Specific educational goals and objectives are designed to ensure that each trainee acquires the body of knowledge, skills, attitudes and behaviors desirable in a modern, world class pathologist.
AP/CP Clinical Track
Combined Anatomic and Clinical Pathology, Clinical Track
A 48-month curriculum with 5 months of electives.
- Surgical Pathology: 15 months
- Autopsy: 3 months
- Forensics, OCME: 1 month
- Cytopathology: 3 months
- Dermatopathology: 2 months
- Neuropathology: 1 month
Total AP Requirements: 25 months
AP conference topics
- Forensic and autopsy pathology
- Frozen sections
- Medical kidney pathology
- Surgical pathology lectures with paired slide and gross conferences in topics such as:
- Bone and soft tissue pathology
- Breast pathology
- Gastrointestinal pathology
- Genitourinary pathology
- Gynecologic pathology
- Head and neck pathology
- Liver pathology
- Thoracic pathology
- Transplant pathology
- Unknown slide conferences
- Chemistry/Coagulation: 1 month
- Cytogenetics: 1 month
- Laboratory Hematology and Hematopathology: 1 month
- *Hematopathology (including Flow Cytometry): 3 months
- *Liver Pathology: 1 month
- *Medical Kidney and Transplant Pathology: 1 month
- Microbiology: 2 months
- *Molecular Pathology: 1 month
- *Molecular Diagnosis Integration: 1 month
- Transfusion Medicine: 2 months
- Senior Rotations**: 4 months (PGY 3 or 4)
Total CP Requirements: 18 months
CP conference topics
- AI and Informatics
- Clinical chemistry
- Lab management
- Molecular and cytogenetics
- Transfusion and apheresis
*Includes AP/CP variable rotations counted as CP rotations = 7
**Senior CP Rotations (PGY 3 and 4) = 4 months, chosen from the following three groups:
a. Competencies for Medical Directorship of Diagnostic Laboratory
|Laboratory management project||1m||VA/DUMC|
|Quality assurance project||1m||VA/DUM|
b. Molecular Pathology and Emerging Diagnostic Technologies
c. Foundation Medicine Molecular Pathology elective rotation: Residents can choose to spend elective time as PGY-3 and/or PGY-4 at Foundation Medicine for a Molecular Pathology rotation at the Foundation Research Triangle Park laboratory campus.
d. Diagnostic Correlations and Consultations
|Transfusion /Coagulation Correlation||1m||VA|
During PGY2, 3 and 4, residents will select a clinical laboratory and participate as a “lab management apprentice” under the mentorship of the laboratory Medical Director.
Electives: 5 months
Electives may be selected from any of the required AP or CP rotations during PGY4. Other approved electives include: Autopsy, Cardiovascular Pathology, Cytogenetics, Electron Microscopy, Foundation Medicine Molecular Pathology, Gynecologic Pathology, Pulmonary Pathology, and Senior Microbiology (DUMC). Novel electives can be proposed and tailored to specific academic interests.
- AP = 25 months (American Board of Pathology requires 18)
- CP = 18* months (American Board of Pathology requires 18) [*includes AP/CP variable rotations counted as CP rotations = 6]
- Electives = 5 months
AP-only, CP-only, and AP/NP residency tracks are not being offered at this time.
These are guidelines designed for pathology residents who decide to spend some of their elective months performing research. The American Board of Pathology (ABP) Requirements for Certification states: “For residents entering pathology training programs on or after 1 July 2003, the ABP will grant up to 6 months of research credit for primary certification. The applicant must be able to demonstrate active participation in the generation of the hypothesis and development of the protocol. No credit is given for research employment as a technician or technologist. The ABP encourages research and believes that candidates should carry on investigation, teaching, and the publication of scientific papers during primary training.”
- Using Elective Time for Research - If the time in the research lab is limited to the time allowed by the ABP Requirements of Certification (listed above), then the resident’s salary is covered by the Department of Pathology. Also, the resident will have access to an annual educational fund and travel reimbursement for presenting at meetings. Malpractice insurance will be covered during this period in the lab. The resident must complete at least 24 months of pathology residency training prior to performing the research as a 6 month block.
- Research Proposal - A research proposal must be submitted to the Education Committee at least three (3) months in advance of the upcoming resident match for that academic year. The proposal should include the name of the lab mentor, a brief summary of the project, and the exact months the resident wishes to perform research. The proposal is subject to approval by the Education Committee.
