Program Overview & Curriculum

Years 1 and 2 introduce fundamentals in Anatomic and Clinical Pathology. Years 3 and 4 serve as a time to consolidate and integrate skills. AP/CP residents will start with either a full year of anatomic or clinical pathology, followed by a full year in the remaining discipline.

In the first year of anatomic pathology training (either PGY1 or PGY2), residents train in both Surgical (~75% of the work time) and Autopsy Pathology (~25%). The first year of AP also includes a one-month rotation in Cytopathology. In Surgical Pathology, residents are exposed to different organ systems and the broad range of specimens, both small and large. Of note, in our program subspecialty signout rotations are of one- or two-week duration rather than one- or two-month blocks. We believe this provides a significant training advantage as residents are continually exposed to disease entities in each organ system throughout the year, thereby reinforcing learning. Importantly, to promote optimal acquisition of diagnostic skills, we give residents ample time to study and diagnose their slides prior to signing out their cases with attending staff pathologists.

In the first year of clinical pathology training (either PGY1 or PGY2), the first eight months of the year are divided into four 2-month rotations in the core disciplines: Chemistry; Hematology/Coagulation/Hematopathology; Microbiology; and Transfusion Medicine. This sequence allows repeat, advanced, one-month rotations in each of the core laboratories in the last four months of the academic year and exposes residents optimally to all of the laboratories while allowing consolidation of the entire laboratory medicine experience. 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. We also recently developed and implemented a new Informatics curriculum based on the national Pathology Informatics Essentials for Residents (PIER) resources. In CP, we emphasize clinical context and the laboratorian serving as a clinician and consultant. Furthermore, we integrate residents within greater hospital teaching conferences (e.g., “Firm” case sessions involving internal medicine faculty, residents and students).

Integration of AP and CP 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 pathological 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. Years 3 and 4 are divided between Anatomic and Clinical Pathology. The schedule also includes a formal one-month rotation in Molecular Diagnostics and Cytogenetics. Genomic pathology is also integrated into this month.

Five months of additional clinical pathology experience are required. Three months involve an advanced rotation in one of the core laboratories. The residents are given additional responsibility in regard to leading rounds and teaching junior residents and often pursue research projects with our faculty. The two remaining months can also be in the core labs, 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). For residents who have demonstrated proficiency in core requirements, three months of elective time may be spent in one-month advanced subspecialty surgical pathology rotations. Years 3 and 4 serve as a time for assumption of greater responsibility. Residents play a more important role in conference preparation and presentation 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 Children's Hospital Boston, in 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 AP/CP residents pursue subspecialty fellowship training in one of the many fellowships offered by our department before going on to faculty positions, often at major academic medical centers. (See Graduate Destinations for information regarding post-residency placement.)

The major educational goal of this program pathway is to train future leaders in academic surgical pathology. The first year is the same initial year of AP described for the AP-CP program above.

Activities in Anatomic Pathology continue in the second and third years, and include rotations in Pediatric and Forensic Pathology, Cytopathology, Molecular Pathology and Cytogenetics, Hematopathology, further exposure to other subspecialties, and opportunities 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.

The Department provides a mentoring program to foster these activities. Graduates of this training pathway will likely pursue a surgical pathology subspecialty fellowship prior to seeking a faculty position in an academic department.

BIDMC is often referred to as “Harvard with a heart.” That is, all the strengths of a Harvard teaching hospital within a caring, supportive environment. In the pathology department, we are proud of our tight-knit community. Both trainees and faculty have a willingness to teach each other and pitch in when help is needed. Such an environment facilitates learning and achievement.

From the start of anatomic pathology training, rather than “throwing residents into the fire”, we provide a month-long period where residents are taught in a step wise fashion the fundamentals and intricacies of grossing, dictation, autopsy techniques, and frozen section analysis. This critical time allows residents to develop optimal practices that will serve them throughout their careers. In both AP and CP, seniors assist junior residents as they acclimate to new rotations and taking call while our faculty is available 24 hours a day to assist with clinical questions. We also provide a generous book and travel fund to support trainee education.

Success as a future pathologist involves much more than memorization of pathological entities. Opportunities and career choices are diverse, and not always obvious. We believe that thoughtful mentors help residents navigate challenges, identify areas of potential interest, and create a career development plan.

In the fall of the first year of residency, a peer mentor, drawn from the residency’s second- and third-year residents, is assigned to each first-year resident. For 2023-2024, we plan to further develop this program, beginning with an initial luncheon meeting for all mentor-mentee pairs, followed by several more meetings of mentor-mentee pairs over the remainder of the first year with suggested topics to explore. The goal of this mentorship program is to help new residents take full advantage of everything the residency has to offer professionally while maintaining a healthy approach to work-life balance.

In the middle of the first year residency, a faculty mentor is assigned each first-year resident based on shared interests. This faculty member will remain available to the resident throughout their training, but we encourage trainees to seek mentorship from multiple faculty members.

In addition, the program directors meet individually with each resident twice per year to review the summative evaluation generated by the Clinical Competency Committee and to discuss each resident's professional goals, personal challenges, or any other topic that the resident wishes. The program directors are keenly interested in chatting with residents at any point in their training, whenever a resident runs across a potential sticking point, wants to celebrate a professional or personal win, or has any other need.

In addition to these in-house resources, BIDMC has a broad alumni network that current trainees can connect with depending on their individual interests.

The Department of Pathology at BIDMC offers junior faculty anatomic pathology positions for outstanding graduating residents.