All residents rotate through Electron Microscopy (EM). During this one month rotation, the resident learns to utilize the transmission electron microscope and interpret electron micrographs. Most EM studies involve kidney biopsies; however, other tissues are studied as well. Over 300 EM studies are performed annually. While assigned to the EM service, the resident is also responsible for reviewing light microscopy and immunofluorescence studies on all kidney biopsies and integrating those results with the EM findings. The resident participates in both in-house cases and consult cases from other institutions.
Hematology, Coagulation, and Flow Cytometry
Penrose-St. Francis Hospital has a large Hematology and Oncology service which is complemented by a very active Hematopathology Department. During Hematopathology rotations, the resident reviews all critical peripheral blood smears and enters appropriate comments in the laboratory information system or, if necessary, speaks directly with a clinician. The residents perform all in-house bone marrow biopsies under the supervision of a staff pathologist. Most residents will finish their hematology rotations with well over 150 bone marrow biopsies performed. The resident reviews the cases and orders any necessary additional studies (eg. flow cytometry, cytogenetics and FISH). In 2009, there were 559 in-house bone marrow biopsies performed.
The Hematopathology service works in coordination with Immunology, Cytogenetics, and Molecular Pathology with integration of data from the various associated disciplines being emphasized. In addition to the core Hematopathology rotations (5 months), residents have rotations in Coagulation (1 month), Flow Cytometry and Immunology (1 month), and Cytogenetics and Molecular Pathology (1 month).
Three months of Blood Banking and Transfusion Medicine are required for completion of residency. The Penrose Blood Bank offers complete service, including a donor center for routine, autologous, therapeutic and apheresis donors. Under staff supervision, the blood bank resident acts as Medical Director for these donor services.
While on the blood banking service, the resident reviews the charts of patients with transfusion reactions, determines the nature of the transfusion reaction, and issues a report for the patient record. Residents also participate in benchwork, such as performing antibody work-ups, in order to gain a better understanding of standard procedures. Residents are also responsible for antibody reports.
The on-call resident will offer advice regarding transfusion reactions or other blood banking issues. Frequent questions include which blood components should be given in certain circumstances and how much of a component a patient needs. Residents also spend one week in HLA testing at ClinImmune Laboratories in Aurora, Colorado.
Each resident spends five months in the Chemistry rotation. The resident interprets electrophoresis gels and answers clinical questions regarding laboratory testing. The resident may participate in benchwork to gain a greater understanding of procedures and instrumentation.
Two weeks of the five months are spent in toxicology at the El Paso County Coroner's Office. If additional toxicology experience is desired, the resident may request more experience as elective time. In toxicology, the resident learns basic instrumentation and interprets mass spectrophotometer graphs, gas chromatographs, and liquid chromatography. During this rotation, the resident evaluates unknown specimens.
Penrose Hospital hosts a full-service Microbiology Laboratory that includes Bacteriology, Virology, Mycology, Parasitology, and Immunofluorescence Sections. Residents study Microbiology for at least four months. During this rotation, the resident answers clinical questions concerning Microbiology, participates in benchwork and is given unknown cases to work up. This affords the resident the opportunity to learn culture algorithms and organism identification.
Penrose Hospital, affiliated hospitals and outreach clients provide the Pathology Program with a diverse, well-balanced caseload. Surgical Pathology volume continues to increase with over 22,000 specimens examined in 2010. While on Surgical Pathology, the resident is responsible for frozen sections and grossing surgical specimens. Surgical Pathology is structured on a 2-day system where the specimens are "grossed-in", and then signed out the following day. During a sign-out session, residents work directly with a staff member at a double-headed microscope. The staff member and resident review the slides, render a diagnosis, and dictate a report. As their skills increase, residents are given graduated responsibility with the goal of relying on staff only for case review and finalization.
A Surgical Pathology Unknown Conference takes place each week. The staff and residents assigned to Surgical Pathology set aside the week's most challenging and interesting cases. These cases provide the basis for the conference. At the conference, the residents present a differential diagnosis for each case, and the staff and residents review the diagnoses in a collegial atmosphere.
The Cytology resident is responsible for examining all Cytology cases reviewed by the staff pathologist. The resident formulates a diagnosis and reviews the cases directly with a staff member. The resident participates in all fine needle aspirations performed by the Pathology Department. In 2010, more than 13,000 cases were reviewed which included over 10,500 gyns and 2,600 non-gyns.
A weekly didactic Cytology Conference and monthly Cytology Unknown Conference is held at a multi-headed microscope in which the cytotechnologist reviews unknown cytology cases with the residents.
Resident autopsies are assigned based on a rotating list with residents responsible for all autopsies performed in the hospital. There are no weekend autopsy duties. Most autopsies are adult cases; however, a small number of pediatric cases are performed at Penrose Hospital. Additional pediatric pathology experience is available during a one month rotation at The Children's Hospital in Denver, Colorado.
Residents have never had to share autopsy cases in order to meet the required number of 50 cases in order to sit for the boards. Our numbers are fulfilled through a combination of full adult hospital autopsies, fetal demises, pediatric autopsies at The Children's Hospital during the pediatric pathology rotation, and coroner case autopsies during the Forensics rotation. Most residents finish their training at Penrose with approximately 60-70 autopsies.
At least one month of Forensic Pathology is available at the El Paso County Coroner's Office in Colorado Springs. The resident may arrange additional training at other facilities including the Office of Medical Investigations in Albuquerque, New Mexico. In addition to the general Forensic Pathology experience, the resident has the opportunity to investigate death scenes and attend court trials. Most residents perform 20-30 full autopsies during this one month rotation.
A one-month Pediatric Pathology rotation takes place at The Denver Children's Hospital. During the rotation, the resident participates in both surgical and autopsy pathology related to the pediatric population. The resident works directly with the pediatric pathologists on staff. Travel expense reimbursement is available at the end of the rotation.