What fellowships are available at Iowa? There are fellowships available in surgical pathology, cytopathology, hematopathology, microbiology, transfusion medicine, and molecular pathology. A neuropathology fellowship has been approved and applications are being accepted. 

What type of call do residents take? First year residents take surgical pathology call starting on their second surgical pathology rotation. Second, third and fourth-year residents take surgical pathology call (on surgical pathology rotations), clinical pathology (CP) call and anatomic pathology/clinical pathology (AP/CP) call on the weekends.

Clinical pathology call (Monday through Thursday) consists of at-home-call every ten to twelve days. The resident can expect to receive questions and problems from any of CP services. For example, residents may be called to approve or deny requests for tests that are usually only done during the day or requests for platelets when the blood bank platelet stock is low. These types of calls often require the resident to contact the requesting physician and decide whether the request is justifiable or if another test or blood product would be more helpful. Rarely, residents on call must come into the hospital for emergent transfusion medicine therapeutic procedures.

AP/CP call is covered on Friday night, Saturday and Sunday by one resident each day. It consists of all those duties explained under CP call as well as weekend frozen section coverage (with faculty back up), checking the gross room for specimens, and consulting with clinical services on the weekend.

How is vacation time handled? Residents have 15 weekday vacation days per year. For most rotations it is fairly easy to take time off and many rotations do not require cross coverage. Residents may take time off on any rotation as long as appropriate coverage is obtained. Residents also have up to a week of educational time per year that can be utilized for attending meetings.

What about fringe benefits such as book/travel funds? Each resident is given $850/year for books/journals/memberships, etc. Unused funds carry over to the next year. On top of the annual book fund, each resident is also provided with a $600 technology stipend by the pathology department to enhance their study and learning at the start of residency. Travel to national conferences is paid for by the department for residents presenting abstracts. Travel to national meetings for pathology organizations that residents are involved with is also covered. Furthermore, during the residency training, the department will sponsor each resident to attend one national conference regardless of whether an abstract is presented (one "free" meeting).

How do residents interact with the surgical pathology fellows? In other words will I simply be a "meat cutter" for the fellows? No! The fellow on the preliminary diagnosis service ("hot seat") essentially works separately from the residents, and the fellows covering the gross room primarily perform frozen section diagnosis and instruct residents on how to handle specimens. The other fellows cover consult cases and work directly with faculty. Surgical pathology at Iowa is extremely resident-friendly.

There are no pathology externs at my medical school. What is their role? Externs are medical students who, toward the end of their second or third year, take a year away from their traditional medical school curriculum and work in the pathology department in surgical pathology and autopsy. They function basically as a resident, except that they do not take call. Externs typically start in July and finish in June.

Do residents interact with visiting professors? In addition to interacting with visiting professors invited by the faculty, each year the pathology residents invite a prominent pathologist to campus. Typically this visiting professor will have several microscope sessions or other meetings with the residents and will give grand rounds. This is an excellent opportunity to not only learn in-depth about a specific area in diagnostic pathology, but also to get to know well-known pathologists from around the country.

How well do Iowa residents fare in finding jobs after training? The established reputation of excellence in training at the University of Iowa, combined with the recent trend of increasing demand and aging of current pathologists, has meant a tremendous opportunity for residents from our program. All departing residents in recent years have had no difficulty getting multiple offers for desirable positions in both academic and private settings.

August 2016

The Anatomic and Clinical Pathology Residency Program ensures that it provides appropriate supervision for all residents, as well as a duty hour schedule and a work environment that optimizes quality patient care, fortifies the educational trajectory of house staff members, and addresses all applicable program requirements. On-call duties are necessary components of University of Iowa Hospitals & Clinics clinical care systems and educational programs; these duties are managed to ensure adequate periods of rest with appropriate levels of supervision to deliver safe, effective patient care. (The terms "resident" or "house staff member" used in this policy shall refer to resident and fellow physicians and dentists at all house staff levels.)

Supervision

The clinical activities of all residents are supervised by teaching staff and/or more advanced house staff members in such a way as to ensure that the resident assumes progressively increasing responsibility according to each resident’s level of education, ability and experience as appropriate to the patient situation and resident capability. The teaching staff determines the level of responsibility accorded to each resident. On-call schedules for teaching staff and more advanced house staff members are structured to ensure supervision is readily available to those on duty.

The following guidelines have been established to assure the appropriate supervision of residents on all services/rotations across all levels of training. Pathology faculty are assigned on a daily basis to staff all services. Detailed coverage schedules are created monthly and are widely distributed to everyone in the department. Each resident is assigned to a primary service and supervision is provided by the faculty assigned for that day. All rotations provide for daily personal faculty interaction. The clinical involvement of faculty and the low trainee to staff ratio ensures that these interactions are frequent and instructive. The intensity and closeness of supervision varies considerably with the experience and abilities of the resident. The faculty determines the level of responsibility accorded to the resident. These factors are judged individually after formal discussions by faculty, and review of resident evaluations. The level of supervision is not dependent solely on the length of time in training.

All call is taken from home in this residency program, with a corresponding faculty member or fellow on call at all times. The resident on call for a particular service knows exactly which pathologist is on call for every service via the departmental call schedules, which are available on the intranet and posted in multiple locations in the department. Residents can contact them at any time via the pager system or phone. Every year the department also publishes a call manual, which provides guidelines for frequently asked questions encountered on call as well as providing contact numbers for all house staff and faculty.

The Anatomic and Clinical Pathology Residency Program demonstrates that the appropriate level of supervision is in place for all patients cared for by all residents. Every service has an attending pathologist assigned who is responsible to assure the excellence of medical care and to supervise and teach pathology house staff involved in patient care. Each clinical service is continuously covered by a faculty member who is accessible at any time by means of the pager system. These levels of supervision include:

• Direct Supervision - The supervising physician is physically present with the resident and patient.
• Indirect Supervision
  i) with direct supervision immediately available – The supervising physician is physically present within the hospital or other site of patient care, and is immediately available to provide direct supervision.
  ii) with direct supervision available – The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision (within 20 minutes travel to the hospital).

