Residents will spend multiple AP blocks on organ-system-based clerkships, including, but not necessarily limited to, gastrointestinal/liver pathology, gynecologic pathology, genitourinary pathology, breast pathology, head and neck pathology, endocrine pathology, cardiovascular pathology, renal pathology, bone and soft tissue pathology, neuropathology, thoracic pathology, and dermatopathology. Ideally, these experiences will occur in the first two to three years of residency and will allow the resident to accumulate a strong foundation in each discipline, resulting in a synthesis of knowledge covering all organ systems and being valuable for use in the general intraoperative consultation service rotations that will occur in the later years of training. 

These organ-system-based working and learning experiences will be focused primarily on previewing in-house biopsy cases, generating appropriate differential diagnoses, and setting up reports for the faculty in the laboratory information system. Gathering information from patient histories, reviewing current clinical settings, correlating with imaging findings, and studying results of other related laboratory tests will be integral parts to establishing best diagnoses. The organ-system-based experiences should provide exposure to reactive, infectious, benign neoplastic, and malignant processes. Cases other than biopsies may be handled as well, generally, those larger resection cases that are not handled by the intraoperative consultation teams with some examples including hysterectomies for benign disease, reduction mammoplasties, and non-neoplastic colectomies.

As a resident, you are encouraged to think of every case as your own, writing up preliminary diagnoses, deciding what ancillary testing might be pursued, and seeking consultations from faculty and fellows in other working groups when appropriate. You will have exposure to grossing in some of these organ-system-based rotations, ideally focusing upon the relevant anatomic sites and being limited to one or two days a week.

Today's Mayo Clinic intraoperative consultation service is based upon decades of tradition descending from early developments in intraoperative frozen section studies that began here more than 100 years ago. Each day, hundreds of intraoperative slides are created for review and rapid diagnoses. The current AP/CP curriculum structure includes five blocks of intraoperative consultation service coverage, ideally occurring in the final three years of training. In the last of these blocks, you will function as a surgical pathology fellow, diagnosing and triaging with as much independence as possible. 

As a resident, you will learn the critical importance of gross-histopathologic correlation through repeated real-time correlations of gross and microscopic features. Of paramount importance, you will also learn how to accurately convey relevant information to the rest of the surgical care team. The frozen section team consists of the pathology resident, a staff consultant, a surgical pathology fellow, pathologist's assistants, technologists, lab assistants, and pathology reporting specialists. Under the mentorship of the more experienced members of the team, you will gradually take on increasing levels of responsibility, including gross examination, frozen section interpretation, communication with the OR, and case write-up. If you ever need help handling a specimen, the entire team is immediately available. During the first few months, you will sit for short periods of time in the "hot seat" directly beside the staff consultant who will mentor you in the fundamentals of interpreting frozen sections and communicating with surgeons. As you progress in your gross and histopathological examination skills, you will sit for longer periods of time in the "hot seat" and take greater responsibility for all aspects of a case. By your final rotation in the frozen section lab, you will effectively function as an experienced surgical pathology fellow, arriving at a diagnosis, communicating that diagnosis to the OR, writing up the case with all relevant prognostic information, and requesting any additional ancillary studies. 

Specimens are grossed in the fresh state as soon as they arrive from the operating rooms, and are distributed among the resident and pathologist's assistants. This typically leads to a steady but manageable stream of work throughout the day. You are generally excused from the frozen section lab between 5 and 7 pm (although grossing responsibilities rarely extend later into the evening). This means there is usually time for reading or other pursuits at the end of the day. A three-day schedule is currently in place for residents. On the two "file days," you will review confirmatory H and E permanent sections of the previous day's frozen sections, generate diagnoses/differential diagnoses, review any ancillary studies (immunohistochemistry, special stains, flow cytometry, and molecular studies) from ordered studies, generate synoptic staging reports, and create preliminary reports for faculty to review, adjust, and finalize. 

Residency applicants often have questions about the frozen section laboratory and its impact on resident training. The simple answer is that the frozen section lab will enhance your surgical pathology skills in a way that could not be achieved anywhere else. The frozen section lab rotations represent an important portion of your overall surgical pathology training. 

