Residency Program Application Information

Dear Prospective Pathology Applicants:

Choosing a pathology residency can be an exciting, but sometimes anxiety-provoking, experience. Given the diversity of pathology residency programs available, distinguishing among the individual programs can be a daunting task. Additionally, the application and interview process can be hectic and exhausting, and one can easily leave an interview without a clear feel for what exactly a program has to offer.

It is with these thoughts in mind that the residents in our program decided to try to facilitate communication with prospective residents. We collectively composed the attached resident-written descriptions of the program rotations in order to give an accurate picture of the pathology resident’s duties on each of the rotations at Iowa. Descriptions of our many excellent teaching conferences are also provided. Additionally, we have included a question-and-answer section with questions applicants frequently ask, and some important questions which may not immediately come to mind.

As pathology residents at The University of Iowa, we are proud of our program and are extremely satisfied with our training. We feel the program is "resident-oriented" and provides an outstanding learning environment. We look forward to meeting many of you over the next few months.

If you have questions about our program or about living in Iowa, please do not hesitate to contact us.

Sincerely,

Nathan Lueck, MD Co-Chief Resident nathan-lueck@uiowa.edu

Elizabeth Manion, MD Co-Chief Resident elizabeth-manion@uiowa.edu

DESCRIPTION OF THE ROTATIONS

Written by the residents

 

Each rotation is five to six weeks in length with nine rotations in each year.

SURGICAL PATHOLOGY -- University Hospital (seven rotations)

The surgical pathology residents follow a three-day schedule. Day One is spent in the gross room, while Day Two and Day Three are spent performing the microscopic examination of the specimens that were received in the gross room on Day One. The resident on Day One staffs the gross room along with a surgical pathology fellow, an extern, a pathology assistant, and support staff. The resident’s responsibilities on Day One include providing intra-operative consultation via frozen sections and gross evaluation, and cutting in cases. Since the gross room is located next to the operating rooms, the resident is easily able to interact with surgical staff. We often will visit operating rooms to view the operative field and review specimen orientation as it appears in situ. The advantages of this arrangement to the resident's understanding of a case are obvious. The presence of an extern, a pathology assistant, and other support staff provides assistance with the workload, to prevent being overwhelmed with small and/or uncomplicated specimens.

 

On Day Two, slides go first to the surgical pathology fellow covering the preliminary diagnosis service. He/she will preview the cases quickly and place a short preliminary diagnosis in the computer. The case then goes to the resident/extern on Day Two. The resident or extern looks at the case, dictates a microscopic description and diagnosis, and the case is typed by the transcriptionists. The surgical pathology fellow does not tell the resident his/her diagnosis but is available to provide assistance when needed. This allows the residents to look at the slides themselves and formulate our own ideas. Although this was painful for all of us at first (sometimes just trying to recognize the tissue), in the end this is an active learning system that is vastly superior to passively looking at slides with a staff member and watching them dictate. Sign-out starts in the early afternoon with the resident and extern sitting down to look at and finalize cases with the staff. This is an opportunity for one-on-one or two-on-one educational time with staff.

 

The resident on Day Three will continue evaluating and dictating cases, including leftovers from the day before. Sign-out with staff continues on Day Three until all the cases are done, which can be as early as noon on light days, or until the early evening. The greatest advantage to this three-day system is that the cases you gross in are the cases you sign out. In addition, there is time to quickly read about challenging cases to reinforce our knowledge base.

 

Call responsibility during the University of Iowa Hospitals and Clinics surgical pathology rotation is set up so that the Day One resident takes overnight frozen section call, with a fellow or faculty, as well as two weekends of frozen section call per rotation.

 

VETERANS AFFAIRS MEDICAL CENTER (VAMC) SURGICAL PATHOLOGY (two rotations)

The two VAMC Surgical Pathology rotations offer senior (generally 3rd and 4th year) residents the opportunity to experience a range of surgical pathology cases. The breadth of specimens is more akin to what one would see in a private practice environment (i.e. skin biopsies, GI/GU biopsies, etc). On a daily basis, the resident is responsible for grossing, dictating the microscopic descriptions and diagnoses, and signing-out all (including neuropathology) surgical pathology specimens with faculty. Other responsibilities include performing and interpreting frozen sections, with faculty back-up as needed. The resident also interacts with physicians at tumor conference where all new malignancies are discussed. The VA Surgical Pathology experience is a rewarding one since it allows senior residents to accept more responsibility and be "on their own" with faculty assistance only as needed.

