Pathology & Laboratory Medicine

Post Sophomore Medical Student Fellowship

Description

The Department of Pathology and Laboratory Medicine, the University of Kentucky Chandler Hospital, offers several post-sophomore fellowships in Pathology each year. This program has been in existence since 1976. Fellows spend 4 months in Surgical Pathology, 4 months in Autopsy Pathology and 4 months on Electives. Opportunities for research are available but not required.

Requirements

Students must have completed their second year of medical school to be eligible.

Stipends

Fellows are paid a stipend of $20,000 annually.

APPLICATION

Send Universal Application with a copy of the candidate's curriculum vitae and a brief statement of reasons for interest in the fellowship program to:
Duncan MacIvor, MD, Director of Residency Training, Department of Pathology and Laboratory Medicine, University of Kentucky, 800 Rose Street Suite MS-117, Lexington, KY 40536-0298.

In order to fulfill American Board of Pathology requirements, the following are guidelines for acceptance into the program:

• Fellow must have fully and satisfactorily completed the sophomore year of medical school (including successful completion of the second year course in Pathology - PAT823 Mechanisms of Disease and Treatment).
• Training is full-time within the fully accredited pathology training program of the Department of Pathology and Laboratory Medicine
• Training is under the direction of the Director of the Pathology training program, and the Chair of the Department of Pathology and Laboratory Medicine
• Prospective fellow applicants are expected to review a description of proposed activities, responsibilities, and assignments for anatomic pathology, electives including clinical pathology, and research which is available on-line and on file within the department.
• Please also refer to guidelines in the Information Booklet of the ABP.

About the Rotations

Autopsy Pathology
Director: Paul Bachner, MD
Associate Director:  Gregory Davis, MD, William N. O'Connor, MD
Duration: 4 months

Educational Goal and Philosophy

Routinely the service is staffed by an attending pathologist and 1 house officer. Weekends are covered by the anatomic faculty/house staff on call. Upon entering the fellowship training program all house staff spend the first month on an introductory rotation with the Chief Resident that includes the autopsy service. Hospital decedents from both the UKMC and VAMC form the majority of patients undergoing prosection on the combined autopsy pathology service. Some outpatient cases primarily neurologically-diseased patients are also included in the student fellow autopsy experience. A faculty pathologist is directly involved at all times (including evening and weekends) in personally supervising the student fellow. After reviewing the clinical record and legal permission for autopsy the student fellow contacts the attending and discusses the approach to be taken in each case. Specific attention is paid to cultures, samples for EM, cytogenetics, flow cytometry, or other serologic or tissue studies and photographs to be taken. For known HIGH risk autopsies the procedure manual is reviewed in detail prior to beginning the case. The faculty member reviews all organs upon completion of the autopsy, makes additional suggestions for sampling and helps the student fellow to formulate the provisional anatomic diagnosis. Recording of gross autopsy findings can be achieved over the telephone line to a pathology micro cassette dictation bank for all UKMC cases. Tissue block labeling and legends with requests for special stains are entered using the anatomic pathology computer terminal in the autopsy suite for all UKMC cases. Specific fixed organs/tissues are retained for presentation by the student fellow at the weekly Gross Autopsy and other conferences including student teaching. All autopsies are assigned to a specific attending who reviews the slides at a double headed microscope with the student fellow, discusses how to describe the microscope findings and formulates a one to two page summary and comment. Student fellows are encouraged to cite the recent literature as a reference to interesting features of a given case. Graduated responsibility is built into the student fellow autopsy experience at all levels. Increasing competence at prosection of gross organs, approach to and interpretation of microscopic findings, creation of provisional and final anatomic diagnosis, correlation of autopsy findings with patient clinical laboratory findings and timeliness of record completion are evaluated monthly. Performance at weekly/biweekly/monthly intradepartmental and interdepartmental conferences is specifically addressed with appropriate commendation or criticism for level of training. Personal interaction with student fellow and supervision of autopsy room technicians is also evaluated. By the final autopsy rotation month, student fellows are expected to bring completed autopsy protocols to the faculty member with the anticipation of a minimum of necessary changes to be made.

