Education/Residency Program/Hematology
The hematopathology rotation at MCW consists of a 3-month block during the
second year, followed by a 1-month senior rotation during the 3rd or 4th years.
Because MCW/Froedtert is tertiary referral center with a large adult bone marrow
transplant program, and by virtue of the fact that we are the only academic medical
center in Southeast Wisconsin, residents are exposed to a wide range and large
volume of neoplastic and non-neoplastic hematologic disorders. Teaching occurs in
the context of daily signout sessions at a 10-headed microscope, including all
trainees and students rotating on service at a given time, as well as through a
comprehensive series of didactic lectures, monthly unknown conferences, and
journal clubs. A weekly working conference around an 18-headed microscope with
faculty and fellows from the division of Hematology/Oncology provides an
opportunity to build professional, consultative relationships with our clinical
colleagues, and also provides valuable insight into the way our work impacts the
care of patients.
The overall goal of the hematopathology resident rotation is to provide broad-based
training in the laboratory approach to diagnosis of hematologic disorders, both
benign and malignant, as well education in the structure and function of the routine
hematology laboratory. A multimodality approach is stressed, with incorporation of
information from multiple sources, including clinical, hematologic, cytogenetic, flow
cytometric, and molecular data. Eight-color flow cytometry analysis and
interpretation is integrated into the microscope signout sessions, as well as into the
final interpretations and reports. Although all resident work proceeds under the
supervision of an attending pathologist, development of increasing degrees of
independence and responsibility commensurate with the resident’s ability and level
of training is fostered. The ultimate goal is to allow the resident to function as
effective laboratory consultants to their clinical colleagues, both in the
interpretation of pathologic material, as well as by providing input into the proper
utilization and interpretation of laboratory tests for the patient work-up.
In addition to resident training in hematopathology, the MCW Pathology
department also maintains a competitive, ACGME-accredited hematopathology
fellowship program.
Education/Residency Program/Clinical Pathology
The Division of Clinical Pathology at the Medical College of Wisconsin encompasses
chemistry, coagulation, cytogenetics, hematopathology, microbiology, molecular
diagnostics, and transfusion medicine. Expert faculty dedicated to each of these
areas have built robust, structured curricula for pathology residency training. These
curricula comprise a mixture of formal and informal didactics, hands-on training,
and abundant experience dealing with real-life, real-time issues coming out of the
clinical laboratories. The Clinical Pathology training at MCW emphasizes developing
residents for the role of effective consultant to clinicians regarding appropriate test
ordering and interpretation, with the goal of being integrated members of the
healthcare delivery team. Also emphasized is the role of the medical director in
ensuring the delivery of high quality laboratory testing to produce the best patient
outcomes within a framework of fiscal responsibility.
The major core rotations (hematopathology, chemistry, and microbiology) are
structured as 3-month blocks in the second year of AP/CP training, with an
additional advanced month in each area scheduled in either the third or fourth year.
These blocks allow concentrated focus on each area over an extended time period
and, through a process of graded responsibility, allow residents to achieve
significant independence in the exercise of clinical lab duties and responsibilities.
The extended rotations also allow the performance of clinical laboratory projects,
such as clinicopathologic studies, quality improvement initiatives, method
comparisons, and instrument validations. Presentation of these projects at national
meetings and publication are highly encouraged and supported financially..
Clinical Pathology Clinical Services
The clinical laboratory at Froedtert Memorial Lutheran Hospital (Dynacare
Laboratory, Milwaukee) is a full-service facility that performs approximately 8
million tests annually. The laboratory is located within Froedtert Memorial
Lutheran Hospital, but also functions as a reference laboratory for clients in the
Milwaukee area and across the state of Wisconsin. Medical direction for the
laboratory is provided exclusively by MCW Pathology Faculty, who deliver robust
clinical consultation and work in close partnership with Dynacare managerial staff
to deliver the best possible patient care.
The clinical test menu includes a wide range of testing encompassing hematology,
chemistry, toxicology, immunology, microbiology, cytogenetics, flow cytometry, and
molecular diagnostics. Our large, open laboratory space houses cutting edge testing
platforms, with automated chemistry and hematology lines, semi-automated blood
leukocyte differential counts and urine sediment evaluations, routine 8-color flow
cytometry for hematologic neoplasia, rapid microbial speciation using nucleic acid
and mass spectrometry techniques, microbial identification and detection of
common resistance determinants directly from culture bottles, and a wide range of
molecular cytogenetic (FISH) targets available for both fresh tissue and paraffin
sections.
Consultative Services, Clinical Pathology
The Division of Hematopathology accepts consultation on challenging cases
spanning the spectrum of non-neoplastic and neoplastic disorders of blood, bone
marrow, lymph nodes, and secondary lymphoid organs. With our broad
armamentarium of immunohistochemical and molecular cytogenetic (FISH) tools,
we can provide cutting edge assessment and expert interpretation. Our
hematopathologists can also provide consultative input into challenging flow
cytometry cases, including the re-analysis of raw data files.
Our experienced Clinical Pathology Medical Directors may also be available in
certain circumstances to provide consultative input into laboratory operational
issues, including instrumentation, workflow, quality control, result reporting, and
accreditation issues.