Staff: Stephen P. Naber, MD, PhD (Chief); Elizabeth M. Genega, MD (Medical Director); Masha Bilic, MD; Knarik Arkun, MD; Yvelisse Suarez, MD; Arthur S. Tischler, MD; Barbara J. Weinstein, MD.
Surgical Pathology: After an introductory period, each resident is assigned to a two- to six-week rotation in surgical pathology with intervening periods of autopsy pathology. During this rotation, the resident has responsibilities for the examination and description of the surgical specimens and the selection of appropriate tissue for microscopic examination. In addition the resident participates in operating room consultation, including the preparation and interpretation of frozen sections.
The resident will choose the appropriate histological sections for microscopic examination and subsequently, prepare a preliminary anatomic diagnosis in each case. The entire case, including all slides and special studies, are then reviewed with the staff pathologist in a combined teaching and diagnostic procedure; All diagnostic problems and/or cases of unusual interest are presented and reviewed by all of the staff. In addition, during this assignment, the resident reviews, with the staff, all of the referral (consult) cases submitted to the department.
All anatomic pathology activities are carried out in a facility which was specially designed and constructed to minimize risks of infection and exposure to harmful vapors.
Autopsy Pathology: Residents perform autopsies in all years of the combined program as well as by those in the straight anatomic pathology program. Most autopsies are performed during the first two years, but residents maintain their skills by performing occasional autopsies during the later years of the program. Especially close supervision and assistance are provided during the first several autopsies that a resident performs, but assistance and consultation are always available.
Before beginning an autopsy, the resident carefully reviews the clinical record and then consults with appropriate clinicians as well as the assigned staff pathologist. On the day following the dissection, the organs are reviewed with the staff pathologist. A provisional anatomic diagnosis is prepared and tissue blocks are selected for microscopic examination. The resident receives the microscopic sections within a few days after submission to the Histology Laboratory, studies them, writes a preliminary microscopic description and orders special stains and studies as indicated. The case is then reviewed with the staff pathologist, and a final anatomic diagnosis is written.
Each autopsy is the subject of a full hour presentation at an autopsy conference at which the clinical, radiographic, laboratory, gross and microscopic findings are correlated. Fixed samples of the gross organs are examined and all pertinent microscopic sections are examined by all participants using a multi-headed microscope. The conference is attended by the appropriate staff pathologist(s) and all the residents.
While on autopsy and surgical service, the residents participate in a variety of morphologic techniques including routine histology and special histochemistry, immunohistochemistry, immunofluorescence, morphometrics and transmission electron microscopy. The trainees are expected to become familiar with the technical procedures as well as their limitations and interpretation. These rotations include both theoretical and practical experience based on current diagnostic care material available in the department.
Conferences: Many conferences and didactic sessions provide an opportunity for the study and discussion of all interesting surgical pathology and gross and microscopic autopsy pathology. These conferences and didactic sessions include:
- Surgical Pathology Conference: Once per week
- Anatomic Pathology Didactic Conferences: Two per week
- CP Case Conference: Once per week
- Autopsy Conference: Once per week
Thin Needle Biopsy: The thin needle biopsy service is a rotation in anatomic pathology in which staff and residents consult with clinicians and begin the diagnostic process by assisting with biopsy aspiration, preparation of smears, interpretation and reporting results. Each resident is expected to become competent in aspiration biopsy, slide preparation, staining, and in interpretation during the course of this rotation.
Cytology: Included in the program is an integrated experience in the cytology laboratory at Tufts Medical Center. The resident is assigned to 2 two-month rotations in the third and fourth years and, in addition, bi-monthly seminars correlating cytology and biopsy material are presented for the entire group. There is also access to an extensive cytology teaching collection.
Neuropathology: There is a four-month rotation in neuropathology, including brain, muscle, and nerve biopsies as well as weekly brain-cutting and weekly didactic conferences covering all aspects of neuropathology.
Dermatopathology: Experience in dermatopathology will be provided by dermatopathologist Monisha Dandeker, M.D. through daily sign-out sessions of skin specimens from Tufts Medical Center and from community dermatologists.
