Department of Pathology

Albert Einstein College of Medicine

Pathology Resident Manual

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 TABLE OF CONTENTS

RESIDENCY TRAINING LEADERSHIP............................................................................................................................................ 3

DEPARTMENT MISSION STATEMENT.......................................................................................................................................... 3
RESIDENCY PROGRAM TRACKS................................................................................................................................................ 4-6
RESIDENT MENTORING PROGRAM ............................................................................................................................................. 7
RESIDENT RESPONSIBILITIES....................................................................................................................................................... 8
RESIDENT COMPETENCY ASSESSMENT ............................................................................................................................... 9-11
PROFESSIONALISM IN PATHOLOGY ...........................................................................................................................................12
TEACHING CONFERENCES...........................................................................................................................................................13
ON-CALL RESPONSIBILITIES ...............................................................................................................................................14-15
RESIDENT EXPENSES ............................................................................................................................................................16-17
ANATOMIC PATHOLOGY ROTATIONS ........................................................................................................................................18
Autopsy ...................................................................................................................................................................................19
Cytopathology ......................................................................................................................................................................20
Dermatopathology .............................................................................................................................................................21
Neuropathology ..................................................................................................................................................................22
Surgical Pathology .............................................................................................................................................................23
Breast Pathology................................................................................................................................................................. 24
CLINICAL PATHOLOGY ROTATIONS ...........................................................................................................................................25
Blood Bank/Transfusion Medicine ....................................................................................................................... 26-29
Chemistry/Immunology ............................................................................................................................................ 30-32
Genetics............................................................................................................................................................................ 33-35
Hematology .................................................................................................................................................................... 36-37
Hematopathology ............................................................................................................................................................... 38
Microbiology/Virology .............................................................................................................................................. 39-44
Hybrid AP/CP Rotations................................................................................................................................................... 45
Solid Organ Transplantation ......................................................................................................................................... 46
IN-HOUSE ELECTIVE ROTATIONS .............................................................................................................................................47
Biopsy Hot Seat Elective ............................................................................................................................................... 48
GI/Liver Pathology ............................................................................................................................................................. 49
Gynecologic Pathology ..................................................................................................................................................... 50
Neuropathology .................................................................................................................................................................. 51
Orthopedic Pathology ....................................................................................................................................................... 52
Pediatric Pathology .......................................................................................................................................................... 53
Perinatal................................................................................................................................................................................. 54
Renal Pathology .................................................................................................................................................................. 55
Surgical Pathology Sign-Out Elective ......................................................................................................................... 56
Ultra Structural Pathology ............................................................................................................................................. 57
AWAY ELECTIVE ROTATION.......................................................................................................................................................58
ADDENDUM A (MONTEFIORE EDUCATIONAL ALLOWANCE FOR HOUSESTAFF) ................................................................ 59
ADDENDUM B (CONFERENCE ATTENDANCE FUNDING APPROVAL FORM) ......................................................................... 60
ADDENDUM C (PATHOLOGY TRAVEL REIMBURSEMENT POLICY) ..................................................................................61-64
ADDENDUM D (POLICY ON EXTERNAL AWAY ELECTIVE ROTATIONS) ......................................................................65-67
ADDENDUM E (TAXI POLICY).68

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Residency Training Leadership
Michael B. Prystowsky, MD PhD Chair
J.J. Steinberg, MD Residency Director
Tiffany Hbert, MD Residency Director of AP Training
James D. Faix, MD Residency Director of CP Training

Department Mission Statement

The ethos of the Montefiore Department of Pathology is that healthcare is a right of

universal social justice.

Our mission is to deliver compassionate and high quality patient-centered healthcare

through the prudent use of state-of-the-art diagnostic procedures; the nurturing and
education of doctors in training; and the translation of new knowledge into the practice of
Pathology. This mission is supported by a commitment to excellence in integrating
research, education, clinical care, and community health to advance the field of
knowledge in Medicine and Biology, and to train professionals who are prepared to meet
existing as well as future challenges to Medicine and Society.

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Residency Program Tracks

The goal of our residency program is to provide the proper educational and clinical
environment in the various areas of anatomic pathology and clinical pathology/laboratory
medicine, which will allow residents to develop into competent, independent and
knowledgeable pathologists who will be life-long learners, effective teachers, successful
laboratory managers and active members of the multidisciplinary patient care team. The
training programs have sufficient latitude to enable residents to become involved in
research opportunities within the medical center and the medical school.

There are three tracks available for Pathology Residency Training:

Combined Anatomic and Clinical Pathology (AP/CP) 4 years
Anatomic Pathology or Clinical Pathology (AP or CP) 3 years
Pathologist Investigator Pathway (AP or CP and post-doctoral research) 4 years
Combined AP/CP
This track provides intensive foundational training in both Anatomic and Clinical
Pathology. The program is combined, with residents experiencing both AP and CP
rotations during the year.

Beginning in 2016-2017, we have devised a curriculum that allows the resident to attain
the requisite knowledge, skills and adaptability to succeed in pathology. This curriculum
unfolds in a step-wise fashion, beginning with core fundamentals in both anatomic and
clinical pathology, advancing to specialty studies, and culminating in a year of
individualized targeted learning.

Integrated AP/CP Training

Core:
Year 1: 8 months of AP and 4 months of CP
Year 2: 6 months of AP and 6 months of CP
Advanced:
Year 3: 4 months of AP and 8 months of CP
Customized:
Year 4: 12 months of focused training

Residents who began training prior to 2016 will continue on the previous curriculum with
the following required rotations:
Track Rotation Blocks Faculty
AP Autopsy Pathology 4 Anatomic pathology faculty
AP Cytopathology 2 Cytopathology staff
AP Dermatopathology 1 Dermatopathology staff
AP/CP Elective 6 Varies
AP Forensic Pathology 1 Bronx ME
AP Hematopathology 2 Hematopathology staff
AP Neuropathology 1 Neuropathology faculty
AP Surgical Pathology 12 Surgical Pathology faculty
AP/CP Solid Organ Transplant 1 Transplant pathology faculty

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 CP Blood Bank 3 Transfusion Medicine faculty
CP Chemistry 4 Chemistry Staff
CP Cytogenetics 1 Cytogentics Staff
CP Hematology 4 Hematology Staff
CP Informatics 0.5 Informatics Staff
CP Lab Management 0.5 Lab Management Staff
CP Microbiology 4 Microbiology Staff
CP Molecular Diagnostics 1 Molecular Staff
CP Virology/Point of Care 1 Virology Staff

AP only or CP only

This track provides training in either AP or CP and consists of the first two years
comprised of core rotations as well as elective time. In an AP only track,
cytogenetics/molecular genetics, molecular diagnostics, junior attending in surgical
pathology, laboratory management and informatics are added to the curriculum as
requirements. Electives can be tailored to fit the specific needs of the resident.

Pathologist Investigator Pathway (AP/Research or CP/Research)

This track is directed towards residents who are interested in a research-oriented
residency program. It is composed of two years of anatomic or clinical pathology training
as described in track #2, followed by two years of supported post-doctoral research in any
lab of the Albert Einstein College of Medicine. Einstein is one of the top 20 medical
research institutions in the United States and offers a wide variety of research
opportunities.

Changing Tracks

Although the resident track is stipulated in the yearly contract, residents may decide that
their career goals are better met by changing their track. For example, a resident may
determine that they would like to change from an AP/CP track to an AP only or CP only
track. For most residents, the faculty strongly encourages all residents to complete
combined AP/CP training as this is the most optimum way to achieve the full scope of a
pathology residency education. However, if a resident desires to change their track, the
Department will assist them to do so to the extent possible, taking into account not just
their desires but also service needs. Please note the following and discuss any potential
changes with the Residency Director and your Mentor as soon as possible.

Changes can only be made prior to renewal of contract, and the resident must finish out
the year they are in at the time the request is made.

The resident must have active interactions with their faculty mentor who, once they have
an understanding of the residents desire for change, should bring the issue to the
Residency Advisory Committee (RAC).

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The resident must also provide a letter to the RAC detailing their reasons for switching
their track.

The RAC and other relevant Departmental leadership must approve all requests.

The final decision will be from the Chairman, based on information provided from the
RAC, the residents mentor/spokesperson and interviews with the resident.

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Resident Mentoring Program

Montefiore Medical Centers Pathology department recognizes the beneficial effects that
a mentor program can engender. The faculty mentor serves as a guide, role model and an
advocate for the resident mentee. Our goal is to provide residents with a positive,
supportive environment in which they can explore and refine career goals with the
guidance of experienced faculty members. The mentor program is a tool for monitoring
and promoting resident career goals, research productivity, professionalism and personal
growth.

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Resident Responsibilities

All residents are expected to be aware of their important role as members of patients
healthcare team and act professionally as they carry out their service obligations.
Residents need also to be aware of how the competency model of assessment and
knowledge acquisition will be utilized to assess their abilities in pathology.

Attendance is mandatory at some teaching sessions. Residents and fellows also

participate in teaching of medical students in small group sessions and laboratories,
present cases at intra- and interdepartmental conferences, participate in journal clubs,
attend unknown slide conferences, and are active in house staff and laboratory
administration.

Senior residents and fellows are expected to provide supervision in the training junior
residents. These activities present the opportunity of graded responsibility, preparation
for independent sign-out for pathologists-in-training and develop valuable
communication and management skills.

Upon starting a service, residents must meet with the attending(s)/directors of service to
review expectations and goals of the rotation. Residents are expected to be present in the
assigned area daily from 8AM to 6PM, except for required conferences. Residents are
expected to complete required and assigned reading. A mid-month or mid-rotation
informal evaluation is encouraged. The end of the month evaluation by the staff with
discussions with the residents is required and the monthly evaluations become part of the
residents record.

