The autopsy service is performed primarily at the IU Health Pathology Laboratory and covers hospital cases from IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health Methodist Hospital, Eskenazi Health, and referrals from several smaller hospitals. Approximately 175 cases are completed at the IU Health Pathology Laboratory each year. Of these cases, about 65 are pediatric cases. The adult cases from IU Health University Hospital are typically complex with many involving bone marrow or organ transplant patients. IU Health University Hospital is also a referral center for amyloidosis patients, and autopsies performed on these patients are done in conjunction with the clinician. Most (90%) of the autopsy cases involve complete examination of the body, including the brain. Neuropathology is taught in part from the consultations on the autopsy brains. In addition to the cases performed at the central laboratory, approximately 10-20 cases annually are performed at the Roudebush Veterans Affairs Medical Center. At the completion of the residency, residents will have completed 50-75 autopsies.
Residents who are assigned to the surgical pathology service are expected to gradually assume more responsibility and show greater knowledge and judgment as training progresses. Residents rotate on three surgical pathology services including the IU Health Pathology Laboratory, Eskenazi Health, and Roudebush Veterans' Hospital.
IU Health Pathology Laboratory handles the combined surgical cases of IU Health University Hospital, IU Health Methodist Hospital, IU Health North and IU Health West Hospitals as well as several smaller hospitals and surgery centers. Residents on the IU Health Pathology Surgical Pathology rotation perform their duties at the central laboratory and IU Health University Hospital (frozen sections). Residents are exposed to a large number of unusual and challenging cases, including male and female genitourinary neoplasms, soft tissue and bone neoplasms, pancreatic neoplasms, head and neck resections, and transplant specimens (heart, lung, liver, bone marrow, multivisceral...). In addition, residents gain proficiency in more commonly encountered types of specimens including mastectomies, hysterectomies and gastrointestinal cases. Approximately 40,000 cases are received each year. Pathologist assistants work closely with the residents during gross dissection and are an integral part of resident education. Frozen section and intraoperative consultation is performed at IU Health University Hospital during the IU Health Pathology Laboratory rotation. In addition to routine sign-out, residents have an added opportunity to review interesting cases at the daily QA/QC conference headed by senior staff.
Eskenazi Health has a surgical caseload similar to a medium-sized acute medical and surgical hospital. Approximately 40%-45% of these cases are gynecologically related. In addition, gastrointestinal and breast biopsies are often a part of the daily caseload. Approximately 10,000 to 12,000 surgical pathology cases are received each year. The residents on the Wishard Hospital service perform gross dissection, frozen section analyses, and sign-out.
At the Roudebush Veterans Affairs Medical Center, gastrointestinal and prostate biopsies as well as skin biopsies are typically part of the daily caseload. Approximately six to seven thousand surgical cases are received each year. The resident on the Veterans Hospital service perform gross dissection, frozen section analyses, and sign-out.
The pediatric pathology rotation is performed at Riley Hospital for Children at IU Health. The pediatric pathology rotation is designed to provide exposure to common childhood diseases, including childhood malignancies. The rotation includes formal education in diagnostic surgical pathology, including fetal/embryo pathology and placental pathology. Immunohistochemistry and electron microscopy are performed on unusual cases. Approximately 5000 surgical pathology cases are received each year. The resident on the pediatric pathology service performs gross dissection, frozen section analysis and sign-out with the supervision of two pediatric pathologists. Additionally, the resident is responsible for presenting cases at the weekly Pediatric Gastrointestinal Conference.
Residents are required to do one month of dermatopathology at IU Health Pathology Laboratory, but are allowed to do additional months as elective rotations if so desired. A typical daily caseload includes shave biopsies performed for carcinoma, punch biopsies for inflammatory diseases, and consult cases. These consult cases are often difficult melanocytic lesions or unusual inflammatory skin diseases, and are valuable learning tools. Residents typically have the opportunity to preview cases with the dermatopathology fellow prior to signing out the cases with one of the dermatopathology faculty members. Residents also attend several interdisciplinary conferences while on service, including Dermatology Grand Rounds for dermatologists in the Indianapolis area, and a melanoma tumor board.
The Division of Neuropathology receives material from IU Health Methodist Hospital, Riley Hospital for Children at IU Health, and IU Health University Hospital, amounting to 1,200 neuropathology and 700 ophthalmic pathology accessions per year, including muscle and nerve biopsies from IU Health and other facilities in central Indiana. Frozen sections are performed on a large percentage of cases. Electron microscopy may be performed in some cases. The neuropathology rotation is usually completed during the third or fourth year. The resident will participate in all frozen section and surgical cases, as well as weekly brain cutting and brain sign out for autopsy cases.
