Rotation Schedule | Rotation Descriptions | Conferences

Curriculum Overview
Our curriculum is designed to provide complete training in all major areas of anatomic and clinical pathology, while remaining flexible enough to accommodate diverse career goals in private practice, academic, or other settings.  Anatomic and clinical pathology rotations are integrated throughout the 4-year AP/CP curriculum to allow continuous exposure to both components. 

Residents gain experience in all aspects of anatomic and clinical pathology, including general surgical pathology, subspecialty areas of surgical pathology (e.g. bone and soft tissue, gastrointestinal, hepatobiliary, pulmonary, breast, gynecologic, genitourinary, renal, head and neck, cardiovascular, ophthalmic, neuropathology and dermatopathology), postmortem examinations (including hospital and forensic cases), cytopathology, molecular pathology, hematopathology, coagulation, transfusion medicine, clinical chemistry, microbiology, cytogenetics and laboratory management.

Rotation Descriptions

Anatomic Pathology Rotations

Frozen section (8 blocks)
As you may be aware, the Mayo Clinic has a unique way of signing out its surgical specimens received from the operating rooms. The great majority of surgical specimens received from the ORs are signed out at the frozen section lab within minutes. This translates into a huge number of frozen sections performed each day. On a typical day 200-400 frozen section slides will be evaluated at each of the two frozen section labs. The frozen section method was developed at Mayo and has been utilized successfully for more than a century. The advantages of evaluating specimens at frozen section are manifold and include rapid diagnosis thereby allowing further treatment plans to be formulated the following day, immediate evaluation of surgical margins thereby avoiding unnecessary subsequent operations, and proper triage of specimens for appropriate ancillary studies. It is important to note, though, that not all specimens are signed out at frozen section. In fact, the vast majority of cases evaluated within our department, and the vast majority of cases you will see during your residency, will not come from the frozen section lab and will therefore be processed in a traditional manner. 

Nonetheless, your experience in the Mayo frozen section labs will represent a formative experience of your overall training. The frozen section model offers a unique opportunity for residents to enhance their gross and microscopic examination skills in a way that would not be possible anywhere else. As a junior resident you will learn the critical importance of gross-histopathologic correlation through the repetitive and instant correlation of gross and microscopic features. Of paramount importance, you will also learn how to accurately convey relevant information to the the rest of your frozen section team and the OR team. The frozen section team consists of yourself, a staff consultant, a surgical pathology fellow, a pathologist's assistant, and numerous technologists. Under the informal mentorship of the more experienced members of your team, you will gradually take on increasing levels of responsibility including gross examination, frozen section interpretation, communication with the OR, and case write-up. During your first month, you will work closely with the pathologist's assistant to learn basic gross examination skills until you are comfortable handling most common specimens. If you should ever need help handling a specimen, the entire team is immediately available.  During your subsequent months, you will sit for short periods of time in the "hot seat" directly beside the staff consultant who will mentor you in the fundamentals of interpreting frozen sections and communicating with surgeons. As you progress in your gross and histopathological examination skills you will sit for longer periods of time in the "hot seat" and take greater responsibility for all aspects of a case.  By your final month in the frozen section lab you will effectively function as an experienced surgical pathology fellow, correlating gross and microscopic features to arrive at a diagnosis, communicating that diagnosis to the OR, writing up the case with all relevant prognostic information, and requesting any additional ancillary studies.

Because specimens are handled in the fresh state as soon as they arrive from the operating rooms, the resident's work is manageably spread throughout the day and generally predictable, rarely extending later than six o'clock in the evening. This means there is still time for reading or other pursuits at the end of the day! On approximately alternating days, you will spend a day away from the frozen section lab and focus on diagnostic histopathology by assisting with the sign-out of outside cases and reviewing the confirmatory H&E permanent sections of the previous day's frozen sections. On this day, you will also review any ancillary studies, including immunohistochemistry, special stains, flow cytometry and molecular studies, ordered previously.

Residency applicants often have a number of questions about the frozen section laboratory and its impact on resident training. The simple answer is that the frozen section lab will enhance your surgical pathology skills in a way that could not be achieved anywhere else. The frozen section lab rotations represent a relatively small but important portion of your overall surgical pathology training, so you will have plenty of time to train in a more traditional method, but you will also have the added benefit of training in, by far, the most active frozen section laboratory in the world. We have tried to answer some of the more common questions about the frozen section lab in the "Frequently Asked Questions" section.

