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Web Editor:
Michelle Rickard
Updated:
Friday, 19-Oct-2007 12:37:44 PDT
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Pathology Residency Program
Program Description
Introduction |
Overview of Program |
Typical Education Program |
Conferences |
Electives |
Research Opportunities |
Teaching Opportunities |
Evaluations |
Resident Representation |
The goal of the University of Washington Residency Program in Pathology is to prepare physicians for the practice of
pathology in any setting -- academic medical center, community hospital, or biotechnology laboratory. We believe this
goal is best achieved in an academic environment that offers breadth and depth in all aspects of pathology. Residents
handle a wide range of traditional problems, as well as practice as the "pathologist of tomorrow" by acquiring familiarity
with emerging technologies and rare diseases seen in tertiary care, academic referral centers such as the University of
Washington Medical Center and its affiliated hospitals. In addition to basic training in pathology, we offer a wealth of
subspecialty and research training opportunities in many areas of Laboratory Medicine and Pathology. The jobs taken by
graduates of our program reflect the diverse goals, training paths, and careers for which we are able to train our residents.
Typically, half of our graduates continue in academic medicine while the other half seeks employment in a community setting.
The Accreditation Council for Graduate Medical Education (ACGME) provides accreditation
for our Anatomic and Clinical Pathology program as well as most of our subspecialty fellowship programs.
Our next residency accreditation review is scheduled for 2008. Upon completion of the training program, residents are
eligible to take the certification exam from the American Board of Pathology (ABP). The ABP provides board certification in the following subspecialty areas:
| *Blood Banking/Transfusion Medicine |
*Hematology/Hematopathology |
| Chemical Pathology |
Medical Microbiology |
| *Cytopathology |
Molecular Genetic Pathology |
| *Dermatopathology |
*Neuropathology |
| *Forensic Pathology |
*Pediatric Pathology |
| *We offer ACGME-accredited fellowship training for these subspecialty areas.
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Our AP/CP program requires two years of structured study each in anatomic pathology and clinical pathology, which will meet Board
certification requirements. The training in Anatomic Pathology provides broad and comprehensive exposure to the areas
of autopsy, surgical pathology (general, breast, gastrointestinal, hepatic and pediatric), cytology, dermatopathology and neuropathology.
During the first year in clinical pathology, the Laboratory Medicine program focuses on skills and methodologies associated
with chemistry, microbiology, immunology, hematology, coagulation, and blood banking based on a comprehensive "core" curriculum. In the
second year residents serve as acting director of one or two lab sections for a total of six months and choose elective
studies in either anatomic or clinical pathology for six months. Both programs encourage residents to take part in ongoing teaching and
research activities.
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In addition to our combined AP/CP program, residents can select an AP only, CP only or
Anatomic Pathology/Neuropathology (AP/NP) track. AP only and CP only residents complete two years of appropriate
training provided in the combined program. The third year is designed for more advanced study in a subspecialty area or
research. The AP/NP track provides two years of anatomic pathology study and two years of neuropathology.
We believe variety is the key to a successful training program and that residents learn best from a diverse faculty of
individual pathologists, broad patient populations in variable clinical settings, and the wide range of disease
processes that we present in our program. Our required rotation sites -- University of Washington
Medical Center (UWMC), Harborview Medical Center (HMC), Children’s Hospital & Regional Medical Center (CHRMC), VA Puget Sound
Health Care System (VA) Children's Hospital and Regional Medical Center (CHRMC) and Puget Sound Blood Center (PCBC) -- provide a
well-rounded and varied experience in anatomic and clinical pathology. Community sites, such as King County Medical
Examiner’s Office, Swedish Hospital, and Seattle Cancer Care Alliance supplement the required sites for senior electives.
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Residents may combine residency training with post-doctoral research, leading to a career in academic medicine. The Pathology
Residency Program provides residents with diverse opportunities for an academic medical career. A number of our residents engage
in post-doctoral research supported by NIH-sponsored grants.
Throughout training, residents can explore your options for additional subspecialty training in our fellowship programs.
We offer clinical subspecialty and research fellowships in most areas of clinical and applied pathology. Additional
information about fellowship opportunities is described further on our website.
