Pathology Residency Curriculum

The Brigham and Women’s Hospital (BWH) Anatomic Pathology (AP) and Clinical Pathology (CP) residency curricula are designed to provide a concentrated core training experience followed by enhanced flexibility in the later years that enables each resident to customize training to suit individual interests and needs.

The residency program is available as either a three-year program in AP, a three-year program in CP, or a combined four-year program (AP/CP). All trainees seeking AP alone or AP/CP will first complete the two-year Core AP program consisting of a broad mix of surgical and autopsy pathology and cytopathology, plus subspecialty rotations. All trainees seeking CP alone or AP/CP complete a 15-month Core CP program consisting of rotations in Chemistry, Microbiology, Transfusion Medicine, Hematology and Molecular Diagnostics. Senior residents in any of the three tracks choose from a broad array of advanced subspecialty rotations, research, and/or leadership positions such as Chief Resident. To complement these rotations, there is an extensive and well-organized schedule of both working and teaching conferences in which residents at all levels participate.

Individualized programs are designed in conjunction with each resident trainee prior to each academic year, with consideration given to level of training, individual preferences, long- term goals, and Board requirements.  Trainees in good standing are guaranteed funding through completion of the training requirements of the American Board of Pathology, plus at least an additional year of clinical or research training. Many residents do multiple pathology subspecialty fellowships or a combination of subspecialty and research training.  The majority of residents enter the program with interests in academic and research careers, and most enter productive careers in academic centers; however, a subset become practicing pathologists in the community.  Thus, Brigham and Women’s Hospital provides a strong core program in diagnostic pathology with in-depth training in subspecialties and research.

Senior residents assume increased diagnostic, teaching, and administrative responsibilities on autopsy, surgical pathology and laboratory services, with appropriate senior staff supervision. In accordance with requirements of the ACGME (the principal accrediting agency for residency programs nationally), competency-based training and evaluation are emphasized.

Anatomic Pathology Core Training: PGY1-2 (AP, AP/CP)

The Core AP Program comprises 24 months, and consists of approximately 6 months of general surgical pathology; 3 months of gynecologic and obstetrical pathology; 3 months of cytopathology; 2 months of autopsy pathology including 2 weeks at the Boston Office of the Chief Medical Examiner (or other accredited program); 1.5 months of frozen sections; 1 month each in gastrointestinal pathology, hematopathology, dermatopathology, neuropathology, molecular diagnostics and cytogenetics and pediatric pathology (at Boston Children's Hospital); and 2-week experiences each in breast pathology, cardiovascular/thoracic pathology and genitourinary/renal pathology. In addition, incoming residents have a 2-week "boot camp" orientation and each year residents receive 1-2 weeks of independent study/subspecialty electives.

During "boot camp", first year AP and AP/CP residents are oriented to and begin their training in various areas of the department. Residents are divided into small groups (usually 3 to 4 residents per group). Each day, a different group rotates to cover the autopsy service and is trained on performing autopsies as cases are received.  The other groups rotate through different areas of the department, including surgical cutting room, the frozen section room, and the histology lab, and are oriented to workflow and operations in each area while receiving basic training on topics such as sharps safety, gross description, dictation, and gross photography as well as the laboratory information system and electronic medical record. Residents also spend time at the microscope, reviewing basic histology and pathology with senior residents and fellows.

Representative Combined AP/CP Residency Rotation Schedule
Representative AP Only Residency Rotation Schedule
Representative AP Only Residency Rotation Schedule with Research

Clinical Pathology Core Training: PGY1-2 (CP), PGY3-4 (AP/CP)

Core CP training for AP/CP or CP residents is a highly structured 15-month program and consists of 3-month rotations in Clinical Chemistry, Microbiology, Transfusion Medicine/Blood Bank, Hematology and Molecular Diagnostics.

The CP rotations are designed to provide training for the pathologist to direct the operation of the clinical laboratory in all of its aspects (methodology, quality control, clinical interpretation of laboratory tests and administration) and to provide opportunities for subspecialty or investigative work during the training period.

