Rotations

Surgical Pathology (11 months)
Residents who are assigned to the surgical pathology service are expected to gradually assume more responsibility and show greater knowledge and judgment as training progresses.  Residents rotate on three surgical pathology services including the IU Health Pathology Laboratory, Wishard Memorial Hospital, and Roudebush Veterans' Hospital.

IU Health Pathology Laboratory handles the combined surgical cases of IU Health University Hospital, IU Health Methodist Hospital, IU Health North and IU Health West Hospitals as well as several smaller hospitals and surgery centers.  Residents on the IU Health Pathology Surgical Pathology rotation perform their duties at the central laboratory and IU Health University Hospital (frozen sections).  Residents are exposed to a large number of unusual and challenging cases, including male and female genitourinary neoplasms, soft tissue and bone neoplasms, pancreatic neoplasms, head and neck resections, and transplant specimens (heart, lung, liver, bone marrow, multivisceral...).  In addition, residents gain proficiency in more commonly encountered types of specimens including mastectomies, hysterectomies and gastrointestinal cases.  Approximately 40,000 cases are received each year.  Pathologist assistants work closely with the residents during gross dissection and are an integral part of resident education.  Frozen section and intraoperative consultation is performed at IU Health University Hospital during the IU Health Pathology Laboratory rotation.  In addition to routine sign-out, residents have an added opportunity to review interesting cases at the daily QA/QC conference headed by senior staff.

Wishard Memorial Hospital has a surgical caseload similar to a medium-sized acute medical and surgical hospital. Approximately 40%-45% of these cases are gynecologically related. In addition, gastrointestinal and breast biopsies are often a part of the daily caseload.   Approximately 10,000 to 12,000 surgical pathology cases are received each year.  The residents on the Wishard Hospital service perform gross dissection, frozen section analyses, and sign-out.

At the Roudebush Veterans Affairs Medical Center, gastrointestinal and prostate biopsies as well as skin biopsies are typically part of the daily caseload. Approximately six to seven thousand surgical cases are received each year. The resident on the Veterans Hospital service perform gross dissection, frozen section analyses, and sign-out.

Pediatric Pathology (1 month)
The pediatric pathology rotation is performed at Riley Hospital for Children at IU Health.  The pediatric pathology rotation is designed to provide exposure to common childhood diseases, including childhood malignancies. The rotation includes formal education in diagnostic surgical pathology, including fetal/embryo pathology and placental pathology. Immunohistochemistry and electron microscopy are performed on unusual cases. Approximately 5000 surgical pathology cases are received each year.  The resident on the pediatric pathology service performs gross dissection, frozen section analysis and sign-out with the supervision of two pediatric pathologists.  Additionally, the resident is responsible for presenting cases at the weekly Pediatric Gastrointestinal Conference.

Hospital Autopsy (5 months)
The autopsy service is performed primarily at the IU Health Pathology Laboratory and covers hospital cases from IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health Methodist Hospital, Wishard Memorial Hospital, and referrals from several smaller hospitals.  Approximately 200 cases are completed at the IU Health Pathology Laboratory each year. Of these cases, about 100 are pediatric cases. The adult cases from IU Health University Hospital are typically unusual with many involving bone marrow or organ transplant patients. IU Health University Hospital is also a referral center for amyloidosis patients, and autopsies performed on these patients are done in conjunction with the clinician. In addition to the cases performed at the central laboratory, approximately 10-20 cases annually are performed at the .0Roudebush Veterans Affairs Medical Center.  At the completion of the residency, residents will have completed 50-75 autopsies.

Forensic Pathology (elective)
The Forensic Division provides autopsy service and consultation for the Marion County Coroner as well as coroners, prosecutors, and attorneys from the rest of Indiana. Over 1,500 cases are handled each year, including approximately 830 autopsies. Three board-certified forensic pathologists and a fellow staff the division. During a month's rotation, the resident will observe and participate in autopsies including cases of sudden death, motor vehicle accidents, suicide, and homicide.  

Neuropathology (1 month)
The Indiana University Division of Neuropathology receives material from the surgeons at IU Health Methodist Hospital, Riley Hospital for Children at IU Health, and IU Health University Hospital, amounting to 1,200 neuropathology and 700 ophthalmic pathology accessions per year. Frozen sections are performed on most cases. In addition, muscle and nerve biopsies from IU Health University and the Indianapolis area are also evaluated.