PGY 1 residents are supervised either directly or indirectly with direct supervision immediately available while they acquire basic knowledge and skills specific to the specialty. As required by the Pathology RC of the ACGME, direct supervision and documentation is done for the first three of each of the following procedures: autopsy, fine need aspiration, apheresis, and grossing of surgical pathology specimens (first three in each organ system). Activities of PGY 2 residents and above are supervised by any level of supervision, as appropriate to the patient situation and resident capability. Supervision does not equate merely to the presence of more senior physicians nor with the absence of independent decision making on the part of residents. These supervision standards encompass the concepts of graded authority, responsibility and conditional independence that are the foundation of delegation of authority to more senior house staff members. Should a resident ever need further assistance or information, they can contact the senior resident or faculty on call. Residents are expected to communicate with the appropriate supervising faculty when leaving for vacation or other absences to ensure all patient care responsibilities are transitioned appropriately. Residents are also expected to have a conversation (in person, via phone, or email) post-call to relay relevant information to the resident taking over the next day. At the end of a rotation each resident is expected to communicate with the resident moving onto that rotation to assure a smooth transition and continuity of patient care.

Duty Hours

Residents work hours are monitored by the Program Director/Associate Program Directors and Program Coordinator by means of a work hour record on MedHub that residents are expected to complete weekly. The work hours for day and night duty on all rotations are designed such that hours worked will fall within the ACGME rules for resident work hours: no more than 80 hours per week when averaged over 4 weeks; one day off in seven when averaged over 4 weeks; there is at least a 10 hour period free of clinical duty between shifts.

All residents will report any concerns about resident hours directly to the Program Director/Associate Program Directors or via rotational evaluations solicited at the end of every rotation.

Specific duty hour requirements are as follows:

1. Maximum Hours of Work Per Week: The duty hours of any resident must be limited to 80 hours per week (or other applicable limit as specified by the appropriate Residency Review Committee (RRC), when averaged over a 4 week period, inclusive of all in-house call activities and any moonlighting activities. Any time spent in the UIHC or at another institution for clinical and academic purposes, related to the residency or fellowship program, both inpatient and outpatient, shall count toward the weekly maximum. Additionally, the weekly maximum shall include time spent for administrative duties related to patient care, the transfer of patient care, scheduled academic activities such as conferences, research related to the program, and any time the resident spends on-site after being called in to the hospital. Not included in the weekly maximum is time spent outside of UIHC (or outside another institution related to the program’s academic purposes) for academic preparation, reading, and studying.

Duty Hour Exception: University of Iowa Hospitals & Clinics, through its Graduate Medical Education Committee (GMEC) has established criteria and procedures for GME programs to petition for an exception to the weekly hour limit. (See the Procedures and Criteria to Petition the Graduate Medical Education Committee to Exceed the Weekly Rule on Duty Hours by 10%). If approved by the GMEC, the Program Director must also obtain approval from the appropriate RRC before the weekly limit is exceeded. If this exception is granted, at no time, shall the average number of duty hours exceed 88 hours per week, when averaged over a 4-week period.

2. Maximum Duty Period Length:

• PGY 1 residents - scheduled duty periods must not exceed 16 hours in duration.
• PGY 2 and above residents – no schedule shall exceed a maximum of 24 hours of continuous duty in the hospital, with no more than 4 additional hours used for any transitional activities (i.e. maintaining continuity of medical and surgical care, transferring patient care, or attending educational sessions).
• In no event shall the PGY 2 or above resident accept a new patient (any patient for whom the resident has not previously provided care) during this 4-hour extension period.
• PGY 2 or above residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
• In unusual circumstances, PGY 2 and above residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring or humanistic attention to the needs of a patient or family. Residents must appropriately hand over the care of all other patients to the team responsible for their continuing care.
• Any resident exceeding maximum duty period lengths will document their justification in the institution’s resident management system (i.e. MedHub).
• Residents are expected to have a conversation (in person or via phone) at the end of each call period to relay relevant information to the resident taking over the service the next day or taking the next call period to ensure continuity of care. At the end of each rotation the resident is expected to communicate with the resident moving onto that rotation to assure a smooth transition and continuity of patient care. Residents are expected to communicate with the appropriate supervising faculty when leaving for vacation or other absences to ensure all patient care responsibilities are transitioned appropriately.

3. Maximum Frequency of Over-Night In-House On-Call Duties: Not applicable, as pathology residents do not participate in in-house call.

4. Maximum Frequency of In-House Night Float: Not applicable, as pathology residents do not participate in in-house call.

5. Mandatory Time Free of Duty: Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). This day off shall not include home call nor shall the resident be required to carry a pager. A day is defined as 24 consecutive hours.

6. Minimum Time Off Between Scheduled Duty Periods: Based on the level of the resident, there are identified levels of time off between scheduled duty periods.

• PGY 1 residents – should have 10 hours, and must have 8 hours, free of duty between scheduled duty periods.
• Intermediate level residents (as defined by the program’s RRC) – should have 10 hours, and must have 8 hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 continuous hours of in-house duty.
• Final year residents (as defined by the program’s RRC) – can participate in transition to practice activities when they are preparing to care for patients over irregular or extended periods. It is still desirable that these residents have 8 hours free of duty between scheduled duty periods, but there may be circumstances where residents must stay on duty to care for their patients or return to the hospital after shorter intervals.
• The Program Director monitors time off between scheduled duty periods.

7. Home Call:Residents returning to the hospital from home call must count their time spent in the hospital towards the 80-hour maximum weekly hour limit. The frequency of home call is not subject to the every-third-night limitation but must satisfy the requirement for 1 day in 7 free of duty, when averaged over 4 weeks.

• Home call activities must not be so frequent as to preclude rest and reasonable personal time for each resident.
• Residents are permitted to return to the hospital while on home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period.”