Our ACGME-Accredited Fellowships |
| Bone & Soft Tissue Pathology |
Cytopathology |
| Dermatopathology |
Forensic Pathology (KCME) |
| GI & Hepatic Pathology |
Hematopathology |
| Neuropathology |
Pediatric Pathology (CHRMC) |
| Renal Pathology |
Surgical Pathology |
| Transfusion Medicine (PSBC) |
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Over the next four years (2005-2008) we will be increasing one resident position per year for a total of 28. In addition,
we will have 15 ACGME-accredited fellowship positions. We typically recruit six or seven new residents each year.
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Residents must be capable of assimilating a large amount of basic information. This includes an understanding of basic
human biology, i.e., an understanding of normal and abnormal human structure - function interactions at all levels of
biologic organization during all stages of life, including information considered to be basic to the general practice of
medicine.
Residents must be capable of practical problem solving. This involves the thoughtful use of general information
in evaluating the significance of specific observations made on specific patients and/or patient specimens. It also
involves recognition of the uncertainty that abounds in medicine and the intellectual honesty to admit, "I do not
know what this observation means," as an important step in an individual's educational process.
Our program has detailed objectives to meet our program goals for each area of training. These objectives outline the
areas of knowledge a resident must master to become a competent pathologist.
Anatomic Pathology Program Goals and Objectives
Clinical Pathology Program Goals and Objectives
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Dr. Rochelle Garcia directs the anatomic pathology training and overall pathology residency training program.
First Year AP Training. During the initial year, residents train in autopsy pathology, surgical pathology, and
cytology. Surgical pathology training covers all systems including a focus on dermatopathology, breast, GI & liver.
Assigned cases in rotation, residents primarily analyze the anatomical disease process and its correlation with clinical
findings. Residents spend 6 months at UWMC, 4 months at VA Puget Sound Health Care System, and 2 months at Harborview Medical Center.
Residents are encouraged to enhance the autopsy experience with forensic pathology training at the King County Medical
Examiner’s Office, under the supervision of Dr. Richard Harruff, Chief Medical Examiner.
Second Year AP Training. Our program is designed to provide increased responsibility
for independent sign out of surgical specimens during the second year of anatomic pathology training. The three-month surgical rotation at UWMC
provides comprehensive training and experience in general surgical pathology, in the management and diagnosis of rare diseases and complex
specimens, and in subspecialty areas, including soft tissue, pulmonary and gynecological pathologies. There are two months of concentration on breast, GI tract, liver and renal pathologies. There is a designated one-month rotation in dermatopathology. Residents study anatomic pathology at Children’s under the direction of Dr. Joe Rutledge, Director, Laboratory Services, for two months. And a two-month rotation at HMC provides in depth experience in cytopathology and neuropathology. There is one month designated for elective study. During the designated renal and elective rotations the resident has the opportunity to continue autopsy study by providing backup to the Autopsy Service at UWMC. Second year training occurs at UWMC (8 months), CHRMC (2 months) and HMC (2 months).
In addition, residents receive case-based training in the specialized testing methods of immunocytochemistry, ultrastructure, and flow cytometry.
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| Rotation |
Location |
Director |
| Autopsy |
UWMC |
Dr. Corinne Fligner |
Autopsy &
Surgical Pathology |
VA |
Dr. David Thorning |
| Breast, GI & Liver |
UWMC |
Dr. Tom Lawton & Dr. Melissa Upton |
| Cytology |
HMC |
Dr. Annette Peck |
| Dermatopathology |
UWMC |
Dr. Zsolt Argenyi |
| Neuropathology |
HMC |
Dr. Tom Montine |
| Pediatric Pathology |
CHRMC |
Dr. Laura Finn |
| Renal Pathology |
UWMC |
Dr. Charles Alpers |
| Surgical Pathology |
UWMC |
Dr. Paul Swanson |
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Clinical Pathology
Dr. Petrie Rainey is the Director of the Clinical Pathology Residency Program.
First Year CP Training. The first year of Clinical Pathology takes place at the University of Washington Medical
Center, Harborview Medical Center, Puget Sound Blood Center and the VA Puget Sound Health Care System. The year
comprises a tightly organized full-year of study, beginning with a 7-week core course (lectures, discussions and
laboratory exercises) designed to introduce you to the breadth of the field of clinical pathology. The introductory
course covers basic material in blood banking, coagulation, immunology, urinalysis, clinical chemistry, microbiology,
hematology, parasitology, mycology, virology, molecular pathology, biostatistics and laboratory computer applications.