- Normal Resident Duties - The resident on research elective will be required to uphold some of the normal resident duties including participation in service coverage, frozen section call, AP/CP call, holidays coverage, and vacation/sick day coverage for other residents, on an as-needed basis. Service coverage is evaluated and may be requested by the Program Director, the Chief of Service, and Chief Residents. Regular attendance at the mandatory resident conferences will be required and in appropriate professional attire. The resident may participate in residency recruitment activities during this elective research time. All service work must be finalized in accordance with the usual departmental policies.
- Extended Period of Research - At the conclusion of the time in research lab the resident is expected to return to regular service coverage and rotations. If the resident desires to continue laboratory research beyond what is allowed by the ABP Requirements of Certification, then early and definite plans must be made and approved in advance. The hospital will fund only 4 total years of AP/CP training (3 years of AP training). Therefore an alternate source of funding must be secured for that extension. The department may provide funds for salary and benefits for a year or longer through a merit based application process. A proposal to extend the time in laboratory research must be submitted to the Program Director at least three (3) months in advance of the upcoming resident match for that academic year. This proposal should include all the information listed above in #2 and also must be approved by the Education Committee. During this extended period of research beyond elective time, the resident will not have access to an educational fund or travel reimbursement for presenting at meetings. Likewise, malpractice insurance may not be continued and service coverage would not be required. Attendance at resident conferences and teaching medical student pathology labs is required.
Surgical Pathology Overview
A mastery over surgical pathology is a foundational skill required to successfully practice diagnostic pathology. Developing surgical pathology expertise is a slow process encompassing visual pattern recognition based on a vast body of medical knowledge and increasingly an integration with data derived from various ancillary molecular and other techniques. Recognizing the central role of these skills in our residents’ training, Duke Pathology training emphasizes Anatomic Pathology (Surgical Pathology and Autopsy Pathology) during the first year of residency, allowing the maximum period for “maturation”. In the initial year of training, each resident spends at least nine months on Anatomic Pathology services, with three autopsy months and six surgical pathology months. Three months of clinical pathology are also introduced. Subsequently, three months per year are devoted to surgical pathology with increasing responsibilities every year.
Typically three first year and three senior residents are on surgical pathology rotation at Duke. First year residents begin with a carefully graduated experience in the gross room, including detailed instruction in laboratory protocols and procedures for both large and small specimens. Residents then rotate in 2 week blocks on one of eight services: Gastrointestinal pathology, Gynecologic pathology, Bone and Soft Tissue pathology, Thoracic pathology, Breast pathology, Genitourinary pathology, ENT/endocrine pathology, and Frozen Sections/intraoperative consultations. Additionally, during years 2-4, residents rotate through dedicated subspecialty services in Dermatopathology, Cytopathology/FNA, and Neuropathology. Forensic Pathology training is gained through a one month rotation at the North Carolina Chief Medical Examiner’s office in Raleigh, N.C.
Attending faculty members rotate on a similar weekly schedule to assure a close working relationship with housestaff. Residents are given graded responsibility appropriate for level of training. Several modern multiheaded microscopes and ample reference material are available which allows self-study as well as peer to peer teaching. Grossing of specimens takes place after morning sign-out, followed by preview of cases in preparation for sign-out the following morning with attending faculty. Senior level residents function at the level of a surgical pathology fellow with responsibilities including oversight of grossing by junior level residents, working with laboratory staff to establish appropriate work flow levels in the lab, “hot-seat” diagnostic decision making responsibility for frozen sections, and microscopic sign-out of cases with the attending.
The department is committed to quality patient care through rapid turnaround time as well as to superior resident education. These competing goals are achieved by expanding the role of Pathology Assistants in the gross room. Six Pathology Assistants are available to guide the residents through the initial learning process and to perform grossing of “routine” cases. The grossing and frozen section experience is augmented by laboratory technicians to assist with small biopsies and operating room courier duties. The histology laboratory in the Duke Clinical Labs operates 24 hours a day, assuring that slides are ready for resident preview early in the day.
The training program is characterized by direct and continuous interaction of residents, fellows, faculty members and pathology assistants. We have a high volume of excellent clinical and laboratory materials received as a result of Duke's nationally and internationally renowned departments of medicine and surgery. We are proud of the residents and fellows who train here and continue to be energized each year by their quality, character, and diversity.