Duties and Responsibilities

Residency | Program Offered | Duties and Responsibilities |

PGY-1 | PGY-2 | PGY-3 | PGY-4

PGY-1: Duties and Responsibilities

The first year of the combined AP/CP residency is spent in Anatomic Pathology training, specifically in the disciplines of Surgical Pathology, Autopsy Pathology, and Cytopathology. The training is conducted during 3-6 month rotational blocks at each of the three major hospital teaching sites: UMDNJ-University Hospital (UH), Hackensack University Medical Center (HUMC), and the Department of Veterans Affairs Medical Center at East Orange (DVAMC).

At the first two sites, the PGY-1 residents, working with PGY-2 residents (and the Chief Resident at UH) and under the direct supervision of the attending staffs: grossly examine surgical and biopsy specimens, dictate their observations, take sections for microscopic examination, review the finished slides, and then sit with the attending at a multi-headed microscope to decide on a final diagnosis. In addition, residents are trained in frozen section technique and some staining methods. At the beginning of the PGY-1, residents are also assigned for a fixed period (e.g. 2 weeks) to the autopsy service where they are taught by the senior residents and attendings how to perform usual hospital-based post-mortem examinations. Training in Cytopathology occurs through a series of didactic presentations by the attendings and by individual case-based discussions.

The rotation at the VA is done only after the residents have gained experience at the other institutions since only one resident is assigned to AP, and, although attendings are present at all times, the resident is expected to work somewhat independently without senior resident guidance.

Once a week, all residents are expected to attend department-wide, didactic presentations at Grand Rounds at NJMS (usually Wednesday mornings, 8-10 a.m., September through June), on selected AP, CP, and Laboratory Management topics. In addition, once the Medical School pathology course begins, all residents are assigned as instructors to 1 or 2 per year gross pathology laboratory teaching sessions after careful "coaching" by the course coordinators. In addition, while at UH, residents serve as mentors for senior medical students taking an elective clerkship in Surgical and Autopsy Pathology.

Each of the AP sites has a full range of textbooks and journals for the residents to use in the laboratory. All sites are fully computerized with Internet online access available.

Duties and call schedules are as follows:

1) UH: Except for the two-week autopsy block in the first quarter, residents are assigned to Surgical Pathology once every 3-4 days (nights) for grossing surgicals and being available for frozen sections. Night call is taken from home. The average workday is from 8 a.m. to about 5 - 6 p.m. except on days when the residents receive their surgical pathology slides (around mid- to late afternoon) and usually stay until mid-evening reviewing and writing up their cases. No autopsies are performed after 5 p.m. Residents are on call from home once every 3-4 weekends for autopsies and frozen sections with PGY-1s supervised, at least for the first six months, by senior residents.

2) HUMC: Residents are on individual one-week rotations in Surgical Pathology, Cytopathology (which includes performing fine-needle aspiration biopsies), and Frozen Sections (performed in the O.R. Suite Laboratory). Night call involves only the latter, but is only once every 3 evenings as all the residents take turns regardless of which "rotation" they are on. Autopsies are performed by any resident available. Residents are on call once every third weekend, grossing surgical specimens on Saturday and being available for frozen sections on both days.

3) DVAMC: The one resident assigned to the VA is responsible for either grossing surgicals or performing any autopsies. Autopsy coverage may include the Lyons VA as well. Each morning, the resident is expected to attend the Surgical Pathology conference at 8:30 a.m. There is no on-call service after 4 p.m. On alternate weekends, the resident covers both VA hospitals for autopsies (the attendings cover the other weekend).

******************************************************************

PGY-2: Duties and Responsibilities

The 2nd year of the combined AP/CP residency is predominantly spent in Anatomic Pathology training specifically in the disciplines of Surgical Pathology, Autopsy Pathology, and Cytopathology. The training is conducted during 3-6 month rotational blocks at each of the three major hospital teaching sites: UMDNJ-University Hospital (UH), Hackensack University Medical Center (HUMC), and the Department of Veterans Affairs Medical Center at East Orange (DVAMC). During the 2nd year, the resident may also do one or two 3-month rotations in a Clinical Pathology laboratory i.e. Microbiology, Hematopathology, or Chemistry.

