The primary focus for this fellowship is in anatomic pathology, but the fellow will rotate throughout the clinical laboratories as well. The fellow is exposed to and participates in the triaging and autopsy of pediatric deaths that are referred to the medical examiner’s office. The fellow accompanies the medical investigators to the death scene, works with one of three medical examiners on the pediatric autopsy, and follows any lab testing from cases in the toxicology lab. The fellow will be required to review their intraoperative consultation diagnoses after the final diagnosis is rendered on each of the cases they are involved in to identify their rate of concordance with the final diagnosis.
Over the fellowship year, the fellow will become more independent in gross pediatric and perinatal specimens, and making diagnoses on specimens (including the decision whether any special stains or studies are required). The fellow will also learn how to triage tissue in oncology cases and direct trainees and pathology assistants what tissue to save for these cases. The fellow will participate in intraoperative consultations of pediatric surgical specimens (“frozens”) and rapid on-site evaluation of cytology specimens. Communication and interpersonal skills are essential in triaging specimens effectively. The steps in triage include comprehension of the question posed by the surgeon; a decision of what tissue to use for the frozen section; the interpretation of the frozen section, including the determination of its adequacy; and the formulation of the diagnosis in a manner that will answer the surgeon’s question adequately.
The fellow will participate in clinicopathologic conferences by presenting applicable cases. These conferences include:
- Pediatric GI conference (biweekly): Microscopy of GI biopsies is shown in conjunction with viewing the corresponding endoscopies for each patient. In this conference the fellow can correlate the pathology with the endoscopic findings and hear from clinicians with respect to follow-up and treatment.
- NICU conference (monthly): Clinical history of one patient who had care in the NICU with subsequent demise and post-mortem examination is presented by a NICU fellow and then the pediatric pathology fellow presents the findings on autopsy pathology and pertinent teaching points related to the case. This presentation allows the fellow to place the pathologic findings in the context of the clinical course and would discuss pathogenesis, including genetic features of the case.
- Prenatal Diagnosis conference (monthly): The fellow joins perinatologists, neonatologists, genetic counselors, and ultrasonographers in this working conference in which patients with abnormal prenatal ultrasounds are presented and triaged. The MFM fellow presents didactic material.
- Maternal Mortality Conference (monthly): The pediatric pathology fellow presents the pathology of perinatal autopsies and placentas that relate to perinatal deaths.
- Pediatric Tumor Boards (biweekly): The clinical history, imaging, and pathology of current pediatric oncology patients are presented in order for pediatric oncologists, surgeons, and radiation oncologists to triage these patients.