During the cytopathology rotation, residents work closely with the fellows on an alternating day rotation. On Day 1, residents cover fine needle aspirations (FNAs) at University hospital. On day 2, they sign out the cases from the previous day as well as consult cases from outside hospitals. Graduated responsibility is given as residents progress. Additionally, the pap smears and non-gynecological cytology cases are split up between the residents and fellows on a daily basis. Finally, daily QC conferences are held to review cases from IU Health University Hospital, Eskenazi Health, and Roudebush Veterans Affairs Medical Center. Residents and fellows are expected to attend.
Blood Bank/Transfusion Medicine
At the IU Health Pathology Laboratory, the resident learns how to perform basic lab tests such as blood typing, screening, and cross-matching as well as how to interpret antibody panels and work up transfusion reactions. The resident also holds an important role in blood product conservation and counsels clinicians on appropriate criteria for usage. At IU Health University Hospital, the residents can observe stem cell collection for future transplantation and other apheresis procedures, for example, plasma exchanges for TTP. At the Indiana Blood Center (IBC) residents have the opportunity to observe the manufacturing of blood components at all stages in the process: collections, manufacturing, laboratory testing and product shipment. A great deal of time is also spent in the reference laboratory observing the work up for unusual positive antibody screens.
During the rotations, the resident learns how to interpret serum, urine, cerebral-spinal fluid, protein and hemoglobin electrophoresis, as well as isoelectric focusing and amniotic fluid studies. The resident is encouraged to participate in quality control issues and the process of implementing new assays.
During the first month, the resident spends one week with an excellent hematology technician who teaches the basis and clinical application of the large volume of automated hematology tests performed at the central laboratory. The resident is then taught cell morphology that is seen in peripheral blood smears and bone marrow aspirates. The resident gradually assumes greater responsibility, starting first with examination of peripheral blood smears and body fluids. The resident also attend afternoon sign-out sessions where bone marrow biopsies and lymph node cases are discussed. The additional months of hematopathology are spent learning how to interpret peripheral blood smears, coagulation studies, and bone marrow and lymph node cases. A monthly hematopathology conference is held for residents in which current interesting cases are shown and discussed.
This core rotation consists of three very organized months during which the resident rotates through all of the different labs (bacteriology, anaerobic bacteriology, mycobacteriology, mycology/parasitology, serology, and virology) and learns how each specimen type is worked up. The resident is given unknowns for evaluation, reading assignments, and weekly quizzes based on the bench rotation. A weekly conference is also held, during which residents on the rotation discuss interesting cases from IU Health University Hospital, Eskenazi Health, and the Roudebush Veterans Affairs Medical Center. Residents also participate in daily Infectious Disease-Pathology Consults, which are usually microscopic.
The molecular rotation consists of four weeks of lecture and laboratory based learning. Two weeks are spent in the clinical cytogenetics and molecular genetics laboratories located on the University Hospital campus. During this rotation residents learn about the processing of specimens and analysis of test results for traditional karyotyping as well as fluorescent in situ hybridization (FISH), short tandem repeat (STR) and various sequencing analyses. Wet lab exercises are included in these 2 weeks. The remainder of the rotation is dedicated to lectures on the clinical usefulness of various molecular methods for diagnosis of diseases involving microbiologic, genetic and malignant processes.
The laboratory administration rotation is completed during the fourth year, with the goal of providing residents exposure to topics relevant for laboratory directorship. The rotation is lecture-based, with discussions concerning management styles, billing, personnel, and general day-to-day operations of a laboratory setting. It also covers the health care system, how it is changing, and how those changes will affect pathology and laboratory regulations.
Eskenazi Health has a surgical caseload similar to a medium-sized acute medical and surgical hospital. Approximately 30%-40% of these cases are gynecologically related. In addition, gastrointestinal and breast biopsies are often a part of the daily caseload. Approximately 10,000 surgical pathology cases are received each year. The residents on the Wishard Hospital/Eskenazi Health service have both anatomic and clinical pathologic duties. Anatomic pathology responsibilities include performing gross dissection, frozen section analyses, and sign-out. Clinical pathologic duties include signing out fluids, peripheral smears, transfusion reactions, antibody interpretations, and serum protein and hemoglobin electrophoresis gels, evaluations of BAL’s from critically ill patients.