The Training Program
I. Clinical Training
During the first 18 months (PGY I and the half of PGY 2), the residents will be functioning as Medical Anatomical Pathology residents within the Pathology Residency Training Program at New York Presbyterian Hospital – Columbia Presbyterian Center.
PGY I Autopsy (5 month) / Surgical Pathology (4 month) /
Orthopaedic Pathology (1 month)/
Hematopathology (1 month) / Cytology(1 month)
PGY 2 Surgical Pathology (4 month) /
Dermatopathology (1 month) / Clinical Pathology (1 month)
A desk with microscope and computer is provided to each resident in the resident’s room.
Autopsy Rotation (A minimum of twenty autopsies must be obtained to meet the requirements of The American Board of Oral and Maxillofacial Pathology). During the Autopsy Rotation the resident will learn to: 1) Independently perform a full post-mortem examination, 2) Identify and photo-document diseased organs and tissues, 3) Take organ, blood and body fluid cultures when appropriate, 4) Prepare tissue sections for fixation and processing, 5) Interpret microscopic slides to identify and diagnose pathologic tissue alterations, 6) Synthesize all the available clinical and pathologic information to formulate a meaningful differential diagnosis regarding the patient’s clinical progress and cause of death, 7) Ably communicate the pathologic findings and conclusions to professional colleagues, 8) Fulfill professional obligations in an efficient, courteous and timely manner (e.g. provisional diagnosis in 48 hours; final diagnosis in 30 days)
Surgical Pathology Rotation When the surgical specimen is received (i.e. various tumor and organ resection specimens), each resident is expected to examine and take sections of the specimen. Then the sections are processed into microscopic slides, which are viewed with the attending pathologist for sign-out. During the sign-out, the salient morphologic findings and microscopic examination will be integrated with the composite gross and clinical findings to render a precise diagnosis. Problems in differential diagnosis will be stressed, and the appropriate differential stains, immunohistochemistry and biomolecular diagnostics will be discussed in order to arrive at a precise diagnosis.
Laboratory Medicine The relevant topics from laboratory medicine , including clinical chemistry, microbiology and immunology will be emphasized concurrently throughout the 18-month rotation.
The second half (18months) of this program is basically devoted to oral pathology.
PGY 2 & 3 Oral Pathology (18 month)
The oral pathology component is based in the clinical and microscopic practices of the 3 board certified full time oral pathologists.
Clinical Component A significant portion of time during the oral pathology segment will be spent in clinical diagnosis and treatment of patients having oral mucosal disease and/or symptoms. The patients referred for the treatment of oral mucosal disease are seen in the Columbia University College of Dental Medicine clinics. The resident will be taught history taking, oral examination and prescription writing from the perspective of a board certified oral pathologist. The surgical removal of mucosal tissue (incisional and excisional biopsy) by the resident is mandatory. He/she will be taught these techniques from the perspective of the clinically oriented oral pathologist and the resident will be required to perform as many biopsies as possible.
Microscopic Component The Oral Diagnostic Biopsy Service receives approximately 5000 cases/year and has been at this level for the past 10 years. These cases serve as the basis of oral pathology experience for the 18-month rotation. They are submitted by a variety of practitioners including periodontists, endodontists, generalists, oral surgeons and head and neck surgeons. There is also a retrospective file of more than 100,000 biopsy specimens and approximately 7000 patients, to serve as a historical basis of study.
The resident will be taught and will have prepared a written gross and microscopic work up of each case to be signed out. Here at the microscope is where the resident will learn the histological features of the various oral disease processes common to the jaws and oral mucosa. It is also at this time that the resident will be taught to correlate the gross, clinical and radiographic features with the microscopic appearance of the various specimens. This is an intense one on one teaching/learning experience, which is essential to the educational development of the resident. Prior to finalizing the resident’s written report, the report will be edited and explained to the resident. Also, consultation with various members of our surgical, dermato and orthopedic pathology services will be obtained by the resident prior to sign out, when necessary in problematic cases. Lastly, rare and interesting cases may be separated out prior to sign out – for conference training at a later date.
Adjustments to Training Program
It is readily apparent that this program is based in general pathology and its various subspecialties prior to the 18 month stint in oral pathology. These varied pathology entities obviously overlap in their education with principles based in medicine, surgery, radiology, dermatology, otolaryngology, pharmacology, microbiology, immunology and psychiatry. The oral pathology resident will be expected to become at least conversant in all the above entities that overlap with his/her cases as the resident proceeds through the program. In addition, with the permission of the director of the oral pathology residency program, small time periods can be substituted in the program for rotations in the basic sciences and clinical sciences mentioned above.
In any pathology program, weekly resident conferences are mandatory. The oral pathology resident will attend and function in all pathology conferences scheduled during the various specialty rotations. These include, but are not limited to, weekly conferences in
1. Autopsy Pathology
2. Surgical Pathology
3. Orthopedic Pathology
5. Oral Pathology
6. Laboratory Medicine
Other conference: The resident will attend
1. The weekly head and neck tumor conferences
2. The monthly New York Institute of Clinical Oral Pathology conferences
3. Other appropriate conferences, as necessary, in this medical center
4. The American Academy of Oral and Maxillofacial Pathology annual meeting
III. Teaching Responsibilities
General Pathology During the first 18 months of this educational program, the oral pathology resident is under the direction of various medical pathology directors of service. In accordance with the teaching principles of each director, the oral pathology resident may be assigned specific teaching responsibilities (i.e., during the Autopsy rotation, fourth year medical students on Pathology rotation will be observing the resident as he/she performs the post-mortem examination). In addition, each resident will be assigned as a Pathology laboratory group leader, instructing second year Columbia University medical students.
Oral Pathology The resident will be assigned to a reasonable number of lectures and conferences – to be delivered to our undergraduate and post graduate students as well as our dental/medical residents. The resident will be guided in the preparation of lecture material and critiqued afterward.
IV. Research Activities
Throughout the 36-month residency program, the oral pathology resident will be encouraged to spend time on appropriate research, be it basic science laboratory or a retrospective clinicopathologic project. Certainly time can be spent after hours, and with the permission of the program director, a small amount of time may be substituted for a research project. The above is in addition to the 1-month research rotation allotted in the third year of the program. Of course the resident will be encouraged to generate adequate data for a publication.
During the last 3 months of the program, the resident will be given a mock fellowship/board examination to measure his/her acquired knowledge and to prepare the resident for these examinations following completion of the program.