The Pathology Residency Program is an integral part of the Department of Pathology and plays an important role in the academic and clinical life of the medical center. During their training at Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, residents build their knowledge and experience in the various disciplines of anatomic pathology, clinical pathology and experimental pathology. Our faculty members are strongly committed to the education of residents. They serve as instructors and mentors across the broad range of experiential and didactic educational activities offered by the department. Learning on rotations is supplemented by a core curriculum of didactic lectures spanning all sub-specialties of anatomic and clinical pathology as well as presentations on important topics by nationally well-known visiting professors. A rich and diverse array of departmental and interdisciplinary conferences allows residents to refine their diagnostic skills, gain exposure to rare and unusual cases, and contribute to patient evaluation and management. In addition, a Visiting Professors lecture series features nationally acclaimed faculty covering important concepts in pathology education, research and practice. Residents benefit not only from Clinical Pathology and Anatomic Pathology topics discussed and unknown slide reviews shared or lab management case studies, but meeting and networking with leaders in the field of Pathology.
As a pathologist, you will have the opportunity to be a clinical specialist as well as a basic scientist. The skills and knowledge you acquire during your residency will prepare you to function as an expert in providing diagnostic and prognostic information. The discipline of Pathology is a link to other basic medical sciences. For those interested in pursuing biomedical research there are opportunities to train with members of our Division of Experimental Pathology as well as with other faculty members involved in basic or clinical research. Our residency program is designed to prepare you for the ever-changing world of laboratory medicine. Educational opportunities in cytogenetics, molecular diagnostics, and laboratory management are all part of the residency experience.
A mentoring program allows each resident the opportunity to select a faculty member for one-on-one career guidance and professional development. Many of us were attracted to the field of pathology by the broad range of opportunities including clinical practice, medical education, research, and laboratory administration. Our faculty is trained and experienced in these diverse sub-specialties, and we stand ready to help you meet your goals.
The laboratory facilities at Penn State Milton S. Hershey Medical Center are exceptional. Our modern full service laboratories are well equipped and designed to meet the needs of our tertiary care facility. Departmental and institutional libraries include a large selection of electronic journals and print journals and books. Resident offices provide an opportunity for sharing knowledge in a comfortable, private area with adequate space for each individual. In summary, we believe that our environment for pathology training is outstanding and one that will prepare our trainees well for the opportunities that their futures will offer them.
Pathologists' activities encompass several broad categories:
- Providing direct patient care by contributing to diagnostic and prognostic evaluation of a variety of samples.
- Medical and scientific direction of clinical laboratories with responsibility for providing high quality laboratory data in a cost-effective and timely fashion.
- Teaching students, residents, physicians, and paramedical personnel about pathologic evaluation of disease and the applications of laboratory medicine to patient care.
- Developing new knowledge about the pathogenesis of disease and its classification and prognostic evaluation.
- A setting that is conducive to self-study and learning-by-doing.
- Training and personal experience in a variety of skills necessary to obtain diagnostic and prognostic information from patient samples.
- Guidance in developing the skills of critical and analytic thinking necessary for proper interpretation of patient or research data.
- Guidance in perfecting the skills of communicating information about disease, both oral and written.
- Enthusiastically perform the assigned clinical services.
- Read extensively about the diseases encountered.
- Acquire understanding and experience with the technical and mechanical aspects of the laboratory.
- Develop the skills required to communicate information about pathology.
- Gain experience in the skills required for problem solving and for interpretation of data.
- Gain experience in laboratory management and quality improvement.
- Assume a role in the education of colleagues.
- Help each resident define career and educational objectives.
- Evaluate each resident's progress, using subjective and objective means of evaluation, and communicate the results of those evaluations to each resident on a timely basis.
- Delegate to each resident gradually increasing levels of responsibility, based on the resident's experience and progress in the training program.
- Communicate to residents their enthusiasm for their own area of research and provide opportunity for participation by interested residents.
- Provide personal instruction to residents as appropriate for their subspecialty focus.
- Participate on a regular basis in conferences that are intended primarily for the education of pathology residents.
- Provide personal instruction in laboratory management and administration, and in use of computers in the laboratory.
- Nurture an atmosphere of mutual respect and trust.
