Goal of the Pathology Residency Program

The goal of pathology training at UT Southwestern Medical Center is the development of competency in the required areas of medical practice, such that the graduate of the Pathology Residency Program will possess the knowledge, skill, and attitude for the successful practice of pathology (i.e. the ability to recognize, interpret, and explain pathologic processes) and for the life-long pursuit of learning.

Objectives of the Pathology Residency Program in the Six Core Competencies

  • Patient Care: The resident will acquire competency in the technical generation and interpretation of laboratory data and in the formulation of clinicopathologic correlations, so as to provide appropriate and effective consultation in the context of pathology services. In those situations where the resident has direct interaction with patients, families, or donors (e.g. bone marrow aspiration, fine needle aspiration, apheresis), the resident will perform such interviewing, examination, and counseling as may be required with caring and respect. The resident will learn how to work effectively within a multidisciplinary health care team, participating as appropriate in informed decision-making and clinical management.
  • Medical Knowledge: The resident will acquire knowledge about established and evolving biomedical, clinical, and clinically related sciences and will apply this knowledge to the understanding of basic pathologic processes in both individual patients and the general patient population. The resident will apply concepts of investigational and analytic thinking to the interpretation of laboratory data.
  • Practice-based Learning and Improvement: The resident will learn to appraise and assimilate scientific data from the medical literature toward the practice of evidence-based medicine. The resident will learn to apply research and statistical methods to laboratory data. The resident will learn the principles and practice of information technology and how it can be used to manage patient data. The resident will learn to investigate and evaluate his/her own diagnostic and consultative practices, and to improve his/her patient care practices.
  • Interpersonal and Communication Skills: The resident will develop interpersonal and communication skills that result in the effective exchange of information and expertise with other health care providers, patients, and patients’ families, and will assume an active role in the education of the health-care community.
  • Professionalism: The resident will develop a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population of patients and health care providers.
  • Systems-based practice: The resident will develop knowledge and experience in laboratory management, an awareness and responsiveness to the place of pathology in the larger context and system of health care, and the ability to call on resources within the system to provide pathology services that are of optimal value.

Design of the Pathology Residency Program with Respect to Levels of Training

The attainment of the six core competencies is achieved through a training curriculum of four years for AP/CP residents (three years for AP-only and CP-only residents). The basic curriculum is composed of a series of required rotations through various areas of the clinical laboratory, in which the resident will gain competency through didactic lessons with faculty and staff, independent study, participation in patient care activities as part of the health-care team, and participation in quality assurance and management activities of the laboratory, the institution and the greater health-care community. While the order of rotations is not absolutely fixed in order that some degree of individualization may be introduced, expected stages of competency are reflected in the general order of the rotations. The basic plan for a four-year AP/CP training program is as follows:

Year 1

The resident is (re-)introduced to basic histology and histopathology through a series of introductory conferences. After the introductory series, the main AP and CP series of lectures and case or slides presentations on a comprehensive overview of topics begins. (The topics repeat on a 2-year cycle.)

The formal rotation schedule for the first year includes initial rotations in Autopsy Pathology (including pediatric, perinatal, and natural-death forensic cases) and Surgical Pathology, where the resident learns basic gross and microscopic anatomical skills, along with skills at obtaining relevant history from caregivers and from the medical record and communicating results verbally and through the preparation of written reports. On the autopsy rotation, residents accrue cases during their first two months, with a third month for completion of reports and participation in morbidity/mortality conferences and other quality assurance activities. Initial rotations in Hematopathology and Transfusion Medicine introduce the resident to the clinical laboratories and permit the resident to begin functioning as a consultant.

Finally, the first year typically begins to introduce the resident to translational pathology through a Molecular Pathology rotation, where the resident begins to learn how fundamental basic science techniques can be adapted to provide clinically useful information. Through the preparation of informal intra-departmental presentations, the resident also begins to polish his/her communication skills and proficiency in utilizing library and internet resources.

