Resident Rotations

Resident Rotations

Typical Pathology Resident Schedule

This is an example of a 4-year pathology resident rotation schedule.  Each resident schedule will resemble this schedule but will vary depending on changes in schedules and time management.

A Typical Pathology  Resident Program Schedule   
 

PGY1 

PGY2PGY3PGY4
JulyOrientation/EMSurg PathCytology IICytology III/Neuropath
AugForensics ICytology IPeds PathHeme IV
SeptemberSurg PathCoagSPL/ NeuropathSurg Path
OctoberSurg PathHeme IIHeme IIIBlood Bank III
NovemberClinical Chem IElectiveDerm PathCytology IV
DecemberMicro IAutopsy/Surg PathSurg PathLab Mgmt.
JanuaryAutopsy/Surg PathBlood Bank IIElectiveSurg Path
FebruaryMolecular 1AP Consult/ NeuropthCytogenetics/ ElectiveMicro III
MarchBlood Bank 1Clinical Chem IIAutopsy/Surg PathSurg Path 
AprilHematologySurg PathMolecular II/ImmunologyElective
MayForensics IIMicro IISurg PathElective
JuneResearch/ NeuropathAutopsy/ Surg PathClin Chem IIIElective

Anatomic and Clinical Pathology Rotations

The University of Louisville Anatomic and Clinical Pathology Residency is a fully integrated AP and CP program comprising of 48 months of training designed to provide a high-quality educational experience.


ANATOMIC PATHOLOGYDURATIONRotation Details
Surgical Pathology134 Autopsy/SurgPath, 1 NH
Cytopathology & Cytopathology/Neuropath43 Cytopath(2 ULH/1 NH) 1 Neuropathology
Forensics2
AP Consult/Neuropath1
Dermatopathology1
Pediatric Pathology1
Research/Neuropath1
Cytogenetics0.5
Electron Microscopy0.5
TOTAL MONTHS24

*ULH - University of Louisville Hospital*NH - Norton Hospital

 

CLINICAL PATHOLOGYDURATIONRotation Details
Hematopathology4Benign Hematology Included
Clinical Chemistry3
Microbiology3
Transfusion Medicine/Blood Banking3
Molecular Pathology1.5
Coagulation1
Lab Management1
SPL/Neuropath1
Immunology0.5
Orientation0.5
TOTAL MONTHS18.5
ELECTIVE PATHOLOGY5.5
FULL ROTATION TOTAL48

ELECTIVES
  • Advanced Heme
  • Breast
  • Cardiopulmonary
  • Clinical Heme
  • Clinical Medicine
  • Clinical Toxicology
  • Forensic Toxicology
  • Gastrointestinal (GI) Path
  • Genitourinary (GU) Path
  • Gynecologic (GYN) Path
  • Human leukocyte antigen (HLA)
  • Head & Neck Pathology
  • Off-site Rotation
  • Oral Path
  • Pediatric Forensics
  • Perinatal/Placental Path
  • Pulmonary Path
  • Renal Path
  • Research Elective
  • Surg Path Sign-out/Consult
  • Transplant Pathology
  • Neuropathology is an AP Core rotation combined with AP Consult, Cytology III, a required PGY1 Research and SPL rotations. The required PGY1 Research can be either AP or CP.
  • Residents may take clinical rotations or design elective rotations that enhance their pathology education and practices with prior approval from Program Director.
  • Residents may take a one-month elective off-site rotation with prior approval from the Program Director and the GME Office.

Resident Core Rotation Descriptions

Blood Bank/Transfusion Medicine

Duration: 2-3 months
Location: University of Louisville Hospital

The blood bank rotation is composed of three on month rotations. A fourth month elective rotation may an also be arranged. These rotations emphasize active learning. Residents have discussions with the rotation director, blood bank fellow, and/or blood bank staff covering the daily assigned topics, reading resources and quizzes provided for each topic. During the first month of the rotation, the resident becomes familiar with the basic immunohematology and blood bank/transfusion service issues. The second month includes work at the donor center, American Red Cross (Blood Collection, Reference Lab. etc.) The final rotation evaluation for the first two months reviews the resident preparedness for daily discussions, as well as the quiz results and residents’ performance on the six core competencies (Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Professionalism). The 3rd month rotation takes place at the Norton and Norton Kosair Children hospitals. During this rotation, residents gain exposure to more advanced and specialized topics such as Pediatric Transfusion, ECMO (Extracorporeal Membrane Oxygenation), Plasmapheresis, HLA, Bone marrow transplant, TEG (Thromboelastography), and other topics. Residents participate in transfusion related clinical case conferences and other Blood Bank/Transfusion related activities.


