The primary training in all tracks of the program is centered at the Yale-New Haven Medical Center. The Departments of Pathology and of Laboratory Medicine provide direct clinical service to all components of the Medical Center but are also responsible for service at the VA Connecticut Medical Center and Bridgeport Hospital, two of the other training locations. This institutional mix assures the residents will be exposed to a very broad range of clinical material, from the common everyday specimens to rare and unusual diseases and neoplasms.
The majority of the resident rotations are at the Yale-New Haven Medical Center. Yale-New Haven Hospital (YNHH) is a nearly 1000 bed hospital, including the Smilow Cancer Center, which opened in late 2009. Pathology and Laboratory Medicine are separate departments at Yale, and as such each focuses on improving the quality of services and training in anatomic and clinical pathology, respectively. Pathology evaluates nearly 50,000 surgical specimens and over 90,000 cytology specimens each year, and performs approximately 220 autopsies. Laboratory Medicine performs over 5 million tests each year. Each department uses a specialty-based approach, in which clinical services are provided by attendings who have specialized in particular areas of interest and expertise. Resident rotations are similarly divided along specialty lines. This affords the residents an in-depth exposure and emersion in focused areas of study, emphasizing the subtle nuances of various disease processes.
The Department of Pathology has clinical space in the East Pavilion of YNHH, where the surgical pathology and inpatient cytopathology services are located. The autopsy service, administrative offices, and research space are located in the Brady and Lauder buildings of the Medical Center. These areas are connected by intervening buildings, so travel from one to the other does not require going outside. Outreach cytology is in a separate building, but plans are underway to move into the main complex. The clinical space in the East Pavilion is recently renovated (May 2008). With the opening of the Smilow Cancer Center in 2009, Pathology moved it's frozen section operation to be adjacent to the new operating rooms. This space is a short walk from the main signout area.
The Department of Laboratory Medicine recently moved its clinical laboratories and administrative offices to the brand new state-of-the-art Park Street Building, immediately adjacent to the Smilow Cancer Center in the Medical Center complex. Research space remains clustered on four floors of the Clinic Building of the Medical Center.
The Pathology department at the West Haven campus of the Veterans Administration Connecticut Healthcare System (located just 10 minutes away from YNHH by shuttle) is staffed, in part, by members of Yale's Departments of Pathology and Laboratory Medicine. It provides both anatomic and clinical pathology services, and therefore offers unique opportunities for instruction in the integrated approach to laboratory diagnosis. The hospital has 200 beds and performs over 2.3 million laboratory tests each year. The anatomic pathology service handles virtually all aspects of diagnostic anatomic pathology including surgical pathology, cytology, and autopsy pathology. The laboratory medicine service provides clinical testing for patients at that facility and also serves as a reference laboratory for other VA hospitals across the country in the areas of molecular diagnostics, pharmacogenetics, mycobacteria, and virology.
The VA-CT West Haven campus is also the home of the Pathology Assistant program, and PA students are used extensively at the VA to assist in many technical aspects of the laboratory including the gross room. The residents are, however, still responsible for understanding the gross analysis of all complex specimens.
The Pathology department at Bridgeport Hospital is staffed by the Department of Pathology at the Yale School of Medicine. Bridgeport Hospital is a 425-bed community hospital located about twenty miles west of New Haven. Although the Pathology department provides both anatomic and clinical pathology services at Bridgeport Hospital, the residents currently rotate only through the anatomic pathology services. This includes over 13,000 surgical specimens and 4,000 cytology specimens.
This community hospital setting broadens the exposure of residents in training beyond the academic medical center practice model by providing them with an opportunity to integrate into the workflow of a larger community hospital pathology department. The case mix complements that seen at Yale. Residents benefit from direct exposure to a setting more akin to a private practice model and can use this experience to help formulate their long term career plans. Resident travel expenses to Bridgeport Hospital are reimbursed by the Program.
Connecticut has a centralized medical examiner system, and by State statute all autopsies performed by authorization of the State are performed at the Office of the Chief Medical Examiner (OCME) in Farmington, CT. Therefore, residents do not get exposed to forensic autopsies during their rotation at YNHH. To allow the residents to participate in forensic autopsies, each resident does a two week rotation at the New York City Medical Examiner's Bronx Office. Dr. James Gill, a former Yale Pathology Resident and now Deputy Chief Medical Examiner for NYC coordinates the experience of the residents while on this rotation. The rotation requires travel to New York on a daily basis. This can be done by car or by train. Residents are reimbursed a fixed amount, based on their chosen method of transportation.