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The discipline of Pathology is devoted to the definitive diagnosis and the understanding of the pathogenesis of human disease. In the Residency Program in Anatomic and Clinical Pathology at the Massachusetts General Hospital (Mass General), we seek to train physicians who will become leaders in this field, whether in clinical practice, research, or a combination of these. We believe that a solid foundation of knowledge of human pathology and understanding of disease mechanisms is essential for either career goal. Both practitioners and researchers must, in addition, be skilled at synthesizing information, communicating it to others, and teaching.
Our program recognizes that each distinct career path in pathology has an optimal blend of training experiences, which should be customized as much as possible within the constraints of the requirements of the American Board of Pathology and the Accreditation Council on Graduate Medical Education (ACGME). We have introduced options for the individual resident, and changed the programmatic required rotations, to accommodate this learning process optimally.
The most important strengths of the Mass General pathology training programs are the high volume of challenging clinical material, the expertise and academic stature of the faculty, the daily involvement of the faculty in training the residents, the enthusiasm and high quality of our residents, the flexibility of our program in constructing individual training pathways, and the international reputation of the Mass General in both clinical and research activities.
The guiding principle of our program, as in most of postgraduate medical education, is that young physicians learn best by having responsibility for patient care in a supervised, supportive setting. Responsibility motivates learning, which is focused on solving the challenging problems presented by each patient. Therefore, training in all Massachusetts General Hospital Pathology programs emphasizes active resident involvement in diagnostic services, whether AP or CP, allowing the resident to take primary responsibility for evaluating clinical specimens and communicating results to clinicians, under the supervision of more senior pathologists. In addition to independent study through reading stimulated by the cases, learning occurs at daily signout sessions, and at working and teaching conferences at which residents discuss their interpretation of pathologic findings and laboratory results with senior pathologists, present pathology and laboratory findings to clinicians, and review and present relevant literature. The faculty and fellows give formal lecture series in both AP and CP. Critically important are the innumerable informal discussions with staff and fellow residents that refine and solidify the knowledge gained.
Resident training is a professional educational process in which the resident is expected to acquire skills, knowledge, attitudes, and behaviors appropriate to a beginning independent practitioner of the medical specialty of pathology. Some of these characteristics can be acquired through a didactic process of lectures and study; others depend on modelling, mentorship, and progressively independent practice under supervision.
The two major components of our residency process are anatomic pathology and clinical pathology, the latter often referred to as laboratory medicine. These have many aspects in common, and some significant differences. The common features include that both are the medical application of a scientific and empirical understanding of health and disease, as these can be detected and assessed by laboratory parameters. This medical application is generally consultative to practitioners in other medical specialties, though it sometimes involves direct patient care responsibilities as well.
Anatomic pathology is distinguished by the patient material to which it is applied, which has structure that can be recognized and assessed morphologically. There is a continuum of scale to which such assessments can be applied, ranging from molecular and ultrastructural through cellular, tissue, and organ-based analyses, to the whole person. Recognition and understanding of the significance of structural patterns representative of health and disease is a key aspect of patient care as provided through anatomic pathology.
Clinical pathology (laboratory medicine) is distinguished by its analysis, based on scientific principles, of body fluids and constituents that are usually, though not always, based on parameters other than the morphological. Many hematology and microbiology analyses, as well as some in immunology, depend on morphological assessments, an important area of overlap between anatomic and clinical pathology. Other areas of overlap have origin in the molecular understanding of disease, as this brings together many hitherto disparate aspects of pathology, as does laboratory management, which applies to all pathology services. Furthermore, some specific areas of pathology are virtually continuous in their manifestations between diagnostic anatomic pathology and clinical laboratory medicine.
With this as background, the overall goals of residency training in pathology may be more specifically stated in terms of achievement of the following competencies, necessary for beginning independent practice.
Medical KnowledgeThe scope of necessary medical knowledge is a broadly based understanding of pathologic anatomy and pathophysiology as these relate to the laboratory-based recognition and assessment of disease.
Patient CareLaboratory-based patient care services require several cognitive and procedural skills. Suitably subtle, sensitive and specific pattern-recognition skills are often referred to as "having a good eye." Though the rudiments of this skill can be acquired didactically, practice in dissection, description, and diagnosis is essential to hone the skill. Other procedures and skills contribute to patient care in specific areas of pathology, including transfusion medicine and fine needle aspiration, both of which also involve the skills for direct patient care.
Professionalism, Interpersonal and Communication SkillsThese start with the consultative basis of laboratory-based clinical care. Effective consultation requires good communication, and this in turn is based on the pathologist's ability to identify first with clinical practitioners directly caring for the patient, but ultimately with the patient him- or herself. Recognizing the patient's interests as primary in the care process is at the heart of a professional attitude to care, while understanding the clinical practitioner's needs and circumstances are essential to serving the patient effectively in a consultative role.
Beyond this ability to identify with, understand, and effectively communicate about the needs of the individual patient and his or her clinical practitioners, modern laboratory-based clinical care is a team endeavor. The pathologist must have the managerial and leadership skill to maintain and advance the operation of a laboratory team, including infrastructure, finance, operation, and personnel.
Systems-Based PracticeLaboratories provide their services in the context of a health care community. This may be a local hospital, a regional health care delivery system, or as a reference laboratory resource, anywhere from local to international in scope. The pathologist's responsibility is to understand the needs and resources of this system, and to ensure the quality, appropriateness, and availability of services.
Practice-Based Learning and ImprovementTo serve their healthcare communities' needs, pathologists must be scientific as well as empirical practitioners of diagnostic medicine. This entails translational skills in evaluating and appropriately implementing new technologies as medical understanding advances, as well as involvement in and understanding of the practical realities of the availability of societal resources for the provision of healthcare services. To achieve this, the pathologist must establish a habit of seeking out new knowledge and critically assessing current practices, starting with his or her own practice and practice environment. A pathologist with these skills, attitudes and behaviors will acquire and maintain the knowledge needed to be a valued and contributory member of his or her healthcare community and, more importantly, of the larger society it serves.
