The Yale-New Haven Medical Center, which consists of the 900-bed Yale New Haven Hospital, the Children's Hospital at YNHH, the Smilow Cancer Center, the Yale Psychiatric Hospital, and the Yale University School of Medicine, provides training for residents seeking Board certification in Anatomic Pathology (AP), Clinical Pathology (CP), and both Anatomic and Clinical Pathology (AP/CP). The mission of our ACGME-accredited training program is to provide comprehensive post-graduate training and to produce pathologists who will be leaders in clinical practice, research, and academia, and who will advance the field of pathology locally, nationally, and internationally.
Pathology training at Yale focuses on developing and enhancing the role of the pathologist as a diagnostic consultant, using both traditional techniques and state-of-the-art approaches, as well as forays into the future of pathology practice. Our faculty provide diverse role models for residents and have a proven track record for the highest quality teaching.
Combined with extensive pathology fellowship opportunities, our residency program has produced community pathology leaders and internationally recognized academicians and scientists. Although most of our graduates proceed along traditional pathways of pathology practice, others have pursued positions in forensic medicine, biotechnology, healthcare administration, and the law. Our diverse graduates are united by the common theme of being among the best in their chosen pathology career.
Residency training in Pathology is provided by the Department of Pathology and the Department of Laboratory Medicine. Working together under a single Program Director, the two departments assure strong training in both Anatomic and Clinical Pathology.
The Department of Pathology is comprised of anatomical pathology services, research laboratories, and support services. Some of Pathology's research laboratories are affiliated with programs physically located in the Boyer Center for Molecular Medicine. The Division of Anatomical Pathology (the clinical Division of the Department) provides autopsy, cytology, and surgical pathology services to all hospitals in the Yale New Haven Medical Center, the West Haven campus of the Veterans Administration Healthcare System (VA), Bridgeport Hospital, Milford Hospital, and to private physician offices. Residents thus are exposed to a very broad range of clinical material, from the common everyday specimens to rare and unusual diseases and neoplasms. The faculty all have subspecialty interests, and residents rotate through the subspecialty systems affording them in-depth exposure and expert training in each area of anatomic pathology. Services that support the department include histology, immunohistochemistry, molecular diagnostics, electron microscopy/advanced imaging, operational informatics, and the report generation unit.
The Department of Laboratory Medicine consists of clinical pathology services, research laboratories, and support services. Clinical laboratories include the Blood Bank, Chemistry, Hematology, Immunology and Flow Cytometry, Microbiology, Virology, Molecular Diagnostics, Apheresis and Stem Cell Processing, and Computer and Instrumentation Services. These are the primary laboratories for Yale-New Haven Medical Center and the Yale Medical Group. They also serve as a core facility for Yale University clinical research centers and as national reference laboratories. The Department also staffs the clinical laboratories at the Veterans Administration Connecticut Healthcare System's West Haven campus, including its mycobacteriology and virology National Reference Laboratories. Residents are exposed to all aspects of laboratory testing from conceptualization in basic research to practical realization in the clinical laboratory and application to patient care. Emphasis is placed upon understanding the basic science and associated biotechnology of Clinical Pathology, becoming familiar and comfortable with modern instrumentation and computers, and the interpretation and utilization of laboratory results. Residents work on research and/or developmental projects in the laboratories and serve as consultants to hospital physicians on the use and interpretation of laboratory data.
Residents are accepted for training onto one of three tracks, and generally follow one of two career paths. This provides trainees an opportunity to tailor their training experience for their own specific career goals.
The training tracks are Anatomic Pathology only (AP), Clinical Pathology only (CP), or combined Anatomic and Clinical Pathology (AP/CP). AP-only and CP-only training are three year programs; combined AP/CP training is four years. The three tracks each include core rotations with specific responsibilities designed to convey competency in the diagnostic practice of pathology. Within each track, residents can pursue one of two career paths: "diagnostic practice" and "physician-scientist". The diagnostic practice path is for those residents who plan to spend the majority of their professional career as clinicians in either an academic or community setting. Trainees on this track typically go on to subspecialty fellowships and/or clinical jobs upon completion of their residency training. Residents interested in a career as a physician-scientist (or physician-engineer, etc.) will spend the majority of their professional time in investigative research. Candidates for this path often have significant research experience and/or a PhD prior to residency, but this is not a requirement. Research may be pursued with any mentor in any department within Yale University, and salary funding is guaranteed for at least two full years of research following residency. More details about research opportunities in the program are provided below.
The AP/CP training track provides broad training in all of the sub-disciplines of anatomic and clinical pathology. This 48 month program is the most common training track, and prepares residents for broad career options ranging from a small community private practice to a large academic medical center. The majority of AP/CP track residents go on to subspecialty fellowship training following their residency, although some graduates have gone straight into practice or full time research.
