About the Residency Program

Strengths of Our Program

Size - We have a total of approximately 20 residents (4-6 residents per class). The relatively moderate size of our program allows for a more individualized training program, more one-on-one teaching at the microscope, more opportunities for research and fellowships, and a more responsive Director and Coordinator.
Faculty - Over 35 different faculty members are directly involved in the training of residents Pathology Faculty. Our clinical faculty come from a wide variety of high quality training programs, rather than all being products of our own program with a homogenous approach to pathology. They consistently receive high marks for their commitment to quality teaching by our residents. If you are looking for academically accomplished faculty with a host of translational research interests and a talent and enthusiasm for training young pathologists, our program may be a good fit.
Fellowships - Our program offers specialty fellowships in cytopathology, hematopathology, surgical pathology and transfusion medicine. While we encourage residents to seek specialty training outside of UW, the fact is that many fellowship spots across the country are filled by "internal" applicants, making the presence of clinical fellowships one important consideration in deciding on a residency program.
Research - The Department of Pathology has made a commitment to resident research, providing small "grants" to residents so projects can get up and running, regardless of faculty funding. This is critical in getting research accomplished during a busy residency. Residents can become involved in basic to clinical research with any UW faculty member, regardless of department.
Location - As a resident, you will be spending four or more years of your life in a new city at the same time that you will find you are growing tired of living like a poor student. Location is not just a superficial consideration when making residency choices. Madison is a small city of about 300,000 people that houses the State Capital and a large public university. Its size makes it an easy place to live, with minimal traffic, crime, or cost-of-living, but its proximity to Chicago and Milwaukee, as well as its highly educated and professional population creates a more cosmopolitan atmosphere than in other cities of comparable size. Madison and its suburbs have received recognition as among the best places to live and work in the U.S. It is a city full of lakes and parks, some great restaurants, good music, and friendly people. Sure, the weather is not exactly like San Diego's, but the four seasons can be spectacular here (and with the money you save on housing, you can afford a trip to the beach in February).
A Bigger View of what Pathology Can Be - The University of Wisconsin Hospital and Clinics Division of Graduate Medical Education makes available salary and malpractice insurance for residents in all specialties to complete rotations in International/Underserved Health. The program encourages residents to experience pathology in resource poor settings such as Belize, Cuba, and Africa by spending 2-4 weeks of elective time in these areas. More opportunities are being actively developed in collaboration with other departments at UW.

The Program in Anatomic Pathology

Anatomic Pathology at UW consists of training in Autopsy, Neuropathology, Cytopathology, and Surgical Pathology.

Autopsy: Approximately 500 autopsies are performed at UW annually, of which at least half are forensic cases. We have three dedicated faculty members with expertise in forensic autopsy, Drs. Brooks, Corliss, and Stier. Residents have excellent opportunity for exposure to forensics during their 4-5 months of required autopsy rotations, but can also do elective months focusing on forensics, pediatrics, or other autopsy areas. Neuropathology is covered both on the autopsy rotation and also during an additional one-month rotation where malignant neuropathology and neuropathologic frozen sections are emphasized.

Cytopathology: There are 4 months of required Cytopathology training at UW, the first being at the State Laboratory of Hygiene, which sees a high proportion of gynecologic cytopathology and the other 3 at University of Wisconsin Health Clinics, where the residents are trained to be proficient in all aspects of cytopathology including gynecologic cytology, body fluid cytology and fine needle aspirations (FNA) from solid organs. This includes hands on experience on rapid on-site evaluation (ROSE) during the initial part of their training followed by training in advanced technologies like telepathology.

Our program is focused on graduated responsibility such that during their fourth rotation the residents are given the opportunity to independently make adequacy assessments for on-site FNA evaluations through telepathology. The residents are required to attend monthly Cytopathology service team meetings, giving them an exposure to laboratory management and quality systems. A recent addition to the fourth rotation is resident involvement in triaging specimens for molecular studies on cytologic specimens. The cytology laboratory works closely with the molecular laboratory further enhancing this aspect of their training. The final months of the cytopathology rotation is adapted to the residents' career interests, with time for research projects for those wishing to apply for cytology fellowships.

Additionally, the residents have access to system based organized study sets throughout their residency. The department also has structured didactic series including slide review sessions, conducted by cytopathology faculty throughout the year at 8.00 am conferences.

