Combined Renal and Solid Organ Transplant Fellowship
The Combined Renal and Solid Organ Transplant Fellowship is a Texas Medical Board-approved program offered by the Department of Pathology at UT Southwestern Medical Center. It is a one-year fellowship with comprehensive training in native kidney and solid organ (renal, liver, heart, lung, pancreas) transplant pathology.
The fellow will receive in-depth exposure to all aspects of evaluation, including light, immunofluorescence, and electron microscopies. Adult and pediatric specimens are well represented. The fellow is given graduated responsibility for handling cases and will become proficient in interpreting immunofluorescence microscopy, electron microscopy, and all typical and immunohistochemical light microscopic stains used in renal and solid organ transplant pathology.
The fellow is expected to participate in independent and collaborative research, including the initiation and completion of at least one research project during the course of the year. The expectation is that the research findings will be submitted and presented to a national scientific meeting, and will be submitted for publication in a peer-reviewed journal. Protected time is provided to perform work related to research activities and manuscript preparation.
In addition, the fellow will participate in renal pathology and transplant conferences and the education of residents and clinical fellows.
Availability: July 2020
Length of Program: One year
The Combined Renal and Solid Organ Transplant Fellowship is structured to provide all needed core training over a one-year period and to ensure proficiency in practice in native kidney and solid organ transplant pathology (histology, immunohistochemistry, electron microscopy, and molecular diagnostics where appropriate).
As clinical competence is gained, the fellow assumes responsibility for performing light, immunofluorescence, and electron microscopic evaluations and interpretations of renal and solid organ transplant biopsies, as well as communicating biopsy diagnoses with clinicians and preparing biopsy reports.
The clinical responsibilities the fellow assumes during the year of training include:
- Opportunity for sign-out of in-house native kidney and solid organ transplant pathology cases with appropriate faculty supervision
- Review of all consult cases
- Presentation and participation in renal pathology and solid organ transplant conferences
- Participation in research project(s)
Fellowship Goals and Objectives
The overall goals are to acquire the necessary medical knowledge, diagnostic skills, and experience to practice as a subspecialty expert in all aspects of native kidney and solid organ transplant pathology; gain research skills to develop a successful academic career; and become an outstanding educator for fellow pathologists, clinicians, and researchers in the field. Specific goals and objectives include:
- To gain diagnostic competence and the ability to provide appropriate and effective pathology services and clinical consultation for medical diseases of the kidney and solid organ transplants.
- To learn to collaborate with other professionals including those in other disciplines, in providing patient-focused care.
- The Combined Renal and Solid Organ Transplant pathology fellow gathers essential and accurate clinical information about the patients on whom they review surgical biopsy and resection specimens, or consult material, including discussion of history with clinicians, hospital chart review, and reports/slides of previous pathologic specimens when applicable.
- The Combined Renal and Solid Organ Transplant pathology fellow uses all appropriate pathologic findings including gross and microscopic pathology, and ancillary tests (immunohistochemistry, immunofluorescence, and electron microscopy) to arrive at an accurate final diagnosis for biopsy and resection specimens.
- The Combined Renal and Solid Organ Transplant pathology fellow uses up-to-date scientific evidence gleaned from journal articles, internet-based searches, and textbooks to support workup and diagnosis and to help educate clinicians by providing relevant literature references.
- To attain and continuously expand knowledge about established and evolving basic biological and clinical sciences and clinicopathologic correlations, and the application of this information to native kidney and solid organ transplant pathology for enhanced patient care.
- To gain analytical and problem-solving skills and their application in native kidney and solid organ transplant pathology.
- The Combined Renal and Solid Organ Transplant pathology fellow demonstrates an investigatory and analytic thinking approach to clinical situations including:
- Development of reasonable and complete differential diagnoses for surgical pathology cases based upon the available clinical information, gross and microscopic features, and applicable ancillary tests including: immunohistochemistry, immunofluorescence, and electron microscopy.
- Suggesting appropriate additional testing (special stains, immunohistochemistry, and further clinical testing such as serologies, etc.) if applicable.
- Formulation of comprehensive and cohesive differential diagnosis and discussion of pathology findings in final pathology reports with physicians in the departments of clinical medicine.
- Design and carry out research projects, such as clinicopathologic and translational studies or series with literature review.
- The Combined Renal and Solid Organ Transplant pathology fellow knows and applies the basic and clinically supportive sciences appropriate to the specialties of renal pathology and transplant pathology including:
- Demonstration of knowledge of the etiology/pathogenesis, epidemiology, clinical presentation, laboratory test findings, and prognosis of various medical diseases of the native kidney and transplanted solid organs, and use of such knowledge to formulate pathological diagnoses.
- Demonstration of familiarity with basic histochemical, immunohistochemical, and immunofluorescence stains including biochemical and immunologic principles, methods, and applications.
- Demonstration of knowledge of gross anatomy, histology, and pathophysiology during description of surgical pathology cases.
