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Post-Junior Medical Student Pathology Fellowship

University of Colorado Anschutz Medical Campus

University of Colorado, School Of Medicine

Pathology Residency Training Program

Aurora, CO 80045

POST-JUNIOR MEDICAL STUDENT FELLOWSHIP

Anatomic Pathology (AP), Clinical Pathology (CP), Research

Duration: 12 months (13 4-weeks blocks)

Offered: Post junior medical students (between year 3 and 4)

Positions: 2 students per academic year

Stipend: $53,106/annum

Teaching Staff: Pathology faculty

GLOBAL DESCRIPTION

The Post-Junior Medical Student Pathology Fellowship provides the medical student who has completed the first three years of medical school with an intensive practical educational experience in diagnostic pathology and laboratory medicine. The Fellow performs the work of a starting PGY1 resident under the close supervision and guidance of Pathology faculty. The training is designed to develop a thorough understanding of disease processes, medical diagnostics, and the relationship of pathology services to patient care. There is some latitude in constructing the rotations to meet the interests and support the career goals of the student. In general, the year will be spent in anatomic pathology (5 blocks), and clinical pathology (5 blocks). Additionally, three blocks are allocated for electives and research. Ultimately, this immersive year in pathology is structured to benefit and enrich the Fellow’s preparation for the practice of any medical specialty.

APPLICATION

Open to qualified University of Colorado medical students who will have completed at least three years in their training by the fellowship start date
Applicants should complete an application form including a personal statement and provide two letters of recommendation and a curriculum vitae.
The application deadline is xx/xx/xx for a xx/xx/xx decision
Questions and requests for further information may be directed to Von Samedi, MD, PhD (e-mail at von.samedi@cuanschutz.edu)

ANATOMIC PATHOLOGY

Surgical Pathology (2 Blocks)

Description

Surgical pathology is the study of tissues removed from living patients during surgery or biopsy to help diagnose a disease and determine a treatment plan. Surgical pathology includes macroscopic assessment (physical exam of the tissue with the naked eye and cutting into the tissue), as well as microscopic assessment (examining processed tissue under a microscope.) The examination may be supported by ancillary studies (e.g., histochemistry, immunohistochemistry, molecular tests.) In conjunction with the clinical impression, the final interpretation of the tissue findings is the cornerstone of a patient’s treatment plan. It provides critical information such as determining if a tumor is benign or malignant, staging the extent of malignant disease.

This rotation provides the medical student the opportunity to acquire extensive experience and necessary technical skills in macroscopic evaluation (also called grossing) of tissues. The medical student becomes familiar with pathologic description, and develops the fundamentals of differential diagnosis in surgical pathology. The student also learns the microscopic appearance and interpretation of a wide variety of pathologic processes.

Responsibilities

The medical student…

is responsible for the surgical specimen from the time that it is obtained from the patient until the final report is received by the ordering physician.
must recognize the importance of maintaining specimen integrity at the bench.
dictates all gross descriptions and is responsible for their accuracy and completeness.
must ensure that the specimen is received in proper time and in proper condition for processing, that the tissue is fixed and prepared for submission to the Histology Laboratory in appropriate fashion so that histologic slides may be prepared in a satisfactory manner.
should develop a systematic approach to slide examination and be able to relate the histologic findings to the clinical and gross features of the case
must formulate a working diagnosis prior to sitting with the attending pathologist for the final report.
is expected to do independent reading on assigned cases.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions and steps of the surgical pathology evaluation (from the time the specimen is obtained from the patient until the final report is generated) are under the supervision of the assigned attending pathologist and pathologist assistants.

Evaluation

Faculty members will directly observe, evaluate, and frequently provide feedback on the student’s performance during the rotation. An objective performance evaluation based on the ACGME Competencies will be provided using multiple evaluators. Evaluation will be documented at the completion of the rotation.

Autopsy (1 Block)

Description

An autopsy, also known as a post-mortem examination, is a specialized surgical procedure used to determine the cause and manner of death. The cause of death is the medical reason explaining why a patient passed. The manner of death is the circumstances surrounding the death. The findings from an autopsy ultimately allow clinicians to better understand disease processes, accurately diagnose diseases, improve therapy, and potentially aid other patients who are currently suffering from a similar disease. Only deaths due to natural causes are examined at the University of Colorado Hospital. All other manners of death are referred to the appropriate Office of Medical Examiners for further investigation.

This rotation includes understanding the many roles of autopsy pathology in the hospital and community settings. The rotation affords the student the opportunity to review normal anatomy, observe evisceration and organ dissection techniques, learn how different organ systems are affected by common disease processes, and understand the process and importance of death certification and medicolegal death investigation.

