Clinical Pathology Program

Introduction

 

Most pathology residents at the Penn State Hershey Medical Center train in a four-year combined clinical and anatomic pathology program. With approval, a resident may be accepted for a three-year program in clinical pathology only.

Our overall goal for Clinical Pathology training is to develop pathologists who can:

  • Communicate effectively as a medical consultant to other clinicians and to patients.
  • Direct the management of the clinical laboratory enterprise, to assure the quality, clinical appropriateness and usefulness of the laboratory data.
  • Consult effectively on methods of diagnostic test utilization, both generally and in the context of patient-specific clinical settings.
  • Consult effectively on assay interpretation in acute and chronic clinical management of patients.
  • Contribute to development and implementation of informatics and systems that optimize patient care.
  • Consult in these areas at the systems level and in the context of health delivery models.
  • Understand the role of research in clinical decision making, test development, knowledge generation and continuing education.
  • Attain sufficient knowledge to be able to pass the clinical pathology section of the board examination.


To accomplish these goals, residents must develop specific competencies. Competencies that are common to all areas of clinical pathology training include:

Patient Care
  • Gathering essential and accurate information about patients using all relevant available modalities.
  • Consulting effectively with other clinicians in developing a diagnostic plan based on specific clinical questions and relevant clinical and pathological information (both in patient-specific and systems contexts).
  • Participating effectively as a member of a multidisciplinary team in developing a therapeutic plan that includes laboratory monitoring of efficacy and toxicity (including laboratory-based therapeutics such as blood transfusion).
  • Consulting effectively on interpretation or follow-up of unusual or unexpected test results.
  • Participating effectively as expert in Laboratory Medicine at multidisciplinary clinical conferences.
Medical Knowledge
  • Acquiring and evaluating evidence-based information using all available resources.
  • Developing and maintaining a knowledge base in the basic and clinical sciences sufficient for effective consultation in Laboratory Medicine.
  • Demonstrating sufficient knowledge to determine clinically optimal yet cost-effective testing and laboratory- based therapeutic strategies, including issues of turnaround time, test menu construction, and in-house versus referral diagnostic testing.
  • Understanding how patient age and other patient population characteristics affect assessment of laboratory data.
  • Understanding general and test-specific standards for method development, evaluation and implementation.
  • Understanding of requirements for and use of proficiency programs.
  • Understanding the various levels of evidence in medicine and their translation into evidence-based practice.
Practice-based learning and improvement
  • Demonstrating the ability to critically assess the scientific literature.
  • Demonstrating knowledge of evidence-based medicine and applying its principles in practice.
  • Using multiple sources, including information technology, to optimize life-long learning and support patient care decisions.
  • Developing personally effective strategies for the identifying and eliminating gaps in the medical knowledge needed for effective practice.
  • Using mathematics and statistics as appropriate to assess laboratory testing procedures.
  • Understanding and implementing quality control (QC) and quality assurance procedures as required.
  • Using laboratory problems and clinical inquiries to identify process improvements to increase patient safety.
  • Demonstrating ability to establish continuing competency assessment for pathologists as well as for laboratory personnel.
  • Using proficiency programs to improve laboratory practices.
  • Demonstrating knowledge of the principles of clinical research design, implementation, and interpretation.
Interpersonal and communication skills
  • Demonstrating the ability to write an articulate, legible, comprehensive and concise consultation note.
  • Providing clear and informative report, including when appropriate a precise diagnosis, a differential diagnosis, and recommended follow-up or additional studies.
  • Providing direct communication to the referring physician or appropriate clinical personnel when a laboratory assay reveals an urgent, critical, or unexpected finding and documenting this communication in an appropriate fashion.
  • Presenting and participating effectively at multidisciplinary conferences.
  • Demonstrating the ability to work with other clinicians and other health care personnel and administrators to develop clinically advantageous and cost-effective care-delivery strategies.
  • Using effective modes and mechanisms of communication.
  • Obtaining informed consent, including effective communication with patients about procedures, alternative approaches, and possible complications of laboratory-based patient care diagnostic and therapeutic activities such as those related to transfusion medicine and therapeutic apheresis.
  • Demonstrating skills in educating colleagues and other health care professionals, including:
  • Helping other residents obtain proficiency in laboratory medicine.
  • Demonstrating the ability to work well with medical technologists and to present Laboratory Medicine concepts to them effectively in continuing education settings and in the day-to-day laboratory environment.
  • Demonstrating the ability to educate non-pathology clinicians and other health care workers, including pharmacists, nurses, residents, medical students, and others about topics such as the fundamental principles of pathophysiology underlying test design/interpretation and the approach to choosing and interpreting laboratory tests.
  • Demonstrating an understanding of how to educate other practicing pathologists through publications or seminars on new testing and therapeutic strategies, research discoveries, and other professional knowledge.
Professionalism
  • Demonstrating compassion, understanding and respect for patients, their families, and the staff and physicians caring for them.
  • Interacting effectively with others, regardless of religious, ethnic, sexual, or educational differences.
  • Demonstrating positive work habits, including punctuality, dependability, and professional appearance.
  • Demonstrating responsiveness to the needs of patients and society that supersedes self-interest.
  • Demonstrating principles of confidentiality with all information transmitted both during and outside a patient encounter.
  • Demonstrating knowledge of regulatory issues pertaining to the use of human subjects in research.
  • Demonstrating a commitment to excellence and ongoing professional development.
  • Demonstrating interpersonal skills in functioning as a member of a multidisciplinary health care team.
Systems-based practice
  • Demonstrating understanding of the role of the clinical laboratory in the health care system.
  • Demonstrating ability to design resource-effective diagnostic plans based on knowledge of best practices in collaboration with other clinicians.
  • Demonstrating knowledge of basic health care finance and reimbursement.
  • Demonstrating knowledge of the laboratory regulatory environment.
  • Understanding and implementing policies and systems to continually improve patient safety as they relate to clinical laboratory testing at all levels.