 

AUTOPSY SERVICE (four rotations)

The four autopsy rotations cover both UI Hospitals and Clinics and VAMC autopsies. The autopsy service consists of two residents, one or two externs, hospital morticians, occasionally a 4th year medical student on elective, and a faculty (rotating daily) staff member. Residents are assigned alternating autopsy cases and are responsible for each case from start to finish. In general, each case involves chart review, consulting with clinicians, external and internal examination, organ dissection, subsequent microscopic examination, and review of the entire case with the staff member and any consultants as necessary. Determination of ancillary testing including toxicology, microbiology, cytogenetics, etc. is also performed. A complete report is written by the resident. The entire process takes anywhere from several days to one month.

Duties while on autopsy call, which is only on weekends, are similar to the rotational duties. Two residents are on most weekends, and they alternate cases such that the first resident up takes the first, third, fifth, etc. autopsy of the weekend and the second resident up takes the second, fourth and so on. The pool from which autopsy call is drawn includes all residents on anatomic pathology rotations. Residents on surgical pathology, cytology, derm/neuro and VA surg path can expect to have one to two weekends of autopsy call during that rotation, while residents on the autopsy rotation can expect to have 2-3 weekends of autopsy call. Any cases that come in after 2:00 p.m. are generally performed the following day.

The breadth of cases on our autopsy service is outstanding. We see a variety of medical, forensic, and pediatric/neonatal autopsies. Approximately 50% of the autopsies we perform are medical examiner cases.

 

CYTOPATHOLOGY ROTATION (two rotations)

During Cytopathology, residents perform fine needle aspirations (FNAs) in the FNA clinic which is run by the Department of Pathology. The resident, fellow and staff make an initial "on-the-spot" interpretation of FNAs in the clinic, radiology suites, endoscopy lab, and bronchoscopy lab. When the additional slides come out one-two hours after the procedure, the resident and the fellow review the slides and enter a diagnosis in the computer. The slides are then reviewed with the resident and fellow with the staff during a sign-out session. Abnormal pap smears, fluids (such as cerebral spinal fluid (CSF) and urine) are also examined this way. Case sign-out continually occurs throughout the day in-between procedures. Most residents will perform a minimum of 50 FNA procedures over their two rotations.

 

DERMATOPATHOLOGY/ NEUROPATHOLOGY ROTATION (two rotations)

A day on the "derm/neuro" rotation typically involves "splitting" the day between dermatopathology and neuropathology responsibilities. Generally, part of the morning is spent looking at both neuro cases (one-five cases per day) and derm cases (50-60 cases per day). Again, the resident interprets and dictates their impression of the case before sign-out with the staff. The resident is also called to assist with neuro frozen sections. Derm staff sign-out begins in the early afternoon. Later in the afternoon the resident grosses-in neuro specimens. A dermatology resident also rotates on the derm service and shares dictation responsibility with the pathology resident. Derm specimens are grossed in by either histotechs or pathology assistants.

 

CHEMISTRY (two rotations)

Resident duties on the clinical chemistry service include signing-out gel electrophoresis, working with medical technologists to solve laboratory problems and reviewing study cases provided by Ronald Feld, Ph.D. and George F. Johnson, Ph.D. Serum protein electrophoresis and immunofixation electrophoresis gels are evaluated by the resident who enters an interpretation in the computer, followed by staff sign-out. In addition, residents contact clinicians about test reports and may suggest alternative testing which would better answer the clinical question. Throughout the week, clinical cases with interesting laboratory findings are directed to the resident who then independently studies the underlying pathophysiology. One of these cases is typically presented by the resident in the clinical pathology conference on Fridays. Finally, during the second rotation, the resident is involved in a laboratory management project of his or her choice. This could range from determining whether the lab should perform a test that is currently a send-out test, to determining the effectiveness of the current methodology for a given test.

