; participate in quality assurance and quality improvement procedures; appraise and assimilate evidence from scientific studies; apply knowledge of study design and statistical methods to the appraisal of clinical and pathologic studies; use information technology to manage information and to support continuing education activities; facilitate learning of medical students and other health care professionals; and are receptive to new ideas. While specific practice-based learning and improvement goals and objectives by level of training are listed under each rotation’s curriculum, residents in all training levels (PGY-1 through PGY-4) should recognize their own limitations and learn the proper channels of consultation; they also should be able to realize the need for teamwork in maintaining a well-run and effective laboratory and participate in laboratory management in the surgical pathology suite and the clinical laboratories.
  4. Interpersonal and Communication Skills: Trainees demonstrate skills that result in effective information exchange and team building with patients, patients’ families, and professional associates; express ideas and positions clearly, both orally and in writing; ensure that reports are complete and up to date; keep thorough and accurate records; are objective, frank, and concise; are an effective listener; work effectively with other members of the health care team; and give clearly-defined orders and administrative directives. While specific interpersonal and communication skills goals and objectives by level of training are listed under each rotation’s curriculum, in general junior (PGY-1 and PGY-2) residents should be able to communicate clearly, effectively, and in a timely manner and be able to obtain relevant medical history when handling surgical and clinical pathology cases, frozen sections, and autopsies. Senior (PGY-3 and PGY-4) residents must also be able to give clear instructions and guidance to junior residents.
  5. Professionalism: Trainees demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient populations; carry out duties with dispatch and thoroughness; are prompt and well-prepared for conferences and teaching assignments; assume delegated responsibility; demonstrate stability in critical situations; demonstrate respect, compassion and integrity; are responsive to needs of patients and society at a level that supersedes self-interest; and are committed to excellence and on-going professional development. While specific professionalism goals and objectives by level of training are listed under each rotation’s curriculum, residents in all levels of training (PGY-1 through PGY-4) must act in a professional manner with respect to timeliness, dress code, behavior in the lab and patient-care areas, as well as in adherence to all work-place policies and procedures (e.g., use of personal protective wear).
  6. SystemsBased Practice: Trainees demonstrate awareness of the role of pathology in large medical systems and public health; are able to call on system resources to provide pathology services that are of optimal value; understand the reciprocal interaction of pathology practice with that of other health care professionals, health care organizations, and the larger society; demonstrate knowledge of different types of health care delivery systems including federal, state, and local laboratory regulations, billing and compliance issues; and practice cost-effective health care and resource allocation without compromising quality. While specific systems-based practice goals and objectives by level of training are listed under each rotation’s curriculum, residents in all levels of training (PGY-1 through PGY-4) should be able to understand the role of the pathologist and the laboratory within the larger context of health care services. Junior residents (PGY-1 and PGY-2 residents) should be able to access the lab and hospital information systems to obtain pertinent patient-care information while senior residents (PGY-3 and PGY-4 residents) should have an understanding of billing and coding procedures.

 Resident Duties and Responsibilities

Residents have intense experience and gradually increasing responsibility in the various disciplines of anatomic and clinical pathology (see description of individual rotations below).  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 the Residents and the Program are Evaluated

            The residents and the program are evaluated continuously and periodically.

    Residents

The 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. A permanent record of the evaluations is maintained in the New Innovations web-based evaluation system and is accessible to the resident or authorized personnel. 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, associate 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, associate program director, and chair (if necessary) counsel, resolve, and follow-up on any such issues.

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.

Program

The program is evaluated on a regular basis. The residents formally evaluate the faculty staff, rotations, conferences, and the overall training program annually. These evaluations are reviewed by the chairman and the program director and associate program director, discussed by the program director with the Education Committee, and discussed by the chairman with the individual pathologists. The St. Luke’s-Roosevelt GME Committee also conducts a periodic internal review of the program. Matters of staff performance, material and budget issues, program content, rotation changes and planning, policy and procedure are discussed at regular Education Committee meetings, which are attended by the chief residents. Through regularly scheduled, ad hoc, and informal meetings with the program director, the residents provide their input, including critique(s), regarding the program.