Recognizing that residents have differing backgrounds and career objectives, the clinical pathology training program is designed to be flexible. This allows us to best meet the needs of each resident and to best prepare each resident for his or her career in pathology. Residents will have the opportunity to develop more in-depth expertise in one or several areas of laboratory medicine.


Role of the Resident

The resident is expected to function as a full physician member of the leadership and management team of the section to which they are assigned during rotations and of the Division of Clinical Pathology. Along with the attending faculty, they are fully participating members of the divisional Quality Improvement Committee. They are expected to be a resource to the laboratory staff and clinical care providers for Laboratory Medicine operational and patient care issues.


Structure of Division, Laboratory and Rotations

There are 9 attending faculty in the Division of Clinical Pathology.

  • Michael H. Creer, MD, Chief, Division of Clinical Pathology, and Director, Clinical Laboratory
  • William J. Castellani, MD, Medical Director of Chemistry and Specimen Processing
  • David W. Craft, PhD, D(ABMM), Medical Director of Microbiology Laboratory
  • Ronald E. Domen, MD, Medical Director of Histocompatibility
  • Keri J. Donaldson, MD, Medical Director of Hematology and Thrombosis
  • M. Elaine Eyster, MD*, Medical Director of Hemostasis
  • Melissa R. George, DO, Medical Director of Blood Bank and Apheresis
  • Wallace H. Greene, PhD, Medical Director of Virology, Interim Director of Microbiology
  • Mary Beth Miele, PhD, Education & Pathology Residency Coordinator, Microbiology Instructor
  • Medical Director of Molecular Diagnostics (currently in recruitment)
  • Hiroko Shike, MD, Associate Medical Director of Histocompatibility
  • Witold B. Rybka, MD*, Medical Director of Hematopoietic Cell Therapy Laboratory

* Member of Division of Hematology/Oncology, Department of Medicine with appointment in Department of Pathology, Division of Clinical Pathology

The Clinical Laboratory is organized into the following units based partially on technology (e.g., Automated Testing), partially on discipline (e.g., Virology, Microbiology) and partially on function (e.g., Quality/Compliance, Business Services).