The PGY-2 residents will work mostly independently, although the responsible attending is always available on the floor. The resident will: grossly examine surgical biopsy specimens, dictate observations, take sections for microscopic examination, review the finished slides, write down the working diagnosis and sit with the attending at a multi-headed microscope to decide on a final diagnosis. In addition, residents will cut and stain frozen section specimens.

The PGY-2 resident is expected to know what special studies (i.e. special stains, immunohistochemistry, immunophenotyping [lymphoma cases], EM, Cytogenetics) should be performed in difficult cases, although the attending pathologist will make the final decision. The PGY-2 residents are also expected to perform autopsies on their own, write the Provisional Anatomic Diagnoses (PAD) review the slides and prepare the case for signout with the attending. Training in Cytopathology occurs through a series of didactic presentations by the attendings and by individual case-based discussions.

The PGY-2 resident, during a Clinical Pathology rotation (the details of which are given in the PGY-3 description), is expected to learn the theory and practice of Clinical Pathology. The call schedule in CP varies from hospital to hospital. The details of each of the Clinical Pathology rotations for the residents are outlined in the Pathology Residency Program Manual given to all residents.

Once a week, all residents are expected to attend department-wide, didactic presentations at Grand Rounds at NJMS (usually Wednesday mornings. 8-l0 a.m. September through June) on selected AP, CP, and Laboratory Management topics. In addition, once the medical student pathology course begins, al1 residents are assigned as instructors to 2 to 3 per year gross pathology laboratory teaching sessions after careful "coaching" by the course coordinators.

Each of the sites responsible for AP and CP training has a full range of textbooks and journals for the residents to use in the laboratory. All are fully computerized with Internet online access available.

Duty and call schedules are as follows:

1) UH: Residents are assigned to Surgical Pathology once every 3-4 days (nights) for grossing surgicals and being available for frozen sections. Night call is taken from home. The average workday is from 8 a.m. to approximately 5-6 p.m. except on days when the residents receive their surgical pathology slides (around mid- to late afternoon) and usually stay until mid--evening reviewing and writing up their cases. No autopsies are performed after 5 p.m. Residents are on call from home once every 3-4 weekends for autopsies and frozen sections. There is no on-call service for CP residents (Microbiology).

2) HUMC: Residents are on individual one-week rotations in Surgical Pathology, Cytopathology (which includes performing fine-needle aspiration biopsies), and Frozen Sections (performed in the O.R. Suite Laboratory). Night call involves only the latter. Autopsies are performed by any resident available. Residents are on call once every third weekend--grossing surgical specimens on Saturday and being available for frozen sections on both days. During the CP rotation, the resident will be on cal1 every third night and every third weekend.

3) DVAMC: The one resident assigned to the VA is responsible for either grossing surgicals or performing any autopsies. Autopsy coverage may include the Lyons VA as well. Each morning, the resident is expected to attend the Surgical Pathology conference at 8:30 a.m. There is no on-cal1 service after 4 p.m. On alternate weekends, the resident covers both VA hospitals for autopsies. The resident on the C.P. Hematopathology rotation also will be on call for the autopsy service every other weekend. (The American Board of Pathology as well as the RRC in Pathology require minimum numbers of autopsies that all residents must perform during their training. The VA Hospital is where most of our residents can "complete" their autopsy numbers.)

******************************************************************

PGY-3: Duties and Responsibilities

During the 3rd year of residency training, the resident will learn the theory and practice of all the major Clinical Pathology Laboratory disciplines (i.e. Blood Bank and pheresis unit, Chemistry, Immunology, Microbiology, Coagulation). Most of the CP rotations are spent at HUMC (i.e. Chemistry, Blood Bank, Immunology, etc.), while the Microbiology rotation is taken at UH and the Hematology rotation at DVAMC. CP training is conducted during 3-month rotational blocks at each of the three major hospital teaching sites. The objectives of the Clinical Pathology training are discussed in detail in the Pathology Residency Program Manual given to each resident at the start of the Program. During the CP rotations, the resident is expected to take call at night and weekends (except in Microbiology). The call is taken from home and usually consists of a phone call from a laboratory technician or a clinician in which a question is being asked about whether to do a test or to interpret the result of a test. The resident is expected to consult with the attending clinical pathologist on call and then get back to the technician or clinical attending with the appropriate answer. All residents are expected to attend Pathology Grand Rounds at NJMS on Wednesdays, 8am - 10 a.m., September through June. In addition, the resident will be assigned to participate as instructors in the Gross Laboratory sessions in the sophomore pathology course (2 or 3 per year) and in the Laboratory Medicine small group case discussions (1 or 2 per year).

