RESIDENCY – FELLOWSHIP OPPORTUNITIES

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Overview

Fellowship opportunities are available in Cytopathology, Dermatopathology, Hematopathology, Neuropathology, Molecular Genetic Pathology, Transfusion Medicine, Pathology Informatics, and Subspecialty Surgical Pathology, including Breast, Bone and Soft Tissue, Cardiovascular, ENT, Gastrointestinal, Genitourinary, Gynecologic, Obstetric and Perinatal, Pulmonary, and Renal Pathology.

General Information

The Massachusetts General Hospital Pathology Service sponsors fellowships designed to prepare trainees for careers in academic diagnostic pathology. These programs provide intensive training in the diagnosis and understanding of diseases in these subspecialty areas. Opportunities for participation in multidisciplinary approaches to treatment and in collaborative clinical and basic science research are available and encouraged.

The fellowships in Cytopathology, Dermatopathology, Hematopathology, Neuropathology, Molecular Genetic Pathology and Transfusion Medicine are accredited and follow curricula approved by the ACGME (complete curricula for each fellowship are available on request). There is no specific ACGME accreditation for Pathology Informatics or Subspecialty Surgical Pathology; these programs are under the purview of the Partners Education Committee, to assure they meet the high educational standards set by the ACGME. The Pathology Informatics fellowship balances operations, imaging and research, with opportunities for concentration in one or more areas.

The Subspecialty Surgical Pathology fellowship opportunities include (depending on availability) breast (the Gillette Fellowship in Women's Cancers), bone and soft tissue, cardiovascular, ear, nose and throat, gastrointestinal, genitourinary, gynecologic, obstetric and perinatal, pulmonary and renal pathology. Fellows doing their training will divide their time between covering their respective diagnostic service(s) and engaging in clinical collaborative and/or translational research. Staff Pathologists who subspecialize in these areas of pathology supervise and teach the fellows through department lectures, specialty conferences and one-on-one review and discussion of individual cases.

The Subspecialty Surgical Pathology fellows have progressive responsibility over the course of the year to independent signout in from one to three of the subspecialty areas listed above, mentored and monitored by the heads of these subspecialty services. All fellows supervise and instruct pathology residents in the elements of diagnosis and provide informal instruction to residents, fellows and staff members in the clinical departments of Massachusetts General Hospital via clinical consultations and interdisciplinary conferences.

Facilities

The Massachusetts General Hospital, founded in 1811, is Harvard Medical School's original teaching hospital. Its bed capacity is 925. During 2008, Pathology Service examined more than 68,000 surgical pathology specimens, 44,500 gynecologic and 14,000 nongynecologic cytopathology specimens, 5,000 fine needle aspirations, and performed 277 autopsies.

In addition, the staff of the Pathology Service receives over 10,000 unusual anatomic pathology cases each year in consultation from hospitals throughout the world. The MGH also performs more than 9,000,000 clinical laboratory studies per year, including many highly esoteric tests requiring substantial expertise for interpretation. Library facilities include the Pathology Service's Mallory Library, the Hospital's Treadwell Library and Harvard Medical School’s Countway Library, which is among the world's largest medical reference libraries. The Pathology Service has research facilities both at the MGH main campus and at MGH East in Charlestown. MGH East is a 400,000-square-foot research complex, which includes Cancer and Neuroscience Centers.

Community

Boston and its surrounding communities have a total population of over three million, the sixth largest metropolis in the nation. The hospital is situated in the center of Boston, on the Charles River at the foot of Beacon Hill, convenient to rapid transit and the airport. The Brigham and Women's Hospital and Dana Farber Cancer Institute are located in the Longwood medical area two miles away; a frequent shuttle service operates between these institutions and the Massachusetts General Hospital. The city has many universities and cultural facilities, including the Boston Symphony, Boston Ballet, and several theater companies. The geographic location is remarkable from a recreational viewpoint, for its proximity to forests, lakes, mountains, and seashore.

Stipends

Fellows are paid in accordance with their PGY level. Travel and book allowances are provided. Health insurance, long-term disability and life insurance are provided at a reasonable cost.

Requirements

Applicants for fellowships in Cytopathology, Dermatopathology, Hematopathology and Neuropathology must 1) have completed residency training in Anatomic Pathology or in Anatomic and Clinical Pathology acceptable to the American Board of Pathology, and 2) be eligible both for medical licensure and employment in Massachusetts.

Applicants for fellowships in Molecular Genetic Pathology must 1) have completed residency training in Anatomic Pathology, Clinical Pathology or Anatomic and Clinical Pathology acceptable to the American Board of Pathology, and 2) be eligible both for medical licensure and employment in Massachusetts.

Applicants for fellowships in Transfusion Medicine must 1) have completed residency training in Clinical Pathology or in Anatomic and Clinical Pathology acceptable to the American Board of Pathology, and 2) be eligible both for medical licensure and employment in Massachusetts.

Applicants for fellowships in Subspecialty Surgical Pathology must 1) hold certification in Anatomic Pathology or in Anatomic and Clinical Pathology from the American Board of Pathology or be eligible to sit for the certification examination given by the American Board of Pathology, and 2) be eligible both for medical licensure and employment in Massachusetts.

Informatics Pathology candidates should have completed their residency training in anatomic, clinical or combined anatomic/clinical pathology, with primary certification or eligibility by the American Board of Pathology. If a graduate of an international medical school, the candidate should have a valid ECFMG certificate and visa. In some cases however, fellows will be accepted before they are Board eligible. Such candidates must qualify for a limited (training) license in Massachusetts, present compelling reasons that the fellowship should be done prior to finishing residency, and have concrete plans for finishing their pathology residency training.

Applications

Please refer to the "Applications" section of the Individual Fellowships below.

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Fellowship in cytopathology

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Description

The Cytopathology Fellowship at MGH, a one-year, ACGME-approved program, provides advanced training in diagnostic cytopathology under the supervision of 11 staff cytopathologists.  The goal of the program is to train cytopathologists who will become leaders in the field.  Whether the candidate intends to practice in an academic setting or in a community based practice, the combination of clinical, teaching and research opportunities will prepare the trainee for any eventuality.