  • Laboratory Administration
    Director: Michael H. Creer, MD
    Operations Director: Karen E. Milakovic, SBB(ASCP)
    Assistant Manager: Andrea Stoner, CLT(HHS)
     
  • Automated Testing Laboratory
    Medical Director of Hematology and Thrombosis: Keri J. Donaldson, MD 
    Medical Director of Chemistry: William J. Castellani, MD
    Supervisors:
         General Chemistry: Monica Straub, MT(ASCP)
         Special Chemistry: Chris Pedersen, MT(ASCP)
         Microscopy: Diane Richwine, MT(ASCP)
         Hematology/Coagulation: Victoria Smalls, MT(ASCP)
     
  • Blood Bank and Apheresis
    Medical Director: Melissa R. George, DO
    Supervisor: Jerry Davis, MT(ASCP)SBB 
     
  • Specimen Processing Area
    Medical Director: William J. Castellani, MD
    Supervisor: Ruth Cheng, MT(ASCP)
     
  • Microbiology 
    Medical Director: David W. Craft, PhD, D(ABMM) 
    Supervisor: Debra Myers, MHA, MT(ASCP)SM 
     
  • Histocompatibility
    Medical Director: Ronald E. Domen, MD
    Associate Medical Director: Hiroko Shike, MD
    Supervisor: Justine Gaspari, MT(ASCP), CHT(ABHI)
     
  • Special Hematology Laboratory
    Medical Director: M. Elaine Eyster, MD
    Sup0ervisor: Jeff Sanders, MS
     
  • Hematopoietic Cell Therapy Laboratory
    Medical Director: Witold B. Rybka, MD
    Supervisor: Joseph Mierski, MS, MT(ASCP)BB
     
  • Virology
    Medical Director: Wallace H. Greene, PhD, D(ABMM) 
    Coordinator: Jerri Anderson, BSMT
     
  • Phlebotomy Services
    Medical Director:  Michael H. Creer, MD
    Supervisor: Jeffrey Moore, MT(ASCP)
     
  • Client Services
    Medical Director: Ronald E. Domen, MD
    Coordinator: Jeffrey Moore, MT(ASCP)
     
  • Business Services (Departmental Resource)
    Chief, Division of Anatomic Pathology: Catherine S. Abendroth, MD
    Chief, Division of Clinical Pathology: Michael H. Creer, MD
    Work Unit Leader: Cheri Foreman, MT(ASCP), AHIMA, AAPC
     
  • Quality/Compliance Section (Departmental Resource)
    Chief, Division of Anatomic Pathology: Catherine S. Abendroth, MD
    Chief, Division of Clinical Pathology: Michael Creer, MD 
    Coordinator: Joanne Baylor, MT(ASCP)
    Coordinator: Carrie Bell, CLT(HHS), MLT(ASCP)
    Coordinator: Chris Kerr
    Coordinator: Thomas Stipe


The "standard" rotations in clinical pathology are Blood Bank and Apheresis, Blood Bank Bench, Chemistry, Hematology and Coagulation, Microbiology, Virology, Cytogenetics & Coagulation, Histocompatibility, and Clinical Pathology Consult.

Each rotation is under the direction and supervision of the faculty member identified with the rotation’s discipline. That faculty member is the rotation director and is responsible for the organization and content of the rotation. The rotation director is also responsible for resident evaluations for the rotation, but input is solicited from each attending who works with the resident during the rotation.

