Training & Curriculum

The Gastrointestinal and Liver Pathology Fellowship encompasses education in all techniques and skills needed for excellence in practice in gastrointestinal (GI) and liver pathology (morphology, immunohistochemistry, molecular diagnostics, laboratory management administration and informatics), which is accomplished in a coordinated fashion. In-house GI and liver disease centers provide the full spectrum of adult and pediatric, medical and neoplastic diseases of the digestive system, with over 15,000 GI biopsies, 1,000 GI resections, 800 liver biopsies, 80 liver resections, 70–80 liver explants and 100 Whipple/pancreatectomy specimens annually. There are 11 monthly rotations that include two weeks each focused on tubular GI/pancreas or on liver/tubular GI pathology, one month of elective rotation. The elective rotation is related to GI and liver pathology and offers a wide range of choices, from research to extramural electives. The fellow spends one week in the molecular pathology laboratory. Two days per week are off-service days for preparation of conferences and work on research projects.


Curriculum

Tubular GI/Pancreas Rotation Responsibilities

  • Tubular GI and pancreas biopsies and large cases
  • All GI consult cases
  • Resident GI, pancreas and liver gross supervision and selected case review
  • Conference presentation and participation (see Conferences below)
  • Administrative responsibilities (see Administrative Responsibilities below)

Liver/Tubular GI Rotation Responsibilities

  • Liver and tubular GI biopsies and liver explants
  • All GI and liver consult cases
  • Liver on-call once a month from January to June (to fall on the fellow's Surgical Pathology on-call days and weekends)
  • Resident GI, pancreas and liver gross supervision and selected case review
  • Conference presentation and participation (see Conferences below)
  • Administrative responsibilities (see Administrative Responsibilities below)

Molecular Pathology Rotation Responsibilities

  • Attend teaching by molecular pathology attendings.
  • Observe and understand concepts relating to common molecular techniques that apply to GI/liver pathology (e.g., Her2 FISH).
  • Discuss selected cases with molecular pathology attendings.

Research Rotation

  • At least one clinical or translational research project is expected.
  • Research may be in the pathology, GI and/or hepatology departments/divisions.
  • State-of-the-art research techniques and departmental support is available.

Opportunities for Graded Responsibility

Examples

  • Teaching GI and liver clinical fellows/residents (see Teaching Responsibilities below).
  • Handling pancreatectomy specimens and their frozen sections in real time. The fellow serves as liaison with pancreaticobiliary surgeons in the operating room and makes decisions regarding handling of specimens and tumor banking.
  • Ordering immunostains independently at time of slide preview prior to sign out.
  • Calling clinicians with malignant diagnoses and discussing difficult cases by phone.
  • After the first three months, the fellow prepares the reports independently and selects the cases they wish to double scope with attending.

Conferences

The fellow is expected to prepare and present at the below conferences:

Mandatory GI and Liver Conferences

  • Colorectal Cancer Conference, monthly
  • Pancreatic/Biliary Conference, monthly
  • GI Neuroendocrine Conference, monthly
  • Inflammatory Bile Disease Conference, monthly
  • GI Pathology Consensus Conference, daily
  • Surgical Pathology Journal Club, monthly
  • Pathology Grand Rounds, monthly
  • Autopsy Conference, when relevant to GI or liver disease

Additional Mandatory Liver Rotation Conference

  • Liver Conference, weekly

The below conferences and educational endeavors are optional, but the fellow may want to participate to maintain competence in GI, liver and general pathology.

Optional Conferences/Activities

  • Consensus surgical pathology case review conference, daily
  • GI/liver and other subspecialty study set review
  • Participation in developing, reviewing and modifying GI gross manual, diagnosis templates and synoptic reports (for GI tumors)

Administrative Responsibilities

The fellow has administrative responsibilities as part of the program structure, affording an opportunity to learn skills required for academic and private practice. Administrative quality assurance activities in which the fellow participates include

  • Frozen section review for cases in which the fellow participated
  • Quality control of MLH1, MSH2, MSH6 and EGFR immunostains
  • Evaluation of new immunostains
  • Monitoring adequacy of lymph node dissections for GI resection specimens
  • Review of amended reports for discrepancies (various areas)
  • Review of oncologic reports to ensure compliance with CAP elements for GI cases
  • Correlation of biopsy/cytology specimens for GI/pancreaticobiliary cases
  • Maintenance of record for consensus conference
  • Frozen section turn-around-time data (all)
  • Quarterly interinstitutional review of cases sent to other institutions (all)

Teaching Responsibilities

The fellow is expected to take an active role in resident education, honing teaching skills during the year. The fellow teaching activities include

  • Supervising residents in GI rotations in the gross room.
  • Microscopic review of selected cases with the residents.
  • Organizing weekly conference of interesting GI cases for GI faculty and house staff members.
  • Presenting two slide conferences for residents during the academic year.
  • Teaching GI and liver clinical fellows/residents. The fellow runs a dedicated conference to teach GI/liver pathology to medical and surgical GI/hepatology residents and fellows. The fellow presents the conference twice a month and determines the curriculum in conjunction with corresponding medical and surgical GI/hepatology program directors

Research Responsibilities

Research is considered an important aspect of education and has strong departmental and institutional support, including a large well-organized biobank. State-of-the-art research techniques are available.

  • Three months of protected research time (also performed during clinical rotations) is provided.
  • At least one clinical or translational research project is expected.
  • Research may be in the Pathology, Gastrointestinal and/or Hepatology Departments/Divisions.

Evaluations and Mentorship

The program director meets with the fellow at the beginning of the academic year to identify the fellow's goals and career aspirations, create an individualized development and learning plan, and tailor training as needed. The program director also meets with the fellow at least biannually to review the fellow's evaluations, ensuring that the fellow is on track to meet all appropriate milestones, make considered career choices and engage with local and national pathology organizations. In addition, the fellow has open access to the program director to discuss any issues that may arise throughout training.

Evaluations are based on Accreditation Council for Graduate Medical Education milestones incorporating the six competencies into the curriculum (medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice). Assessment tools include direct observation, faculty evaluations, 360 evaluations, fellow in-service examinations, educational and research activities, quality assurance and patient-safety activities, and conference presentations. The fellow will also become a member of the fellowship Program Evaluation Committee, reviewing the fellowship program and offering insight regarding areas in need of improvement.