Pathology

Rotations

Core AP Rotations

Autopsy

The UCLA autopsy service encompasses experience in medical/hospital autopsies. Residents draft autopsy preliminary and final reports, and present at the biweekly multidisciplinary autopsy case conferences. Residents also rotate through the Los Angeles County Medical Examiner-Coroner office, and get experience with forensic autopsies, with opportunities to visit court and go on “scene day.” Residents easily achieve their required experience for board qualifications.

Cytopathology/FNA

Residents spend 3 months on the cytopathology/FNA service where they review gynecologic, non-gynecologic, and fine needle aspiration specimens on the Westwood-UCLA campus. Both consult and non-consult cases are previewed by clinical trainees.

Residents cover requests for rapid on-site evaluation of cytologic material in the afternoon. They also participate in regular quality review case conferences and journal clubs.

Residents also experience UCLA’s pathology-run ultrasound-guided fine needle aspiration clinic service where they learn to take a focused history, physical examination, and perform fine needle aspiration of superficial lesions in our free-standing clinic on the Westwood campus. They are introduced to the use of ultrasound guidance in localizing and sampling superficial lesions. They preview slides and compose complete reports of each patient they encounter in our clinic.

Surgical Pathology

Residents experience intensive, subspecialty-based surgical pathology training. They rotate through each core subspecialty three times in two-week blocks, with a focus on graduated responsibility. The surgical pathology rotations are scheduled on a “one-day” cycle.  The core subspecialties include: 

  • Cardiothoracic Pathology
  • Obstetric/Gynecologic Pathology
  • Head and Neck Pathology
  • Breast Pathology
  • Genitourinary/Renal pathology
  • Bone and Soft Tissue Pathology
  • Dermatopathology

In addition, residents spend a total of 1 month on the endoscopic GI Biopsy pathology service.

Resident responsibilities while on surgical pathology rotations:

Gross pathologic examination/sectioning: daily, limited to specimens on subspecialty service.

Preview and preparation of reports: Residents are responsible for drafting reports for all cases on their services in preparation for sign-out with the attending pathologist on service. Graduated responsibility is achieved over time as more senior residents are expected to "take-ownership" of their cases and prepare more complete "sign-out" ready reports.

Daily sign-out sessions with attending sub-specialty pathologist.

Residents of all levels regularly present at specialty specific tumor boards and radiology-pathology conferences. Residents are also considered the point person for clinician communications for their service.

Junior residents receive supervision by service specific fellows, senior residents, the JA-Westwood, pathology assistants in the gross room, and attending pathologists as appropriate.

Pediatric Pathology

Residents rotate for two weeks at the Children’s Hospital of Los Angeles (CHLA), one of the nation’s leading pediatric hospitals. Residents on this rotation receive experience and teaching in many of the genetic syndromes, neoplasms, and conditions, that primarily affect pediatric patients. Rotating residents work alongside the CHLA Pediatric Pathology Fellows and Attendings, and have the opportunity to write up unique surgical pathology cases, and participate in autopsy, FNA rapid onside assessments, and didactic sessions.

Neuropathology

The Neuropathology service is bolstered by a strong neurosurgery program, including the UCLA Brain Tumor Center (designated SPORE site by the NIH), Tumor Translational Resource, and the Mary S. Easton Center for Alzheimer’s Research at UCLA. Residents draft neuropathology reports, participate in intraoperative consultations, examine peripheral nerve and skeletal muscle biopsies, and participate in weekly brain cutting of autopsy neurodegenerative cases.

PGY-1 Frozen Section Rotation

The PGY-1 Junior Frozen section rotation is a 2-week rotation designed to introduce residents to intraoperative surgical pathology consultations early in their training. The rotation provides exposure to different aspects of intraoperative consultation, including frozen lab workflow, gross specimen assessment and sampling, slide preparation, histologic examination of frozen sections, and communication with clinical colleagues. The aim is not only to help first-year residents prepare for anatomic pathology call and more advanced rotations, but also to provide early experience in an integral component of the practice of pathology.

Senior-Level/Advanced AP Rotations

AP Supervisor

On this rotation, senior residents have the opportunity to supervise junior residents on surgical subspecialty services and the gross room. There is ample opportunity for teaching and mentoring our junior residents and medical students on service. In addition, the AP supervisor is assigned challenging consult cases from international hospitals using digital pathology.

Senior Frozen Section

The senior frozen resident evaluates and interprets all day-time interoperative consultations, under the supervision and guidance of the frozen attending on service. The senior frozen resident also plays a role in training and mentoring the junior frozen resident on service.