Training in CP is directed toward residents acquiring proficiency in 3 major areas:

  • Technical Expertise: This requires an understanding of the principles of test methodology to allow trouble-shooting, identify interferences, evaluate new instrumentation/techniques, and monitor appropriate specimen collection, etc. Most of these skills are best acquired by being in the laboratory and interacting with medical technologists and technical supervisors.
  • Medical Knowledge: Clinical pathologists function as the "bridge" between clinical practice and laboratory analysis. Residents should learn how to interpret laboratory tests and apply this knowledge to assist clinicians in patient diagnosis and management. This includes interaction with clinicians, appropriate utilization of the laboratory and interpretation of test results.
  • Management: Administration, data management, cost containment, reimbursement and quality control are all important aspects of CP.  These are covered in formal lectures and experienced by the involvement of residents in the routine administration of the laboratories.

The program encourages active participation by the resident in the daily life of the laboratory. Resident duties and responsibilities vary from laboratory to laboratory, but include interpretation and reporting of significant laboratory findings, active participation in quality control programs, clinical problem solving, attending morning report held by clinical services and functioning as a liaison between the laboratory and clinical staff. Residents actively participate in teaching seminars for students, residents, and staff. The program is sufficiently flexible to provide time for residents to receive in-depth training and experience in subspecialties of particular interest without jeopardizing the overall training experience, and to increase cross-training and use of molecular diagnostics and other technologies, in order to prepare trainees for careers in modern pathology. Residents are also encouraged to become involved in projects in clinical, translational, and basic research.

Representative CP Residency Rotation Schedule with Research

Training for Senior Residents

Following the Core program, the training is individualized to meet each resident's specific career goals, and includes a customized combination of electives, advanced core rotations, service as Chief Resident, and research.

AP electives for AP only residents (1 year) or AP/CP residents (6 months) include rotations lasting 1.5 to 12 months in general surgical pathology, hematopathology, cytopathology, neuropathology, soft tissue pathology, pediatric pathology, cardiovascular pathology, dermatopathology, thoracic pathology, gastrointestinal pathology, women's and perinatal pathology, breast pathology, genitourinary pathology, renal pathology, cytogenetics, and molecular diagnostics. The schedule for each resident is custom-designed following consultation with surgical pathology leadership. In addition, residents are welcome to rotate in advanced CP electives, described below.

CP electives for CP only residents and AP/CP residents include rotations lasting 3 to 6 months in clinical chemistry, toxicology, hematology, microbiology, transfusion medicine, molecular diagnostics, Immunology and tissue typing. In addition, residents are welcome to rotate in advanced AP electives, described above, if needed for their future career goals.

Four AP chief residents are appointed each year for 3 month terms. In addition, CP only residents function as chief residents in their second year. The opportunity to serve as chief resident facilitates development of management, organizational and problem-solving skills that form a firm foundation for future leadership positions.

Elective rotations outside of BWH may also be pursued both locally and outside of Boston.  Recent residents have spent elective time at the Boston Public Health Laboratories, New York City Medical Examiner’s office, and in medically underserved areas of Africa studying transfusion medicine, surgical pathology and parasitology.

In-depth basic or translational research rotations can supplement clinical electives if so desired. Extensive research opportunities are available within the Department of Pathology and elsewhere in the Longwood Medical Area and the greater Boston area.

Representative Weekly Conference Schedule

The core and elective rotations are complemented by an extensive and well-organized schedule of both working and teaching conferences, in which residents at all levels participate.  Below are highlights of only a few of the many formal and informal educational opportunities for trainees in the Department.

Teaching Conferences

AP Summer Teaching Conferences

AP Summer Teaching Conferences are held 5 days per week from July through early October. These conferences, given primarily by BWH faculty, cover all aspects of how to function as a pathologist (including gross descriptions, histology, frozen sections, special stains and other ancillary tests, photography, the computer system, etc.) as well as introductory lectures on the pathology of various organ systems. Breakfast or lunch provided.