Responsibilities

The medical student…

is responsible for extracting the clinical record, contacting and communicating with the responsible clinicians.
performs the evisceration and dissection.
is responsible for dictating all gross and microscopic findings, and formulating a succinct summary of findings and correlating them with the clinical course.
prepares the preliminary anatomic diagnoses (PAD).
is expected to evaluate microscopic slides, and to interpret clinicopathologic correlation of autopsy findings.
is expected to learn administrative details concerning proper permission, death certification, and satisfactory preparation of the body for the funeral director.
should be able to accurately and concisely present a clinical case in intradepartmental and interdepartmental conference settings and in addition should be able to interact with physicians from clinical services.
is also responsible for the case at the appropriate brain cutting conference and for preparing the final neuropathology report.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions and steps of the autopsy (from gross organs and microscopic evaluation to the time until the final autopsy report is generated) are under the supervision of the assigned attending pathologist, pathologist assistants and dieners.

Evaluation

Cytopathology (1 Block)

Description

Cytopathology involves examining cells from bodily tissues or fluids to determine a diagnosis. The presence of abnormal characteristics or morphologic changes of cells is assessed under a microscope. Only a very small sample of tissue is needed to do a cytology test.

This rotation is designed to let the medical student learn the diagnostic characteristics and relevant differential diagnoses of malignant and benign lesions, and to apply this knowledge to the screening and diagnosis of cytology samples. The medical student is exposed to gynecologic, non-gynecologic and fine needle aspiration materials.

Responsibilities

The medical student…

should be familiar with cytologic preparations such as cytospins, direct smears, cell blocks (for fluids, washings, brushings, fine needle aspirations).
is required to attend, obtain consent and perform FNAs under staff supervision.
should be thoroughly familiar with all aspects of gynecologic cytology.
should be familiar with respiratory cytology, cytology of effusions, cytology of the cerebrospinal fluid, cytology of the urinary tract, thyroid cytology, anal pap cytology and deep organ cytology
is responsible for preliminary screening of all cytology cases and sign-out with attending staff.
should be familiar with cytologic features of normal constituents and lesions
is responsible for preliminary interpretation of all image-guided FNAs.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions and steps of the cytopathology evaluation (from the time the specimen is obtained from the patient, to cytologic preparations and until the final report is generated) are under the supervision of the assigned attending pathologist and cytotechnologists.

Evaluation

Intraoperative Consultation (1 Block)

Description

The primary purpose of intraoperative pathologist consultation is to guide immediate surgical management. It can provide surgeons with important information that may be used to modify or even terminate a surgical procedure. Frozen tissue sections performed during intraoperative consultation can also be used to establish the nature and extent of a lesion, to determine the status of surgical margins and to confirm that sampling of lesional tissue is sufficient for further investigations.

This rotation is designed for the medical student to learn tissue selection for frozen sections, techniques in tissue sectioning and staining, appropriate tissue handling for special studies, and limitations of frozen section interpretation.

Responsibilities

The medical student…

must be able to perform, in a reasonable time period, a technically adequate frozen section and be able, with increasing experience, to deliver an appropriate interpretation.
should be aware of the limitations of the frozen section technique and likewise know when a diagnosis must be deferred.
must be able to apply additional special techniques, i.e. imprint cytology, which complement the frozen section examination, when appropriate.
should be able to communicate in a professional and mature manner with attending surgeons to obtain and deliver pertinent information.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions and steps of the intraoperative consultation (from the time the specimen is obtained from the patient, to frozen sections and until the final interpretation is relayed to the surgeon) are under the supervision of the assigned attending pathologist and pathologist assistants.

Evaluation

CLINICAL PATHOLOGY

Transfusion Medicine and Coagulation (2 Blocks)

Description

Transfusion medicine is a field of medicine dealing with the removal and/or transfusion of blood or blood components. Traditionally, it has been thought of as just blood collection, pretransfusion testing, and blood administration, but also includes the field of apheresis.

This rotation will provide medical students with a foundation in clinical & laboratory transfusion medicine and coagulation as well as exposure to donor and therapeutic apheresis. The intent is to prepare the student for residency responsibilities in transfusion medicine, focusing on practical topics including 1) understanding appropriate therapeutic use of blood components for different patient populations, 2) necessary steps in ordering and administering blood components, 3) recognizing the risks and benefits of transfusion, 4) recognizing, diagnosing, and managing adverse events related to transfusion, and 5) learning the basics of apheresis procedures, including the conditions they can treat and when it is appropriate to do them. This rotation also provides a foundation in transfusion and hemostasis necessary for virtually all specialties, but will be of particular interest for those students interested in anesthesia, hematology/oncology, surgery, obstetrics, or pathology.

