Anatomic Pathology Program

Musculoskeletal Pathology Subspecialty

Unit Director:
Elizabeth Frauenhoffer, MD

Goals and Objectives:

Patient Care:

Residents must demonstrate a satisfactory level of diagnostic accuracy and the ability to provide appropriate and effective consultation about the pathology of musculoskeletal diseases. Residents are expected to:

  • Recognize and correctly interpret the pathology of common musculoskeletal diseases, including benign and malignant musculoskeletal neoplasms, congenital anomalies, metabolic conditions, trauma, and infectious, degenerative and inflammatory diseases.
  • Formulate appropriate differential diagnoses based on the histologic findings.
  • Correlate pathologic lesions with clinical and radiographic findings.
  • Appropriately use histochemistry, immunohistochemistry, and molecular pathology studies for evaluation of musculoskeletal diseases.

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to musculoskeletal pathology. Residents are expected to:

  • Develop knowledge of the spectrum of neoplastic and non-neoplastic musculoskeletal diseases through reading of textbooks and primary literature
  • Identify specific morphologic changes in tissues, and their significance
  • Understand the relationships between normal development and repair, anatomic pathology findings, radiology, pathophysiology, and patient signs and symptoms
  • Understand the utilization of ancillary diagnostic testing ( immunohistochemical and special stains, electron microscopy, flow cytometry, cytogenetics, molecular testing) in evaluation of musculoskeletal diseases

Practice-based Learning and Improvement:

Residents must be able to demonstrate the ability to evaluate and improve their clinical practices based on new and evolving scientific evidence. Residents are expected to:

  • Apply current medical knowledge and recent literature to current cases
  • Utilize library, web-based, and other educational sources to evaluate cases
  • Prepare clinical cases in an optimal timeframe
  • Utilize performance evaluations to improve practice
  • Acquire skills to engage in "lifelong" learning through appraisal and assimilation of scientific studies related to specific musculoskeletal pathology problems
  • Facilitate learning of medical students, residents and fellows, and other health care professionals

Systems-based Practice:

Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide optimal pathology services. Residents are expected to:

  • Become involved with management issues related to musculoskeletal pathology and their effects on other health care professionals, organizations, and society
  • Consider cost-effectiveness in their practice of musculoskeletal pathology without compromising patient care
  • Understand the pathologist's role and professional practices in relation to other health care professionals
  • Demonstrate ability to access and utilize the resources, providers, and systems necessary to provide optimal care
  • Advocate for quality patient care

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and learning with other health care providers, patients, and patients' families. Residents are expected to:

  • Exhibit effective listening skills and the ability to follow standard operating procedures and verbal instructions
  • Interact with departmental and extradepartmental personnel, including healthcare professionals, administrators, and other staff in an appropriate manner
  • Provide effective and professional consultation to other health care professionals demonstrating care and respect for them, and sustain ethically sound professional relationships with colleagues, staff, patients, and patients' families
  • Present musculoskeletal pathology material at a conference in an organized, coherent fashion, with well-constructed audiovisual materials
  • Provide accurate communication of pathology information using non-verbal and verbal skills
  • Work effectively as a team with other health care professionals and other staff


Residents must demonstrate a commitment to fulfilling professional responsibilities and ethical principles and sensitivity to a diverse patient population. Residents are expected to:

  • Demonstrate commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices
  • Demonstrate respect, compassion and integrity in all interactions with patients, their families, faculty, other trainees, technologists, and other staff
  • Demonstrate sensitivity and responsiveness to the ethnicity, diversity, age, gender, sexual orientation, and disabilities of patients, colleagues, and staff
  • Attend all required conferences and actively participate in them to enhance individual and group learning
  • Demonstrate a commitment to excellence and on-going professional development
  • Demonstrate adherence to guidelines and regulations set forth by regulatory and accrediting agencies
  • Demonstrate ability to identify deficiencies in peer performance

Teaching Staff:

Elizabeth Frauenhoffer, MD
Karmaine Millington, MD


1.  Background reading (covered independently by resident); While these are the most recommended, any of the textbooks available in the residents' room are appropriate; additional materials available in shared folder under:
\\\files\pathology\Shared\ResidentsandFellows\MSK Service reading and viewing materials

This also contains a detailed rotation description.

Bone and Soft Tissue:

  • Bullough and Vigorita: Atlas of Orthopaedic Pathology with Clinical and Radiologic Correlations, University Park Press - Gower Medical Publishing - JB Lippincott Company (distributors as of 1985).
  • Christopher D.M. Fletcher, Julie A. Bridge, Pancras C.W. Hogendoorn, Fredrik Mertens (Eds.): WHO Classification of Tumours of Soft Tissue and Bone, IARC: Lyon 2013
  • Folpe and Inwards: Bone and Soft Tissue Pathology, Saunders, 2010
  • Huvos: Bone Tumors: Diagnosis, Treatment, and Prognosis, 2nd Edition, Saunders,1991.
  • Weiss and Goldblum: Enzinger and Weiss' Soft Tissue Tumors, 4th Edition, Mosby, June 2001.

2.  In-house Cases

  • Active cases will be reviewed independently and then with the faculty member on service.

3.  Multidisciplinary Conference: Adult Sarcoma conf 2nd Monday 5 pm T4007&  MSK/Rad/Path conf:  1st and 3rd Tuesday 7 am  C7702

  • Attendance is mandatory at each of these conferences
  • Cases to be presented will be available in the Conference box outside Dr. Frauenhoffer's office and may be  reviewed prior to the conference with a faculty member.

4.  Research or educational project (optional)

  • If desired, the resident can work on a small research or educational project.

Method(s) of Evaluation:

The resident will be evaluated at the end of the rotation using New Innovations. The evaluations will be based on the resident's daily performance including diagnostic accuracy, and oral "quizzes" throughout the rotation. Performance on the rotation components will be assessed. The resident should be able to formulate appropriate differential diagnoses in >90% of cases in this area.

Residents will be expected to evaluate faculty and the rotation using New Innovations. These evaluations will be collated and reviewed by the program director and chair and the results will be reported yearly to each faculty member and submitted for review to the Residency Program Committee for feedback.

Updated:  9/2015