(1 ) Pediatric pathology fellow; (Board certified or eligible in anatomic only, or anatomic and clinical pathology; spending 1 or 2 years learning pediatric pathology with a view to academic practice) Board certification in Pediatric Pathology after one year.
Service Duties: Fellows take part in the surgical pathology, autopsy pathology, clinical laboratory diagnosis and and cytology services; they take weekend call as detailed below. All activities are reviewed by an assigned staff pathologist.
Graduated Responsibility: New fellows will do frozen sections side by side with the staff pathologist, take call with the pathologist and review biopsies prior to final writing or dictation. Senior fellows will take call and do frozen sections, checking with the staff person (in the room) prior to communicating the diagnosis.
Surgical Pathology: Fellows make decisions regarding the handling or triage of fresh tissue specimens. The fellows, under the guidance of the attending staff or a pathologists' assistant, grossly describe tissue by dictation, sample, triage and process the specimens. Fellows review and correct dictation. They review the glass slides, dictate microscopic descriptions and tentative diagnoses. The fellow is responsible for obtaining x-rays for relevant cases. The fellow is responsible for identifying any relevant prior biopsies and pulling the slides from the files for comparison. Fellows order special stains, go to the medical record for more clinical information, call clinicians for further clinical elaboration or to provide results. Fellows go to the literature, (Medline) and find pertinent literature for discussion with the attending pathologist. The fellow proofreads all surgical pathology results. The fellow may, only under supervision and after review of the case with the attending pathologist, sit with the clinicians and review the slides. Fellows go to the operating room, talk to the surgeon, take tissues for frozen section, cut and stain the tissues for review with the attending pathologist.
Call: Week-end call is with a pathologist, no pathologists' assistants. Fellows field calls on weekends and come in to the hospital to handle cases after discussion with the attending pathologist. Saturdays are full working days for the fellow on weekend service, about one weekend in four, and the fellow is responsible for grossing and processing "rapid" specimens before 9 am on Sundays. They then collect and review the slides, pull previous slides, and review the case with the attending pathologist before showing the slides to the clinicians.
Autopsy Pathology Service: Fellows discuss the approach to an autopsy with the attending pathologist and review and summarize the clinical chart. They physically perform (prosect) the autopsy. Fellows dissect the organs, review the findings with clinicians after review with the staff pathologist and dictate the gross description and findings.
The fellow prepares a preliminary anatomic diagnosis (PAD) to be reviewed by the staff and signed out within 72 hours.
The fellow presents the clinical summary and the gross findings at the weekly Gross Autopsy Conference.
The fellow samples and processes tissue sections for microscopy. They review the glass slides and write the findings, to be reviewed with the attending pathologist. The fellow orders, reads, writes up and reviews special stains and other special autopsy procedures. The fellow reviews the literature and prepares a summary for the case sign-out. The fellow presents the clinical summary, slide results and tentative findings at the weekly Autopsy Sign-out Conference, after discussion with the attending pathologist about four weeks after autopsy.
The fellow proofreads the completed autopsy prior to its verification by the attending pathologist.
Cytology Service: The fellow reviews the cytology slides for the day, writes the results, reviews the case with the attending pathologist and corrects/proofreads the report.
Teaching: The fellows are responsible for providing literature review for teaching cases at the slide conferences. There is a well stocked library in the department, and personal computer access to the web at their desk.
When medical students are on rotation, the resident or fellow apprentices and instructs the medical student. Fellows may be required to prepare presentations for hospital-wide conferences, mortality, surgical pathology, tumor board, and clinical-pathological exercises and to review the cases for presentation with the attending pathologist.
Fellow Load: A fellow may be involved in the full workup of up to 150 surgical specimens, consisting of about 450 separate parts per week.
There are about 25 cytology specimens and an average of 1 autopsy per week.