Pediatric Pathology Fellowship Curriculum
Pediatric pathology practice differs from adult pathology, and training requires exposure to high volume and diverse material. Residents are supervised, in rotation, by all staff members to get the benefit of the subspecialty expertise that is available in the department and be exposed to different points of view.
They participate in clinical consulting activities of the staff and in all teaching activities in which the department is involved. They are also required to do clinical research.
ONE-YEAR CLINICAL ROTATION SCHEDULE
* Pediatric Anatomical Pathology – 6 months, done in 2 installments. Electron Microscopy is a concentrated 2-week course. Surgical, autopsy, embryofetal, placental and forensic pathology and neuropathology make up the rest of the rotation. Neuropathology is also available as a separate 4-week elective.
Fellows may remain in our program for a second year. However, ACGME only accredits pediatric pathology programs for one year.
Conferences and Other Educational Activities
Akron General and Summa Health System have several large training programs, including a pathology program at Summa that is affiliated with Akron Children's Hospital department of Pathology. Pediatric pathology fellows attend many conferences and seminars in the northeast Ohio region.
- Anatomical Pathology Review Conference - All interesting, instructive and problematic surgical cases are reviewed in a weekly working session attended by faculty, fellows, and rotating residents and medical students. Fellows have the opportunity to see every interesting case presented to the department and participate in the problem-solving process. Every pediatric and fetal autopsy is also reviewed at the same conference. Autopsy slides are shown as unknowns. An objective microscopic analysis is followed by presentation of the case history, discussion, and correlation of clinical and anatomical findings. Fellows present and discuss their cases. This meeting is the most important departmental meeting and teaching session. It is also a key component of performance improvement in anatomical pathology and gives the opportunity to evaluate fellow performance.
- Grand Rounds – Hospital-wide grand rounds are held 3 times a month. Every 2 months, grand rounds include a hospital-wide M&M conference in which autopsy findings are presented. Fellows may be invited to help prepare and present the cases.
- Surgical Pathology Conference -This conference is held monthly and includes presentation of interesting surgical specimens to surgery residents and staff. Fellows present their cases.
- Oncology (Tumor Board) Conference - Tumor cases are presented weekly. Each case opens with a presentation of the clinical findings. The radiological and pathological findings are then presented and discussed. Once each month, the conference is devoted to reviews of interesting clinical or pathological topics, providing fellows with a broad perspective of the problems of pediatric neoplasia. Fellows present cases they have worked up.
- GI Review -Twice a month, pathologists review endoscopic biopsies with the gastroenterologists and other staff, using the multiple-head microscope or video microscope. This gives the opportunity for clinical-pathological correlation. Fellows present their cases.
- Neonatal Intensive Care Unit (NICU) Mortality Review - All neonatal autopsies are reviewed during this quarterly meeting, attended by staff neonatologists, staff pathologists and pathology residents. Clinical presentation and discussion is followed by presentation of pathological findings and clinical-pathological correction. Pathology fellows discuss the autopsies they have performed.
- Pediatric Intensive Care Unit (PICU) Mortality Review - Similar to the NICU Mortality Review, this conference is held 4 to 6 times a year.
- Neuroradiology Conference - The most interesting neuroimaging studies of the previous week are presented and discussed by radiology, neurology and neurosurgery.
- Cytogenetics-Molecular Pathology Lecture Series - This 8-10 hour didactic lecture series is given every spring to pathology residents, covering basic aspects of cytogenetics and molecular pathology.
- Pediatric Didactic Conferences - Formal pediatric lectures are provided to pediatric house staff on a daily basis at noon, providing fellows with a broad concept of clinical pediatrics.
- Administrative (Staff) Meeting – Monthly meetings for professional staff and laboratory administrators provide experience in administrative and laboratory management.
- DNA Administrative Meeting –Weekly meetings focus on technical and administrative aspects of molecular pathology and cytogenetics.
- Fetal Treatment Center Meeting - Discussion and management planning of pregnancies with prenatally detected congenital abnormalities and other problems by a multidisciplinary panel, including perinatologists, neonatologists, cardiologists, neurosurgeons and general pediatric surgeons. Embryofetal cases are presented by pathology.
- Medical School Teaching - Fellows may attend medical school pathology lectures at the NEOMED Rootstown campus.
- Cooperative Medical Technology Program – Fellows may attend lectures given to students of the medical technology program, which is housed in the department.
- Other Conferences - Fellows are given a special allowance that may be used for attending a national conference, such as the meeting of the Society for Pediatric Pathology, where they can present their research. They may also attend seminars given at Akron or Cleveland hospitals.
- Pediatric Pathology Teaching Sets - Approximately 1,000 histological sections arranged by organ system (Cardiorespiratory, GI, Hepatobiliary, Hematopoietic, Reproductive, Renal, Skeletal, Skin, Pediatric tumors, CNS, Muscle and Nerve, Placenta, Soft Tissue Tumors, and other)
- Society for Pediatric Pathology Slides - Interesting cases that have been acquired through the SPP Proficiency Testing Program and through attendance of national meetings. Approximately 100 slides
- Hematology Teaching File - Approximately 100 slides
- EM Teaching File - A set of approximately 100 EM prints arranged as a multiple choice question practical exam. EM lab archives, arranged by patient name and diagnostic category
- Autopsy, Surgical, and Neuropath Slide and Image File Collections
- Digital Image Files and Power Point Presentations of Autopsy, Embryofetal, EM and Surgical Cases
- Medical Infomatics - All specimens are accessioned into the SoftPath Laboratory Information System (LIS). The LIS includes a history card file and an online data base used to store and retrieve specific patient results. The card file displays essential demographics and laboratory results for each accessioned test. Specific data searches can be performed. In clinical pathology, a daily list of significant abnormal results is generated and reviewed by the supervisor and medical director for each section. Specific data searches can be performed. Online terminals are present in nursing stations, laboratories, staff offices, and resident and student offices. Residents are taught to use the system for data entry and retrieval.
The EM suite includes a full digital imaging station. In addition to processing EM images, this station can acquire and process gross and light microscopic images and images obtained from scanning kodachromes, prints and radiology films. The computers in this station have Adobe Photoshop, Microsoft PowerPoint and other image processing software. The residents use this station to prepare their presentations.
Staff pathologists and other faculty interact with fellows extensively and have the opportunity to observe them in action, at conferences and other settings. Formal evaluations are done twice a year with input from staff, particularly directors of laboratories in which residents have rotated. Fellows are graded on a variety of parameters included in the six competencies scheme. The results of this written evaluation are shared with the fellows at a meeting with the program director. Informal discussions focusing on performance and suggestions for improvement are part of everyday interaction between faculty and fellows.
Performance and management issues are discussed weekly at the end of the Pathology Review Conference, which is attended by the resident. The director of anatomic pathology conducts a formal, quarterly review of performance improvement, focusing on diagnostic accuracy, turnaround times and other parameters.
The quality of educational experience, adequacy of educational materials, and other matters are occasionally discussed at staff meetings with participation of the fellow, and adjustments are made as needed. Throughout the residency, fellows grade the quality of their experience on a number of points, including facilities, quality of staff, time devoted to them, etc.
A measure of the effectiveness of any program is success of its trainees in Board Examination and in getting jobs. Pediatric pathology is not a popular subspecialty and full-time jobs in pediatric pathology are relatively scarce.