This is followed by a series of rotations in the following areas:
- Chemistry (11-12 weeks)
- Microbiology (6-7 weeks)
- Immunology/Genetics (5 weeks)
- Blood Banking (2 weeks)
- Virology (2 weeks)
- Hematology (8-9 weeks)
- Coagulation (6-8 weeks)
- Laboratory testing - interpretative course (1 weeks)
Second Year CP Training. You can tailor the second year to meet your specific career goals. During the first six
months, second-year residents receive an in-depth exposure to one or two areas of laboratory medicine and exercise
graded responsibility by acting as directors of subspecialty lab sections. Additionally, three weeks of the second year
are spent in a clinically-oriented rotation in transfusion medicine at Puget Sound Blood Center (PSBC). The remainder
of this year is spent in either AP or CP electives. You may spend this time developing skills in one or more
areas of the clinical laboratory or receive a more generalized experience at one of the community hospitals associated
with the program. Second year Clinical Pathology residents train at UWMC, Harborview, the VA, and PSBC.
Resident Portfolio. Medicine has become increasingly dependent on the existence of documented evidence to
support decisions and practices. This extends to a need for concrete documentation of resident competency.
One well-accepted way of documenting competency is by the development of a portfolio of representative work products.
Accordingly, residents develop an electronic portfolio documenting experiences and work products while a resident.
This may include summaries of consultations, etc., while on call or on rotations, papers and abstracts published or
submitted, PowerPoint presentations of Grand Rounds and other formal talks, method evaluation data and written
procedure(s) from a method development project, and anything else that may be useful to the American Board of Pathology,
the ACGME, or a potential future employee in evaluating the your competency and training. This portfolio also provides
an opportunity for self-reflection and practice-based learning. At the end of training, the portfolio will be
copied onto a CD, with one copy for the resident and a copy placed in the training file.
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In addition to extensive one-on-one, over-the-microscope training with our faculty,
residents learn by attending and presenting at didactic teaching sessions, sign outs and clinical conferences. Pathology
specific conferences are supplemented with a wide variety of multi-disciplinary teaching conferences in subspecialty areas, i.e. breast
cancer, hematology, infectious disease, medical-pathology, surgical-pathology, tumor board, sarcomas. Numerous departmental seminars provide opportunities for residents to learn about
the research activities being conducted by the faculty and by visiting scientists.
Pathology Conferences - Master List
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During the second year of AP or CP training, residents pursue subspecialty interests with elective studies. With 150 faculty
members affiliated with our program from all of the training sites, residents can design an elective that meets their professional
interests. In addition, electives may also be designed at off site locations within the guidelines from the School of
Medicine Graduate Medical Education Office. We encourage residents to discuss these options early in the training program.
The following are brief descriptions of electives that residents have taken in the past.
- Anatomic Pathology: In-depth elective training is available in the pathology subspecialty areas of
dermatopathology (Dr. Zsolt Argengyi), breast (Dr. Tom Lawton), gastrointestinal (Dr. Melissa Upton),
gynecological (Dr. Rochelle Garcia), pulmonary (Dr. Rod Schmidt), renal (Dr. Charles Alpers),
immunohistochemistry (Dr. Paul E. Swanson), liver (Dr. Matthew Yeh), and cytology (Dr. Verena Grieco and Dr. Annette Peck).
- Laboratory Medicine: Electives in all areas - clinical chemistry (Dr. Pete Rainey, Dr. Hossein Sadrzadeh),
microbiology (Dr. Brad Cookson). hematology/hematopathology (Dr. Dan Sabath, Dr. Brent Wood, Dr. Jonathan
Fromm, Dr. Harvey Greisman, Dr. Sindhu Cherian), immunology (Dr. Mark Wener), computer/informatics (Dr. David Chou, Dr.
Michael Astion), virology (Dr. Lawrence Corey, Dr. Keith Jerome) - are available.
- Blood Center/Transfusion Medicine: An elective of 3 months is available at the Puget Sound Blood Center,
which is the central laboratory for blood banking for Seattle.
- Cytogenetics: Training under the co-direction of Drs. Disteche and Norwood provides experience in diagnostic
cytogenetics with emphasis on prenatal diagnosis employing amniotic fluid cells and postnatal diagnosis employing white
blood cells, bone marrow cells and skin fibroblasts.
- Electron Microscopy: Training in the use and interpretation of diagnostic electron microscopy is available
in rotations of one to two months at either the VA Puget Sound Health Care System (Dr. Thorning) or at UWMC.