Autopsy Pathology Conferences

Gross Autopsy Conference consists of presentation of fixed relevant organs from all UKMC and VAMC autopsies from the previous week as well as occasional interesting Medical Examiner program forensic cases. A clinical summary with laboratory data on each hospital patient is prepared in advance by the resident/student fellow on a large index card (to be copied and distributed to all in attendance) together with a listing of the major gross findings. Verbal presentation of the clinical summary is followed by review of available patient x-rays by an assigned radiology resident. Macroscopic organ changes are presented and correlated with clinical findings. Pertinent laboratory data are discussed. Suggestions by the faculty of issues to be resolved by the time the case is to be presented at Autopsy Follow-up conference (usually 10 days later) are noted by the Director of Autopsy pathology and these are typed for distribution. A record is kept of pathology student fellow/faculty and other attendance.

Follow-up Conference consists of presentation of relevant clinical data, gross photographs of major autopsy findings and microscopic findings (on a TV monitor) generally 11 days at the earliest following pro section of the autopsy. Prior to presentation at Follow-up conference the entire case has been examined with an assigned faculty member, relevant issues from Gross Autopsy conference have been addressed and a preliminary summary and comment has been developed and is presented for discussion. The Conference is lead by the Director of Autopsy Pathology and cases presented and satisfactorily completed are checked off the listing of autopsy cases awaiting presentation that are noted on the weekly conference schedule. The conference is attended by faculty, residents and student fellows. Priority of presentation is given to house staff who have rotated onto surgical pathology and clinical pathology and these individuals are excused as soon as their presentation is over. Student fellows are encouraged to be timely, brief and concise and to learn to use the TV properly.

Medical Pathology Conference is attended by faculty and house staff of the Departments of Internal Medicine and Pathology from UKMC and VAMC. Cases (generally 1 to 2 per conference) are selected by the Chief Resident of both services with a view to interesting/educational content. The presentation and discussion is in the format of either a classical clinicopathologic conference, or by members of the Medicine department who have prior knowledge of the patient/outcome. The pathology house staff is the primary presenter of all autopsy findings - gross, microscopic, clinicopathologic correlation with special attention to laboratory data and relevant summary of the literature. The assigned faculty member coaches the student fellow as necessary with the Chief Resident and takes the photomicrographs. Tables are constructed of major findings or relevant data from the literature. This should be planned well in advance so that the House Staff Coordinator can create the diazo slides for projection. The mix of cases is quite broad and recently has included cardiac, GI, pulmonary, renal, neurologic, endocrine and hematologic disease; bone marrow/renal transplantation; infectious disease and AIDS. The input of clinical pathology faculty in this conference is routine. Consultation is frequently obtained on relevant laboratory medicine issues and the faculty member comments as necessary at the conference.

Pediatric Pathology Conference has a very similar format to the Medicine Pathology conference outlined above. Cases selected by the Chief Residents of both services include both autopsies and tissue biopsy/resection specimens with accompanying relevant laboratory data. Two to three cases are presented at each conference. Generally the format is presentation of clinical findings by a Pediatric resident supervised by faculty followed by the autopsy findings presented by the pathology house staff (coached by the assigned attending and chief resident) with appropriate gross/micro and summary data. An interactive discussion ensues. Again attention is directed specifically to any related laboratory medicine correlation. Areas presented and discussed recently include congenital heart disease, prematurity/lung disease, necrotizing enterocolitis, infectious disease, neurologic neuromuscular disease, renal disease, genetic malformation complexes, solid tumors of childhood (neuroblastoma Wilm's tumor, rhabdomyosarcoma, Ewing's tumor, mesothelioma, rhabdoid tumor hepatoma), leukemia, bone marrow transplant, sudden infant death syndrome, child abuse, metabolic diseases (Hurler's, Pompe's, GSD).

VA Monthly Medicine Autopsy Conference For the past several years this conference has been attended by primarily medicine resident/chief residents with a few Medicine faculty including the VAMC Chief of Staff and the Program Director and Pathology Autopsy Faculty. Pathology house staff who have been on the autopsy rotation during the previous month show the relevant gross (fixed organ) findings from their cases after a brief review of the history and laboratory data by a medicine resident. Attention is paid particularly to the role of the autopsy as a quality assurance tool. The premortem clinical diagnoses are highlighted; expected and unanticipated autopsy findings are correlated and clinical issues not evident from a review of the written medical record are brought to light and correlated. Minutes of this meeting are distributed to the relevant service chiefs and to the pathology student fellow for incorporation into the final autopsy report.

