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Baystate Medical Center/Tufts University School of Medicine Program

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Baystate

Program Director: James D. Mueller, MD, PhD Baystate Med Ctr Dept of Pathology 759 Chestnut St Springfield, MA 01199

Tel: (413) 794-5085 Fax: (413) 794-5893

E-mail: gretchen.lussier@baystatehealth.org

BMC Pathology Residency

Anatomic and Clinical Pathology Residency ProgramEdit

Number of Residents (total): 16

Number of Residents (annually): 4

Program sponsors H1/J1 visas (H1 visas require passing Step 3 before starting residency)


EDUCATION:

Our department is comprised of 22 attendings. The SP service is covered by 13 and cytology by 6. The subspecialties are covered as follows: 1 for neuro, 2 for derm, and 2 for renal. We have 2 hematopathologists, 3 attendings covering transfusion medicine, 2 on molecular, and 1 for genetics, immunology, micro, and chemistry. We receive didactic lectures on numerous topics in depth in both the AP and CP fields. All of our attendings participate in the core curriculum and often host slide conferences over the lunch period. Our CP is evealuated quarterly by testing on the previous three month's topics. Once per month we have an interactive gross conference, which significantly aids in our ability to diagnose at the bench. The attendings are always interested in teaching at the scope during sign-out.

We are also actively involved in educating other services. We run the tumor board and several subspecialty oncology conferences. We also offer a medical autopsy conference monthly and will participate in M&M when necessary. Further, we participate as a on team consult for both heme and infectious disease.


LIFESTYLE:

As a suburban location, the cost of living is quite low here compared to any city, while being paid comparable to, if not better, than most city residencies.

Unfortunatley, the trade of of being in a less urban region means we have to travel further for some forms of entertainment (Boston is 1.5 hrs away, NYC is 3). However, there are numerous museums, as well as the basketball hall of fame nearby. We are within a 1/2 hr of the Berkshires and there are numerous outdoor activities taht can be participated in (skiing, hiking, etc) nearby. For shows, there are multiple across CT, MA and in nearby Albany.

The residents are about 50/50 for American vs. foreign grads and we enjoy an excellent rapport with one another. We try to set up events outside of work whenever possible, but several of us have families as a limiting factor.


DAILY SCHEDULE:

There is a daily 8 am conference that breaks down as follows: Monday is autopsy presentations, Tuesday and Thursday are AP/CP didactics, Wedneday alternated between cytology and dermpath, and Friday is unknowns. Some AP didactics will have follow-up slide presentations on one of the following days at noon. Further, every monday at noon we have a resident driven CP conference (3 resident case-based presentations) and every Wednesday at noon we have a second resident driven conference based on a topic from your service (2 presentations). All conferences are considered protected time.

Surgical pathology rotations are divided on a weekly basis, wheer the service you cover will either be Large 1 (urogenital/breast), Large 2 (thoracoabdominal/soft tissue), Biopsy 1, Biopsy 2, or frozen sections (each with a different grossing schedule). Large 1 grosses Tues/Thurs and signs out the other three days and Large 2 grosses Mon/Wed/Fri and signs out the other two. Biopsy 1 signs out all days and grosses its largest specimens Mon/Wed (breast excisions and Cones) and Biopsy 2 signs out all 5 days. The following subspecialties have their own dedictated rotation and require no grossing: Derm, Renal, and Neuro. Days end at a variable time based on surgical schedule (you are responsible for all cases that arrive that day for your rotation) and the pace an attending signs out. The latest nights are nearly alway Large 2.

Autopsy is its own rotation and we cover all cases for the month (excluding call cases). The length of the day varies based on the number received for the day and the speed with which you can perform the case.

All CP rotations are considered to have their responsibilities end at 5 pm, at which point all new events move to the call person (however completing your work make extend beyond this time).

Call is covered on a weekly basis by one primary resident and one backup. The primary covers all AP/CP issues during the weekdays. On the weekend, both are expected to come in on Saturday to gross any carryover from Friday. The primary will also be responsible for all AP/CP (apheresis/frozen/autopsy) beyond this over the weekend (the back-up must always be available still, in the event that the primary is either overwhelmed or is confused).

Cytopathology FellowshipEdit

Cytology is "the study of cells" and cytopathology is “the study of cellular disease and the use of cellular changes for the diagnosis of disease”. The fellowship training program in cytopathology offered at Baystate Hospital affords the trainee great exposure to a high volume, high complexity daily case load. The “typical day” starts around 7:30 AM and wraps-up around 5:30. In the course of that day, the fellow will be previewing and ordering any ancillary studies needed to sign-out cases that fall into two general categories: exfoliative (spontaneously shed, washed or mechanically abraded) and aspiration (fine needle) specimens. Virtually any organ system in the body can be “sampled” in one or both of these fashions. The most common examples seen on a daily basis include Pap screens, urine specimens, breast (nipple discharge and FNA), thyroid FNA, body cavity fluids (pleural, peritoneal and pericardial), lung (FNA, sputum, brush, washings and lavages) and the list goes on. In addition, the fellow is responsible for the initial evaluation of “immediate FNA” interpretations that are submitted by the interventional radiologists. These are typically either ultrasound or CT guided aspirations resulting from targeting just about any site in the body you can safely put a needle! In this situation, the fellow is screening the slides to ensure that the targeted lesion was adequately sampled, ensure proper triaging of material obtained (e.g. microbiology or flow cytometry, etc.), and make recommendations regarding the need for further sampling while the radiologist still has the patient. This can be the more “stressful” part of the day, but also the most exciting and rewarding. This latter responsibility touches upon one of the most critical aspects of the fellowship – communication skills and interdepartmental interactions. By the end of the day your pager will be full, you will have been on the phone with countless clinicians, surgeons, and radiologists. You will have “pulled together” all relevant information regarding the patient (case) at hand in an effort to ensure the proper diagnosis. You will not do this alone however; the training program at Baystate is rich with daily didactic slide sessions, appropriate attending supervision and fantastic ancillary support from outstanding cytotechnologists. Other responsibilities falling to the fellow include: presenting at morning resident cytology sessions (every other week), 2 departmental presentations (45 min. talks), participation in the annual regional Baystate Cytology Conference (each Spring) and adequacy assessment of thyroid FNAs performed at the office of Dr. Robert Cooper (2-3 mornings/month). BOTTOM LINE: There exists a well-established, well-seasoned cytopathology curriculum in place at Baystate that ensures success (workplace and boards) for the hard working, diligent trainee.

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