Pathology Residency Overview
During the four years of training there are also approximately five months of elective time wherein the resident is free to either spend more time in an area of particular interest or even pursue rotations at other institutions. The required rotations outside of the military institutions include a month at the San Antonio (Bexar County) Medical Examiner's Office for experience in Forensic Pathology, a month at MD Anderson Cancer Center for experience in intraoperative consultations (frozen sections), and a month at Texas Children’s Hospital for experience in pediatric pathology. Rotations at our facilities by interested medical students is welcomed and encouraged for any prospective applicant or for medical students interested in other specialties such as surgery or obstetrics/gynecology.
The resident will be introduced to and be responsible for basic techniques of both autopsy and surgical pathology. The resident is expected to assimilate details as rapidly as appropriate on an individual basis. The resident will learn the fundamentals of tissue fixation, processing and staining in the realm of light microscopy and immunohistochemistry and within a few weeks will assume responsibilities for a share of the anatomic pathology workload. During the first year all of the resident's work will be carefully guided and supervised by faculty and senior residents. At unspecified conferences, the resident will review the cases and be expected to accurately describe the microscopic or gross findings and give a basic diagnosis or differential as appropriate for his/her level of experience.
Residents will start rotations through all the major services of the clinical laboratory. Normally a rotation through Transfusion Medicine is scheduled this year. Residents will learn the basic organization of the laboratory and the flow of specimens and data. The resident will participate in solving technical and administrative problems as they arise in each section. Residents will participate and interact in consultations with clinicians and confer with them on laboratory problems as they arise.
The second year of anatomic pathology training is similar to that of the first year except that additional responsibilities and knowledge are expected of the resident. Residents are expected to possess additional expertise in the realm of gross anatomic morphology and diagnoses. On surgical pathology the resident will examine cases prior to sign out with the staff. The second year resident should be able to accurately diagnose common entities and be able to suggest a differential diagnosis and plan of work up in more difficult cases. Gynecologic and non-gynecologic cytology rotations are scheduled this year.
The residents will continue rotations through the remaining major sections of the clinical laboratory comprising the core rotation. Immunology including flow cytometry is often scheduled in this year. Residents are expected to be familiar with all procedures performed in the laboratory and the routine flow of work in the laboratory. Clinical consultations and problem-solving continue to be intricate parts of the resident's experience. The resident is expected to solve clinicians' problems or laboratory problems with some assistance from staff or senior residents. One lecture in clinical pathology will be given by the resident.
Most of the anatomic electives occur in the third or fourth year in anatomic pathology. A rotation to MD Anderson Caner Center in Houston, TX is required for one month for intensive exposure to intraoperative consulation. The mandatory forensic pathology rotation at the Bexar County Medical Examiner’s Office usually occurs in the third year. In surgical pathology there is much more emphasis on diagnostic accuracy, communication, and performance improvement with some autonomy of practice being expected. Research experiences are encouraged and should be well planned or underway. In the third year, a resident will assume some responsibility for the guidance of younger residents. This is to include demonstrations in the surgical pathology laboratory and the morgue. Residents will also increase their didactic lecturing responsibility both in the laboratory and in the hospital setting. The resident will actively participate in studies using fine needle aspiration, immunofluorescence and immunoperoxidase techniques.
During this period the resident normally finishes required rotations in the laboratory sections. Problem solving in the laboratory is an important resident experience of the third year. Involvement in a performance improvement project is expected. Residents will also participate in evaluating new methods, techniques, and instruments. Opportunities for original investigation are encouraged.
The fourth year of this training program will usually be divided equally between clinical and anatomic pathology. Pediatric pathology training that enhances earlier training will take place at Texas Children’s Hospital in Houston, TX. Cytogenetics and molecular pathology are combined in a mandatory one month rotation whereas laboratory management, telepathology and informatics are combined into an additional mandatory rotation for fourth year residents. A majority of electives will be taken in the third and fourth year. Electives in gastrointestinal pathology, dermatopathology in a busy civilian practice setting, or soft tissue pathology are a few of the electives available. The resident's professional and intellectual development will be stimulated in order to prepare for responsibilities which must be assumed after the completion of the residency. The resident will function essentially as a junior staff member. The Chief Resident (a duty which bridges third and fourth year for the selected resdient) will possess sole responsibility for preparation of on-call and duty rosters for the residents. The residents will also prepare and coordinate conference schedules and will act as a liaison with all other clinical services. The resident will act as consultant in pathology (both anatomic and clinical) to the house staff. Senior resdients will assist in educating the junior residents at all levels and will provide one lecture in the anatomic and clinical lecture series. Throughout the fourth year the residents will be involved in increasing management responsibilities and will actively participate in the Department of Pathology staff meetings and QA/RM committee. As opportunities arise, the resident should participate in at least one College of American Pathologists (CAP) laboratory accreditation inspection which involves traveling to other laboratories within the area. Submission of a case report or brief research study is required for graduation. However, the article does not have to be accepted for publication to graduate.
Residents will attend courses and take advantage of other educational opportunities to achieve a more complete education and to be exposed to national consultants. Optional attendance at the monthly San Antonio Society of Pathologists meeting is encouraged. During the third or fourth year, residents will present an interesting case at this meeting. Residents are encouraged to seek membership in professional societies such as the American Society of Clinical Pathologists and College of American Pathologists.