Clinical Chemistry

Duration: 3 months
Location: University of Louisville Hospital

The clinical chemistry and toxicology rotations for our residency program are designed to give the resident the knowledge base necessary to take on the duties of a laboratory director in clinical chemistry. The rotations also prepare the Resident for success on Boards in clinical pathology. The training is comprised of a 3-month rotation experience (Chem I, Chem II and Chem III) and has the following components: a) an introductory session to prepare residents to take and manage On-call situations; b) 12 structured learning Modules; c) an interactive lecture series; d) multiple On-call experiences; and e) opportunity to participate in research scholarly activities with faculty guidance.


Clinical Microbiology

Duration: 4 months
Location: University of Louisville and Norton Hospital

The clinical microbiology rotation consists of three 4-week blocks designed to provide an in-depth exposure to the laboratory diagnosis of infectious diseases. The rotation consists primarily of observation and shadowing with bench technologists during assigned bench rotations, didactic lectures, organ system focused discussions, participation in daily "plate" rounds, and attendance at Infectious Disease Patient Management Conference, Infection Control and Prevention Committee meeting, and the Antibiotic Stewardship Committee meeting. Opportunities for research are available and performed under the guidance of the Director or Research Technologist. The expectation is for residents to serve as a resource for the microbiology laboratory by communicating with the medical staff on unusual or critical test requests or reports and recommending the most appropriate course of action while on the rotation. Additionally, the resident will conduct chart reviews for the purpose of clinical correlation and extent of workup of positive cultures, for example, blood cultures in efforts to differentiate contamination versus a true-positive.


Cytology

Duration: 4 months
Location: University of Louisville and Norton Hospital

At the University of Louisville Hospital, the resident alternates on a weekly basis between the fine needle aspiration (FNA) service and the hospital service (pap smears and exfoliative non-gynecology). During the first month, the resident acquires the skill needed for daily service and becomes familiar with daily laboratory operation issues. In the second and third months, the resident will become competent in all aspects of cytopathology. The cytopathology rotation at Norton hospital is for senior residents and offers a different mix of cases plus an extensive study set in cytopathology.


Dermatopathology

Duration: 1 month
Location: Dermatopathology Practice

The resident will alternate the days between sign-out of daily cases prior to review with the dermatopathologist and diagnosis of unknowns selected by the dermatopathologist. The goal is for the resident to gain experience in signing-out common dermatologic cases and to recognize the varied histologic presentations of common dermatologic conditions as well as to see a broad range of less common, but representative examples of a variety of dermatologic neoplasms and inflammatory conditions.


Forensic Pathology

Duration: 2 months
Location: Office of the Chief Medical Examiner

The Forensic Pathology rotations develop skills in medicolegal death investigation focusing on the forensic autopsy. Each resident completes a minimum of 25 autopsies per month and by the end of month two, the resident must independently prosect a body and dissect all organs. At the end of each monthly rotation, the residents must present a short review of a forensic pathology/forensic science topic of their choice. In addition, the resident will understand the death investigation system, recognize the legal aspects of a forensic autopsy, understand the legal chain of custody, and how to complete a death certificate.


(Benign) Hematology 1

Duration: 1 month
Location: University of Louisville Hospital

The Hematology I rotation develops skills in test interpretation, evaluating clinical information and cellular smears related to hematologic and body fluid disorders. The rotation will provide experience to the resident in the clinical hematology laboratory and will emphasize the interpretation of peripheral blood smears, the hemogram, body fluid smears, bone marrow smears, hemoglobin electrophoresis , coagulation studies and special hematologic tests. The teaching materials used in the rotation are the textbook Practical Diagnosis of Hematologic Disorders, Vol. 1 edited by Carl R. Kjeldsberg, daily review of problematic peripheral smears from the laboratory, the study set of peripheral smears, sign-out cases in hemoglobin electrophoresis, a study set of hemoglobin electrophoresis cases , review of body fluid cases, and instruction about the automated equipment in hematology for blood and body fluids.