In 2008, the Cytopathology Laboratory handled more than 61,000 cases, of which approximately 14,000 were non-gynecologic and about 5,000 were fine needle aspirations, including 800 fine needle aspirations performed by the cytopathologists in the FNA clinic. 

After an introductory period, the fellows are given gradually increasing responsibility in cytopathology with appropriate supervision, as well as the possibility of limited surgical pathology sign-out responsibility. Work-up of clinical cases is facilitated by a modern pathology information system that is integrated into the hospital information and electronic record systems. Cytopreparatory techniques are taught in a short laboratory rotation. Training also includes performance of superficial fine needle aspiration biopsies after instruction by the staff, rapid interpretation of deep needle aspirations performed by the radiologists, interpretation of ancillary tests including immunocytochemistry, flow cytometry, fluorescence in-situ hybridization, electron microscopy and molecular techniques. Aspects of quality assurance and laboratory management are integrated throughout the year.

Teaching responsibilities that include individual resident teaching, lectures and journal club presentations are incorporated into the program. An emphasis is placed on refinement of communication and teaching skills whether dealing with pathology colleagues, clinicians, patients or families. Fellows are encouraged to design and complete a research project, either a clinicopathologic study or a project utilizing the extensive research resources of the department. Most often the work is presented at national pathology meetings. 

Finally, fellows are encouraged to join and to actively participate in national cytopathology and pathology organizations so as to develop confidence in their ability to influence the current and future practice of their profession.

Structure of the Cytopathology Fellowship

In order to develop diagnostic acumen, the fellow spends approximately half of the year on cytopathology signout. Although always under supervision, the fellow is the primary cytopathologist in charge of cytology cases along with the accompanying surgical pathology, either cellblocks or core biopsies, and is responsible for professional communication with clinicians, radiologists and cytotechnologists and for timely completion of signout.  The fellow will spend 4 weeks in the cytopathology division of the Brigham and Women's Hospital in order to be exposed to a varied case mix and to alternate methods in laboratory management and cytopreparatory techniques. The fellow will spend, under supervision, at least 4 weeks in one or more of the sub-specialized areas of surgical pathology signout at MGH.  As much as possible, the area will be chosen according to the desires of the fellow. Outside of the four weeks of vacation, the fellow will spend the remainder of the year working on projects.  Duty hours are 8 am to usually 6 pm, but no later than 9 pm, Monday to Friday.  There is no night or weekend call responsibility.

Faculty

Rosemary H. Tambouret, MD, Program Director
David C. Wilbur, MD
Jian Shen, MD, PhD
Martha B. Pitman, MD
Joseph Misdraji, MD
William Faquin, MD, PhD
John Eichhorn, MD
Vikram Deshpande, MD
Elena Brachtel, MD
W. Stephen Black-Schaffer, MD
Ronald Balassanian, MD

Requirements

Applicants must be Board-certified or eligible for certification in AP or AP/CP, and if a graduate of an international medical school, have a valid ECFMG certificate.  The candidate must also be eligible for employment in Massachusetts and obtain a Massachusetts medical license prior to starting the fellowship.

Community

Boston and its surrounding communities have a total population of over three million, the sixth largest metropolis in the nation.  The city has many universities and cultural facilities, including the Boston Symphony, Boston Ballet, and several fine theater companies.  The Massachusetts General Hospital is situated in the center of Boston, at the foot of Beacon Hill on the Charles River, convenient to rapid transit, downtown, and the airport.

Stipends

Commensurate with the candidate’s level of postgraduate training.

Applications

Applications should be submitted by December 1 (18 months prior to start date; Fellowships usually commence on July 1) .

Individuals interested in applying for a fellowship position should send their Curriculum Vitae and a brief personal statement of interest and qualifications, USMLE transcript, with letters from three referees including their training program director or pathology supervisor to:

Joan Ricker, Fellowship Program Administrator
Pathology Service, Massachusetts General Hospital
55 Fruit Street
Warren 219
Boston, MA  02114-2696

Telephone:  (617) 643-4482
Fax:    (617) 643-4045
E-mail:  jaricker@partners.org

Rosemary H. Tambouret, MD, Program Director

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Fellowship in Dermatopathology

(a Harvard Joint Program) 

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Description

The Harvard Dermatopathology Program is ACGME accredited to train residents and fellows in dermatopathology.  The program draws on the facilities of the Beth Israel Deaconess Medical Center, the Brigham and Women's Hospital, and the Children's Hospital Boston, as well as the Massachusetts General Hospital.  The normal period of training is one year, but two-year training is considered in some circumstances.  Research and/or clinical fellowships are also available.  Residents enter the program eligible for Board certification in dermatology or pathology and receive six months of complementary training in pathology or clinical dermatology, respectively.  Additionally, fellows take required training in basic dermatopathology, dermatoimmunopathology, immunofluorescence, microbiology/ mycology, tissue processing for both routine and specialized microscopy, diagnostic electron microscopy, immunocytochemistry, and laboratory management.  Clinical and basic research are conducted throughout the program.  Residents and fellows have the opportunity to attend varied clinical and pathological diagnostic conferences, and teach in the training programs offered to students, residents, and postgraduates.

Requirements

Applicants must be Board-certified or eligible for certification in Pathology or Dermatology and have a full Massachusetts license prior to starting the fellowship, and, if an international medical graduate, have a valid ECFMG certificate and visa.

Types and Numbers of Appointments

Three dermatopathology fellowship positions are available.  Fellowships in research are also available with staff at the various institutions of Harvard Medical School.