An unsatisfactory resident demonstrates:
An outstanding resident demonstrates:
Limited knowledge of basic and clinical sciences; poor understanding of diagnostic criteria and of relevant patterns and mechanisms of disease; minimal interest in learning
Exceptional knowledge of basic and clinical sciences; comprehensive understanding of diagnostic criteria and of relevant patterns and mechanisms of disease; highly resourceful in development of knowledge
Patient Care Anatomic Pathology
Incomplete or inaccurate gross descriptions, microscopic diagnoses, and reviews of clinical data; incomplete or incompetent application of diagnostic criteria and performance of gross dissections and other procedural services; fails to analyze clinical data and consider patient implications when making medical decisions
Superb, accurate, comprehensive gross descriptions, microscopic diagnoses, reviews of clinical data, and procedural skills; always makes medical decisions using sound judgment, considering patient implications and available evidence
Patient Care Clinical Pathology
Incomplete or inaccurate review, interpretation, and assessment of clinical and laboratory data and performance of history and physical examinations; incomplete or incompetent application of diagnostic criteria and performance of clinical duties including on-call responsibilities; fails to analyze clinical and laboratory data and consider patient implications when making medical decisions; medical judgment is poor
Superb, accurate, comprehensive review, interpretation, and assessment of clinical and laboratory data, performance of history and physical examinations, and application of diagnostic criteria; exceptionally able performance of clinical duties including on-call responsibilities; always makes medical decisions using sound judgment, considering patient implications and available evidence
Interpersonal and Communications Skills
Does not establish even minimally effective medical relationships with co-workers and clinical colleagues; does not demonstrate ability to build relationships through listening, narrative, or nonverbal skills; does not provide education or advice to co-workers and clinical colleagues
Establishes highly effective medical relationships with co-workers and clinical colleagues; demonstrates excellent relationship building through listening, narrative, and nonverbal skills; excellent education and counseling of co-workers and clinical colleagues, always "interpersonally" engaged
Lacks respect, compassion, integrity, honesty; disregards need for self-assessment; fails to acknowledge errors; does not consider needs of patients, families, co-workers, and clinical colleagues; does not display responsible behavior
Always demonstrates respect, compassion, integrity, honesty; teaches/role models responsible behavior; totally committed to self-assessment; willingly acknowledges errors; always considers needs of patients, families, co-workers, and clinical colleagues
Practice-Based Learning Improvement
Fails to perform self-evaluation; lacks insight, initiative; resists or ignores feedback; fails to use available resources to enhance patient care or pursue self-improvement
Constantly evaluates own performance, incorporates feedback into improvement activities; effectively accesses and utilizes resources to manage information for patient care and self-improvement
Unable to access/mobilize outside resources; actively resists efforts to improve systems of care; does not use systematic approaches to reduce error and improve patient care
Effectively accesses/utilizes outside resources; effectively uses systematic approaches to reduce errors and improve patient care; enthusiastically assists in development of system improvements
Anatomic Pathology (AP) Program
The Anatomic Pathology (AP) program includes 24 months of structured training in surgical pathology, autopsy pathology, cytopathology, and cytogenetics/molecular pathology. These 24 months constitute the same structured core rotations as the AP core of the AP/CP program. Rotations on most AP services are weekly. The Autopsy Service is covered in weekly blocks in the first two years, including one two-week Medical Examiner rotation in the second year. Residents spend 12 weeks in Cytopathology (six weeks in each of the first two years). Surgical Pathology at MGH is subspecialized by organ system, and residents rotate weekly among these subspecialties (Bone and Soft Tissue, Breast, Cardiovascular, Dermatopathology, Gastrointestinal, Genitourinary, Gynecologic and Obstetric, Head and Neck (ENT), Hematopathology, Neuropathology, Pulmonary, and Renal and Immunopathology), as well as in the Frozen Section Laboratory.
The third (flexible) year is structured according to career goals; for subspecialty or community practice, this typically includes time spent taking supervisory and teaching responsibility for junior residents, as well as doing subspecialty electives. For those planning a research career, two to three years of laboratory research training are available via an NIH training grant. The resident chooses electives based on interests and career goals (community or subspecialty practice, or research) and readiness to advance beyond the core competencies. Qualified applicants interested in Hematopathology or Neuropathology may apply for combined Anatomic Pathology-Hematopathology or Anatomic Pathology-Neuropathology training. Three or (usually) four trainees share AP Chief Resident responsibility in their final year.
Clinical Pathology (CP) Program
The Clinical Pathology (CP) program includes an initial 12 months of basic structured training, with rotations in Clinical Chemistry/Laboratory Management, Coagulation, Hematology/Immunology, Hematopathology, Microbiology, and Transfusion Medicine, followed by six months of advanced structured training as CP Senior Residents. Senior Residents have 12 weeks of required rotations (Blood Bank, HLA, Cytogenetics, Molecular Pathology and Flow Cytometry), and spend the remainder of their time on CP electives, which may consist of service rotations through the CP laboratories or a CP research project. The responsibilities of the Senior Residents on the clinical services distinguish them from the first year residents. Among these responsibilities are assisting in the orientation of the first year residents to the service, helping first year residents to find appropriate resources, and providing primary backup for first year residents on call.
In addition, the Senior Residents have some general CP responsibilities, including the organization of several conferences. The remaining six months of the second year include elective rotations with an opportunity to participate in laboratory development projects. Three second-year or third-year Clinical Pathology residents or fourth-year APCP residents share CP Chief Resident responsibilities. The third (flexible) year may consist of advanced clinical study and research training. For those planning a research career, two to three years of laboratory research training are available via an NIH training grant.
ABP Physician-Scientist Track in Pathology
The American Board of Pathology has recently created a physician-scientist track in Pathology, similar to those already created in Internal Medicine, Pediatrics, Dermatology, and Radiology. The Massachusetts General Hospital Pathology SP-LIT program, which combines clinical training in Pathology with laboratory research, fulfills the requirements for the physician-scientist track. Mass General Pathology residents who complete the SP-LIT program will be eligible to receive a certificate indicating that they have trained as a physician-scientist in Pathology upon board certification.
