The Gastrointestinal (GI) Pathology service at Yale is a large, interactive practice comprised of five GI pathologists who oversee more than 15,000 surgical pathology cases per year. The clinical training during fellowship is a one year experience with a primary emphasis on acquiring outstanding skills in diagnostic pathology of gastrointestinal specimens. In addition to a rigorous clinical schedule, fellows participate in research, attend and present at intra- and interdepartmental conferences, and teach pathology residents and clinical fellows. In addition to the one year clinical program, the GI program also offers a three-year program combining one year of training in diagnostic gastrointestinal, hepatic and pancreatic pathology with two years of laboratory-based research.
GI pathology at Yale is a subspecialty service, where only GI specimens are grossed in and signed out. The sign out team consists of an attending, the GI fellow and a resident who rotates monthly. Each day 40-50 GI biopsies, liver biopsies and resections are signed out. In the gross room, the GI fellow teaches residents in the handling of all GI specimens. The attending frequently examines complicated specimens. As the fellow gains experience and confidence, graduated responsibility is quickly given in decision making in the gross room.
In general, slides (biopsies and resections) are reviewed by the GI fellow, independent of the resident prior to sign out. This is done to ensure that residents generate an independent opinion. Residents write up all resections, while biopsies are dictated by either the attending or fellow. At the time of sign out with the attending, all cases are reviewed and discussed by the entire team together at a multiheaded microscope. Following sign out of in house cases, the GI fellow and attending sign out consults and discuss conferences.
The role of the resident and fellow are distinct and clearly defined. The resident is responsible for all in house cases, while the fellow serves as supervisor and teacher. The fellow is responsible for generating his or her own opinion on in house cases, outside consults, and for ensuring the orderly flow of the service. The fellow becomes adept at ordering special stains and molecular studies independently and in reviewing the literature on unusual cases. At sign out, it is expected that the fellow will be able to generate an extensive differential diagnosis and be prepared to discuss the clinical consequences of diagnoses at length. In addition, the fellow is a liaison to the clinical service, becoming a consultant to clinical GI fellows and attendings. The GI fellow is frequently asked to show and discuss cases with the clinical team on rounds.
The GI fellow quickly attains graduated responsibility in sign out. Within one month, the fellow begins dictating biopsies prior to sign out. At the time of sign out the fellow’s diagnoses are discussed and corrected as needed. Within two months the fellow signs out with the resident one day each week. In addition, the fellow is responsible for teaching residents in gross and histologic interpretation as well as case management. The fellow also presents the pathology component at two weekly interdepartmental case conferences throughout the year and gives occasional conferences to clinical GI fellows.
In addition, there are a number of ongoing clinical and translation research projects in the gastrointestinal pathology division in which the fellows often participate, or develop research projects of their own. Three weeks of dedicated research time, free of usual clinical responsibilities are ensured for the clinical fellowship in order to facilitate the completion of projects. There is a strong and long established interest in diseases of the gastrointestinal tract, liver, biliary tract, and pancreas at Yale, with an outstanding liver center and section of digestive diseases. Fellows in the past have also collaborated with investigators from these sections with publications in peer-reviewed journals.
Where Are Our GI Fellows Now?
Since 1990, more than 70% of graduates from the Yale Gastrointestinal Pathology Program are academic pathologists at major academic institutions across the United States. These institutions include the University of Washington, Indiana University, University of Vermont, University of Pittsburg, and Yale University. Fellows are also successfully placed in a variety of private practice settings, including large clinical hospitals and specialty laboratories.