8. Moonlighting: Moonlighting is not permitted in the Department of Pathology.

The Anatomic and Clinical Pathology Residency Program meets the requirements of this policy as well as any applicable standard set by the ACGME, the appropriate RRC, or other accrediting or certifying body. This policy is distributed by the GME Office to all GME contract holders, as well as provided in the departmental orientation materials and posted on the departmental intranet. The Anatomic and Clinical Pathology Residency Program monitors resident duty hours with a frequency sufficient to ensure compliance with this policy and the ACGME/RRC/other accrediting or certifying body’s rules.

We have indexed our policies and procedures in a document clearinghouse as a means of keeping items there as up to date as possible. Each of the documents listed on the clearinghouse page is in .pdf format and will be downloaded to your computer. All policies are subject to change.

Go to the index of GME policy documents.

University of Iowa Policies

• Sexual Harassment
• Sexual Misconduct Involving Students, Including Sexual Assault and Sexual Harassment
• Policy on Violence
• Physical and Sexual Abuse of Children
• Policy on Consensual Relationships Involving Students
• Non-Discrimination Statement
• Policy on Human Rights
• Anti-Harassment Policy
• Accessibility Statement
• Anti-Retaliation Policy

Each rotation is 4 weeks for a total of 13 rotations per year.

SURGICAL PATHOLOGY -- UI Hospitals & Clinics (12 rotations throughout training divided into subspecialties)

Surgical pathology was subspecialized in January of 2024 into 5 subspecialty services: Gynecologic, Gastrointestinal, Head and Neck with Thoracic, Genitourinary, and Breast. Bone and soft tissue and peds are mixed into the other services at this time although we have faculty who are subspecialty experts in all areas. Residents are assigned to a subspecialty service for two-week intervals, so 2 subspecialties are encountered during each four-week block. This is designed into the system to allow for more iterations of each subspecialty service throughout training and to decrease the time interval between iterations.

We feel this allows our program to benefit from the efficiency and depth of teaching gained by subspecialty signout while reducing the negative impact of only having one or two instances of each rotation that can be encountered in subspecialty systems. Residents will have approximately 2.5 blocks of each subspecialty or 5 two-week iterations of each subspecialty spread throughout training. The general structure of the rotations include a frozen section/grossing day that is meant to focus resident experience on frozen sections. This includes selecting tissue for examination from the gross specimens and reading the slides. the other 4 days each week will focus on previewing histopathology, generating reports, and limited grossing each day to allow residents to review slides of cases they have grossed.

In the gross room, we have 6 pathology assistants to help with the grossing labor and to help with teaching our residents. There is a surgical pathology fellow in the gross room as well who focuses on management of the workload and calling back frozens with faculty supervision. Residents have the opportunity to increase their responsibility in these roles on their frozen section days as they gain skill and confidence under supervision of fellows and faculty.

Special opportunities at Iowa:

• Residents start dictating and taking ownership of cases from day one.
• Six pathology assistants in the gross room ensure that residents spend time grossing educational specimens and guarantee adequate supervision for junior residents.
• Residents microscopically see what they gross.
• There is adequate preview time.
• Residents are not required to present at tumor boards; however, many attend and present based on their interests.
• Residents will experience the importance of molecular pathology as it relates surgical pathology through correlation with molecular rotations.
• Residents are exposed to a wide array of diagnostic techniques including immunohistochemistry; many residents have the opportunity to get involved in the process of bringing up and validating new immunohistochemical stains in the department.
• Acting fellowships (on a voluntary elective basis) and VA rotations (see below) allow for graduated responsibility and autonomy.

VETERANS AFFAIRS MEDICAL CENTER (VAMC) SURGICAL PATHOLOGY (Two to three rotations)

The VAMC Surgical Pathology rotations offer senior level (generally 3rd and 4th year) residents the opportunity to experience an even broader range of surgical pathology cases with increased autonomy. The breadth of specimens is more akin to what one would see in a private practice environment (i.e. skin biopsies, GI/GU biopsies, etc). Overall there is lower volume and complexity than the university setting, but more independence for the resident. On a daily basis, the resident is responsible for grossing, dictating the microscopic descriptions and diagnoses, and signing-out all surgical pathology specimens with faculty. Other responsibilities include performing and interpreting frozen sections with faculty back-up as needed. The VA Surgical Pathology experience is a rewarding one because it allows senior residents to accept more responsibility and be "on their own" with faculty assistance as needed.

ACTING FELLOWSHIP (Electives available)

The acting fellowship allows for more graduated responsibility by residents during their senior years of residency. Residents spend time in the gross room teaching junior residents and interpreting frozen sections (with faculty backup as needed), rotating through preliminary diagnoses (“hot seat”), and previewing outside cases sent for consultation or needing second review. Similar experiences are available in other subspecialty areas when interest is present from residents.

AUTOPSY SERVICE (four rotations)

The four autopsy rotations cover both hospital and forensic cases, all of which occur in our state-of-the-art facility within the hospital. The autopsy service consists of one to two residents, one to two externs, decedent care specialists (hospital morticians who assist in evisceration), and faculty members. Residents are assigned alternating autopsy cases and are responsible for each case from start to finish. In general, each case involves chart review, consulting with clinicians, external and internal examination, organ dissection, microscopic examination, and review of the case with the staff member and any consultants as necessary. Determination of ancillary testing including toxicology, microbiology, cytogenetics, immunohistochemistry, etc. is also performed. A complete report is written by the resident prior to sign-out.

The autopsy rotation utilizes a five-day work week. Any case that comes in after 2:00 p.m. is generally performed the next working day.

The breadth of cases on our autopsy service is outstanding. We see a variety of medical, forensic, and pediatric/neonatal autopsies. Approximately 50% of the autopsies we perform are medical examiner cases. Residents have no problem getting the requisite number of cases needed to sit for boards (30), without sharing.

Special opportunities at Iowa:

• Meet with law enforcement and medical investigators during a daily morning report.
• Attend court hearings and depositions with forensic staff.
• Learn to comfortably and efficiently perform an autopsy from start to finish.
• Forensic cases performed on site.