- Flow Cytometry:Under the direction of Dr. Rabinovitch, the flow lab routinely analyzes DNA ploidy patterns of
tumors from most organs using multi-parameter flow cytometry.
- Forensic Pathology: The King County Medical Examiner’s Office, located in HMC, performs
1,000 autopsies per year under Dr. Harruff’s direction. Training and experience in forensic pathology include scene
investigation and court testimony.
- Community Practice: Provides residents with a hands-on opportunity to work with pathologists at Swedish Medical
Center with faculty members from CellNetix Pathology.
- Research: Elective time is available at virtually any research lab at UWMC, HMC, CHRMC, Fred Hutchinson
Cancer Research Center, or Seattle Cancer Care Alliance. This is a valuable opportunity for residents interested in a
multi-year research fellowship to familiarize themselves with the lab, its director and personnel, and its projects.
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Our goal is to train residents to become well-rounded academic and clinical pathologists
who will practice and develop pathology into the future. To achieve this goal, we believe research training is important
for all residents, whether they seek a career in academic or community pathology. We encourage residents to work with faculty
members by investigating a biomedical area of interest. We support residents' research endeavors by providing travel funds
for presentations at national meetings.
2007 USCAP Faculty and Resident Presentations
Areas of Research
In 2007 for the first time the University of Washington received more than $1 billion dollars in research funding, which was for peer-reviewed research proposals for individual faculty members. The Departments of Pathology and Laboratory Medicine are consistent in the top three NIH recipients for pathology programs in the United States. For the 06-07 fiscal year, Pathology received $30,585,000 and Laboratory Medicine received $15,165,760 in overall research funding. AP/CP residents can apply for a fifth year of clinical research which can be funded by the departments through a combination of departmental funds and training grants. This can also be an option for the third year of training for AP or CP only residents. If you are interested in continuing or pursuing an academic research career, you should discuss your future plans as soon as possible with your faculty advisor who will be very helpful in mentoring your career aspirations.
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Residents teach medical students taking electives in Anatomic and Clinical Pathology. For the first and second year
students, residents work with faculty teaching pathology laboratory sessions. For medical students on elective rotation
in Anatomic Pathology, residents work directly with students on both autopsy and surgical pathology cases. Residents
also work with trainees from other programs including radiology and dermatology residents. In
addition, residents give lectures and assist faculty in small group teaching of allied health personnel (medical
technology students, cytotechnology students, physician assistants, etc.). The opportunity to teach students in the
Health Sciences Center of the University of Washington and residents from other programs is an important component of
our training program.
Although we are considered to be a large training program, residents are strongly encouraged to discuss directly
suggestions or problems with any faculty member or the program directors. We meet the ACGME requirements for evaluation
with several online, written evaluation forms for both the residents and faculty members.
- Resident Evaluation: completed by faculty members at the end of each rotation
- Mid-Year Evaluation: a face-to-face meeting between the resident and faculty advisor
- Year-End Evaluation: a face-to-face meeting between the resident and program director
Residents receive copies of these evaluations once they are reviewed by the program directors. Copies are also placed
in the training file.
- Rotation Evaluation: completed by residents at the end of each rotation
- Individual Faculty Evaluation: completed by residents once a year on each faculty member with whom they have trained
- Annual Evaluation: a compiled review of the AP and CP programs led by the chief residents and presented to the Residency Management Committee
Residents complete these evaluations anonymously. Rotation service chiefs or faculty members receive the evaluations in
a batch every six months.
Residents also participate annually in the Residency In-Service Exam, a national skills assessment provided by the
American Society of Clinical Pathologists. The results are reviewed by the program director but are not the sole means
of determining progress in the program.
Being an effective pathologist also means understanding the business of medicine or systems-based practice. We encourage residents to participate in many program management opportunities to learn by doing. Residents are represented on the Residency Management Committee by the Chief Residents from both Anatomic Pathology and Laboratory Medicine. Many of our residents participate in CAP laboratory inspections in-house and at sites across the country. For more global issues affecting residents and their training, a peer-elected representative is selected every two years to attend CAP conferences and School of Medicine committees. On the national level, Dr. Sandra Bohling and Dr. Erin Grimm attend the Resident Forum sponsored by the College of American Pathologists (CAP). For 2006-2008, Dr. Erin Grimm is a resident representative on the UW GME Institutional Resident/Fellow Advisory Committee, which develops policies regarding resident education.
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