- Encourage the development of residents' participation in scholarly activities.
- Encourage and provide opportunities for residents to gain competency, proficiency and to reach a level in which they are ready to enter independent practice.
The Division of Anatomic Pathology is composed of 25 faculty members with diverse subspecialty interests and educational backgrounds. However, all share a commitment to undergraduate and pathology resident education which is accomplished through a variety of educational methods. Each week, the teaching calendar for the section includes an anatomic pathology unknown conference, dermatopathology conferences, and a gross pathology conference. Clinicopathologic correlation, the generation of a complete differential diagnosis, and the definition of the natural history and response to therapy are stressed. In addition, multiple interdisciplinary subspecialty conferences which correlate pathologic observations with radiologic and clinical data, and core curriculum lectures covering the full range of anatomic pathology subspecialties, complete the weekly calendar.
As residents gain experience, we encourage them to take on more responsibility in patient care and teaching roles. Semi-independent sign-out in Surgical Pathology is an extremely valuable privilege awarded to qualifying senior residents, which allows them to approximate the experience of a junior faculty member. More experienced residents will also have the opportunity to serve as the presenting pathologist at interdisciplinary conferences, where they will provide information important for influencing patient care decisions. Residents will also be invited to serve as instructors in medical student laboratory or problem-based learning sessions, provide formal lectures in our core curriculum, and present the results of their Quality Improvement projects at our departmental Grand Rounds.
The educational program is based largely on the clinical material seen at Penn State Milton S. Hershey Medical Center. The case material includes approximately > 42,000 surgical specimens, 20,000 cytology specimens, and 80 autopsies. As a tertiary care center, we receive numerous challenging diagnostic specimens which reflect the patients treated here, including complex resections of advanced neoplasms, transplant pathology, iatrogenic immunosuppression, unusual infections, and pediatric diseases.
The Pathology Residency program's annual rotation schedule contains thirteen four-week blocks. The core anatomic pathology rotations include 16 blocks of surgical pathology, 6 blocks of autopsy and cytopathology, 1 block of autopsy and gross dissection, 1 block of autopsy and elective and pediatric study set, and 1 block of forensic pathology. Forensic pathology experience is located in Dauphin (about 20 minutes away) and Lancaster Counties (about 30 min. away). The surgical pathology, autopsy and cytopathology services encompass material from all organ-based subspecialties and pediatric and perinatal pathology. Electron microscopy, Molecular diagnostic testing, flow cytometry utilizing immunofluorescence and immunohistochemistry testing is incorporated into these basic rotations and is also offered in elective rotations. There are five blocks of elective rotations available and can be in areas of Anatomic or Clinical Pathology. During the training period one "Away" elective (2-4 week block) can be arranged at an outside institution in an area of interest with approval from the Designated Institutional Official (DIO).
The Hershey Medical Center's Cytopathology Laboratory has a total annual volume of approximately 20,000 cases. Approximately 50% of these are Pap smears, 29% are non-gyn, non-FNA specimens (fluids, CSF, brushings and washings), and 21% are fine needle aspiration specimens (FNAs). There is an approximately 2-3% dysplasia rate in the gynecologic material. The Cytopathology Laboratory staff attend most radiographically-guided FNA's to provide immediate feedback on adequacy and a preliminary diagnosis when appropriate. Cytopathologists perform fine needle biopsies on a variety of superficial lesions. A typical 4-week Cytopathology rotation will include exposure to more than 50 FNAs from the lungs, thyroid, abdominal organs, bone, and other sites. A formal program including reading assignments, study sets, lectures, technical skills, and a post-test exists for the first three months, with a check-list to help the resident assure that all goals have been met. Training beyond the first three months allows residents to gain further exposure to uncommon and unusual processes with enrichment from an extensive study set.
On the autopsy rotation, the resident performs all autopsies under the guidance of an attending pathologist. Opportunities exist for senior residents to spend one or two months supervising less experienced residents. In addition to extensive reading, an integral part of each resident's training is participation in several types of conferences, each emphasizing different aspects of autopsy pathology, e.g., autopsy case review conference, gross organ conference, medical mortality conference, neuropathology, and perinatal pathology conferences. The teaching of second year medical students is an important and valuable part of the rotation. Residents also observe and participate in forensic cases performed by the local coroner's office at the coroner's facility. There also exists an opportunity to experience other facets of forensic pathology, e.g., scene investigation and legal testimony, during the four-week block rotation with the local medical examiner.