Monthly evaluations are performed on each resident and fellow in order to identify areas
in which the person is excelling, to provide ideas for career guidance and to identify early
on if a resident or fellow is having difficulty in a particular area in order to develop a plan
for improvement

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Pathology Resident Competency Assessment

Residents are evaluated during their rotations using the ACGME competencies utilizing
the criteria of competent, outstanding or needs remediation. Evaluations are
located on New Innovations (the institution-wide computer based resident assessment
tool).

Competent evaluations reflect specific knowledge, skills, behaviors and attitudes and the
appropriate educational experiences required of residents specific to complete GME
programs. Competent residents demonstrate these characteristics as appropriate for
their level of training.

The table below details outstanding criteria and need remediation criteria as defined
by academic resident training programs:

An outstanding resident Needs remediation

demonstrates: demonstrates:

Competency Exceptional knowledge of basic and Limited knowledge of basic and

Medical clinical sciences; comprehensive
Knowledge understanding of diagnostic criteria
and of relevant patterns and
mechanisms of disease; highly
resourceful in development of
knowledge.
Patient Care Superb, accurate, comprehensive
Anatomic gross descriptions, microscopic
Pathology diagnoses, reviews of clinical data,
and procedural skills; always makes
medical decisions using sound
judgment, considering patient
implications and available evidence.
Patient Care Superb, accurate, comprehensive
Clinical review, interpretation, and
Pathology 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
clinical sciences; poor
understanding of diagnostic
criteria and of relevant patterns
and mechanisms of disease;
minimal interest in learning.
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 medial decisions.
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

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 medical decisions using sound
judgment, considering patient
implications and available evidence.
Interpersonal Establishes highly effective medical
and relationships with co-workers and
Communications clinical colleagues; demonstrates
Skills excellent relationship building
through listening, narrative, and non-
verbal skills; excellent education and
counseling of co-workers and
clinical colleagues; always
interpersonally engaged.
Professionalism 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.
responsibilities; fails to analyze
clinical and laboratory data and
consider patient implications
when making medical decisions;
medical judgment is poor.
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 non-verbal skills;
does not provide education or
advice to co-workers and clinical
colleagues.
Lacks respect, compassion,
integrity, honesty; disregards
need for self-assessment; fails to
acknowledge errors; does not
consider needs of patient,
families, co-workers, and clinical
colleagues; does not display
responsible behavior.

Practice-Based Constantly evaluates own Fails to perform self-evaluation;

Learning performance, incorporates feedback
Improvement into improvement activities;
effectively accesses and utilizes
resources to manage information for
patient care and self-improvement.
System-Based Effectively accesses/utilizes outside
Practice resources; effectively uses systematic
approaches to reduce errors and
improve patient care; enthusiastically
assists in development of system
improvements.
lacks insight, initiative; resists or
ignores feedback; fails to use
available resources to enhance
patient care or pursue 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.

Scholarship/research project(s) is another area in which residents are expected to

participate during training (especially during longer rotations). The list of Pathology
faculty members also includes their subspecialty interest. Funding is available through
the Committee on Clinical Pilot Projects, which accepts and reviews project proposals at
regular intervals. In addition, funds are available to support residents who present their
work at various meetings.

Residents and fellows are encouraged to attend local pathology meetings. A modern
research library, including MEDLINE and Internet access, as well as current medical

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journals and textbooks, is available at each campus. Many on-line journals are also
available. The MMC house staff office provides a yearly educational allowance for the
purchase of textbooks, journal subscriptions, professional society membership dues,
educational software and PDAs.

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Professionalism in Pathology

All Pathology residents and fellows are expected to act in a professional manner and to
utilize the following criteria adopted from the American College of Graduate Medical
Education (ACGME). Additionally all residents are expected to attend a Professionalism
in Pathology lecture to be given at the start of the academic year.

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Teaching Conferences

Teaching conferences are divided into two categories: The Boot-camps and the didactic
lecture series. Boot camps are required for all PGY1 residents. Beginning in 2016, the
two weekly teaching sessions on Tuesday and Thursday mornings will be AP & CP
sessions required for all AP/CP residents.

The schedule of lectures and conferences can be found on the resident calendar at
http://bit.ly/montepath. Location for each entry can be found by clicking on in. The
following is an abbreviated list that may be of interest for residents. This list does not
include the breakdown of rotation specific conferences which will be scheduled at the
beginning of certain rotations. Residents are encouraged to attend all clinical conferences
as their interests dictate, as long as they have prior approval from the director of their
current service.

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On-Call Responsibilities AP

The AP On-Call Schedule is the schedule of residents responsible for frozen section
coverage at Moses, Wakefield and Weiler campuses from 5PM for Moses and Wakefield
and from 6 PM for Weiler and ending at 8 AM the following day from Monday through
Friday.

The Autopsy on Duty Schedule is the schedule of residents responsible for Autopsy
Coverage Monday through Friday. Residents are responsible for completing up to 2
autopsies they are paged for between 8am and 3pm. The resident who is covering the
service on the following day may need to complete any additional autopsies.

If a problem should arise while on call during the week or on weekends, residents should
first contact the chief resident(s) to discuss the problem.

On-Call Responsibilities CP

The clinical pathology resident on call provides consultative and problem solving
coverage for all laboratories/services in Laboratory Medicine.

The CP resident shall provide consultations to clinicians and laboratory staff related to
clinical lab testing. Examples include suggesting the proper testing algorithm for different
disease states, discussion of the appropriateness of specific tests, facilitating the
performance of appropriate tests, providing information as to collection procedures and
where tests are to be sent, and providing information about reference ranges, critical
values, interfering substances and cost. The resident may be called by laboratory
personnel or by clinicians referred to the resident by lab directors, supervisors, or
technologists.

When providing consultation, the resident should respond to pages immediately and
provide whatever information he or she is comfortable answering immediately. In the
event the resident does not know the proper answer, he or she should take down the
requestors telephone number and return the call as soon as possible. In the interim, the
resident shall look up whatever information that is available from lab manuals or
textbooks. If he or she needs more information, then a call to the relevant lab director
should be made. If an appropriate Lab Director cannot be found, the chief resident on-call
should be contacted.

Each call should be fully documented in the on-line On-Call Record Log.

The resident may also need to help contact appropriate medical personnel to deal with life
threatening panic values that have been reported on outpatients or recently discharged
inpatients. The resident shall utilize whatever resources available (e.g., CIS, LIS,
admitting office) to find an attending physician responsible for the patients care to
contact. If this cannot be accomplished the resident shall provide the patients telephone
number to the Emergency Department for them to contact the patient.

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If you are paged after hours for a critical value, take the patients MRN, name and who
you spoke to and what the value was and e-mail the information to the Chief Resident
who will communicate with customer service to discover why a provider was not
contacted.

Combined AP-CP Weekend Coverage

Weekend coverage begins on Saturday and Sunday at 8AM and lasts until the next day at
8AM. The resident can be paged for anything involved in AP or CP on call
responsibilities, including emergent autopsies.

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Resident Expenses
Residents may be reimbursed for a variety of expenses including purchase of textbooks,
journal subscriptions and professional society dues. The complete list is in the Montefiore
Medical Center Administrative Policy & Procedure #JH24.2(Addendum A). The GME
Housestaff Office will provide reimbursement up to $500 per year and the Pathology
Department will add an additional $300. Note that the supplement provided by the
department can not be used for reimbursement of the purchase of software or electronic
devices. All requests for reimbursement (whether from the GME Housestaff Office of the
Pathology Department) must be submitted to the Residency Coordinator no later than
May 31.

Pathology Travel Reimbursement Policy

We encourage residents to collaborate with faculty on research projects and to submit
results of these collaborations to conference and meetings. When submitted abstracts are
accepted (as either a poster or platform presentation), we encourage the resident to attend
the conference. We also want to support resident attendance at conferences and meetings
for educational or networking purposes.

Residents may, of course, attend meetings on their own time and at their own expense.
But, if an abstract is accepted, the department will support the residents attendance both
by allowing her/him time off (which will not count as vacation) as well as by funding
some (or all) of the travel expenses. The department will also similarly help a resident to
attend a conference or meeting for educational or networking purposes (i.e. without
presenting an abstract). The guidelines for this departmental support are as follows:

Residents may only receive support to attend conferences or meetings for which
an authored or co-authored abstract has been accepted. An exception is that a
resident may receive support to attend one meeting during their residency for
educational or networking purposes (i.e. without presenting an abstract).
Residents must discuss their desire to attend such a meeting with their mentor
and receive their mentors approval.

Time off (without counting as vacation) for attendance at conferences and

meetings is limited to up to five days per year. Leave from responsibilities must
be approved in advance by the faculty leadership for the rotation impacted.

Eligibility for reimbursement of travel expenses must be approved in advance by

the training program leadership, and is limited to up to $1500 per year.

Montefiore Medical Centers procedures for reimbursement must be followed.

(This policy is included in this manuals Addendum B)

Approval in advance requires submission of a formal request, using the Resident

Conference Attendance Funding Approval Form (Addendum C). If the resident is
submitting an abstract to a conference or meeting and anticipates that he or she will want
department support to attend the meeting if the abstract is accepted, the request should be

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submitted to Zudith at the same time that the abstract is submitted (and a copy of the
abstract should be included).

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Anatomic Pathology Rotations

Note: Beginning in 2016, Autopsy and Surgical Pathology will be a combined 5-day AP
rotation. The five day cycle for PGY-1 residents is as follows:
Day 1- Grossing
Day 2- Frozen coverage (From 8AM-5PM at Moses and 8AM-6PM at Weiler)
Day 3- Biopsy
Day 4- Bigs
Day 5- Autopsy/(Subspecialty signout for current senior residents)

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Autopsy Pathology
JJ Steinberg, K. Whitney

All incoming residents taking anatomic pathology cover the autopsy service as part of the
5-day cycle on the anatomic pathology service. Current PGY2-4 residents will continue
with the required 4 blocks of hospital autopsy coverage from previous schedules. The
autopsy experience is divided between the East and West campuses. Upon starting the
rotation, residents are provided with an autopsy handbook which provides detailed
information on service responsibilities and expectations. Each resident learns to perform
a complete autopsy, analyzes gross and microscopic materials, and prepares the autopsy
protocol under the direct supervision of an anatomic pathology attending. Each case is
presented and reviewed at a weekly/monthly Gross Review conference, which is attended
by all residents and attendings. Selected cases are presented at interdepartmental
pathology conferences, as well as at surgical, medical, pediatric, and perinatal
morbidity/mortality conferences. Residents sign-out autopsies with the members of the
AP faculty. Autopsy cases are to be signed out within 30 days. The autopsy
curriculum/guidelines are available at the Department of Pathology website:
http://education.montepath.com.