CYTOPATHOLOGY (three rotations)

During cytopathology, residents preview cytology cases, go to adequacy assessments, and perform fine needle aspirations (FNAs). FNAs are either done on the hospital inpatient floors or in the FNA clinic, which is run by the Department of Pathology. The resident, fellow and staff also make an initial on-site adequacy evaluation of FNAs performed by the radiology, endoscopy, and bronchoscopy suites. When additional slides are processed, the resident and the fellow review the slides and enter a diagnosis in the computer. The slides are then reviewed with the fellow and the staff. Abnormal pap smears and fluids (such as cerebral spinal fluid and urine) are also examined this way. Case sign-out occurs throughout the day in between procedures.

Special opportunities at Iowa:

• Residents will experience the importance of molecular pathology as it relates to cytology. 
• FNAs are performed by the Department of Pathology. Residents will perform numerous FNA procedures over the three rotations.

DERMATOPATHOLOGY (two rotations)

Pathology residents work with a dermatology resident to preview and write up in house and consult dermatology cases. Residents usually preview cases in the morning and sign out with staff in the afternoon. Residents are also responsible for previewing and writing up direct immunofluorescence (DIF) reports on skin. Dermatology specimens are grossed by either histology technologists or pathology assistants (no resident grossing required on this rotation).

Special opportunities at Iowa:

• Work alongside dermatology residents to correlate clinical histories with histology.
• Correlate DIF with H&E slides.

NEUROPATHOLOGY (two rotations)

Residents are required to gross neurosurgical specimens, then preview and write up neuropathology cases. Residents preview in the morning and sign out one-on-one with on staff neuropathologists. Specimens may be grossed throughout the day as time allows. Residents may attend autopsy brain cutting. Renal pathology is also included in the first rotation, and includes one on one signout and teaching sessions with renal pathology faculty. More senior residents may present at tumor board and spend more time in ocular pathology and neuro/muscular pathology during their second rotation.

Special opportunities at Iowa:

• Iowa is a referral center for neuromuscular pathology and autopsy brains.
• See a wide variety of specimens from brain tumors to muscular dystrophies.
• Attend weekly interdepartmental conferences, including neuromuscular conference Friday morning with neurologists in attendance.
• Updated intraoperative study sets.

CHEMISTRY/INFORMATICS (three rotations)

Resident duties on the clinical chemistry service include signing out protein electrophoresis, working with medical technologists to solve laboratory problems and reviewing study cases provided by the faculty. Serum protein electrophoresis and immunofixation electrophoresis are evaluated by the resident who enters an interpretation in the computer, followed by staff sign-out. Residents may be asked to contact clinicians about test requests reports and may suggest alternative testing which would better answer the clinical question. Throughout the week, clinical cases with interesting laboratory findings are directed to the resident who then independently studies the underlying pathophysiology. One of these cases is typically presented by the resident in the clinical pathology conference on Fridays. During the second or third rotation, the resident is involved in a laboratory management project which often results in publication or presentation at national meetings. The coagulation curriculum is also introduced during the second or third rotation. Though informatics is incorporated throughout each rotation, it is formally introduced in the curriculum during the third rotation.

Special opportunities at Iowa:

• Be involved with staff during mock CAP surveys; upper-level residents are often asked to join CAP survey teams for inspecting outside laboratories.
• Exposure to in-vitro fertilization (one of the best in the country)
• Thorough exposure to informatics
• Attend diagnostic services committees and other high-level meetings.

HEMATOPATHOLOGY (four rotations)

One to two residents are assigned to hematopathology and work with the hematopathology fellow and faculty. Responsibilities are split between previewing bone marrows and writing up reports, and reviewing blood smears and fluids (“wet side”). Bone marrow signout occurs in the early afternoon and the rest of the time is set aside for previewing. First-year residents start on the bone marrow service and are introduced to the wet side at the end of the first rotation. Lymph node cases are introduced during the second rotation and residents are responsible for previewing them during the third rotation and onward. Unknowns are often prepared by faculty for residents to review. Hematology and oncology clinical teams frequently stop by to review cases, and interesting cases are also discussed weekly at interdepartmental conferences and tumor boards.  

Special opportunities at Iowa:

• Weekly blood club: Clinicians from the hematology and pathology (heme and transfusion) meet to discuss interesting cases. Fellows usually present; residents are encouraged to attend.
• Lymphoma conference: Pathologists and clinicians discuss interesting patients with lymphoma. Heme fellow or resident usually presents.
• Correlation with molecular testing (PCR, FISH, etc.) during molecular and cytogenetics rotations.
• Bone marrow biopsies are not required for residents; however, scheduled training can be done through the hematology/oncology department at the University and the VA.

IMMUNOPATHOLOGY (three rotations)

Residents are required to preview and write up all flow cytometry cases on lymph nodes, peripheral blood, CSF etc. Cases are usually looking for tumor; however, immunodeficiency cases are also reviewed. Residents may be asked which particular panel to perform on cases. All flow cytometry reports are written by the resident and signed-out with staff throughout the day. In addition, an interesting case is presented by the resident at the clinical pathology conference each Friday morning. Residents also prepare for and present at leukemia tumor board weekly.

Special opportunities at Iowa:

• 10 color flow cytometry is performed.
• Residents perform cluster analysis using specialized computer software.
• Chairman’s Rounds review special topics and interesting cases in flow cytometry.

MICROBIOLOGY (two rotations)

The two rotations in microbiology include a wide variety of activities. Time is allowed to sit on the bench with the technologists as they process specimens and identify organisms. The resident also participates in daily lab rounds with the lab directors. During these rounds, the technologists in each area of the lab present interesting cases and ask questions regarding extent of identification required for a particular isolate, clinical significance of an organism, need for susceptibility testing, etc. Gram and Giemsa stains on a variety of organisms are previewed then reviewed with staff. The resident carries a service pager as well. The resident also works-up a series of "unknowns" including mycology and bacteriology specimens. In addition, an interesting case is presented by the resident at the clinical pathology conference each Friday morning.