Responsibilities

The medical student…

is to become familiar with the laboratory evaluation and diagnosis of coagulation abnormalities and the use of Blood Bank resources to handle the coagulation defects.
should be able to diagnose adverse reactions to blood transfusion.
should be able to advise on the feasibility of further transfusion in patients with adverse reactions.
should be able to demonstrate and understand the appropriateness of transfusion of serologically incompatible blood in selected clinical circumstances.
should offer consultation regarding preoperative and intraoperative autologous blood collection and transfusion.
should demonstrate an understanding of, and perform at least once, ABO blood grouping, Rh(D) testing, unexpected red cell antibody identification, and compatibility testing using current techniques.
should be able to explain and demonstrate an understanding of the diagnostic criteria and current methods of treatment and prevention of alloimmunization and refractoriness to platelet transfusion.
should be able to explain the appropriate indications for irradiation of blood components.
should be familiar with the current standards and criteria for donor screening, acceptance, and deferment.
should be knowledgeable about blood anticoagulation and preservation solutions, the preparation and storage of blood components, and quality control aspects of component preparation.
should be able to interpret the results of infectious disease marker testing and be knowledgeable about the pathophysiology, diagnosis, and treatment of hemolytic disease of the newborn (including ABO, Rh(D), and other red cell antibodies).
should be able to explain the use and interpretation of the direct antiglobulin test (DAT, or Coombs test).
should be able to explain the appropriate indications, and techniques, for the leukocyte reduction of blood components.
should be familiar with the techniques and reliability of standard blood banking and transfusion service laboratory procedures.
should be familiar with ethical issues in blood banking and transfusion medicine (e.g., confidentiality as it relates to the blood donor or the patient, HIV testing and reporting, a patient’s right to refuse blood transfusion, the use of hematopoietic growth factors in normal donors, etc.)
should be familiar with programs of quality control, quality assurance, and GMPs (Good Manufacturing Practices) for blood banks and transfusion services.
should be familiar with the basic concepts and issues of quality assurance in blood banking and transfusion medicine.
should develop an appreciation of stewardship of the blood supply.
Should recognize the instruments used in apheresis procedures and their appropriate use
Should participate in obtaining informed consent from donors and patients who undergo apheresis procedures
Should recognize adverse events that are associated with apheresis procedures and how to treat them
should be able to appropriately order and interpret coagulation laboratory tests.
must learn hemostasis/thrombosis pathways and be familiar with the common and scientific name of each protein/element that participates in these metabolic pathways.
should learn and be familiar with both acquired and congenital hemostasis/thrombosis abnormalities or disease states.
is expected to observe testing procedures and operations in the coagulation laboratory.
should review and understand methodologies of hemostasis/thrombosis laboratory testing.
should be aware of and assist in the handling of problems in the coagulation laboratory.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions of transfusion medicine and blood banking are under the supervision of the assigned attending pathologist, nursing staff, and laboratory professionals.

Evaluation

Hematopathology (1 Block)

Description

Hematopathology is a broad field that spans both anatomic and clinical pathology. It is an area in which the growth of knowledge and the applications of new technologies (i.e. molecular biology, flow cytometry) is expanding particularly rapidly. It is the study of diseases and disorders affecting and found in blood cells, their production, and any organs and tissues involved in hematopoiesis, such as bone marrow, spleen, and thymus. Hematopathology is involved in the analysis of the cellular elements of blood, bone marrow, body fluids, and lymphoid tissues with a focus on neoplastic and non-neoplastic hematologic disorders. These cells originate in the bone marrow and become white blood cells, red blood cells, and platelets. White blood cells are present in many important structures of the body, like lymph nodes, and are major components of the immune system. When disease invades, the body sends these cells to fight bacteria and viruses. Blood cells can occasionally become abnormal; in some cases, abnormal blood cells give rise to cancers such as leukemia.

This rotation gives the medical student a broad-based experience in all aspects of clinical and anatomic hematopathology. It emphasizes a clinicopathologic and integrated approach to bone-marrow and solid-tissue diagnostic hematopathology utilizing histology, immunohistochemistry, flow cytometry, in situ hybridization, cytogenetic and molecular studies (gene-rearrangement and next-generation sequencing).

Responsibilities

The medical student…

is expected to review all teaching sets during their rotations. In addition, once each week a set of unknown cases will be reviewed and discussed with the staff hematopathologist.
is expected to complete a 1 week rotation in the Cytogenetics laboratory.
should acquire sufficient judgment to confidently diagnose and address common morphologic and laboratory problems.
will meet twice weekly with attending pathologist and informally discuss specific topics, including normal hematopoiesis, benign lymphadenopathies, lymphomas, myeloproliferative and myelodysplastic disorders, acute leukemias, chronic lymphoid leukemia, plasma cell dyscrasias, anemias, and benign disorders of leukocytes. Required readings will be provided for each topic.
are responsible to assist Surgical Pathology with processing of lymph nodes and spleens.
will attain competence in review of body fluid smears, which includes correlation with cytopathology.
will attain competence in review of peripheral blood smear morphology.
should be familiar with instrumentation and techniques including cell counting, manual and electronic determination of sedimentation rate,and various aspects of special hematology.
is responsible for the diagnosis of various non-neoplastic hematologic disorders including anemias, and quantitative and qualitative disorders of white cells and platelets.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions of hematopathology are under the supervision of the assigned attending pathologist and laboratory professionals.