Combined Anatomic and Clinical Pathology training includes 24 months of core AP rotations and 18 months of core CP rotations. Core training teaches the principles of gross, microscopic, and analytical evaluation of specimens and laboratory data graduated responsibility tailored to each resident's individual progress. Senior rotations encourage the resident to assume responsibility for the professional supervision of the services, often functioning as a junior attending. Elective opportunities allow for advanced training and/or investigative work with a faculty sponsor.
Residents most commonly do AP or CP rotations in six or twelve month blocks. Because of the flexibility of the program, there can be little correlation between a resident's PGY (post graduate year) status and their rotations. For example, a PGY-1 resident may start their training with clinical pathology rotations alongside PGY-3 residents who have already completed two years of anatomic pathology rotations. The performance expectations of these two residents would be comparable, since they are both just beginning their clinical pathology training. Residents are therefore collectively referred to by the group of rotations which they are currently doing. For example, PGY-3 residents who have completed two years of training in AP and are beginning their training in CP are "CP-1" residents, just as are PGY-1 residents who begin their training in CP. PGY-4 AP/CP residents typically do some combination of CP-2 and AP-3 rotations. Within each year, clinical training is divided into a series of rotations, each typically four weeks in duration. There are, therefore, 13 rotations each academic year. The scheduling of residents to the various rotations is the responsibility of the Chief Residents in anatomic and clinical pathology, respectively.
AP/CP training typically begins with 2 years of AP followed by one year of CP followed by a year combining six months of senior CP training and six months of flexible training opportunities, including advanced training and/or basic research (experimental pathology), but past residents have chosen other options:
During the first 12 months of anatomic pathology training, AP-1 residents focus on acquiring the technical skills that will form the basis for their careers in pathology. They also must acquire a fund of knowledge to be able to apply these skills intelligently as physicians (not technicians) towards the goal of becoming diagnosticians. The first year of core training in AP includes multiple rotations on the autopsy service. Residents acquire familiarity with a variety of dissection techniques, learn anatomy, and learn how human disease is manifested in anatomic changes throughout the body. Exposure to Forensic Pathology, Neuropathology and an introduction to Molecular Pathology is integrated into the autopsy experience. Residents also begin their training in Surgical Pathology and Cytopathology during their first year of AP. Rotations through the major surgical pathology services at YNHH (eg breast, GI, GYN) as well as in general surgical pathology at the VA Connecticut introduce residents to the broad scope of surgical pathology material. The subspecialty-focused training at YNHH affords the resident an in-depth exposure to these major areas of surgical pathology practice. Each AP-1 resident also does one rotation in Cytopathology.
In the second year of core anatomic pathology training, AP-2 residents further expand their histopathologic diagnostic skills by focusing on a broader range of specialty areas within pathology, and delving deeper into an understanding of differential diagnoses. They also become more actively involved in interdepartmental interactions, taking on the role of a diagnostic consultant. A second rotation in each of the major surgical pathology subspecialties is incorporated into the AP-2 year, as are rotations in hematopathology, pediatric pathology, neuropathology, dermatopathology, and ophthalmic pathology. AP-2 residents also get their first exposure to a "leadership" role in anatomic pathology by serving as a senior resident on the autopsy service, overseeing the operation of the service and the training of the AP-1 residents. Finally, elective time allows residents to pursue or enhance training in areas of special interest, or to get involved in formal research projects.
Detailed rotation descriptions are available elsewhere on this site. Throughout the core training in anatomic pathology, a series of daily morning conferences provides residents with both formal instruction and a longitudinal exposure to all of the areas of anatomic pathology, regardless of which rotation they are currently on.
During the first 12 months of CP experience, CP-1 residents rotate through each of the sections of the Clinical Laboratories. The first 5-weeks of CP training consists of one week mini-rotations in each of the major sections of the clinical laboratories. This provides an initial exposure to the breath of the discipline and prepares residents for the responsibilities of taking call. This introductory exposure is then followed by an in depth experience on each of the 6 major rotations (transfusion medicine, microbiology / virology, hematology / flow cytometry, clinical chemistry / immunology, general clinical pathology at the VA, and subspecialty clinical pathology at the VA). All CP-1 residents rotate twice through each service in order to have the opportunity for more senior responsibilities on the second and subsequent rotations. Throughout their training, emphasis is placed upon understanding the basic science and associated biotechnology of Clinical Pathology, becoming familiar and comfortable with modern instrumentation and computers, and upon the interpretation and clinical utilization of laboratory tests. To accomplish this, residents also work on research and/or developmental projects in the laboratories and serve as consultants to hospital and outside physicians. Teaching is another strong area of emphasis during CP training. Residents fully participate in medical student teaching by serving as preceptors in the hematology and microbiology laboratories. Detailed rotation descriptions are available elsewhere on this site.