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Cytopathology
M Suhrland and S. Khader

PGY-1 residents will have an introductory month in cytopathology their first year. This
will be followed by more advance training in subsequent years. These rotations will take
place at the Moses Division, which reviews 70,000 cytology specimens per year,
including fine needle aspirations. The rotation insures exposure to gynecologic and non-
gynecologic cytopathology with emphasis on aspiration biopsy (FNA). The cytology
division interacts closely with surgical pathology and the resident will be involved in
tissue correlation, as needed. There are a variety of regular conferences, including an
interesting case conference presented by residents and fellows, Journal Club, Cytology-
Histology correlation conference, and didactic lectures. Participation in these
conferences as well as fellow teaching conferences is mandatory. An extensive library of
teaching cases is available to the rotating resident. Additional elective time is available
to interested residents. The cytopathology curriculum/guidelines are available at the
Department of Pathology website: http://education.montepath.com.

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Dermatopathology
M Jacobson, B. Amin

Residents on Dermatopathology rotation have the opportunity to participate in the work-

up and sign-out of dermatopathology cases from the Moses and Weiler Divisions with
Dr. Jacobson and the dermatopathology fellows. Review of dermatopathology cases with
residents rotating in surgical pathology is strongly encouraged. Residents are expected to
attend weekly dermatology grand rounds and dermatology clinic while on service. The
residents are also expected to spend some time at the Dermatopathology Diagnostics
laboratory located Port Chester where they are exposed to a large variety and number of
dermatopathology specimens.
Forensic Pathology
JJ Steinberg

All residents will spend one block in Forensic Pathology at the New York Office of the
Chief Medical Examiner in Manhattan, NY. Residents will work each day with
assignedmedical examiners that are to perform cases. The resident will initially observe
and assist with cases, progressing to a more active role, under supervision. Opportunities
will be available to view death scene investigations, observe forensic courtroom
testimony, and to attend lectures and teaching conferences at the central office in
Manhattan. Rotation objectives include: understanding the difference between hospital
and medicolegal autopsies, learning how to perform a medico-legal autopsy (including
methods of injury evaluation, specimen collection, and chain of custody handling),
learning how toxicology and forensic biology aid the medical examiner in his/her work,
and gaining a basic understanding of the field of Forensic Pathology. Additional elective
time is available to interested residents. A series of lectures during the year will further
acquaint residents with the medical examiners role.

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Neuropathology
K Weidenheim

The neuropathology rotation provides didactic and one-on-one instruction by the

Neuropathology faculty. Residents participate fully in gross, microscopic, and teaching
conferences. There is also an extensive collection of teaching materials, including glass
slides sets, Kodachrome sets, and a collection of gross brain slices. The full curriculum
for the Neuropathology rotation is available on the Departmental website:
http://education.montepath.com.

Rotation objectives include:

a. Participating in diagnosis of all brain, nerve, and muscle specimens seen in MMC
b. Learning proper interpretation of diagnostic techniques (including electron
microscopy, immunohistochemistry, muscle histochemistry, single teased fiber studies of
peripheral nerve, frozen sections, and CSF cytology)
c. Learning proper technique for removal of brain and spinal cord at autopsy and
collection of post-mortem CSF
d. Learning methods of handling tissue in neurodegenerative diseases (including
cryopreservation) and precautions for infectious cases (e.g. Creutzfeld-Jacob and AIDS)
e. Preparing conferences and other learning experiences for students, residents, and
clinical faculty.

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Surgical Pathology
T. Hbert, J Pullman and K Whitney

At the heart of the anatomic pathology curriculum are the surgical pathology rotations,
taking place at the Weiler and Moses Divisions of MMC. Upon starting each rotation,
residents are provided with a surgical pathology handbook which provides specific and
detailed information on service responsibilities and expectations. During the first year,
residents acquire expertise in the basics of gross and microscopic pathology and become
competent in describing and processing all types of routine surgical specimens. In
addition, residents become competent in the technical and diagnostic aspects of intra-
operative consultations (i.e., frozen sections). Second year and later residents, in addition
to increasing their own skills and knowledge, also train and mentor junior residents,
participate in interdisciplinary conferences, and teach medical students and residents
from other subspecialty programs. Graded responsibility and accountability are key
features that should develop as a resident progresses through the residency. Fourth year
residents, AP only residents and chief residents may function as junior attendings and
sign out cases with junior residents under supervision. The surgical pathology
curriculum/guidelines are available at the Department of Pathology website:
http://education.montepath.com.

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Breast Pathology
S Fineberg

A portion of the anatomic pathology rotation is spent at the Weiler Division of Surgical
Pathology, which has particularly rich resources in the field of breast Pathology, which
are available to residents. The MMC hospitals offer a full range of benign and neoplastic
conditions affecting the breast. The elective allows the resident to explore cases in
greater depth, by securing appropriate literature and reviewing similar or related lesions.
Residents participate in the work-up and sign-out of breast cases, including outside
consultation cases. Additional resource material includes archival material, and breast
pathology texts. Residents will attend, participate in, and present at a range of didactic
lectures and interactive conferences involving medical students and residents from within
and outside the Department of Pathology. In addition, the resident with prepare cases and
present at an interdepartmental Tumor Board, in which all current cases are discussed in a
multidisciplinary context, occurs on a weekly basis. This rotation is also available as an
elective.

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Clinical Pathology Rotations

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Blood Bank/Transfusion Medicine
J Uehlinger, R Walsh

I. ROTATION OVERVIEW
Pathology residents rotating through the Blood Bank are responsible directly to the Blood
Bank Medical Director or his/her delegate. During the three-month rotation, the residents
will perform specific duties and assignments as well as meet education goals and
objectives as defined below.

II.COMPETENCY OBJECTIVES AND ROTATION GOALS

A. Goal
The goal of Blood Bank rotation is to develop in our residents a working knowledge of
immunohematology theory, competent to perform and interpret immunohematologic
procedures, and clinical judgment in apheresis, blood transfusion practice and component
therapy.

B. Objectives
The resident will become sufficiently familiar with current knowledge in the basic areas
to allow him/her to serve as consultants to clinicians and to blood bank staff. Toward this
end, the resident must:

Understand basic immunology as applicable to Transfusion Medicine: antigens,

antibodies, and complement; immune reactions, involving blood cells and blood
constituents, both in vivo and in vitro.

Be conversant with blood group serology and genetics; including red cell, leukocyte, and
platelet antigens; their respective antibodies; and the serologic techniques necessary for
their demonstration.

Be able to follow workflow through the laboratory, including: specimen acceptability and
patient identification; accessioning and test ordering; ABO/Rh typing and antibody
screening; antibody identification; resolution of discrepancies; component preparation
and inventory management.

Be familiar with the blood donation process, including the preparation and storage of
blood cells and components, including hematopoietic stem cells. Be able to evaluate the
suitability of allogeneic and autologous donors. Understand the principles of donor
deferral and counseling, and be able to state all regulatory and voluntary requirements.

Be familiar with blood component therapy; including knowledge of the coagulation

mechanism, evaluation and treatment of coagulation disorders, and advantages and
disadvantages of specific blood components.

Be conversant with principles of tissue transplantation and blood transfusion; including

red cell compatibility testing; histocompatibility testing, rejection phenomena; and
hazards of blood transfusion, including transfusion reactions and disease transmission.

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Be able to evaluate patients for therapeutic apheresis procedures. Be able to communicate
with clinicians regarding indications and contraindications. This requires: obtaining and
evaluating pertinent information from the patients clinical record and taking an
appropriate history at the bedside; examination of cardiovascular and pulmonary systems,
in addition to any other appropriate examination; preparation of the patient by explaining
the reason for the procedure and the risks, benefits and alternatives to the use of apheresis
in the patients clinical condition; formulation of a treatment plan for the patients
condition; providing written orders for the procedure and communicating with nursing
staff about the orders; familiarity with equipment and settings, and be able to integrate
them into orders and treatment plans; provide medical supervision during the procedure;
provide follow-up care, including checking follow-up vital signs, laboratory results, etc,
as indicated. It is expected that each resident will supervise at least 5 apheresis patients
care during the rotation.

The resident will become sufficiently skilled in blood banking techniques (donor room,
compatibility testing and antibody identification) to recognize technical limitations and
pitfalls, to critically interpret the data generated by these procedures and to assist staff in
the analysis and resolution of technical problems.

The resident will develop sufficient clinical judgment in transfusion therapy to assess its
risk/benefit balance, to recognize unreasonable or inappropriate demands for blood
products, and when indicated, to recommend appropriate blood or component therapy.
Judgment can be developed only by dealing directly with clinical problems. Residents
also must be able to resolve logistic problems inherent in meeting demands for blood and
components under routine and emergency conditions.

Be able to evaluate patients or donors for stem cell collection. Be able to communicate
with clinicians regarding indications and contraindications. This requires all of the same
steps described for therapeutic apheresis in 1g above. In addition, the resident will follow
the collected product through cryopreservation, storage, and when possible, infusion.

