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Combined Anatomic and Clinical Pathology (AP/CP) Training Track

  • 48-month program (4 years) and the most common training track
  • Provides broad training in all the sub-disciplines of anatomic and clinical pathology
    • Prepares residents for broad career options ranging from a small community private practice to a large academic medical center
    • The majority of AP/CP track residents go on to subspecialty fellowship training following their residency
  • 36 months of Core Rotations from PGY-1 to PGY-3
    • Combined Anatomic and Clinical Pathology training includes 22-24 months of core AP rotations and 12-14 months of Core CP rotations.
      • Core AP training teaches the principles of gross, microscopic, and analytical evaluation of specimens and laboratory data with graduated responsibility. Elective time is also taken in PGY-2.
      • Core CP rotations vary depending on the year. PGY-1s rotate and take call only during the day for Transfusion Medicine and Hematology for a total of 2 months. Then as PGY-3, residents complete a 12 month rotation on all the CP subspecialties taking calls during the day, overnight, and weekends.
    • PGY-1 starts with 3 weeks of introduction to AP and CP (“bootcamp”)
  • 12 months of Senior Rotations during PGY-4
    • AP/CP trainees also have 6-8 months of AP senior and 4-6 months of CP senior rotations. Senior rotations encourage the resident to assume responsibility for the professional supervision of the services, often functioning as a junior attending and acting as laboratory director. Elective rotation time is also allotted in AP. CP senior rotations include acting director in a small laboratory (SRC campus).
  • Elective opportunities allow for advanced training and/or investigative work with a faculty sponsor.

Core Training in AP and CP

During the first 12 months of training residents focus on acquiring the technical skills that will form the basis for their careers in pathology. They also must acquire a fund of knowledge to apply these skills towards the goal of becoming diagnosticians. The first year of core training in AP includes multiple rotations on the autopsy service. Residents acquire familiarity with a variety of dissection techniques, learn anatomy and normal histology, and learn how human disease is manifested in anatomic changes throughout the body. Exposure to Forensic Pathology and Neuropathology is integrated into the autopsy experience. Residents also begin their training in Surgical Pathology and Cytopathology during their first year. Rotations through the major subspecialty surgical pathology services at YNHH (breast, GI, GYN, GU, thoracic, endocrine, head and neck), as well as general surgical pathology at the West Haven VA Medical Center provide opportunities for immersive learning.

In the second year of core AP training, residents further expand their histopathologic diagnostic skills by focusing on a broader range of specialty areas within pathology, and delving deeper into an understanding of differential diagnoses. A second rotation in each of the major surgical pathology subspecialties is incorporated into the second year, as are rotations in pediatric pathology, bone and soft tissue pathology, neuropathology, and molecular pathology. Second year residents also get their first exposure to a "leadership" role by serving as a senior resident to incoming first years on the major surgical pathology services. In addition, they begin to work with PGY-4 residents on the frozen section service. Finally, elective time allows residents to pursue or enhance training in areas of special interest, or to get involved in formal research projects.

Throughout the core training in anatomic pathology, a series of daily 8 am conferences provides residents with both formal instruction and a longitudinal exposure to all of the areas of anatomic pathology, regardless of which rotation they are currently on. This is further supplemented by unknown slide conferences that take place on Thursday mornings. These are presented by our own nationally and internationally renowned faculty, as well as invited grand rounds speakers. In addition, a resident driven interesting case conference takes place on Tuesdays. In this session, residents share cases they’ve seen on service and show their house staff colleagues. The Department of Pathology Grand Rounds take place every Thursday at 12:30pm from the fall to spring and offer a broad range of topics from the most advanced diagnostic surgical pathology to translational and basic science research to DEI and QI and mentorship. Take a look at some of the videos of last years’ distinguished presenters here. Subspecialty services also have journal clubs and consensus conferences that residents can attend.

Academic days have been adopted in three of the surgical pathology core rotations: gynecological, endocrine/head and neck (during PGY-2), and pediatric/bone and soft tissue. One day each week on these rotations, residents may elect to have a full day to pursue academic endeavors without signout or grossing responsibilities.

During their final 6 months of AP training(PGY-4), residents rotate on senior level rotations, including autopsy senior, hot seat, molecular, informatics, frozen section, subspecialty biopsy and general sign out at Bridgeport Hospital. There is also elective time.

