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 Mass General 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 Lectures
These 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 Cases
The 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 Conferences
Many 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 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 Residents
In 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 Offerings
The 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" Teaching
During 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 Conferences
Residents 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 Services
Second 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 Presentations
Residents 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 a Mass General Clinicopathologic Conference (published in the New England Journal of Medicine as the Case Records of the Mass General).

Medical Students
Residents 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, 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.

Residency Evaluation 

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.

Related Information
  • The SP-LIT Program: The SP-LIT Program combines training in anatomic pathology (AP) or clinical pathology (CP) with post-doctoral fellowships in cutting-edge scientific laboratories, all under the aegis of a proactive career mentoring program. Click here for more information: SP-LIT Program
  • The NIH T32 Training Grant: The NIH T32 Training Grant is a postdoctoral research program to train a select group of young physicians (MD or MD-PhD), who have completed a core residency program in pathology, in the fundamentals of basic research in cancer biology and immunology. Click here for more information: NIH T32 Training Grant
  • Research Opportunities: Research Opportunities in Pathology include basic science, translational, and clinicopathologic projects with various faculty members. Click here for more information: Pathology Basic & Translational Research Opportunities
  • Description of Rotations