The autopsy service at Mayo Clinic is one of the busiest hospital autopsy services in the country. Approximately 800-900 autopsies are performed each year. As a resident, you are given responsibility for both forensic and medical autopsies, and all of our residents are able to reach the minimum number of 30 autopsies required for AP board eligibility. Our autopsy service is staffed by multiple consultants, including board-certified forensic pathologists. The autopsy service is also staffed by a laboratory supervisor, autopsy technicians, and pathologist assistants. The physical facilities are modern and spacious and include two autopsy rooms, a separate gross dissection room, an x-ray room, a resident work area, digital photography equipment, storage freezers, and heart/lung perfusion fixation apparatus. During the first month of autopsy, new residents will be paired with a supervising pathologist assistant and will be taught standard autopsy dissection techniques. Gross and microscopic autopsy findings will be reviewed with faculty consultants. By the end of the rotations, you will be comfortable formulating a complete autopsy report, incorporating relevant clinical information, autopsy findings, and supplemental studies. The autopsy rotation is an excellent rotation to learn systemic pathology, gross anatomic pathology, and histopathology.

You will complete a minimum of three blocks on the cytology service. Three broad areas of coverage include: gynecologic cytology (the Pap test), non-gynecologic exfoliative cytology (urine, body fluids, anal, respiratory, and biliary cytology), and fine needle aspiration biopsy interpretation and performance. Corresponding needle core biopsies are also signed out in the cytology service, allowing for real-time cyto-histologic correlation. As your proficiency increases over time, you will take greater responsibility for the caseload, previewing cases prior to consultant review, and, when necessary, gathering applicable clinical data, imaging reports, and patient history. Throughout the three rotations in cytology, you will also participate in a structured, progressive curriculum of one-on-one teaching sessions with the director of our cytologist (CT) training program. Additionally, you will attend cytology-histology correlation conferences and participate in cytology-specific journal clubs. Teaching files are available for resident study. Hands-on experiences with the procurement of FNAs happen through collaboration with our clinical colleagues in Endocrinology.

The required Mayo Clinic Internal Consults (MCIC) rotation is considered a senior resident rotation, in which you are responsible for reviewing outside pathology cases for patients coming to Mayo Clinic for additional care. These cases have been finalized at their home institutions and are double-checked here for accuracy and detail. Cases across many specialties are represented, including neuropathology, bone and soft tissue pathology, cytopathology, gynecologic pathology, breast pathology, head and neck pathology, gastrointestinal pathology, urologic pathology, and dermatopathology. Approximately 30 cases are seen per day. This includes a combination of surgical excision specimens and biopsies. You are responsible for reviewing the slides and preparing reports with all necessary details for sign-out. You review the cases with consultants and are also responsible for seeking opinions from fellows and faculty in the various AP working groups.

Peripheral blood and bone marrow examination are the focus of the initial blocks of this rotation. The fourth block consists of rotations through the molecular and metabolic hematopathology labs. The lymph node portion (one block) of hematopathology is most often done as a third-year rotation. You perform a requisite number of bone marrow biopsies and have additional opportunities to improve your proficiency with this procedure as time and interest allow. You review smears, aspirates, and biopsies independently each morning and then sign out completed cases with staff consultants later in the day. As a major center for hematology/oncology, the volume of material encountered in the Mayo Clinic hematopathology lab is tremendous. You receive graduated responsibilities as you progress to review an average of 10 bone marrow cases each day. This volume, along with substantial referral sources also allows for in-depth exposure to flow cytometry, molecular genetic modalities, and other ancillary and esoteric tests. 