Facilities

The Massachusetts General Hospital, the Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, and the Children's Hospital Boston provide total program resources of about 3,000 beds and 250,000 surgical pathology specimens, of which 25,000 are skin biopsies.  In addition, there are approximately 90,000 referred dermatopathology specimens.  The dermatology clinics at three institutions have a total monthly patient census of approximately 15,000.  Research facilities available at each participating institution include specialized histology laboratories, transmission and scanning electron microscopes, and laboratories for immunocytochemistry, including immunofluorescence and molecular biologic studies and laser capture microdissection and genetic profiling using microarrays.  There are libraries in all participating Pathology and Dermatology departments and at the individual institutions.  The Harvard Medical School’s 500,000-volume collection, housed at the Countway Library, is adjacent to the Longwood area hospitals.

Faculty

Steven Tahan, MD, Program Director (Beth Israel Deaconess Hospital)
Lyn Duncan, MD
Mai Hoang, MD
Martin Mihm, Jr., MD
Adriano Piris, MD

Applications

Applications should be submitted by November 15 of the previous year (19 months prior to start date; Fellowships usually commence on July 1).

Applications should be addressed to:

Joan Allin, Fellowship Training Program Administrator
Beth Israel Deaconess Medical Center
330 Brookline Avenue, East Campus, Room SH-177
Boston, Massachusetts 02215
Telephone:  (617) 667-7284
FAX: (617) 667-7120
e-mail:      jallin@bidmc.harvard.edu

Program Director
Steven Tahan, MD (Beth Israel Deaconess Hospital)

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Fellowship in Hematopathology

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Description

The Hematopathology program at the MGH seeks to train individuals who will become leaders in the field of hematopathology. Leadership can involve generation of new knowledge in the form of basic or clinical research, dissemination of knowledge through teaching of medical students, trainees, or practitioners of either pathology or clinical medicine, and the provision of high-quality, state-of-the-art patient care. The philosophy of post-graduate Pathology training in our department is based on the premise that trainees learn best by being exposed to a wide variety and large volume of clinical material and by having a level of responsibility appropriate to their level of experience. An appropriate service workload and level of responsibility must stretch the trainee’s capabilities in order to strengthen them, but should not overload them. Training in both the Anatomic and Clinical Laboratories involves consistent exposure to and responsibility for clinical specimens, with supervision and backup from faculty. The trainee’s involvement with challenging consultation cases from pathologists around the world gives him/her insight into some of the most difficult issues in hematopathology diagnosis as well as the role academic institutions play in making their expertise available to other institutions within the health care delivery system. Communication with clinical colleagues in the course of patient care is an important part of this experience. Fellows are given enough responsibility to test their knowledge and decision-making capacities. Every case and every decision is reviewed by a senior pathologist, who corrects and gives feedback on the fellow’s judgments and performance. In this way, the interests of patient care are served and the fellow's communication skills and overall professional development are monitored. Fellows must also learn to critically evaluate the literature, practice evidence-based medicine, and present laboratory and other data at conferences; these activities are incorporated into the daily responsibilities of our trainees. Fellows are expected to design and carry out at least one independent clinical or basic research project, thereby teaching them the use of scientific evidence and application of research methods to advance the field.

Goals and Objectives

• To develop medical knowledge in the techniques of bone marrow aspiration and biopsy and their interpretation, lymph node interpretation, coagulation testing, cell analysis systems, peripheral smear and body fluid morphology interpretation, and the applications of advanced technology (including in-situ hybridization, immunocytochemistry, cytogenetics, and molecular diagnosis), to hematologic problems of both adults and children.

• To become proficient in the diagnosis and classification of hematologic malignancies, and of non-neoplastic diseases of hematopoietic and lymphoid tissues and peripheral blood.
  
  
• To be able to effectively and in a timely fashion communicate hematopathologic diagnoses by formulating an interpretive report that will provide, in a clear, concise, and complete form, the information needed by clinicians to proceed in the management of the patient .
  
  
• To learn the appropriate, cost-effective performance and interpretation of techniques utilized in the diagnosis of hematologic diseases, including cytochemistry, flow cytometry, immunohistochemistry, cytogenetics, fluorescence in-situ hybridization (FISH), molecular diagnostics, automated cell counting, hemoglobin electrophoresis, and coagulation testing, and to understand the role of these tests in the overall health care delivery system.
  
  
• To be able to use effectively hospital information technology systems to construct and communicate hematopathologic diagnoses, including integrating laboratory studies and clinical information with morphologic findings and proficiently using pathology information systems.
  
  
• To become a proficient communicator in the presentation of information at clinical conferences and scientific meetings.
  
  
• To learn to professionally interact with and effectively teach residents, medical students, clinical colleagues, and ancillary laboratory staff and to respect the input and effectively learn from other members of the health care system.
  
  
• To be able to effectively access pertinent scientific literature, analyze the literature critically, integrate new information in an ongoing fashion into diagnostic decision-making, and use systems-based resources to improve one's practice.
  
  
• To have an understanding of the principles of clinical investigation, including the ability to design, carry out and publish studies using patient-related information to advance knowledge or to disseminate existing knowledge in the specialty.
  
  
• To develop an understanding of issues involved with managing a diagnostic hematopathology service, a flow cytometry laboratory, and a hematology/coagulation laboratory and to understand the function of these services in the hospital and overall health care delivery system

Structure of the Hematopathology Program

The most difficult area of hematopathology is the diagnosis and classification of hematologic malignancies and their precursors in bone marrow, lymph nodes and other tissue biopsy specimens. To acquire proficiency in this area requires consistent supervised exposure to diagnostic specimens over as long a period as possible. For this reason, the largest amount of time in the 1-year program is spent on the Hematopathology Service. This service is responsible for all bone marrow, lymph node, spleen, and thymus specimens, as well as blood and body fluid specimens requiring pathologist interpretation and specimens from other services with extranodal lymphoid infiltrates and lymphomas. The fellow is assigned to this service for 28 weeks, spread throughout the 12-month fellowship. The remaining weeks include assigned time to be spent in the other laboratories (Hematology, Coagulation, Flow Cytometry, Immunopathology, Molecular Diagnostics and Cytogenetics) and on a clinical service (Leukemia, Lymphoma, Bone Marrow Transplant, and/or Hematology Consult), as well as unscheduled weeks that can be used for in-depth involvement in ongoing research projects, rotations at other institutions or laboratories of interest to the trainee (to be set up in consultation with the Program Director), and/or additional experience on Hematopathology or another service.