Experience in laboratory management and medical informatics forms another important component of education in anatomic pathology. The diagnostic reports of the Division of Anatomic Pathology have been computerized for over 25 years, and are accessible for retrieval and review. These reports are also integrated into the electronic medical record, which is also accessible for electronic review. We have incorporated education in anatomic pathology laboratory management in our core curriculum, as an experiential learning opportunity in quality improvement, through inclusion of residents in divisional quality assurance meetings, through participation in capital budget and departmental budget planning, and by involving residents in the preparation for, and sometimes service as an inspector in, laboratory inspections.
The Division of Clinical Pathology is composed of 10 faculty members, who provide medical and scientific direction for the hospital's clinical laboratories and specific core and research laboratories. The Clinical Laboratory performs more than 2.1 million billed tests each year, reflecting the diverse population of patients seen at this academic medical center. The laboratory includes units for Blood Bank/Apheresis, Microbiology, Virology, Hematology, Chemistry, HLA/Immunology, Laboratory Information Systems, Phlebotomy/Specimen Collection and Specimen Processing. As residents rotate through the various laboratory units, they receive instruction from the faculty and medical laboratory scientists in each section.
The Pathology Residency program's annual rotation schedule contains 13 four-week blocks. In the course of their training in clinical pathology, residents become familiar with the technical aspects and clinical applications of each laboratory procedure through active participation in bench work and frequent consultations with clinicians. The core clinical pathology rotations include four blocks of blood bank/apheresis, three blocks of microbiology, one block of virology, five blocks of hematology (2 blocks of Clinical Pathology focusing on peripheral smear review, cell counting, and coagulation; 2 blocks of Anatomic Pathology focusing on lymph node and bone marrow slide review, flow cytometry, and molecular testing; and 1 block in the final year combining both Clinical hematology and Anatomic hematopathology service work), two blocks of chemistry, 2 weeks of HLA/immunology followed by 2 weeks of Blood Bank bench, and 2 weeks of cytogenetics training combined with an elective. There are also five blocks of Clinical Pathology Consult (CP consult) rotations in which the resident acts the front line Laboratory Director. Residents on CP consult are exposed to laboratory management, specialized testing, molecular diagnostics training, and the pathologist as a consultant to clinicians regarding laboratory test utilization and interpretation.
Residents rotate through each unit and serve as laboratory physicians in all unit activities. During their rotations, residents are members of the unit management team and are actively involved in administration, planning and implementation of services, as well as solving operational problems. In addition, residents participate on numerous hospital committees, and are encouraged to attend and provide continuing education conferences. Opportunities to participate in research projects are available for those interested. There are five blocks of elective rotations. Residents can arrange electives in areas of Anatomic or Clinical Pathology. During the training period one "Away" elective (2-4 week block) can be arranged at an outside institution in an area of special interest. The away elective must be approved by the Designated Institutional Official (DIO).
The Division of Experimental Pathology is dedicated to improving human health through basic and translational research that involves the study of disease or disease processes. We are a growing group, currently of 7 faculty with Ph.D. or M.D./Ph.D. degrees, occupying about 10,000 sq. ft. of laboratory space. Four of our faculty members also fall under the umbrella of The Jake Gittlen Laboratories for Cancer Research, which is supported by local charity. Our areas of research include a range of topics, from molecular and genetic studies of esophageal, bladder, and skin cancer, to the biochemical basis of mutation, genetic mechanisms of papillomavirus-induced cancer, polycystic ovary disease, zebrafish as a model for personalized medicine, the genetic basis of skin color, web-based infrastructures for science, and high-dimensional image informatics.
Our faculty collaborate with their colleagues in anatomic and clinical pathology and with other basic and clinical scientists. We participate in residency training by offering research opportunities and by contributing to curriculum and research conferences. We participate locally in medical and graduate education at Penn State University, and globally through collaborative research and scholarly activity.