Evaluation

Microbiology (1 Block)

Description

Clinical microbiology focuses on the isolation and characterization of infectious organisms so they can be managed and treated in patients. Infections can be caused by bacteria, fungi, viruses, and parasites.

The rotation is designed for the student to develop the necessary skills to function as a medical director in a modern clinical laboratory environment. The rotation includes a combination of bench-level training, case-based learning with infectious disease specialists, and interactive didactic sessions.

Responsibilities

The medical student…

should develop an understanding of the role of the Clinical Microbiology Laboratory in the diagnosis and management of infected patients.
should understand the principles of infectious disease including diagnosis and patient management.
must be able to select the appropriate microbiological and/or serological procedures for establishing a diagnosis based on the clinical history, an understanding of the epidemiology and modes of infectivity of the various organisms causing infectious disease and the interpretation of microbiology data in light of other laboratory findings.
must become familiar with appropriate antimicrobial therapy and various factors that enter into these decisions.
is to review basic virology, including virus structure and classification, viral replication, antiviral therapy, pathogenesis and host response to viral infection.
should be familiar with contemporary strategies for the diagnosis of viral infection including various direct detection methods and serodiagnosis.
must review the basic and newer viral syndromes and learn the appropriate diagnostic strategies for each.
be readily available to the clinical staff for the interpretation and clinical application of laboratory data.
must prepare for Infectious Disease Rounds and Case Conference. This includes preparatory reading, obtaining appropriate slides and plates for demonstration, and may include some photography work.
must become proficient in the presentation of Infectious Disease Rounds.
should also complete all assignments during each block of training as outlined in the syllabus, including the work up of unknowns, attending rounds and conferences, and reviewing the book chapters and current papers as listed in the bibliography.
will assist with ongoing QI/QA projects, lab administration projects, library research, etc.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions of microbiology are under the supervision of the assigned attending pathologist and laboratory professionals.

Evaluation

Clinical Chemistry (1 Block)

Description

The rotation is to provide the student with an understanding of the wide and varied scope of laboratory diagnostics in clinical chemistry. This includes a basic understanding of disease pathologies assessed via clinical chemistry testing, methodology principles, specimen types, appropriate interpretation and clinical use of tests, method validation considerations, quality assurance and quality control.

Responsibilities

The medical student…

must learn a clinically useful differential diagnosis of high and low results for tests done in the chemistry sections and be able to interpret panels of chemistry results, electrophoretic patterns and the results of any uncommon tests encountered during the chemistry rotations.
should understand principles of pharmacokinetics and therapeutic drug monitoring.
should understand principles of toxicologic analysis and be familiar with commonly used methods for screening and confirmation, and their pitfalls.
must learn principles of chemical instrumentation, both manual and automated, and become familiar with the specific instruments in use in that laboratory during the chemistry rotation and what desirable features to look for in selecting such instrumentation.
should become familiar with units used in clinical chemistry and proficient in conversions between units, calculations unique to clinical chemistry (e.g., anion gap, osmolar gap).
should become familiar with sample types used in clinical chemistry.
must learn the indications for requesting chemistry tests, both common tests done frequently and any uncommon tests encountered during the chemistry rotations.
will consult with ordering clinicians regarding appropriateness of tests and alternate tests when indicated.
should become familiar with quality assurance concepts applicable to the Clinical Chemistry laboratory.
must become familiar with the hazards in a clinical laboratory and with the pathologist’s responsibility to promote staff and patient safety.

Supervision

The medical student will receive intense faculty supervision and instruction. All functions of clinical chemistry are under the supervision of the assigned attending pathologist and laboratory professionals.

Evaluation

ELECTIVE ROTATIONS

The medical student can opt to participate in the following rotations in order to customize their experiences with their career goals. The student can choose to spend their remaining three blocks in one area, or do up to three different areas.

Anatomic Pathology

Surgical Pathology (beyond the required 2 blocks)

Forensic Pathology

Dermatopathology

Pediatric Pathology

Female Reproductive Pathology

Male Reproductive Pathology

Genitourinary Pathology

Clinical Pathology

Transfusion medicine/apheresis (beyond the required 2 blocks)

Molecular Genetic Pathology

Clinical Informatics

Laboratory Management

Immunology (ClinImmune)

RESEARCH

The medical student may spend up to 3 blocks in research. During that time, the student is freed from clinical responsibilities. A faculty mentor is required for any research activities.

VACATION

The medical student is allowed to take 4 weeks of vacation.