  • Medical Knowledge: Reviews basic histology and histopathology; begins to be introduced to topics and illustrative cases in general and subspecialty pathology; begins to acquire depth of knowledge in hematopathology and transfusion medicine; is introduced to molecular diagnostics as a field in translational pathology.
  • Patient Care: Begins to acquire basic techniques in autopsy prosection and gross examination of surgical specimens by working on patient material; begins to develop interpretive skills on slides, smears, and clinical laboratory test results; refines skills in obtaining relevant historical information for patient care from charts and other sources.
  • Interpersonal Skills and Communication: Begins to interact with clinicians and other health-care providers to obtain history and convey results and interpretations; begins to learn modes of effective interaction within the laboratory and physician hierarchy; begins to compose effective autopsy, surgical, and clinical laboratory consultation reports; begins to give oral presentations.
  • Professionalism: Observes and begins to emulate the professional behavior of colleagues; learns basic concepts of patient information confidentiality and ethics in the practice of medicine; learns the basics of informed consent, particularly as regards the autopsy; learns to follow rules of behavior and practice within the residency program and hospitals as governed by regulatory and accrediting agencies.
  • Practice-based Learning: Observes and participates in quality assurance activities such as case reviews and morbidity-mortality conferences in surgical pathology and autopsy; observes and participates in quality control and quality assurance activities in hematopathology and transfusion medicine; reviews and refines basic skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources; begins developing a plan for ongoing learning through the residency and on a lifelong basis.
  • Systems-based practice: Begins to learn appropriate utilization of testing through managing the work-up of autopsies and uncomplicated surgical and bone marrow specimens and through oversight of ordering of blood products in transfusion medicine; begins to learn to navigate the health care system at Parkland Memorial Hospital and Children’s Medical Center, as well as the medico-legal aspects of the medical examiner facility.

Year 2

The resident further refines his/her skill and knowledge in surgical pathology through at least one additional rotation in Surgical Pathology. In addition to assuming greater responsibility for his/her cases, the second year resident on surgical pathology also functions as instructor for first-year residents on the service.

An initial rotation in Cytopathology introduces the resident to the preparation and interpretation of cytologic specimens, as well as administrative and quality assurance aspects of the cytopathology laboratory. In addition, this rotation staffs a fine-needle aspiration clinic which allows the resident to attain competency in the performance of FNAs. Typically, the second year also includes rotations in Clinical Chemistry and/or Microbiology, which provide not only an introduction to those areas of the laboratory but also include introductory aspects of laboratory management, such as quality control, quality assurance and test evaluation. On the CP rotations, the resident serves as a consultant to the send-out area of the laboratory, helping to ensure appropriate utilization of unusual tests, locations and requirements for testing, and interpretation of received results. Through a rotation in Flow Cytometry, the resident builds on knowledge and morphologic skills acquired in the basic Hematopathology rotation to act as a supervised laboratory consultant.

Elective time for subspecialty rotations or research projects typically is made available to the resident in the second year of training, so that residents may begin to explore developing interests in subspecialty areas (in ample time for fellowship applications during the third year of training).

Also, in the second year, the resident begins taking night and weekend call for both the surgical pathology and clinical laboratories, as a step in graduated responsibility. Communication skills are further polished as the resident begins making formal case presentations and literature reviews and assumes the responsibility of leading a case discussion group in the second-year pathology course at UT Southwestern.

