Curriculum

• Autopsy – 14 weeks (3 rotations + 2 weeks in forensics)

• Cytology – 16 weeks (4 rotations)

• Surgical Pathology - 80 weeks (~ 20 months/rotations), including 40 weeks (~10 months) at the VA Medical Center

Surgical pathology rotations include a “boot camp” orientation at Loma Linda University Medical Center with introductory experiences at the Loma Linda VA Medical Center and FMC. All other rotations are organized by general signout with subspecialists available for additional teaching from faculty with expertise in each area.

• Dermatopathology – 2-4 weeks

• Neuropathology – 2-4 weeks

• Renal Pathology/Electron Microscopy – 2-4 weeks

• Chemistry/Toxicology/Informatics – 12 weeks (3 rotations)

• Cytogenetics – 2-4 weeks

• Hematopathology/Flow Cytometry – 36-48 weeks (6-8 rotations)

• Microbiology – 12 weeks (3 rotations)

• Molecular Diagnostics– 2-4 weeks

• Transfusion Medicine, including Apheresis/Coagulation – 12-16 weeks (3-4 rotations)

• Lab Administration – 2-4 weeks

Residents will have 12-16 weeks of elective rotations available during their core AP/CP 48 month training program. Numerous electives are available; elective time can also be utilized as protected research time. Novel electives may be pursued with an identified mentor and approval by the Residency Program Director. This is to ensure the overall quality of the training experience and that the experience meets American Board of Pathology (ABP) requirements.

Integrated AP/CP Curriculum in a Unique Environment

The Department of Pathology at Loma Linda University Health is committed to excellence in clinical practice, education, and research. The four-year anatomic and clinical pathology core program is designed to train physicians to qualify for careers in the academic or community practice of pathology, and we actively encourage interest in any and all types of practices.

The training is provided in the setting of a Christian institution and a health sciences university, which serves a diverse population, including many underserved communities.

Training Sites

The majority of residency training is based at Loma Linda University Medical Center and Loma Linda University Children’s Hospital, which together serve as an adult and pediatric tertiary referral center responsible for over 2 million patient visits per year.

Residency training also incorporates the nearby Jerry L. Pettis Memorial VA Medical Center, San Bernardino County Medical Examiner’s Office, and San Bernardino County Blood Bank.

Faculty Focus

Over 30 faculty provide a broad range of subspecialty training and expertise within anatomic and clinical pathology. In addition to the strongest commitment to patient care, teaching residents to become excellent pathologists is the foremost priority among our faculty.

Abundant opportunities are available for residents to participate in departmental research programs, the California Tumor Tissue Registry, and other consultative pathology, as well as special techniques such as electron microscopy, immunohistochemistry, and molecular medicine.

Didactic Education and Tailored Training

• Regularly scheduled, protected didactic morning conferences are held at 8AM in anatomic and clinical pathology, some of which cover laboratory management and medical informatics.
• Unknown slide sessions are also regularly included in morning conferences.
• Pathology residents are an integral part of the medical care team at LLUH, with deliberate graduated responsibility that begins with resident case ownership from the onset of our tailored Anatomic Pathology “Boot Camp.”
• Training is tailored to each resident’s individual interests, with elective time provided both within the institution and through outside rotations.

Surgical Pathology

This four-week rotation repeats during the four years of residency training, allowing residents to progressively develop and maintain their skills with graduated responsibility. The caseload is broad and includes both common surgical specimens and challenging disorders and tumors, supplied by an active LLUH Transplantation Institute and Cancer Center.

The rotation includes a rotating three-day schedule with an entire day of protected preview time to independently generate complete reports and triage ancillary testing, with oversight and advice provided as needed. The other days include a combined sign-out and frozen section day, and a grossing day.

Grossing instruction and support is ample, aided by working alongside instructors and students in LLUH’s Pathologists’ Assistant program, the only PA school in the western United States.

Autopsy and Forensic Pathology

The adult and pediatric autopsy pathology service provides an opportunity for residents to study and correlate morphologic abnormalities with clinical manifestations of disease, and to participate in the educational and quality assurance functions of the hospital autopsy.

Residents also gain autopsy experience at the nearby Jerry L. Pettis Memorial Veterans Medical Center and forensic experience during a two-week rotation at the San Bernardino County Medical Examiner’s Office.

Residents have no issues achieving the 50 required autopsies needed to take the American Board of Pathology board examination.

Cytopathology

This recently revised four-week rotation incorporates daily sign-out of exfoliative and fine needle aspirate cytopathology specimens in both the inpatient and outpatient settings.

Residents review cytology slides, prepare complete reports, and triage appropriate immunohistochemical studies. An integrated Rapid On-Site Evaluation (ROSE) service provides opportunities to gain expertise in this rapidly growing discipline.

Exposure to both gynecologic and non-gynecologic cytopathology is provided, as well as training in the performance and interpretation of superficial fine needle aspiration biopsies.

Hematopathology & Flow Cytometry

This recurring four-week rotation provides abundant experience in the diagnosis of bone marrow, lymph node, and peripheral blood smears.

Residents are trained in the interpretation of histologic, immunohistochemical, flow cytometric, cytogenetic, and molecular diagnostic findings in a wide range of adult and pediatric leukemias, lymphomas, and non-neoplastic hematologic disorders.

One rotation provides a dedicated focus on flow cytometry interpretation, and training in performing bone marrow biopsies is also provided.

Transfusion Medicine and Coagulation

The blood bank portion of this rotation focuses on the management of a hospital-based transfusion service, including practical aspects of transfusion medicine and the management of common transfusion-associated problems.

An available rotation at Lifestream, the blood donation center serving the Inland Empire and surrounding areas, offers additional exposure. Teaching is provided by Joe Chaffin, also known as the Blood Bank Guy, who also delivers occasional morning didactic conferences.

Other Clinical Pathology Rotations

Dedicated subspecialty clinical pathology rotations are incorporated into the curriculum. Residents are supervised by clinical pathologists or technical specialists in charge of the respective laboratory sections.

Experience in laboratory quality assurance, test validation, and continuous quality improvement processes is provided.

• Chemistry / Toxicology / Informatics – 12 weeks (3 rotations)
• Microbiology – 12 weeks (3 rotations)
• Cytogenetics – 2–4 weeks
• Molecular Diagnostics – 2–4 weeks
• Laboratory Administration – 2–4 weeks

Jerry L. Pettis Memorial Veterans Medical Center (VA) Rotation

Residents rotate at the VA Medical Center in Loma Linda for ten four-week rotations. Anatomic pathology responsibilities include handling surgical pathology specimens, performing autopsies, and presenting at multidisciplinary oncology tumor boards.

This rotation also provides the opportunity to serve a different patient population, adding exposure to a greater diversity of surgical specimens. Opportunities to perform superficial fine needle aspiration biopsies are also available.