During their final 6 or 12 months of CP training, CP-2 residents assume a more senior, supervisory role and choose directed clinical responsibilities within each laboratory. We encourage specialization in areas of interest and an in-depth experience as a "junior attending."
Integration of the subspecialties is achieved through interdisciplinary teaching and clinical conferences in the Department, through on-call responsibilities, and during rotation at the VA Connecticut Healthcare System. Residents are exposed to all aspects of clinical testing from conceptualization in basic research to practical realization in the clinical laboratory and application to patient care.
Core training leaves six months available to AP/CP residents for additional training, and there are many options available, including research and advanced clinical rotations. The advanced clinical rotations allow the resident to function essentially in the capacity of a clinical fellow, resulting in a mini-fellowship. Experiences are available in both laboratory medicine and pathology. In anatomic pathology, a set of AP-3 rotations provide residents with exposure across all subspecialty areas of pathology to solidify their diagnostic skills. These include the "Hot Seat" rotation, Frozen Sections, Autopsy Senior Resident, and General Signout at Bridgeport Hospital. In clinical pathology, senior CP rotations similarly focus on advanced consultative and diagnostic skills within selected subspecialties. These rotations also further the resident's interactions with clinical teams and allow them to take on greater independent responsibility, gradually transitioning them to independent practice. Elective time is also available. All AP/CP residents must spend at least one month of this period on the frozen section service, to meet ACGME training requirements.
The AP-only and CP-only training tracks provides focused training in all of the sub-disciplines of anatomic or clinical pathology, respectively. Each of these 36 month programs is for residents who have more defined career objectives at the time of applying for residency training. These three year training programs afford residents a solid foundation in their respective discipline and an opportunity for in-depth subspecialty training and/or a significant research experience. Most commonly, AP-only and CP-only track residents go on to a career in academic pathology, typically at an academic medical center.
Residents on the AP-only or CP-only tracks who are on the diagnostic practice pathway have an emphasis on clinical science and teaching. This path often leads directly to a post-residency fellowship in such areas as Transfusion Medicine, Neuropathology, Dermatopathology, Medical Microbiology, Hematopathology, or Gastrointestinal Pathology. Other residents on the AP-only and CP-only tracks will pursue two or more years of research following their residency training. Many options exist on this physician-scientist pathway; fellowship experiences can be incorporated into training, and some residents have elected a physician-engineer track in which the research portion is oriented predominantly toward Biomedical Engineering in conjunction with the Yale Dept of Biomedical Engineering. Finally, for individuals without a PhD degree, there is the option of enrollment in the Yale Investigative Medicine Program in which one obtains research training (translational or basic) in the context of a rigorous PhD program.
Residents are encouraged to establish a mentored relationship with a Yale University investigator to oversee their ongoing career development. The philosophy of the Program is to provide all means necessary to assure resident success in becoming a physician-scientist or physician-scholar. To that end, research may be pursued within the Department of Laboratory Medicine or the Department of Pathology, but residents are encouraged to consider mentors in other basic science or clinical departments within the School of Medicine or any other School or department at Yale University. Salary is guaranteed for at least two years of mentored research following residency training (minimum of 5 years of salary support).
Training in AP-only is most commonly for individuals who either have already decided that the focus of their clinical practice will be within some subspecialty area of anatomic pathology, or for individuals who are planning a career which combines on-going basic or applied research and a more limited clinical practice of pathology.
AP-Only training begins with the 24 month core AP curriculum described above for the AP/CP track. The third year of training typically includes at least six months of specifically designed AP-3 rotations: "Hot seat", frozen section, autopsy senior resident, and general surgical pathology signout at Bridgeport Hospital. These cross-specialty rotations carry minimal grossing responsibility and are designed to strengthen the resident's diagnostic skills, further their role as clinical consultants, and transition the resident toward the independent practice of pathology. The remaining six months can be used to spend additional time on these AP-3 rotations as well as for clinical and/or research electives. Alternatively, a full six month block of protected research time can be arranged.
The specific research strengths in the Department of Pathology are diverse and include basic as well as translational research. Major efforts are centered in cell biology, virology, cancer biology and diagnosis, biotechnology, computational biology, vasculogenesis and vascular disease, mitochondrial biology, structural biology. Many of the laboratories have overlapping interests and have joined together to build program projects. The department is also home to several core facilities for the institution, folded together into "Yale Pathology Tissue Services", which provides tissue procurement and banking, tissue micro-array, and research histology services.
The most common pathway for the CP-only training program is designed to provide residents with: (1) a solid foundation of knowledge in all aspects of Clinical Pathology; (2) an in-depth experience in a subspecialty of particular interest; and (3) a research experience that facilitates development of an independent physician-scientist career pathway.
