Goals and Objectives of the Surgical Pathology Fellowship Program


The Fellowship in Surgical Pathology at the Columbia University Medical Center is a unique program which bridges the gap between senior residency and attending status. During the one year program, the successful candidate will hone his or her diagnostic skills by being exposed to a large volume of cases ranging from routine and commonplace to complicated and unusual. While sharpening his diagnostic skills, the Fellow will also acquire the confidence and judgment necessary to be an outstanding diagnostic pathologist.

In order for the program to achieve these goals, the Fellow must be able to work independently. Therefore, the Fellow will be appointed to Columbia University as an Instructor, and to the New York Presbyterian Hospital as an Assistant Attending Pathologist. This latter appointment requires a New York State License. Therefore, the fellow must hold a valid New York State License and must be board eligible or board certified in anatomic pathology.

The program is under the supervision of Dr. Kathleen O’Toole who is the Director of Surgical Pathology. The Fellows also work directly with the entire attending staff in Surgical Pathology.

The traineeship provides graduated responsibility in all areas of diagnostic surgical pathology. In the earlier part of the year, the emphasis is on frozen section diagnosis. The emphasis toward the latter half of the year is on the sign out of biopsy and non-biopsy material. The number of cases is gradually increased so that by the end of the academic year, the successful Fellow is handling a sign out load comparable to that of a full time attending pathologist.

Our academic year is divided into thirteen four week blocks. During the first several blocks, each fellow will cover frozen sections two days a week. The Fellows will have the authority to render frozen section diagnoses on their own. However, they will be expected to show any case in which they are not one hundred percent sure of their interpretation to an attending pathologist. All the attending pathologists are aware that they will be asked for help, and encourage the Fellows to call upon them in any situation in which a Fellow feels uncomfortable.

Beginning in the second block, the Fellows will be assigned limited numbers of cases. These are assigned randomly by the accessioning staff. Initially, the workload will include three or four biopsy cases per day. Over time, the number of cases will increase, and will include a limited number of non-biopsy cases including simple cases and complicated resections. By the mid point of the year, the Fellows will occupy a formal position on the sign out schedule, and will sign out a load comparable to half an attending load. This will be repeated several more times in the second half of the year such that by June, the Fellow will be handling a full workload.

The Fellows will be seeing the entire spectrum of material that is processed in the Division of Surgical Pathology. As with the frozen section responsibility, the Fellows will be expected to review their slides independently, dictate their own reports, and sign them out electronically. They will be encouraged to consult with one or more attending pathologists on any case about which they feel uncertain.

During the first few weeks of the fellowship, each fellow will be trained by a divisional administrator. This training will include the mechanics of using the attending module of the Co-Path system, as well as principles of CPT and ICD-9 coding.

The Fellows will also have a limited amount of teaching responsibility. They will be expected to be available in the gross room to help junior residents, particularly first year residents. They will also be available to preview slides with junior residents. Depending on staffing needs, they may be asked to participate in the laboratory sections for second year medical students enrolled in the systematic pathology course.

The Fellows will be expected to participate on a regular basis in the daily attending QA conference held at 12:30 in the multi-headed microscope room. This conference is an important learning experience. It gives the Fellows an opportunity to see how differences of opinion among pathologists are dealt with. It also provides an efficient way for the Fellow to get multiple consensus opinions on his own cases. Finally, it provides an opportunity for the Fellow to see large volumes of what are usually interesting and difficult cases.

The Fellows are also expected to participate in the surgical pathology case conferences, held Wednesday and Friday morning from 8:30-9:30. They are encouraged to present their own cases. In addition to providing case material for the conference audience, these presentations also allow the Fellow to gain skills that will be needed throughout one’s career, i.e. presenting cases to other physicians.

Fellows may be asked to present cases to other departments. They will also be encouraged to attend, or present at, our regularly scheduled interdepartmental conferences (for example, Urology, Thoracic, Pediatric, etc.).

The Fellows will be evaluated in several ways. Throughout the year, the attending staff will meet and discuss the Fellow’s performance. In addition, the director often gets feedback from clinicians in other department who have interacted in some way with the Fellows.

A high percentage of the Fellow’s reports are reviewed by our departmental compliance officer. The purpose of this review is to check the accuracy of the coding, particularly the CPT (billing) codes.

Finally, the Fellows will be evaluated on the same QA parameters as is the attending staff. These parameters include accuracy of frozen section diagnoses, turnaround time of frozen sections, turnaround time of cases, changes in diagnosis, and number of cases signed out.

The Fellows are encouraged to get involved in a research project. This is more easily doable in the first half of the year, when the Fellows have limited scheduled responsibilities. These research projects could be independent, or could be in collaboration with another attending.

The Fellows are entitled to four weeks paid vacation. The director should be informed at least one month in advance of any planned vacation.

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