Anatomic and Clinical Pathology (AP/CP) Program
The combined Anatomic and Clinical Pathology (AP/CP) training program consists of a 24-month structured core in AP and an 18-month structured core in CP, followed by six months of advanced training in AP and/or CP via elective rotations or in a research laboratory (as in the AP or CP only programs). Residents in the AP/CP program who have completed the AP and/or the CP structured core training are eligible to be considered for appointment as Chief Residents on the AP and/or the CP service, respectively.
CONFERENCES, LECTURES, PRESENTATIONS, COURSE OFFERINGS
Didactic Conferences and LecturesThese include Pathology Grand Rounds, the introductory anatomic pathology lecture series for first-year residents, presentations throughout the year during the Anatomic Pathology "Outs" Conferences, and the Laboratory Medicine lecture series given in conjunction with every pair of clinical pathology rotation. Residents are expected to attend these conferences except when precluded by urgent clinical responsibilities, as these cover both basic information relevant to their training and more advanced research and basic science topics. The educational rationale for these conferences is introduction to basic medical knowledge and its application to patient care.
Departmental Conferences based on Current CasesThe daily Anatomic Pathology "Outs" Conference is organized by senior AP residents, and is the principal teaching conference in anatomic pathology. Residents on anatomic pathology rotations are expected to review the slides that are "put out" at least one day prior to the conference, and be prepared to comment on them at the conference. Autopsies are presented at the weekly Autopsy Conference, which is organized by the autopsy staff pathologist and residents on the service. Residents present the decedent's history and autopsy gross findings, and are expected to have microscopic correlations ready if appropriate. Interested clinicians and subspecialist pathologists are invited to attend as appropriate. Neuropathology fellows and staff attend to review the neuropathology findings. All these conferences involve participation on a case-by-case basis of the residents, and thus provide opportunities not only for the introduction of medical knowledge and its application to patient care, but also challenge the residents to develop their skills, attitudes, and behaviors in practice-based learning and improvement and interpersonal and communication skills. Regular Consensus Conferences are held on all services in both anatomic and clinical pathology to discuss interesting or difficult cases. These are attended by the residents and fellows on service, who are encouraged to participate as well as observe. These conferences thus provide excellent opportunities for the trainees to see how their faculty deal with real world aspects of practice that involve all the core competencies, and in particular to see how they balance their professional responsibilities with their concern for systems-based practice.
Clinical-Pathologic Correlation ConferencesMany clinical services hold working conferences at which pathologists present cases. Residents rotating on each of the corresponding pathology subspecialty services are encouraged to attend these conferences and present selected cases as their experience permits, under the supervision of a staff pathologist. These include Gynecology Tumor Board, Sarcoma Conference, Lymphoma Conference, Renal Conference, GI Conference, and Breast Conference. Residents also present their autopsy cases at various clinical service rounds, including Pediatrics and Neurology. Residents prepare and present pathology material under supervision of a faculty member. AP Chief Residents present cases at the monthly Department of Medicine Morbidity and Mortality Conference. Residents rotating through the CP laboratories also attend clinical service rounds as appropriate. The Chief Resident in CP reviews interesting current cases with the Medicine residents at Bigelow Rounds four times/week. Second and third year AP residents present cases of interest to Oncology fellows, Pulmonary fellows, and Radiology residents at regular weekly conferences. They prepare and present these cases themselves, seeking advice from their faculty as they deem appropriate. Finally, the Clinicopathologic Conferences (published in the New England Journal of Medicine as the Case Records of the Massachusetts General Hospital) are held weekly, and senior residents are encouraged to present one of these, with appropriate faculty supervision. In all these conferences, the resident's growing medical knowledge, understanding of the pathologist's role in patient care, and ability to access appropriate information resources, and communicate efficiently and meaningfully are exercised.
Formal Presentations by ResidentsIn order to learn critically to review the medical literature and give a formal presentation, residents are required to give Molecular Pathology and Research Conferences based on interesting cases. They review the recent literature on both basic science and clinical aspects of the disease, and make a formal, didactic presentation to other residents and staff, lasting 30 minutes. In clinical pathology, there are required 45-minute formal presentations for each rotation on a specific topic. These represent exercises in teaching that also require critical review and interpretation of the current medical literature, both of which relate to several competencies required in pathology practice, including the specific competencies of medical knowledge and patient care, as well as the general ones of practice-based learning and improvement and interpersonal and communication skills.
National Course OfferingsThe department faculty offers annual courses in cytopathology, dermatopathology, breast, gastrointestinal, gynecological and obstetric pathology, and surgical pathology, sponsored by Harvard Medical School and attended by registrants from around the world. Since the residents are generally welcome to attend these courses, regular departmental conferences are usually canceled during these times to permit them to attend. This is not only intrinsically educational, but also puts into the context of the registrants' perspective on their actual practices, the significance of the learning activities and faculty with whom the residents are training.
OPPORTUNITIES FOR TEACHING
"On the Job" TeachingDuring the first several months of the academic year, teaching residents (second and third year AP or AP/CP residents) are assigned to teach new residents on both the Autopsy and Surgical Pathology services. Pathology residents also supervise medical students rotating through the service on elective. Second-year Clinical Pathology residents supervise junior Clinical Pathology residents as well as medical students and clinical residents on rotation. House-staff from the clinical services regularly consult with their opposite numbers on the pathology service on open cases, providing an opportunity for mutual education between services.
Working ConferencesResidents on the AP Service attend and present selected cases at clinical conferences when they are assigned to that service, including Gynecology tumor board, Sarcoma conference, Lymphoma conference, Renal conference, GI conference and Breast conference. They also present their autopsy brain cases at Neuropathology conference. Residents are responsible for preparing and presenting pathology material under the supervision of a faculty member. Chief Residents present cases at the monthly Department of Medicine Morbidity and Mortality Conference. The Chief Resident in CP reviews current cases with the medicine residents four times/week at Bigelow Rounds. Interesting test results from current patients are discussed at each session. CP residents and directors or supervisors from relevant laboratories participate. Test performance, interpretation, and appropriate utilization are reviewed, along with the pathophysiology of the disease.
