The Autopsy/Neuropathology service encompasses experience in both medical and forensic cases. Forensic autopsies are performed during a rotation at the Los Angeles County Department of Medical Examiner-Coroner. The neuropathology service is bolstered by a strong neurosurgery program, including the UCLA Brain Tumor Center (designated SPORE site by the NIH), Tumor Translational Resource, and the Mary S. Easton Center for Alzheimer’s Research at UCLA. Residents draft neuropathology reports and participate in weekly brain cutting and autopsy case conferences. Residents easily achieve their required experience for board qualifications.
In addition, they spend 1 month on the endoscopic GI biopsy service.
All services are on the Westwood-UCLA campus with the exception of Bone and Soft Tissue and Junior Attending services, which are at the Santa Monica-UCLA/Orthopedic Hospital campus (approximately 20 minutes from the Westwood-UCLA campus).
Gross pathologic examination/sectioning: daily, limited to specimens on subspecialty service.
Preview and preparation of reports: Residents are responsible for drafting reports for all cases on their services in preparation for sign-out with the attending pathologist on service. Graduated responsibility is achieved over time as more senior residents are expected to "take-ownership" of their cases and prepare more complete "sign-out" ready reports.
Daily sign-out sessions with attending sub-specialty pathologist.
Residents of all levels regularly present at specialty specific tumor boards and radiology-pathology conferences. Residents are also considered the point person for clinician communications for their service.
Junior residents receive supervision by service specific fellows, senior residents, the JA-Westwood, pathology assistants in the gross room, and attending pathologists as appropriate.
Residents spend 3 months on the cytopathology service where they review gynecologic, non-gynecologic, and non-pathologist-obtained fine needle aspiration specimens on the Westwood-UCLA campus. Both consult and non-consult cases are previewed by clinical trainees.
Residents cover requests for rapid on-site evaluation of cytologic material in the afternoon. They also participate in regular quality review case conferences and journal clubs.
Senior residents spend one month on the ultrasound-guided fine needle aspiration clinic service where they learn to take a focused history, physical examination, and perform fine needle aspiration of superficial lesions in our free-standing clinic on the Westwood campus. They are introduced to the use of ultrasound guidance in localizing and sampling superficial lesions. They preview slides and compose complete reports of each patient they encounter in our clinic.
The jeopardy rotation serves as an additional elective rotation. Residents may choose to spend their time on any in house AP or CP service or design their own schedule as applicable. Examples of the latter include rotating through various surgical pathology subspecialty services and participating in research. The jeopardy resident also may be called on to provide backup coverage for unexpected trainee absences.
The PGY-1 Frozen Section Rotation is a new two-week rotation designed to introduce residents to intraoperative surgical pathology consultations early in their training. The rotation provides exposure to different aspects of intraoperative consultation, including frozen lab workflow, gross specimen assessment and sampling, slide preparation, histologic examination of frozen sections, and communication with clinical colleagues. The aim is not only to help first-year residents prepare for anatomic pathology call and more advanced rotations, but also to provide early experience in an integral component of the practice of pathology.
Residents interpret results for high performance liquid chromatography, serum protein gel electrophoresis, and immunoelectrophoresis. Cases are reviewed with attendings. Residents also meet with attendings weekly for didactics, which involves lectures and case-based learning of chemistry concepts and laboratory management.
Clinical Microbiology is a comprehensive diagnostic laboratory that, in addition to receiving patient specimens from the UCLAHealth System, also acts as a referral center for other hospitals and clinics in Los Angeles and nationally. Drs. Omai Garner and Shaun Yang coordinate resident training in Microbiology. The section also has several postdoctoral fellows in Microbiology with whom responsibility is shared.
The resident rotation includes mandatory bench rotations and clinical responsibilities as defined by the faculty. Residents will meet daily with the faculty to discuss clinical cases, review areas of general microbiology, and identify topics for clinical correlation conferences. The curriculum includes didactics in Bacteriology, Virology, Serology, Mycology, and Parasitology.
Activities include daily plate rounds with faculty, conferences, and time for bench work or independent activities. Residents often present interesting cases or articles to the group. Weekly call review is held to follow up on interesting call and sign-out problems from the prior week.
The overall objectives of the Clinical Cytogenetics rotation are for the residents to be familiar with the basic techniques of chromosome preparation, banding, karyotype and Fluorescence In situ Hybridization (FISH) analysis, and some of the more common cytogenetics anomalies associated with genetic and neoplastic disease. During this period the resident will have opportunities to setup their own peripheral blood and perform analysis and learn the chromosome nomenclature, to know when the different cytogenetics tests are called for, and what the results mean vis-á-vis the disease. The resident will also have exposure to newer methods in molecular Cytogenetics such as multi-color FISH (m-FISH) and array Comparative Genomic Hybridization (aCGH). There will be ample opportunity to review abnormal cases and participate in lab meetings. A series of practical lectures will be given covering prenatal diagnosis, postnatal constitutional analysis, hematological disorders and solid tumors. Residents will have the opportunity to participate in the daily sign out with the directors. Finally, there will be opportunities for research and developmental projects.
