Mayo Clinic in Rochester, Minn., and Phoenix/Scottsdale, Ariz.
The clinical rotations occur mainly at Mayo Clinic in Rochester, Minn., though fellows have the opportunity to spend up to two months at Mayo Clinic in Scottsdale, Ariz.
The breadth and volume of cases exposes fellows to all areas of thoracic pathology, including neoplastic and non-neoplastic diseases of the lung, pleura and mediastinum. This occurs through review of in-house material specimens as well as our large referral practice, which averages 3,500 to 4,000 specimens a year.
Weekly interactions between chest radiologists and pulmonary pathologists allow the fellow to gain extensive experience in radiologic-pathologic correlation for both neoplastic and non-neoplastic thoracic disease. A weekly gross pulmonary conference allows for dissection and review of lung explants and interesting specimens from Mayo Clinic's busy autopsy service.
Weekly lung cutting, where all transplant lung specimens and challenging lung specimens are grossed and correlated with the clinical and radiologic findings.
Fellows are also involved in evaluating both heart and lung transplant biopsies, which prepares them to confidently evaluate all aspects of thoracic transplant pathology. Finally, fellows have the opportunity to rotate in the florescence in situ hybridization (FISH) and molecular pathology laboratories to familiarize themselves with the various molecular tests performed on lung cancers.
The fellow's responsibility is gradually increased over the training period, such that by the end of the fellowship, he or she is responsible for the initial case work-up and final conversations with referring pathologists. At Mayo Clinic in Scottsdale, Ariz., fellows rotate on the consultation service, where approximately 4,000 cases are seen annually.
To complement the clinical material, teaching files consisting of more than 4,000 cases are available to the fellows at Mayo Clinic in both Rochester and Arizona.
As different fellows have different career goals, the curriculum allows for electives and opportunities to explore diverse areas of pathology that may complement pulmonary pathology or fulfill the needs of a future job or practice. As such, we have had fellows rotate in areas such as cardiovascular pathology, cytology, bone and soft tissue pathology, lymph node pathology, and others.
Rotation at the Saint Marys Frozen Section Laboratory, where direct interactions occur between the surgeons and pathology team.
The curriculum is divided into 13 four-week blocks. Eight blocks are dedicated to pulmonary pathology and the consultation practice, which may include rotations at Mayo Clinic in Scottsdale. For two blocks, the fellow has the opportunity to rotate through our famous frozen section laboratory at Mayo Clinic Hospital, Saint Marys Campus, gaining exposure to in-house thoracic patient specimens.
Three additional blocks are electives, in which the fellow can choose from many different areas of pathology to complement knowledge in thoracic pathology, prepare for a future job, do research or complete more pulmonary rotations. We allow for flexibility to tailor to each fellow's career goals.
Sample rotation schedule
Each block is four weeks.
||Saint Marys frozen section
||Saint Marys frozen section
Mayo Clinic performs basic, translational and clinicopathologic correlative research. Therefore, there are many opportunities for fellows to participate in and complete several projects in one year. Our research is typically multidisciplinary, featuring collaboration with clinicians, surgeons, radiologists, bioinformaticians, molecular biologists and biostatisticians. Our fellow has access to secretarial, laboratory and statistics support as well as funding and help from a research assistant.
The Lung Cancer Epidemiology Project at Mayo Clinic has enrolled and followed more than 14,000 lung cancer patients with extensive clinically annotated tissue available through our Tissue Registry and Lung Specimen Registry. This epidemiology project is headed by Ping Yang, M.D., Ph.D., a molecular epidemiologist. Multiple ongoing research projects occur in collaboration with Dr. Yang. These projects include research on the epidemiology and optimal testing of anaplastic lymphoma kinase (ALK)-rearranged lung cancers, as well as radiology-pathology correlation studies of adenocarcinoma in situ and microinvasive adenocarcinoma, that have resulted in computer-aided nodule assessment and risk yield (CANARY) technology for lung cancer screening and diagnosis, among others.
The Mayo Clinic Center for Individualized Medicine has multiple translational programs, including the Biomarker Discovery Program, which focuses on lung cancer along with several other diseases. Marie-Christine Aubry, M.D., and thoracic surgeon Dennis Wigle, M.D., Ph.D., head the Lung Cancer Biomarker Discovery Group. The Biomarker Discovery Program focuses on the use of next-generation sequencing with the goal of developing clinically useful tests for lung cancer. Our pulmonologists, headed by Jay H. Ryu, M.D., have developed a detailed database of all non-neoplastic lung disease, which has led to numerous collaborative studies and publications on IgG4 disease. Through this work, faculty member Joanne (Eunhee) E. Yi, M.D., has become a known expert in IgG4 diseases of the lung.
Faculty member Anja C. Roden, M.D., has developed a large thymoma database that is an important resource for multiple projects. The Tissue Registry is our clinical biorepository, which contains all paraffin-embedded specimens removed from Mayo Clinic patients since the early 1900s and offers a wealth of lung specimens for research, both neoplastic and non-neoplastic. The Lung Specimen Registry was started in 1998 and contains consented blood and fresh frozen lung cancer tissue from more than 1,000 patients.
One month of research is included in the curriculum and distributed through the fellow's pulmonary rotations according to the research requirements and needs. Additional months of research can be taken during the electives.
All our fellows have presented at national meetings such as the United States & Canadian Academy of Pathology (USCAP), the American Thoracic Society (ATS), and the Pulmonary Pathology Society, and have authored several articles. See a list of fellow activities.
Fellows participate in the second-year medical student curriculum during their pulmonary block. Fellows also supervise residents as they rotate through the frozen section laboratory and pulmonary pathology rotations and oversee the lung-cutting conference. Additional opportunities exist based on each fellow's interest in education.
Tri-weekly radiology-pathology conference, where the imaging and pathology of challenging interstitial lung diseases are reviewed and teaching is performed.
In addition to the weekly lung-cutting and radiologic conference, fellows participate and present in weekly or biweekly clinical conferences, which include Clinical Chest Conference, the Thoracic Tumor Board (done with Mayo Clinic and affiliate hospitals of Mayo Clinic Health System), Critical Care Medicine Conference, and Pulmonary and Critical Care Research Conference. Thoracic Morbidity and Mortality Conference also occurs twice a year.
There is a monthly, multi-institutional Pulmonary Journal Club, in which 1 of 13 pulmonary pathologists reviews the monthly literature from 15 different journals. Fellows actively participate in this activity.
Fellows receive daily feedback on their performance as well as monthly electronic evaluations by all consultants, allied health staff and peers (residents and fellows). The program director meets quarterly with the fellows to review each fellow's performance and offer mentorship and guidance for future career choices.
Fellows evaluate the consultants and rotations on a monthly basis as well as the entire program at the completion of their training. Improvements to the program over the years have been based on fellows' feedback.