III. SCHEDULE OF DUTIES AND REQUIREMENTS

A. General Schedule
Under the supervision of the Blood Bank Medical Director, the resident will perform the
routine duties specified below and become involved with daily activities and special
projects of the blood bank. It is required that the resident spend the rotation physically in
the blood bank or donor room, to experience and be available immediately when
consultative situations occur. Mornings are usually spent in the donor center or blood
bank laboratory, to fulfill the requirements listed under Donor Center, Transfusion
Service, and Management categories below. Depending on the needs of the clinical
service, most afternoons will be spent in sessions with one of the blood bank attendings,
as described in Didactic Sessions below.

B. Specific Duties and Responsibilities

1. Presentations: Present a minimum of one in-service to blood bank and/or donor

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center staff.

2. Donor Center
a) Resolve donor medical history acceptability questions.
b) Evaluate apheresis donor acceptability.
c) Assist with therapeutic apheresis procedures.
d) Explain deferral to donors.
e) Become familiar with the significant issues in donor recruitment.
f) Describe the techniques used for blood component preparation.
g) Explain the differences in preservation and storage of blood components
using different anticoagulants and preservatives.
h) Discuss the rationale of the testing performed on donor blood.
i) Evaluate outpatients for transfusion and therapeutic phlebotomy. Write
notes, orders as indicated.
j) Evaluate and follow all patients being treated with therapeutic apheresis.
k) Evaluate and follow all stem cell collections.

3. Transfusion Service
a) Clarify orders and/or consult with physicians concerning type and quantity
of blood components requested. The resident must not change or modify blood bank
policies and procedures without knowledge and prior consent of the Blood Bank Medical
Director. The blood bank procedure manuals and supervisory staff can be consulted for
guidance.
b) Review technical problems as they occur and consult with physicians as
needed.
c) Review all transfusion reactions and issue pathologists consultative report.
Review with pathologist before issuing report.
d) Describe basic procedures used for compatibility testing.
e) Discuss basic immunologic principles of compatibility testing.
f) Review all current antibody identifications on a daily basis

4. Management - Administrative
a) Attend and participate in blood bank administrative meetings.
b) Attend Transfusion Committee meeting.
c) Inspect blood bank utilizing AABB or CAP inspection form.
d) Review and evaluate new blood bank/donor center policies and/or
procedures
e) Describe procedures to assure confidentiality and informed consent.
f) Demonstrate a working knowledge of the organization and function of
regional blood centers.

5. Regulatory Issues
a) Attend and participate in any inspection or survey.
b) Be familiar with FDA, AABB, CAP and NY State requirements.

6. Didactic Sessions:

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 a) Review of instructive or complex cases
b) Discussion of assigned reading topics
c) Three to four afternoon sessions per week on: blood groups, transfusion
reactions, hemolytic disease of the newborn, pediatric and neonatal transfusion practice,
autoimmune hemolytic anemia, apheresis, solid organ transplantation, stem cell
transplantation and regulatory issues.

IV. REQUIRED TEXTBOOK

1. AABB Technical Manual
Other suggested references:
1. AABB Standards
2. Clinical Practice of Transfusion Medicine, Petz and Swisher
3. Principles of Transfusion Medicine, Rossi, Simon, Moss
4. AABB Blood Transfusion Therapy
5. Apheresis: Principles and Practice, B. McLeod, ed.

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Clinical Chemistry & Immunology
Jim Faix MD, Rao Mendu PhD

1. Goals & Objectives

Learn to interpret results for a variety of Clinical Chemistry & Immunology tests
including:
markers of myocardial damage and cardiovascular risk
tests used to diagnose common and uncommon endocrine disorders
tests important in management of critical illness
common markers of renal and liver function
serologic markers of autoimmune disorders and infectious diseases
therapeutic drug monitoring and toxicology

Become familiar with the wide variety of analytical principles used in Clinical Chemistry
& Immunology including spectrophotometry, electrochemistry, chromatography, mass
spectrometry and immunoassay

Understand how laboratory tests used in the diagnosis of diseases reflect the underlying
pathophysiology

For all important Chemistry & Immunology analytes, become familiar with:
common pre-analytic influences on test results
common uses in diagnosis of disease and/or monitoring of treatment

Be able to interact effectively with providers of direct patient care regarding

interpretation of laboratory results and selection of appropriate tests

Be able to interact effectively with clinical laboratory scientists regarding

laboratory technical problems

Understand different approaches to resolving human resource issues

Recognize important aspects of the administration of a clinical laboratory

Be capable of implementing a method, as indicated by understanding how to:

do a formal method evaluation
write a procedure
establish quality control policies and evaluate QC performance
evaluate proficiency testing results

2. Requirements of the rotation

The resident will meet with a director each weekday to review any major clinical issues,
and with a supervisor each weekday to review any major technical problems.

The resident will take first call (in place of director) for all clinical questions

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addressed to laboratory during each weekday.

The resident should cover all of the major topics in Clinical Chemistry and Clinical
Immunology. To assist the resident, each of these has a specific exercise:

Chemistry Methods & Instruments

Photometry
Electrochemistry
Chromatography & Mass Spectrometry
Immunochemistry & Immunoassay
Critical Care Chemistry
Osmolality & Body Fluids
Electrolytes
Blood Gas & Oximetry
Acid/Base
Glucose & Ketones
Endocrine Disorders
Diabetes Mellitus
Thyroid Disorders
Adrenal Disorders
Reproductive Disorders
Bone Disorders
Unusual Endocrine Disorders
Growth & Development
Pregnancy & Perinatal Testing
Proteins & Enzymes
Iron & Heme
Biochemical Genetics
Nutrition
Organ Injury & Dysfunction
Liver Disease
Renal Disease
Gastrointestinal Disorders
Cardiovascular Disease
Tumor Markers
Toxicology & TDM
Pharmacokinetics
Therapeutic Drug Monitoring
Immunosuppressive Drug Monitoring
Toxic Syndromes
Environmental Toxins
Immunologic Disorders
Innate Immunity & Cytokines
Serologic Diagnosis of Infectious Disease
Allergic Disorders
Autoimmune Disorders

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Chemistry of Myeloma & Lymphoma
Immunodeficiency Disorders

By the end of the rotation, the resident should be able to function as the medical director
(handle all medical and administrative issues, review quality control and proficiency test
results and plan the implementation of a new assay).

3. Learning resources
The primary learning resource is Henrys Clinical Diagnosis & Management by
Laboratory Methods 23nd Ed. This text should be supplemented by the resident in a
variety of ways, including more current journal articles.

4. Supervision & evaluation

During the rotation, the resident will meet daily with a medical director to discuss
problems encountered during the day, on-going issues or any of the topics outlined in the
schedule noted above. She or he should reserve some time for these review sessions.

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Genetics
KH Ramesh, R Naeem, Y Goldstein

CYTOGENETICS CURRICULUM FOR AP/CP RESIDENTS

WEEK 1: PRENATAL CYTOGENETICS

On day one of this 4-week schedule Residents are given a formal introduction by the
Director - K.H. Ramesh and/or Supervisor Mahnaz Zohouri to all the personnel and
briefed regarding policies and procedures that are in place in the Clinical Cytogenetics
laboratory located at 1635 Poplar Street, 2nd floor, Bronx, NY 10461. Residents are
given a list of reading material with special emphasis on certain chapters that they need to
familiarize during their rotation in Cytogenetics. They are advised that they need to
attempt the Cytogenetics 50 question Quiz during their 3rd or 4th week of rotation. They
are allowed a maximum of 3 attempts to obtain a minimum of a 70 per cent passing
grade. Microscopy is essential during the entire rotation. Residents are advised
regarding the abnormal cases that will be discussed at the monthly cytogenetics
laboratory meeting and encouraged to gather information and present one of these cases
on the 4th week of their rotation.

Formal discussion regarding introduction to clinical cytogenetics which includes history,

principles, methodologies and the International system of Human Chromosome
Nomenclature is given in Week 1. Special emphasis is placed upon pre-natal cytogenetics
during the resident's first week rotation. Residents are shown samples of normal
karyotypes. They are then encouraged to practice identifying GTG banded chromosomes
by preparing several karyotypes, first manually and then on the computerized image
analyzer. These karyotypes are checked on a daily basis by the supervisor or senior
personnel in the laboratory.

Introduction to amniotic fluid, chorionic villi sampling (CVS) and products of conception
(POC) accessioning using our LIS, culture, harvesting, and banding begins from day 2 of
Week 1. Senior cytogenetics personnel are involved in showing these techniques to
residents under the guidance of the lab supervisor. At the end of the week discussions are
held with the Director regarding reporting and their rotation during this week.

WEEK 2: PERINATAL CYTOGENETICS

Residents are briefed on peripheral blood cytogenetics by the supervisor and/or one of the
senior cytogenetics personnel. Special emphasis is placed upon the relevance of certain
common syndromes including micro-deletion syndromes. Residents are advised to
familiarize themselves, by reading pertinent chapters from the list of reading material. A
senior cytogenetic technologist will guide them through all the techniques involved in
setting up peripheral blood cultures, harvesting and GTG-banding procedures under the
guidance of the Director and/or supervisor. During this week residents are encouraged to
set up a culture of their own blood and the process to create a karyotype. Residents are
assisted in identifying chromosomes under the microscope during their 2nd week of

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rotation. At the end of the week, discussions are held with Dr. Ramesh regarding
interpretive reporting and progress of bench-work and microscopy skills.

WEEK 3: CANCER CYTOGENETICS

Introduction to cancer cytogenetics begins on day 1 of Week 3. The current International
system for Human Cytogenetic Nomenclature (ISCN) is touched upon. Several
important manuscripts and text books are given to the residents for extensive reading in
order to become familiar with characteristic chromosome abnormalities that are
associated with the diagnosis and prognosis of malignant diseases. Residents are advised
to select 2 abnormal interesting leukemic/lymphoma cases, and perform a literature
search to prepare these cases for presentation at the monthly Combined Flow
Cytometry/Cytogenetics conference that is held at the Moses division. Residents are
advised to correlate flow cytometry, and hematopathology results with cytogenetic
findings in leukemia/lymphoma cases. During the middle of this week residents are
advised to attempt the cytogenetics quiz for the first time.

