Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Residency Program

Anatomic Pathology

Anatomic pathology training involves the examination of human tissues. These studies include performance and examination of tissues from autopsy and surgical material. The complete examination of these cases includes gross dictation and examination of histologic slides from autopsy, routine, frozen, and biopsy cases that the resident/fellow will review prior to sign-out with a faculty member. Discussion of the pertinent aspects of each case and the sign-out will occur using a double or multi-headed microscope.

Eventually, with graduated responsibility, it is expected that the upper level residents rotating on the surgical pathology service will sign out cases on their own with minimal supervision by the faculty prior to the dictation of diagnoses. Service responsibilities are important components of training in anatomic pathology, where nothing can replace the experience of the autopsy gross dissection and intraoperative consultation for both gross and microscopic (frozen section) findings in the pathology of disease. Anatomic pathology study packets are being prospectively accrued for every organ system and currently over 500 slide sets are available for review by residents.

Daily microscopic review conferences, frequent unknown frozen section conferences, subspecialty conferences, didactic teaching sessions, grand rounds, and journal clubs are among the educational opportunities that residents attend. With graduated responsibility, upper level residents will present unknown and tumor board conferences. Individual faculty study sets are also available in many subspecialty areas. These materials aid trainees in the fine nuances of diagnosis and allow for review of various subspecialty topics in anatomic pathology with attending pathologists. The Methodist Hospital program also offers a research scholars program for residents interested in pursuing careers as investigative pathologists. Learn more about the Pathology Resident Research Program.

Clinical Pathology

Clinical pathology requires extensive knowledge of disease, medical practice, diagnostic technology, and laboratory practice. In clinical pathology training, this broad discipline will include rotations in each of the subspecialty laboratories. Generally, initial orientation to each of the laboratory sections will be accompanied by didactic lectures and reading exercises to build the fund of knowledge required for effective practice of clinical pathology. In addition, training on instrumentation and laboratory processes will be provided. In each subspecialty, consultative services are provided for test interpretation, test utilization, and diagnostic strategies. Each subspecialty has its own assays that require interpretation by a pathologist and residents will participate in these activities with an emphasis on the development of graduated responsibility and the development of appropriate managerial skills. Residents will also receive training through participation in occurrence investigation, utilization review, interaction with clinical medical staff and house staff, interaction with technical staff, interaction with other pathologists, and independent study. Resident training will be provided under the direct supervision of the clinical pathology staff.

Residents will have frequent opportunities to provide feedback on the effectiveness of the training program, the faculty, and their colleagues. They will also have regular individual performance reviews, with emphasis on career counseling. Many opportunities for fellowship training are subsequently available in The Methodist Hospital Department of Pathology and Genomic Medicine for graduates of the programs, including surgical pathology, clinical chemistry, cytopathology, neuropathology, ophthalmic pathology, hematopathology (2 programs), blood banking/transfusion medicine, and HLA for Ph.D. laboratory directors.

At the conclusion of training in either anatomic pathology/clinical pathology combined, anatomic pathology only, or clinical pathology only tracks, residents will become competent and independent practitioners of pathology.


ROTATION OVERVIEW

Anatomic and Clinical Pathology Training

ANATOMIC PATHOLOGY REQUIRED ROTATIONS:

Core Rotations:

Autopsy Service (The Methodist Hospital [TMH] Service – 3 months)
Surgical Pathology (TMH - 6 months)
Pediatric Pathology (Memorial Hermann Children’s Hospital – 1 month)
Cytopathology (TMH - 2 months)

Upper Level Rotations:

Forensic Pathology (Harris County Institute of Forensic Sciences [medical examiner’s office] - 1 month)
Autopsy and Surgical Pathology (M.D. Anderson -1 month)
Neuropathology (TMH - 1 month)
Cytopathology (TMH - 1 month, preferably PGY4)
Surgical Pathology (TMH - 8 months)

TOTAL: 24 months

CLINICAL PATHOLOGY REQUIRED ROTATIONS:

Core Rotations:

Hematopathology (3 months: 2 months TMH, 3rd month at TMH, or Memorial Hermann by arrangement)
Microbiology (3 months TMH)
Blood Banking/Transfusion Medicine (3 months: 2 months TMH, 1 month Memorial Hermann)
Clinical Chemistry (3 months: 2 months TMH, 1 month Memorial Hermann)

Upper Level Rotations:

Hematopathology (including 2 months of flow cytometry – TMH)
Cytogenetics (1 month – Baylor College of Medicine)
Molecular Pathology (1 month – TMH)
HLA (1 month – TMH)
Laboratory Management (1 month – TMH)

TOTAL: 18 months

ELECTIVES:

AP, CP or Research: 6 months
See list below of AP and CP ELECTIVES
For those residents who are interested in a CP fellowship, flexibility is warranted.