Directors of the “standard” rotations are:

  • Blood Bank and Apheresis: Melissa R. George, DO 
  • Blood Bank Bench:  Melissa R. George, DO
  • Chemistry: William J. Castellani, MD
  • Cytogenetics: Steven Schonberg, PhD
  • Molecular Diagnostics:  Keri Donaldson, MD
  • Hematology and Coagulation: Under recruitment 
  • Histocompatibility: Ronald E. Doman, MD
  • Clinical Pathology Consult: William J. Castellani, MD 
  • Microbiology: David W. Craft, PhD, D(ABMM)
  • Virology: Wallace H. Greene, PhD, D(ABMM)

"Standard" Core training in Clinical Pathology for combined Anatomic/Clinical Pathology residents consists of a curriculum of 22 four-week blocks. A curriculum for a “typical” resident would be:

RotationFour Week Blocks
Blood Bank and Apheresis

4

Hematology (2 blocks CP hematology/coagulation, 2 blocks AP hematopathology and 1 block CP & AP hematology)

5

Chemistry

2

Microbiology

3

Virology

1

Histocompatibility & Blood Bank Bench

1

Clinical Pathology Consult (including Molecular Diagnostics)

5

Cytogenetics & Molecular Pathology

1

TOTAL

22

Plus Elective Rotations1 - 4 

The above table indicates the time a “typical” resident would spend training in each rotation. As we focus on accomplishing the training goals and objectives of each rotation (and the overall goals of clinical pathology training) rather than the amount of time spent in each rotation (and in overall clinical pathology training), actual time spent in each rotation (and in overall clinical pathology training) may differ from resident to resident. While most residents can accomplish the rotation and overall goals in 22 four-week blocks, some residents require up to 26 four-week blocks of clinical pathology training to achieve basic competence. The rotation directors and the Chief of Clinical Pathology make determination of a resident’s competence in a rotation and in basic clinical pathology. Residents training in Clinical Pathology only will be required to spend additional time in Blood Bank and Apheresis and in Hematology and Coagulation.


Elective Rotations

A wide variety of elective rotations are available in clinical pathology. Elective rotations must be planned in consultation with appropriate faculty. A description of the elective rotation, with goals and objectives must be generated in advance, and must be approved in advance by the rotation director, program director, and Chief of Clinical Pathology.


Transition Between Anatomic and Clinical Pathology Services

When a resident moves from Anatomic to Clinical Pathology, it is expected that on the first day of the Clinical Pathology rotation the resident may spend time in Anatomic Pathology to allow orderly transfer of pending cases to the appropriate resident on the Anatomic Pathology service. It is also expected that after the first day, completion of pending Anatomic Pathology responsibilities will not interfere with the resident’s service and educational responsibilities on Clinical Pathology. In most cases agreeable arrangements for completion of Anatomic Pathology duties can be made in consultation with the Clinical Pathology attending. It is also expected that when a resident moves from Clinical to Anatomic Pathology, arrangements will have been made in advance to resolve pending issues.


On-Call Coverage

Scheduling resident on-call coverage is a responsibility of the Chief Resident, and may be delegated to one of the senior residents. A Clinical Pathology faculty attending is available to the resident at all times. Resident and faculty coverage schedules are available electronically.

A monthly On-Call Conference, facilitated by Clinical Pathology Medical Directors on a rotating basis, is held to review on-call issues, interesting cases, and problems. 


Books, Teaching Material and Conferences

A library of books and teaching materials is maintained in the resident office area. Computer workstations are also available with access to the Clinical Information System, the Laboratory Information System, library resources and the internet.


Orientation for New Residents

Each year an orientation program is presented for residents new to Clinical Pathology at the Penn State Hershey Medical Center. The purposes of this orientation are to:

  • Provide an overview of laboratory organization, operations, policies and services.
  • Introduce residents to key personnel and resources.
  • Prepare the resident for taking call.

The orientation program is revised each year to best prepare residents in a constantly changing environment. Therefore its structure, duration and topics vary. The orientation typically lasts from three days to one week in a concentrated form, with follow-up didactic sessions extending over several weeks.