DEPARTMENT OF PATHOLOGY 2017 – 2018 HOUSESTAFF HANDBOOK 300 Pasteur Drive, L235 Stanford, CA 94305 http://pathology.stanford.edu 1 Please use the bookmarks as the Table of Contents 2 Training in Pathology at Stanford Overview The Department of Pathology at Stanford University Medical Center seeks to train outstanding candidates for academic, private practice and other leadership positions in pathology. We offer residency training in Anatomic Pathology (AP), Clinical Pathology (CP), and combined AP and CP (AP/CP). The overall goal of our program is to provide in-depth, flexible training, in all aspects of pathology, leading to board certification in AP, CP or AP/CP. We also offer accredited clinical fellowships in Blood Banking/Transfusion Medicine, Breast Pathology, Cytopathology, Dermatopathology, Gastrointestinal Pathology, Gynecologic Pathology, Hematopathology, Neuropathology, Microbiology, Molecular Genetic Pathology, and Surgical Pathology. Combined AP/Neuropathology is also offered, but must be discussed with the Program Directors and appropriate Fellowship Directors prior to pursuing these training avenues. Trainee Selection All eligible applicants will be considered for training in the Pathology Department at Stanford. Applicants must have one of the following qualifications to be eligible for consideration: ● Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME) ● Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA) ● Graduates of medical schools outside the United States and Canada who have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates or have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction. ● Graduates of medical schools outside the United States who have completed a Fifth Pathway program provided by an LCME-accredited medical school. The Pathology Department selects trainees on the basis of their preparedness, ability, aptitude, academic credentials, communication and interpersonal skills. All trainee applications are reviewed by the Selection Subcommittee of the Residency & Fellowship Committee (RFC), which selects those applicants to invite for interviews. Faculty, clinician educators and current residents and fellows interview selected candidates. All teaching faculty and trainees prepare written evaluations of each applicant they meet with. 3 Anatomic Pathology (AP) Training Residents complete 24 months of structured training followed by 12 months of flexible training. The details of the current program of rotations are given below. Structured Training in Anatomic Pathology (24 months) The two years of AP training will be structured into 26 blocks of 4 weeks each. ● 12 blocks of surgical pathology/cytology experience and 2 blocks of Autopsy experience at Stanford Hospital ● 5 blocks of combined surgical pathology and autopsy experience at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) ● 7 blocks of anatomic pathology specialty training at Stanford Hospital to be distributed as follows: dermatopathology, forensic pathology, ancillary diagnostics, bone marrow hematopathology, tissue hematopathology, neuropathology (1 block each), one additional block of an “elective” rotation . Flexible Training in Anatomic Pathology (12 months) The third year of required training may be customized by the resident to meet her/his individual needs. Residents may apply for our Surgical Pathology or other subspecialty ( Breast/ Gyn/ GI) Fellowship or do an alternative year of AP training designed in conjunction with the faculty in accord with the trainee’s career plans. A wide variety of research opportunities also exists. Clinical Pathology (CP) Training Residents complete 26 4 - week blocks of structured training followed by 12 months of flexible training. The details of the current program of rotations are given below. Structured Training in Clinical Pathology (26 4 - week blocks) ● 13 4 - week blocks of training in the four major established areas of laboratory medicine: chemistry/immunology, hematology (including one month in coagulation/red blood cell special studies), microbiology/virology, and transfusion medicine. These are divided into introductory rotations of two blocks, followed by one-block return visits after all of the areas have been experienced, allowing the resident to integrate experience gained in various sections and function with a graduated level of responsibility. Residents completing CP training who have not previously completed AP training are encouraged to attend AP hematopathology didactic sessions, including lectures and round the scope conferences, and may wish to complete an elective tissue hematopathology rotation. ● 2 4 - week blocks of training in laboratory genetics (biochemical genetics, molecular genetics, and cytogenetics) 4 ● 2 weeks of training in finance ● 2 weeks of training in histocompatibility ● 2 4 - week blocks of training in general laboratory medicine at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) ● 8 4 - week blocks of structured training in pathology and laboratory medicine or research to be determined by the resident, in consultation with Clinical Pathology faculty Flexible Training in Clinical Pathology (12 months) The third year of required training may be customized by the resident to meet his/her individual needs. A wide variety of patient care projects and/or research opportunities (clinical, translational and basic) exist. Combined AP/CP Training The combined program consists of 24 months of structured training in AP and 18 months of structured training in CP. This is followed by 6 months of flexible training which should be used to integrate aspects of AP and CP. Structured Training in Anatomic Pathology (24 months) Note: This is identical to the 24 structured months for AP only residents. Structured Training in Clinical Pathology (18 months) Note: This is identical to the 18 assigned structured months for CP only residents. Flexible (Integrated) Training in Pathology (6 months) The remainder of the fourth and final year of required training may be customized by the resident to meet her/his individual needs but she/he will be encouraged to synthesize and integrate ALL areas of diagnostic pathology during this period. Combined AP/CP training at Stanford may be summarized as: ● Years 1 & 2: a solid grounding in Anatomic Pathology ● Year 3: a solid grounding in the core areas of Clinical Pathology ● Year 4: two periods of integration ● Integration of Clinical Pathology The laboratory medicine rotations that complete the residents' 18 months of structured CP training are designed to allow the resident to see familiar diagnostic and management 5 problems in different ways. These include genetic and molecular approaches (during the two- month rotation in genetics), histocompatibility, the perspective of a community hospital (during the two-month rotation at the Veterans Affairs Palo Alto Health Care System) and the special viewpoint of the pediatric patient (during the rotation in pediatric laboratory medicine). ● Integration of all of Pathology 6 The final six months of the four years of combined AP/CP training should be customized by residents to allow them to connect all areas of Pathology into one integrated knowledge base. We strongly recommend that this is solidified by doing an additional year of anatomic pathology (either a subspecialty fellowship or the Surgical Pathology fellowship). Combined Anatomic Pathology & Neuropathology Training The program guarantees a position in the neuropathology fellowship program at the time they enter the residency program (assuming the trainee is in good standing). The combined AP/NP training consists of 24 months of AP (similar to the AP only program) and 24 months of neuropathology. The current composition of the 48 months of required combined AP/NP training is as follows: ● Twenty-four months of AP similarly scheduled as the AP only training. ● The first 12 months of NP training concentrates on general diagnostic surgical and autopsy neuropathology. The second 12 months offers the opportunity for the trainee to develop a research project and/or develop additional expertise in diagnostic NP, depending upon the ultimate career objectives of the trainee. ● Candidates who wish to be certified in NP must first become certified in AP which will require 2 years training for residents who ultimately seek certification in AP and NP. Time-wise this means that becoming certified in AP and NP will require 4 years - 2 years for AP and 2 years for NP. 7 General Information Stanford pathology residents and fellows play a central role in the Department’s goal to provide quality service to patients. Clinical duties vary depending on the service being covered. In general pathology trainees take on graduated responsibility, functioning as liaisons between the clinical teams and the pathology laboratory. For a detailed description of resident and fellow duties on each of the services, refer to the appropriate section in this handbook. Regular Work Hours & Availability In general the work week is Monday through Friday and the day begins with a teaching conference at 8:00 AM and the day ends at around 6:00 PM. The days and times vary with the service but the total time commitment (including on-call coverage) should not be more than 80 hours per week, averaged over a four-week period. Trainees