Residency Goals and Objectives

The goal of pathology training at UT Southwestern Medical Center is the development of competency in the required areas of medical practice, such that the graduate of the Pathology Residency Program will possess the knowledge, skill, and attitude for the successful practice of pathology (i.e., the ability to recognize, interpret, and explain pathologic processes) and for the life-long pursuit of learning.

Objectives of the Pathology Residency Program in the Six Core Competencies

Patient Care: The resident will acquire competency in the technical generation and interpretation of laboratory data and in the formulation of clinicopathologic correlations, so as to provide appropriate and effective consultation in the context of pathology services. In those situations where the resident has direct interaction with patients, families, or donors (e.g., bone marrow aspiration, fine needle aspiration, apheresis), the resident will perform such interviewing, examination, and counseling as may be required with caring and respect. The resident will learn how to work effectively within a multidisciplinary health care team, participating as appropriate in informed decision-making and clinical management.
Medical Knowledge: The resident will acquire knowledge about established and evolving biomedical, clinical, and clinically related sciences and will apply this knowledge to the understanding of basic pathologic processes in both individual patients and the general patient population. The resident will apply concepts of investigational and analytic thinking to the interpretation of laboratory data.
Practice-based Learning and Improvement: The resident will learn to appraise and assimilate scientific data from the medical literature toward the practice of evidence-based medicine. The resident will learn to apply research and statistical methods to laboratory data. The resident will learn the principles and practice of information technology and how it can be used to manage patient data. The resident will learn to investigate and evaluate his/her own diagnostic and consultative practices, and to improve his/her patient care practices.
Interpersonal and Communication Skills: The resident will develop interpersonal and communication skills that result in the effective exchange of information and expertise with other health care providers, patients, and patients’ families, and will assume an active role in the education of the health-care community.
Professionalism: The resident will develop a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population of patients and health care providers.
Systems-based practice: The resident will develop knowledge and experience in laboratory management, an awareness and responsiveness to the place of pathology in the larger context and system of health care, and the ability to call on resources within the system to provide pathology services that are of optimal value.

Design of the Pathology Residency Program with Respect to Levels of Training

The attainment of the six core competencies is achieved through a training curriculum of 4 years for AP/CP residents (3 years for AP-only and CP-only residents on focused clinical research tracks). The basic curriculum is composed of a series of required rotations through various areas of the clinical laboratory, during each of which the resident will gain competency through didactic lessons with faculty and staff, independent study, participation in patient care activities as part of the health-care team, and participation in quality assurance and management activities of the laboratory, the institution and the greater health-care community. While the order of rotations is not absolutely fixed so that the curriculum can be individualized according to the goals and interests of each resident, expected stages of competency are reflected in the general order of the rotations. The basic plan for a four-year AP/CP training program is as follows:

Year 1

The resident is oriented to the training program and (re-)introduced to basic histology and histopathology through a series of introductory conferences. After the introductory series, the main AP and CP didactic series of recorded lectures and interactive teaching sessions (a comprehensive two-year cycle of topics) begins, supplemented by unknown slide challenges and presentations of interesting cases. The formal rotation schedule for the first year includes an initial rotation in Surgical Pathology, which begins with a 3-week “boot camp” experience, in which the emphasis is on mastering the basics of gross examination of a wide variety of tissues and on the technical preparation of frozen and paraffin-embedded sections. This is followed by the beginning of 1-4 week rotations through subspecialty areas of Surgical Pathology that will continue through the subsequent years. In the first year of training, there is also a rotation in Autopsy Pathology (including adult, pediatric and perinatal cases), where the resident learns basic gross and microscopic anatomy, along with polishing skills at obtaining relevant history from caregivers and from the medical record and communicating results verbally and through the preparation of written reports. On the initial autopsy rotation, residents accrue cases during their first two months, with a third month set aside for completion of reports and participation in morbidity/mortality conferences and other quality assurance activities. Initial rotations in Hematopathology and Transfusion Medicine introduce the resident to the clinical laboratories and permit the resident to begin functioning as a consultant. Finally, the first year typically begins to introduce the resident to translational pathology through a Molecular Pathology or Cytogenetics rotation, where the resident begins to learn how fundamental basic science techniques can be adapted to provide clinically useful information. Through the preparation of informal intra-departmental presentations, the resident also begins to polish his/her communication skills and proficiency in utilizing library and internet resources.