Duties and call schedules are as follows:

1) UH: The resident is expected to prepare one presentation to the laboratory personnel every month on an assigned topic in Microbiology. There are no night or weekend calls at UH during Microbiology rotation.

2) HUMC: Residents will prepare for one presentation on an assigned topic every week, as advised by the Laboratory Director. The resident will attend all departmental and interdepartmental committee meetings (e.g. QA). He/she will be on call every third night and third weekend. During the nights on call, he/she will take phone calls from the lab techs. During weekends-on-call, the resident is expected to be in the laboratory between 9 a.m. and 2 p.m. (both Saturday and Sunday). During on-call hours, on weekdays and weekends, the resident is expected to stay in the hospital for any pheresis procedure, i.e. plasmapheresis, red cell exchange, and monitor the entire procedure. The resident will then discuss the weekend call events on Monday morning with the senior clinical pathologists.

3) DVAMC: There are no night calls on weekdays. On weekends, the resident will take autopsy call every other weekend covering, both the Lyons and East Orange centers.

******************************************************************

PGY-4: Duties and Responsibilities

One-month rotations, totaling six months, are usually done in the 4th year. These include:

-Cytogenetics

-Forensic Pathology

-Toxicology

-Molecular Pathology

-Flow Cytometry

-HLA and Tissue Typing

Elective rotations (6 months): Any branch of Clinical and/or Anatomic Pathology, including dedicated basic or applied research, in which the resident would like to spend more time.

Elective rotations (usually 1 to 2 months maximum) may be taken at an outside academic institution only with the prior approval of the Program Director. Recently, NJMS residents have taken extramural electives at NYU in Hematopathology, the AFIP in Surgical Pathology, and the MD Anderson Tumor Institute in Cytopathology.

Cytogenetics: This rotation is taken in the Regional Referral Cytogenetics Lab in the Department of Pediatrics at NJMS where the resident spends one month learning the techniques of collecting and processing tissue for cytogenetic studies, learns to do C, G, and O banding and FISH techniques, prepares and stains slides, and performs chromosomal analyses. The resident also learns to interpret the results every afternoon under the supervision of the cytogeneticist.

Molecular Pathology: This one month rotation at University Hospital is where the resident learns the fundamental principles of molecular diagnosis (i.e. PCR) of infectious diseases (i.e. viral, Chlamydial, Mycobacterial) and learns the methods for quantitative analysis (viral loads) of certain chronic viral diseases, such as HIV, Hepatitis B, and Hepatitis C, using RNA and DNA technology, along with the interpretation of results. An adjunct to this rotation is a basic course in molecular diagnostics given to technologist students by the UMDNJ/School of Health Related Professions on consecutive Thursday evenings for one month.

Toxicology: This is usually a two week rotation at the Regional Medical Examiners Office in Newark observing both drug screening and diagnostic techniques for illegal and therapeutic drugs. The resident also learns the pharmacology, pharmacokinetics, clinical features, and signs of overdose of common drugs in the field of Forensic medicine.

Flow Cytometry: The resident spends one month at University Hospital learning the principles and interpretation of flow cytometric data under the supervision of the Hematopathologists.

HLA and Tissue Typing: Usually one week is spent at the NJ Sharing Network headquarters in Springfield learning the principles and interpretation of HLA typing for organ/tissue transplantation and paternity testing.

Usually there is no on-call responsibility for doing any of the Clinical Pathology rotations described above. For electives in AP, the cal1 schedule will depend on the type of rotation.

Forensic Pathology: This one month rotation at the Regional Medical Examiners Office in Newark includes scene investigation of unnatural deaths (which includes being on call on weekdays and weekends), attendance at the daily "morning report" by the medical examiners and investigators, observing and performing forensic autopsies, and attendance at didactic presentations given by the medical examiners to medical students or other parties. This is a core rotation, which may also be taken again as an elective rotation.

Neuropathology: This one-month rotation at UH is with the department's two neuropathologists, It involves the resident attending didactic lectures and gross and microscopic neuropathology sessions along with the clinical neurology residents. The objectives include learning about neuropathologic congenital anomalies, infectious diseases, demyelinating diseases, dementia and CNS tumors, and diseases of muscle and peripheral nerve. There is no night or weekend call associated with this rotation.