Hematopathology

Duration : 3 months
Location: University of Louisville Hospital

The hematopathology rotation is designed to train residents in the practice of modern hematopathology, with an emphasis on neoplastic hematologic disorders. Upon completion of all rotations, the residents should be able to interpret the results of a variety of diagnostic procedures, including conventional morphology, immunohistochemistry, flow cytometry, cytogenetics and molecular genetics. Integration of these diagnostic modalities, with an emphasis on clinical correlations is the primary aim of the rotation. Active hematology/oncology and bone marrow transplantation services at the University of Louisville Hospital (ULH) and the Brown Cancer Center (BCC) provide us with a large and varied selection of clinical materials. ULH/BCC serve as one of the top referral centers for hematologic neoplasias in Kentucky, serving the consultation needs of numerous hospitals and clinics. Research opportunities are also available to the residents and supported by the Department's well-equipped Special Procedures Laboratory.


Immunology

Duration:
Location:

During their rotation in the Immunology Department of Norton Healthcare Clinical Laboratories, the residents learn the methodologies and theoretical basis for immunological techniques utilized in the diagnosis of the many immune-mediated diseases.  The diseases encompass autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis, infectious diseases such as HIV, syphilis, many viral or fungal infections, immunodeficiency disorders in both children and adults, evaluation of immunoproliferative diseases especially those expressing monoclonal immunoglobulins, allergic diseases, and others.  The methodologies include familiar techniques of precipitation and agglutination, plus various types of immunoassays including enzyme-linked, chemiluminescent, nephelometric and turbidometric, agarose gel electrophoresis and capillary electrophoresis, and multiplex flow immunoassays.  Performance and interpretation of flow cytometric assays is also presented.   In addition, the residents are given a variety of unknown case studies on previous problem/unusual patients for their independent investigation.  The cases begin with the initial laboratory finding that precipitated further investigation.  The resident must then decide why this finding requires more attention, suggest what additional testing or clinical information is needed and obtain that information, and then determine a final resolution or course of action.


Laboratory Management

Duration: 1 month
Location: University of Louisville Hospital

The goal of the Laboratory Management rotation is to prepare future pathologists for the role of Laboratory Director. The topics covered in the rotation are the following: Infrastructure and environment needed for a functional clinical laboratory, basic principles of material management, basic principles of managing human resources, information management, quality control/quality assurance/quality improvement, financial management, laboratory accreditation, laboratory safety, and contracting for laboratory services. The resident will choose and complete a project in laboratory management while on the rotation. The textbook for the rotation is "Laboratory Administration for Pathologists" by Wagar E A, Horowitz RE and Siegal GP. The faculty and 10 senior technologist from the laboratory conduct the rotation.


Neuropathology

Duration: 4 Months (in combination with Cytopathology III, Consults, Research and SPL rotations)
Location: Clinic at University of Louisville Hospital

In this rotation, you will learn how to handle and triage appropriately the various types of specimens encountered in the practice of neuropathology including central nervous system (brain and spinal cord), peripheral nervous system, nerve and muscle, pituitary, and autopsy brains. You will also learn to recognize the most common neuropathologic entities, work them up, and report them according to current best practices. In particular, learners will become familiar with the most frequent molecular alterations in brain tumors and the use of available surrogate markers to enable the delivery of precision medicine.


Pediatric and Perinatal Pathology

Duration: 4 weeks
Location: Norton Children's Hospital

The Pediatric and Perinatal Pathology rotation at Norton Children's Hospital provides exposure to common perinatal and childhood diseases, including childhood malignancies, with attention to surgical pathology, cytology, and autopsy. The rotation includes formal education in pediatric, fetal, and placental pathology, with emphasis on diagnostic competence and appropriate utilization of ancillary studies. Residents are expected to gradually assume more responsibility and show advancement in knowledge and judgment, as the rotation progresses. Responsibilities include gross dissection, frozen section interpretation, and case preparation for sign-out with supervision by board-certified pediatric pathologists. The staff pathologists monitor the resident's progress and performance daily.


Molecular 1

Duration: 4 weeks
Location:  University of Louisville Hospital

Training conducted in the Molecular Diagnostics I rotation focuses on understanding the fundamental principles and chemistries of nucleic acid analyses as applied in laboratory medicine. The clinical emphasis is on applications in personalized therapeutics and in infectious diseases.  The duration of training is four weeks.  The primary objective of the training is to familiarize the resident with basic molecular diagnostic principles and assays for a variety of applications ranging from optimizing individualized pharmaco-therapy to clinical conditions involving infections due to bacteria and viruses.  The secondary objective is the preparation of the resident to develop a significant level of comprehension necessary to interact with clinicians, especially interpretation of results and their correlation with the clinical status of the patient.  Expectations are for the resident to have knowledge of the current use in personalizing drug therapies and in the epidemiology (seasonal vs non-seasonal), symptoms, clinical presentation, and optimal specimen selection, collection, and transport to molecular laboratory.  The resident will also understand the limitation of the respective molecular assays including the recognition of false-positives and false-negatives and their management from both the technical and clinical perspective.  Other items of importance during this training are:  understand the strengths, limitations, and difference between open and closed molecular platforms; understand the principles and techniques of test validation, and the differences between qualitative and quantitative assays as it relates to clinical interpretation.


