Pathology and laboratory resident and medical student programs
Minneapolis VA Health Care System Pathology and Laboratory Medicine Service offers a variety of resident and fellow rotations available to anatomic and/or clinical pathologist trainees as part of our affiliation with the University of Minnesota Medical School Laboratory Medicine and Pathology Residency and Fellowship Training Program.
Pathology and Laboratory Medicine Services general rotation information
Resident and fellow rotations include anatomic and surgical pathology, chemistry/toxicology, blood bank and transfusion medicine. In addition, infectious disease (ID) fellows will rotate through microbiology as part of the University of Minnesota’s School of Public Health ID Fellowship Program.
Medical student rotations are available through affiliation with the University of Minnesota, Midwestern University College of Osteopathic Medicine and other medical schools. A one-month rotation at the VA is intended to expose the student to the duties of a pathologist. Students rotate through the various modalities and interact with the residents and staff.
Residents will be excused to attend didactic lectures and clinical presentations at the University. In addition, multi-specialty conferences are attended by residents, as appropriate for their rotation. Conferences designed for the rotating anatomic/clinical pathology residents, fellows and medical students include a daily consensus meeting, dermatopathology conferences, autopsy conferences, weekly pathology CME conference, weekly morbidity and mortality conferences, as well as, monthly journal club and case presentations.
Residents are expected to become certified as laboratory inspectors through the College of American Pathologists training program during this rotation.
Anatomic pathology VA rotation (anatomic and surgical pathology)
Residents rotate three months through Minneapolis VA Health Care System in their first year of residency (PGY-1), and once again (elective one-month) in their subsequent training, generally as PGY-3/4 or late in PGY-2.
The junior level anatomic pathology training is designed to train the residents in grossing techniques for biopsies and large specimens, with the objective of residents being comfortable in independently handling these duties by the end of the rotation. The rotation allows for adequate preview time for the residents to develop microscopic skills in histopathology and opportunities for one-on-one teaching with staff pathologists during sign-out sessions. Two weekly grossing-in days alternate with sign-out days. Flexibility allows for progressive responsibilities. Junior residents also perform autopsies and generate autopsy reports under the guidance and supervision of pathology assistants and staff pathologists.
Senior level residents (one month elective) are involved in activities designed to impart a higher level of responsibility, commensurate with their advanced level of training. The rotation allows these residents to be involved with frozen section processing, reporting and on-site adequacy assessment for diagnostic needle biopsies, again under the guidance and supervision of staff pathologists. The senior level resident is also responsible for daily preview, generation of diagnoses for surgical pathology cases under the tutelage of the staff pathologist; and teaching the junior resident. Grossing-in surgical pathology and autopsy performance are not included in senior elective rotation.
Daily expectations and responsibilities
Goals and objectives for VA surgical pathology rotation
Junior residents (3 months); Senior residents (1 month)
- Starting interview and finish interview: Rotation Director (room BB-105).
- Junior residents gross-in specimens and sign them out on alternate days. They sign-out (SP-1 rotation) everything that they grossed-in (Wednesday is University lectures and “catch-up” day).
- Senior residents sign-out cases every day (Wednesday is University lectures and "catch-up" day).
- All residents are expected to have reviewed relevant aspects in the Medical Record before sign-out session, and to have read relevant literature.
- All residents are expected to have a presumptive diagnosis on their cases at the time of sign-out. Presumptive diagnoses must be written (either on the paperwork or on a separate list, but the method should be consistent). Junior resident must have considered differential diagnoses. Senior residents must include staging information as per CAP templates for tumor resections. Junior and Senior residents must consider possible immunostains or special stains that may be needed for differential diagnosis, to be discussed at the time of sign-out
- Junior residents are expected to take the “White Belt” workshop training in quality improvement (offered by the VA every three months). Sign-up with Minneapolis VA Systems Redesign on the first day of the rotation.
- Junior and Senior residents are expected to present one monthly Journal Club, one article assigned to them (conference room BD-131). PowerPoint of journal club discussion must be copied to Director of the rotation and uploaded by resident in their portfolio.
- Junior and Senior residents are expected to discuss one monthly Case Presentation (date assigned to them) on an interesting case they have worked on, with review of relevant literature (conference room BD-131). PowerPoint of this case presentation must be copied to Director of the rotation and uploaded by resident in their portfolio.