Other conferences

Autopsy cases are presented with expected pathology student fellow involvement at a variety of other conferences. This includes Surgery-Pathology Mortality and Morbidity Conference, Cardiac Pathology Conference, GI Conference, GYN-Pathology Conference, Neuropath Conference.

Curriculum in Autopsy Pathology: Annual periodic presentations are made by faculty members in variations in autopsy technique for example pro section of the heart, brain, forensic, or other general features of overall method.

Surgical Pathology Rotation
Eun Young Lee, M.D., Director UKMC
Davis Hunt, M.D., Director VAMC
Weekly rotation faculty: Drs.  Kim Absher, Yolanda Brill, Virgilius Cornea, Eun Lee, William O'Connor, Matt Purdom, Dana Richards, Luis Samayoa, Dianne Wilson
Duration: 4 months

Educational Goal and Philosophy:

Our goal is to help the resident/student fellow become competent in the gross and microscopic evaluation of diagnostic specimens. As a function of this, the student fellow is educated in the importance of quality control, quality assurance and laboratory management as they pertain to surgical pathology. These goals are met by having the student fellow be an integral and necessary component of the Surgical Pathology Laboratory with primary responsibility for grossing in specimens performing accurate microscopic assessments and completing cases in a timely fashion. The student fellow is expected to identify his/her limits and to develop appropriate strategies for maintaining a high level accuracy in diagnosis in this context. The educational goals are achieved by maintaining a close working relationship between the student fellow and faculty in Surgical Pathology in addition to encouraging the student fellow to consult the literature when appropriate and to attend a wide variety of conferences (listed below) that pertain to Surgical Pathology.

Description of Required Rotations:

The student fellow is required to rotate on Surgical Pathology for a total of 4 months. During these rotations the student fellow participates in the gross examination and appropriate sampling for histologic sections of the specimens that come through the Surgical Pathology Laboratory; evaluating the histologic sections obtained from those specimens and then signing out these specimens in final form with an attending pathologist. During the sign-out the student fellow pathologist is expected to formulate opinions concerning his specimens with regard to abnormalities identified and to render diagnoses where appropriate within the limitations of the student fellow's level of training. Further requirements include the acquisition of skills with regard to frozen section performance and interpretation which includes proper sampling of specimens, proper sectioning and staining and microscopic interpretation and direct consultation/reporting of frozen section results to the surgeon. The student fellow is also expected to become familiar with the various ancillary techniques used in Surgical Pathology including electron microscopy, histochemistry and immunohistochemistry, flow cytometry and molecular diagnostics.

Description of Elective and Related Rotations:

Rotations that address specific disciplines or ancillary techniques are available. In this regard, elective rotations are available in hematopathology, renal biopsy pathology, neuropathology, transplant pathology, electron microscopy, immunohistochemistry and flow cytometry as well as various aspects of molecular biology. These rotations are generally administered by the individual in charge of the specific laboratory. Student fellows are encouraged to assume responsibility for their cases concerning appropriate description sectioning and histological interpretation. Student fellows are also encouraged to become intraspective and self critical identifying areas where consultation is needed. Standard textbooks in Surgical Pathology are kept in the Surgical Pathology Lab and a detailed gross room manual is available at all times.

Evaluation of Student Fellows:

Student fellows are evaluated monthly by written report in the standard format utilized for all house staff at the University of Kentucky Medical Center. The report is completed by the Director of Surgical Pathology with the input of the other surgical path faculty. A copy of the written report is made available to the student fellow as well as retained as a portion of his/her permanent record. The formal and informal evaluations described above are used as instruments of constructive criticism to improve or maintain the student fellow's high level of excellence, to maintain the level of excellence of patient care offered by the Surgical Pathology Laboratory and to evaluate the student fellow for appropriateness of retention and advancement.

Supervision of Student Fellows:

The student fellows are supervised by the attending faculty in Surgical Pathology and the senior staff person in the laboratory. At UKMC Surgical Pathology faculty consist of the Director of Surgical Pathology and 8 other faculty members who rotate through Surgical Pathology (Drs. Absher, Brill, Cibull, Lee, Mourad, O'Connor, Samayoa, and Wilson). The faculty member is the supervisor of student fellows during his/her rotation on the service. The Director of Surgical Pathology is responsible for coordinating the overall supervision of the student fellow while on the service and for communicating information regarding the student fellow and surgical pathology rotations to the Director of Resident Training and the Chairman of the Department where appropriate. Three staff technicians are permanently assigned to Surgical Pathology and by virtue of their experience and expertise plays a supervisory role with relation to junior resident training in gross room procedures and frozen section performance.