Junior Attending - Santa Monica General Service

The Junior Attending on the Santa Monica General Service experiences a high-volume, general signout service, simulating what may be encountered in many private practice settings. On this service, the resident takes ownership of their cases, and continues to develop their diagnostic proficiency.

Junior Attending - Subspecialty Surgical Pathology

Senior residents have the opportunity to use their elective time to act as Junior Attending on their surgical subspecialty of choice. Exact roles and duties are flexible based on the interest of the Junior Attending, but tend to include a “deep dive” into a subject of interest, opportunities to work up challenging consult cases, outreach cases, give tumor board, and teach junior residents on service.

Core CP Rotations

Clinical Chemistry

Residents interpret results for high performance liquid chromatography, serum protein gel electrophoresis, and immunoelectrophoresis. Cases are reviewed with attendings. Residents also meet with attendings weekly for didactics, which involves lectures and case-based learning of chemistry concepts and laboratory management

Clinical Microbiology

Clinical Microbiology is a comprehensive diagnostic laboratory that, in addition to receiving patient specimens from the UCLA Health System, also acts as a referral center for other hospitals and clinics in Los Angeles and nationally. The section also has several postdoctoral fellows in Microbiology with whom responsibility is shared.

The resident rotation includes mandatory bench rotations and clinical responsibilities as defined by the faculty. Residents will meet daily with the faculty to discuss clinical cases, review areas of general microbiology, and identify topics for clinical correlation conferences. The curriculum includes didactics in Bacteriology, Virology, Serology, Mycology, and Parasitology.

Activities include daily plate rounds with faculty, conferences, and time for bench work or independent activities. Residents often present interesting cases or articles to the group. Weekly call review is held to follow up on interesting call and sign-out problems from the prior week.

Cytogenetics/Immunogenetics

The overall objectives of the Clinical Cytogenetics rotation are for the residents to be familiar with the basic techniques of chromosome preparation, banding, karyotype and Fluorescence In situ Hybridization (FISH) analysis, and some of the more common cytogenetics anomalies associated with genetic and neoplastic disease. During this period the resident will have opportunities to setup their own peripheral blood and perform analysis and learn the chromosome nomenclature, to know when the different cytogenetics tests are called for, and what the results mean vis-á-vis the disease. The resident will also have exposure to newer methods in molecular Cytogenetics such as multi-color FISH (m-FISH) and array Comparative Genomic Hybridization (aCGH). There will be ample opportunity to review abnormal cases and participate in lab meetings. A series of practical lectures will be given covering prenatal diagnosis, postnatal constitutional analysis, hematological disorders and solid tumors. Residents will have the opportunity to participate in the daily sign out with the directors. Finally, there will be opportunities for research and developmental projects.

Hematopathology

Rotations are scheduled in two-week blocks for a total of twelve weeks in bone marrow service and four weeks on lymphoma service. Routine daily activities include reviewing and signing out bone marrow, flow cytometry, and lymph node cases. Residents are responsible for obtaining the clinical history for cases and communicating results to clinicians directly when appropriate. Other activities performed as they arise include evaluation of peripheral blood and body fluid smears. Time is set aside each week for specific teaching sessions. Experience in performing bone marrow biopsies can be obtained at the Santa Monica Hospital. Residents attend and prepare presentations as indicated at pathology resident conferences as well as the HemePath Multidisciplinary Conference series and Lymphoma Tumor Boards.

Coagulation and Benign Hematology

Residents rotate through the Coagulation service, and gain experience and knowledge in the principles underlying laboratory hemostasis/thrombosis and inherited/acquired non-malignany hematologic disorders. Trainee are offered a wide experience in the evaluation of patients with hematologic or coagulation disorders and the interpretation of a variety of abnormal laboratory findings associated with defects in blood components or the coagulation system. Residents will assist clinicians in the selection of appropriate testing and proper interpretation of results.

Lab Management

Residents will appreciate and prepare themselves for the multifaceted responsibilities of being a lab director by engaging in both applied and didactic opportunities. Specifically, residents will attend and participate in various lab management meetings, including weekly clinical meetings (blood bank, hematology, chemistry, etc), as well as special-need meetings for instrument validation, physical space allocation, personnel and resource management, laboratory disaster/pandemic preparedness, and others, as they arise. Residents also benefit from weekly lab director-led didactics, earn a lab inspection training certificate from the College of American Pathologists (CAP), and participate in inspections of the UCLA laboratories. As always, opportunities for additional mentorship, education, research, and quality improvement projects are readily available to residents upon request. Upon completion, residents will have an improved understanding of a lab director's role in patient care in a hospital-based setting and set a foundation for their own future in this exciting field.