Special opportunities at Iowa:

• Exposure to MALDI-TOF technology as well as traditional chemical diagnostics.
• The research activities of the microbiology and immunology division are extensive and there are numerous opportunities to become involved in projects.
• Exposure to the Iowa State Hygienic Laboratory (run by the University of Iowa).
• Weekly meetings with infectious disease fellows to discuss interesting cases.

MOLECULAR PATHOLOGY (two rotations) and CYTOGENETICS

Residents are responsible for interpretation of a variety of molecular tests within three broad categories of molecular pathology (genetic diseases, molecular infectious disease testing, and molecular oncology). Residents are exposed to different molecular techniques including next generation sequencing (multiple platforms), Anchored Multiplex PCR, Sanger sequencing, droplet digital PCR, etc. Residents are required to preview and interpret and write up molecular reports. Residents field molecular questions from clinicians and are also involved in microdissection of surgical and cytology specimens.

Special opportunities at Iowa:

• Exposure to interpretation of multiple next generation sequencing platforms and Sanger sequencing
• Multiple molecular pathologists with varied interests
• Correlation of surgical and cytology specimens
• During the cytogenetics rotation, residents will get hands on training with karyotypes and FISH. Residents will perform their own karyotype from start to finish (optional).

TRANSFUSION MEDICINE (three rotations)

The transfusion medicine resident(s) work with the transfusion medicine fellow and faculty to oversee the acquisition and distribution of blood products for the hospital. Residents frequently become involved in the care of patients who require massive transfusion (i.e. patients with trauma, coagulopathy, or surgical difficulties). Transfusion medicine residents evaluate requests for special products such as granulocyte transfusion or crossmatched platelets. The transfusion service performs apheresis procedures for conditions such as thrombotic thrombocytopenic purpura (TTP), Guillain Barre, and hyperviscosity syndromes, as well as collects peripheral stem cells for bone marrow transplants (residents write the orders and the notes for all procedures). Transfusion medicine residents assist the blood donor nurses in screening potential blood donors. Residents write orders and notes for all procedures. Residents are also required to write reports for suspected transfusion reactions and positive antibody panels, to be signed out later with the staff.

Special opportunities at Iowa:

• Exposure to a variety of procedures performed in the apheresis clinic: plasmapheresis, leukapheresis, photopheresis, LDL pheresis, red cell exchange, therapeutic phlebotomy, stem cell collections, and T cell collections (for oncologic immunotherapy).
• Residents oversee a blood collection center, apheresis clinic, and blood bank, which are all located within the hospital.
• Weekly blood club: involves clinicians from the hematology department and pathology (heme and transfusion) to discuss interesting cases. Fellows usually present; residents are encouraged to attend.
• Weekly hands-on lab exercises: residents will perform several lab assays including type and screens (can be done on their own blood), elutions, and antibody panels.

VAMC CLINICAL PATHOLOGY (three rotations)

The three VAMC Clinical Pathology rotations offer residents the chance to experience an integrated clinical pathology laboratory (blood bank, hematopathology, chemistry, microbiology, immunopathology). On a daily basis the resident is responsible for interpreting, writing up and signing-out bone marrow examinations with faculty consultation. The resident interprets blood smears, body fluid analyses, bronchioalveolar lavage specimens (BALs), flow cytometry, microbiology slides, and electrophoreses with faculty back-up as needed. Other duties include blood bank audits and approving send-out tests. Each week the resident leads a laboratory meeting discussing the send-out tests that they were asked to review as well as any pages received during the week.

On this rotation the resident may gain more experience performing bone marrow biopsies, under the supervision of Hematology-Oncology fellows. Finally, the resident is responsible for "troubleshooting" problems that arise in the laboratory, being a clinical laboratory consultant for physicians, and other projects. The VAMC clinical pathology rotation offers residents the chance to have an experience akin to the private practice environment. The residents perform laboratory management, make interpretations and diagnoses with faculty backup as needed, and act as a laboratory consultant. There is adequate time available for reading or research projects.

Special opportunities at Iowa:

• The VAMC in Iowa City is a national leader in test and protocol development and is a referral center for other VA hospitals.

MEDICAL RENAL (one rotation)

Residents will preview and write up medical renal cases following interpretation of H & E slides, special stains, electron microscopy, and DIF. Residents are also required to gross medical renal biopsies using light microscopy for glomerulus evaluation and divide the specimen up for DIF and EM studies. Residents rotate through medical renal with the first neuropathology rotation.

Special opportunities at Iowa:

• Residents will spend time in the EM lab to understand its role in diagnostics.

ELECTIVE (six rotations)

Each resident is allowed six electives over the four years of AP/CP residency. Residents spend this time in a variety of ways including further experience in areas of interest, as well as clinically related research. Any standard rotation can be taken to gain additional experience. Acting fellow experiences are available. Custom rotations focusing on areas of interest can be designed on an ad hoc basis as well.

Daily resident teaching conferences occur each morning.

The spectrum of topics covered in these teaching conferences are as diverse as the field of pathology. Attendance is required at these conferences.

Monday and Tuesday: AP didactics and unknown conferences.

• Surgical Pathology Didactics: The surgical pathology curriculum operates on a two year cycle, with faculty presenting on topics within their expertise. The current curriculum is based on prior resident feedback and spearheaded by faculty to ensure adequate coverage of relevant topics. The didactics are typically focused on a specific topic within a subspecialty area and may cover microscopy, diagnostic workup, reporting, molecular testing. Occasionally, gross conferences with live specimens are also held. Generally, the resident talks about specimen's possible organ of origin, gives a differential diagnosis of the disease process and discusses the best grossing technique for the specimen. Pathology boards include questions with gross pictures, so this is valuable preparation for boards and for broadening one's knowledge base.