  • Medical Knowledge: Gains additional knowledge of histopathology through further exposure to topics and illustrative cases in general and subspecialty pathology; begins to acquire depth of knowledge in microbiology and clinical chemistry; is introduced to flow cytometry and cytogenetics as major areas of translational pathology.
  • Patient Care: Acquires basic skills in the performance of superficial fine-needle aspirations on patients; continues to polish skills in gross examination of surgical specimens by working on patient material; continues to develop interpretive skills on surgical slides and begins to develop interpretive skills on cytologic preparations, along with correlation between the two; expands skills in interpretation of laboratory test results into areas of microbiology and clinical chemistry; learns interpretations of flow cytometry and cytogenetic laboratory results and their correlation with findings from other areas of the AP and CP laboratories; begins taking service call for surgical pathology and the clinical laboratories.
  • Interpersonal Skills and Communication: Continues to interact with clinicians and other health-care providers to obtain history and convey results and interpretations; continues to learn modes of effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; further develops skills in composing effective surgical, cytological and clinical laboratory consultation reports; enhances skill in giving oral presentations through additional practice; begins to acquire teaching skills through orientation of new residents and medical students and through leading a discussion group in the second-year medical school pathology course.
  • Professionalism: Continues to develop concepts of personal professional behavior and begins acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent, particularly with respect to working in the fine-needle aspiration clinic; reinforces the importance of rules of behavior and practice within the residency program and hospitals as governed by regulatory and accrediting agencies.
  • Practice-based Learning: Continues to participate in quality assurance activities such as case reviews; observes and participates in quality control and quality assurance activities in microbiology, clinical chemistry, flow cytometry and cytogenetics; refines basic skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; continues developing a plan for ongoing learning through the residency and on a lifelong basis.
  • Systems-based practice: Further develops a sense of appropriate utilization of testing through managing the work-up of surgical and cytology specimens and send-out specimens from the clinical laboratories; learns finer points of navigating the health care systems at Parkland Health & Hospital System, Children’s Medical Center, and UT Southwestern University Hospitals.

Year 3

An advanced rotation in Autopsy Pathology affords the resident the opportunity to attain greater proficiency and independence in basic and more specialized dissection techniques and to serve as an instructor for first-year residents on the service. Participation in forensic pathology cases in the office of the Medical Examiner exposes the resident to the specialized aspects of the forensic autopsy and crime-scene investigations. A rotation in Neuropathology gives the resident additional, concentrated experience in autopsy and surgical neuropathology as well as an introduction to the work-up of nerve and muscle biopsies. The resident acquires further skill, knowledge, and teaching experience through additional surgical pathology rotations, especially through rotations at UT Southwestern University Hospitals and Children’s Medical Center, which allow the resident access to a broader spectrum of patients and specimens.

The resident gains a practical introduction to electron microscopy, and also manages subspecialty cases in skin, kidney, liver, and eye pathology. The clinical laboratory experience is enriched by a rotation in Immunopathology, a senior rotation in coagulation and transfusion medicine, in which the resident assumes greater responsibility for the management of therapeutic apheresis patients, and a senior rotation in hematopathology, during which the resident has the opportunity to perform bone marrow aspirations and biopsies in the Hematology-Oncology Clinic.

Additional elective time for subspecialty training and/or research is also available. The resident continues to take AP and CP call for the clinical laboratories. The resident prepares a departmental presentation for the Update in Pathophysiology Conference series and may be given additional small-group teaching responsibilities in the MS2 pathology course.

  • Medical Knowledge: Refines knowledge of histopathology through further exposure to topics and illustrative cases in general and subspecialty pathology, including forensic pathology, neuropathology, dermatopathology, renal pathology, hepatic pathology, ophthalmic pathology, and pediatric pathology; refines knowledge in hematopathology, coagulation and transfusion medicine, and expands knowledge in immunopathology.
  • Patient Care: Refines skill in basic and more specialized techniques in autopsy prosection and gross examination and microscopic interpretation of surgical specimens by working on patient material, especially the distinct patient populations of the UT Southwestern University Hospitals and Children’s Medical Center; learns specialized procedures for handling and interpreting skin, kidney, liver, and eye specimens; gains practical exposure to electron microscopy; refines skills in interpretation of laboratory test results, especially in immunopathology, hematopathology, coagulation and transfusion medicine; continues taking service call for surgical pathology and the clinical laboratories.
  • Interpersonal Skills and Communication: Refines skill in interacting with clinicians and other health care providers to obtain history and convey results and interpretations; refines effective interaction within the laboratory and physician hierarchy, both through routine service and call activities; refines skills in composing effective autopsy, surgical, and clinical laboratory consultation reports; refines skill in giving oral presentations through additional practice, including a major departmental presentation; refines teaching skills through orientation and teaching of new residents and medical students.
  • Professionalism: Refines concepts of personal professional behavior and continues acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent, particularly with respect to working in the autopsy, forensic, and surgical pathology areas; reinforces the importance of rules of behavior and practice within the Pathology Residency Program and hospitals as governed by regulatory and accrediting agencies.
  • Practice-based Learning: Continues to participate in quality assurance activities such as case reviews; observes and participates in quality control and quality assurance activities in immunopathology, hematopathology, coagulation and transfusion medicine; refines skills in the practice of evidence-based medicine and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; continues developing a plan for ongoing learning through the residency and on a lifelong basis.
  • Systems-based practice: Refines sense of appropriate utilization of testing through managing the work-up of surgical and autopsy specimens and send-out specimens from the clinical laboratories; learns finer points of navigating the health care systems at Parkland Health & Hospital System, Children’s Medical Center, and the UT Southwestern University Hospitals.

