Educational Goals and Philosophy
The major educational goals of the Beth Israel Deaconess Medical Center Selective Pathology Fellowship Training Program are to provide an environment in which more advanced study in diagnostic surgical pathology (with particularly high exposure to gastrointestinal, genitourinary and breast pathology) can occur and to encourage scholarly activity in clinical and basic research. Our aim is to train Fellows who will develop a life-long interest in learning, will exhibit the highest professional and technical behavior, and will become integral members of the Pathology community as consultants, administrators, mentors and teachers. We provide the professional staff, the diversity of clinical material and experiences, and the intellectually stimulating environment necessary to obtain these objectives.
Organization of the Selective Pathology Fellowship Program
At the BIDMC, we have a high volume of surgical pathology specimens (over 55,000 in 2011). The Selective Pathology Fellows are able to spend the year refining their diagnostic skills at the microscope. The first two months of the year are spent on the surgical pathology rotation schedule, so that the Fellows can act as a resource to the junior residents as well as polish their own grossing skills and integrate their gross diagnostic impressions with the microscopic findings. Once the Fellows have demonstrated competence in the grossing and diagnosing of a broad range of organ specimens, they are advanced in responsibility to "junior signout". In this role, the Selective Pathology Fellows are responsible for signing out cases with the residents on the rotation as though they were their own cases. The attending to whom the case is assigned also reviews the case prior to final signout. In this way, the Fellows develop their clinical and teaching skills, as well as learn how to manage a larger caseload.
There is the opportunity for two or more of the Fellows to spend a concentrated period of time in subspecialty training in breast or gastrointestinal pathology. At the BIDMC, we have a large volume of these types of specimens, both in house and in the form of consultation materials. We also have leaders in these fields (both nationally and internationally) within our department.
Description of Assignments
For the first two months, the Selective Pathology Fellows are on the routine surgical pathology service to allow for polishing of grossing skills and integration of gross diagnostic impressions with microscopic findings. The Fellows act as a resource to junior residents with questions regarding grossing and processing of surgical specimens.
Subsequent months are spent in the role of "junior attending" As the "junior attending", the Selective Pathology Fellow is responsible for his or her own case load of surgical specimens; he or she is responsible for review of each case and "double-scoping" with the resident on the team. The Fellow is expected to be available to answer questions in the grossing room and to work up the case to completion (ordering levels, special studies and obtaining in-house consultations) before passing the case to the attending with whom he or she is working. Note that every case is still reviewed by an attending prior to final signout.
Selective Pathology Fellows are responsible for teaching residents with whom they are working on a surgical pathology team. Fellows also cover the frozen section service, acting as the "senior" to the resident on the service. Each frozen section is also reviewed by an attending prior to rendering the intraoperative diagnosis.
Selective Pathology Fellows are responsible for the appropriate billing for each case and, after review of the final report in the computer, for SNOMED coding of the cases prior to final review and release of the report by the attending with whom he or she is working.
Fellows also have rotating responsibilities for teaching and administration of the residency training program.
The Fellow provides services as a teacher and/or consultant at a variety of departmental and interdepartmental conferences and provides supervision of junior residents acting as teachers/consultants in these venues. The Fellow is responsible to the senior attendings assigned to the conferences.