Medical Knowledge: Reviews basic histology and histopathology; begins to be introduced to topics and illustrative cases in general and subspecialty pathology; begins to acquire depth of knowledge in hematopathology and transfusion medicine; is introduced to molecular diagnostics as a field in translational pathology.
Patient Care: Begins to acquire basic techniques in autopsy prosection and gross examination of surgical specimens by working on patient material; begins to develop interpretive skills on slides, smears, and clinical laboratory test results; refines skills in obtaining relevant historical information for patient care from charts and other sources.
Interpersonal Skills and Communication: Begins to interact with clinicians and other health-care providers to obtain history and convey results and interpretations; begins to learn modes of effective interaction within the laboratory and physician hierarchy; begins to compose effective autopsy, surgical and clinical laboratory consultation reports; begins to give oral presentations.
Professionalism: Observes and begins to emulate the professional behavior of colleagues; learns basic concepts of patient information confidentiality and ethics in the practice of medicine; learns the basics of informed consent, particularly as regards the autopsy; learns to follow rules of behavior and practice within the residency program and hospitals as governed by regulatory and accrediting agencies.
Practice-based Learning: Observes and participates in quality assurance activities such as case reviews and morbidity-mortality conferences in surgical pathology and autopsy; observes and participates in quality control and quality assurance activities in hematopathology and transfusion medicine; reviews and refines basic skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources; begins developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Begins to learn appropriate utilization of testing through managing the work-up of autopsies and uncomplicated surgical and bone marrow specimens and through oversight of ordering of blood products in transfusion medicine; begins to learn to navigate the health care system at Parkland Memorial Hospital and Children’s Medical Center, as well as the medico-legal aspects of the medical examiner facility.

Year 2

The resident further refines his/her skill and knowledge in surgical pathology through at least one or two additional blocks of subspecialty rotations in Surgical Pathology. An initial rotation in Cytopathology introduces the resident to the preparation and interpretation of cytologic specimens and to the administrative and quality assurance aspects of the cytopathology laboratory, while also beginning to perform adequacy checks on procedures in Interventional Radiology. Typically, the second year includes initial rotations in Clinical Chemistry, Laboratory Management and Informatics and/or Microbiology, which provide not only an introduction to those areas of the laboratory but also include aspects of laboratory management, such as quality control, quality assurance and test evaluation. On the CP rotations, the resident also serves as a consultant to the laboratory, helping to ensure appropriate ordering and utilization of tests and interpretation of results. Through a rotation in Flow Cytometry, the resident builds on knowledge and morphologic skills acquired in the basic Hematopathology rotation in order to act as a supervised laboratory consultant. Elective time for subspecialty rotations or research projects often begins being used by residents in the second or even first year of training, as they begin to explore developing interests in subspecialty areas (in time for fellowship applications). Also, in the second year, the resident begins taking night and weekend call for both the surgical pathology and clinical laboratories, as a step upward in graduated responsibility. Communication skills are further polished as the resident begins making formal case presentations and literature reviews and assumes the responsibility of leading a case discussion group in the second-year pathology course at UT-Southwestern Medical School.

Medical Knowledge: Gains additional knowledge of histopathology through further exposure to topics and illustrative cases in general and subspecialty pathology; begins to acquire depth of knowledge in microbiology, clinical chemistry, laboratory management and informatics; is introduced to flow cytometry as a major areas of interpretive technology.
Patient Care: Continues to polish skills in gross examination of surgical specimens by working on patient material; continues to develop interpretive skills on surgical slides and begins to develop interpretive skills on cytologic preparations, along with correlation between the two; expands skills in interpretation of laboratory test results into areas of microbiology and clinical chemistry; learns interpretation of flow cytometry histograms and their correlation with morphologic hematopathology; begins taking service call for surgical pathology and the clinical laboratories.
Interpersonal Skills and Communication: Continues to interact with clinicians and other health-care providers to obtain history and convey results and interpretations; continues to learn modes of effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; further develops skills in composing effective surgical, cytological and clinical laboratory consultation reports; enhances skill in giving oral presentations through additional practice; begins to acquire teaching skills through orientation of new residents and medical students and through leading a discussion group in the second-year medical school pathology curriculum.
Professionalism: Continues to develop concepts of personal professional behavior and begins acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent; reinforces the importance of rules of behavior and practice within the residency program and hospitals as governed by regulatory and accrediting agencies.
Practice-based Learning: Continues to participate in quality assurance activities such as case reviews; observes and participates in quality control and quality assurance activities in microbiology, clinical chemistry, and flow cytometry; refines basic skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; continues developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Further develops a sense of appropriate utilization of testing through managing the work-up of surgical and cytology specimens and send-out specimens from the clinical laboratories; learns finer points of navigating the health care systems at Parkland Health and Hospital System, Children’s Medical Center, and the University Hospitals.

