The second year in the straight Clinical Pathology track includes a required four-week rotation divided between Cytogenetics and Molecular Diagnostics; most residents additionally take an elective rotation in Informatics. The remainder of the year is designed according to the individual interests of the resident and clinical service needs; residents rotate through multiple services during the year, but unlike the core rotations in the first year, residents now act in a senior supervisory role and choose directed clinical responsibilities within each laboratory rotation.
Residents in the AP/CP program similarly acquire subspecialty experience during the last six months of their 18-month CP core. During the subspecialty rotations, the resident affiliates with one of the laboratories and serves as a junior attending, responsible for QC assessment, CAP surveys, troubleshooting methods, and backup to the first year residents assigned to the lab. The resident's major goals during the subspecialty rotation are to acquire subspecialty expertise and perhaps to carry out a project of applied or basic research related to the clinical subspecialty. These projects are often begun during the second year and then are intensively carried out in the third year of the CP program.
Dr. Peining Li
In the cytogenetic training program, the trainee will receive training by the director and the laboratory staff in aspects of clinical cytogenetics including background on biology and genetics of chromosomes, analytical cytogenetic techniques (specimen requirements, processing etc), cytogenetic nomenclature, and management and counseling of cytogenetic diseases.
Skills and areas of instruction offered during rotation:
- Human chromosome identification and nomenclature.
- Peripheral blood culture and harvest.
- Chromosome banding techniques.
- Chromosome abnormalities (slide viewing, image analysis, case logbooks, reporting).
- Brief overview on Cancer cytogenetics techniques
- Interpretation and reporting of numerical and structural chromosome abnormalities
- In situ hybridization (this is becoming an integral tool in clinical cytogenetics).
- Possibility of doing a Research projects or at least a case report.
Drs. Howe, Smith, Rinder, Edberg, Landry, and Campbell
Molecular techniques are changing the face of medicine. Few areas are being more intensely affected than Laboratory Medicine, which has the duty of translating assays developed in the research laboratory into routine, rapid and cost-efficient clinical laboratory assays. Believing that techniques based on recognition of nucleic acid sequences will become widely applicable, we have established a Molecular Diagnostics Laboratory that has the job of developing molecular assays, transferring them to routine clinical use and overseeing their continued use. We are currently developing a wide range of molecular diagnostic assays that will affect all aspects of Laboratory Medicine and are at the forefront of the molecular diagnostics field.
A large number of tests, including those for genetic disorders such as hemochromatosis, prothrombin G20210A mutation, Factor V Leiden, HPA-1 and cystic fibrosis screening, as well as those for tumor diagnosis and minimal residual disease detection, are carried out. Techniques include several amplification strategies, sequencing, quantitative PCR, RFLP analysis and in situ hybridization. Bacterial and mycobacterial identification by 16S ribosomal amplification and sequencing are also performed.
Residents are regularly exposed to molecular techniques in the majority of their rotations. For example, the Virology and Microbiology laboratories test for a number of organisms by molecular diagnostics methods, such as, HIV, HSV, enterovirus, chlamydia and mycobacterium.
In addition, the pathology department at the affiliated VA, performs molecular diagnostics testing for HCV and Factor V Leiden. Residents also have the opportunity to work on new assays in the Molecular Diagnostics Laboratory, either as a rotation project or as a development project in their rotation. Finally, a lecture series in molecular diagnostics is taught jointly by Anatomic and Clinical Pathology.
Drs. Rathbone and Wardlaw
In today's highly automated laboratories, results can be generated at rates which can only be handled by computer. The Yale Clinical Laboratories were pioneers in laboratory information systems and today boast an extensive computer system which has been completely developed and maintained with in-house expertise. The same staff of computer scientists, programmers and engineers also carries out maintenance and repair of existing instrumentation as well as design and development of new instruments, instrument interfaces and software. Although there is no formal rotation in this area, the service is an integral part of all the laboratories, so learning occurs on a continual basis. Those wishing more in-depth exposure may pursue research and development projects as part of a second year subspecialty focus.