A senior cytogenetics technologist will walk them through the techniques involved in
cancer cytogenetics, which includes culturing, harvesting and banding of bone marrow,
unstimulated peripheral blood and solid tumor specimens under the guidance of the
Director and/or supervisor. At the end of the week, discussions are held with Dr. Ramesh
regarding interpretive reporting, their performance in the cytogenetics quiz and technical
skills acquired in their rotation so far.

WEEK 4: MOLECULAR CYTOGENETICS (FISH & aCGH)

Dr. Ramesh and/or supervisor will introduce the residents to FISH and Microarray
techniques employed to detect Copy Number Variants (CNV), trisomies and monosomies
in all patient specimens and the use of repetitive and unique sequence probes to detect
and resolve complex chromosome anomalies in peripheral blood, bone marrow, and solid
tumor specimens. Reading material is given prior to Residents' observing and performing
the FISH/microarray techniques themselves. Two senior technologists will assist and
walk residents through all molecular cytogenetic techniques.

Residents are expected to perform FISH analysis by using at least one DNA probe on any
specimen of their choice, and report their findings after screening is completed. In
addition, the resident is expected to report one abnormal microarray result with FISH and
chromosome analyses of at least one interesting patient/patients cases.

Residents are expected to give a 45 min presentation on a Cytogenetics topic during this
week of their rotation. Residents are advised during this week to attempt the cytogenetics
quiz again, if required. At the end of the week, discussions are held with Dr. Ramesh
regarding interpretive reporting of FISH results, their performance in the cytogenetics
quiz and other skills acquired during their rotation. Dr. Ramesh will hold the final exit
conference which consists of a few questions to determine their level of competency once
the rotation is finished.

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LIST OF CLINICAL CYTOGENETICS READING MATERIAL (available in the
Cytogenetics lab)
1. An International System for Human Cytogenetic Nomenclature (ISCN): 2016, Eds, J
McGowan-Jordan, A Simmons, M Schmid. Karger Publication.

2. Cancer Cytogenetics. Chromosomal and Molecular Genetic Aberrations of Tumor

Cells. 1995, 2nd edition. S. Heim and F. Mitelman. Wiley-Liss.

3. Catalog of Chromosome Aberrations in Cancer. 1994, 5th edition, F. Mitelman,

Wiley-Liss.

4. The Chromosomes in Human Cancer and Leukemia. 1992, 2nd edition, Avery A
Sandberg, Elsevier.

5. Human Molecular Cytogenetics. 1999, 2nd edition , T. Strachan and AP. Read, Bios.

6. The Principles of Cytogenetics. 1999, S.L. Gersen and M.B. Keagle, Humana Press.

7. The AGT Cytogenetics Laboratory Manual. 1997, 3rd edition, M.J. Barch, T. Knutsen
and J.L. Spurbeck, Lippincott-Raven.

8. Recognizable Patterns of Human Malformation. 1997, 5th edition, K.L. Jones, W.B.
Saunders.

9. Genetic Disorders and the Fetus. 1998, 4th edition, A. Milunsky, Johns Hopkins
press.

10. Genetics in Medicine. 1999, 6th edition, M.W. Thompson, R.R. McInnes and H.F.
Willard, W.B. Saunders.

11. Chromosome abnormalities and Genetic Counseling. 2004, 3rd edition, R.J.M.
Gardner and G.R. Sutherland, Oxford press.

12. The Ultimate Fishing Guide: Sample preparation and Application protocols. 1996,
Oncor Inc.

13. Current Published manuscripts related to Prenatal, perinatal, cancer and Molecular
cytogenetics.

A dedicated computer is available in the laboratory, to the Residents for literature search
using the internet, and to prepare power point presentations.

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Hematology
L Wolgast, M Reyes, Y Fang

I. Introduction to Hematology (Didactic Session with Director)

A. Principles of quantitative hematology
1. Automation

B. Principles of Quality Control in Hematology

II. The Automated CBC and Differential (With Director and Lab Supervisor)
A. Learn how to calibrate QC and operate a CBC analyzer
B. Learn how to perform Quality Control of instruments
C. Learn how to interpret cytograms and histograms
D. Learn how to interpret and take action on "flagged specimens

III. Medical Microscopy (With Director and Clinical Staff)

A. Peripheral Blood Smears
1. Preparing a peripheral blood smear
2. Analyzing a normal blood smear-red cells, white cells, platelets
3. Analyzing abnormal smears referred from "flagged CBC specimens"
4. Preparing and interpreting a manual microscopic reticulocyte count
5. Analyzing "abnormal" slide collection

B. Body Fluids (With Director and Supervisor)

1. Cytocentrifuge preparations of CSF and other body fluids
2. Analysis of normals and abnormals from the lab
3. Analyzing abnormal slide collection

IV. Hemostasis (Didactics with Director; Hands on with Supervisors)

A. Routine Coagulation
1. Learn principles, performance and clinical utility of PT, APTT, Fibrinogen, FDP, D-
dimer

B. Special Coagulation (at Moses Division)

1. Learn principles and performance of coagulation factor assays
a. Learn how to diagnose acquired and hereditary factor deficiencies
2. Learn principles and performance of von Willebrand Factor work-ups
a. Learn how to diagnose, treat and monitor von Willebrand Disease
3. Learn principles and performance of Antithrombin III, Protein C, Protein S, APC
resistance and lupus anticoagulant testing.
a. Learn how to diagnose, treat and monitor hereditary thrombophilias and
acquired prothrombotic disorders.
4. Learn principles and performance of assays to monitor anticoagulants
C. Platelets
A. Learn principles and performance of platelet aggregation studies
a. Learn how to diagnose and treat platelet disorders

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B. Learn principles,performance and clinical utility of platelet function assays (e.g.
thromboelastograpgh)
5. Learn how to diagnose and treat coagulopathies (e.g. DIC, fibrinolysis)
VI. Special Hematology (With Director and Supervisor)
A. Learn principles and performance of hemoglobin analysis: HPLC and
electrophoresis
1. Learn how to diagnose and treat hemoglobinopathies and thalassemias
2. Learn how to diagnose and treat anemias
B. G6PD determinations
C. Immunofixation electrophoresis

VII. Recommended Text

Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd Edition

VIII. Resources
A. Private slide collection-blood and marrow
B. NYSDOH and CAP slides and Kodachromes.
C. Dr. Reyes ppt lectures

IX. Resident Responsibilities

A. Review and fulfill the portfolio requirements
B. Interpret all complex coagulation cases, including obtaining clinical information where
warranted and participate in consultations with primary care physicians
C. Review all unusual peripheral blood and body fluid smears
D. Interpret all unusual hemoglobin electrophoresis
E. Interpret all SPEP, UPEP, IFE studies
F. Review daily QC data
G. Perform initial consultation for questions from clinicians
H. Prepare and present an in-service for the laboratory technical staff and present it to the
3 shifts of the Moses Core Lab.
I. During the course of the rotation, each resident will define and undertake 2 projects:
one addressing an aspect of hematology/coagulation laboratory testing and a second
involving a practical aspect of laboratory improvement.
J. Each resident will prepare two PowerPoint presentations to be given to fellow
residents. These include an interesting case presentation and a journal club.
K. Each resident is responsible for preparing 5 interesting cases write-ups.

X. Conferences
-Hematology Grand Rounds (Fridays, 8:30am)
-Medical Hematology-Pathology Hematology joint conference
-Attendance at monthly staff meetings

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Hematopathology
Y Wang

Hematopathology is considered as a CP rotation for purposes of American Board of

Pathology eligibility. The full curriculum for the Hematopathology Rotation is available
on the Departmental website. It includes exposure to the major morphological
classification schemes of lymph node based diseases, such as non-Hodgkins and
Hodgkins lymphomas. Bone marrow biopsies are correlated with bone marrow and
peripheral blood smears in the majority of cases, when evaluating the leukemias, as well
as myelodysplastic and myeloproliferative disorders. Due to the nature of the diagnostic
work-up for these diseases, there is additional emphasis placed on immunologic features,
using flow cytometry and immunohistochemistry. Emphasis is also placed on molecular
pathology abnormalities using Southern blot analysis and polymerase chain reaction.
Teaching sets and a collection of original references are provided for study.

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Microbiology
M Levi, W. Szymczak

I. OVERVIEW:

The residents training in microbiology consist of a three month rotation in the

microbiology laboratory and its subunits plus one month of rounding with the Clinical
Infectious Disease Service. The residents are given intensive bench training and are
supervised for the entire three months by Drs. Levi and the Senior Microbiology
Supervisory staff. Supervisors and/or senior technologists provide much of the bench
training. Microbiology is in many ways analogous to tissue pathology. A high degree of
observational skills are needed. Residents are taught the basic elements as prescribed by
the ACGME regarding specimen collection and processing, examination of cultures,
identification of microorganisms and the clinical relevance of the organisms. They are
also taught antibiotic susceptibility testing and interpretation. The understanding and
interpretation of serologic assays, immunofluorescent assays, enzyme immunoassays and
molecular probes are also an integral part of their training. Clinical correlations of
microbiology are provided as much as possible during the bench rotation but is also
taught in other forms as will be delineated later. The residents practice based learning
and improvement competency is evaluated as residents progress through each rotation.
Their medical knowledge should increase in such a manner that allows them to
accumulate the scientific evidence and apply this knowledge to future rotations and their
consultations.

The broad based learning objectives of the rotation are as follows:

Learning enough of the technology at each workstation so that the testing procedures can
be analyzed and trouble shoot as is necessary.
Learn the inherent limitation of biologic test systems.
Build on the basic knowledge in items 1 and 2 which, when combined with clinical
knowledge will lead to the ability to do test interpretation and consultations.
Learn lab management skills and communication skills which will lead to a foundation
for the ability to direct a laboratory.