MML (3 blocks)
In combination with the frozen section rotation, the MML rotation provides additional training in general surgical pathology, with an emphasis on learning the histopathology of more common, "bread-and-butter" type specimens, such as prostate and breast biopsies. During this rotation, the resident has primary responsibility for in-house clinic biopsies as well as surgical specimens received from surrounding community hospitals. As noted above, these specimens are not processed through the frozen section lab.  On a typical day, the resident may see 40-50 biopsies and 10-20 specimens from surrounding hospitals. As the primary pathologist for these specimens, the resident is responsible for writing up a preliminary diagnosis, ordering any special stains, obtaining any intra-departmental consults, and communicating with clinicians. In the afternoons, the resident will typically gross in any large or complicated biopsies, as well as any specimens received from surrounding community hospitals. Pathologist's assistants and histotechnologists assist with the grossing responsibilities.  Residents have found this to be a very rewarding rotation and some have likened the MML rotation experience to "running your own small private practice".

Autopsy (4 blocks)
The autopsy service at Mayo is one of the busiest hospital autopsy services in the country. Approximately 500 autopsies are performed each year (about 1-2 autopsies per day). Because the vast majority of our autopsies are performed by residents, none of our previous residents have had difficulty reaching the minimum number of 50 autopsies required for board certification. Most residents have accumulated 70-100 autopsies as the sole prosector by the end of residency. Our autopsy service is staffed by 6 consultants, including a board-certified forensic pathologist. Both forensic and hospital autopsies are performed under the direct supervision of a consultant. The autopsy service is also staffed by a laboratory supervisor, 6 full-time autopsy technicians and 2 rotating pathology assistants. The physical facilities are modern and spacious and include 2 autopsy rooms, a separate gross dissection room, a gross neuropathology room, an x-ray room, a resident work area, digital photography equipment, storage freezers, a freezing microtome, and heart/lung perfusion fixation apparatus. The lab is located on the 9th floor of the recently constructed Stabile building with sweeping panoramic views of the surrounding hills. During the first month of autopsy, new residents will be paired with another new resident and a supervising senior resident. During the first weeks, the senior resident, pathologist's assistants and autopsy technicians will teach the new resident standard autopsy dissection techniques. Autopsy findings including histopathology will be reviewed with the senior resident and the staff consultant. By the end of the rotation, the resident will be comfortable formulating a complete autopsy report incorporating all relevant clinical information, autopsy findings, and supplemental studies. The autopsy rotation is an excellent rotation to learn systemic pathology, gross anatomic pathology, and histopathology. For those who are interested in forensic pathology, a unique opportunity exists to work part-time as the Olmsted County Deputy Coroner. 

Cytology (3 blocks)
Residents spend a total of 3 months on this rotation during the course of residency. The cytology service is one of the busiest services a resident will encounter, processing approximately 130,000 specimens each year. Of course, you will only review the abnormal and challenging specimens such as abnormal conventional pap smears and thin preps, urine cytology, pulmonary cytology, body fluids and fine needle aspirates. An important educational feature of the cytology rotation is that vaginal, cervical and endometrial tissue biopsies are also signed-out in cytology, thereby allowing immediate cyto-histologic correlation. During the first week on the cytology service, the resident will double-scope with the consultant on all cases. As the comfort level increases, the resident will take more responsibility for the case load, previewing cases prior to consultant review and, when necessary, gathering applicable clinical data and patient history. Throughout the three rotations in cytology, the resident will also participate in a structured, progressive curriculum of one-on-one teaching sessions with the director of our cytotechnologist school. The first rotation is focused on learning gynecological cytology, primarily normal and abnormal Pap smears. The second rotation is focused on learning non-gynecological cytology, primarily pulmonary, body fluid and urine cytology. The third rotation is focused on learning FNA interpretation and emerging molecular cytology techniques. Additionally, the resident attends a weekly cytology-histology correlation conference. Extensive teaching files are also available for resident study. Hands-on FNA experience is provided through collaboration with our clinical colleagues in Endocrinology.

GI Pathology (1 block)
The required 1-month rotation in gastrointestinal pathology serves primarily as an introduction to upper and lower endoscopic biopsies. The breadth of pathology seen while on this rotation spans the entire spectrum of gastrointestinal disease, and includes inflammatory bowel disease, celiac disease, infectious disease, microscopic colitis, dysmotility disorders, neoplastic disease and rare genetic syndromes. On a typical day the resident will preview approximately 50 biopsies in the morning which will then be signed out with an attending in the afternoon. Sign-out occurs at a double-headed scope and is heavily focused on teaching residents key diagnostic features and pitfalls. The resident, in conjunction with the fellow, will also review intra- and extra-departmental consultations that are received throughout the day. Residents may also participate in the evaluation of liver biopsies that are received throughout the day, although many residents choose to complete an additional month of GI pathology focusing on liver pathology. At the end of the month, residents present an interesting case or project at the GI working group education meeting. 