Cytopathology (3 months)
The first month on cytology is designed to introduce residents to the more common cases, such as pap smears and body fluids. The resident is provided with study sets that systematically review basic cytology findings seen on pap smears. A cytotechnologist will review the slides with the resident as needed. As the resident becomes more experienced, he/she will learn to perform fine needle aspirations by accompanying an upper level resident or fellow. Daily conferences are held to review interesting cases from IU Health University Hospital, Wishard Memorial Hospital, and Roudebush Veterans Affairs Medical Center. These conferences are attended by fellows and residents on the cytology service each month. A weekly Friday morning didactic conference taught by staff, fellows, and cytotechnologists is attended by all residents.

Dermatopathology (1 month)
Residents schedule at least one month of dermatopathology, At IU Health Pathology Laboratory, a typical daily caseload includes shave biopsies performed for carcinoma, punch biopsies for inflammatory diseases, and consult cases. These consult cases are often melanocytic lesions or unusual inflammatory skin diseases. In the afternoons, residents sign out cases at a private high-volume lab. Residents attend several conferences while on service, including a weekly dermatopathology teaching conference, as well as Dermatology Grand Rounds for dermatologists in Indianapolis.

Hematopathology (4 months)
During the first month, the resident spends one week with an excellent hematology technician who teaches the basis and clinical application of the large volume of automated hematology tests performed at the central laboratory.  The resident is then taught cell morphology that is seen in peripheral blood smears and bone marrow aspirates.   The resident gradually assumes greater responsibility, starting first with examination of peripheral blood smears and body fluids.  The resident also attend afternoon sign-out sessions where bone marrow biopsies and lymph node cases are discussed. The additional months of hematopathology are spent learning how to interpret peripheral blood smears, coagulation studies, and bone marrow and lymph node cases. A monthly hematopathology conference is held for residents in which current interesting cases are shown and discussed.

Transfusion Medicine (3 months)
The transfusion medicine rotation is at the IU Health Pathology Laboratory. During the first month, a technician teaches the resident how to perform basic lab tests such as blood typing, screening, and cross-matching. The resident also learns how to interpret the antibody panels and work through transfusion reactions. At IU Health University Hospital, the residents observe stem cell collection for future transplantation. Both IU Health University Hospital and IU Health Methodist Hospital perform other apheresis procedures, including plasma exchanges for TTP.  At Riley Hospital for Children at IU Health red blood cell exchanges for pediatric sickle cell crises are performed. Cytogenetics/Molecular Pathology (2 weeks each)
During this one-month rotation, various cytogenetic and molecular techniques will be presented through didactic lectures to the residents. The resident will learn about techniques in the prenatal, hematology, and tumor cytogenetics laboratories. Karyotypes are performed on chorionic villi, amniocentesis fluid, bone marrow aspirates, and solid tumors. One lab also performs FISH. Each resident is permitted to karyotype his/her own cells using peripheral white blood cells. The residents will also learn how to perform Southern blots, in-situ hybridization, polymerase chain reactions, and many other molecular procedures. At Roudebush Veterans Affairs Medical Center, the resident may observe how these procedures are used clinically: tests such as viral load levels for hepatitis and HIV, gene rearrangements and Factor V Leiden mutation assays are performed.

Clinical Microbiology (3 months)
This core rotation consists of three very organized months during which the resident rotates through all of the different labs (bacteriology, anaerobic bacteriology, mycobacteriology, mycology/parasitology, serology, and virology) and learns how each specimen type is worked up. The resident is given unknowns for evaluation. In addition, a weekly conference is held during which residents on the rotation discuss interesting cases from IU Health University Hospital, Wishard Memorial Hospital, and the Roudebush Veterans Affairs Medical Center.

Clinical Chemistry (3 months)
During the rotations, the resident learns how to interpret serum, urine, cerebral-spinal fluid, protein and hemoglobin electrophoresis, as well as isoelectric focusing and amniotic fluid studies. The resident is encouraged to participate in quality control issues and the process of implementing new assays.  

Hospital-based Clinical Pathology  

Residents participate in a variety of clinical pathology activities including transfusion medicine, serum and urine electrophoresis, peripheral blood smear and body fluid analysis, and lymph node protocols on clinical pathology services at Wishard Memorial Hospital and Roudebush Veterans Affairs Medical Center.