• Surgical Pathology Unknown Conference: The week before this conference, an assigned faculty member will put out slides for several cases (usually about six to eight) for the residents to review and formulate a diagnosis. Digital slides are frequently available. During the conference, a resident will be called on to discuss the microscopic features, provide a differential diagnosis and explain what further studies (stains, molecular etc.) may be necessary to achieve a definitive diagnosis. The case is then discussed by staff and residents as a group. Usually the conferences have a theme (soft tissue, breast lesions, etc.) related to the special interest of the presenting faculty member.

• Autopsy Gross Conference: Once a month, the residents on the autopsy rotation will present and review interesting cases from the previous rotations. The autopsy conference is entirely resident-driven with oversight from our dedicated autopsy staff members.

Wednesday: Clinical Pathology Didactic Conference. Responsibility for this conference rotates from one clinical pathology service to another throughout the year (Transfusion Medicine, Chemistry, Hemepath, Immuno, Microbiology, Molecular Pathology, and Informatics). For example, seven didactic sessions of Hemepath are followed by seven sessions of Microbiology, etc. Topics are widely variable, and include classification of leukemias and lymphomas, flow cytometry, coagulation testing, mycobacteria, endocrine testing, platelet usage, laboratory information systems etc.

Thursday: Anatomic Pathology Specialty Conference. Usually this conference is a didactic, but occasionally unknown cases are put out similar to the surgical pathology unknown conference on Tuesday. Neuropathology, cytopathology, and dermatopathology are areas typically covered.

Friday: Clinical Pathology Morning Report. Residents from each of the clinical pathology services present cases via PowerPoint format to the other residents and staff, with a short discussion. Usually each presentation lasts 10 minutes. These are typically informal presentations and do not require the resident to spend an inordinate amount of time in preparation. Interesting components of the cases and presentations are discussed among the group of residents, staff, and faculty. The benefit of having the opportunity to hone presentation skills throughout residency training is invaluable.

Other Conferences:
Attendance is suggested, but not required:

Pathology Grand Rounds (Thursdays at noon): Similar to grand rounds in other specialties, a staff member, senior resident, fellow, or visiting faculty from another institution gives a didactic presentation. Lunch is usually provided.

Residents as Professionals (RAP) (aka Residents and Pizza): This is an hour long session held one Monday a month at noon. The topics discussed are varied, including: Business management, human resources, research techniques, time management, etc. Pizza is provided

Chairman Rounds: Held on the first Wednesday of every month at noon, Dr. Karandikar reviews special topics and interesting cases in flow cytometry.

Gastrointestinal (GI) pathology conference (Fridays): GI faculty present recent cases to gastroenterology clinical staff and give a short didactic regarding the pathologic features of the case. This conference provides a lively and informal experience in interdepartmental communication.

In addition to these, there are several other learning opportunities specific to each rotation, including, blood club, core lab meetings and hematopathology unknown conferences.

Rotations are organized into 13 blocks per year (each block is 4 weeks).

Rotations for AP/CP residents are as follows: 

• Anatomic Pathology (25 blocks):
  • University Surgical Pathology (12 blocks):
    • Gastrointestinal Pathology (2.5 blocks)
    • Gynecologic Pathology (2.5 blocks)
    • Head & Neck/Thoracic Pathology (2.5 blocks)
    • Genitourinary Pathology (2 blocks)
    • Breast Pathology (2.5 blocks)
  • VA Surgical Pathology (2-3 blocks)
  • Cytology (3 blocks)
  • Neuropathology (2 blocks)
    • First neuropathology rotation is lighter and paired with medical renal pathology
  • Dermatopathology (2 blocks)
  • Autopsy (4-5 blocks)
     
• Clinical Pathology (20 Blocks):
  • Hematopathology (4 blocks)
  • Transfusion Medicine (3 blocks) 
  • Clinical Chemistry/Informatics (3 blocks)
  • Microbiology (2 blocks)
  • Molecular Pathology (2 blocks)
  • Immunopathology (3 blocks) 
  • VA Clinical Pathology (3 blocks)
    ​
• Electives (6 blocks)
  • Electives may include research and/or additional advanced AP or CP rotations. Residents frequently use elective time to participate in some type of scholarly project which may involve scientific research, (basic, translational or clinical) or educational scholarship.
     
• Advanced subspecialty training is offered on an elective basis in all areas of anatomic and clinical pathology. 

The Department of Pathology offers approved training for residents as follows:

• Combined Anatomic and Clinical Pathology - 4 years
• Anatomic Pathology only - 3 years
• Clinical Pathology only - 3 years
• Anatomic Pathology/Neuropathology - 4 years
• Physician Scientist Training Program - 4-6 years

Twenty pathology residency positions are available, generally with five residents in each year of training. The number of residents apportioned to AP or CP only versus combined AP/CP training is flexible.

First year residents will take surgical pathology weeknight call starting on their second surgical pathology rotation with direct supervision provided by surgical pathology fellows and faculty.  First year residents will not take any weekend call or any clinical pathology call.  Second, third and fourth-year residents take surgical pathology call (on surgical pathology rotations), clinical pathology (CP) call and anatomic pathology/clinical pathology (AP/CP) call on the weekends.

Clinical pathology call (Monday through Thursday) consists of at-home-call every ten to twelve days. The resident can expect to receive questions and problems from any of CP services. For example, residents may be called to approve or deny requests for tests that are usually only done during the day or requests for platelets when the blood bank platelet stock is low. These types of calls often require the resident to contact the requesting physician and decide whether the request is justifiable or if another test or blood product would be more helpful. Rarely, residents on call must come into the hospital for emergent transfusion medicine therapeutic procedures.

AP/CP call is covered on Friday night, Saturday and Sunday by one resident each day. It consists of all those duties explained under CP call as well as weekend frozen section coverage (with faculty back up), checking the gross room for specimens, and consulting with clinical services on the weekend.

Go to Research Investigators to see the research interests of individual faculty.