Didactic Conferences with Clinical ServicesSecond and third year AP residents present cases of interest to Pulmonary fellows, Radiology residents, and Oncology residents at regular weekly conferences. They prepare and present these cases themselves, seeking advice from faculty as they deem appropriate.
Formal PresentationsResidents present Molecular Pathology and Research conferences to the Department, based on interesting cases they have encountered; they review current medical literature on both the clinical and the basic scientific aspects of the disease, and make a formal didactic presentation to other residents and staff, lasting 30 minutes. Each resident prepares at least one conference each year. While on the hematopathology rotation, residents present at the Cytogenetics Conference, and on clinical pathology rotations, each resident presents a Case Conference once in every two-month block. Senior residents are encouraged to present an Massachusetts General Hospital Clinicopathologic Conference (published in the New England Journal of Medicine as the Case Records of the Massachusetts General Hospital).
Medical StudentsResidents are encouraged to participate in the laboratory teaching of pathology at the Harvard Medical School and the Harvard-MIT Health Science and Technology program. In general, residents in the third year of AP and the second year of CP are most likely to have time to participate in this activity. Residents also participate in teaching medical students taking hospital-based clerkships, and in particular, Massachusetts General Hospital AP and the CP Chief Residents are the primary presenters for pathology each week in our Harvard Medical School Principal Clinical Experience Case-Based Sessions.
Each resident receives an electronic global performance rating addressing each core competency at the end of every rotation. Each staff member who has supervised a resident is automatically emailed a notification to complete a performance rating online. The completed forms are summarized by the Program Administrator and then reviewed with the residents at their semiannual cumulative general performance evaluation. The review is held in alternation with the Program Director and the Associate Program Director for Anatomic Pathology or with the Associate Program Director for Clinical Pathology. Evaluations are requested from faculty at the end of rotations at affiliated institutions and electives at other institutions; these are incorporated with the global performance ratings and are reviewed with the residents at their semi-annual cumulative general performance evaluation meeting.
Another assessment of the resident's performance is at the regularly scheduled departmental conference on Molecular Pathology and Research. This is a CME type conference evaluation, which assesses the resident's ability effectively to locate, appraise, and communicate information on the application of emerging scientific knowledge to pathology. The annual American Society of Clinical Pathologists Resident In-Service Examination is required of all residents, and performance of our residents is used as an overall assessment tool for the training program. Each resident's national percentile performance and his or her relative performance in each area compared with his or her peers in the program are discussed with him or her at the first semi-annual meeting after the examination. These results are also specifically used as a calibrator by subject area for our global, general, and focused observation systems of performance assessment in the area of medical knowledge. Our AP information system generates case and procedure log type reports the residents use in preparing their American Board of Pathology applications. We are using a 360º assessment for AP residents in the grossing area to ensure quality and provide feedback in the areas of professional behavior and communication skills.
We have implemented a focused observation and evaluation system in AP. This entails prospective assessment, on a per case basis, of resident confidence/hesitancy. Being prospective and comprehensive, it is free of prior expectation bias, thus offering the potential objectively to assess our balance of training across AP subspecialties. Over time, it can establish expected ranges of resident performance in the areas of medical knowledge and patient care.
The faculty member supervising each rotation provides ongoing feedback on the resident's performance. The results of these online faculty end-of-rotation evaluations are immediately available to the resident online. In addition, faculty are encouraged informally to discuss with the resident the strengths and weaknesses of the resident's performance during and at the end of each rotation, and to seek feedback about the quality of the learning experience. Serious or urgent problems are reported immediately to the chief resident and, as appropriate, the Program Director, for discussion with resident and faculty, without waiting for this formal evaluation process.
Each first-year resident is assigned a faculty mentor based on compatibility and mutual interests. To ensure that meetings take place, discussion about whether the resident has been assigned a suitable mentor is included in each semi-annual assessment meeting. Faculty mentors are given access to the same evaluation information as the resident him/herself, and the resident is encouraged to meet with the faculty member to discuss both the course of the resident's training and future career plans.
The Residency Training Committee discusses each resident's readiness to progress to the next level of responsibility, based on the evaluations submitted, their own experience with the resident, and available objective performance assessments. In the event there is concern that a resident may not be ready for increased responsibility, this is discussed with the resident by the Program Director, and a plan is developed for the remainder of the year to maximize the likelihood of success for the resident, and in any case to ensure there is a clear mutual understanding of the issues involved. Elective rotations and advanced positions such as senior call in anatomic pathology are awarded only to trainees who show clear evidence of accomplishment. Residents whose performance does not demonstrate that they are ready for such responsibilities are required instead to perform additional rotations on core services as appropriate to the circumstances.
In addition to electronic records of end-of-rotation evaluations, paper copies of semi-annual evaluations are kept in an evaluation folder within each resident’s departmental personnel file. A separate evaluation file exists for each resident. This is accessible to the resident and faculty mentor, the Program Administrator, the Program Director and Associate Director, the Department Administrator, and the Service Chief.
The cumulative evaluation of each resident's final six months of training is discussed with the resident by the Program Director or Associate Director, and this is documented at the final semi-annual evaluation. It includes a statement on the resident's competency to commence independent practice. This is considered the resident's final written evaluation, and becomes a permanent part of his or her credentialing file.
The Residency Training Committee considers several factors in evaluating the educational effectiveness of our training programs. These include objective information on our residents' These include objective information on our residents' American Society of Clinical Pathologists Resident In-Service Examination performance and American Board of Pathology examination results, as well as subjective assessments of the faculty, the rotations, the conferences, and the program itself from the residents.
Evaluations of the contributions of each member of the teaching staff are solicited automatically by email from each resident at the end of every rotation with a faculty member. These are completed by the residents online, and are made available to the faculty members only in unattributed batches of ten to maintain anonymity. They are also provided in detail to the Chief of Service for feedback to individual faculty members, and in summary form by the Program Director to the Credentialing Committee for consideration in decisions on reappointment to teaching positions. This feedback has resulted in significant improvements in availability and teaching by several faculty members.