II. THE LEARNING OBJECTIVES TO FULFILL COMPETENCY REQUIREMENTS

CAN BE ACCOMPLISHED BY PARTICIPATION IN THE FOLLOWING:

The laboratory will organize these activities for the resident. The resident will receive a
copy of the curriculum, a three month schedule, a monthly evaluation form and a final
evaluation form at the beginning of the rotation. A one month sample rotation schedule
is provided at the end of the Microbiology information section.

Rotation through each workstation of the laboratory to learn the techniques performed on
the specimens analyzed at that workstation as outlined below. (MK)
Attendance at lectures given to each resident by the directors and senior supervisory staff
of the laboratory as outlined below. (MK)

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Performance of reading assignments in the text provided as directed by the directors.
(MK,SBP)
Reading of special topic files of papers as provided by the directors. (MK,SBP)
Independent reading as interest indicate. (MK,PBLI)
Attendance at clinical infectious disease rounds and other subspecialty rounds needing
microbiology input with the directors. (PC,SBP)
Attend infection control meeting with the directors. (MK,SBP,PC)
Give conferences on topics as directed by the director. (ICS,PROF)
Analyze unknowns provided to insure competence in test procedures. (MK,SBP,PBLI)
Trouble shoot problems and perform consultations with other clinical services. The
resident may receive guidance from the directors until they feel competent to answer
questions without supervision. (PROF,ICS)
Attend the Tuesday morning clinical pathology lecture series. (MK)
Attend and participate in the every other week Journal Club. (MK)
Attend and participate in the every other week interesting case conference. These are
often preceded by Board question type discussions. (MK,SBP,PROF)
Participate in laboratory QC and QA. (PBLI)

III. EVALUATIONS

Evaluations consist of both objective evaluations and subjective evaluations.

Analysis of Unknowns
The resident should get at least 80% of the specimens or analytes analyzed correctly
which are given to them during their rotation.
Objective Evaluations
The resident should take the microbiology standardized electronic exam (E-test)
composed of seventy multiple choice questions and images. The resident should get at
least 70% of the questions correct. The E-test is also administered at the beginning of the
rotation so that the acquisition of medical microbiology knowledge can be documented
by the end of the rotation.

Subjective Evaluation
During the three months rotation the faculty will give continuous feedback to each
resident regarding their performance. If at any time a residents performance is deemed
to be unsatisfactory and it is not corrected after communication with the residence the
residency training program director will be informed for further action.
The resident will receive a monthly evaluation in order to assess their progress toward
competency (Appendix 2).
The resident will receive an end of rotation evaluation in which it is expected that the
resident will have achieved competency in all areas and will be certified as successfully
completing a rotation (Appendix 3).

IV. RESOURCES

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 Please note that most major texts are purchased for the resident by from the
Microbiology education and research fund.

A desk will be provided in the residents room for each resident. A computer is available
and has internet access.
Books
Koneman, E.W., Allen, S.D., Janda, W.M., Schreckenberger, P.C. and Winn, W.C.
Color Atlas and Textbook of Diagnostic Microbiology, Sixth edition. J.B. Lippincott;
Philadelphia 2006 (A personal copy will be provided by the department for each resident
on service.)
Mandel, G.L., Bennett, J.E. and Dolin, R., Ed. Principles and Practices of Infectious
Diseases, Sixth edition. Churchill Livingston; New York 2005 (A Personal copy will be
provided by the department for each resident on service.)
Rose, N.R., DeMacorioe, C., et al Manual of Clinical Laboratory Immunology, sixth
edition. American Society for Microbiology; Washington D.C. 2002 (A personal copy
will be provided by the department for each resident on service.)
Murray, P.R. et. al., Manual of Clinical Micrrobiology, Ninth edition, 2007, ASM Press,
Washington, DC

Handbooks
ASM CumiTech series and handouts specific to the lectures or workstation.
CD ROM
Cookson, B.T., et al Gram Stain Tutor (Version 2). University of Washington, Seattle,
Washington. 1994
Ash, Wheel of Parasites
Koneman, E.W., Wheel of Bacteriology
Koneman, E.W., Wheel of Mycology
Control of Communicable Disease Manual, 1995. American Public Health Association.
Alphabetical compendium of all infectious diseases and their public health implications.
Mycology - Tutor
Parasite-Tutor, 1997. Fritsche, T.R., Eng, S.C., Curtis, J.D., et al University of
Washington. An interactive tutorial that teaches the morphological identification of
parasites.
Wheel of Parasites 1998. Zeibig, E. and Williams, D. Media Lab., Inc.
Principles and Practices of Infectious Diseases, Eds Mandell, G., Bennett, J.E. and
Douglas. Churchill Livingston International, New York 1995
Kodachrome Slide Collections
Ash, L.R. and Orihel, T.C., Human Parasitology Teaching Slide Set, ASCP Press,
Chicago, 1990
Chandler, F.W. and Watts, J.C. Pathologic Diagnosis of Fungal Infections. ASCP Press,
Chicago l987
Mims, C.A., et al, A Slide Atlas of Medical Microbiology, Mosby, 1993
Murray P.R., et al, Medical Microbiology, second edition, Mosby, St. Louis, l994
Personal Glass Slide Collections of Laboratory Directors and Supervisors
An Extensive Collection of Reference and Specialty Books From
Libraries of the Directors

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V. LECTURES
The following lectures are given one on one to each resident on service. The
lectures are extended to be in sync with the bench rotations.

1. Antimicrobial Susceptibility Testing: Critical Laboratory Aspects

2. Serologic Methods Used in Clinical Microbiology
3. Laboratory Diagnosis of Urinary Tract Infections
4. Blood Cultures: Techniques, Significance and Interpretations
5. Stool Cultures/Genital Cultures: Techniques, Significance and Interpretations
6. Respiratory Cultures: Techniques, Significance and Interpretations
7. Anaerobic Bacteriology: Techniques and Interpretations
8. Methods of Identification of Bacteria
9. Culture Media Used in Bacteriology
10. Mycology: In Vivo Appearance of Fungi
11. Mycobacteriology: Lab Identification and Diseases
12. Parasitology: Methods Life Cycles and Diseases
13. Mycology: Lab identification
14. Urine Cultures: What do they really mean?
15. Molecular Microbiology: Diagnostics
16. Basic Urinalysis

VI. MICROBIOLOGY LABORATORY BENCH ROTATION

This is the heart of the acquisition of Microbiology knowledge from which all
other levels of knowledge and competency spring. The Microbiology Laboratory is
divided into workstations. Specimens are analyzed at each workstation depending on the
specimen type. The resident will have a personalized schedule for the entire thirteen
week rotation in which they will be assigned to workstations for time frames as indicated
below.

At each workstation the focus of the resident should be to observe and learn, then to
perform hands on analysis of specimens and when appropriate to teach. the resident
should focus on the following:
The major clinical syndromes represented by the specimens at that workstation.
Proper specimen collection and processing.
The analytical procedures performed (i.e. identify, quantitate and susceptibility test the
bacteria).
Develop skills at reading and interpreting Gram and other special stains. The
interpretation of microbiologic stains is a learned art (as are surgical pathology stains)
and is a highly important competency to develop.
Develop the skill necessary to interpret the test results of the specimens from each
clinical syndrome.
Learn the therapeutics of each clinical syndrome and the influence of the test results on
the therapeutics.

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The workstation assignment and approximate length of time at each workstation are as
follows:
Intake of specimens, specimen processing and selection and basic laboratory information
system skills - 1 week.
Bacteriology/Blood Cultures - 1 week
Stool and Genital Cultures - 1 week
Wound cultures/Anaerobic Microbiology - 1 week
Respiratory Cultures - 1 week
Urine Cultures - 1 week
Anaerobic Bacteriology - 1 week
Serologic diagnosis of infectious disease and special antibiotic susceptibility testing - 1
week
Parasitology - 1 week
Mycology -1 week
Urinalysis -1 week
Mycobacteriology -1 week
Identification of unknowns/review/special topics -1 week

VII. DUTIES OF THE RESIDENT ON SERVICE

The major duty of the resident is to learn and develop competency. The
department is committed to intensive training of residents and fellows. Directors,
supervisors and senior technologists will devote much time to the teaching of the
residents. As the resident learns, increasing amounts of responsibility will be granted to
the resident. Specific duties of the residents are as follows:

Participate with the directors in the 24 hour on call schedule.

Investigate the QNS status of any critical specimens (i.e., CSF) with the submitting
physician to determine appropriate tests.
Investigate unusual laboratory findings by chart review and consultation with the
physician submitting the specimens.
Act as the Microbiology consultant to the anatomic pathology division, specifically in
the area of the acquisition and processing of the appropriate specimens at time of
autopsy.
Participate in the quality control and quality assurance efforts.
Participate with the directors in efforts to control the appropriate ordering and utilization
of tests.
Review special test request and send outs for appropriateness.
Participate in the continuing educational efforts of the laboratory by presenting
conferences as directed.
Review unusual test results before release of the information from the laboratory.
Attend appropriate administrative meetings with the directors and participate in
management and budgetary decisions.
Learn a lot and have fun. Its a good rotation in an exciting area of clinical pathology.

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VIII. RESEARCH ACTIVITIES
The resident will be encouraged to participate in research efforts of the division.
These efforts may be in the area of test development and evaluation or in collaboration
with other faculty in Pathology or on other services as approved by the director.

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Hybrid AP/CP Rotations

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Solid Organ Transplantation
M Lin, J Pullman

This is a rotation offered at the Moses Division which is split between Surgical Pathology
and the HLA/tissue typing laboratory. Residents are expected to work-up cases showing
transplantation associated histology including kidney, liver and heart specimens.
Montefiore Medical Center has an active solid organ transplantation service and residents
may also have the opportunity to gross explanted organs and to be exposed to histology
of diseases requiring transplantation.

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In-House Elective Rotations

The purpose of Electives in our residency program is to allow individual residents the
opportunities to explore a field that is not a required aspect of the curriculum. In order to
optimize a residents experience during an Elective period, it is important that Electives
be chosen well in advance of starting the Elective so that the sponsoring faculty members
of Divisions are prepared to integrate the resident into the service and plan the
individuals experience.