Surgical Pathology

Duration: 8 months        
Location:  University of Louisville (Pending)

Duration: 1 months
Location:  Norton Hospital

Norton Hospital has numerous gynecologic, urologic, orthopedic, and breast oncology resection specimens.  The resident will be required to pick a staff pathologist and review all cases assigned to that staff, dictate the cases, order immunostains, complete synoptic reports and finalize the cases.  The resident should work with the Physician Assistants to complete regrossing when required.  The resident will participate in all daily consensus conferences.  The resident will be expected to arrive at the appropriate differential diagnosis for all malignancies and suggest appropriate work ups.  This will include molecular studies.  The resident will also review all assigned cytology cases.  The resident will participate in frozen section analysis of all assigned specimen.  The resident will select appropriate tissue for frozen section analysis.  At the completion of the month, the resident should be thoroughly familiar with the grossing of esophagogastrectomies, Whipple resections, prostatectomies, and hepatic resection specimens and the common neoplasms of these organs.  The resident will also gain experience in pathology care at tertiary private hospitals.


Surgical Pathology Consult Rotation

Duration: 1 month       
Location:  University of Louisville 

The Surgical Pathology Consult Rotation is a one-month AP core rotation taken with Neuropathology II during the PGY2 year.  This rotation can also be taken as an elective on its own.  The rotation gives residents experience handling surgical pathology consults in the subspecialty areas of Breast, Cytology, Derm, GI, GU, GYN, Head and Neck, and Lung.  Residents preview consult cases and learn to generate a consult report under the direction of the respective subspecialty-attending pathologist. 

 

 

Resident Elective Rotation Descriptions

Breast

Duration:  1 month
Location: University of Louisville Hospital

The Breast elective rotation is a one-month rotation recommended for residents who are at the end of PGY2 through PGY4.  During this one-month rotation, the resident will cover the full spectrum of breast pathology diagnoses by previewing all in house and consult breast cases during the month, in addition to previewing selected archived cases.  The selected archived cases are organized by subject matter.  The resident will sit with the rotation director to review previewed cases and discuss important related topics.  The resident will be the point person for the gross room answering any questions the surgical pathology residents may have when grossing breast specimens, and reviewing and correcting breast write-ups from the residents on ULH surgical pathology.  The resident will go on all frozen sections for breast cases and go on any breast related FNAs.  The resident will attend and present at tumor board.  Throughout the month, seminal journal articles in breast pathology will be provided and discussed. The resident will spend a day with mammography to attain a better understanding of radiologic lesions in breast.  If requested, didactic powerpoint lectures and/or and end of the month test can be provided.  Up to 5 days of vacation are allowed on this rotation but must be taken in the middle of the month.

Expectations:

  • On the first day of the rotation, meet with the Director of the Rotation for a brief orientation.
  • Preview all cases (in house, consult, and archived) in a timely manner.
  • Complete all archived cases before the month is over.
  • Read and discuss at least 4 seminal journal articles.
  • Improve diagnostic skills and expand you knowledge of breast pathology as the month progresses.

Electron Microscopy (EM)

Duration: 1 month Location: 
Location: Jewish Hospital

Jewish hospital has a large transplant pathology volume.  The resident gains exposure to the fixation requirements for electron microscopy as well as the processing, embedding, cutting and evaluation of electron microscopy specimens.  The case mix is heavily weighted to renal pathology.  The resident will be exposed to and learn how to incorporate electron microscopy along with immunofluorescence and light microscopy in diagnosing renal pathology.


Forensic Toxicology

Duration: 1 month
Location: University of Louisville Hospital

The rotation will introduce the resident or fellow in pathology to forensic toxicology. A combination of on campus and off-campus visits will allow the learner to become acquainted with general concepts in forensic toxicology. As a part of this rotation, various analytical techniques such as immunoassays, gas chromatography, mass-spectrometry and related methodologies will be reviewed. The director will involve the resident with a few "real-life" cases in litigation after obtaining approval of the respective attorneys involved. Cases from the Medical Examiner's office will also be used by the resident while in this rotation to become familiar with interpretation of toxicology results.