Year 3

A 1-month senior rotation in Autopsy Pathology affords the resident the opportunity to attain greater proficiency and independence in basic and more specialized dissection techniques and to serve as an instructor for first-year residents on the service. Participation in forensic pathology cases in the office of the Dallas County Medical Examiner exposes the resident to the specialized aspects of the forensic autopsy and crime-scene investigations. The resident acquires further skill, knowledge and teaching experience through revisiting the major surgical pathology areas as well as experiencing additional subspecialties such as Pediatric Pathology, Neuropathology, Dermatopathology and Renal and Solid Organ Transplant Pathology. The clinical laboratory experience is enriched by a rotation in Cytogenetics, by a senior rotation in Coagulation and Transfusion Medicine, in which the resident assumes greater responsibility for the management of therapeutic apheresis patients, and/or a senior rotation in Hematopathology, during which the resident not only assumes greater responsibility for his/her cases but also functions as instructor for first-year residents on the service. Additional elective time for subspecialty training and/or research is also available. The resident continues to take AP and CP call for the clinical laboratories. The resident prepares a departmental presentation for the Update in Pathophysiology conference series and may be given additional small-group teaching responsibilities in the medical school pathology curriculum.

Medical Knowledge: Refines knowledge of histopathology through further exposure to topics and illustrative cases in general and subspecialty surgical pathology, autopsy and forensic pathology; refines knowledge in hematopathology, coagulation and transfusion medicine, and expands knowledge in cytogenetics.
Patient Care: Refines skill in basic and more specialized techniques in autopsy prosection and gross examination and microscopic interpretation of surgical specimens by working on patient material, especially the distinct patient populations of the University Hospitals and Children’s Medical Center; learns specialized procedures for handling and interpreting skin, kidney, liver and eye specimens; gains practical exposure to electron microscopy; refines skills in interpretation of laboratory test results, especially in immunopathology, hematopathology, coagulation and transfusion medicine; continues taking service call for surgical pathology and the clinical laboratories.
Interpersonal Skills and Communication: Refines skill in interacting with clinicians and other health-care providers to obtain history and convey results and interpretations; refines effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; refines skills in composing effective autopsy, surgical, and clinical laboratory consultation reports; refines skill in giving oral presentations through additional practice, including a major departmental presentation; refines teaching skills through orientation and teaching of new residents and medical students.
Professionalism: Refines concepts of personal professional behavior and continues acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent, particularly with respect to working in the autopsy, forensic and surgical pathology areas; reinforces the importance of rules of behavior and practice within the residency program and hospitals as governed by regulatory and accrediting agencies.
Practice-based Learning: Continues to participate in quality assurance activities such as case reviews; observes and participates in quality control and quality assurance activities in hematopathology, coagulation and transfusion medicine; refines skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; continues developing a plan for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Refines sense of appropriate utilization of testing through managing the work-up of surgical and autopsy specimens and send-out specimens from the clinical laboratories; learns finer points of navigating the health care systems at Parkland Health and Hospital System, Children’s Medical Center, and the University Hospitals.

