Orientation and Gross Only Rotations

Length: 1 x 4 and 1 x 2 week-long blocks

Location: University of Cincinnati Medical Center

Rotation Director: Lauren Rosen, M.D.

The orientation and gross-only rotations were introduced in 2018 with an objective to provide the incoming residents a bird’s-eye view of anatomic pathology (including exposure to surgical pathology, autopsy, and frozen section services) and clinical pathology services - all in one month’s time. All PGY-1s start their training with 4 weeks of orientation.  The gross-only rotation falls during the first two weeks of a PGY-1s first surgical pathology rotation (either during the second or third block of training).

Surgical pathology and gross only: We start by providing introductory lectures covering the basics of grossing, providing the required vocabulary for describing resection specimens, inking specimens, and procuring margins (enface vs. perpendicular, etc). Senior residents lead morning didactics designed to teach normal histology, while our pathology assistants provide grossing lectures and teaching sessions at the gross bench. The residents receive a tour of the AP lab and receive hands-on training that includes the experience to embed tissue, cut blocks, and stain their own H&E slides. The residents also receive an overview of lab safety from our lab manager and cytopathology from our lead cytotechnologist. This process is designed to help the residents get a better understanding of the AP Laboratory workflow and makes them aware of the "dos and don’ts" at the grossing bench. A weekly feedback form is designed to provide real-time feedback to the resident. A pre and post-test is provided to objectively measure each resident's progress. The residents are supervised at all times during their orientation and are handed graduated responsibility depending on their competency, which is assessed and signed off on by the PAs. PGY-1 residents are expected to demonstrate proficiency in grossing of biopsies and small specimens by the end of their orientation month.  A PGY-1s first surgical pathology block will begin with 2 weeks of a “gross only” rotation, in which residents will further hone their grossing skills and focus on grossing more complex specimens. A checklist of specimens is provided, and residents are expected to keep a concurrent log of their specimens to date.

Autopsy: Each PGY-1 is paired with a senior resident (usually a PGY-4) who teaches the junior resident “the ropes” of the autopsy service. They perform cases with the senior resident and are expected to contribute to the workup and sign-out of the entire case from start to finish, as well as participate in the brain cutting of each case.

Frozen section: This is another hands-on learning experience, during which the PGY-1 residents learn to sample specimens, perform frozen sections and stain slides. They are given graduated responsibility, and by the end of the month, most residents are proficient in cutting sections on their own.

Clinical Pathology: A Clinical Pathology Bootcamp consists of a series of lectures that review the basics of transfusion medicine, coagulation and hematology, and help to prepare residents for CP call.