At the end of the academic year, each resident is required to fill out an anonymous comprehensive evaluation of the program. These evaluations are reviewed and presented by the Program Director and Associate Director to the Residency Training Committee, where they form one of the bases for programmatic change. Programmatic feedback on resident workload from this evaluation, and from analysis of the daily duty hour records that are kept by the residents on the online residency management system, continues to direct the ongoing reevaluation and adjustment of service assignments and of resource and time allocation on rotations.
All residents may take up to four weeks of vacation per year as per the requirements of the American Board of Pathology.
RESIDENT AND FELLOW FRINGE BENEFITS PROGRAM
Each resident and fellow has a practice-funded account on which he or she draws for fringe benefits, including books, subscriptions, memberships and dues, travel, non-clinical Pathology Media Lab usage, publication costs and reprints. Each trainee is thus responsible for determining the allocation of his or her own spending for such professional expenses. These fringe benefits are made available annually to trainees in our funded clinical training programs, including residency programs (Anatomic, Clinical and Neuropathology), ACGME (Cytopathology, Dermatopathology, Hematopathology, Neuropathology, and Transfusion Medicine), and non-ACGME (Clinical Chemistry, Medical Microbiology, and Subspecialty Surgical Pathology) fellowship programs.
Resident and Fellow salaries by post-graduate year for academic year 2014-2015
Please direct inquiries to:
Trina PappadiaMassachusetts General HospitalMedical Education Specialist, Pathology Service55 Fruit Street, Warren 219Boston, MA 02114
Phone: 617-643-4397Fax: 617-643-4045Email:firstname.lastname@example.org
Residency Training Program Faculty
W. Stephen Black-Schaffer, MDAssociate Professor of Pathology, Harvard Medical SchoolAssociate Chief and Pathology Residency Program DirectorMassachusetts General HospitalPathology Service, Warren Building, Room 21955 Fruit StreetBoston, MA 02114-2696
Robert P. Hasserjian, MDAssociate Professor of Pathology, Harvard Medical SchoolAssociate Director for Recruitment, Pathology Residency ProgramDirector, Hematopathology Fellowship Program Massachusetts General HospitalPathology Service, Warren Building, Room 219Massachusetts General Hospital55 Fruit StreetBoston, MA 02114
Peter M. Sadow, MD, PhDAssociate Professor of Pathology, Harvard Medical SchoolAssociate Director for Anatomic Pathology Training, Pathology Residency ProgramDirector, Head and Neck PathologyMassachusetts General HospitalPathology Service, Warren Building, Room 21955 Fruit StreetBoston, MA 02114-2696
Christopher P. Stowell, MD, PhDAssociate Professor of Pathology, Harvard Medical School Associate Director for Clinical Pathology Training, Pathology Residency Program Director, Blood Transfusion ServiceMassachusetts General HospitalBlood Transfusion ServiceGray/Jackson Building, Room 21255 Fruit StreetBoston, MA 02114-2696
Matthew P. Frosch, MD, PhDAssociate Professor of Pathology, Harvard Medical SchoolAssociate Director for Research Training, Pathology Residency ProgramDirector, Neuropathology ServiceMassachusetts General HospitalPathology Service, Warren Building, Room 21955 Fruit StreetBoston, MA 02114-2696
Trina PappadiaProgram Manager
The application deadline is typically December 1.
Thank you for your interest in our Residency Training Program in Pathology. Our application requirements are listed below. Please specify the training program or programs to which you are applying: Combined Anatomic and Clinical Pathology, Anatomic Pathology only, or Clinical Pathology only.
All applications should be made through the Electronic Residency Application Service (ERAS). Paper applications will not be accepted. ERAS information is available on their website at http://www.aamc.org/eras. Please arrange for us to receive your Dean's letter and three letters of recommendation through ERAS.
The Massachusetts General Hospital Pathology residency offers training tracks in Anatomic Pathology, Clinical Pathology, Anatomic/Clinical Pathology, and Anatomic/Neuropathology. Residency applicants wishing to pursue Anatomic or Anatomic/Neuropathology tracks should select the “Anatomic/Clinical or Anatomic Pathology” choice in ERAS, since ERAS no longer allows automated separate selection of the AP or the AP/NP individual tracks. Prior to interviews, we will clarify with applicants who select “Anatomic/Clinical or Anatomic Pathology” in ERAS which specific track or tracks they wish to pursue, in order to arrange the appropriate interview day.
All applicants are encouraged to apply through the National Resident Matching Program (NRMP). NRMP information is available on their website http://www.nrmp.org.
United States and international medical graduates must have passed Part 1 of the United States Medical Licensing Examination (USMLE). For United States medical graduates, documentation of successful completion of the USMLE Part 2 (Written and Clinical Skills Assessment) is not required for application or interview, but is required prior to starting residency. It is therefore strongly encouraged that applicants take the USMLE Part 2 examination by December 31 so that scores will be available by the time of match list submission. For international medical graduates, a valid ECFMG certificate is required for visa and licensing prior to starting residency; this is also required for participation in the NRMP. Please Note: to qualify for H1B status to perform clinical medicine, it is necessary to pass Parts 1, 2 and 3 of the USMLE. For a J1 visa, only USMLE Steps 1 and 2 are required. For additional information, see the FAQs for International Medical Graduates section below.
FAQ's about Residency Application Process
The Massachusetts General Hospital Pathology training programs have changed considerably over the years, but have always maintained an emphasis on providing the highest quality education in the clinical, teaching and research components of Pathology. This list of FAQs and answers provide accurate and up-to-date information on our residency application process.
Q. What are the general requirements for applying to the program?A. We require that the entire application for a PGY-1 position be completed via ERAS (Electronic Residency Application Service). No paper applications will be accepted, except for off-match upper level positions. Information about applying through ERAS may be found on the ERAS website.