Practice-Based Learning and Improvement
- To gain the ability to evaluate and improve a diagnostic and consultative practice based on scientific evidence.
- To locate, appraise, and use scientific data to improve patient care.
- To apply knowledge of rigorous scientific principles, study design, and statistical methods to evaluate published clinical studies and clinicopathologic investigations.
- To learn to use information technology to manage information and conduct personal continuing education.
- To facilitate the learning of students, residents, colleagues, and other health care-related professionals.
- The Combined Renal and Solid Organ Transplant pathology fellow shows the ability to analyze practice experience and perform practice-based improvement activities using a systematic methodology including:
- Active participation in periodic conferences, including retrospective review of surgical case reports and slides; evaluating reports for diagnostic and typographical errors, assessing for suboptimal slide quality, and observation of various trends.
- The Combined Renal and Solid Organ Transplant fellow shows ability to locate, appraise, and assimilate evidence from scientific studies related to patients’ health care problems, including:
- Use of literature searches and reviews to find relevant scientific references to aid in the workup of cases.
- Obtain and use information about patient populations (via computer searches and medical records chart review) for clinicopathologic study of selected diseases.
- Design and conduct clinical, pathologic, translational, or basic science research studies.
Interpersonal and Communication Skills
- To acquire and use interpersonal and communication skills that result in effective information exchange and collaboration with other health care professionals.
- To create and maintain an effective, ethically sound, and respectful relationship with peers and other health care professionals.
- To use effective listening skills.
- To work effectively with other professional and non-professional staff.
- The Combined Renal and Solid Organ Transplant pathology fellow demonstrates effective communication and writing skills. This includes:
- Following instructions from attending pathologists during sign-out of cases and executing independent projects.
- Demonstrating interest in pathology case material during case sign-out by asking relevant questions and responding articulately to questions from attending pathologists.
- Eliciting relevant clinical information from and providing preliminary diagnostic information to clinicians via telephone conversations or trips to the operating room during intraoperative consultations.
- Effectively preparing and delivering oral surgical pathology case presentations to various intra-and extra departmental audiences.
- During fellowship training, serving as an effective teacher for the junior pathology house staff during their pathology rotations.
- Demonstrating effective oral and written communication skills in reports and research projects.
- The Combined Renal and Solid Organ Transplant pathology fellow works effectively with others as a member or leader of a healthcare team or other professional group, including:
- Preparation and presentation of cases during weekly and monthly pathology/clinical conferences.
- To maintain a commitment to excellence in carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity in the workplace.
- To maintain respect, compassion, and integrity; responsiveness to patients that supersedes self-interest; accountability to patients, colleagues, and the profession and discipline of pathology; and a commitment to on-going professional development.
- To develop and maintain a commitment to confidentiality of patient information, informed consent, and ethical business practices.
- To learn the highest principles relating to conflict of interest and commitment.
- To develop the maximum sensitivity to colleague and patient ethnicity, age, gender, and disability.
- The Combined Renal and Solid Organ Transplant pathology fellow must demonstrate a commitment to completion of professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population, including:
- Showing respect, compassion, and integrity during active participation in multidisciplinary conferences.
- Showing responsiveness and accountability to the needs of patients and their families and clinicians that supersedes self-interest, including contributions to the timely completion of surgical pathology reports and discussion of results with clinicians.
- Demonstrating commitment to excellence and ongoing professional development, such as completing directed and independent reading from pathology textbooks and journal articles during the fellowship year, designing and completing research projects, undertaking literature searches on various pathology topics, providing high-quality presentations at conferences, and attending in-house and off-site pathology lectures and conferences.
- Demonstrating a commitment to ethical principles pertaining to confidentiality of patient information acquired during handling of case material.
- Demonstrating adherence to the highest principles of mutual respect of colleagues and support personnel.
- Understand how patient care related to Renal/Transplant pathology relates to the health care system as a whole.
- Participate in identifying system error and implementing solutions.
- Incorporate consideration of cost awareness in daily practice.
- The Combined Renal and Solid Organ Transplant pathology fellow must know critical aspects of patient care/safety including critical values in pathology relevant to GI and Liver ecologic pathology.
- The Combined Renal and Solid Organ Transplant pathology fellow must understand how certain aspects of specimen processing, grossing, and turnaround time of pathology reports can affect patient care and learn to develop problem solutions.
- The Combined Renal and Solid Organ Transplant pathology fellow must be aware of costs related to additional tests and studies, and learn how to select the best test based on clinical necessity while considering the related costs.
Evaluation of Fellow
The program directors and other pathology faculty members with whom the fellow interacts will evaluate the fellow on a quarterly basis.
Prospective candidates must have completed an ACGME-accredited residency in anatomic pathology, must be board eligible or board certified in anatomic or anatomic and clinical pathology by the American Board of Pathology, and must be eligible for a training license to practice in Texas by the beginning of the fellowship program.
Salary for Fellows
The salary will be commensurate with the applicant’s level of training.