The fellowship Core Curriculum encompasses 43 weeks for fellows with AP/CP background (45 weeks for fellows with AP only background) in the following rotations:

Hematopathology (28 weeks)
Flow cytometry (2 weeks)
Laboratory Hematology (2 weeks for fellows with AP/CP background, 4 weeks for fellows with AP only background)
Coagulation Laboratory (4 weeks)
Immunopathology (1 week)
Leukemia/Lymphoma/Hematology Clinical Rotation (2 weeks)
Molecular Diagnostics (2 weeks)
Cytogenetics(2 weeks)

Exclusive of 4 weeks of vacation, the remaining 5 weeks (3 weeks for fellows with AP only background) are devoted to elective time on research projects, review of hematopathology consultation cases, and/or additional elective time in one of the core areas. 

Graduated responsibility

As the year progresses, the fellow is encouraged to write complete reports and to communicate preliminary results to clinicians. The fellow will provide backup and supervision for the residents on the service in gross and microscopic interpretation, in handling calls regarding specimens, and in presenting at clinicopathologic conferences. In the final 6 months of the fellowship, each fellow spends two weeks performing independent Hematopathology signout with the residents, showing cases to the attending only when problems are encountered.  This responsibility includes teaching individuals at various levels (medical students, junior residents, senior residents on electives, and visiting pathologists) who may participate in hematopathology signout. All cases are reviewed subsequently by the attending and countersigned, but the expectation is that no changes should be necessary to specimens that the fellow thinks are straightforward; major changes are reviewed together with the fellow and supervising attending. In this way, the fellow and the faculty will be able to assess the fellow’s ability to function independently, while maintaining an adequate level of supervision.

Faculty

Robert P. Hasserjian, MD
Hematopathology Fellowship Program Director

Nancy Lee Harris, MD
Director of Hematopathology

Judith Ferry, MD
Frederic Preffer, PhD
Aliyah Sohani, MD
Elizabeth Van Cott, MD
Lawrence Zukerberg, MD

Requirements

Applicants must be Board-certified or eligible for certification in AP or AP/CP, and if a graduate of an international medical school, have a valid ECFMG certificate and visa and have a Massachusetts license prior to starting the fellowship.

Types and Numbers of Appointments

There are two Hematopathology fellowship positions each year. 

Through the individual components of the fellowship over the course of the year, the fellow is expected to develop competency in (and is continually evaluated in) the following:
1) patient care (case ownership, responsibility, and teamwork),
2) medical knowledge in all aspects of hematopathology,
3) the ability to continually learn and improve his/her practice (by analyzing his/her own clinical and research experiences, incorporating information from didactic lectures, conferences, and evaluations, and practicing evidence-based medicine),
4) interpersonal and communication skills (teaching, learning, clear diagnosis, and effective interaction with patients and members of the health care system),
5) professionalism (ethical behavior, maturity, and respect for patients and members of the health care system),  and
6) systems-based practice (using hospital and pathology information systems, practicing cost-effective care, and understanding the role of hematopathology in the hospital and overall health care system).

Applications

Applications should be submitted by December 1 (18 months prior to start date; Fellowships usually commence on July 1) .

Interested applicants should send a current CV, a copy of their USMLE transcript, a one-page personal statement concerning their interest in hematopathology, and three letters of reference (including one from their residency program director or department chief) to:

Joan Ricker, Fellowship Program Administrator
Pathology Service, Massachusetts General Hospital
55 Fruit Street, Warren 219
Boston, Massachusetts 02114-2352.

Telephone:  (617) 643-4482
Fax:    (617) 643-4045
E-mail:  jaricker@partners.org

Program Director:
Robert P. Hasserjian, MD
Director, Hematopathology Fellowship
Associate Director for Recruitment, Pathology Residency Program
Pathology Service - WRN 219
Massachusetts General Hospital
55 Fruit Street
Boston, MA 02114

Telephone: (617) 724-1445
Fax: (617) 726-7474
E-mail: rhasserjian@partners.org

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Fellowship in Molecular Genetic Pathology

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Description

The Harvard Medical School Molecular Genetic Pathology Training Program represents a collaboration of the major Harvard teaching hospitals. The overall goals of this one-year accredited training program are:

• Provide extensive training in broad areas of molecular diagnostics and molecular genetics including inherited genetic disorders, disorders of human development, infectious disease, neoplasia, and identity testing.

• Provide training in the performance and interpretation of molecular, cytogenetic and biochemical laboratory tests.

• Provide training as a medical consultant in Molecular Genetic Pathology to assist clinicians in the diagnosis and care of patients.

• Provide training and direct exposure to laboratory management, quality-assurance, troubleshooting of molecular tests, assay development and evaluation, and instrument evaluation.

• Provide training and direct exposure to clinical genetic practice through active participation in genetics clinics with the aim of better understanding the clinical implications of genetic testing.

• Ensure that the fellows achieve the following:

  • Acquire a sound knowledge base of the basic science of molecular biology and molecular genetics.

  • Learn to integrate molecular and clinical data and calculate genetic risk.

  • Develop research skills and participate in a research project.

  • Demonstrate good communications skills with laboratory and clinical physicians, patients, technologists, and ancillary staff.

  • Demonstrate sensitivity to ethical issues in genetics, particularly those raised by molecular diagnostic testing.

Requirements

Board-eligible or certified in Pathology or Medical Genetics. Applicants must be eligible for a Massachusetts medical license.

Stipends

Commensurate with level of post-graduate training.