Required for a United States or Canadian medical graduates: Application, curriculum vitae, personal statement, dean’s letter, 3 letters of recommendation, and confirmation of a passing grade for USMLE (or NBME) Step I. Documentation of successful completion of USMLE (or NBME) Step II (written and Clinical Skills Assessment) is required prior to starting residency; applicants are strongly encouraged to complete the latter exams by December 31. Successful completion of USMLE Step III is required for appointment (or re-appointment) at the PGY-3 level or higher and is also required of Canadian medical graduates seeking H-1B visa status. Canadian medical graduates do not require an ECFMG certificate.
Required for an International medical graduate: Requirements are the same as for United States medical graduates; in addition, an ECFMG certificate must be obtained by the start of residency (preferably by the time of rank list submission in mid-February). Successful completion of USMLE Step III is also required for applicants seeking H-1B visa status (see last section of this page titled FAQs for International Medical Graduates).
Visit the following websites for more comprehensive information: ACGME, ECFMG, USMLE.
Q. Who must apply through the matching program (NRMP)?A. Only seniors graduating from United States medical schools are required to apply through the match. United States graduates who have done any post graduate (post MD) training are not required to apply through the match, nor are international medical graduates or upper level candidates. However, we encourage all applicants to apply through the match. Information about applying through the NRMP may be found at the NRMP website.
Q. Do you accept people off the match?A. Depending on the number of openings in a given year, a very limited number of first year positions may be filled outside of the Match. Any upper level openings that occur are generally filled outside of the Match.
Q. Does it matter whether I apply as AP only, CP only, or AP/CP?A. No. However, if you have a clear preference, you should state it. We would like to know as soon as possible if you are unsure about your choice. Applicants interested in AP/NP or AP/HP tracks (both offered at Massachusetts General Hospital) should indicate their interest at the interview and/or in their personal statement.
Q. My reference letters are over a year old - will that do?A. No, they should be dated within the past year.
Q. Do you give Harvard graduates preference?A. No.
Q. Do you have any limit on the year of graduation (i.e., how many years the applicant has been graduated from medical school)?A. No.
Q. How many positions do you have?A. We usually offer 9 first-year positions, but may offer more or fewer positions in a given year.
Q. Does your Department offer fully funded positions?We offer fully funded residency positions to both United States and International medical graduates. Residents are funded until they are Board eligible.
Q. What are your criteria for setting up an applicant interview?A. Once an application is complete, it is reviewed by members of the Pathology Training Committee and a decision is made as to whether to offer an interview. We receive a large number of applications from people who are very well qualified but we can only interview a small number of them.
Q. Can I check whether my application is complete?A. Applicants can check this via ERAS.
Q. What are your policies regarding international medical graduates?A. See the last section of this page titled FAQs for International Medical Graduates.
Q. What resources are available at Massachusetts General Hospital for minority applicants and trainees?A. The Pathology Service is fully committed to the recruitment of outstanding minority applicants. The Center for Diversity and Inclusion (CDI) at the Massachusetts General Hospital has been set up to assist training programs in the effort. In addition, the CDI assists in career development, counseling, mentoring, and advocacy, and in assisting the trainee to affiliate with a social network of minority physicians at Massachusetts General Hospital and within the larger Boston area. The CDI staff works collaboratively with all residency training programs by hosting a series of informal reception dinners to connect residency and fellowship candidates with minority faculty and housestaff. For further information, please visit the CDI website.
FAQs about Residency Training Program
The Massachusetts General Hospital Pathology training programs have changed considerably over the years, but have always maintained an emphasis on providing the highest quality education in the clinical, teaching and research components of Pathology. This list of FAQs and answers provide accurate and up-to-date information on our residency training program.
Q. What are the working hours like during Massachusetts General Hospital pathology residency?A. Exaggerated rumors about the resident working hours at Massachusetts General Hospital have been circulating for decades; when interviewees actually speak with our residents, they are invariably pleasantly surprised to find that these rumors are inaccurate. In fact, Massachusetts General Hospital residents are eager to take advantage of the opportunities here and they do work hard. However, the time spent at work is comparable to other large training programs. We take great pride in graduating residents who are outstanding pathologists — ready to hit the ground running when they finish training — and this takes dedication and time investment from both the faculty and the trainees.
We have designed the program to maximize the teaching benefit residents obtain from their hard work and we are continually improving this process. We employ five Pathology Assistants and three Laboratory Technicians to assist with grossing our large volume of cases, as well as a full-time frozen section technician. We have structured our curriculum around resident education rather than service work, so most of our surgical pathology services operate on a partially 'resident-free' basis and high-volume specialties (e.g. breast, skin, and gastrointestinal pathology) are split into two services per week. This provides a more efficient leaning experience for residents. Slides and paperwork are organized by support staff so that residents can focus on looking at slides rather than on non-educational 'scutwork.'
Q. Massachusetts General Hospital is famous for its clinical training, but I am also interested in getting top-notch research training. What are the opportunities?A. Massachusetts General Hospital Pathology has always had a robust research program divided between pathologist investigators both in the department and in many other Massachusetts General Hospital departments (e.g., Cancer Center, Dermatology, Neurology, Neurosurgery, Pediatric Surgery). In addition, the past 5-7 years have witnessed a marked expansion of the research program within Massachusetts General Hospital Pathology itself. More information is available in our Research Brochure, which is available as a downloadable PDF.
For trainees, the pathology department at Massachusetts General Hospital is committed to providing research training to our interested residents and maintains an NIH/NCI Training Grant (recently increased to fund seven positions) for this purpose. Research-oriented residents may consider following our SP-LIT (Specialized Pathologist-Laboratory Investigator Training) Program, which specifically tailors their residency experience to a future career combining clinical service with funded research and provides longitudinal mentoring by research-oriented faculty. We have had extraordinary success with many of our residency graduates going on to successful post-doctoral fellowships and research careers.
Q. What type of residents train at Massachusetts General Hospital?A. The program aims to train leaders in the field of Pathology. As such, we tend to attract dynamic individuals who are interested in taking forward-thinking roles in moving the field of Pathology forward, whether in the clinical, teaching and/or research realms. As discussed in point 2 above, we have an active research training program. Given our clinical strengths, however, most residents who join our program want to thoroughly learn the clinical aspects of anatomic and/or clinical pathology. Our residents are typically individuals who enjoy 'rolling up their sleeves' and taking an active role in managing clinical cases and in teaching colleagues. Each resident class tends to be closely knit and the individuals within the class are highly supportive of one another. The residents come from varied backgrounds: about 35% of the current residents have PhD degrees and 90% have graduated from United States or Canadian medical schools. Please click here for a list of our current residents and fellows.