Residents are encouraged to become involved in research. Elective time may be used for research training or in depth study in a subspecialty area. Six months of elective time is available. Clinical pathologic studies and developmental projects can be carried out during short elective blocks; whereas, one or more years of research time is recommended for in-depth laboratory investigation. The opportunity for clinical pathologic studies or developmental projects exists in all clinical areas of the department and residents are given travel support to present abstracts at national meetings.

The Department also offers a Physician Scientist Training Program (PSTP) for those interested in an academic career with an emphasis on basic or translational research.

Active areas of laboratory investigation within the department include cellular and molecular immunology, vascular biology, molecular virology, hemostasis/thrombosis, experimental neuropathology, and cell and tumor biology. A variety of NIH funded intramural programs are available for additional years of research training. These include:

• Program in Hemostasis Thrombosis for Academic Trainees
• Tumor Biology Training Grant
• Cardiovascular Center Training Grant
• Physician Scientist Program Award
• Immunology Training Program
• Parasitology Training Program
• Infectious Disease Training Program

Residents participate in both formal and informal teaching in the department in a variety of venues that allow each trainee to grow and develop as a teacher. Residents facilitate pathology small groups that occur in the pre-clinical medical school curriculum (Mechanism of Health & Disease courses) for first- and second-year medical students. These are case-based sessions for 8-10 medical students that utilize a web-based portal and virtual slides for pathology education. Not only do these sessions provide valuable education to our medical students, they provide an opportunity for residents to revisit important concepts themselves. These small groups are also a great way for residents to mentor medical students who might be interested in pathology.

Residents are also involved in teaching medical students who rotate on pathology electives in both AP and CP. We also have a robust Externship (post-sophomore fellowship) program for medical students, and other residents take an active role in teaching and mentoring our externs. There are a variety of other learners on some of our services (residents or fellows from other programs) and residents participate informally in teaching in those settings.

Residents give formal presentations in a number of departmental and interdepartmental conferences. Some are short 10-15 minute case-based presentations, while others are longer sessions such as a slide unknown conference, grand rounds, mortality and morbidity conferences, etc. In addition to the above activities, other opportunities for teaching are available for a resident with an interest and aptitude for teaching and medical education. For example, occasional residents have given a formal lecture in one of our pathology courses for allied health students.

Overview

The University of Iowa Pathology Physician Scientist Training Pathway (PSTP) seeks to facilitate outstanding biomedical research opportunities balanced with a strong tradition of excellence in anatomic and clinical pathology training, for those trainees who plan to include a significant research component in their career. The training pathway is designed to be flexible in order to accommodate the individual needs and training goals of its members, and to be well integrated within the University of Iowa College of Medicine PSTP. This site provides programmatic structure and guidelines that coordinate the admission and residency/postdoctoral fellowship training of physician scientists under the auspices of the University of Iowa Department of Pathology.

Why Iowa PSTP?

UI Health Care and the Department of Pathology have a rich research environment with great opportunities for physician-scientists. Our program is committed to support physician-scientists at every stage of their career, from providing a robust clinical experience in residency training, assuring protected time and support for research training, receiving high priority for fellowship positions as well as mentorship toward obtaining funding such as K08 awards.

The Department of Pathology has significantly increased the research opportunities under the leadership of our current chair, Nitin Karandikar, MD, PhD. This enhanced focus on research has yielded a number of improvements:

• We have expanded to over 20 laboratory-based principal investigators in the department, 10 of whom are physicians and 6 of those physician-scientists were recruited in the last 4 years.
• Pathology maintains a rolling advertisement for physician-scientist investigators interested in clinical work in any area of clinical/anatomic pathology. We are committed to mentoring our residents and fellows to be well prepared for academic positions.
• Beyond laboratory-based investigation, the majority of our clinical faculty are involved in basic, clinical or translational research projects as both collaborators and primary investigators.
• Almost our entire clinical pathology faculty and a sizable proportion of our anatomic pathology faculty have PhDs, providing a very large mentoring community for PSTP trainees and junior physician-scientist faculty.
• All PSTP trainees are provided a $4000/year stipend from the institutional PSTP program for academic expenses. This is in addition to developmental funds as well as funding for small projects available through the department.

A physician-scientist coming to the UIHC Department of Pathology will be joining a cohort of experienced researchers that contribute to our department’s research strengths in immunology and cancer biology, as well as supporting departmental and institutional pockets of excellence in the neurosciences, cardiovascular and pulmonary research, genetics, and metabolism.  The Pathology department’s national ranking in Blue Ridge NIH funding has increased over 30 places in the last 5 years.

Admission Process

Interested individuals apply to the University of Iowa College of Medicine PSTP, and to the University of Iowa residency program through ERAS. The candidate then interviews for PSTP and Anatomic Pathology (AP), or Clinical Pathology (CP), or both AP/CP, if undecided. Nationally, the trend is for research pathway candidates to pick either AP only or CP only tracks. It is anticipated that the undecided candidate would eventually pick AP or CP during their first year of residency. However, in keeping with the flexible and individualized nature of this program, the UI Pathology PSTP does not mandate this choice.

The successful candidate generally will have both an MD and PhD in a field of biological or physical science. Those applicants with an MD and significant prior research training (but not a PhD) will also be considered.

Training Overview

Each PSTP trainee receives individualized guidance and mentoring from two committees. In the first 12-18 months in the program, the Pathology PSTP Oversight Committee provides mentoring. After a research laboratory has been chosen, a customized PSTP Advisory Committee (PAC) provides continued guidance.

A general training sequence is outlined below as a starting point for trainees and their mentoring committees to discuss. Trainee interests and discussions with residency program/postdoctoral laboratory mentors may result in a different superior pathway for a specific trainee.

