Pathology Residency Program Overview

The Department of Pathology and Laboratory Medicine offers 20 positions in an ACGME-accredited four-year combined anatomic and clinical pathology program. The curriculum provides comprehensive experience in all aspects of pathology and laboratory medicine. Cedars-Sinai's large staff of pathologists, representing all subspecialty areas, is committed to teaching residents and fostering increased confidence. With more than 50,000 surgical specimens, 17,000 cytology samples including 2,500 FNAs and 7,000 non-gyn cytology cases, and 5 million clinical laboratory tests performed and analyzed each year, residents benefit from an abundance of learning opportunities. Clinical consultation is an integral part of the practice of pathology, and residents at Cedars-Sinai learn the skills required of an active, valuable consultant. Additionally, residents are encouraged to participate in professional pathology societies.

The program is structured to prepare residents for academic or community practice careers. The curriculum encompasses 27 months of anatomic pathology, 18 months of clinical pathology and three months of unspecified elective time. The core rotations include:

Anatomic Pathology

• Surgical Pathology (16 months)
• Autopsy Pathology (5 months)
• Cytopathology (3 months)
• Forensic Pathology (1 month)
• Neuropathology (1 month)
• Renal Pathology (1 month)

Clinical Pathology

• Hematopathology (5 months)
• Transfusion Medicine (4 months)
• Clinical Chemistry (2.5 months)
• Microbiology (2.5 months)
• Molecular Pathology (1.5 months)
• Cytogenetics (1 month)
• Coagulation (1 month)
• HLA (0.5 month)

The first two years are focused on the core elements of pathology. The first year is primarily anatomic pathology which comprises 9 or 10 months of this year, the remainder being clinical pathology. Conversely, during the second year the resident rotates for 9 or 10 months in clinical pathology rotations, the remainder spent in anatomic pathology rotations. By the end of the first two years, residents are exposed to the core areas of anatomic and clinical pathology, allowing for considered decision-making in thinking about subspecialization and future fellowships. The third and fourth years are mixed including anatomic and clinical pathology rotations, specialty rotations such as neuropathology, and electives.

In anatomic pathology, residents have early exposure to the autopsy service, which provides the study foundations of gross and histologic pathology. Biweekly autopsy conferences and monthly formal resident presentations enhance opportunities for learning. After an initial orientation during the first two months of the residency, the remainder of the surgical pathology rotations are structured in two-week subspecialty blocks, allowing for concentrated study by organ system. Cedars-Sinai provides a wide variety of specimens, extensive frozen section experience and a large subspecialized and available faculty. Cytopathology includes Gyn, non-Gyn and FNA specimens, and residents gain further experience by attending and giving cytology conferences.

Clinical pathology provides intensive experience in all subspecialty areas, with concentrated time during the second year. The curriculum focuses on the role of the pathologist as a clinical consultant, with residents making rounds, examining patients, and performing procedures, such as bone marrow biopsies and therapeutic apheresis. Molecular pathology and cytogenetics are coordinated with Medical Genetics. Laboratory management and informatics are included in the core rotations. The faculty includes specialists in all areas of clinical pathology.

Elective time may be taken in any area of anatomic or clinical pathology; elective time is focused at Cedars, but may be taken at another institution if academically appropriate. Many residents use elective time to undertake research projects, which are strongly encouraged.

Conferences are focused and enhance the practical education obtained during rotations. The daily surgical pathology consensus conference is a working conference providing excellent exposure to unusual and challenging cases, particularly for senior residents. There are weekly AP didactics, unknown slide conference, tumor board, and gross conference which alternates between autopsy and surgical pathology gross specimens. CP didactics and cytology conference occur several times per month. AP journal club, CP journal club, Molecular Pathology journal club, resident autopsy, CP and cytology presentations, and Grand Rounds are presented monthly. There are other subspecialty and interdepartmental conferences the resident may attend or which are required during subspecialty rotations.

All residents are required to undertake at least one research project during the four years, although most residents do considerably more research. The pathology department at Cedars-Sinai has been commended for two years running by the United States and Canadian Academy of Pathology, the largest academic pathology organization, for the number of resident abstracts submitted to the USCAP. In excess of 60 abstracts were presented by our housestaff members at various pathology meetings during the 2008-09 academic year. The performance of research with resulting publication is an important asset in obtaining an excellent fellowship in any subspecialty, in learning to understand and interpret the literature, and in furthering an academic career if that is the resident's chosen professional path.

Evaluations of the residents by the faculty are collated and shared with the residents three times per year. The program director reviews each resident's portfolio with them twice annually to ensure residents are on track to become competent in all areas of pathology, are making considered career choices, are appropriately involved in a research project, and are engaged with national pathology organizations.

Former Department of Pathology and Laboratory Medicine Chairman of
22 years, Stephen A. Geller, MD and pathology residents