The 18-month CP core curriculum (see above) is required for CP-only residents to assure familiarity with all aspects of Laboratory Medicine, while still allowing flexibility for sub-specialization within that 18 months and tailoring of CP electives to the individual interests of each resident. Research and/or clinical subspecialty opportunities are then available during the remainder of the 2nd and 3rd years of the CP-only track.
The format for the advanced training is individualized for each resident to assure both relevance to career goals and adherence to the requirements for residency training of the American Board of Pathology. Subspecialty training is handled by giving the residents more senior, graduated responsibilities under the direction of the attending physician. Some residents elect to participate in clinical fellowships in clinical pathology at this stage of their training, while others begin more basic research endeavors. Projects may be in practical areas, such as methods development or outcomes, or they may be in an area of basic research. The broad range of potential research opportunities can be explored in the Yale University medical faculty research database.
The specific research strengths of the Department of Laboratory Medicine are diverse and include R01 and program project funded investigators in immunohematology, molecular immunology and virology, transplantation immunology, molecular diagnostics, hemostasis, hematopoietic stem cells and progenitors, and clinical pharmacology, as well as other areas. The research laboratories (including the Yale Stem Cell Center) are located in close proximity to the clinical laboratories, facilitating ready interaction and transfer of biotechnology.
Each resident is strongly encouraged to complete some form of clinical-pathologic investigation during the course of their residency. A variety of options and opportunities are available, ranging from a detailed study of multiple cases using a new diagnostic approach to implementation of a new clinical diagnostic test to a basic research project. The results of the study should be presented intradepartmentally and, if appropriate, submitted for presentation as either an abstract at a national meeting or a manuscript for publication (or both). These projects should be conducted under the supervision of a faculty member in Pathology or Laboratory Medicine, and funding for these investigations are available through the faculty (who can solicit additional funding from the department if needed).
Residents on the physician-scientist pathway, particularly those on the AP-only and CP-only training tracks, may elect to incorporate up to six months of full time research into their training. This experience must be approved by the Program Director to be sure that it will be eligible for credit toward the training requirement. This discussion should occur no later than the first half of the academic year preceding that during which the research is planned, to assure adequate time to plan for coverage of the service needs of the program (for AP-only or CP-only tracks, this means during the first half of the second year of training). Residents must be in good standing with respect to their clinical training, and will be expected to submit a written proposal describing the purpose and scope of the planned research. The research may be conducted under the direction of a faculty member in any department at Yale University. The research proposal should be approved by the research sponsor before being submitted to the Program Director. The Departments of Pathology and/or Laboratory Medicine will guarantee salary funding for an additional two years of research (non-ACGME accredited) following completion of the residency training. This will aid in launching that resident on a successful research career. Any resident planning to pursue this career path should discuss their plans with the Program Director and/or Chair of either department early in their training.
For those residents with an MD degree who desire not only research training but also a PhD degree, Yale offers an Investigative Medicine Program. Residents enter this program after completion of the residency training, and pursue additional course work and research leading to a PhD degree.
A complete manual describing the training tracks and paths, rotation descriptions, resident responsibilities and competencies, and resident benefits is provided to applicants at the time of interview and to residents when they enter the program. This manual is also available for download.
The precise number of positions varies from year to year, due to the flexibility of the program and our desire to accommodate a variety of training tracks. However, in general, the program accepts six to eight incoming residents each July. PGY-1 residents typically begin training in Anatomic Pathology, but occasionally the opportunity arises for PGY-1 residents to start their training in Clinical Pathology. There are a total of twenty-six to twenty-nine residents in the program each year.
All PGY-1 residency candidates will be accepted through the National Residency Matching Program (NRMP). The Electronic Residency Application Service (ERAS) is used for ALL PGY-1 residency applications. The deadline for application is October 31 each year. Applicants should submit the following documents via ERAS:
Occasional positions may become available for applicants who have already completed some training at ACGME accredited pathology training programs. Contact the program coordinator for information about the availability and application process for any such positions.
Interviews are conducted on Tuesdays in October, November, December, and January. Interviews may occasionally be granted at other times, as the need arises.
IMGs seeking entry into the Yale Pathology residency program should meet the following requirements:
Visas: Yale-New Haven Hospital sponsors only J-1 visas for residents. This policy is not negotiable.
ALL questions about eligibility for application should be addressed to the Residency Program Coordinator. Exceptions to the above criteria will be considered only under extenuating circumstances.
Residency Training Program in Pathology
Department of Pathology
Yale School of Medicine
310 Cedar Street, BML LH108
P.O. Box 208023
New Haven, CT 06520-8023
Fax: 203-785-3585
Karen Broderick
(203) 737-4142
karen.broderick@yale.edu
Diane Kowalski, M.D.
Tel: 203-785-2774 or 785-6933
Natalia Buza, M.D. (AP)
Henry Rinder, M.D. (CP)