While rotating through the surgical pathology service, the fellow is responsible for following each case from point of accession to final sign out. The fellow is expected to reach a conclusion and a diagnosis and to answer all pertinent questions that may arise when a pathological lesion is found. When necessary, the fellow is expected to research difficult cases through reading and computer database searching. The fellow's responsibilities include the gross examination and trimming of all surgical pediatric specimens, except for small biopsies. The fellow first receives the daily load of microscopic slides and is expected to formulate a preliminary diagnosis after reviewing the pertinent literature. The fellow's diagnosis and description are then reviewed over the microscope with the attending staff pathologist. The fellow must preview the daily operating room list and become familiar with patients in the hospital. The fellow must be alert for procedures likely to require a frozen section diagnosis. In those cases in which electron microscopy is performed, the fellow reviews the photographs with the attending pathologist prior to the final sign out. An attending pathologist will be available to answer questions and assist with difficult cases at all times.
The hematopathology rotation integrates a myriad of findings to generate a unified and comprehensive diagnosis. During the rotation, the fellow will be exposed to the numerous components of the hematopathology service. These components include morphology and immunohistochemistry of biopsy sections, bone marrow aspirate smears, peripheral blood smears, cytochemistry, flow cytometry, cytogenetics, molecular diagnosis and clinical history.
While rotating through the autopsy service, the fellow is primarily responsible for handling, sampling and describing tissues and gross findings as well as reviewing the pertinent literature. All autopsies are performed under the supervision of a staff pathologist. After examining the microscopic slides, the fellow writes a preliminary autopsy report and then reviews the slides and discusses the case with the attending pathologist. Pertinent clinical information and clinical laboratory findings are incorporated into the final report. The fellow must also supervise residents from the Hospital of the University of Pennsylvania (HUP) when a fetal autopsy from HUP is performed at Children's Hospital. The fellow participates in all brain cutting conferences and reviews surgical specimens with the neuropathologists.
During the first year, the fellow is expected to participate in clinical research in collaboration with the staff pathologists or interested clinicians. There is more time available for clinical research during the medical pathology rotation, but additional time can also be spent on research during the surgical pathology rotation. At the beginning of the academic year, the staff pathologists give the fellow a selection of research projects to choose from. It is expected that the fellow become involved in at least one of these projects and submit an abstract to the annual meeting of the Society for Pediatric Pathology, which is held in late winter.
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