Curriculum

The trainees rotate through 10 active molecular diagnostic laboratories at four Harvard-affiliated teaching hospitals, including the Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Children's Hospital and the Massachusetts General Hospital and participate in the respective pathology departments. Fellows also actively participate in genetics clinics at these institutions and the Dana-Farber Cancer Center. The fellowship is integrated with the HMS Genetics Training Program and shares a year-long didactic program.

Core Pathology Faculty
There are more than 40 faculty members. Representative faculty include:
Brigham and Women's Hospital
Janina Longtine, MD, Program Director
Frederick Bieber, PhD
Frank Kuo, MD, PhD
Jeffery Kutok, MD, PhD
Azra Ligon, PhD
Neal Lindeman, MD
Edgar Milford, MD
Shuji Ogino, MD, PhD
Andrew Onderdonk, PhD
Beth Israel Deaconess Medical Center
Olivier Kocher MD, PhD
James Kirby MD
Children’s Hospital
Bai-lin Wu, PhD
David Harris, MD
Dana Farber Cancer Institute
Judy Garber, MD
Sapna Syngal MD, MPH
Massachusetts General Hospital
David N. Louis MD
A. John Iafrate, MD, PhD
Eric Rosenberg, MD
Vivian Shih, MD
Katherine Sims, MD
Winnie Xin, PhD

Applications

Applications should be submitted by December 31 (18 months prior to start date; Fellowships usually commence on July 1).

Address inquires to:

Janina A Longtine, MD
Chief, Molecular Diagnostics
Department of Pathology
Brigham and Women's Hospital
75 Francis Street
Boston, MA 02115
Phone: 617-732-7444
Fax: 617-730-2894
Email: JLongtine@Partners.org

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Fellowship/Residency in Neuropathology

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Description

The Neuropathology Program at the Massachusetts General Hospital seeks to train individuals who will become leaders in Neuropathology through combinations of basic or clinical research, teaching and the provision of high-quality, state-of-the-art patient care. The philosophy of post-graduate pathology training at MGH is based on the premise that trainees learn best by being exposed to a wide variety and large volume of clinical material, with a level of responsibility appropriate to their level of experience.

The training program in Neuropathology is a two year ACGME-accredited program that involves consistent exposure to, and responsibility for, clinical specimens, with supervision and backup from senior trainees and faculty. Interaction with other clinical service in the hospital during the course of patient care is an important part of this experience.  Fellows are given graded responsibility to test their knowledge and decision-making capacities.  They also learn to evaluate the literature critically, integrate new knowledge into their practice, and present this data at clinical conferences.  Trainees are expected to teach in the second year neuroscience course at Harvard Medical School and to design and carry out at least one independent clinical or basic research project.

Goals and Objectives:

• To develop knowledge and skills in the techniques and interpretation of frozen section and intraoperative smears and the applications of advanced technology, including image analysis, immunocytochemistry, and molecular diagnostics to neurologic problems of adults and children.
  
  
• To become proficient in the diagnosis and classification of nervous system neoplasms and of non-neoplastic diseases of brain, spinal cord, muscle and nerve and to be able to effectively communicate these diagnoses to clinical staff.
  
  
• To learn the performance and interpretation of special techniques utilized in the diagnosis of these diseases, including immunohistochemistry and molecular diagnostics.
   
• To be able to integrate laboratory information, including morphology and basic and advanced laboratory studies and clinical information, and formulate an interpretive report that will provide, in a clear, concise, and complete form, the information needed by clinicians to proceed in the management of the patient.
  
  
• To become proficient in the presentation of information at clinical conferences and to have the opportunity to present at local and national meetings.
  
  
• To interact with and effectively teach residents, medical students, clinical colleagues, and ancillary laboratory staff.
  
  
• To analyze the literature critically, integrate new information into clinical practice, and use systems-based resources to improve diagnostic skills.
  
  
• To have a basic understanding of the principles of clinical investigation: to design, carry out and publish a study using patient-related information to advance knowledge or to disseminate existing knowledge in the specialty.
  
  
• To develop an understanding of laboratory management issues appropriate to a diagnostic Neuropathology service. 

Structure of the Neuropathology Program

The Neuropathology program is a two year training program, designed to be entered either after two years of Anatomic Pathology training (AP/NP path approved by the American Board of Pathology) or after completion of Anatomic Pathology or Anatomic and Clinical Pathology training. The Neuropathology Service examines about 1500 surgical specimens per year including over 500 intraoperative consultations, 100 muscle biopsies and around 20 nerve biopsies and about 200 brains. Training during the first year is predominantly focused on classification and diagnosis of neoplasms as well as medical diseases of the nervous system.  In addition, the first year includes a one month rotation at Children’s Hospital to expand experience with pediatric and developmental neurological diseases and neuropathology.  Trainees present at hospital-wide patient-oriented conferences as well as in teaching conferences for other trainees.  Additional teaching experience comes when fellows teach in the Neuroscience Course at Harvard Medical School as laboratory instructors.  The second year, the trainees are appointed as the Alzheimer Disease Research Center (ADRC) Neuropathology Fellow and are responsible for the processing and analysis of 65-70 brains with a wide variety of neurodegenerative disorders that are received by the ADRC Brain Bank.  This allows them to develop experience in the current diagnosis of neurodegenerative diseases, while they continue their experience in surgical neuropathology and frozen section diagnosis.

Graduated responsibility

Fellows take on the responsibility for assisting in the training and teaching of residents from other training programs, including within the MGH Pathology Departments (AP or AP/CP residents) and from Neurology (both adult and pediatric services).  As the year progresses, the fellow is encouraged to write complete reports and to communicate preliminary results to clinicians.  In the final 2-3 months on the Neuropathology service, the fellow is given the opportunity to sign out cases independently, showing cases to the attending only when problems are encountered. The attending subsequently reviews and countersigns all cases, but the expectation is that no changes should be necessary to cases that the fellow thinks are straightforward. In this way, the fellow and the program will be able to assess the fellow’s ability to function independently, while maintaining an adequate level of supervision.