Surgical Pathology: Surgical Pathology at UW (combined with the VA) sees close to 40,000 specimens per year with an excellent mix of routine biopsies and more esoteric specimens originating from the large number of surgical procedures, including surgical oncology and organ transplants, performed at UW and the NCI-funded Carbone Cancer Center. Diagnosis and training in Surgical Pathology are based on a subspecialty model. The subspecialties include Gastrointestinal, Breast, Gynecologic, Bone and Soft tissue, Thoracic, Genitourinary, Endocrine, ENT pathology, Pediatric, Renal and Neuropathology. Dermatopathology, Eye Pathology, and Nerve and Muscle Pathology are affiliated with the division, but not integrated in daily Surgical Pathology practice.

Overall, the division of Surgical Pathology is committed to providing an outstanding educational venue, by creating an environment conducive to learning and by expecting residents to play an integral role in patient care. At UW, we emphasize quality of work and graduated responsibility. We have tailored the Surgical Pathology rotations to meet the educational needs of the residents based on their level of training. Some of the unique aspects of Surgical Pathology training at UW include: a unit system for grossing based on year of residency, a tumor board rotation and a recently added frozen section rotation for senior residents. Our residents work in a new facility, where their work and study area are centrally located, surrounded by faculty offices and 7 multi-headed scope stations. The Surgical Pathology labs, frozen section area and grossing room are located in the same facility. Learning opportunities at daily sign out are supplemented by regular didactics, numerous slide sessions and structured, sub-specialty based curricula created by expert faculty along with glass slide study sets for independent study. For residents with additional interest in Surgical Pathology, the department offers electives across multiple subspecialties.

Residents have ample opportunities to participate in research, development of digital imaging capabilities, informatics and quality improvement programs. Faculty also encourage and support residents' independent research initiatives. Residents routinely present at national and local conferences, particularly the USCAP Annual meeting.

The Program in Clinical Pathology

How UW's program is unique.
We have a clinical pathology "Super Block" in which 2-3 residents at a time rotate through many of the UW clinical laboratories over the course of an 8-week period. Each resident rotates through Super Block 3 times during their residency for 24 weeks total.

Residents on Super Block gain experience in the areas of chemistry, immunology, molecular diagnostics, cytogenetics, special coagulation, and some "wet" hematology. The goal of this unique experience is to couple bench-side teaching of procedures and laboratory techniques with an emphasis on case-based learning with faculty, through didactic sessions, participation in sign-out and interpretation of laboratory tests (e.g. SPEP reports, clinical consultations, test approvals, etc), and involvement in real-world laboratory management issues.

Due to the more acute and unpredictable nature of consultations in Transfusion Medicine and Microbiology, these two services each have their own standalone rotations. In addition to 6 blocks of CP Superblock and 3 blocks each of Transfusion Medicine and Microbiology over the course of training, residents also spend 3 blocks in hematopathology at UW and 3 blocks at St. Mary's hospital, a private hospital in Madison, where they have a great deal of independence dealing with hematology and other laboratory issues as well as experience in a private practice setting.

Why the change?
Before we had this Super Block, we found that dividing up the clinical laboratory entirely into narrowly focused 1 month rotations worked well for some areas but in other areas sometimes resulted in limited and widely separated exposure to high-impact learning opportunities with too much emphasis on learning the technologists' jobs in order to fill the time rather than that of the attending laboratory director. Further, the lack of repeated exposure throughout residency to these high-impact experiences sometimes resulted in even senior residents feeling like beginners when they would return to a rotation that they hadn't experienced for 1-3 years. Thus, combining some services into one rotation allows for more repetition and greater density of high-yield learning opportunities.

Lastly, one of the deficiencies noted across the country in newly graduated pathology residents is their lack of exposure to, and understanding of, laboratory management issues that they are expected to take on early in their first jobs. These include personnel management, QA/QC/QI, understanding the elements involved in bringing a new test online in the laboratory, or purchasing a major piece of equipment, to name a few. Our revised edition of the clinical pathology curriculum includes particular attention to the management aspect of laboratory medicine via both clinical responsibilities, real world projects, and adjunct learning modules. Finally, the 8-week duration of each Super Block also allows for more realistic chances of completing QA and other projects during the rotation.

Summary
In sum, the big picture goal is to provide our residents with enough depth of hands-on experience to "try out" each clinical pathology subspecialty in earnest for possible career specialization and enough variety of experience to be prepared for general pathology private practice.