How UW’s program is unique
We have a clinical pathology “Core Rotation” in which 2-3 residents at a time rotate through many of the UW clinical laboratories over the course of an 8-week period. Each resident rotates through CP Core 3 times during their residency for 24 weeks total.
Residents on CP Core gain experience in the areas of chemistry, toxicology, laboratory management, informatics, immunology, molecular diagnostics, cytogenetics, special coagulation, and some “wet” hematology. The goal of this unique experience is to couple bench-side teaching of procedures and laboratory techniques with an emphasis on case-based learning with faculty, through didactic sessions, participation in sign-out and interpretation of laboratory tests (e.g. SPEP reports, clinical consultations, test approvals, etc), and involvement in real-world laboratory management issues.
Due to the more acute and unpredictable nature of consultations in Transfusion Medicine and Microbiology, these two services each have their own standalone rotations. In addition to 6 blocks of CP Core and 3 blocks each of Transfusion Medicine and Microbiology over the course of training, residents also spend 3 blocks in hematopathology at UW and 3 blocks at St. Mary’s hospital, a private hospital in Madison, where they have a great deal of independence dealing with hematology and other laboratory issues as well as experience in a private practice setting. We have also recently designed a novel graduated responsibility block for senior residents known as the “CP Leadership” rotation.
Why the change?
Before we had this CP Core rotation, we found that dividing up the clinical laboratory entirely into narrowly focused 1 month rotations worked well for some areas but in other areas sometimes resulted in limited and widely separated exposure to high-impact learning opportunities with too much emphasis on learning the technologists’ jobs in order to fill the time rather than that of the attending laboratory director. Further, the lack of repeated exposure throughout residency to these high-impact experiences sometimes resulted in even senior residents feeling like beginners when they would return to a rotation that they hadn’t experienced for 1-3 years. Thus, combining some services into one rotation allows for more repetition and greater density of high-yield learning opportunities.
Lastly, one of the deficiencies noted across the country in newly graduated pathology residents is their lack of exposure to, and understanding of, laboratory management issues that they are expected to take on early in their first jobs. These include personnel management, QA/QC/QI, understanding the elements involved in bringing a new test online in the laboratory, or purchasing a major piece of equipment, to name a few. Our revised edition of the clinical pathology curriculum includes particular attention to the management aspect of laboratory medicine via both clinical responsibilities, real world projects, and adjunct learning modules. Finally, the 8-week duration of each CP Core block also allows for more realistic chances of completing QA and other projects during the rotation.
In sum, the big picture goal is to provide our residents with enough depth of hands-on experience to “try out” each clinical pathology subspecialty in earnest for possible career specialization and enough variety of experience to be prepared for general pathology private practice.