Requirements

Applicants must have completed two years of Anatomic Pathology training or be eligible for certification in AP, AP/CP, Neurology or Neurosurgery.  Applicants should have already passed USMLE Part 3.  Graduates of an international medical school must also have a valid visa and ECFMG certificate.
Types and Numbers of Appointments:
There is one first year and one second year fellow each year.  Normally one Neuropathology fellowship position is available per year, although the program is approved for a total three trainees at any one time. 

Faculty

Matthew P. Frosch, MD, PhD, Associate Professor of Pathology; Chief, Neuropathology Service and Training Program Director
E. Tessa Hedley-Whyte, MD, Professor of Pathology
David N. Louis, MD, Professor of Pathology; Chief, Pathology Service
Anat Stemmer-Rachamimov, MD, Assistant Professor of Pathology

Applications

Applications for combined AP/NP training should be submitted through the NRMP as described for the AP program, with indication that they wish to be considered for this combined training program.  For potential candidates who are already engaged in residency training (AP, AP/CP, Neurology or Neurosurgery), inquiries should be made as early as feasible since positions are often filled several years in advance.  Applicants should send a current CV, 1-page personal statement concerning their interest in Neuropathology, and three letters of reference to:

Matthew P. Frosch, MD, PhD
Program Director, Neuropathology Fellowship Training
Massachusetts General Hospital, Warren 325
55 Fruit Street, Boston, Massachusetts 02114
Telephone:   (617) 726-5156
Fax:   (617) 724-1813
e-mail: mfrosch@partners.org

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FELLOWSHIP IN PATHOLOGY INFORMATICS

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Goals and Description:

The Pathology Informatics Program at the Massachusetts General Hospital seeks to train pathologists to become leaders in Informatics and imaging. Our educational philosophy considers informatics a part of pathology practice and central to pathology’s future, and our program’s architecture provides exposure to a wide variety of clinical operations, research consistent with long term career goals, a national vision, multiple, independent faculty, and a level of responsibility appropriate to experience and skill.

After finishing the MGH Pathology Informatics Fellowship, fellows should be able to:

• Effectively lead the pathology informatics service at a major medical center, plan and execute the long term evolution and growth of such a service and effectively represent pathology informatics at any level of the medical enterprise

• Have a deep understanding of an important area of pathology informatics and have the skills necessary to execute a successful academic/research career

• Have significant experience with national and international working groups in pathology informatics

Consistent with our philosophy and goals, the program has developed a number of unique approaches including:

The program includes training integration with the Departments of Pathology at Brigham and Women's Hospital, the Beth Israel Deaconess and the North Shore Medical Center. Rotating through these competing and collaborating institutions, fellows experience a very wide range of issues, systems and approaches, and they also develop a wide, general understanding of operational informatics. This existing collaboration is being formalized as a integrated fellowship, probably in 2010

The program supports a customized research concentration for all Fellows. Fellows choose an area of informatics and the program makes available multiple, independent research mentors, laboratories, classes and one or more projects in that area. Potential research concentrations include imaging, support for translational research, clinical communications, and molecular informatics. Concentrations are designed to create deep understanding and academic leadership.

The program expects fellows to take active participation in national pathology informatics activities. Fellows will attend the major pathology informatics meetings (APIII and Lab Infotech Summit) and will join at least one international working group such as DICOM WG 26 or the HL7 Pathology SIG.

Structure of the Program:

The program is based on a set of operational meetings, didactic symposia, working groups and a research concentration under multiple faculty members. These include:

Director’s Meetings

Weekly meetings with the Director and Executive Council (see below) that focused on the growth and long term goals of the fellows.

Operational Meetings

Operational meetings are the venues in which a Director of Pathology Informatics manages and leads the clinical informatics activities of a department. There are approximately five such meetings per week and tend to be based on specific systems or projects. Fellows will attend the operational meetings of the hospital they are rotating through, giving them a wide range of experience in clinical operations.

Local and National Informatics Symposia

Informatics Symposia are groups of didactic lectures in various aspects of informatics. There are at least five symposia per year for a total of approximately 45 lectures. Local symposia are supplemented by attendance at the major pathology informatics conferences APIII (apii.upmc.edu) and Lab Infotech Summit.

National and International Working Groups

An important goal of the fellowship is to produce pathologists who will be national and international leaders in pathology informatics. To this end, fellows will be expected to join and attend at least one national or international working group. This is done through our faculty who are members of such groups including the HL7 Pathology SIG, the DICOM Pathology Working Group, the College of American Pathology Informatics Working Group and the WHO/ITU group on Health Care Informatics in Developing Countries.

Diagnostic Pathology Conferences

The Clinical Fellows in Pathology Informatics are pathologists and as such may choose to attend selected pathology teaching conferences at the Massachusetts General Hospital, the Brigham and Women's Hospital and the Beth Israel Deaconess Medical Center.

Research Concentration

Very early in their term, fellows will work with the executive council and the faculty to select a research concentration: a year long set of classes, rotations and research projects in a specific area of informatics or imaging. Ideally these concentrations will include projects in multiple independent laboratories under multiple independent faculty members and will provide both a breadth and depth of understanding in the field. Potential concentrations include imaging (in vitro and in vivo, absorption and phase), pathology support for translational research (tissue banking, outcomes and clinical research laboratory informatics), clinical operations (design of LIS systems, workflow engines, informatics management of the total testing cycle and the use of structured data), molecular pathology informatics, etc.

This combination of meetings, didactics, conferences and concentrations, combined with the strength of our faculty (vide infra), results a program that is both grounded in the operations, needs and interests of the diagnostic laboratory, and incorporates the resources, facilities and faculty of four independent (competing and collaborating) pathology departments, two health systems, two major universities and international working groups. The goal is to provide the pathology informatics trainee unparalleled breadth and depth of operational and research experience.

Faculty

In line with its goals and structure, the program incorporates faculty and leadership from the Massachusetts General Hospital, the Brigham and Women's Hospital, the Beth Israel Deaconess Medical Center and the North Shore Medical Center.