• Residency training is initiated at beginning of PSTP training.
• The placement of clinical and research rotations is flexible. One of the recommended sequences for an AP or CP only candidate (30 months of clinical rotations + 6 months research) may look as follows:
  • 12 months clinical rotations – 6 months research – 18 months clinical rotations.
  • 18 months clinical rotations – 6 months research – 12 months clinical rotations.
• Research during residency is done in the post-doctoral training lab. Ideally, this lab should be selected in first six to nine months in the PSTP.
• The trainee sits for AP or CP or AP/CP board exam within one year of completing clinical training.
• The trainee will complete activities needed to maintain board certification (MOC) thereafter, as required by the American Board of Pathology.
• Post-doctoral research training - the trainee will typically participate in 3-4 years of Post-doctoral research. The mentor is encouraged (but not required) to be Pathology faculty.
• Clinical involvement during the postdoctoral research period is determined by the stipulations of the training grant and the nature of the clinical specialty; but will not exceed 25% of the trainee’s effort and may allow for a fellow- or faculty-level clinical involvement, dependent on other details. Clinical opportunities during this phase include (but are not limited to):
  • attendance at conferences pertinent to clinical specialty
  • limited on-call duties
  • limited on service duties
  • workup of consult cases related to clinical specialty
  • tumor boards
• Teaching opportunities:
  • The trainee will prepare and present Path Grand Rounds both as part of their resident and fellowship requirements.
  • The trainee may lecture as part of a formal course to medical, graduate, or allied health students but may also provide a lecture to residents during their fellowship training. 
  • The trainee also may participate in medical student small group teaching during residency (for AP residents).
  • The trainee will present research seminars at least three times during training.
    • One presentation must be Pathology Grand Rounds.
    • Other possible venues include:
      • Pathology research day
      • Seminar series sponsored by trainee’s research department/program
      • Regional or national meeting
• Trainee participation in College of Medicine PSTP seminars and other activities is encouraged.

Research Training Funding

• Pathology guarantees salary/benefits support during 2-3 years of research training. This will be a combination of departmental funds, training grants and funds available to the research mentor.
• Salary/benefits will generally be supplemented at least up to PGY level throughout the training period.
• The trainee will also apply for funding to sources determined by consultation with the research mentor, PSTP Oversight Committee and/or PSTP Advisory Committee. The trainee should qualify to apply for transitional funding (e.g., K08 award) during postdoctoral training.

The pathology department occupies approximately 100,000 sq. ft. of space in the Medical Laboratory Building, Medical Research Center and University of Iowa Hospitals & Clinics, and approximately 30,000 sq. ft. of space in the adjacent Veteran's Administration Hospital.

The department currently occupies approximately 26,000 sq. ft. of research-dedicated space in the Medical Laboratory Building and Medical Research Center. This space consists of modern laboratories and core facilities that support cutting edge cellular, molecular and genetic research investigating a range of diseases. Faculty in Pathology currently have research programs in immunology, inflammation and vascular biology, microbiology, neuroscience, signaling and cell death, stem cells, tumor biology and cancer, and virology. In addition to faculty-directed laboratories, the Department provides core laboratories to support the efforts of its investigators.

Surgical Pathology

The surgical pathology preview area consists of individual computer workstations with microscopes. The department continually updates the surgical pathology library; additionally, residents can access hundreds of pathology texts through the Hardin Library with their iPad or other device (provided by the department). Case sign out happens at one of the multi-headed scopes in the department or in individual faculty offices (residents always sign out one-on-one or two-on-one with faculty, never a fellow).

The gross room is located next to the operating rooms. There are numerous grossing benches, each with computer touch screens and cassette printing access. Residents work alongside 5 pathology assistants (PAs) and a surgical pathology fellow to gross specimens and perform frozen sections.

Transfusion Medicine

Residents work in the oldest continuously running blood bank in the United States, the DeGowin Blood Center, consisting of a blood donor collection center, blood bank, and an active apheresis clinic. Residents have their own office space and present at morning rounds.

Autopsy

Both hospital and medical examiner cases are performed in state-of-the-art autopsy suites. Residents on service share an office on the rotation and discuss cases each morning in the autopsy conference room/library. Investigative staff and law enforcement officials may attend these morning meetings.

Cytopathology

Residents on cytology are involved in on-site adequacy assessments, perform superficial FNA procedures, and preview cases. FNA procedures are performed on the inpatient floors or in the pathology–run FNA clinic. Case sign out occurs throughout the day at the cytology multi headed scope, which is also the site of the weekly resident-led interesting case conference.

Flow Cytometry

Residents have access to two 10-color flow cytometers (BD FACSCanto) in the laboratory. Residents’ Office/analyzing station is connected to the lab by a window. Residents have access to unique method for flow analysis: cluster analysis vs. traditional gating. Residents can analyze up to 12 parameters at a time. This office also contains a multiheaded scope and 3 workstations.

Hematopathology

The hematopathology resident workspace is adjacent to the lab and has individual workstations and scope areas.

Hematopathology sign out microscope area includes a large flat-panel display for sign-out or didactics/unknowns sessions.

Residents frequently review cases of interest with the clinical team here.

Microbiology

The microbiology resident office is located within the microbiology lab. Residents gain exposure to the newest diagnostic techniques (molecular and MALDI-TOF) as well as traditional testing. Residents also review smears for organisms throughout the rotation.

Molecular

The molecular office and sign out area is located adjacent to the molecular lab. Residents and fellows evaluate a variety of oncology and genetics cases requiring molecular testing and interpret results from a range of PCR and NGS-based tests.

Chemistry

The chemistry resident oversees the Core Laboratory which incorporates management skills, clinical correlation, and informatics troubleshooting. Residents are exposed to a wide variety of laboratory tests, involving both automated methods and specialized instrumentation, such as gas chromatography. Residents have their own office next to the Core Lab and sign out daily protein electrophoresis as well.

Lecture Halls

Numerous conference rooms and libraries can be found within the department. Daily teaching conferences occur most often in 5249 RCP and in the HP Smith auditorium.

Resident Room

The resident room is located in the hospital near all clinical workspaces. It is a quiet place to study, work on research, or finish up paperwork. There is a fridge and sink, plenty of workstations with microscopes, a multiheaded microscope with a camera, and each resident has their own space for storage.