During the 12 months of PGY-3 CP experience, CP residents rotate through each of the sections of the Clinical Laboratories. The first 4-weeks of CP training consists of one week mini-rotations in each of the major sections of the clinical laboratories. This provides an initial exposure to the breadth of the discipline and prepares residents for the responsibilities of taking calls overnight and during the weekends, where residents cover all laboratory medicine calls. This introductory exposure is then followed by an in-depth experience on each of the 6 major rotations (transfusion medicine, microbiology/virology, hematology/flow cytometry, clinical chemistry/immunology, and general and specialized clinical pathology at the VA). Throughout their training, emphasis is placed upon understanding the basic science and associated biotechnology of Clinical Pathology, becoming familiar and comfortable with modern instrumentation and computers, and upon the interpretation and clinical utilization of laboratory tests while also communicating with clinical teams to assist with care and optimizing laboratory testing. To accomplish this, residents also work on research and/or developmental and/or quality improvement projects in the laboratories and serve as consultants to hospital and outside physicians. Teaching is another strong area of emphasis during CP training. Residents fully participate in medical student teaching by serving as preceptors in the hematology and microbiology laboratories. Residents also are responsible for teaching the laboratory medicine team including medical laboratory scientists with presentation of CP case conferences and journal club. Every morning, residents receive didactics that provide the education to prepare for the board exams.

During their final 6 months of CP training, CP-senior residents assume a more senior, supervisory and acting director role and choose directed clinical responsibilities within each laboratory. We encourage specialization in areas of interest and an in-depth experience as a "junior attending."

Integration of the subspecialties is achieved through interdisciplinary teaching and clinical conferences in the Department, through on-call responsibilities, and during rotation at the VA Connecticut Healthcare System. Residents are exposed to all aspects of clinical testing from conceptualization in basic research to practical realization in the clinical laboratory and application to patient care.

First & Second Years: AP

Resident training in the Anatomic Pathology curriculum is structured to provide in depth exposure to all specialties within surgical pathology. Surgical pathology at Yale New Haven Hospital is organized on a subspecialty system, and residents rotate through all specialties over the course of their training. First year residents also rotate on the autopsy service and spend time at the Connecticut Office of the Chief Medical Examiner to gain forensic pathology experience. The Tables below present the rotations with approximate weeks spent on the service per year.

AP Rotations First Year Second Year
Surgpath: Breast, Head/Neck/Endocrine, Gastrointestinal, Gynecologic, Thoracic, Genitourinary 2-4 weeks (each) 2-4 weeks (each)
Dermatopathology 2-4 weeks 2-4 weeks
Hematopathology 2 weeks 4 weeks
Cytopathology 2-4 weeks 4 weeks
Medical Renal/VA 5-6 weeks 2-3 weeks
Autopsy 8-10 weeks 2-3 weeks
Forensic Pathology 2 weeks
Pediatric/Bone/Soft Tissue 6 weeks
Molecular/Neuropathology 4 weeks
Frozen Section 3 weeks
Elective 4 weeks
CP Rotations First Year Second Year
Transfusion Medicine 4 weeks -
Hematology/Flow cytometry 4 weeks -

Third Year: CP

The CP portion of the AP/CP curriculum is run by the Department of Laboratory Medicine and typically encompasses the entire third year of the program and half of the fourth year. During this time, residents focus solely on clinical pathology rotations. These include transfusion medicine (blood bank and apheresis), hematology/flow cytometry, clinical microbiology, clinical chemistry and immunology, a mentored experience in laboratory management at the St Raphael campus, and rotations at the nearby Veterans Affairs Hospital. Residents serve as consultants on complex clinical cases, and are also involved in triaging and answering questions from both clinicians and laboratory staff. The Table below presents the rotations with approximate weeks spent on the service per year.

CP Rotations Third Year (CP1)
Transfusion (Blood Bank/Apheresis) 8-12 weeks
Hematology/Flow Cytometry 8-12 weeks
Clinical Microbiology 8-10 weeks
Clinical Chemistry/Immunology 8-10 weeks
VA Main Lab 4-6 weeks
VA Clinical Projects 4-6 weeks

Fourth Year: AP/CP

The fourth year of the AP/CP curriculum is split, with residents spending six months on AP senior rotations and six months on CP senior rotations. On CP senior rotations, emphasis is made on laboratory management. The table below presents the rotations with approximate weeks spent on the service per year.

Service AP Rotations CP Rotations
Blood Bank/Transfusion Medicine - 4 weeks (senior)
Hematology/Flow Cytometry - 4 weeks (senior)
Microbiology - 4 weeks (senior)
Clinical Chemistry - 4 weeks (senior)
Laboratory Management - 4 weeks
Molecular - 4 weeks
Frozen Section 6-8 weeks -
Bridgeport Hospital 4 weeks -
Hot Seat 2-4 weeks -
Specialty Biopsy 4 weeks -
Autopsy Senior 4 weeks -
Molecular Senior 2 weeks -
Informatics 2 weeks -
Elective 2 weeks -