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 Residency Program's mission is to provide comprehensive post-graduate training in anatomical and clinical pathology, and to prepare physicians for leadership in clinical practice, research, and/or academia. The goal of the program is to produce world class physicians, physician-scientists, and physician-scholars capable of advancing the field of pathology locally, nationally, and internationally.
The training program in Pathology at Yale focuses on developing and enhancing the role of the pathologist as a diagnostic consultant, using not only traditional techniques but also current state-of-the-art approaches as well as continual forays into the future of pathology practice. A large and diverse faculty provide many varied role models for residents in training and have a proven track record for the highest quality teaching.
Combined with an extensive array of pathology fellowships, the residency program has a rich history of producing community pathology leaders as well as internationally recognized academicians and scientists. Although most of our graduates proceed along one of the traditional pathways of pathology practice, others have pursued positions in forensics, biotechnology, major administrative posts, and even patent law. We are proud of the diverse pathways our graduates have taken, united by the common theme of being among the best in their chosen pathology career.
Residency training in Pathology is provided both by the Department of Pathology and the Department of Laboratory Medicine. Working together, the two departments assure strong training in both Anatomic and Clinical Pathology.
The Department of Pathology is comprised of research laboratories, anatomical pathology services, 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 Yale New Haven Medical Center, the West Haven campus of the Veterans Administration Healthcare System (VA), Bridgeport Hospital, and to external clients. Residents thus have the opportunity for exposure 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 to each area of anatomic pathology, with training provided by specialists in those areas. The laboratories/units that support the department are: histology, immunohistochemistry, flow cytometry, molecular diagnostics, electron microscopy/advanced imaging, operational informatics, and the report generation unit.
The Department of Laboratory Medicine consists of research laboratories, clinical pathology services, and support services. Departmental clinical laboratories include the Blood Bank, Clinical Chemistry, Hematology, Immunology, 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 the VA national mycobacteriology and virology reference laboratories. Residents have opportunities for exposure to all aspects of clinical 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 clinical utilization of laboratory tests. To accomplish this, residents work on research and/or developmental projects in the laboratories and serve as consultants to the hospital physicians on the use and interpretation of laboratory data.
Upon completion of the program, residents will be prepared for careers in either academic pathology or community medicine.
Residents are accepted for training in 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 provide trainees an opportunity to tailor the training experience for their own specific needs and career goals, and each includes core rotations which carry with them specific responsibilities and which are designed to increase the resident's competency in the practice of pathology. Details of each of these rotations is provided elsewhere on this website. Any of the training tracks can be further modified to accommodate areas of focus for our residents. The program endeavors to accommodate a variety of training schedules and goals without compromising core training. However, since resident responsibilities are integrated into the functioning of the services and patient care cannot be compromised, not all scheduling variations can be accommodated. Advanced planning in consultation with the Program Director is important in developing a customized training program.
For residents interested in a career as a physician-scientist, physician-engineer, or other type of physician-scholar, investigative training can be integrated into and/or appended onto training in any of the three tracks. Research may be pursued not only within the two Departments, but also with mentors in other basic science or clinical departments in the School of Medicine, School of Public Health, and Yale University. More details about research opportunities is 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 for residents, and prepares them for broad career options ranging from a small community private practice to a large academic medical center. Because four years is barely enough time to train residents in all of the subspecialties which make up anatomic and clinical pathology, limited time is available for in-depth subspecialty training. The majority of AP/CP track residents go on to subspecialty fellowship training following their residency, although some have elected to go straight into practice.
Combined training in Anatomic and Clinical Pathology includes 24 months of core AP training and 18 months of core CP training. Core training in the diagnostic/clinical programs is devoted to learning the principles of gross, microscopic, and analytical evaluation of specimens with an increase in responsibility tailored to the progress made by the individual resident. Senior resident rotations allow the resident to assume responsibility for the professional supervision of the services. Elective time allows opportunities for advanced training and/or investigative work sponsored by a faculty member in the departments.
Residents most commonly do AP or CP rotations in six or twelve month blocks. However, because of the flexibility of the program, there is often limited 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.
Combined training typically begins with 2 years of anatomic pathology training, followed by one full year of clinical pathology training, followed by a year combining six months additional training in clinical pathology, and six months of flexible training opportunities, including advanced training and/or basic research (experimental pathology), but other options exist:
- 24 months core AP training, 18 months core CP training, 6 months AP senior resident rotations
- 24 months core AP training, 18 months core CP training, 6 months specialty training in AP or CP
- 24 months core AP training, 18 months core CP training, 6 months research experience
- 18 months core CP training, 6 months additional CP training, 24 months core AP training
Communication with the Program Director of your interests and plans early in your training is crucial to designing your training path.
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 (July 1 to June 30). Each level of training is characterized by a particular group of rotations. Together, these rotations provide a broad exposure to diagnostic pathology. The scheduling of residents to the various rotations is the responsibility of the Chief Residents in anatomic and clinical pathology.
Core training in AP
During the first 12 months of anatomic pathology training, 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 as technicians, and toward 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 being their training in Surgical Pathology and Cytopathology during their first year of AP. Rotations through the major surgical pathology services at YNHH (breast, GI, GYN, and the general/multi-specialty service) as well as rotations 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, 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.
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. Details of the conferences, as well as information about on-call responsibilities, are provided elsewhere in this manual.