 

HEMATOPATHOLOGY (three rotations)

Generally, there are two people on service, either two residents or one resident and the hemepath fellow. The hematopathology rotation is divided into two three-week blocks. During one block the resident works on the bone marrow service, writing descriptions of the marrow aspirates and biopsy and entering a diagnosis in the computer. A major part of the write-up consists of performing a manual differential on the bone marrow aspirate. Bone marrow technologists perform counts on some of the marrows as well. Similar to surgical pathology, sign-out occurs in the early afternoon and is generally finished by 5:00 p.m. The second three week block is spent on the "wet" bench where the resident reviews and writes-up peripheral blood smears, CSFs, body fluid cytospins, abnormal urine sediments, and other laboratory procedures including hemoglobin electrophoresis. Hemepath unknowns are put out once a week by staff and reviewed at a multi-headed scope. This is very similar to the surg path micro unknown conference held on Tuesdays. An elective may be used for a fourth hemepath rotation to focus on lymph node pathology.

 

IMMUNOPATHOLOGY (two rotations)

The experience on this rotation includes interpretation of flow cytometry analysis performed on a variety of specimens, interpretation of direct immunofluorescent studies of skin, interpretation of indirect immunofluorescence tests (ANA, ANCA, and other autoantibodies), and ancillary assistance for immunoperoxidase studies. When problems/questions occur in the immunology lab, the resident has the opportunity to troubleshoot them first. All flow cytometry reports are written by the resident and signed-out with staff through the day.

 

MICROBIOLOGY (two rotations)

The two rotations in microbiology include a wide variety of activities. Time is allowed to sit on the bench with the technologists as they process specimens and identify organisms. (Benches include blood cultures, urine, wound/sterile body fluids, respiratory, surveillance, tuberculosis (TB)/mycology, antimicrobial susceptibility, and virology). The resident also participates in daily lab rounds with the lab directors. During these rounds, the technologists in each area of the lab present interesting cases and ask questions regarding extent of identification required for a particular isolate, clinical significance of an organism, need for susceptibility testing, etc. Gram and Giemsa stains on a variety of organisms are reviewed weekly with staff. The resident carries a service pager as well. The resident also works-up a series of "unknowns" including mycology and bacteriology specimens. In addition, an interesting ten-minute case is presented by the resident at the clinical pathology conference each Friday morning. The research activities of the microbiology division are extensive and there are numerous opportunities to become involved in projects.

 

MOLECULAR PATHOLOGY ("MO PATH") (one rotation)

Residents are responsible for interpretation of a variety of molecular tests within three broad categories of molecular pathology (genetic diseases, molecular infectious disease testing, and molecular oncology. Among many others, T- and B-lymphocyte clonality studies, Hepatitis C viral genotyping, factor V Leiden and Prothrombin gene mutation studies, and muscular dystrophy (FSHD) studies are offered. Residents learn the clinical applications and limitations of agarose and polyacrylamide gel electrophoresis, polymerase chain reaction (PCR), and Southern Blot technique. Hands-on practical exercises are included to demonstrate basic principles of molecular techniques. The in-house test menu of molecular tests expands each year, hence ample material will be available for resident education in molecular pathology.

TRANSFUSION MEDICINE (two rotations)

The Transfusion Medicine resident oversees the acquisition and distribution of blood products for the hospital. Residents frequently become involved in the care of patients who require massive transfusion (i.e. patients with trauma, coagulopathy, or surgical difficulties). This may require the resident to visit the operating or emergency room to assess a situation before providing advice or authorizing the release of blood products. The transfusion resident evaluates requests for special products such as granulocyte transfusion or crossmatched platelets. The transfusion service performs pheresis procedures for conditions such as thrombotic thrombocytopenic purpura (TTP), Guillain Barre, and hyperviscosity syndromes, and also collects peripheral stem cells for bone marrow transplants. Finally, the blood bank resident assists the blood donor nurses in screening potential blood donors.