Curriculum in Surgical Pathology:

Throughout the year, topics in Surgical Pathology are presented periodically (ad hoc) by members of the faculty at the request/selection of the chief resident. In addition, approximately four times a year an invited outside expert in Surgical Pathology presents cases. The latter format involves discussion of a set of slides in a topic area (such as Pulmonary Pathology) which student fellows review in the week prior to the presentation.

Scheduled Conferences

Slide Conference: A weekly conference under the supervision of the Director of Surgical Pathology in which 10 unknown histologic or cytologic cases (4 University Hospital, 4 VA Hospital, 1 St. Claire Hospital and 1 cytopathology) are discussed by the student fellows, residents and faculty. The conference is mandatory for all student fellows in anatomic pathology and is highly encouraged for all anatomic faculty.

Clinical - Pathology Conferences: As listed in the overall schedule individual conferences are held with a wide range of clinical services including urology, renal medicine (weekly), endocrinology, hematology (biweekly), GI medicine (biweekly), cardiology and surgery and neurosurgery (weekly). These conferences are generally of a clinical case presentation format with attending and/or student fellow presenting the pathologic findings.

Anatomic Pathology Quality Assurance: A quarterly conference involves the surgical pathology, cytology and autopsy services at UKMC. Matters dealing with the quality of patient care are discussed. This meeting is presided over by Dr. Cibull and attended by all AP Faculty and house-staff. Student fellows review a specific assigned topic for each meeting. Recent examples include correlation of frozen section with permanent diagnoses; breast and colectomy gross description evaluation for accuracy; thyroid FNA correlated with resection specimen finding.

Electives

Blood Bank (Transfusion Medicine) Elective
Director:  Leonard Boral, M.D., Duncan McIvor, M.D.
Faculty:  Leonard Boral, M.D., Duncan McIvor, M.D., Dennis Williams, M.D.
Duration: One or more months

The Blood Bank introduces student fellows to all aspects of Immunopathology and Transfusion Medicine. The goal is to provide an introduction to these topics. The objectives include data useful to the student fellow whether he or she seeks later training in Clinical Pathology or another specialty; in other words, information appropriate for either the provider or use of blood bank products and services. This training includes blood component manufacture and administration. In addition, tissue typing, therapeutic pheresis and parentage testing are introduced. Patient care includes essentially every aspect of blood bank activity with experience in planning and problem solving for immunologic and pharmacologic (i.e., transfusion indications). The student fellows accompany residents and faculty as they perform consultations skills with physicians in other specialties.

The Pathologists serve as gate-keepers for blood component therapy. All requests for a component other than packed red blood cells require approval by the Department of Pathology and Laboratory Medicine. This responsibility is handled by residents. This provides extensive experience in application of standards, selection of appropriate tests and treatment, explanation and advocacy for a position, conflict avoidance without compromise of quality of care. These activities are reviewed immediately, if needed, and at least daily in a meeting for this purpose. The student fellows also accompany residents as this service is provided. This emphasizes the necessity properly to plan transfusion therapy.

The student fellows also briefly participate in blood center operations at the Central Kentucky Blood Center. Parentage testing is introduced by both didactic means and participation in test result analysis.

Therapeutic pheresis is performed by a section of the Blood Bank. Student fellows are encouraged to participate in all phases of these activities. This laboratory also obtains autologous whole blood donations. These activities complete the list of activities in the Blood Bank. Essentially no gaps at present in opportunities for training for the practice of Pathology in a hospital of any size.

Scheduled Conferences:

Blood Bank Continuing Education: This meeting occurs monthly. The main purpose is continuing education for Medical Technologists. The student fellow in the Blood Bank attends and presents some conferences. This provides experience in meeting continuing education needs of Medical Technologists.

Hematology/Oncology Conference: This monthly conference is conducted by the Director of the Blood Bank. The purpose is instructional review of selected patients and issues. The student fellow in Blood Bank attends and provides comments. The resident gains additional experience not only in solving problems, but in communication with colleagues.

