At Beth Israel Deaconess Medical Center (BIDMC), our mission is to combine academic excellence with a collegial, supportive training environment. We look to prepare residents for all potential career pathways including academia and private practice. Our faculty are nationally recognized for clinical excellence and, as a Harvard Medical School teaching hospital, we provide access to outstanding research and other collaborative opportunities. We have also been on the forefront of novel training approaches for Pathology residents. Faculty at BIDMC have developed and published curricula on evidence-based Transfusion Medicine, teaching Pathology to third year medical students, and genomic testing. BIDMC offers three training pathways: Combined Anatomic and Clinical Pathology (AP/CP), AP-only and CP-only. The AP/CP training pathway is available every year and accounts for the majority of residents. Availability of AP-only and CP-only training pathways varies by year; interested applicants should contact Joan Allin (Residency coordinator, contact information below).
Combined Program At BIDMC, we believe that learning requires a cohesive, longitudinal experience. For example, it is difficult to develop an effective curriculum in an area such as Transfusion Medicine if rotations are randomly spaced over four years of training. As such, the first two years of training are organized in one-year blocks (beginning with a one-year block of AP or CP training, followed by a one-year block of the other discipline). In this way, residents develop a solid foundation in both areas of Pathology. After obtaining core AP and CP knowledge during the first and second years, the third and fourth years allow a period of review and synthesis, in part designed by the residents themselves, with graduated clinical responsibility and research opportunities. Although the first two years are organized in one-year blocks of AP or CP, integration of these areas starts at the beginning of training with residents attending both AP and CP conferences, regardless of their year in training. In this way, they develop a multi-disciplinary knowledge base and deeper appreciation for pathologic issues that often optimally require insights from both arms of our discipline. In addition, they maintain skills obtained during their training in AP while in their CP years and vice versa.
First Year, Anatomic Pathology: In their first year of anatomic pathology training, residents train in Surgical Pathology, Autopsy Pathology, and Cytology. In Surgical Pathology, residents are exposed to different organ systems and a broad range of specimens, both small and large. Of note, in our program, subspecialty sign out rotations are of one or two weeks’ duration rather than one or two-month blocks. We believe this provides a significant training advantage as residents have recurrent focused exposure to different disease entities in each organ system throughout the year, thereby reinforcing learning.
First Year of Clinical Pathology: In their first year of clinical pathology training, the first four months of the year are divided into four one-month rotations, one in each of the four core disciplinaries (Chemistry; Hematology/Coagulation/Hematopathology; Microbiology; and Transfusion Medicine) to facilitate call and allow residents to gain exposure to all four fields efficiently. The remaining eight months of the year consist of two-month blocks, again in each of the four core disciplines. Our Laboratory Management curriculum, (including quality control, quality assurance and utilization review) includes not only lectures but exercises such as a mock laboratory inspection to help residents better understand key concepts. Informatics and the use of new technologies are integrated into the rotations. We emphasize clinical context for the laboratorian serving as an effective consultant. For example, residents cover the pagers for the laboratories, write reports and interact directly with other clinicians. Furthermore, we integrate residents within greater hospital teaching conferences (e.g., “Firm” case sessions involving internal medicine faculty, residents, and students).
Years Three and Four: Putting It Together Now that the resident has a solid foundation in both AP and CP, rotations during years 3 and 4 allow consolidation and integration of the disciplines. The schedule also includes a formal one-month rotation in Molecular Diagnostics and Cytogenetics. This rotation incorporates teaching from all the clinical laboratories as well as Anatomic Pathology and there is also the opportunity to develop skills to critically analyze the literature and present findings. This month also includes our novel Genomic Pathology curriculum. Genomic technology will affect the practice of all medical practitioners. As the physicians who manage the hospital laboratories, pathologists must understand next-generation sequencing technology and its application to patient care. In 2009 we created, to our knowledge, the first Genomic Pathology curriculum in the country. We have published our curriculum and continue to refine and improve the content. Our curriculum has served as the basis for a collaborative effort to develop a national genomics curriculum (www.pathologylearning.org/trig) which is currently being funded by a $1.3 million R25 grant from the NIH. Five months of additional Clinical Pathology experience is required. Three months involve advanced rotations in the core laboratories. The residents are given additional responsibility in regard to leading rounds and teaching residents and often pursue research projects with our faculty. The two remaining months can also be in the core labs, as a subspecialty rotation (e.g., stem cell processing laboratory) or residents can design their own novel rotations under the guidance of a faculty member. In addition to required Surgical and Autopsy Pathology rotations, year 3 and 4 rotations in Anatomic Pathology include Cytopathology (2 months), Pediatric Pathology (4 weeks) and Forensic Pathology (2 weeks). Three months of elective time may be spent in one-month advanced subspecialty Surgical Pathology rotations for residents who have demonstrated proficiency in core requirements. Residents play a more important role in conference preparation and presentation (e.g., tumor boards) and often participate in research projects; Furthermore, they act with greater autonomy during clinical consultations. All of our rotations occur at BIDMC with two exceptions: Residents learn Pediatric Pathology during a rotation at Boston’s Children’s Hospital, a large, well-organized department with an excellent faculty and educational resources; The Forensic Pathology rotation occurs at the Massachusetts Medical Examiner’s Office in Boston with a large volume of medical-legal autopsies. Upon graduation from this pathway, a large proportion of our residents pursue subspecialty fellowship training in one of the many fellowships offered by our department, before going onto faculty positions, often at major academic medical centers.