 

VAMC CLINICAL PATHOLOGY (two rotations)

The two VAMC Clinical Pathology rotations offer residents the chance to experience an integrated clinical pathology laboratory (blood bank, hematology, chemistry, microbiology, immunopathology). On a daily basis the resident is responsible for writing up, interpreting and signing-out bone marrow examinations with faculty consultation. The resident interprets blood smears, body fluid analyses, bronchioalveolar lavage specimens (BALs), flow cytometry, and electrophoresis with faculty back-up as needed. Other duties include blood bank audits and approving send-out tests. Furthermore, it is on this rotation the resident will gain experience performing bone marrow biopsies, under the supervision of Hematology-Oncology fellows. Finally, the resident is responsible for "troubleshooting" problems that arise in the laboratory, being a clinical laboratory consultant for physicians, and other projects. The VAMC clinical pathology rotation offers residents the chance to have an experience akin to the private practice environment. The residents perform laboratory management, make interpretations and diagnoses "on their own" with faculty backup as needed, and act as a laboratory consultant. However, there is adequate time available for reading or research projects.

 

ELECTIVE (five rotations)

Each resident gets five electives over the four years of residency. Residents spend this time in a variety of ways including further experience in some of the service rotations (particularly Hemepath or Cytology), clinically related research in almost any area of the department, and special electives like Ocular Pathology. Some residents also opt to spend some elective time at other facilities pursuing special interests such as forensic pathology or surgical pathology subspecialty study.

 

MAJOR TEACHING CONFERENCES:

Daily resident teaching conferences occur each morning. The spectrum of topics covered in these teaching conferences are as diverse as the field of pathology.

 

Monday: Gross Unknown Conference. Staff will show kodachrome slides of recent surgical pathology specimens, and then call on a resident to discuss what they see. Generally, the resident talks about what organ they think the specimen is, gives a differential diagnosis of the disease process and explains how they would handle the specimen (what areas they would sample for histology, etc.) Pathology boards include questions with gross pictures, so this is a valuable preparation for boards and for broadening the knowledge base.

 

Tuesday: Surgical Pathology Unknown Conference. A few days before this conference staff will put out slides of difficult cases (usually about six) for the residents to review and formulate a diagnosis. During the conference, a resident will be called on to discuss the microscopic features, provide a differential diagnosis with their favored diagnosis and explain what further studies (special stains, immunoperoxidase etc.) that may be necessary to achieve a definitive diagnosis. The case is then discussed by staff and residents as a group. Usually the conferences have a theme such as lymphomas, breast lesions, etc. related to the special interest area of the presenting faculty member.

 

Wednesday: Clinical Pathology Didactic Conference. Responsibility for this conference rotates from one clinical pathology service to another throughout the year (Transfusion Medicine, Chemistry, Hemepath, Immuno, Microbiology, Molecular Pathology). For example, seven didactic sessions of Hemepath are followed by seven didactics of Microbiology and so on. Topics are widely variable, and include classification of leukemias and lymphomas, flow cytometry, coagulation testing, mycobacteria, endocrine testing, platelet usage, etc.

 

Thursday: Anatomic Pathology Specialty Conference. Usually this conference is a didactic, but occasionally unknown cases (dermatopathology) are put out similar to the surg path unknown conference. Neuropathology, cytopathology, dermatopathology and ophthalmic pathology are areas typically covered.

 

Friday: Clinical Pathology Morning Report. Residents from each of the clinical pathology services present cases via PowerPoint format as unknowns to the other residents and staff, with a short discussion. Usually each presentation lasts 10 to 15 minutes. These are typically informal presentations and do not require the resident to spend an inordinate amount of time in preparation. The benefit of having the opportunity to hone our presentation skills throughout residency training is invaluable. Bagels, fruit, and coffee are served.

 

Pathology Grand Rounds (Thursday): Similar to grand rounds in other specialties; usually a staff member, senior resident, fellow, or visiting faculty from another institution gives a didactic presentation.

 

Other conferences:

 

Hemepath/Transfusion Medicine conference (Mondays): This is a thirty-minute didactic conference given by residents, fellows or staff. Presentations consist of an in-depth look at a particular topic/or a series of interesting cases.

Gastrointestinal (GI) pathology conference (Fridays): Frank A. Mitros, M.D., presents recent cases to gastroenterology clinical staff and gives a short didactic regarding the pathologic features of the case. This provides residents with understanding of the importance of interdepartmental communication.