Blood Bank Orientation: At the beginning of each training year extensive information is provided by a series of conferences. The subjects cover the whole breadth of immunohematology and transfusion medicine. The goal of these conferences initially is to prepare new residents to provide adequate patient care and blood bank management while on evening and weekend call. Additional information is provided concerning recent developments in the field in general including regulatory and accreditation requirements. While intended primarily for entering house staff, sessions usually are attended by residents at all levels. Beyond basic orientation, topics for these lectures are selected by the Chief Resident.

Patient Review and Planning: The meeting occurs daily. Individual patient problems are reviewed. The most frequent are immunohematologic and are due to acquired atypical antibodies. Autoantibodies as barriers to effective red cell therapy also occur with considerable frequency. Platelet therapy problems are also discussed with frequency. Platelet therapy problems are also discussed with frequent assessment of immune versus non-immune problems in a wide variety of patients. Selection of treatment for clotting factor deficiencies also occurs. Administrative issues are discussed. The activities for residents and fellows are planned. Communication with patient's primary physicians is planned. Transfusion reactions are reviewed.

Cardiac Pathology Elective
Director:  William O'Connor, M.D.
Duration: One or more months

Goals and objectives: This elective is designed to expose student fellows to commonly encountered problems in prosection, evaluation and interpretation in cardiovascular pathology. Utilizing a combination of gross specimen examination, microscopic slide review, clinical adult and pediatric cardiology interaction and focused study the curriculum should enable improved understanding and diagnostic abilities related to cardiac necropsy specimens (adult and pediatric), endomyocardial biopsies and vascular pathology.

Duties and Responsibilities: Dr. O'Connor meets daily to review alternately (a) gross necropsy specimens from the extensive file of adult and congenital hearts in the autopsy suite and (b) specific slides from the cardiovascular file at the double-headed microscope in his office. Instruction is offered in sampling of cardiac conduction tissues. Reading assignments are tailored to each student fellow's needs. Access to an extensive coded file of relevant current cardiovascular pathology literature is available. The student fellow is expected to attend the weekly cardiac catheterization conferences with adult and pediatric cardiology; prepare and present current cases at the Cardiac Pathology Conference and be available daily to review transplant and non-transplant endomyocardial biopsies. Curriculum includes review of clinical data, laboratory data, cardiac catherization data, echocardiography and angiography on selected cases.

Those desiring a second month of elective are encouraged to design a project such as a case report of review of cases that would result in publication of a paper.

Evaluation includes continuous daily feedback during gross/microscopy sessions; and, completion of the standard graduate medical education office from which is shared with the student fellow and placed in the student fellow's file.

Forensic Pathology Elective
Director: John C. Hunsaker, III, MD, JD
Faculty: John C. Hunsaker III, M.D., J.D., Cristin Rolf, M.D.
Duration:  One or more months

Objectives

As part of the pathology student fellow's experience within the Department of Pathology and Laboratory Medicine, the month-long Forensic Pathology rotation during the academic year has several major objectives:

• To educate student fellows about the role of the medico legal autopsy in death investigation and in the administration of justice.
• To give student fellows an opportunity to observe and perform selected medico legal autopsies.
• To enhance the student fellow's knowledge of anatomy with emphasis on correlation of anatomic abnormality and pathophysiologic mechanisms.
• To afford student fellows the opportunity to start with objective findings at autopsy and employ the logic of induction as a method to determine how and why a human being died.
• To introduce the student fellows to the Death Certificate and the proper method of death certification.
• To give the student fellows experience in legal processes and settings.

Hematology/Hematopathology Elective
Director:  Melissa Kesler, M.D.
Faculty: Drs. Michael Cibull, Darrell Jennings (Immunohematology/Flow Cytometry), Melissa Kesler
Duration: One or more months

Goal and objectives: To increase the student fellow's understanding of one or more of the various facets of Hematopathology including neoplastic hematopathology (leukemia and lymphoma), immunohematology and/or coagulation. This rotation builds upon the skills already acquired during the required hematopathology rotation and allows a student fellow to expand their understanding within this discipline and/or perform research in this area.

Description of the Rotation: Several possibilities exist under the heading of Hematopathology Elective, including research projects performed with individual faculty members in areas related to hematopathology. These projects are structured by mutual agreement between the student fellow and individual faculty member. An elective is offered in neoplastic hematopathology that stresses the morphologic, clinical, immunologic, and molecular basis of leukemia's and lymphomas. The student fellow combines microscope work both individually and with an attending including extensive literature review. In addition, during these elective periods the student fellow may take an active role in the Hematopathology conference organization, including presentation of some of the cases. Advanced coagulation is also an available elective that entails close interaction between the student fellow and the Chief of the Coagulation Laboratory, Dr. Marciniak. This rotation is structured in such a way that the student fellow is expected to acquire skills in diagnosing the more complex coagulation problems encountered in clinical medicine.