Previous residents have often found the transfusion medicine rotation to be one of the busiest, but also one of the most rewarding clinical pathology rotations, largely due to the close interactions required with the clinical services. You spend a total of four blocks on the transfusion medicine service. The first block is devoted exclusively to education and is comprised of didactic sessions, practical hands-on labs, and various seminars. After completing this preliminary rotation, you assume the transfusion medicine "hot seat" acting as a liaison between clinicians and the transfusion medicine service. You manage the utilization and inventory of blood components, donor eligibility issues, donation-related reactions, coordination of apheresis treatments, and other special problems that may arise. The on-call responsibility is by pager and most trainees handle calls from their homes. An on-call transfusion medicine fellow or consultant is always available should challenging issues arise that require more expert assistance.

The clinical chemistry rotation consists of required rotations through a number of different general and specialty laboratories. Some of these facilities are located in the Hilton Building on the main campus and some are located at a satellite laboratory building on Superior Drive, necessitating travel for parts of the clerkships. The general structure is one block in Chem 1 in the first two years, followed by two additional blocks of Chem 2 and Chem 3 in later years. Chem 1 includes time spent in the Central Clinical Laboratory in toxicology. Chem 2 includes time spent in the renal specialty lab, protein immunology, the cardiovascular specialty lab, and therapeutic drug monitoring. During Chem 3, you participate in the clinical mass spectrometry/endocrinology laboratory, neuroimmunology, cellular and molecular immunology, protein immunology (including SPEP interpretation), and antibody immunology. Throughout your chemistry rotations, you also participate in the administrative activities of the laboratory directors. Supplemental lectures and interactive problem-based sessions occur throughout the rotation, with the weekly CP core seminar series containing much of the core didactic content in clinical chemistry. Many esoteric tests are performed in the clinical chemistry laboratories with a large enough volume to allow significant interpretive experience if a resident desires to focus on a particular area. During the rotation, you will periodically take clinical chemistry call. Calls are directed to residents from our core laboratory and also from Mayo Lab Inquiry, the customer service branch of Mayo Medical Laboratories. These calls deal with interpretive and diagnostic dilemmas faced by community pathologists and laboratorians from outside of Mayo Clinic. These calls provide an excellent means to supplement learning in chemistry. Weekly call rounds allow you to learn from these calls throughout the chemistry rotations.

The microbiology rotation consists of eight weeks of rotations through each of the major microbiology labs, including bacteriology, virology, parasitology, hepatitis and HIV, and tuberculosis/mycology. You will be introduced to the basic and advanced methods used for microbe identification in each lab. You will also spend one week with the clinical infectious diseases team. Toward the end of the rotation, you will also get a week-long "day call" experience fielding questions from the microbiology labs and from outside clients. Throughout the rotation, you will give informal talks on selected topics in microbiology. The faculty have expertise in the development of new molecular assays for microbe identification utilizing methods, such as real-time PCR, ribosome sequencing, mass spectrometry, and in situ hybridization. 

The coagulation rotation consists of four weeks spent between the special coagulation laboratory and the coagulation clinic. The coagulation service at Mayo is run cooperatively between the Departments of Hematology and Laboratory Medicine and is staffed by clinical hematologists and clinical pathologists. Typically, you will rotate along with hematology fellows, although you will focus on the interpretation of special coagulation studies. This rotation is organized by an education specialist who teaches test profile interpretation until you are able to independently provide a written interpretation of coagulation study profiles. A typical day consists of seeing patients in the morning at the coagulation clinic, followed by a didactic lecture on selected coagulation topics given by the attending hematologist or pathologist. The afternoon is spent previewing special coagulation study profiles, writing interpretations, and signing out profiles with the assigned coagulation consultant for that day. The spectrum of disease that you will see is very wide, and includes inherited coagulation factor deficiencies, specific coagulation factor inhibitors, lupus anticoagulants, acquired and inherited thrombophilias, heparin-induced thrombocytopenia, and rare inherited platelet disorders. 