ROTATION DESCRIPTION OF THE PROGRAM

Required and Elective Rotations

I. Anatomic Pathology Core (AP/CP or AP only) - Required

Duration: 12 months in the first 2 years of training
Location: Residents will be assigned to TMH

The first week includes an overall orientation to anatomic pathology, which is followed by an intensive 3-week autopsy experience for PGY1 residents.

3 Months Autopsy
2 Months Cytology
6 Months Surgical Pathology
1 Month Pediatric Pathology

Cytopathology (AP/CP or AP only) - Required

Duration: 2 months
Location: Residents will be assigned to TMH
Description: These rotations include training in exfoliative gynecologic and non-gynecologic cytopathology, as well as performance and interpretation of fine-needle aspiration biopsies.

Pediatric Pathology (AP/CP or AP only) - Required

Duration: 1 month
Location: Memorial Hermann Children's Hospital
Description: This is a combined experience in pediatric autopsy and surgical pathology. Residents are eligible for this rotation after completion of the 9-month anatomic pathology core. For most AP/CP residents, this rotation will occur in their third or fourth year of residency.

II. Upper Level Anatomic Pathology (AP/CP or AP only) - Required

Duration: 12 months (includes the subspecialty rotations in: cytopathology, forensic pathology, neuropathology, and 1 month autopsy/surgical at M.D. Anderson) and 8 months of general anatomic/surgical pathology.
Location: TMH

General Anatomic/Surgical Pathology (AP/CP or AP only) - Required

Description: The 8 months are intensive anatomic pathology experience in which residents concentrate on biopsy interpretation, frozen sections, and supervision of junior residents. The rotation includes additional upper level autopsy and surgical experience at M.D. Anderson with graduated responsibility.

Forensic Pathology (AP/CP or AP only) - Required

Duration: 1 month
Location: Harris County Institute of Forensic Sciences (medical examiner’s office)
Description: Residents receive training in a variety of forensic cases and are exposed to toxicology, crime scene investigation, and court appearances.

III. Upper Level Anatomic Pathology (AP/CP or AP only) - Elective

Duration: 1 to 2 months
Location: TMH
Description: This rotation is an additional upper level junior faculty-type experience in which residents will be given increasing independence and responsibility and the opportunity to refine their diagnostic skills in the latter part of their residency.
(Examples of elective AP rotations: GI pathology, GU pathology, pulmonary pathology, renal pathology, biopsy & breast consult Service)

IV. Clinical Pathology Core (AP/CP and CP only) - Required

Duration: 18 months during the 4 years of training
Location: Residents will be assigned to TMH, Memorial Hermann, The University of Texas Medical Branch (Galveston, TX), and Baylor College of Medicine.

3 months - Hematopathology (flow cytometry, lymph node, and bone marrow)
3 months - Transfusion Medicine/Blood Banking
3 months - Clinical Chemistry, including Serology and Informatics
3 months - Medical Microbiology
1 month - Coagulation
1 month - Cytogenetics
1 month - Molecular Diagnostic Pathology
1 month - Histocompatibility Laboratory (HLA)
1 month - Upper Level Hematopathology
1 month - Laboratory Management

Residents may be assigned to one hospital for a given rotation. However, to broaden the educational experience for clinical chemistry and transfusion medicine, two months are usually provided at TMH with one month at Memorial Hermann. The cytogenetics rotation will be conducted at the Baylor College of Medicine.

V. Clinical Pathology (AP/CP or CP only) - Elective

Duration: Up to 6 months for AP/CP
Location: Residents will be assigned primarily to TMH; however some rotations are available at Memorial Hermann and Baylor College of Medicine/Texas Children's Hospital.
Description: Varied experiences are available in hematology/coagulation, clinical chemistry, transfusion medicine, HLA testing, microbiology, flow cytometry, and molecular pathology