Forensic Pathology: A series of monthly lectures in forensic pathology is given by selected speakers. In addition, residents participate in a one-month rotation at the Suffolk County Medical Examiner’s Office during their third year of training.
Cytogenetics: Residents have a two-week rotation in cytogenetics under the direction of Dr. Janet Cowan. The cytogenetics laboratory examines amniotic fluid, peripheral blood, bone marrow, and solid tumor specimens using both routine karyotype analysis and fluorescent in situ hybridization. Additional training may be scheduled based on the interest of the resident.
Medical School Teaching: Residents participate in teaching of the laboratory sections (15 to 20 students) in the general pathology course in the fall of the second year at Tufts University School of Medicine and in laboratory sections in the systemic pathology course (winter and spring of the second year). Stipends are provided for these teaching activities.
Research: Research opportunities are available under the guidance of established investigators on the Pathology staff. Areas of research include immunopathology, immunochemistry, histochemistry and immunocytochemistry, molecular genetics, immunohematology, viral oncology and ultrastructural analysis. Residents may also participate in basic research projects in Pathology or in other departments at Tufts Medical Center or Tufts University School of Medicine.
Resident Evaluation: Performance of residents will be evaluated in a number of ways. After each rotation, the faculty will discuss individualized performance with the resident. Bi-annual evaluations are completed by all staff on each resident and a composite evaluation is constructed by the residency program director, which is discussed with each resident. Residents are also asked to evaluate the staff performance on a bi-annual basis. The resident will also participate in the National Resident In-Service Examination annually.
Staff: Barbarajean Magnani, PhD, MD (Pathologist-in-Chief), Arthur R. Rabson, MD; Monika E. Pilichowska, MD, PhD; Steven A. Bogen, MD, PhD; Raymond L. Comenzo, MD
Integrated Program: Residents receive training in all branches of clinical pathology including clinical immunology and tissue typing, medical microscopy, hematology, clinical microbiology, clinical chemistry and blood banking. In addition, residents will develop consultative and managerial skills across the subspecialty borders in an integrated training program. Residents training in a particular clinical pathology subspecialty will spend most of their time in that area, although they will continually receive training in all aspects of clinical pathology.
In this integrated program, residents will be trained to serve as consultants to physicians regarding cost-effective test strategy and interpretation of results. In addition, they will be trained to use the techniques of medical informatics to acquire, manage and translate data into clinically useful information, to communicate that information in support of patient care and to play an influential role in medical staff and Healthcare delivery activities that reach beyond the confines of the laboratory.
The residents, under the guidance of all Clinical Pathology medical directors, will seek intralaboratory and clinical consultations. As their knowledge base expands, they will be provided with the opportunity to assume increasing responsibility for clinical and consultative service. Residents will become familiar with the Laboratory Information System. One of their service roles will include the retrieval and interpretation of both clinical and management data designed to assess quality and promote cost-effective utilization of laboratory resources.
Staff: Monika E. Pilichowska, MD, PhD, Medical Director, Hematology/Microscopy Laboratory; Rouette C. Hunter, M.T. (ASCP), Manager, Hematology/Microscopy Laboratory; Clinical Staff, Hematology/Oncology Service
General Objectives: Training in hematology/microscopy is divided into two time blocks. The first rotation takes place during the second year and aims to give the resident solid grounding in hematologic morphology, clinical laboratory testing in the areas of hematology, coagulation and clinical interpretation. The training program is coordinated and integrated with the activities of the Clinical Hematology/Oncology Service.
The second rotation takes place during the fourth year. This provides opportunity to further develop skills covered in the initial rotation but also provides elective opportunities for more advanced training in hematologic techniques. During this period, the resident also has opportunities to carry out projects of limited scope related to development of new methodology or management problems. These activities are planned with residents and would be oriented to clinical sub-specialization or research in hematopathology.
Orientation: There is a formal orientation scheduled at the beginning of each academic year. This experience introduces the resident to the organization, staffing and procedures of the laboratory. This experience also includes didactic presentations introducing the areas of hematologic morphology and hemostasis/thrombosis.
Although training will place major emphasis on morphology and clinical laboratory testing methods, it is planned to encompass those areas which represent major roles the pathologist plays as medical director of a clinical laboratory. These roles include administrative, technical director, clinical consultation and clinical interpretation, teaching and research.