Q. How much interaction do residents have with faculty?A. All of our faculty, including many world-famous pathologists with busy schedules, work very closely with the residents. Massachusetts General Hospital residents are encouraged to develop independence in managing clinical cases, but are always supervised and taught by faculty. Our faculty encompasses individuals across a spectrum of age and experience in diagnostic and investigational pathology. Residents benefit from the faculty's wealth of knowledge through working directly with them in managing clinical cases, attending teaching conferences in all branches of diagnostic pathology, and being mentored by staff in research projects and presentations. Importantly, our entirely subspecialty approach to diagnostic anatomic and clinical pathology provides extensive interactions between residents and experts in particular fields of pathology, which increases both the efficiency and depth of the teaching experience. The daily Surgical Pathology Unknown 'Outs' Conference and Clinical Pathology 'Outs' Conference — in which faculty share 'bread and butter' as well as unusual 'zebra' teaching cases with the residents — is felt by the residents to be among the strongest aspects of our program and is very popular. Most faculty offices are located in close proximity to the residents' working areas. Our faculty maintain an open door policy and frequently interact informally with residents. Residents and faculty mingle outside the hospital setting at several departmental social events — including an annual Resident Graduation Dinner in which residents (and the Chairman) 'roast' faculty members!
Q. What sort of supervision do residents have during evening and weekend call coverage? A. In keeping with our philosophy that residents benefit greatly from being given responsibility at the appropriate time, our senior residents take first call for the sign out of frozen sections and rush cases on evenings and weekends. We maintain a full system of supervision and backup for the residents: a surgical pathology fellow covers the senior resident and there is also always a frozen section attending available on call. We find that this level of backup provides an ideal balance of allowing the resident to develop his/her confidence and independence, while maintaining full clinical supervision as needed. Our residency graduates confirm that these roles greatly enhanced their level of confidence in their first post-residency job experiences.
Q. What career paths do Massachusetts General Hospital resident graduates pursue?A. Our current residents include 20% pursuing AP training, 20% pursuing CP training, and 60% pursuing combined AP/CP training. We realize that career plans change and our program has been flexible in allowing residents to change training tracks during residency. Many of our residents pursue fellowship training following residency (see below). The majority of our alumni go on to academic careers that vary considerably in the level of clinical work. Many of these alumni play major roles in teaching and others are engaged in cutting-edge research. We are very proud of our residency alumni, who include leaders in pathology all over the world.
Q. What fellowships does Massachusetts General Hospital offer and how are the positions filled?A. Massachusetts General Hospital has its own ACGME fellowships in Cytopathology, Hematopathology and Neuropathology and participates in Harvard-wide fellowships in Molecular Genetic Pathology, Dermatopathology, and Transfusion Medicine. Massachusetts General Hospital also offers surgical pathology fellowships encompassing nearly all sub-specialties and certain subspecialty combinations. Fellowships are increasingly competitive and are often filled by Massachusetts General Hospital residents; however, we also consider qualified candidates from other programs. In fact, currently about 25% of our fellowship positions are filled by individuals who trained at other programs. Please see our Fellowship Training site for application information.
Q. What should I expect on my interview day?A. We strive to make our interview day as informative to the applicant as possible: we really want you to get a good picture of what it would be like to train at Massachusetts General Hospital! Applicants invited to interview are typically asked to show up between 8 am and 9 am and the last scheduled activities end between 3:30 pm and 4:30 pm. The day typically includes:
FAQs for International Medical Graduates
The department preferentially fills its positions with graduates from United States and Canadian medical schools, but will consider applications from outstanding graduates of top-quality international medical schools.
Q. Does the Department sponsor visas, if so which ones?A. The Department sponsors J-1 visas via ECFMG. In certain circumstances, the Department will sponsor H-1B visas or will extend someone in H-1B status by assisting in transferring the visa. To qualify for H-1B status to perform clinical medicine, it is necessary to have passed USMLE Steps I, II and III, hold a valid ECFMG certificate, and hold a full or limited Massachusetts Medical License. Graduates of U.S. and Canadian medical schools are exempt from the ECFMG requirement. Processing at the Department of Homeland Security varies and can take as long as six months. It is strongly recommended that applications for H-1B visas be submitted to the Partners International Office as soon as possible in advance of commencing residency training in order to reduce the likelihood of delay in starting the residency program.
Q. What visa documents are required for International applicants?A. J-1: Exchange Visitor (Clinical): The ECFMG is authorized by the United States Immigration Agency (USIA) to sponsor foreign national physicians as exchange visitors in accredited programs for graduate medical education or training. ECFMG is the sole sponsor of J-1 physicians in clinical training programs in the United States. Foreign national physicians applying for ECFMG sponsorship must meet the following requirements:
Processing time for sponsorship applications is generally 4 to 5 months. Application for renewal is recommended at least eight weeks prior to the expiration of the current DS2019 Form. J-1 visa holders may not participate in moonlighting or activities outside of their training program.
Q. Do I need to have United States research/clinical experience?A. No, but some clinical experience in the United States is very helpful for International Medical Graduates.
Q. Do you require previous formal residency training in the United States?A. No.
Q. When do I need to take the Step II exam?A. Massachusetts General Hospital requires successful completion of Step II (written and Clinical Skills Assessment) prior to starting residency. For this reason, we strongly encourage applicants to complete these examinations by December 31.
Q. Which tests are required for licensure in Massachusetts?A. Most physicians beginning residency training will obtain a Massachusetts Limited License. The Limited License is a training license that is valid only at the institution where the MD is located and is available for J-1 and H-1B applicants also. In order to qualify for the limited license, the applicant must have passed parts I and II of the USMLE. Applicants on an H-1B visa (including Canadian medical school graduates) must also have passed USMLE part III for the purpose of obtaining the visa. To qualify for a permanent Massachusetts license, physicians must also pass part III of the USMLE and have completed two years of clinical training in the United States. We will arrange licensing when an applicant has been accepted into the Program.