AP Teaching Conferences

Starting in October, the AP teaching conferences are held on Tuesday and Thursday mornings at 8am. These conferences are grouped by organ system and often involve unknown slides that are available a week in advance. Breakfast is provided.

Women's & Perinatal and Cytology Conferences

The Women's & Perinatal conference series is held on two to three Wednesdays a month and includes didactic review of obstetrical and gynecologic diseases by the faculty of the Women’s & Perinatal Division, case review and interactive teaching using the Classroom Performance System, review of perinatal/fetal autopsy cases, and presentation of abstracts by residents and fellows prior to national meetings. One week of each month is devoted to topics in Cytopathology.

CP Teaching Conferences

CP Teaching Conferences are held every Wednesday morning at 8am. In the summer, these include introductory lectures on clinical chemistry, microbiology, hematology, molecular diagnostics, and blood bank/transfusion medicine. Later in the year more advanced topics are introduced including a lab management series in January. Breakfast is provided. In addition, one-on-one educational sessions (such as hematology slide reviews, microbiology unknowns, and other didactics) are provided during individual CP rotations.

CP Call Conference

Residents on CP rotations meet every Monday morning at 9am with the Chief Resident, Associate Program Director and Medical Directors of each specialty to present and discuss interesting cases and call questions.

Departmental Conferences

Pathology Grand Rounds and Research Conference (CME)

Pathology Grand Rounds and Research Conference are held on alternating Mondays at 1pm. Grand Rounds invites senior faculty members from Harvard, other Boston institutions, and nationally and internationally known experts to present state-of-the-art lectures on evolving clinical/diagnostic issues or basic scientific topics that link pathogenesis to the clinical expression of disease, educational topics, bioinformatics and novel technological innovations in pathology. Pathology Grand Rounds incorporates 3 named lectures per year (Robbins, Cotran and Dammin) for which national or local luminaries are invited. In addition, academic year 2018-2019 debuted the "Trainees' Choice" lecture, in which residents and fellows select and host a national speaker. The Research Conference is a terrific opportunity for faculty within the Department to present the arc of their work, as well as current experiments, so that residents, fellows and faculty can learn about the ongoing research opportunities within the Department.

Clinical Pathology Conference (CME)

Senior faculty and invited speakers from other departments and institutions review a variety of aspects of clinical laboratory medicine, including management considerations, as well as cutting-edge research. These conferences include leaders in their respective fields who will discuss emerging diagnostic and investigative technologies and therapeutics, as well as showcase research opportunities for trainees. This conference is held on Tuesdays at 1pm.

Professional Development Series

Initiated in the past 2 years, this conference addresses topics of broad interest that do not fit neatly into another conference format. Topics covered, often in workshop format, have included academic promotion criteria, unconscious bias, feedback, how to write and review scientific papers, negotiation, how grant review panels work, developing research support, and how to prepare poster presentations. Sessions are held on one Wednesday a month at 1pm.

Gross-Micro Conference

The Gross-Micro Conference is a long-standing and proud tradition in the Department. Held on Thursdays at 1pm, the conference consists of two 20-minute presentations by residents on a topic of their choice, inspired by a clinical case. These presentations synthesize information from the clinical case, diagnostic pathology, and the latest research, in order to obtain a truly complete and contemporary picture of a disease. During the first two years, each resident will give approximately 5 of these conferences; in most cases, residents work in close association with faculty to develop a Gross-Micro topic and to refine their talks. Each presentation is formally reviewed after the conference by a faculty member to help coach the residents in ways to improve their presentation skills.

Surgical Pathology Update (CME)

Held each Friday at 1pm, faculty members from the Department and other Boston teaching hospitals, as well as invited national experts, present lectures on topics of current or evolving interest in the field of diagnostic anatomic pathology. These conferences are geared to bring the audience "up-to-date" on the latest classification systems and phenotypic/genetic advances in surgical pathology entities. Invited speakers often also hold an unknown slide seminar for trainees at 10 am on the same day.

Representative Weekly Conference Schedule

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