Year 4

In the last year of training (or sometimes the third year for appropriately advanced trainees), the resident has an extended rotation in advanced anatomic pathology at the Dallas Veterans Administration Medical Center. Because this health care setting allows the resident to function more independently as a caregiver, this rotation represents the highest plane of graduated responsibility available in the Residency Program. It encompasses surgical pathology, cytopathology, and autopsy services, and qualified residents perform and interpret their own frozen sections and fine-needle aspirations, with appropriate supervision and back-up from faculty. The senior rotation in laboratory management affords the resident an opportunity to participate in the management activities of the clinical laboratories.

The fourth year of training allows time to complete any further required rotations that could not be accommodated in the previous years’ schedules, as well as elective time for subspecialty training or research. The resident continues to take AP and CP call for the clinical laboratories and may be given additional small-group teaching responsibilities in the MS2 pathology course.

Two residents are chosen as Chief Residents and assume administrative roles in the operation of the Residency Program.

  • Medical Knowledge: Achieves competency in the knowledge of anatomic pathology through further exposure to topics and illustrative cases in general and subspecialty pathology; achieves competence in clinical pathology through additional study, call and elective rotations; achieves competency in knowledge related to laboratory management through study.
  • Patient Care: Achieves competency in techniques in autopsy prosection and gross examination and microscopic interpretation of surgical and cytologic specimens by working on patient material, especially the distinct patient population of the VA Medical Center; achieves competency in interpretation of laboratory test results, through service and call for surgical pathology and the clinical laboratories; achieves competency in laboratory administration through participation in management activities in the clinical laboratories.
  • Interpersonal Skills and Communication: Achieves competency in interacting with clinicians and other health care providers to obtain history and convey results and interpretations; achieves competency in interaction within the laboratory and physician hierarchy, both through routine service and call activities; refines skills in composing effective autopsy, surgical, and clinical laboratory consultation reports; achieves competency in giving oral presentations through additional practice; refines teaching skills through orientation and teaching of new residents and medical students, including leading a discussion group of second-year medical students.
  • Professionalism: Achieves competency in personal professional behavior and continues acting as a role model for beginning residents and students; practices basic concepts of patient information confidentiality, ethics in the practice of medicine, and informed consent, particularly with respect to working in the autopsy, forensic and surgical pathology areas; achieves competency in behavior and practice within the residency program and hospitals now and for the future, as governed by regulatory and accrediting agencies.
  • Practice-based Learning: Achieves competency in quality assurance activities such as case reviews; observes and in quality control and quality assurance activities; achieves competency in the practice of evidence-based medicine, and review of relevant literature through journal clubs and independent use of library and Internet resources and through serving as a consultant to clinical services; achieves competency in planning for ongoing learning through the residency and on a lifelong basis.
  • Systems-based practice: Achieves competency in appropriate utilization of testing through managing the work-up of surgical, cytologic, and autopsy specimens and send-out specimens from the clinical laboratories; achieving competency in navigating the health care systems at Parkland Health & Hospital System, Children’s Medical Center, UT Southwestern University Hospitals, and the VA Medical Center.