Therefore, in order to meet requirements and optimize the experience it is necessary we

have a formal Elective Policy and that residents comply with the below instructions.

1. Residents must indicate their Electives before the start of each residency year.
2. Electives must be chosen from the Resident Manual posted on the resident web
site.
3. We recognize that your elective preferences may occasionally change during the
year and you will be able to make your own alternate plans up to 8* weeks before
the start of the scheduled block. You will be responsible for notifying the Chief
Residents & Education Leadership of these changes. Changes within 8* weeks of
the start date will be considered on a case by case basis.
4. Electives outside of this institution (including international Electives) require a
separate approval process and additional time and planning. Dean Skae in the
Office of GME must approve off-site Electives and ensure at least 2-3 months of
planning. Please see specific Away Elective Policy for additional details
(Addendum D)

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Biopsy Hot Seat Elective
K Whitney, J Pullman

Senior residents in this elective will have the opportunity to sign out biopsy material
daily, and thus have the experience of seeing many types of specimens while honing
organizational skills and diagnostic skills. The residents are expected to have worked up
all cases including ordering of special stains, levels by the time they sit with the
attendings later the same day. Residents will become more aware of the idea of turn
around time the role of pathology interacting quickly with clinicians.

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GI/Liver Pathology
K Tanaka

The Department currently receives a mix of adult and pediatric biopsies and complex
surgical specimens, including liver transplant. There are approximately 16,500 GI
biopsies; 545 liver biopsies, 220 GI resections and 30 liver resections/explants. The
residents responsibilities include slide review and preparation of reports of selected
cases, presenting at interdepartmental conferences and tumor boards. The rotation will be
split between Moses and Weiler campuses. At the end of the rotation, the resident do a
presentation on an interesting case or specific topic that will be selected in conjunction
with one of the members of the GI/Liver team. PGY-2 and above residents have the
opportunity to rotate with the GI service on day 5 of the sign out cycle. This block is also
available as an elective.

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Gynecologic Pathology
K Whitney

The Weiler Division of Surgical Pathology has particularly rich resources in the field of
Gynecologic Pathology. The elective allows the resident to explore cases in greater
depth, by securing appropriate literature and reviewing similar or related lesions.
Residents on elective participate in the work-up and sign-out of gynecologic cases,
including outside consultation cases. Residents will participate in the weekly multi-
disciplinary gyn-oncology tumor board and interactive conferences involving medical
students and residents from within and outside the Department of Pathology.

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Neuropathology
K Weidenheim

An elective rotation in Neuropathology is offered to residents.. This elective will explore

surgical neuropathology in depth using cases from our active neurosurgical and
neuromuscular services. Residents are expected to take an active role in planning and
presenting clinicopathological conferences and planning, preparing and presenting
didactic conferences. A two-year fellowship is also offered.

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Orthopedic Pathology
E Villanueva

An elective rotation in Orthopedic Pathology is offered to to residents. The resident is

given the opportunity to review surgical pathology material related to bone and joint
disorders from the Moses Division and other affiliated hospitals, as well as those referred
to Dr. Dorfman from other centers. Emphasis is placed on clinicopathologic and
radiologic correlation in patients with orthopedic and rheumatologic disorders. Close
working relationships with radiologic imaging facilities and the Department of
Orthopedic Surgery facilitate this process. A large computerized collection of study
cases is utilized in an organized teaching program, which includes periods of independent
study. Cases sent for consultation are reviewed with the Orthopedic Pathology Fellow
and Dr. Dorfman. Residents are encouraged to complete an assigned project and assist in
the preparation of teaching material.

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Pediatric Pathology
M Ewart

Residents will be reviewing and signing out a wide mixture of pediatric pathology and
will have the opportunity to participate several interdepartmental pediatric diagnostic
conferences. Creation of a teaching set of interesting pediatric cases will be part of the
curriculum on this service. At the end of the elective, the resident will present an
interesting case to the residents and staff.

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Perinatal Pathology
S Reznik

Residents are introduced to this service during their first year, during autopsy rotations
that require performance of fetal/neonatal autopsies. Those taking this elective provide
supervision to first year residents on the autopsy service and coordinate the development
of clinicopathologic correlation, by appropriate study of fetus/neonate, placenta, and
laboratory records. Emphasis is placed on acquiring an understanding of central
principles in dysmorphology and congenital malformations, normal placental anatomy
(including structure-function correlations), maternal fetal medicine, and neonatal
intensive care management. Residents are encouraged to attend and present at clinical
conferences with physicians from a variety of clinical services.

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Renal Pathology
J Pullman

A large number of renal biopsies are processed each year from MMC affiliated hospitals.
Residents will be involved in the light, immunofluorescence, and electron microscopic
study of each biopsy, as well as the processing of each specimen, and sign-out of the
cases. In addition, teaching sets, archival material, and appropriate literature are
available for resident review. The resident will be encouraged to present the pathology
section of a conference in the Department of Nephrology.

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Surgical Pathology Sign-Out Elective
J Pullman, K Whitney

The surgical pathology sign-out elective allows a senior resident to function, with
supervision, as a Junior Attending. He/she will teach rotating residents and medical
students, give departmental and interdepartmental conferences, and sign-out autopsy and
surgical cases under the supervision of an attending pathologist. A pre-requisite for this
elective is the consent of the faculty instructor.

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Ultrastructural Pathology
K Weidenheim

The goal is that a resident assume responsibility for all clinical specimens that are
received, which usually includes 10 renal biopsies, 5 surgical specimens, muscle and
nerve biopsies, as well as unusual findings from autopsy cases. Residents are instructed
in the processing of EM specimens, including embedding and staining. The resident
reviews sections with the attending, examines the specimen under the electron
microscope, and photographs the pertinent EM morphology. He/she then participates in
the writing of a report from each case, which is finalized by the attending. The
ultrastructural facility has an extensive teaching collection, which residents review during
the course of the rotation. The resident will organize and run the monthly EM
conference, at which interesting cases and pertinent literature are presented to the
Department of Pathology.

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Away Elective Rotations

Residents may desire to take an elective rotation at an outside institution within the
United States or abroad. Such away electives should have as its primary goal an
educational focus that cannot be obtained at Montefiore Medical Center. During the
elective rotations, Montefiore Medical Center will continue to pay the residents salary,
benefits, and malpractice insurance as currently provided. Malpractice coverage is not
provided for rotations outside the United States. All other associated expenses (housing,
meals, travel, etc.) will be the responsibility of the resident.

Requirements and Process:

1. All forms must be completed and signed/approved by the applicants Program

Director and the Associate Dean for Graduate Medical Education and DIO. All
requests must be received by the GME Office at least 60 days before the
beginning of the rotation to be considered for approval.

2. The preceptor at the outside elective site must provide a letter agreeing to accept
the resident for the time period requested, agreeing to the stated goals and
objectives of the rotation, and agreeing to complete an evaluation of the residents
performance during the rotation and to send this evaluation to the residents
Program Director.

3. No more than one elective away month may be taken per resident during their
training period. Exceptions may be granted by the DIO.

4. Elective rotations to countries either on the U.S. Departments Travel Warning

list http://travel.state.gov/travel/cis_pa_tw/tw?tw_1764.html or those with U.S.
Treasury OFAC restrictions will not be permitted.

For further information please review Addendum C

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Addendum A

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Addendum B

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Addendum C

Pathology Travel Reimbursement Policy

Process for Submitting

The employees direct report (manager, supervisor, etc.) must approve the
Employee Reimbursement request form. The following signatures are
required: Employee signature;

Program Director; Directors from Administration. A stamped imprint of an

authorized signature is not acceptable.

Supporting Documentation

1. An original receipt and an adequate explanation of the Medical

Centers business purpose must support all expenses. To facilitate
processing of the reimbursement, the receipts must be arranged by
date and all original receipts smaller in size that of this page must be
scotch taped to a blank page of this size. Only one side of each page
should be used.
2. In those cases where the employees proof of payment is a check, as
opposed to an original credit card receipt of e-receipt, the original
cancel check or Internal Bank cashed check image is the required
supporting documentation together with the invoice or equivalent
documentation.
3. Any incomplete forms those lacking receipts, approvals, explanation
of business purpose or other documentation will be returned, thus
delaying reimbursement.
4. The Program Director and Residency Training Administrator must
review each expense report submission to determine that the proper
expense code is being charged and must maintain a log to prevent
duplicate submissions.
5. All checks for reimbursement will be mailed directly to the employees
home. The Accounts Payable Department will process and mail out
checks within 14 days of receipt providing all documentation, approvals
and related explanations are properly completed.

Meals and Entertainment:

Reimbursement of actual meal expenses, including gratuities, will require submission of
the original receipt. The expenses must be reasonable and in compliance with the
guidelines set in each department.
Meals: Reimbursement for meals will be on a $86.00 per diem basis consisting of the

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following:
Breakfast - $12.00; Lunch - $24.00; Dinner - $50.00.

Expenditures for liquor, entertainment, dry cleaning or valet service will not be approved
for reimbursement. Such expenses are properly the responsibility of the employee.
Entertainment expenses beyond that of meals must be essential to the transaction of the
business. Documentation of reimbursable entertainment expenses must include the
following:
Names, dates, places of entertainment, and acceptable business purpose.

Poster & Slide Preparations

You are expected to get your supplies and presentation materials done in a cost efficient
manner. This should be done In House through Barry Mordin where our costs are the
cheapest or via competitive internet poster production companies (many prepare posters
for about $150).

Transportation Arrangements

1. If applicable, MMC associate must complete the Travel Request Voucher

form. The form must be approved in accordance with Medical Center
policy. In the case of research or sponsored funds, prior approval of
Research Administration is required.

2. Automobile Rental: Automobile rental must have the prior approval of the
Department Chairman. Use of rented automobile for travel within the New
York Metropolitan area is prohibited.