The clinical molecular genetics laboratory rotation is an outstanding and well-organized three-month course. The three blocks include basic principles/congenital genetics, genetics of hematologic neoplasms, and genetics of solid tumors. The activities of this rotation include developing a thorough understanding of molecular genetic techniques and cytogenetic studies and applying those techniques and studies to render diagnoses. You also spend time working with our clinical genetic counselors. Additionally, you participate in molecular pathology journal clubs, prepare lectures on particular molecular genetic topics, develop an understanding of how statistics play a role in assessing risk in genetic diseases, and participate in sign-out with molecular genetics consultants. You learn to interpret results from both our in-situ hybridization laboratory (such as the evaluation of head and neck cancers for HPV) as well as our molecular anatomic pathology laboratory, which performs PCR-based tests for the presence of particular translocations in solid tumors (such as synovial sarcoma or alveolar rhabdomyosarcoma). 

We have an integrated two-year didactic core curriculum covering major topics in anatomic and clinical pathology. The entire core lecture series is digitally recorded and available for review at any time through the departmental intranet. The core curriculum is supplemented by numerous individualized didactic lectures and conferences during specific rotations.

You will attend several monthly conferences, including Anatomic Pathology Grand Rounds, Laboratory Medicine and Pathology Grand Rounds, interesting case conferences, and laboratory medicine resident/fellow forum. Visiting professors from around the world also frequently give lectures to the department. In addition, the department sponsors an annual diagnostic surgical pathology conference for practicing pathologists, which you are welcome to attend. 

Unknown slide conferences are held frequently for you to interact with cases and learn from a consultant in their area of expertise. You are also welcomed at monthly multidisciplinary teaching slide conferences in gastrointestinal pathology, oral pathology, and ophthalmic pathology, as well as weekly clinical slide conferences in liver pathology, urine and cervical cytopathology, and dermatopathology.

Visiting professors frequently provide slide conferences specifically for pathology residents. 

You will present at monthly journal clubs, with topics alternating between anatomic and clinical pathology. You will work closely with a consultant sponsor, who will mentor you during your preparation and will facilitate discussion at the meeting. You are exposed to multiple presentation styles as well, including formal presentations of the articles and more informal, discussion-based formats.

You are encouraged to participate in various multidisciplinary clinical service conferences. For example, residents rotating through the autopsy service may be asked to present at the weekly Internal Medicine Morbidity and Mortality conference. 

While on selected rotations, residents attend various organ-specific multidisciplinary conferences such as the orthopedic oncology conference, the neuro-oncology conference, and the breast oncology conference. 

Each month, there is a gross and microscopic diagnosis correlation conference. This long-standing conference was started in the 1900s by Mayo Clinic's first pathologist, Dr. Louis B. Wilson. The conference tradition was continued by another prominent Mayo Clinic pathologist, Dr. Malcom B. Dockerty, for whom the conference was renamed.

At this conference, you review gross photographs of specimens received through the frozen section laboratory and generate a list of differential diagnoses based on their gross pathology examination skills. The corresponding histopathology is then shown, allowing immediate correlation with the gross impression.

Second-year residents and pathology fellows participate in a unique, interactive seminar series aimed at developing critical leadership and management skills that have often been neglected in pathology residency training programs. 

The Department of Laboratory Medicine and Pathology at Mayo Clinic developed an expanded curriculum to address these skills. This curriculum utilizes predominantly Mayo Clinic faculty along with invited outside speakers. The emphasis in the curriculum is placed on practice and interactive cases that stress high-quality, cost-effective laboratory medicine and pathology.

Sessions are attended by other anatomic and clinical pathologists (including division chairs), laboratory scientists, supervisors, and experienced administrators. Interaction among all groups occurs in a team-based environment. You will be excused from your service obligations to attend seven one- to two-day sessions scheduled throughout the year.

 Session topics include:

• Management Basics I
• Management Basics II
• Quality Silver Boot Camp (general health care quality concepts)
• Quality School (pathology-specific quality concepts)
• Informatics
• Finance
• Quality Improvement Capstone Project seminar

The Quality Improvement Capstone Project requires students to form teams and answer a practical management or leadership question (For example, one of the previous team presentations answered the question, "How do we get our physicians to accept a new test or algorithm?"). 

In addition, residents and fellows are invited to attend departmental meetings, such as the Clinical Practice Committee, on a monthly basis. Residents and fellows are routinely included in College of American Pathologists inspection teams.