Administrative: To expose the resident to administrative problems and their management, the resident will be exposed to discussion of personnel, fiscal management, workload and work-flow management, equipment purchase and maintenance, test trouble-shooting, critical values, quality assurance and clinical liaison.
Although the resident may not be given primary responsibility and authority in these areas and will participate primarily as an observer, wherever possible, the resident will participate especially in promoting communication. The resident will carry a call beeper during the daytime hours and will be available to the supervisory staff and technical staff for consultation.
Coagulation: The resident will be introduced to coagulation testing by spending scheduled time at the workbench with technologists. This experience will involve exposure to the Instrumentation Laboratory ACLTOP 500; and the Verify Now instrument.
Blood and Bone Marrow Morphology: The medical director and laboratory supervisor will provide supervised study of normal and abnormal blood smears and bone marrow specimens. This will be accomplished by utilizing the teaching microscope in the Clinical Hematology Laboratory. The resident will attend the weekly Hematopathology Microscopic Conference during which current case materials will be studied
In addition to these more structured teaching experiences, the resident will learn morphology through case material which is generated from the daily load of blood and bone marrow smears in the Clinical Laboratory, from clinical ward rounds, as well as from the Surgical Pathology Service.
Hematology/Microscopy: Throughout the period of training, time will be scheduled for the resident to work with technologists at the workbench. This experience will introduce the resident to practical testing methods, instrumentation, use of standards and calibrators, quality control, machine maintenance and trouble-shooting in a diagnostic hematology laboratory.
Flow Cytometry: The laboratory is equipped with two Beckman Coulter Cytomics FC500 instruments. .Residents will be trained in their use and the general applications of flow cytometry. Training will include the interpretation of cytometric data in cases of leukemia and lymphoma and quantitation and subset analysis on rare leukemia and lymphoma cases are available for resident review.
Resident Conferences and Clinical Round Schedule during Hematology/Microscopy Rotation:
Weekly conferences include:
- Hematology/Oncology Clinical Conference
- Lymphoma/Bone Marrow Transplantation Conference
- Hematopathology Microscopic Conference
- Hematology/Oncology Microscopic ConferenceDaily Conferences
Daily conferences include:
- Clinical Laboratory Rounds: Hematology/Microscopy Laboratory. Includes bone marrow sign-out, review of smears, abnormal hemoglobins and coagulation problems.
- Hematopathology Microscopic Conference: The Hematopathology Microscopic Conference is conducted weekly at the multi-headed microscope adjacent to the Resident’s library. All clinical laboratory trainees are required to attend during the entire period of clinical laboratory training. The purpose of this conference is to provide all trainees with continuous and reinforced exposure to hematologic and lymphoreticular morphology during the entire two years of training in the Clinical Laboratory. The resident rotating in Hematology and the Medical Director are responsible for providing material for study. The content consists of active case material and of material from the teaching files. The latter, especially, allows for a systematic and comprehensive presentation of normal and abnormal hematologic and lymphoreticular morphology. Emphasis is placed on blood and bone marrow morphology.
- Teaching: The resident is responsible for formal case presentations at the Hematology/Oncology/Pathology Conferences. The resident will be afforded the opportunity to teach technologists by presenting an in-service program as part of the laboratory’s continuing education program.
Arthur Rabson, MD; Cody Meissner, MD; David Snydman, MD; Susan Bollinger, MPH, MT (ASCP), Manager; Cassandra Parker, MT (ASCP), Supervisor.
Objectives: The eight-week basic course in medical microbiology during the second residency year is intended to introduce the resident to the various procedures, techniques, media, stains, equipment and thought processes which underlie modern diagnostic microbiology. Laboratory experience will cover diagnostic procedures, interpretation of results, problem solving, quality control, nosocomial infections and laboratory administration relating to the disciplines of bacteriology, mycology, parasitology, virology, mycobateriology and immunoserology.
The resident will gain a substantial understanding of the technical work performed in a microbiology laboratory and will be able to anticipate and solve problems as well as make decisions. Ancillary to the laboratory experience in diagnostic microbiology, the resident will also have the opportunity to participate in conference and consult rounds of the Adult Infectious Disease Service in the Department of Medicine.
