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University of Missouri-Columbia Program

Douglas C Miller MD,PhD

Univ of Missouri Hosp & Clinics

M263 Med Sci Bldg

One Hospital Dr

Columbia, MO 65212

Tel: (573) 882-1201 Fax: (573) 884-4612

E-mail: millerdc@health.missouri.edu

Anatomic and Clinical Pathology Residency ProgramEdit

Program Director: Douglas C. Miller

University of Missouri-Columbia is a combined AP/CP program with a total of 11-12 residents and 2-3 post-sophomore fellows, depending on the year.

Average work hours on surg path?

  • 7 AM – 6 PM M-F with obvious occasional late and early days.

Are you allowed to do external rotations?

  • Yes, if we don’t get enough volume of the subspecialty in question (i.e., molecular, soft tissue)


Comment 1

We are a friendly program with a great open-door policy and strong training in both AP and CP. Plus, Columbia MO is a great place to live. Read below for more detail:

AP:

Surgicals: Each resident does a minimum of 10 months of surgical pathology, 3 months per year for the first 3 years, and at least one month during the 4th year. MU gets roughly 22,000 surgicals per year, with an emphasis in Head and Neck and GI. We see a nice mixture of biopsy specimens and bigger, resection specimens. We have a significant volume of neuropathology tumor cases, a growing volume of bone oncology cases, and a broad spectrum of other tissue and organ specimens.  Because we don't think our residents see an adequate volume of pediatric surgical pathology cases there is a one month required rotation at Children's Mercy Hospital in Kansas CIty, MO where there is a considerable load of such cases. There are three residents covering the service at any one time, so frozen section call is roughly every 3rd day.

Signout in Surgical Pathology is partially subspecialized: all GI Biopsy Pathology (endoscopic, liver, pancreatic) is signed out by dedicated GI specialists; all Hematopathology is signed out by dedicated Hematopathologists; all Neuropathology (anything a neurosurgeon takes out) is signed out by a Neuropathologist.  The Neuropathologist also does all the Ophthalmological Pathology.  Other than eyelids from Ophthalmology and large skin excisions from general surgery, the skin pathology is done in Dermatopathology within the Department of Dermatology; the residents each have two required DermPath rotations plus each week the Dermatopathologist signs out with the Pathology residents in the Pathology suite.  Other case types are in general signout, with plans for future further subspecialization in progress.

Cytology: Each resident is required to do 4 months of cytology, usually one month per year. We have a great mix of gyn and non-gyn cytologies, with two board-certified cytopathologists who rotate on service. During the first month, the focus is on having the resident learn the basics through extensive teaching sets. During all four months, the resident attends all FNAs and rapid evaluations and actively participates with attending supervision. We also have great cytology lectures, many of which are held at our 14-head scope.

Autopsy: Each resident easily exceeds 50 autopsies in 4 years, as the Office of the Chief Medical Examiner of Boone and Callaway Counties is housed within the Department of Pathology and residents participate in the forensic autopsies (over 500/year) in addition to doing the hospital autopsies.  Autopsy training includes autopsy neuropathology, done with the program's neuropathologist (also the Program Director) who ensures rigorous and accurate descriptions and diagnoses for all hospital autopsies and also does forensic neuropathology cases as deemed necessary by the other Medical Examiners.

CP:

Blood Bank: The Blood Bank/Transfusion Medicine Program has been thorougly reorganized and modernized in the last several years.  Residents participate in the analysis of all transfusion reactions, take first call during massive transfusion protocols, answer clinician questions and requests for products, and work closely with the Blood Bank staff as well as with the Blood Bank Director and other faculty.

Heme: Our Hematology rotations are now combined with and integrated in Hematopathology.  Residents work up each patient from blood smear to bone marrow aspirates and biopsies, to lymph node resections.

Molecular:  We incorporate molecular techniques and data in most aspects of other rotations, including surgical pathology, hematopathology, microbiology, and cytopathology.  Molecular cytogenetics is taught in a required away rotation at Cardinal Glennon Children's Hospital in St Louis

Chemistry:

Micro: Microbiology rotations include a considerable exposure to molecular diagnostic techniques with an ever-growing menu of DNA and RNA-based techniques for rapid identification of organisms.  Traditional culture methods are not neglected.

Other:

Away rotations are allowed at MU, given that we do not have enough of that subspecialty to adequately train someone with a special interest in that area.

Comment 2


(Posted May 2011)

Pros:

  • Solid AP/CP training without horrible work hours. Very friendly program. Attendings are very “open door.” Lots of forensic experience, so no trouble getting required autopsies.

Cons:

  • Heme and molecular are weak. No in-house fellowships. Policy on external rotations is somewhat limited.


Do you feel you have:


Adequate preview time?

  • Yes – protected time from 7 AM to 10 AM – Seniors often continue to preview after 10 AM.

Adequate support staff (P.A.’s, secretarial, etc.)?

  • Great transcriptionists and histotechs, recently hired a pathology assistant who will gross smalls and mediums

Adequate AP Teaching?

  • Yes ~20,000 surgicals each year. High volume head and neck and GI. No subspecialty sign-out. We see everything, everyday. We visit the hospital across town (private practice) for extra gyn path, dermpath.

Adequate CP Teaching?

  • Yes – particularly in lab management and blood bank. Heme and molecular are not as strong; low volume of bone marrows (3-5/week) and only 9 molecular tests. Cytogenetics is a required 2-week rotation in St. Louis (1/5 hrs from Columbia).


FellowshipsEdit

There are currently no ACGME-accredited fellowships offered.

Fellowship Programs Offered? No – however, no trouble placing people in fellowship spots, including in GI, dermpath, surg path placements at competitive places.

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