Year 4

The last year of training typically features anatomic pathology rotations with the greatest emphasis on graduated responsibility. There is a “senior” rotation in Cytopathology as well as a Frozen Section “Hot Seat” rotation, in which the resident’s focus is on the interpretive rather than the technical aspects of frozen sections. The “Hot Seat” resident also is often scheduled alongside first-year residents in the Boot Camp experience and assists in teaching them gross tissue examination and the basics of cutting frozen sections. As the capstone to the Anatomic Pathology experience, the resident has a three-month rotation in Advanced Anatomic Pathology at the Veterans Administration Hospital. Having rotated through all subspecialties, the resident at the VA brings together his/her subspecialty knowledge on a general surgical pathology service along with cytopathology and autopsy coverage. In all of these services, the resident works up and reports cases with a maximum level of trainee independence, but always with faculty back-up when needed. The VA provides the bulk of the residents’ experience in performing superficial fine-needle aspirations on patients. In the CP realm, the resident spends a month in the HLA laboratory, which supports the hospitals’ transplant programs, while a senior rotation in Laboratory Management and Informatics affords the resident an opportunity to participate in the management activities of the clinical laboratories. The fourth year of training allows time to complete any further required rotations that could not be accommodated in the previous years’ schedules, as well as elective time for subspecialty training or research. Residents often save their six months of elective time for the fourth year, when slide review electives are popular for Board preparation. The resident continues to take AP and CP call for the clinical laboratories and may be given additional small-group teaching responsibilities in the MS2 pathology course. Two senior residents are chosen as Chief Residents each year and assume administrative roles in the operation of the residency program.

Medical Knowledge: Achieves competency in the knowledge of anatomic pathology through further exposure to topics and illustrative cases in general and subspecialty pathology; achieves competence in clinical pathology through additional study, call and elective rotations; achieves competency in knowledge related to laboratory management through study.
Patient Care: Achieves competency in techniques in autopsy prosection and gross examination and microscopic interpretation of surgical and cytologic specimens by working on patient material, especially in the general pathology service at the Veterans Administration Hospital; achieves competency in interpretation of laboratory test results, through service and call for surgical pathology and the clinical laboratories; achieves competency in laboratory administration through participation in management activities in the clinical laboratories.
Interpersonal Skills and Communication: Achieves competency in interacting with clinicians and other health-care providers to obtain history and convey results and interpretations; achieves competency in interaction within the laboratory and physician hierarchy, both through routine service and call activities; refines skills in composing effective autopsy, surgical, and clinical laboratory consultation reports; achieves competency in giving oral presentations through additional practice; refines teaching skills through orientation and teaching of new residents and medical students, including leading a discussion group of second-year medical students.
Professionalism: Achieves competency in personal professional behavior and continues acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent, particularly with respect to working in the autopsy, forensic and surgical pathology areas; achieves competency in behavior and practice within the residency program and hospitals now and for the future, as governed by regulatory and accrediting agencies.
Practice-based Learning: Achieves competency in quality assurance activities such as case reviews; observes and in quality control and quality assurance activities; achieves competency in the practice of evidence-based medicine, and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; achieves competency in planning for ongoing learning through the residency and on a lifelong basis.
Systems-based practice: Achieves competency in appropriate utilization of testing through managing the work-up of surgical, cytologic and autopsy specimens and send-out specimens from the clinical laboratories; achieving competency in navigating the health care systems at Parkland Health and Hospital System, Children’s Medical Center, the University Hospitals, and the Veterans Administration Hospital.

Evaluations

At the end of every rotation, the rotation director discusses the resident's performance directly with the resident and provides the resident with a written review, indicating areas of strength and weakness. Each resident meets individually with the Pathology Residency Program Director at least twice a year. The Program Director and the Clinical Competency Committee monitor progress. Residents have the opportunity to provide an anonymous evaluation of each rotation and of the program as a whole to the Program Evaluation Committee. Meetings of the Program Evaluation Committee are open to residents, and residents are key participants in the annual Program Evaluation Retreat.

The Chair of the Department asks each resident to complete a formal evaluation of the entire teaching faculty at the end of each year, which he uses to evaluate faculty performance relating to resident education. The residents meet monthly for a luncheon with the chief residents, who provide feedback to the Residency Program Director; the faculty and Program Director attend these meetings when invited. The Chair meets with the entire house staff periodically to provide updates on the Pathology Department and the University and to discuss any issues of concern.