Dermatopathology (1 block)
The resident experience in dermatopathology is centered in a one month rotation in the Department of Dermatology's dermatopathology service. Their faculty includes several board certified dermatopathologists who sign out nearly 30,000 skin biopsies per year. The case load has an excellent mix of "bread and butter" cases along with rare and challenging cases from both the intramural practice and external consultations. In conjunction with a dermatopathology fellow and dermatology residents, pathology residents participate in a group sign-out of cases during morning and afternoon sessions. Furthermore, an extensive study set is maintained that residents may access to aid their study. Part of the resident's training includes attendance of lectures given in the Department of Dermatology regarding both pathology and clinical topics. Moreover, the dermatopathology sign-out area is located adjacent to the clinical exam room area and the pathology group routinely breaks during sign-out to examine interesting patients and correlate the gross findings with pathology results. This ability to stress clinicopathologic correlation in a multidisciplinary manner greatly enhances the resident learning experience and most residents find their time in dermatopathology to be very high-yield.

Clinical Pathology Rotations:

Hematopathology, including Lymph Node pathology (5 blocks)
Peripheral blood and bone marrow examination are the focus of the initial three months of this rotation. The lymph node portion of hematopathology is covered as a third or fourth year rotation. Residents perform a requisite number of bone marrow biopsies and have opportunities to improve their proficiency with this procedure as time and interest allow. Residents review smears, aspirates, and biopsies independently each morning and then sign out completed cases with staff consultants later in the day. As a major center for Hematology/Oncology, the volume of material encountered in the hematopathology lab is tremendous. Residents review an average of 10 to 15 bone marrow cases each day. This volume, along with substantial referral sources also allows for in-depth exposure to flow cytometry, molecular genetic modalities, and other ancillary and esoteric tests.

Transfusion Medicine (4 blocks)
Residents have often found the transfusion medicine rotation to be one of the busiest, but also one of the most rewarding clinical pathology rotations, largely due to the close interactions required with the clinical services. Residents spend a total of 4 months on the transfusion medicine service. The first month is devoted exclusively to education and is comprised of didactic sessions, practical labs, and various seminars. After completing this month, residents assume the transfusion medicine "hot seat" acting as a liaison between clinicians and the transfusion medicine service. Residents manage utilization and inventory of blood components, donor eligibility issues, donation-related reactions, coordination of apheresis treatments, and other special problems that may arise. The resident rotating on the transfusion medicine service is on-call every other week, alternating with a transfusion medicine fellow and pathology residents from other rotations. The on-call resident is available by pager from 5:00 p.m. to 7:00 a.m. on weekdays and 24-hours on weekends. An on-call transfusion medicine fellow or transfusion medicine consultant is also always available should an issue arise that the resident does not know how to handle. 

Clinical Chemistry (3 blocks)
The Clinical Chemistry rotation consists of 4 required rotations through the Central Clinical Laboratory (2 weeks), Protein Lab (1 week), Renal Lab (1 week) and Lipid Lab (1 week) followed by 7 weeks of elective time. For their elective time, residents may choose to rotate through the Antibody Immunology, Drug Monitoring, Metals, Endocrine, Nucleotide Polymorphism, Biochemical Genetics, Metabolic Hematopathology, Neuroimmunology, or Immunodeficiency labs. During their elective time, residents are also encouraged to undertake a research project or to participate in the validation of a new assay. Throughout the rotation, residents also participate in the administrative activities of the laboratory directors. Throughout the year, residents attend a weekly seminar series that covers all major topics in clinical chemistry and that repeats every year. Many esoteric tests are performed in the clinical chemistry laboratories with a large enough volume to allow significant interpretive experience if a resident desires to focus on a particular area. For example, a resident interested in porphyrias could complete an elective in the Biochemical Genetics Laboratory which performs more tests for porphyrias than any other laboratory in the world.

Microbiology (2 blocks)
The Microbiology rotation consists of 8 weeks of rotations through each of the major microbiology labs, including bacteriology, virology, parasitology, Hepatitis and HIV, and Tuberculosis/Mycology. The resident will be introduced to the basic and advanced methods used for microbe identification in each lab. The pathology resident will also spend 1 week with the clinical Infectious Diseases team. Each year, the Microbiology department holds a series of core lectures which residents and microbiology fellows attend. Throughout the rotation, residents will also give frequent informal talks on selected topics in microbiology. The department has particular expertise in the development of new molecular assays for microbe identification utilizing methods such as real-time PCR, ribosome sequencing, and in situ hybridization.     

Cytogenetics (1 block)
This rotation is designed as a month-long orientation to the field of cytogenetics, including both neoplastic and congenital diseases, with an emphasis on understanding the principles of different techniques used in the laboratory. The rotation is very structured, with lectures and seminars in the morning and case sign-out with attendings in the afternoon. There is a team of educational specialists in the laboratory that guides residents through the lecture series, as well as through the practical exercises that include karyotyping using different staining techniques, fluorescent in-situ hybridization (FISH) signal analysis, cell culturing techniques, and data analysis. A particular hands-on exercise that residents have found interesting is the karyotyping of their own chromosomes. Residents are expected to give two 20 minute seminars on selected topics (one on congenital abnormalities and one on tumor markers) for the department. Participation in ongoing research projects is highly encouraged.