G.I./liver pathology consults (Daily): Frank A. Mitros, M.D., and Chris Jensen, M.D., review GI/liver biopsy cases in an informal setting at a multi-headed scope with anyone who is interested. These consult reviews generally occur at 9:00 am daily.

Hemepath unknown conference (Wednesdays) and more...

 

 

FREQUENTLY ASKED QUESTIONS AND ANSWERS

What health care plan is offered by the University Hospital? Very few residencies can match University of Iowa's health care plan for residents. Health care and medications for the resident, his/her spouse and their children are free. If you and your spouse decide to have a child you will pay nothing. Prenatal care, ultrasound, the delivery, etc. is free. Residents can also write prescriptions for their family at no cost. If you want a bottle of Tylenol, you simply write a prescription and they give it to you. In addition at no cost, you are provided a Blue Cross/Blue Shield coverage plan in case you or your family is injured or becomes ill outside of Iowa City.

 

What fellowships are available at Iowa? There are fellowships available in Surgical Pathology, Cytopathology, Hematopathology, Microbiology, Transfusion Medicine, and Molecular Pathology.

 

What type of call do residents take? There are three types of call: surgical pathology, autopsy and clinical pathology. Surgical pathology and autopsy call have been described previously. Clinical pathology call approximately every eight to ten days, from home, and the resident handles a wide variety of questions and problems. Residents may be called to approve or deny various requests for tests that are usually only done during the day, or requests for platelets when the blood bank platelet stock is low. These types of calls generally require the resident to contact the requesting physician and decide whether the request is justifiable or if another test or blood product would be more helpful. In addition for patients with massive bleeding, the pathology resident will come in to assist with blood product choice and facilitation of hematologic testing. Rarely residents on call must come into the hospital to consult with clinicians regarding massive transfusions and also to initiate emergent transfusion medicine therapeutic procedures.

 

How is vacation time handled? Residents have 15 weekday vacation days a year and you can "roll over" up to five days into the next year. For most rotations it is fairly easy to take time off and many rotations do not require cross coverage.

 

What about fringe benefits such as book/travel funds? Each resident is given $750/year for books/journals/memberships, etc. Unused funds carry over to the next year. Travel to national conferences is paid for by the department for residents presenting abstracts. Travel to national meetings for pathology organizations that residents are involved with is also covered. Furthermore, during the residency training, the department will sponsor each resident to attend one national conference regardless of whether or not an abstract is presented.

 

How do residents interact with the surgical pathology fellows? In other words will I simply be a "meat cutter" for the fellows? NO! The fellow on the preliminary diagnosis service essentially works separately from the residents, and the fellow covering the gross room primarily performs frozen section diagnosis and provides instruction to residents on how to handle specimens. The other fellows cover consult cases and work with the staff. Surgical pathology at Iowa is extremely resident friendly. While the work is not easy, you will not be grossing in ten placentas at 10:00 pm.

 

There are no pathology externs at my medical school. What is their role? Externs are medical students who toward the end of their second year take a year off and work in the pathology department doing surgical pathology and autopsies. They function basically as a resident, except they do not take call. Externs start in July and finish in June.

 

What national pathology conferences are held at Iowa? The Iowa Anatomic Pathology and Cytopathology Course in the fall is a three-day conference where Iowa staff members and pathologists from around the country give lectures on a variety of topics. Practicing pathologists and residents from around the country attend these, and Iowa residents are excused from their service duties to attend for free.

 

Do residents interact with visiting professors? In addition to interacting with visiting professors invited by the faculty, each year the pathology residents invite a prominent pathologist to spend a day exclusively with the residents. Typically this visiting professor will have several scope sessions with the residents and will give grand rounds. This is an excellent opportunity to not only learn in depth about a specific area in diagnostic pathology, but also to get to know well-known pathologists from around the country on a personal level.

 

How well do Iowa residents fare in finding jobs after training? The established reputation of excellence in training at the University of Iowa, combined with the recent trend of increasing demand and aging of current pathologists, has meant a tremendous opportunity for residents from our program. All departing residents in recent years have found little difficulty getting multiple offers for desirable positions in both academic and private settings.