Anatomic Pathology Program The first year is the same as in the combined program. The activities in Anatomic Pathology continue in the second and third years, and include rotations in Pediatric and Forensic Pathology, Cytopathology, Cytogenetics, Hematopathology, Molecular Pathology, further exposure to other subspecialties, and opportunity for research. The third year is modified to suit subspecialty interests; Here residents polish their skills as diagnostic surgical pathologists in preparation for a career in academic surgical pathology. Typically, electives involving clinical or translational research projects enable the resident to develop a subspecialty research interest.
Clinical Pathology Program The major educational goal of this program pathway is to train future leaders in Laboratory Medicine. It is especially intended for those who wish to develop leadership capabilities in a Clinical Pathology subspecialty. The first year is the same as the Clinical Pathology core year in the combined APCP program and the second year includes a rotation in Molecular Pathology and Cytogenetics. Further training in the second and third years is based on the needs and interests of the resident. The resident, residency director and faculty work together to create a personalized curriculum of additional rotations.
There are 32 residency positions available with 7-9 first-year positions available yearly. Also, there are separate one-year fellowship positions available in Breast Pathology, Cytopathology, Dermatopathology, Gastrointestinal Pathology, Hematopathology, Molecular Pathology, Neuropathology, Surgical Pathology, and Transfusion Medicine. Preference for these positions is given to residents already enrolled in our program. Molecular Pathology, Neuropathology, Transfusion Medicine and Dermatopathology are joint fellowships with other Harvard teaching hospitals.
Beth Israel Deaconess Medical Center is the result of the 1996 merger of Beth Israel Hospital and New England Deaconess Hospital. The department has three major divisions: Anatomic Pathology; Laboratory Medicine; and Experimental Pathology. Each resident has his or her own microscope and computer workstation, as well as access to scanners, presentation software, online learning resources, and an extensive interactive laboratory information system. Major renovations of the conference room and gross room spaces are underway, with completion expected in the Summer of 2017. Beth Israel Deaconess Medical Center is one of the primary Harvard teaching hospitals and all residents receive an academic appointment at Harvard Medical School and access to the Countway Medical Library.
Boston is a great city. The neighborhoods adjacent to the medical center are Brookline, Fenway, and Jamaica Plain, and it is a short commute from Beacon Hill, Back Bay, or any of several Boston suburbs. Our department places great emphasis on building a supportive community of faculty and residents. We want to help residents achieve their goals regardless of career pathway. While we assign advisors to first year residents, this process is likely unnecessary given faculty doors are always open. This collegial and collaborative spirit is exemplified by the many resident research projects leading to presentations at national meetings and first-author publications as well as the decision by many of our residents to remain at BIDMC for fellowship training. Education as a central mission is emphasized throughout BIDMC. BIDMC houses the Shapiro Institute for Education and Research which provides teacher development resources for faculty and residents and has created an effective community of clinical educators. In a similar vein, pathology residents at all levels are actively encouraged to participate in medical student as well as fellow/resident education in a variety of settings. Residents directly supervise medical students rotating through our department and act as instructors for pre-clinical medical school courses. To assist in these endeavors, we offer a resident-as-teacher curriculum providing structured training to improve teaching skills in areas such as providing effective feedback, effective use of PowerPoint and leading small-group discussions.
