The University of Vermont pathology residency program is associated with Fletcher Allen Health Care of Vermont.
Through a vital partnership, Fletcher Allen, the University of Vermont College of Medicine and the College of Nursing and Health Sciences form Vermont’s university medical center – one of just 131 such centers in the country.
Fletcher Allen also serves as the community hospital for approximately 160,000 residents in Chittenden and Grand Isle counties.
As a regional referral center, Fletcher Allen provides advanced-level care to a population of one million people throughout Vermont and northern New York.
Residency Program Director: Scott Anderson, MD
Number of Residents (total): 16
Number of Residents (annually): approx. 4
The program runs on a 4-week block system (13 blocks/year for a total of 52 blocks during residency) with 45 required AP/CP blocks and 7 blocks of elective time.
The anatomic pathology core curriculum includes: required rotations in surgical pathology (11 blocks), hot seat (2-3 blocks), autopsy/neuropathology (4 blocks), forensics (1 block) cytology (3 blcoks), and dermatopathology (3 blocks) .
The clinical pathology core curriculum consists of rotations in clinical chemistry (4 blocks), microbiology (4 blocks), hematopathology (6 blocks), blood bank/coagualtion (4 blocks), immunopathology (1 block), molecular pathology (1 block), and an informatics/laboratory management bi-monthly course spread over 2 years.
To provide a sense of the volume of material available for teaching purposes, our laboratories process over 1,000,000 specimens annually. Furthermore, we perform approximately 450 autopsies, process 27,000 surgical specimens, evaluate over 80,000 cytology smears, and receive over 400 bone marrow aspirates and biopsies each year.
Each day residents arrive around 8am (earlier on surgical pathology) and begin clinical duties which end around 5 to 6pm. Sometimes the day is longer on the busier rotations, but residents do not gross past 7pm since the processor starts at 7pm. This is not an issue for residents.
Conferences: The residents attend weekly conferences, which are protected time, Monday through Thursday (and an occasional Friday), which includes unknowns, AP journal club, didactics from faculty which are subspecialized in that field, CP conferences, and Grand Rounds. There are weekly cytopathology conferences on Tuesdays at 7:30am. These are led by Dr. Leiman and Dr. Elhosseiny and include unknown cytopathology cases. Every Friday at 8am, the dermatopatholgy conference is led by Dr. Cook and Dr. Greene. This is a joint conference with the dermatology residents structured around the Lever's dermatopathology text. Residents are also responsible for leading interdisciplinary conferences throughout the year.
Surgical pathology: The service is structured to learn as efficiently as possible with a graduated responsibility approach. The program recently switched to a partial sub-specialty signout (GI, breast/cervix, and general). Three residents are on surgical pathology each block and each resident covers one of the three benches for two weeks, then switches to a different bench. A typical day includes signing out cases with the attending in the morning (must be done by 11:30), grossing in the afternoon (usually done by 5pm), and previewing in the evenings.
Graduated responsibility is built into the system: As a first year, you are not expected to predictate your cases. As you progress through your surgical pathology months, you are then expected to gradually begin predictating your cases. By the end, the attendings expect that you come to sign out with your cases predictated and essentially ready to be signed out by the attending (with minimal editing on their part). Additionally, performing frozen sections is incorporated into the rotation beginning your second year. One morning each week, residents predictate their cases and hand them off directly to the attending to sign out. In lieu of morning sign out, residents are in the gross room, covering frozen sections. At first, residents assist the PAs in performing frozens. By the end of the surgical pathology rotations, residents are expected to be able to do frozens independently.
There are three to four PA's which assist in the gross room with biopsies and large specimens. The PA's are very energetic and excited to teach the residents. There is always a PA in the frozen section room to assist the resident assigned to frozens. Every resident has a bridge month which is the introduction month to surgical pathology. On bridge month, a PA is assigned to the bridge resident to guide in grossing and an upper level resident is assigned to the bridge resident for previewing and signing out.
After the core surgical pathology months, every resident rotates for 2-3 blocks through Hot Seat, a rotation in which the resident acts as a surgical pathology fellow or junior attending. The Hot Seat is responsible for previewing the daily surgical pathology cases, ordering immunohistochemical stains, fielding questions from clinicians, and triaging cases. The Hot Seat is not responsible for grossing specimens; instead the Hot Seat works at the scope the way a faculty member would and is available for any issues which arise. In the Hot Seat position, the resident assumes a leadership role and serves as the senior on the service to the three to four junior residents on surgical pathology. The Hot Seat is also responsible for signing out frozen sections in the afternoon with faculty back-up as needed.
Clinical Pathology: The clinical pathology rotations are led by excellent faculty. The microbiology rotation includes a hands-on approach with teaching slides, work-ups of unknown cultures, and daily microbiology rounds. Every rotation has a detailed curriculum and hands-on experience.
Comment (Updated September 2014)
Residency Program Name: University of Vermont/Fletcher Allen Health Care
Residency Program Director: Scott Anderson, MD
Number of residents (per year / total):
Excellent teaching, entire labs located in one location in the hospital, small size, few fellows. Plenty of opportunities for interdepartmental conferences. We have a hot seat rotation with built-in graduated responbility.
Small size, very homogenous (Caucasian) patient population
Average work hours on surgical path?
Are you allowed to do external rotations?
Dr. Debra Leonard - Molecular
Dr. Don Weaver - Breast
Do you feel you have:
Adequate preview time? Yes, in afternoon/evenings
Adequate support staff (P.A.’s, secretarial, etc.)? Yes, we have 3 PA's who cut in nearly all biopsies and small cases
Adequate AP Teaching? Yes, we have 1 full 4-week block at the beginning of our residency called "bridge"...during that month we work closely with the PA's to learn how to gross specimens and get orientated to our system. The PA's are always happy to assist with any difficult cases in subsequent months.
Adequate CP Teaching? Yes, our CP rotations are excellent
Are Fellowship Programs Offered? Please list: Dermpath, cytopath, surgical path, heme
CAP Standardized Fellowship Application Accepted? Yes
Additional benefits to trainees (book fund, travel fund, other resources): $500/year book fund and Apple iPad mini (PGY1); $1000/year book fund (PGY2-4); travel paid for all conferences in which you present (international travel as well).