Q. Do we have a minimum USMLE score?A. No, we do not have a minimum requirement above the passing level.
Maps & Information
Facilities and General Information
The Massachusetts General Hospital
The Mass General, founded in 1811, is Harvard Medical School's original teaching hospital. Affiliated hospitals in the Partners HealthCare System include the Brigham and Women's Hospital, Dana Faber Cancer Institute, North Shore Medical Center, and several community hospitals. Find information on the Hospital Overview page.
The Mass General Pathology Department staff provides pathology services for the Massachusetts Eye and Ear Infirmary, Cambridge Hospital, Shriner's Hospital for Children, Spaulding Rehabilitation Hospital, and Harvard and MIT Health Services. Find information on the About Pathology page.
The Pathology Service
The Anatomic Pathology laboratories are located in approximately 30,000 sq. ft. on six floors of the Warren Building and one floor of the adjacent Blake Building. The combined Clinical Laboratories are located mainly in the contiguous Jackson and Gray Buildings (approximately 30,000 square feet). The Immunopathology and Electron Microscopy Units are located on the fifth Floor of the Warren Building. Research space includes over 40,000 sqare feet divided among four main facilities at Massachusetts General Hospital, Charlestown, and Charles River Plaza.
The Pathology Department's Mallory Library contains current pathology journals, Nature, Science, Cell, and others. A library for the use of the clinical pathology residents is adjacent to the Clinical Pathology residents' office. Both are open 24 hours a day. The hospital's Treadwell Library is well equipped with a wide range of journal titles, textbooks, and bibliographic search capabilities, and is open until 8:00 weekday evenings, and 4:00 pm on the weekend. Harvard Medical School's Countway Library is three miles away and is one of the largest medical reference libraries.
Anatomic Pathology uses the Impac PowerPath computer system for specimen and data management. The Clinical Laboratories use the Misys system. All anatomic and clinical laboratory results are available on the Clinical Application Suite (CAS) of MGH/Partners. Each resident has a personal computer at his/her desk. An additional twenty-five computers are available for the use of the residents. All are equipped to access PowerPath and CAS and have Internet access. BRS Colleague, Medline, and other clinical and research information search tools are also available on these computers.
Photography and Text Slide Preparation
The Photography Unit in the Pathology Department takes gross photographs and photomicrographs, both film and digital. The Unit prepares projection slides for conferences and lectures, and also prints posters. The photographers teach residents these skills and are available for consultation. Residents are encouraged to photograph interesting specimens and are given copies for their own collections.
The Pathology Service has 90 full-time M.D. and/or PhD faculty. The AP/CP program presently has 38 residents. There are fellowships in the Pathology of Women’s Cancers, Bone and Soft Tissue Pathology, Gynecologic Pathology, Cytopathology, Hematopathology, Neuropathology, Dermatopathology, Gastrointestinal Pathology, Immunopathology, Clinical Chemistry, Molecular Pathology Research, Renal Pathology and Transfusion Medicine. At least five NIH supported laboratory research fellowship positions are available for two to three years each.
Partners Office of Resources for Trainees (P.O.R.T.)
The Partners Office of Resources for Trainees (PORT) helps to address trainee “quality of life” issues by linking trainees to various resources and offering a variety of presentations and social activities.
Massachusetts General Hospital Center for Diversity and Inclusion (CDI)
The Massachusetts General Hospital Center for Diversity and Inclusion works closely with every department at Massachusetts General Hospital to advance the careers of physicians and scientists who are underrepresented in medicine ("URM"), and to educate our workforce on cross-cultural interactions with patients and colleagues, helping to make Mass General a more inclusive and welcoming environment.
About Boston and the Region
Massachusetts General Hospital is located in Boston, Massachusetts, affording our residents access to the many amenities of Boston and New England. Information a bout the region can be obtained from the Higher Education Recruitment Consortium website.
Kristine Albin, MD
Melis Anahtar, MD, PhD
Harvard Medical School
Michael Astudillo, MD
Samantha Champion, MD
Adam Fisch, MD, PhD
University of Maryland
Megan Fitzpatrick, MD
University of Minnesota
Grace Mahowald, MD, PhD
Washington University-St Louis
University of Milan
University of Central Florida
Andrew Crabbe,MD, PhD
University of Pennsylvania
University of Kansas
University of Miami
Lucas Massoth, MD
University of Oklahoma
Julian Villalba-Nunez, MD
Universidad Central De Venezuela
Nida Safdar, MD
Oregon Health & Science
Alexander Subtelny,MD, PhD
Mingjuan Lisa Zhang,MD
Johns Hopkins University
Rory Crotty, MBBCH
Cork School of Medicine, Ireland
Raza Hoda, MD
Max Jan, MD, PhD
University of California, San Francisco
William Jeck, MD, PhD
University of North Carolina, Chapel Hill
Zehra Ordulu Sahin, MD
Hacettepe Universitesi, Turkey
Lena Stuart, MD
Marty Taylor, MD, PhD
Kristen Tomaszewski, MD
State University of New York-Downstate
Athena Chen, MD
John DeWitt, MD, PhD
University of Vermont
Krzysztof Glomski, MD, PhD
Stephan Kadauke, MD, PhD
Chieyu Lin, MD, PhD
Erik Williams, MD
University of Virginia
Kristen Basnet, MD
Surgical Pathology (Breast)
Nathan Clement, MD
Karen (KC) Coffey, MD
George Eng, MD, PhD
Jonathan England, MD
Surgical Pathology (Gastrointestinal)
Julie Guilmette, MD
Surgical Pathology (Head & Neck)
Daniel Johnson, MD
Danielle Kurant, MD
Kirsten Pierce, MD
Angela Shih, MD
Bradford Siegele, MD, JD
Wesley Samore, MD
Matthew Rosenbaum, MD
Patrick Rush, DO
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