Minneapolis VA Health Care System
Pathology & Laboratory Resident/Med Student Program
Minneapolis Veterans Affairs Health Care System (MVAHCS) is one of three major training sites for residents and medical students enrolled in the Anatomic and Clinical Pathology (APCP), Anatomic Pathology (AP), or Clinical Pathology (CP) residency programs offered by the University of Minnesota Medical School.
Pathology and Laboratory Medicine Services
Minneapolis VA HCS
The Minneapolis VA HCS Pathology and Laboratory Medicine Service offers a variety of resident and fellow rotations available to anatomic / clinical pathologist trainees as part of our affiliation with the University of Minnesota Medical School Laboratory Medicine and Pathology Residency and Fellowship Training Program. Rotations include Anatomic and Surgical Pathology, Hematology, Cytology, Chemistry / Toxicology, Blood Bank and Transfusion. In addition, Infectious Disease (ID) Fellows will rotate through Microbiology as part of the University of Minnesota’s School of Public Health ID Fellow Program.
Medical student rotations are available through affiliation with the University of Minnesota, as well as Midwestern University College of Osteopathic. Rotation at the VA is intended to expose the student to the duties of a pathologist. Students rotate through the various modalities and interact with the residents and staff.
Residents will be excused to attend didactic lectures and clinical presentations at the University. In addition, multi-specialty conferences are attended by residents, as appropriate for their rotation. Conferences designed for the rotating Anatomic / Clinical Pathology residents, fellows and medical students include a daily consensus meeting, Dermatopathology conferences, autopsy and neuropathology conferences, weekly pathology CME conference, weekly Morbidity and Mortality (M&M) conferences, as well as monthly journal clubs.
Residents rotate 3 months through MVAHCS in their first year of residency (PGY-1), and once again (elective one-month) in their subsequent training, generally as PGY-3/4 or late in PGY-2.
The junior level AP training is designed to train the residents in grossing techniques for both biopsies and large specimens, with the objective of residents being comfortable in independently handling these duties by the end of the rotation. The rotation allows for adequate preview time for the residents to develop microscopic skills in histopathology and opportunities for one-on-one teaching with staff pathologists during sign-out sessions. Junior residents also perform autopsies and generate autopsy reports under the guidance and supervision of pathology assistants and staff pathologists.
The senior level residents (one month elective) are involved in activities designed to impart a higher level of responsibility, commensurate with their advanced level of training. The rotation allows these residents to be involved with frozen section processing, reporting and on-site adequacy assessment for diagnostic needle biopsies, again under the guidance and supervision of staff pathologists. The senior level resident is also responsible for daily preview and generation of diagnoses for surgical pathology cases, under the tutelage of the staff pathologist.
Daily Activities Expectations and Responsibilities
Goals and Objectives for VA Surgical Pathology Rotation
Junior residents (3 months); Senior residents (1 month)
- Starting interview and finish interview: Rotation Director (Room BB-105)
- Junior residents gross-in specimens and sign them out on alternate days. They sign-out (SP-1 rotation) everything that they grossed-in (Wednesday is University lectures and “catch-up” day).
- Senior residents sign-out cases every day (Wednesday is University lectures and "catch-up" day).
- All residents are expected to have reviewed relevant aspects in the Medical Record before sign-out session, and to have read relevant literature.
- All residents are expected to have a presumptive diagnosis on their cases at the time of sign-out. Presumptive diagnoses must be written (either on the paper-work or on a separate list, but the method should be consistent). Junior resident must have considered differential diagnoses. Senior residents must include staging information as per CAP templates for tumor resections. Junior and Senior residents must consider possible immunostains or special stains that may be needed for differential diagnosis, to be discussed at the time of sign-out
- Junior residents are expected to take the “White Belt” workshop training in Quality Improvement (offered by the VA every three months). Sign-up with Minneapolis Systems Redesign VHAMINSystemsRedesign@va.gov on the first day of the rotation.
- Junior residents are expected to do one Q/I project or research project during their rotation and to present it to faculty on the last Friday of their rotation (Conference Room BD-131). Powerpoint of this presentation must be copied to Director of the rotation and uploaded by resident in his/her portfolio. Research projects is expected to be submitted for presentation at a pathology meetings and will be submitted for publication. A draft of the manuscript must be available and submitted to the Director of the rotation.
- Junior and Senior residents are expected to present one monthly Journal Club, two articles assigned to them (Conference Room BD-131). Powerpoint of journal club discussion must be copied to Director of the rotation and uploaded by resident in his/her portfolio.
- Junior and Senior residents are expected to discuss one monthly Case Presentation (date assigned to them) on an interesting case they have worked on, with review of relevant literature (Conference Room BD-131). Powerpoint of this case presentation must be copied to Director of the rotation and uploaded by resident in his/her portfolio.
- Junior residents are expected to take the on-line training and pass the test to be certified as CAP Inspectors for Laboratory Accreditation. Copy of the certificate must be given to the Director of the rotation, and uploaded by the resident in his/her portfolio http://www.cap.org/web/home/lab/accreditation
- All residents are expected to copy the director an electronic version of their case-log with the cases and diagnoses that they were assigned during the rotation. No patient personal identification can be included (Only date, biopsy number and diagnosis; pathologist signing out, comments and references are optional). Residents must upload their case-log into their portfolio.
