During the majority of the Cytopathology Fellowship (10 months), you have full cytology clinical service duties including a one-month dedicated research time. The remaining two months are spent in molecular pathology where emphasis on fluorescence in situ hybridization (FISH), testing for urine (UroVysion) and other specimens (esophageal brushing, bronchial washings, and biliary tract brushings) is taught.
In addition, you will learn the use of digital image analysis (DIA) and DNA ploidy studies for prostate and breast cancer. Additional technologies that are integrated into the rotation include CellSearch for circulating tumor cells and Automated Cellular Imaging System (ACIS) digital image analysis for automated quantitation of hormonal receptors (ER and PR) and scoring of human epidermal growth factor receptors 2 (HER2) and MIB-1 antibody.
During training, you will acquire extensive experience and develop special competence in cytopathology including cytopreparatory techniques and stains, interpretation of gynecologic and nongynecologic cytology specimens, the performance of fine needle aspiration, rapid on-site interpretation of fine needle aspirates, and issues related to Clinical Laboratory Improvement Amendments (CLIA) regulations and quality control. During this period, you will achieve high competency in the core educational requirements including patient care, medical knowledge, interpersonal communication skills, professionalism, practice-based learning, and system-based practice.
During the first four months, you are under supervision of the cytopathology faculty specifically during the sign-out period, which includes the attending pathologist and any resident(s) currently on the cytology services. This is conducted at the cytology multiheaded microscope. Specifically concerning cervicovaginal cytology, it is expected that fellows spend a portion of at least one day a week during the first four months screening these exfoliative specimens in the laboratory as if they are the initial cytotechnologist. This provides an appreciation for, and understanding of, this important screening process.
You are expected to spend a portion of one day each week, for as long as is deemed necessary, in the cytology preparation lab in order to learn different cytopreparatory techniques during this phase of the training.
During the second half of the training year, you will have more independence. When time permits, you will review and interpret preliminarily most or all specimens dispersed from the laboratory to the pathologist. After this, the specimens go to the attending pathologist who then finalizes the diagnosis. You will have the option of attending this subsequent sign-out session.
You will see a true assortment of classic and unusual cases during the fellowship. The annual volume of cytology specimens at Mayo Clinic's campus in Rochester, Minnesota is 103,149, including:
- GYN cytology. 30,547
- Non-GYN cytology: 9,502
- FNA cytology: 9,142
- FISH-urovysion: 4,556
- FISH-biliary: 2,448
- Biomarker and image analysis (ER/PR, Her2, Ki-67): 11,363
- Tissue slide review (TSR): 35,591
The Cytopathology Fellowship is completed in 12 months with 13 four-week blocks. The order of rotations will change from fellow to fellow, coordinating with the residency program.
|Orientation||Introductions, tours, and general onboarding logistics. Dedicated time to complete institutional and departmental training.|
|Leadership and management||This course is required of all trainees within the Department of Laboratory Medicine and Pathology. It is aimed at developing critical leadership and management skills with an underlying focus on systems-based practice.|
|GYN/non-GYN||Introduction to terminology, concepts, theories, and skills used within GYN/non-GYN. Dedicated time to develop and demonstrate diagnostic competence in diagnosing GYN and non-GYN cytology specimens.|
|Fine needle aspiration (FNA)||Introduction to terminology, concepts, theories, and skills used within FNA biopsy procedures. Dedicated time to develop and demonstrate diagnostic competence in diagnosing FNAB specimens. You will alternate daily, providing preliminary diagnosis on day 1 and working on follow-ups on day 2.|
|Endocrine FNA + non-GYN cytology||Demonstrate diagnostic competency in performing fine needle aspirate biopsies. When it's slow in the endocrine lab, you are expected to come back to work on non-GYN cytology. As a fellow can generally complete 50 endo FNAs within four weeks total, this rotation is scheduled within the first half of the year (may extend to second-half if needed). Endo FNA may not appear as a full block, but as single weeks over 2-3 blocks alternating with GYN/non-GYN cytology.|
|Rose procedures (EUS)||Dedicated time to develop and demonstrate diagnostic competence in providing on-site preliminary diagnosis on EUS and EBUS-guided FNAB specimens. You will be responsible for follow-up of these cases once they arrive in the lab. This rotation is paired with pap smears and cervical biopsies.|
|Molecular cytopathology and CSF||This rotation focuses on understanding the molecular techniques utilized in the molecular cytopathology laboratory and includes TSR and FISH lab. Exposure to cerebral fluid cytology should be organized during this rotation with hematopathology and through review of study sets.|
|CYT consults and GYN pap smears||Consults rotations supporting consultation practice alongside GYN rotations (pap smears and cervical biopsies). This rotation is completed towards the end of the fellowship.|
|Research||Four weeks of research can be spread throughout the year during the GYN/non-GYN or FNA rotations, or, if preferred, as a research block. Research also includes engagement with a quality improvement project.|
|Elective||You will have one elective rotation where you have the option to select an on or off campus rotation in the pathology department. Examples include surgical pathology fellowship rotation, subspecialty rotations, Mayo Clinic in Phoenix, Arizona or Jacksonville, Florida, or time to complete research.|
The wealth of surgical pathology and cytopathology material at Mayo Clinic offers limitless opportunities for research projects. We also collaborate with large, active clinical and research groups in all subspecialty areas. Core science laboratories are located in the same building as the pathology division, providing access to techniques such as microdissection, molecular genetics, cytogenetics, and flow cytometry.
Specifically, you will be expected to complete at least one research project with submission for publication at the end of the year before exiting the fellowship training.
The integrated didactic core lecture series, attended by all residents and fellows, covers a range of topics in anatomic and clinical pathology. An extensive teaching file contains glass slides demonstrating the entire spectrum of neoplastic and non-neoplastic pathological diseases.
There is a monthly education conference in cytopathology as well as cytotechnologist student lectures where fellows are expected to present material periodically.
Throughout the year, fellows attend formal presentations on laboratory management principles as part of the established teaching conferences that are given by expert staff members, which is a designed curriculum for leadership and management developed by the Department of Laboratory Medicine and Pathology at Mayo Clinic.
As a fellow, you will teach pathology residents and trainees rotating on the cytology service.
To ensure that trainees acquire adequate proficiency and develop appropriate technical skills, performance is monitored carefully during the course of the program. Fellows are evaluated by supervising faculty members at the completion of each rotation block, which may range in length from four to eight weeks. Faculty also formatively assess patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and interpersonal and communication skills.
The program director will meet with you quarterly to review their evaluations and discuss professional growth. In addition, allied health staff and residents are asked to evaluate trainee performance periodically.
You will be able to view your evaluations electronically and final written summative evaluations will be compiled for you upon completion of the program. You will also evaluate the faculty to ensure that your educational needs are being met.