Introduction to Bacteriology: Introduction to accessioning and processing of specimens; selection and inoculation of appropriate media for different specimens, including special cases in which additional or unusual primary isolation media may be appropriate; Introduction to the laboratory filing system and information retrieval; review of proper requisition requirements; review of specimen labeling. Introduction to the use of the Gram stain.
Urine Cultures and Antimicrobial Susceptibility Testing: Bench instruction in the interpretation of quantitative urine cultures, subculturing to diagnostic media and evaluation of results to establish bacteriological diagnoses; review and proper handling of urine specimens, both in patient-care areas and in the laboratory. Bench instruction in the use of the Vitek method of antimicrobial susceptibility testing and special susceptibility problems of synergy, serum cidal levels, and their interpretation. Introduction to bacterial taxonomy, and to the reference literature of medical bacteriology.
Blood Culture: Bench instruction in the interpretation of blood cultures; review of methods of obtaining blood cultures; discuss pitfalls of blood culturing; review the literature of blood culturing; introduction to pour plate methodology.
General Bacteriology and Anaerobic Bacteriology: Bench instruction in the interpretation of cultures obtained from nose, throat, sputum, wound, genital, stool and body fluid specimens. Introduction to Lancefield grouping of streptococci, serotyping of Salmonella, Shigella and identification of Hemophilus influenza, using satellite plates, X and V factors; coagulase testing of staphylococci. Review of bacterial taxonomy, introduction to various test systems for identification of gram-negative enteric bacilli, introduction to various identification schemes for the non-fermentative gram-negative bacilli. Observation of planning and performing quality control.
Mycobacteriology: Introduction to mycobacteriology; acid-fast staining of clinical specimens and mycobacteria; auramine-fluorescent staining procedure for tubercle bacilli; selection of specimens for digestion prior to culture; digestion procedures; use and maintenance of the safety hood and ultraviolet lamp; review of safety measures in the TB laboratory, including appropriate precautionary measures in the patient care areas.
Parasitology: Introduction to processing stool for examination for ova and parasites. A teaching collection will be utilized for study of common pathogens.
A further rotation in the fourth year will serve to expand the knowledge of the clinical pathology resident. The two month period will be concentrated in areas of virology, molecular diagnostics, immunoserology, mycology, special susceptibility testing and rapid diagnostic methods.
Virology: The resident will observe cell culture techniques, primarily focusing on the Herpes group viruses, respiratory syncytial virus, enteroviruses, and adenoviruses. The resident will learn about immunologic identification of viral pathogens, processing of specimens for viral culture and maintenance of culture media.
Molecular Pathology: Throughout their training residents are exposed to molecular technologies both in surgical pathology and in the clinical areas. While in the microbiology and chemistry laboratories, the resident will assess many of the molecular platforms used to test for HBV, HCV, HIV, HPV, CMV, BK virus and C.difficile. Further molecular experience is obtained in the tissue typing laboratory where the residents will work with Luminex technology to determine the tissue type and the presence of preformed antibodies in patients undergoing transplant procedures.
Immunoserology: The resident will observe immunoserologic techniques including latex agglutination and enzyme-linked immunosorbent assay (ELISA). The immunoserologic techniques for screening or diagnoses of Herpes group viruses, toxoplasmosis, rubella, and rotavirus will be emphasized.
Mycology, and Special Susceptibility Testing: Differentiation of pathogenic fungi will be emphasized. Emphasis will be placed on need for special susceptibility tests including clinical situations which dictate need for minimum inhibitory concentrations, minimum bactericidal concentrations, and synergy.
Hospital Epidemiology: The resident will gain exposure to epidemiologic methods, problem solving in hospital epidemiology, and statistical analysis. The resident will attend infection control meetings and problem solving sessions.