Coagulation (1 block)
The Coagulation rotation consists of 4 weeks spent between the special coagulation laboratory and the coagulation clinic. The Coagulation service at Mayo is run cooperatively between the Departments of Hematology and Laboratory Medicine and is staffed by clinical hematologists and clinical pathologists. Typically, the pathology resident will rotate along with hematology fellows, although the pathology resident will focus more on the interpretation of special coagulation studies. The resident rotation is organized by a dedicated education coordinator who tutors the resident in test profile interpretation until the resident is able to independently provide a written interpretation of coagulation study profiles. A typical day consists of seeing patients in the morning at the coagulation clinic followed by a didactic lecture on selected coagulation topics given by the attending hematologist. The afternoon is spent previewing special coagulation study profiles, writing interpretations, and signing out profiles with the assigned Coagulation consultant for that day. The spectrum of disease seen by the pathology resident is very wide and includes inherited coagulation factor deficiencies, specific coagulation factor inhibitors, lupus anticoagulants, acquired and inherited thrombophilias, heparin-induced thrombocytopenia, and rare inherited platelet disorders.

Molecular Techniques (elective)
The molecular techniques rotation is a 1-month elective for residents who wish to learn basic techniques in molecular biology. Run in conjunction with the Graduate School, this is a hands-on laboratory type of experience where residents are introduced to nucleic acid extraction methods, gel electrophoresis, southern and northern blotting, PCR primer design, PCR set-up and performance, basic cell culture techniques, and data analysis. This rotation is an excellent starting point for residents who wish to undertake a basic science or translational research project but who have little previous background in molecular techniques.  

Conferences

Mayo Clinic pathology resident conferences
Throughout your residency, you will attend and participate in a vast series of conferences, seminars, journal clubs and lectures. As would be expected in an institution as large as the Mayo Clinic, there are almost limitless opportunities to sit in on lectures and conferences held by world-renowned physicians and scientists. The following are only a few of the pathology-oriented conferences that residents attend on a regular basis:

Didactic lectures
We have an integrated 2-year didactic core curriculum covering major topics in anatomic and clinical pathology. The entire core lecture series is digitally recorded and available for review at anytime through the departmental intranet. The core curriculum is supplemented by numerous individualized didactic lectures and conferences during specific rotations. Visiting professors from around the world also frequently give lectures to the department. In addition, the department sponsors an annual diagnostic surgical pathology conference for practicing pathologists which residents are welcome to attend.

Slide conferences
There are numerous regularly scheduled teaching slide conferences for pathology residents including a weekly Monday night unknown slide conference held by a consultant in his or her area of expertise, a monthly California Tumor Registry unknown slide conference consisting of various themed unknown slides, and a quarterly "in situ rounds" conference consisting of cases referred to the in situ hybridization laboratory. There are also monthly multidisciplinary teaching slide conferences in gastrointestinal pathology, oral pathology and ophthalmic pathology, as well as weekly multidisciplinary clinical slide conferences in liver pathology, urine and cervical cytopathology and dermatopathology.  Visiting professors also frequently provide slide conferences specifically for pathology residents.

Multidisciplinary clinical conferences
Residents are encouraged to participate in various multidisciplinary clinical service conferences. Residents rotating through the autopsy service attend and occasionally present at the weekly Internal Medicine Morbidity and Mortality conference. While on selected rotations, residents attend various organ-specific multidisciplinary conferences such as the orthopaedic oncology conference, the neuro-oncology conference, and the breast oncology conference.

MBD conference
At the end of each month, there is a long-standing gross pathology conference that was started in the 1900s by Mayo's first pathologist, Louis B. Wilson. The conference tradition was continued by another prominent Mayo pathologist, Malcolm B. Dockerty, for whom the conference was renamed. The MBD conference is now moderated by Dr. Krishnan K. Unni. At this conference, residents are shown gross photographs of specimens received through the frozen section laboratory and then asked to use their gross pathology examination skills to derive a differential diagnosis and make an educated guess on the actual diagnosis. The corresponding histopathology is then shown thereby allowing immediate correlation with the gross impression.

Leadership and Management Seminar Series
Senior residents participate in a unique, interactive seminar series aimed at developing those critical leadership and management skills that have often been neglected in pathology residency training programs. Invited speakers and in-house experts hold multiple all-day seminars on topics such as "Managing Change, Negotiation and Conflict Management, Principles of Motivation", "Leadership and Management Basics", "Quality School", "Informatics" and "Healthcare finance". The seminar series culminates in "Capstone Seminars" of team projects presented by the participants.