Pathology and Laboratory Medicine

The Surgical Pathology Fellowship at Tufts Medical Center offers comprehensive training in diagnostic surgical pathology including in-depth exposure to subspecialty areas of general surgical pathology.

The goal of the 1-year surgical pathology fellowship is to prepare the Fellow for advanced practice in surgical pathology.  Fellows should have a strong background in general diagnostic pathology, and acquire skills though the fellowship training to become an independent attending pathologist able to practice in either an academic, community hospital, or commercial laboratory setting, or pursue further subspecialty fellowship training.

Tufts Medical Center presents a rich diversity of cases including transplant pathology, cancer pathology (e.g., breast, prostate, lung, gastrointestinal, gynecologic) and non-neoplastic diseases. There are approximately 20, 000 surgical cases annually at Tufts Medical Center. In addition, Tufts Medical Center is one of two hospitals in Boston with a focus on cardiac transplantation.

The fellow will be mentored and will assume graduated responsibility for diagnostic sign out of cases with the surgical pathology faculty at Tufts Medical Center. The fellow also will participate in conference presentations, tumor boards, pathology laboratory administration, and the education of Pathology and Laboratory Medicine residents.

Although this is a non–ACGME-accredited program, the fellowship meets the American Board of Pathology criteria for Maintenance of Certification credit and is modeled on surgical pathology fellowship programs at other major academic medical centers. Opportunities exist to become involved in ongoing clinical or translational research in the Department of Pathology and Laboratory Medicine, particularly in partnership with other clinical services. Available diagnostic and research techniques include immunohistochemistry, in situ hybridization, cytogenetic techniques, and some molecular applications.

The goal of the one-year surgical pathology fellowship is to prepare the candidate for advanced practice in surgical pathology. The fellowship is based on a model of practice under supervision, rather than a program of didactic and practical exercises.

In general, the practice of surgical pathology occurs in one of three major practice settings:  academic practice, community hospital based group practice, or commercial laboratory practice.  Each of these settings varies in terms of their typical workloads, spectrum of case types, case complexity, and involvement in teaching and scholarly activity. This fellowship takes place in an academic practice setting and will adequately prepare the candidate for practice in any of the major pathology practice models.

At the end of the one-year Surgical Pathology Fellowship, the successful candidate will be expected to:

1. Provide competent diagnostic interpretation of all surgical pathology specimens.  The Fellow’s expertise will include the following:
   1. Intra-operative consultations 
interpretation of frozen sections 
interpretation of touch preparations 
immediate gross evaluations
   2. Complete and systematic gross examination of surgical specimens
   3. Biopsy diagnosis/interpretation
   4. Appropriate work-up and reporting of cancer resections
2. Develop an analytical approach to diagnoses, which includes the appropriate selection, interpretation, and integration of ancillary techniques such as electron microscopy, immunohistochemistry, and molecular pathology.
3. Recognize own limitations and ask for appropriate consultations.
4. Serve as a consultant to health care providers:
   1. Effectively communicate results with clinicians in a concerted effort to improve patient care
   2. Discuss cases in pathology and clinical conferences as well as recognize patient care implications.
5. Have demonstrated effective teaching of medical students, residents, pathologists, and clinicians in the following settings:
   1. Instructing junior residents in proper grossing technique
   2. Previewing surgical pathology cases with junior pathology residents to assist and guide them in their work-up
   3. Preparing and providing teaching/slide conferences for residents
   4. Participation in multidisciplinary conferences and offering consultative services at these conferences with appropriate faculty backup.
6. Have demonstrated effective management of the surgical pathology Laboratory 

   1. Through supervision of the grossing room, promptly addressing any specimen backlogs, problems regarding specimen processing, or matters of workflow efficiency and safety
   2. Knowledge of applicable regulations, to include participation in inspections of the surgical pathology service by the CAP, or any other agencies, and participation in inspections performed by the department of other surgical pathology services.
   3. Through assisting the Director of Surgical Pathology in preparing pathology resident schedules
7. Professional responsibility for patient care: The fellow will inform the fellowship director and the attending pathologist of any planned or unplanned absence and will make arrangements for coverage of their service and cases.
8. Participate in lifelong learning: The fellow is expected to attend: 

   1. Departmental didactic and teaching conferences related to surgical pathology
   2. Resident presentations
   3. The residency evaluation meeting to facilitate communication of information related to GME
   4. Departmental Quality Assurance meetings (quarterly)

The program is structured to provide all necessary core training over a one year period and to assure that learning the techniques and skills required for excellence in surgical pathology practice (morphology, immunohistochemistry, molecular diagnostics, laboratory management administration and informatics) is accomplished in a coordinated fashion.

Although the surgical pathology faculty at Tufts Medical Center practice as generalists, each faculty member has subspecialty expertise; therefore, the surgical pathology rotations are structured so that each period focuses on a subspecialty area while allowing the Fellow to continually develop essential general surgical pathology skills.

The year is divided as follows:

• 4 months – surgical pathology
• 4 months – surgical pathology (without grossing)

• 2 months – frozen sections/intraoperative consultations

• 2 months – research/subspecialty electives

During surgical pathology periods with grossing, the surgical pathology Fellow rotates through subspecialties in 2-week rotational blocks; the last 2 week block may be done in an area of the Fellow’s interest.  The subspecialty areas include:


• Dermatopatholgy/Renal/Bone/Soft Tissue
• Gastrointestinal/Transplant
• Genitourinary/Endocrine
• Breast/Gynecologic
• Lung/Liver, Neuropathology
• Head and Neck/Placenta
• Cardiac/Cytogenetics 


Days are structured with biopsy sign-out in the subspecialty area every morning, and alternating subspecialty grossing and large case sign-out in the afternoon. During the 4 months of surgical pathology without grossing, the Fellow signs out all consultation cases in all subspecialty areas and evaluate a portion of biopsies and large cases. The volume at Tufts Medical Center is such that residents and Fellows have their own cases even when on similar specialty services.