The program director attends Graduate Medical Education Committee meetings at Mount Sinai St. Luke’s/Mount Sinai West Hospitals and at the Mount Sinai Hospital and advises the Education Committee and the residents of relevant issues from those meetings.

SAMPLE ROTATION SCHEDULE BY POST-GRADUATE YEAR

[13 Four-Week Blocks]

 

PGY 1 2 3 4 5 6 7 8 9 10 11 12 13
1 AP

MSSL

AP

MSSL

Autopsy AP

MSSL

AP

MSW

Hem AP

MSW

H&N Path AP

MSW

AP

MSW

BB AP

MSW

Vacation*
2 Micro AP

MSSL

TA/MK AP

MSW

AP

MSW

BB AP

MSSL

Cyto AP

MSW

AP

MSW

AUTO Hem Vacation*
3 AP

MSW

SP-HS Coag ME Elect Micro Cyto DP/NP Hem Chem LM/I Mol Vacation*
4 CP

Elect

Micro Hem Elect FNA CP

Elect

Chem Ped BB Mic Chem Elect Vacation*

*Vacations taken as 1-2 week blocks and scheduled throughout the year.

 

ANATOMIC PATHOLOGY  (25.5 BLOCKS)
Rotation Site* Number of Months
AP Mount Sinai West (AP MSW) MSW 10 months
AP Mount Sinai St. Luke’s (AP MSSL) MSSL 5 months
Autopsy MSH 2 months
Cytopathology (Cyto) MSH 2 months
Dermatopathology (DP) / Neuropathology (NP) MSH 1 month (2 weeks DP / 2 weeks NP)
Fine Needle Aspiration (FNA) PACC 1 month
Head and Neck Pathology (H&N Path) MSW 1 month
Medical Examiner / Forensic Pathology (ME) NYCOCME 1 month
Pediatric Pathology (Ped) MSH 1 month
Surgical Pathology – Hot Seat (SP-HS) MSW 1 month
Medical Kidney (MK) MSH 0.5 months
CLINICAL PATHOLOGY  (19.5 BLOCKS)
Rotation Site Number of Months
Hematopathology / Hematology (Hem) MSW 4 months
Microbiology (Micro): Bacteriology/Virology/Immunology/Mycology/Parasitology MSH 4 months
Blood Bank / Transfusion Medicine (BB) MSW 3 months
Chemical Pathology (Chem) MSBI 3 months
CP Elective (CP-Elect)–In-house MSW/MSH/MSBI 2 months
Hematology/ Coagulation (Coag) MSW 1 month
Molecular Pathology (Mol) MSH 1 month
Lab Management and Informatics (LM/I) MSW/MSH 1 month
Therapeutic Apheresis / Stem Cell (TA) MSH 0.5 months
ELECTIVE ROTATIONS (3 BLOCKS) [Elect]
Electives Rotations (Elect)

Sample elective rotations:

Bone Pathology, Dermatopathology, GYN Pathology, Liver Pathology, Neuropathology, Renal Pathology

MSSL/MSW/MSH

or

Outside Elective

1 month each / total 3 months

*MSSL: Mount Sinai St. Luke’s; MSW: Mount Sinai West; MSH: Mount Sinai Hospital; MSBI: Mount Sinai Beth Israel; PACC: Phillips

Ambulatory Care Center; NYCOME: New York City Office of Chief Medical Examiner’s Office

 

Scholarly Activity

Residents are highly encouraged to participate in scholarly activities, including the write up and presentation of scholarly works (i.e., journal articles, abstracts, etc.). Residents may get reimbursed for travel to meetings (such as ASCP, CAP, and USCAP Annual Meetings) when they have been accepted or invited to present their work (such reimbursement is limited to one resident per work and once per year per resident unless approval is otherwise granted by the program director).