Molecular Pathology

The goal of this rotation is to expose the resident to the principles and practice of diagnostic molecular pathology in the day-to-day laboratory setting. Using primarily a case-based learning system supplemented with didactic and selected reading material, the resident will be exposed to our laboratory's diverse applications in molecular diagnosis of genetic diseases, cancer, and individual identification by DNA fingerprinting. The resident will observe and participate in all aspects of specimen handling, case workups, and results reporting. Key molecular biologic procedures such as the polymerase chain reaction, Sanger sequencing, and next-generation sequencing will be introduced. In addition, the resident will be exposed to quality assurance activities such as internal quality control and inter-laboratory proficiency testing; laboratory management including specimen triage, budgeting, licensing, accreditation, patent issues, ethical and legal issues, and decisions regarding new test development and interfacing with other clinical laboratories; and communication with referring clinicians and genetic counselors. Residents will also be exposed to our Orphan Disease Testing Center, dedicated to the molecular diagnosis of rare genetic disorders, the Clinical Genomics Center, where the comprehensive sequencing of a patient's entire exome (all of the coding regions in the genome) is performed and interpreted for a variety of clinical indications, and to outpatient and inpatient consultative activities in medical genetics. Time permitting, there will be opportunities for independent research and developmental projects.

Resident Responsibilities:

  • Observation of molecular testing procedures (as desired) and interpretation of test results (daily)
  • Preview cases, draft reports, and sign out with Directors (daily)
  • Journal club presentation (one per month)

Transfusion Medicine/Blood Bank

The Transfusion Medicine Section of Clinical Laboratories includes a Blood and Platelet Center to collect, process, and prepare blood components from whole blood and aphaeresis donations, a Therapeutic Apheresis Center to perform therapeutic apheresis procedures and stem cell collections, a Transfusion Service to provide compatible blood products and offer specialized immunohematology tests for resolving complex antibody problems and for evaluating immune-mediated hemolysis, and a transfusion medicine Consultation Service.

About 75,000 blood products are transfused each year at UCLA. The need to monitor appropriate blood usage and transfusion safety places a growing emphasis on the Consultation Service. Some consultations are initiated automatically when unusual orders are received or atypical test results are noted; others are provided upon physician request. In addition, transfusion practices are continuously audited according to guidelines established by the UCLA Committee on Blood and Blood Derivatives. The residents will be involved actively in the consultation service and must become familiar with the clinical, technical, and administrative aspects of all transfusion medicine (TM) areas.

Teaching activities are routinely scheduled Monday through Friday, and include discussions of clinical cases at sign-out sessions, didactic sessions on specific transfusion medicine topics, and regular clinical ward rounds on patients with unusual or interesting transfusion requirements. Residents are also encouraged to attend education seminars held in the department and also hematology/oncology rounds to follow specific consult patients with the TM fellow and faculty. Senior residents are welcome to participate in Blood Services and Transfusion Services management under the direction of the senior supervisors and medical directors. Residents at all levels of training are strongly encouraged to undertake small research projects with the support of the faculty. Residents are provided with a work area in the laboratory, which allows them to actively participate in ongoing activities and work closely with the staff. The work area is equipped with a collection of useful reference texts in transfusion medicine.

Informatics

The Informatics rotation is designed for residents as an overview of key informatics concepts and practical applications in Laboratory Medicine. Residents are exposed to the breadth and content of what “Informatics” is and how it is employed at the institutional, department, laboratory, and patient levels, and what the pathologist’s role is in these settings. The goal is to provide a sufficient exposure and understanding for ABP exam preparation and foundation for appreciating informatics role in future career environments.

Resident activities include scheduled meetings and didactics with informatics faculty to discuss goals and content, assigned reading, attending ongoing Lab Informatics related meetings as available, performing a database exercise, and participating in resolution of topical Informatics issues. These activities will be tailored to the resident’s background and to the extent possible towards their career plans.

Senior/Advanced Hematopathology

The purpose of this rotation is to provide additional training on lymphoma diagnosis and to provide experience with integration of molecular/cytogenetic findings. Residents have the opportunity to review and participate in the diagnosis of lymphoma cases on the service including write up and signing out of cases. They also formulate the integrated reports of bone marrow and lymphoma case as well as attending the Molecular Databoards.

Advanced CP Rotations

Senior, fellowship-level CP rotations are available as electives in any of the clinical laboratories including Clinical Chemistry, Cytogenetics, Immunogenetics, Microbiology, Molecular Pathology, or Transfusion Medicine