- All residents are expected to attend daily AP Consensus Conference (3:00 PM in Multi-headed Microscope Conference Room (Room BD 110a).
- All residents are expected to attend and present weekly autopsy conference (Morgue, Monday 9:00 AM)
- All residents are expected to attend Dermatopathology didactic conference with Dermatopathologists (twice a week, 8:00 AM in Multiheaded Microscope Conference Room, BD 110a).
- Residents are expected to attend Dermatopathology specialty sign-out sessions with Dermatopathologists (twice a week, 9: 00 AM in Multiheaded Microscope Conference Room, BD 110a).
- All residents are expected to attend weekly Medicine Morbidity and Mortality Conference (Atrium Auditorium)
- Residents are expected to present the pathology of their cases when they are presented at interdisciplinary conferences (ad-hoc).
- Junior residents are expected to learn how to cut frozen sections, participate in the examination of frozen section slides and communicate frozen section diagnoses to surgeons.
- Senior residents are expected to assist staff pathologists during immediate cytologic interpretation in Radiology.
- Residents are invited to attend interdisciplinary clinicopathologic conferences as interest and time allow: Breast Cancer conference, GI Conference, Urology Conference Colorectal, thoracic, head and neck, etc).
- Junior residents are expected to perform all autopsies performed during their rotation; autopsy has priority over other activities.
- All residents are expected to attend Monthly Quality Management Meeting (Third Thursday, Noon, Room BD-131).
- Daily schedule: 08:00 to 17:00 hs. Monday to Friday.
- There is no on-call duty.
J. Carlos Manivel, M.D.
This rotation is intended to appreciate the spectrum of, and learn diagnostic approach to Hematologic disease in a diverse patient population. The problems range from non-neoplastic CBC abnormalities occurring in varying and often complex medical and surgical settings to a number of common, as well as complicated, myeloid and lymphoid neoplastic disorders. Daily sign-out with the Hematopathologist on service will cover review of peripheral smears, bone marrow aspirates and biopsies, as well as evaluation of solid Hemato-lymphoid lesions.
Study sets are available for resident review.
Initial rotations in cytology are intended to help the resident become familiar with cytologic diagnostic tools used in an increasingly diverse veteran patient population. The problems range from non-neoplastic gyn and non-gyn cytology, including urine cytology, ThinPrep Pap test, fluids, and fine needle aspiration (FNA) cytology. In addition, cytologic specimen preparation methods are reviewed. The different teaching modalities include daily sign-out of pap tests with the Cytopathologist on service, performing of fine needle aspiration (FNA) that include immediate evaluation of specimens by the resident under supervision of a pathologist / cytotechnologist, as well as evaluation of clinical correlations of cytologic and surgical specimens. Study sets of Pap tests, fluid and urine cytology with available histologic correlations available for resident review.
The Blood Bank lab provides blood products for transfusion to our veteran patients while also offering trainees an experience similar to labs in medium-sized community hospitals. A wide variety of patients are served, including hematology/oncology, cardiac surgery, neurosurgery, general surgery and general medical patients. The transfusion process is a team effort that extends beyond the lab. The process starts with the clinician's assessment of the patient's needs, obtaining of informed consent and writing orders. Residents and fellows can gain perspectives on all aspects of transfusion from verified specimen collection and crossmatch in the Blood Bank lab to patient infusion and investigation of adverse reactions.
Fellows on service for one month will participate in day-to-day blood bank operations and provide consultation for blood utilization, therapeutic apheresis procedures, ordering of lab testing, and investigation of transfusion reactions. In addition, they will attend related conferences and have the option to receive laboratory bench training. Resident rotations are 1-2 weeks and focus on basic laboratory bench training and an orientation to blood bank given in a series of basic lectures. Residents can also participate in transfusion service activities if time permits.
The transfusion service is AABB (American Association of Blood Banks) accredited, and is inspected by the FDA, CAP and JCAHO.
Chemistry is part of the Core Laboratory and is the largest section of the Pathology and Laboratory Medicine Service, while Toxicology is part of the Special Diagnostics section.
Chemistry tests include electrolytes, glucose, urea, creatinine, liver function tests, cardiac profiles and lipid profiles, amongst others. Blood gases and urinalysis are also done in this section along with endocrine tests (TSH, Vitamin B12, Folate, LH, FSH and Prolactin); therapeutic drug monitoring (Dilantin, digoxin, etc.) and tumor markers (PSA, AFP).
The Toxicology section includes both Analytical Toxicology and the Forensic Toxicology section. Analytical toxicology testing deals with routine toxicology testing for drugs of abuse and therapeutic drugs to support clinical needs of the Medical Center. Our Forensic Toxicology laboratory is a unique laboratory within the entire VA system, and is certified to perform employee drugs of abuse testing for the entire VA system.
The Clinical Chemistry rotation for the Residency program in Clinical Pathology is a two- week rotation. Learning is by observation and through didactic sessions. In this rotation, the residents will spend time in various areas of the laboratory observing how common automated analyzers used in a Clinical Chemistry laboratory work. Basic analytical techniques such as spectrophotometry, nephelometry, gas and liquid chromatography, mass spectrometry and immunoassays are discussed. Residents will be introduced to the basic concepts of laboratory quality control and quality assurance.
Advance rotation of one month is also available for the Fellowship program in Clinical Chemistry.