Clinical Immunology experience will be integrated into both the microbiology and clinical chemistry rotations. The aim is to give the resident a working knowledge of immunological principles and experience in performing and interpreting the wide variety of tests carried out in a modern, active, clinical immunology laboratory. In particular, the resident will be instructed in the clinical application and interpretation of the various tests, and how they assist in the diagnosis of autoimmune, allergic, and immunodeficiency disorders. With the establishment of tissue typing, the resident will develop an understanding of the support services provided by an immunology laboratory to the various transplant programs in the hospital.
Residents will be instructed in techniques used for making the diagnosis of auto-immune disease including immunofluorescent and ELISA tests. The residents will obtain experience in detecting antibodies to nuclear antigens, smooth muscle, mitochondrial and parietal cell antigens, DNA, antibodies to various extractable nuclear antigens including RO, La, Sm, RNP, SCL-70, measurement of cardiolipin antibodies and anti-thyroid and anti-microsomal antigens. Residents will be encouraged to perform, read, and interpret these tests and relate the results to the clinical evaluation of the patient.
Experience will also be obtained in setting up and interpreting serum and urinary protein electrophoretic patterns and immunofixation tests for the diagnosis of monoclonal gammopathy. The classification and diagnosis of monoclonal gammopathy and the application of measurements of light chains are discussed at a monthly Plasma Cell Dyscrasia meeting with the clinical oncologists.
Tissue Typing and Immunogenetics: Instruction will be given on the techniques involved in supporting a renal or bone marrow transplantation service. The resident will therefore gain experience in the performance and interpretation of cross-matching techniques and their relationship to results of HLA typing. The resident will gain experience in the use of PCR and Luminex technology for detecting both Class I and Class II MHC proteins and donor-specific antibodies. Weekly meetings with the transplantation team take place to discuss problem cases and interpretation of laboratory results.
Resident Conference and Clinical Round Schedules – Clinical Microbiology
Clinical Laboratory Rounds (daily): Clinical Microbiology Laboratory
Infectious Disease Consult Rounds (daily)
Infectious Disease Clinical Conference (weekly)
Infection Control Committee (monthly)
Location: Tufts Medical Center Clinical Chemistry Laboratory
Staff: Steven A. Bogen, MD, PhD; Barbarajean Magnani, PhD, MD; Bola Akeredolu, MT C (ASCP), CM POCS, Chemistry Manager; Subathira Suntharalingam, MT (ASCP), Technical Supervisor
Objectives and Program: The objective of the core rotation in clinical chemistry is to develop an understanding of the analytical methods and instruments, quality control procedures, and logistic and data processing systems used to maintain the timely output of consistently accurate laboratory results. This will be accomplished through hands-on experience at each of the laboratory workstations, tutorial sessions with the instructors, and active involvement in problem solving. The resident will gain experience, while helping provide laboratory services, by being responsible for review and interpretation of tests where interpretation is included in the report; for review and approval of requests for certain special tests; for in vivo procedures involving administration of radioisotopes; and for being on-call to handle special requests, answer questions and deal with problems. Specifically, the rotation will provide:
- A review of basic chemical and physiological concepts and principles
- Knowledge of the chemical and physical basis for assays that are typical of the most commonly encountered tests in clinical chemistry
- An understanding of the principles and operations of the analytical systems and instrumentation we use
- Experience in performing typical assay procedures and working with, maintaining, calibrating, and "trouble-shooting" the instruments employed
- An appreciation of the factors inherent in an analytical method or system such as chemical specificity and sensitivity, susceptibility to interference, accuracy and precision, that must be taken into account in correctly interpreting chemistry measurements
- An appreciation of the factors that must be controlled in various tests to insure reliability; i.e., timing, temperature, specimen handling, etc.
- Understanding the use of blanks, standards, standard curves, and controls
- Experience in calculating results, the statistical analysis of laboratory data, estimating errors, and determining confidence limits
- Experience in methods evaluation and comparison
- An introduction to the clinical chemistry literature
The laboratory sections through which the resident will rotate are:
- General Chemistry: Electrolytes, proteins, metabolites, and enzymes measured by manual procedures and on a wide range of automated systems.
- Immunoassay: Therapeutic drug monitoring by abused-drug screening, hormones, B12 and folate, manual RIA, and a wide range of automated systems.
- Blood gasses and pH
- Special Procedures: Isoenzymes, serum and urine proteins by agarose gel electrophoresis.