Executive Council

John Gilbertson, MD; Director of Pathology Informatics, MGH - Director of the Informatics Fellowship
Frank Kuo, MD PhD; Director of Pathology Informatics, BWH
Mark Boguski, MD; Director of Pathology Informatics, BIDMC
Bruce Beckwith, MD; Chief of Laboratory Medicine, NSMC

Independent Faculty

Pathology informatics faculty members hold academic positions at Harvard Medical School and/or the Harvard-MIT Division of Health Sciences and Technology (HST), run their own independent research and/or clinical operations and publish extensively in areas of informatics and imaging.
 
The current faculty includes:

Kamran Badizadegan, MD
Bruce Beckwith (NSMC)
Mark Boguski (BIDMC)
Lynn Bry, MD PhD, (BWH)
Anand Dighe, MD PhD
John Gilbertson, MD
Tom Gudewicz, MD
Frank Kuo, MD PhD
James Michaelson, PhD
Gary Tearney, MD PhD
David Wilbur, MD
Yukako Yagi, PhD

Requirements

Candidates should have completed their residency training in anatomic, clinical or combined anatomic/clinical pathology, with primary certification or eligibility by the American Board of Pathology. If a graduate of an international medical school, the candidate should have a valid ECFMG certificate and visa. 

In some cases however, fellows will be accepted before they are Board eligible. Such candidates must qualify for a limited (training) license in Massachusetts, present compelling reasons that the fellowship should be done prior to finishing residency, and have concrete plans for finishing their pathology residency training.

Types and Number of Appointments:

The fellowship is normally for one year. However, we will work with candidates that might be interested in a six month or two year program.  The number of appointments available at a given time is variable, please contact the Program Director (vide infra).

Applications

Applications should be submitted by December 1, (18 months prior to start date; Fellowships usually commence on July 1.)

Interested candidates should contact the Program Director, John Gilbertson MD, at jrgilbertson@partners.org.

Interested applicants should send a current CV, a copy of their USMLE transcript, a one-page personal statement concerning their interest in Informatics, and three letters of reference (including one from their residency program director or department chief) to:

Joan Ricker, Fellowship Program Administrator
Pathology Service, Massachusetts General Hospital
55 Fruit Street, Warren 219
Boston, Massachusetts 02114-2352.
Telephone:  (617) 643-4482
Fax:    (617) 643-4045
E-mail:  jaricker@partners.org

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Fellowship in Subspecialty Surgical Pathology      

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Scope of Training

Pathology Service at the Massachusetts General Hospital offers a one-year fellowship program in subspecialty surgical pathology.  The goal of this fellowship is to combine in-depth training in various subspecialties of surgical pathology with opportunities for conducting related research, and provide a basis for a future career in academic pathology. 

The one-year fellowship is centered on active clinical services with outstanding diagnostic material to enhance the experience of the fellow.  It provides an opportunity to conduct clinicopathological and translational research in the chosen area of subspecialty interest with pathology faculty members and clinical physicians.

Fellows are encouraged, and expected, to prepare one or more abstracts for presentation at annual national or international meetings and such as those of the International Academy of Pathology and its US-Canadian division.

Number of training positions available per year/per program year

Fellows may be involved in either one or up to three specialty areas including breast, bone and soft tissue, cardiovascular, ear, nose, and throat, gastrointestinal, genitourinary, gynecologic, obstetric and perinatal pulminary, and renal pathology.

Graduated responsibility

An attending pathologist reviews and countersigns all cases for at least the first two weeks of a service, but the expectation is that no changes should be necessary to cases that the fellow thinks are straightforward. In this way, the fellow and the program will be able to assess the fellow’s ability to function independently, while maintaining an adequate level of supervision until completely unsupervised signout is approved.

Requirements

Applicants must be Board-certified or eligible for certification in AP or AP/CP, and if a graduate of an international medical school, have a valid O visa, H visa or permanent residency and ECFMG certificate and have a full Massachusetts license prior to starting the fellowship.

Program list of program faculty (only senior pathologist in each subspecialty area of anatomic pathology is listed):

Robert B. Colvin, MD  (Medical Renal)
Gregory Y. Lauwers, MD   (Gastrointestinal)
Eugene Mark, MD   (Pulmonary)
Ben Z. Pilch, MD (Head and Neck)
Drucilla Roberts, MD (Obstetric and Perinatal)
G. Petur Nielsen, MD (Bone and Soft Tissue)
Dennis Sgroi, MD (Breast/Women's cancers)
James Stone, MD  (Cardiovascular)
Robert H. Young, MD (Gynecologic and Urologic)

Supervision of the fellow by the faculty

The fellows are supervised by the subspecialty unit directors (see above) and the director of Subspecialty Surgical Pathology (Gregory Y. Lauwers, MD).

Schedule, format and content of didactic activities

The clinical teaching is assumed by various faculty members.  During the week of clinical service by the fellow, the faculty will countersign the diagnosis for at least the first 2 weeks.  During a typical signout week, the fellow reviews cases and makes diagnoses independently (reviewing with residents).  The staff will review the cases during a one-on-one session and reassess the original diagnoses.   This will amount to about 2 to 3 hours of didactic teaching.  After evaluation of the progress of the fellow, she/he will be progressively allowed to sign out independently.

The fellow will be expected to participate in all educational activities of the subspecialty group, including but not limited to journal clubs, and various conferences with clinicians.

While covering the clinical service, the fellow will perform literature searches and review articles when appropriate to research questions about current cases and to develop ideas for projects.  The fellow has the opportunity to present the pathology at one of the weekly Clinicopathologic Conferences (published in the New England Journal of Medicine).  Other activities will combine attendance at conferences, research and teaching of residents.

An organized schedule of activities is planned on a 6-month basis.  The fellows are expected to attend all educational meetings and to be responsible for clinical conferences when on service.