- Junior residents are expected to take the online training and pass the test to be certified as CAP Inspectors for Laboratory Accreditation. A copy of the certificate must be given to the Director of the rotation and uploaded by the resident in their portfolio.
- All residents are expected to copy the director an electronic version of their case-log with the cases and diagnoses that they were assigned during the rotation. No patient personal identification can be included (only date, biopsy number and diagnosis; pathologist signing out, comments and references are optional). Residents must upload their case-log into their portfolio.
- All residents are expected to attend daily AP Consensus Conference (3:00 p.m., Multiheaded Microscope Conference Room, BD-110a).
- All residents are expected to attend and present weekly autopsy conference (Morgue, Monday 9:00 a.m.).
- All residents are expected to attend dermatopathology didactic conference and consultation conference with dermatopathologists (twice per week, Tuesday AM, Thursday PM, Multiheaded Microscope Conference Room, BD-110a).
- All residents are expected to attend weekly Medicine Morbidity and Mortality Conference (Wednesday, noon, atrium auditorium).
- Residents are expected to present the pathology of their cases when they are presented at interdisciplinary conferences (ad-hoc).
- Junior residents are expected to learn how to cut frozen sections, participate in the examination of frozen section slides and communicate frozen section diagnoses to surgeons.
- Senior residents are expected to assist staff pathologists during immediate cytologic interpretation in radiology.
- Residents are invited to attend interdisciplinary clinicopathologic conferences as interest and time allow: breast cancer conference, GI conference, urology conference colorectal, thoracic, head and neck, etc.).
- Junior residents are expected to perform all autopsies performed during their rotation, with assistance of autopsy pathologist PA; autopsy has priority over other activities.
- All residents are expected to attend Monthly Quality Management Meeting (3rd Thursday, Noon, room BD-131) and daily high reliability organization level 1 huddle.
- Daily schedule: 0800 to 1700; Monday to Friday.
- There is no on-call duty.
J. Carlos Manivel, M.D.
Blood bank rotation
The blood bank lab provides blood products for transfusion to our Veteran patients while also offering trainees an experience similar to labs in medium-sized community hospitals. A wide variety of patients are served, including hematology/oncology, cardiac surgery, neurosurgery, general surgery and general medical patients. The transfusion process is a team effort that extends beyond the lab. The process starts with the clinician's assessment of the patient's needs, obtaining of informed consent and writing orders. Residents and fellows can gain perspectives on all aspects of transfusion from verified specimen collection and crossmatch in the blood bank lab to patient infusion and investigation of adverse reactions.
Fellows on service for one month will participate in day-to-day blood bank operations and provide consultation for blood utilization, therapeutic apheresis procedures, ordering of lab testing, and investigation of transfusion reactions. In addition, they will attend related conferences and have the option to receive laboratory bench training. Resident rotations are 1-2 weeks and focus on basic laboratory bench training and an orientation to blood bank given in a series of basic lectures. Residents can also participate in transfusion service activities if time permits.
The transfusion service is AABB (American Association of Blood Banks) accredited, and is inspected by the FDA and JCAHO.
Chemistry and toxicology rotation
Chemistry is part of the core laboratory and is the largest section of the Pathology and Laboratory Medicine Service, while toxicology is part of the special diagnostics section.
Chemistry tests include electrolytes, glucose, urea, creatinine, liver function tests, cardiac profiles and lipid profiles, amongst others. Blood gases and urinalysis are also done in this section along with endocrine tests (TSH, Vitamin B12, Folate, LH, FSH and Prolactin); therapeutic drug monitoring (Dilantin, digoxin, etc.) and tumor markers (PSA, AFP).
The toxicology section includes both analytical toxicology and forensic toxicology sections. Analytical toxicology testing deals with routine toxicology testing for drugs of abuse and therapeutic drugs to support clinical needs of the medical center. Our forensic toxicology laboratory is a unique laboratory within the entire VA system, and is certified to perform employee drugs of abuse testing for the entire VA system.
The clinical chemistry rotation for the residency program in clinical pathology is a two-week rotation. Learning is by observation and through didactic sessions. In this rotation, the residents will spend time in various areas of the laboratory observing how common automated analyzers used in a clinical chemistry laboratory work. Basic analytical techniques such as spectrophotometry, nephelometry, gas and liquid chromatography, mass spectrometry and immunoassays are discussed. Residents will be introduced to the basic concepts of laboratory quality control and quality assurance.
Advance rotation of one month is also available for the fellowship program in clinical chemistry.