Histocompatibility (HLA)

Duration: 2-4 weeks
Location: Jewish Hospital

The histocompatibility (HLA) rotation is designed to give the resident an understanding of the role of the clinical laboratory in transplantation. In addition to learning the basics of histocompatibility and transplant immunology, the resident learns how results from all sections of the clinical laboratory come together to paint an overall picture of the transplant patient from candidacy evaluation to post-transplant follow-up. In the laboratory, the resident will learn the basics of flow cytometric lymphocyte crossmatching, DNA methods of HLA genotyping, as well as various methods of HLA antibody detection and identification. They will then experience, under the supervision of the Transplant Immunologist, how all of that information is evaluated and interpreted for the purposes of transplantation and monitoring. This is an immersive rotation designed to give the resident an appreciation for the crucial role of the histocompatibility laboratory in the overall transplant program.


Placental Pathology

Duration: 2 – 4 weeks
Location: Norton Children's Hospital

This elective is intended to build upon a resident's foundation in perinatal pathology with a more intensive focus on the gross dissection, microscopic evaluation, and case preparation of placentas and fetal autopsies. Residents are expected to gradually assume more responsibility and show advancement in knowledge and judgment, as the rotation progresses. The perinatal staff pathologists monitor the resident's progress and performance daily.


Renal Pathology

Duration: 2 – 4 weeks
Location: Norton Children's Hospital

This elective rotation focuses on renal pathology by incorporating the histopathology, ultrastructure, and immunofluorescence of a diverse spectrum of pediatric and adult renal medical diseases, including transplant pathology. The resident will help collect kidneys, assess adequacy, and determine appropriate triage for light microscopy, immunofluorescence microscopy, and electron microscopy. The resident will learn the basics and understand the importance of electron microscopy and immunofluorescence. Residents are expected to read and prepare cases for sign-out. The renal staff pathologists monitor the resident's progress and performance daily.


Surgical Pathology 

Duration:  2 – 4 weeks    
Location:  Jewish Hospital

An upper level resident choosing this elective gains exposure to a high volume private practice.  The practice sees specimens from three hospitals, several medical centers and several surgery centers.  The main hospital where the resident will be primarily located is also the central hub for histological specimen processing including the above-mentioned facilities and the University of Louisville.
    
The resident should be able to become familiar with the various issues that arise in managing a central processing area as well as see a diverse case mix of surgical specimens. The resident will work with the senior pathologists at Jewish Hospital in collaboration to arrive at differential diagnoses, proper handling of difficult cases and eventual sign out of those cases. The resident should also be prepared to actively engage other clinicians who visit the department and need guidance.


Surgical Pathology Consult

Duration: 1 month
Location: UofL Hospital

The Surgical Pathology Consult Rotation is a one month AP core rotation taken with Neuropathology II during the PGY2 year. This rotation can also be taken as an elective on its own. The rotation gives residents experience handling surgical pathology consults in the subspeciality areas of Breast, Cytology, Derm, GI, GU, Gyn, Head and Neck, and Lung. Residents preview consult cases and learn to generate a consult report under the direction of the respective subspecialty attending pathologist.

Expectations:

  • On the first day of the rotation, meet with the Director of the Rotation for a brief orientation.
  • Handle all surgical pathology consult cases. The staff person in charge of accessioning consults will give all surgical pathology consult cases to the resident on rotation throughout the day. Each consult is assigned to an attending according to subspeciality. The resident previews each case in a timely manner, generating a consult report and reviews the case with the assigned attending. If for some reason a case cannot be previewed the same day the resident must notify the appropriate attending.
  • Read about each case.
  • Learn how to write appropriate notes and provide histologic descriptions when appropriate.
  • Learn appropriate coding.
  • Follow-up with each attending on cases previewed for feedback.
  • Improve diagnostic skills and ability to generate a professional consult report as the month progresses.

Transplant Pathology

Duration:  2 – 4 weeks
Location:  Jewish Hospital

An upper level resident choosing this elective gains exposure to a high volume solid organ and composite tissue transplant service.  Jewish Hospital has become well known for successful and innovative transplant care.  The first US hand transplant occurred at Jewish Hospital in 1999.  Jewish hospital also placed the first implantable.  Currently the facility receives numerous specimens from heart, liver, kidney and lung transplants on a routine basis.  The facility also occasionally sees specimens from hand transplants, pancreas, and small bowel transplant specimens.

The resident will become proficient at how to handle transplant specimens, the grading rejection schemes for the specimens and how best to help other clinicians with treating their transplant patients. The resident will work in close collaboration with the senior pathologists at Jewish Hospital.