Compact or "intermediate" cars should be specified (Cavalier, Corolla,

Escort, Neon, etc.) which will result in a substantially lower rate. "Collision
Damage Waiver Insurance" should be obtained, the cost of which is fully
reimbursable.

3. Airline Travel: Employees should use regularly scheduled coach or

super-saver airfares. First-class fares may not be used except in instances
where coach or super-saver fares are not available or practical; first-class
fares must be specifically approved by the Director of Finance. Travel by
public conveyance (subway, bus, taxi, car service, etc.) will be
reimbursable in connection with such authorized travel.

Standby Procedure: If you bought a non-refundable ticket and missed

the flight, as long as you dont change the day or carrier, you can still
travel on standby without incurring a charge fee.

4. Airport Transfer vs. Taxi Fares: Transfers to and from the airport are to
be by bus, train, car service or other common carrier when available.
Once at the destination, taxis are allowed between a lodging and

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 meeting/conference site. You must keep all original receipts in order to be
reimbursed for the expense.

5. Procedure for Non-Airline Travel: Reimbursement for cost incurred for

trains, buses, or your own vehicle, parking and tolls will be reimbursed by
MMC when the expense incurred was on approved medical center
business. All expenses (except car mileage) must be substantiated with
original receipts in order to be reimbursed.

6. Procedure for Car Rental: You should contact one of the approved travel
agencies to reserve a rental car for the discount rate after you have
received department approval for the car rental. The travel agency mid-
size or small cars are available for one or two travelers; full size cars are
available for three or more people.

Gas tank refills required before returning cars. You must have a personal
credit card available for car rental. All expenses must be substantiated
with original receipts in order to be reimbursed. Unauthorized rentals will
not be approved for reimbursements. This approval is controlled by the
department administration. The mileage will be reimbursed
based on the approved MMC rate. For mileage reimbursement, the
employee must indicate the destination of travel and the total miles
claimed multiplied by the Medical Center approved mileage rate.
Reimbursement will be at the rate of 50.0 cents per mile, plus tolls and
parking.

Procedure of Lodging

Hotel reservations can be made through the authorized travel agencies

and reserved either a 6pm hold or guaranteed for late arrival basis. You
must use your personal credit card for lodging expenses. Lodging
expenses are reimbursed on an actual, reasonable cost basis. All lodging
expenses must be substantiated with original receipts in order to be
reimbursed. Cancellation Fees: It is the travelers responsibility to cancel
guaranteed hotel reservations. Any cancellation charges arising from the
failure to cancel reservations is the responsibility of the associate. To
protect yourself from unnecessary cancellation fees, always ask for the
cancellation policy at time of reservation and, if you do cancel, request a
cancellation number and associate name at time of cancellation.

Reimbursement will not be made for hotel accommodations to employees

attending or participating in local seminars (defined as less than 50 miles
away from the individuals home). The expenses of an associates spouse,

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 family member or travel partner are not reimbursable. If for example, a
double room occupied, only the single room rate will be allowed.
Insurance

Insurance is provided by MMC, at no cost to the traveler, by means of

blanket institutional travel insurance coverage. This policy covers
employees who travel on official MMC business trips that originate from
home or MMC.
Foreign Travel Reimbursement

Reimbursement for foreign travel should clearly show the exchange rate
used to convert the foreign dollars to U.S. dollars. Adequate support for
the exchange rate would include a copy of an exchange receipt from a
currency exchange center, the credit card statement, a copy of recent
exchange rates published in a newspaper.

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Addendum D

POLICY ON EXTERNAL ELECTIVE ROTATIONS AWAY ELECTIVES POLICY

This External Elective Rotation or Away policy is to set up a mechanism to guide

Programs and Residents in a process for away educational rotations outside
Montefiore Medical Center and affiliated hospitals/clinical sites. By providing
appropriate oversight, Resident participation in away electives may provide educational
experiences that may not be available in the current Residency programs curriculum.
This policy does not apply to ACGME required rotations that are not offered by the
training program.

DEFINITIONS AND LIMITATIONS

a. An External Elective Rotation or Away elective is defined as educational time

away from the Montefiore Medical Center Department of Pathology Residency
training program.

b. All away elective rotation applications must have initial approval by Education
Leadership and by the Designated Institutional Official (DIO) at least six months
(6) months in advance of the start of the elective.

c. Final approval must be granted by the Education Leadership and the Designated
Institutional Officer (DIO) at least three (3) months in advance.

MINIMUM REQUIREMENTS FOR PROGRAM POLICIES

Program shall set minimum requirements for their Residents Externship eligibility
status. At a minimum, though, each Programs policy shall address and include the
following:

a. The Resident/Fellow must be in good academic standing to be eligible for

applying for an externship.
b. Guidelines for determining if the externship will have educational value, be of
superior educational quality and verification that of the electives written Goals
and Objectives that meet RRC/ACGME Core competencies.
c. Process for obtaining a Program Letter of Agreement (PLA) with the receiving
Program/Institution if one has not been previously completed.
d. Process for verifying that the receiving institution will accept responsibility for
Resident training, supervision, evaluation and staying within ACGME and RRC
guidelines on work duty.

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 e. Process to determine if medical malpractice insurance will be provided by
Montefiore Medical Center or assumed by the accepting institution.
f. Process to determine whether the Resident will paid during the away elective by
the Residency Program or the receiving institution.
g. Process for determining Resident is aware that trip and away elective related
expenses, including but not limited travel, lodging, and meals will it be the
responsibility of the Resident or the receiving institution.
h. Consideration for any core educational sessions missed. Will the Resident/Fellow
be required to make up the sessions and how.
i. Statement that application has final approval by the Education Leadership and
the DIO must be given at least three (3) months in advance of the start of the
Externship.
j. Limitation that away elective rotations may not exceed one month in length.

PROCEDURE

Residents who wish to obtain a specific education experience outside of Montefiore

Medical Center or the programs standard list of off-site electives are required to meet
with the Program Director to provide the following:

a. Demonstration that the proposed rotation will provide professional experience

important for the Residents education;
b. Demonstration that the experience cannot be obtained at Montefiore Medical
Center or one of its affiliates;
c. Demonstration that the experience will be appropriately supervised by faculty at
the site; and,
d. Determination of whether the Resident will remain on the Programs payroll and
receive normal benefits during the approved away elective or will be paid by the
receiving institution.

After successfully demonstration of the above requirements and its subsections are
met, the Resident must obtain initial approval of the application by the Education
Leadership and DIO at least six months (6) prior to the start of the requested elective.
Once the initial application has been approved by the Program Director and the DIO, the
Resident must submit the following material to be reviewed and approved by the
Education Leadership and the DIO:

a. A CV of the preceptor for the elective which must include at a minimum, the
name, address and telephone number of the preceptor who will oversee the
Residents away elective experience. The preceptor must be board-certified.

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 b. Written goals and objectives of the elective experience provided by the
preceptor.
c. Documentation of medical liability insurance and compliance with the states
licensing requirements, if applicable.
d. An acknowledgment by the elective preceptor, in writing, at least ninety days in
advance of the elective that he/she approves the Residents request to spend
elective time at their facility.
e. Will provide the opportunity for the Resident to achieve the goals and objective
of the elective experience as written and that they comply with the ACGME
competencies.
f. Provides assurance that the elective is compatible with the residency training
requirements of the appropriate RRC.
g. Any and all arrangements associated with the away elective are the sole
responsibility of the Resident, including travel, food and lodging, obtaining
approval from the appropriate program, and, if necessary, obtaining medical
liability insurance and an out-of state temporary medical license.
h. The approving program prepares a Program Letter of Agreement (PLA) and
submits it to the Office of Graduate Medical Education for approval and
processing.
i. Final elective approval must be obtained by the Education Leadership and the
DIO at least three (3) months in advance.

RIGHT TO CANCEL

The Program Director upon consultation with the DIO reserves the right to cancel or
suspend the elective application process at any time during the application process,
review of supplemental material or during the elective. Any costs obtained by the
Resident up to that point would not be reimbursable. The decision of the DIO is final.

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 MONTEFIORE MEDICAL CENTER (MMC)
PATHOLOGY RESIDENCY PROGRAM

TAXI POLICY (UPDATED 9/26/16)

The taxi policy of the Pathology Department from MMC is designed to facilitate transportation
between our three hospitals/campuses when free shuttle service is not available, and to ensure
the safety of our residents.

Currently, AECOM operates free shuttle service between Moses and Weiler on weekdays from
6:00 am through 8:00 pm and between Moses and Wakefield from 6:30 am through 6:50 pm.
There is an additional shuttle service between Waldo Avenue Housing and Moses which
operates during the morning and evening hours during the week.

Taxi fare will be reimbursed for transportation between Moses/ Weiler/Wakefield/Waldo only
for those times that the shuttle is not in service. For residents who do not live in or near Monte
or Waldo housing, taxi reimbursement will be honored for travel to the nearest subway station
during late/off hours (see list).

Acceptable destinations for taxi fare reimbursement:

1) Moses Campus
2) Weiler Campus
3) Wakefield Campus
4) Waldo Avenue Housing
5) Westchester Square subway station (6) from Weiler
6) Pelham Parkway subway station (5) from Weiler
7) Mosholu Pkwy subway station (4) from Moses
8) Norwood-205th Street subway station (D) from Moses
9) 233rd Street subway station (2, 5) from Wakefield

Taxi service to transport residents to personal destinations is not reimbursable.

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MODIFICATIONS IMPLEMENTATION July 1, 2016

Date: Description of Modification: Modified by:

07-10-2016 Reyes Gil changes to Hematology rotation description JDF
09-06-2016 KH Ramesh changes to Cytogenetics rotation description JDF
09-20-2016 Addition of resident travel/conference reimbursement ZL
09-29-2016 Creation of separate resident expenses section JDF
10-19-2016 Addition of taxi policy ZL

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