The objectives of the second rotation in Clinical Chemistry are to develop an understanding of how the laboratory is organized, managed and maintained to accomplish its mission effectively. The aim is to provide the conceptual framework required if one were required, de novo, to assess the requirements of a hospital for laboratory services, then direct the equipping, staffing, organization and operation of a clinical chemistry laboratory to meet these requirements. This will be accomplished through tutorials, problem solving assignments and being available to field questions. Specific areas that we will focus on are:
- Organization of workflow
- Operation and management of the laboratory computer system for data processing and communication
- Quality control and quality assurance programs: Monitoring quality control records; reviewing proficiency surveys; preventive maintenance; investigating problems; regulatory and accreditation requirements
- Methods and instrument comparison: Statistical analysis of data; functional analysis
- Personnel management: Scheduling and deployment; productivity and workload analysis; performance review
- Fiscal management: Budget report review; purchasing and inventory management
- Develop the role of clinical consultant so that, given the clinical question to be evaluated, the resident will be able to recommend an effective test strategy, or, given test results, will be able to provide the interpretation. This will be accomplished through tutorials, being on-call and handling questions, review for approval of special send-out tests, participation in clinical conferences and rounds, and involvement in our emergency drug testing and toxicology programs.
Opportunity also will be provided to carry out a limited project, e.g., evaluation of a new procedure or instrument, correlation of clinical and laboratory findings, reference range studies, or biochemical investigations.
Training Program in Clinical Pathology – Blood Bank
Location: Tufts Medical Center Blood Bank and Transfusion Services
Staff: Raymond L. Comenzo, M.D.; Judith Forbes, MT (ASCP), Blood Bank Manager
- Review blood group immunology, typing, compatibility testing and antibody identification (including panels, absorptions, elutions)
- Monitor problem cases and transfusion reactions
- Apheresis of normal donors; therapeutic apheresis; use of cell separators (CS3000, Model 30 Model 50, Cobe 2887)
- Blood collection (including autologous donors), component preparation, storage and preservation of blood
- Transfusion therapy (hazards, use of components, hepatitis, HIV and CMV
- Red cell freezing and cryobiology
- Hemolytic disease of the newborn
- Outpatient transfusion
- Bone marrow processing and freezing
- Blood irradiation-transplantation
- Intra-operative cell salvage
Our department thrives through the efforts of a dedicated and caring faculty working in close collaboration with our residents. Our faculty consists of experienced and nationally recognized general and sub-specialty pathologists who are committed to guiding and mentoring the residents through their training.
Barbarajean Magnani, PhD, MD
Stephen P. Naber, PhD, MD, Chief, Anatomic Pathology
Elizabeth M. Genega, MD, Medical Director, Surgical Pathology
Masha N. Bilic, MD, Surgical Pathologist
Janet M. Cowan, PhD, Medical Director, Cytogenetics
Yvelisse Suarez, MD, Surgical Pathologist
Arthur S. Tischler, MD, Senior Surgical Pathologist (Endocrine Pathology)
Barbara J. Weinstein, MD, Surgical Pathologist and Cytopathologist
Knarik Arkun, MD, Director of Autopsy and Neuropathology
Barbarajean Magnani, PhD, MD, Chief, Clinical Pathology
Steven A. Bogen, PhD, MD, Medical Director, Clinical Chemistry
Raymond L. Comenzo, MD, Medical Director, Blood Bank and Transfusion Medicine
Arthur R. Rabson, MD, Medical Director of Immunology & Microbiology, Tissue Typing, Andrology, and Molecular Laboratories
Monika Pilichowska, MD, PhD, Medical Director of Hematology
Sandra Gaston, PhD, Director of Molecular Biomarkers Research Lab
Nicholas Heger, PhD, Assistant Director Clinical Chemistry
Residency and Fellowship Programs
Arthur R. Rabson, MD, Program Director, Residency Training Program
Stephen P. Naber, PhD, MD, Program Director, Surgical Pathology Fellowship
Veronica M Carvajal, BA, Academic Programs Coordinator
James Rogers, MT(ASCP), MBA, Administrative Director
Beth Harubin, MS, Operations Director