Typical Daily Schedule When on Signout

Description of basic science and/or clinical research requirements and opportunities

The fellow is actively expected to assume 2 clinical projects per year.  The department offers ample opportunities for special studies including extensive availability of immunohistochemistry and molecular diagnostics. Translational and/or clinical research may be undertaken as part of the ongoing investigative programs in Pathology Services, or as part of the programs within the numerous laboratories in the Departments of Surgery and Medicine. To support these research projects, grants are available.

Responsibilities of the fellow, including teaching responsibilities

The Pathology service supports numerous teaching and educational activities.  Those include: 1) review of cases at the daily surgical pathology conferences; 2) attendance at the weekly molecular pathology and research conference;  3) subspecialty presentations to the residents; 4) attendance at several Harvard Medical School postgraduate courses on  Surgical Pathology.  The fellows are responsible for teaching residents through signout and presentation at the surgical pathology conference and regularly presenting cases at conferences with clinicians.

Vacation time/Personal Time:      Four weeks per year.       

Curriculum

Educational goals and objectives for the fellows to become competent diagnostic pathologists, through the acquisition of skills, knowledge and judgment reviewing approximately 4000 specimens per year depending on the particular subspecialty(s).

Trainee Selection

The subspecialty faculty and the fellowship committee review applications, and selection is based on proof of interest in the chosen subspecialty, quality of training in surgical pathology, letters of support, and potential for independent research.

Evaluation Procedures

The fellow meets twice a year with the program supervisor of the fellowship to evaluate his/her progress. Written evaluations are given to the fellow twice a year and they are kept in the fellow’s file.

Appointment

• Hospital appointment given to the fellow: Graduate Assistant in Pathology
• Billing privileges are the same as for staff
• The fellows sign an annual contract

Applications

Applications should be submitted by December 1 (18 months prior to start date; Fellowships usually commence on July 1).

Individuals interested in applying should send their Curriculum Vitae and a brief personal statement of interest and qualifications and USMLE transcript (Subspecialty Surgical Pathology fellowship applicants should indicate specific subspecialty area(s) of interest), with letters from three references including their training program director or pathology supervisor to:

Joan Ricker, Fellowship Program Administrator
Massachusetts General Hospital, Pathology Service
55 Fruit Street, Warren 219
Boston, MA 02114-2352

Telephone:  (617) 643-4482
Fax:  (617) 643-4045
E-mail:   jaricker@partners.org

Program Director

Gregory Y. Lauwers, MD
Program Director, Subspecialty Surgical Pathology Fellowship Program
Massachusetts General Hospital
Pathology Service Warren 219
55 Fruit Street
Boston, MA 02114

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Fellowship in Transfusion Medicine

(A Harvard Medical School Joint Program)

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Description

The Harvard Medical School Fellowship Program in Transfusion Medicine is an ACGME accredited program which draws on the facilities of the Massachusetts General Hospital, the Brigham and Women's Hospital, Children's Hospital Boston, the Dana-Farber Cancer Institute and the Beth Israel Deaconess Medical Center.  In addition, the program maintains strong ties with the Center for Blood Research.  The usual period of clinical fellowship is one year; however, the program offers suitably qualified fellows the opportunity to pursue research relevant to transfusion medicine supported by a NIH training grant for an additional one or two years.

Trainees spend 4 months at their base hospital (Massachusetts General Hospital, the Brigham and Women's Hospital, or the Beth Israel Deaconess Medical Center) and an additional 2 months at one of the partner hospitals.  Fellows rotating at the Brigham and Women's Hospital also train at the Dana-Farber Cancer Institute and Children's Hospital Boston.  An additional 4 weeks is spent at the Cell Manipulation Core Facility of the Dana-Farber Cancer Institute.  The remaining 3 months are spent in elective rotations, which are chosen once the trainee has received a thorough grounding in transfusion medicine and begun to formulate specific career goals.

Clinical and basic research are conducted throughout the program.  Fellows are encouraged to develop a research focus during their first year which can be pursued for an additional one or two years.  Fellows have the opportunity to attend varied clinical and research conferences and are required to teach in the training programs offered to residents, students and post-graduates.

Additional information about the program is available on the website: www.harvardtransfusion.org

Types and Numbers of Appointments

There are 3 funded clinical fellowship positions and 8 funded research fellowship positions.

Facilities

The combined facilities of the Harvard Joint Program comprise 2,478 hospital beds supporting a comprehensive array of general and specialized services including transplantation, Level I Pediatric and Adult Trauma and Burn Units, multiple intensive care units, and centers for Sickle Cell Disease and Hemophilia.  The facilities collect approximately 38,000 donations of whole blood and platelets and transfuse approximately 190,000 components annually.  The combined facilities of the Harvard Joint Program offer an unparalleled array of services, which encompass all aspects of Transfusion Medicine.

Community

Boston and its surrounding communities have a total population of over three million, the sixth largest metropolis in the nation.  The city has many universities and cultural facilities, including the Boston Symphony, Boston Ballet, and several fine theater companies.  The Massachusetts General Hospital is situated in the center of Boston, on the Charles River at the foot of Beacon Hill, convenient to downtown areas, rapid transit, and the airport.

Stipends

Commensurate with the candidate’s level of postgraduate training.

Requirements

Applicants must be Board-certified or eligible for certification in Clinical Pathology, adult or pediatric Hematology/Oncology or Anesthesia and, if a graduate of an international medical school, have a valid ECFMG certificate and visa and a full Massachusetts medical license prior to starting the fellowship.

Applications

Applications should be submitted by December 31 (18 months prior to start date; Fellowships usually commence on July 1).

Instructions for application, an application form and contact information are available on the program website: www.harvardtransfusion.org.

Inquiries about the program, and particularly the MGH-based rotations, should be addressed to:

Christopher P. Stowell, MD, PhD, Associate Program Director
Director, Blood Transfusion Service
Massachusetts General Hospital
Gray/Jackson, Room 148
55 Fruit Street
Boston, MA 02114-2696

Telephone: (617) 726-2815
FAX:   (617) 726-6832
e-mail:    cstowell@partners.org

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