Surgical Pathology - 19 months
Surgical Pathology is the heart of our anatomic pathology training, and with a caseload of more than 55,000 surgical specimens a year, residents receive excellent exposure to a wide spectrum of diagnostic material. After an introductory month learning to grossly examine, describe and dissect under the tutelage of senior residents and experienced pathologists' assistants, new residents are immersed in the busy surgical service.
With a 2-day schedule of alternate days grossing and signing out cases, specimens that are grossly examined are reviewed the following day, independently by the resident and then together, with the teaching faculty, for continuity of care and gross-histologic correlation. There is individual sign-out with residents working one-on-one with each attending. Residents perform frozen sections, communicate with clinicians, and spend time in the histology laboratory.
Autopsy and Forensics - 3 months
Residents spend three months learning to perform adult, child and fetal autopsies under the direct supervision of a forensic pathologist. Due to the large volume of deliveries (more than 14,000 yearly) in the Orlando Health system, residents have the opportunity to see a variety of rare and uncommon fetal conditions, such as histiocytoid cardiomyopathy and spondyloepiphyseal dysplasia. One month is spent at the District 9 Medical Examiner's office, learning forensics under Dr. Joshua Stephany and his staff.
Cytology - 3 months
Three months are spent training residents to diagnose both gynecologic and medical cytology specimens with direct one-on-one teaching by cytology faculty and staff. Residents independently review all cytology cases prior to sign out. Our cytotechnologists are present for all EBUS-FNA procedures and bring the smears directly to the resident and attending on service for rapid on-site examination.
Hematopathology - 6 months
More than 700 bone marrow biopsies are examined yearly on the hematopathology service, along with numerous lymph node biopsies, blood smears and fluid preparations. Our association with Orlando Health Cancer Institute provides abundant diagnostic material. All benign and malignant conditions are represented on this busy service, creating a rich environment for resident learning. Flow cytometry is an integral component, so residents sign out all aspects of each case. Hemoglobin electrophoresis runs and coagulation panels are reviewed daily.
Blood Bank - 2 months
Residents rotate at One Blood, which is the blood product testing and processing center for more than 70 hospitals in 21 Florida counties. During the rotation, residents learn all aspects of blood banking, from collection to antibody workups, by spending time with laboratory staff and from lectures by blood bank pathologists.
Clinical Chemistry - 3 months
The clinical laboratory performs more than 2 million procedures yearly. On the chemistry rotation, residents spend time learning principles of instrumentation and how to interpret tests. Troubleshooting and interaction with clinicians are encouraged. Additionally, residents receive one-on-one lectures from teaching faculty and prepare cases to share in conference. Electrophoresis is signed out daily. During the third month of Chemistry, a two-week Toxicology rotation is offered at University of Florida in Gainesville, Florida with expenses paid.
Microbiology - 3 months
From mundane community-acquired bacterial infections to exotic zoonoses, the diverse Orlando population provides an interesting spectrum of microbiologic specimens. Residents are actively engaged during their rotations through bacteriology, mycology, and virology and learn traditional culture/morphologic techniques along with newer immunologic and molecular methods.
Miscellaneous
Additional months are spent on rotations in immunology, electron microscopy and laboratory management to round out clinical pathology training. There is also an excellent 2-week rotation in molecular pathology at the state-of-the-art facilities of NeoGenomics in Ft. Myers, Florida with expenses paid.
Electives
Three elective months are available to focus on areas of interest, up to 2 of which may be used to schedule away rotations at unaffiliated, off-site locations.
Typical Rotation Breakdown
PGY-1
7 months Surgical Pathology
2 months Autopsy
1-month Chemistry
1-month Blood Bank at One Blood
1-month Surgical Pathology or Chemistry
PGY-2
5 months Surgical Pathology
1-month Autopsy
2 months Hematopathology
1-month Cytology
1-month Chemistry
1-month Microbiology
1-month Immunology
PGY-3
5 months Surgical Pathology
1-month Autopsy
1-month Forensic Autopsy at District 9 Medical Examiner’s Office
2 months Hematopathology
1-month Cytology
1-month Microbiology
2 elective months
PGY-4
2 months Surgical Pathology
2 months Hematopathology
1-month Cytology
1-month Chemistry (including 2 week Toxicology at UF in Gainesville)
1-month Molecular with 2 weeks at NeoGenomics in Ft. Myers
1-month Blood Bank at One Blood
1-month Lab Management
1-month Microbiology
2 elective months
Didactics
Didactics are an integral component of the Orlando Health pathology residency. Formats include teaching staff lectures and microscopy sessions, resident lectures, "unknowns" conferences, hands-on brain cutting and gross pathology conferences, journal club, and a variety of multidisciplinary conferences in which residents often present cases.
Educational Conferences
- Anatomic/Clinical Pathology Didactic lecture - 1-3/week
- Surgical Pathology Unknown Case Conference - Weekly
- Orlando Health Cancer Institute Tumor Board (Breast, Hematology, Thoracic, GI, Brain & Spine, Head & Neck) – Weekly
- Orlando Health Cancer Institute Tumor Board (Colorectal, Pediatric Neuro, Melanoma/Sarcoma, GU) - Biweekly
- Pediatric GI Clinical/Pathologic Conference - Biweekly
- OB/GYN Clinical/Pathological Conference - Monthly
- Doctor Phillips Hospital Tumor Board - Monthly
- Neuropathology (Brain Cutting) Conference - Twice/Month
- Gross Autopsy Conference- Monthly
- Forensic Pathology Conference - Monthly
- Laboratory Management - Monthly
Additional Educational Opportunities
All residents are encouraged to attend major national conferences with institutional financial support. The department will pay approved expenses if residents are presenting scientific studies at these meetings. Since Orlando has become a popular city for national meetings, numerous pathologic conferences and workshops are held locally each year, including the Florida Society of Pathologists annual conference.
Statistics
The Department of Pathology at Orlando Health offers a high volume of teaching material of excellent variety in both anatomic pathology and clinical pathology. The following table represents the statistics for the year of 2015.
Number of types of cases/procedures:
- Surgical - 55,000
- Cytology - 15,000
- FNA - 1,000
- Frozen Section - 5,000
- Autopsy - 176
- Electron Microscopy - 400
- Bone Marrow Biopsy/aspirate - 800
- Laboratory Procedures - 2,300,000
- Flow Cytometry - 1,100