Core training in CP
During the first 12 months of CP experience, residents rotate through each of the sections of the Clinical Laboratories. The first year of CP training begins with a "round-robin" series 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 work on research and/or developmental projects in the laboratories and serve as consultants to the hospital physicians on the use and interpretation of laboratory data. Teaching is another strong area of emphasis during the CP training. Residents fully participate in medical student teaching by serving as preceptors in the hematology and microbiology laboratories.
During their final 6 or 12 months of CP training, 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." Residents thus have the opportunity for exposure to all aspects of clinical testing from conceptualization in basic research to practical realization in the clinical laboratory and application to patient care. Upon completion of CP training, residents should be prepared for careers in either academic or community medicine.
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. Details of the conferences and on-call responsibilities are provided elsewhere.
Additional Training
Core training in AP and CP leaves six months available to AP/CP residents for additional training. As discussed, there are many options available to residents for this period, 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, and early consultation with the Program Director is strongly advised if a customized program is desired. The majority of the AP/CP residents spend this six months obtaining additional training in anatomic pathology. A series of special AP-3 rotations have been designed to provide residents with a broad exposure across all subspecialty areas of pathology and to solidify their diagnostic skills. These include the "Hot Seat" rotation, Frozen Sections, Autopsy Senior Resident, and General Signout at Bridgeport Hospital. These rotations all increase the resident's interactions with members of the clinical team and allow them to take greater independent responsibility for cases, gradually transitioning them to independent practice. Elective time is also available. All AP/CP residents must spend at least one month of this period for a rotation on the frozen section service, to meet ACGME training requirements.
The AP-only and CP-only training track provides focused training in all of the sub-disciplines of anatomic or clinical pathology, respectively. Each of these is a 36 month program, and prepares residents who have more defined career objectives for, most commonly, a life in academic pathology, typically at an academic medical center. The three year training affords residents not only a broad exposure and solid foundation in the respective discipline, but also an opportunity for in-depth subspecialty training and/or a significant research experience.
In addition to the physician-scientist track, some residents pursue a physician-engineer track in which the research portion is oriented predominantly toward Biomedical Engineering in conjunction with the Yale Dept of Biomedical Engineering. Others pursue a physician-scholar track in which clinical and teaching work is emphasized; this track often involves a post-residency fellowship, for example, in Transfusion Medicine, Neuropathology, Dermatopathology, Medical Microbiology, or Gastrointestinal Pathology. Finally, for individuals who do not already have 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 who will then 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. While residents aiming for an academic research career are eventually expected to apply for external support for post-residency research fellowships (e.g. K awards), salary is guaranteed for the full 3-year training period required for board eligibility. In addition, as described below under "Research Experience", both the Departments of Pathology and Laboratory Medicine are willing to commit salary support to facilitate additional research training after residency completion, providing an additional 1-3 years of mentored research.
AP-Only Training
Training in AP-only is most commonly for individuals who either have already decided in which subspecialty area of anatomic pathology they wish to focus, or 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, increase 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. 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, research histology, and DNA synthesis services.
CP-Only Training
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 the AP/CP track 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 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 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 the 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 or a paper to a national meeting. 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 intending to pursue a career involving significant basic research activities, 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). To be eligible, residents must be in good standing with respect to their clinical training. Residents will be expected to submit a written proposal describing the purpose and scope of the planned research. The research must be conducted under the direction of a Yale faculty member, but does not necessarily have to be in the department of Pathology or the department of Laboratory Medicine. The research proposal should be approved by the research sponsor before being submitted to the Program Director.
In addition, if the resident demonstrates a commitment to a research career, the Departments of Pathology and/or Laboratory Medicine will guarantee salary funding for an additional year of research (non-ACGME accredited). If during that year the trainee completes and submits a grant application for external funding, a second full year of research will be guaranteed, even if the grant application is not funded. 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, but no later than the beginning of their final year of 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 available, 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. Note, however, that the printed manual is updated only once per year. The most up-to-date information is available on this web site.
Positions
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 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 residents in the program each year.
Application
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:
- ERAS Common Application Form (CAF) / Curriculum Vitae (CV)
- Official Medical School Transcript
- Three letters of recommendation
- A letter from the Dean of their medical school
- USMLE transcript
- ECFMG (Educational Commission for Foreign Medical Graduates) status (if applicable)
- Personal Statement
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
Interviews are conducted on Tuesdays in October, November, December, and January. Interviews may occasionally be granted at other times, as the need arises.
International Medical Graduates
IMGs seeking entry into the Yale Pathology residency program should meet the following requirements:
- Passing USMLE scores on the first attempt (2 digit score > 85 preferred)
- At least one year of educational or clinical experience in the United States
- The ability to communicate clearly and effectively in English
- Graduation from medical school within the last eight years or full time attending patient care responsibilities in the United States within the last five years
- ECFMG certification prior to application
- Preferred: Ph.D. in a related field, in the United States
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 B38
P.O. Box 208023
New Haven, CT 06520-8023
Fax: (203) 785-3644
Residency Coordinator:
Susan de Guardiola
(203) 737-4142
susan.deguardiola@yale.edu
Program Director:
John Sinard, M.D., Ph.D.
(203) 785-6424
Associate Program Directors:
Diane Kowalski, M.D. (AP)
Henry Rinder, M.D. (CP)
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