In addition to their day-to-day service work responsibilities, the Fellow will participate in additional departmental and interdepartmental activities listed below.

Fellow responsibilities

1. Case Editing, preparation and signout
2. Signout of outside consultation cases during non-grossing months
3. Rotation as Gross Room Supervisor (GRS)
4. Grossing duties required up to 2-3 days/wk during 4 grossing months

5. Consultant for junior residents on grossing (and where possible slide preview) for all major soft tissue and bone tumor resections

6. Late coverage (until 6PM) on rotational basis with other AP Fellows
On call responsibilities are one Saturday/month. While on call, the Fellow functions as gross room supervisor for the residents and PA grossing on Saturday, performs all frozen sections requested from 8am-5pm, diagnoses all emergent biopsies and cytology silver stains (with faculty oversight) and generally functions a junior faculty. A faculty member is available on Saturdays for back up, if needed.  

The fellow has administrative responsibilities as part of the program structure; this affords an opportunity to learn skills that are required for academic and private practice and are critical to master. Administrative Quality Assurance activities include:

1. Review (under supervision) of monthly surgical pathology monitors; collate and present data
2. Surgical pathology turnaround time
3. Frozen section-final diagnosis correlation
4. Completeness of tumor reports to ensure compliance with required CAP reporting elements
5. Review of amended reports for discrepancies
6. Correlation of inter-institutional review case diagnoses

7. Assist/conduct daily review of histology slide quality

During the year, the Surgical Pathology Fellow mandatory conferences include:

1. Surgical pathology staff consensus conference (daily)
2. Specialty-specific tumor boards (rotating to various tumor boards)
3. Departmental  Journal Club (monthly)
4. Surgical pathology weekly conference

The fellow is expected to prepare for and be present at the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference.  Fellows may attend other departmental and interdepartmental conferences and educational opportunities to maintain competence in general pathology.

Teaching responsibilities

Tufts Medical Center has an anatomic and clinical pathology residency program with 12 residents. The fellow is expected to take an active role in resident education. The fellow teaching activities are:

1. Consultation/supervision of junior residents in grossing room
2. Unknown slide conferences for residents
3. Gross pathology conferences for residents

The fellow is expected to initiate or participate in one or more research projects related to any area of surgical pathology, to present the research data at national meetings, and to publish the data in pathology/biomedical journals.

The department provides funds for purchasing books and attendance at a national meeting. If an abstract is presented at a meeting, additional funds and time off are provided.

Anatomic Pathology
Elizabeth M. Genega, MD, Chief, Anatomic Pathology
Knarik Arkun, MD, Director of Autopsy and Neuropathology
Jeffrey Arnold, MD, Cytopathologist and Surgical Pathologist
Natalie Ciomek, MD, Surgical Pathologist, Hematopathologist
Janet M. Cowan, PhD, Medical Director, Cytogenetics
Stephen P. Naber, PhD, MD, Senior Pathologist, Medical Director, Biorepository
Monika Roychowdhury, MD, Acting Medical Director, Cytology, Surgical Pathologist
Daniel Rust, MD, Surgical Pathologist, Pediatric Pathology
Arthur S. Tischler, MD, Senior Surgical Pathologist (Endocrine Pathology)
Julie Y. Tse, MD, Dermatopathologist

Fellows complete their training at Tufts Medical Center, a world-class academic medical center located in Boston and the principal teaching hospital for Tufts University School of Medicine. It also sponsors nineteen specialty ACGME-accredited clinical training programs.

Tufts Medical Center is a 415-bed robust organization, providing everything from routine medical care to treating the most complex diseases affecting adults and children. Tufts Medical Center is also home to the Tufts Children's Hospital, a full-service children's hospital dedicated exclusively to all levels of pediatric care.

Tufts Medical Center provides heart, kidney and bone marrow transplants, is a level I trauma center, provides comprehensive neurological and neurosurgical care, and offers cutting-edge cancer treatments.

Tufts Medical Center is also home to The Boston Gamma Knife Center, the first and only Gamma Knife Center in Massachusetts and northern New England.

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Applicants must be board eligible in AP or AP/CP and licensed to practice medicine in the State of Massachusetts by the time their fellowship begins. We encourage those interested to apply 18 months in advance. To apply, download the CAP Standardized Application for Pathology Fellowships. Letters of recommendation should be addressed to:

Elizabeth M. Genega, MD
Surgical Pathology Fellowship Director
Department of Pathology and Laboratory Medicine
Tufts Medical Center
800 Washington Street
Boston, MA 02111

Application materials and requests for further information should be addressed to:

Madeline Harrison
Residency Program Coordinator
Department of Pathology & Laboratory Medicine
Tufts Medical Center, Box 115
800 Washington Street
Boston, Massachusetts 02111

Telephone: 617-636-2567
Fax: 617-636-7128
E-mail: mharrison3@tuftsmedicalcenter.org

Coby Horowitz
Academic Program Coordinator
Department of Pathology & Laboratory Medicine
Tufts Medical Center, Box 115
800 Washington Street
Boston, Massachusetts 02111

Telephone: 617-636-1112
Facsimile: 617-636-7128
E-mail: chorowitz@tuftsmedicalcenter.org