Rotations are scheduled for a month at a time, for a total of 3 months in bone marrow service and 1 month on lymphoma service. Routine daily activities include reviewing and signing out bone marrow, flow cytometry, and lymph node cases. Residents are responsible for obtaining the clinical history for cases and communicating results to clinicians directly when appropriate. Other activities performed as they arise include evaluation of peripheral blood and body fluid smears, review of platelet aggregometry testing, and communicating results to clinicians after consultation with the attending pathologist. Time is set aside each week for specific teaching sessions on peripheral blood and body fluid morphology and other topics listed above that are not routinely encountered in the daily work. Experience in performing bone marrow biopsies can be obtained at the Santa Monica Hospital. Residents attend and prepare presentations as indicated at pathology resident conferences as well as the HemePath Multidisciplinary Conference series and Lymphoma Tumor Boards.
Residents will appreciate and prepare themselves for the multifaceted responsibilities of being a lab director by engaging in both applied and didactic opportunities. Specifically, residents will attend and participate in various lab management meetings, including weekly clinical meetings (blood bank, hematology, chemistry, etc), as well as special-need meetings for instrument validation, physical space allocation, personnel and resource management, laboratory disaster/pandemic preparedness, and others, as they arise. Residents also benefit from weekly lab director-led didactics, earn a lab inspection training certificate from the College of American Pathologists (CAP), and participate in inspections of the UCLA laboratories. As always, opportunities for additional mentorship, education, research, and quality improvement projects are readily available to residents upon request. Upon completion, residents will have an improved understanding of a lab director's role in patient care in a hospital-based setting and set a foundation for their own future in this exciting field.
The goal of this rotation is to expose the resident to the principles and practice of diagnostic molecular pathology in the day-to-day laboratory setting. Using primarily a case-based learning system supplemented with didactic and selected reading material, the resident will be exposed to our laboratory's diverse applications in molecular diagnosis of genetic diseases, cancer, and individual identification by DNA fingerprinting. The resident will observe and participate in all aspects of specimen handling, case workups, and results reporting. Key molecular biologic procedures such as the polymerase chain reaction, Sanger sequencing, and next-generation sequencing will be introduced. In addition, the resident will be exposed to quality assurance activities such as internal quality control and inter-laboratory proficiency testing; laboratory management including specimen triage, budgeting, licensing, accreditation, patent issues, ethical and legal issues, and decisions regarding new test development and interfacing with other clinical laboratories; and communication with referring clinicians and genetic counselors. Residents will also be exposed to our Orphan Disease Testing Center, dedicated to the molecular diagnosis of rare genetic disorders, the Clinical Genomics Center, where the comprehensive sequencing of a patient's entire exome (all of the coding regions in the genome) is performed and interpreted for a variety of clinical indications, and to outpatient and inpatient consultative activities in medical genetics. Time permitting, there will be opportunities for independent research and developmental projects.
The Transfusion Medicine Section of Clinical Laboratories includes a Blood and Platelet Center to collect, process, and prepare blood components from whole blood and aphaeresis donations, a Therapeutic Apheresis Center to perform therapeutic apheresis procedures and stem cell collections, a Transfusion Service to provide compatible blood products and offer specialized immunohematology tests for resolving complex antibody problems and for evaluating immune-mediated hemolysis, and a transfusion medicine Consultation Service.
About 75,000 blood products are transfused each year at UCLA. The need to monitor appropriate blood usage and transfusion safety places a growing emphasis on the Consultation Service. Some consultations are initiated automatically when unusual orders are received or atypical test results are noted; others are provided upon physician request. In addition, transfusion practices are continuously audited according to guidelines established by the UCLA Committee on Blood and Blood Derivatives. The residents will be involved actively in the consultation service and must become familiar with the clinical, technical, and administrative aspects of all transfusion medicine (TM) areas.
Teaching activities are routinely scheduled Monday through Friday, and include discussions of clinical cases at sign-out sessions, didactic sessions on specific transfusion medicine topics, and regular clinical ward rounds on patients with unusual or interesting transfusion requirements. Residents are also encouraged to attend education seminars held in the department and also hematology/oncology rounds to follow specific consultpatients with the TM fellow and faculty. Senior residents are welcome to participate in Blood Services and Transfusion Services management under the direction of the senior supervisors and medical directors. Residents at all levels of training are strongly encouraged to undertake small research projects with the support of the faculty. Residents are provided with a work area in the laboratory, which allows them to actively participate in ongoing activities and work closely with the staff. The work area is equipped with a collection of useful reference texts in transfusion medicine.