Evaluation: The student fellow is evaluated by the faculty member(s) involved in the elective utilizing the standard graduate medical education office form. A narrative review and a copy of this form is shared with the student fellow and a copy kept in the student fellow file.

Molecular Diagnostic Laboratory Elective
Director:  Charles Lutz, M.D.
Faculty: Drs. Darrell Jennings, Charles Lutz
Duration: One month

Goals and Objectives:

This rotation is offered to residents at any level of training. It is designed to familiarize and educate residents on the scientific principles and clinical applications of recombinant DNA technologies.

The house officer will spend part of his/her rotation in the laboratory with the senior technician where he/she will observe the performance of a variety of tests offered by the lab. As schedules permit, he/she may help perform some of the tests with close supervision. These should foster an understanding and appreciation for the technical skills needed for this complex type of testing.

At least once a week, Dr. Lutz will meet with the house officer to discuss in an informal mini lecture a specific application of this technology. Topics will include the use of nucleic acid probes for = (1) identity testing (2) microbial identification (3) genetic disease diagnosis and (4) prognosis and diagnosis of neoplastic diseases. Specimen requirements, test format and interpretation of results will be discussed. The resident will be encouraged to supplement these discussions with reading material - including current literature reviews and textbooks provided by Dr. Lutz.

Since there is no existing forum for these tests, i.e., no regular conference, and no direct patient contact, evaluation is based on daily interaction and assessment of the house officer's effort and ability to understand the basis and appropriate use of molecular diagnostic tests. The standard graduate medical education office form will be completed, shared with the house officer and a copy kept for his/her file.

Neuropathology Elective
Director:  Peter Nelson, M.D., Ph.D.
Faculty: Drs. Peter Nelson, Craig Horbinski, Janna Neltner, Dianne Wilson
Duration: One or more months

Description of Rotation:

The elective is offered to all house officers regardless of their level of pathology training, however, they are encouraged to pursue the elective after completion of the second year. Concentrated experiences in surgical and autopsy neuropathology are offered with special emphasis on the topics of CNS and PNS neoplasms and degenerative diseases using light and electron microscopy. Immunohistochemical and muscle biopsy interpretative skills are also emphasized.

Goals and Objectives:

The elective is primarily designed to train the house officer in common processing techniques (peculiar to the handling of tissues from the nervous system, skeletal muscle, and peripheral nerve) and interpretation in neuropathology. This experience is inclusive of stereotaxic CNS biopsy frozen and permanent section specimens. The rotation includes neuropathologic specimens from pediatric and adult populations. If the house officer desires, an in depth experience in interpretation of necropsy specimens from patients with degenerative diseases is available utilizing the specimens referred to Sanders-Brown Center on Aging.

House Staff Responsibilities: The house officer is required to attend all CNS frozen sections at the University and VA Medical Centers. Conferences where their attendance and occasional presentation are mandatory include the following:

Autopsy brain cutting: TBA
Neuroradiology/neurosurgery: 1st and 3rd Thursday
Other conferences e.g., slide conference, autopsy conferences

The house officer is required to review all in-house and referral cases, formulates their diagnostic opinion and reviews the cases with the neuropathologist covering the service schedule; this includes interpretation of any immunohistologic or ultrastructural studies Reading assignments are extensive, but tailored primarily to topics most likely to be encountered by a practicing surgical pathologist serving a hospital with an active neurosurgical service. An extensive neuropathology and neuroanatomy textbook reference collection are available in the neuropathology lab. Additionally, an organized slide collection containing over 1,200 slides and covering the topics of neoplasms, degenerative diseases, demyelinating diseases, trauma, malformations, infections, vascular disease, toxins and metabolic diseases is available for study.
The elective is primarily directed by Dr. William R. Markesbery, with assistance by Drs. Wilson and Davis. Basic or clinical research opportunities in neuropathology are provided to house officers showing an interest and commitment in neuropathology.

Evaluation is based on performance during the gross and microscopy didactic sessions and completion of a standard graduate medical education office form. The evaluation is shared with the house officer.