The fellowship in Liver Pathology is a one- to two-year program providing in-depth training in liver pathology combined with research. The program has been in existence since 1991, with graduates attaining international recognition in the filed, as well as leading positions at prestigious medical institutions in the United States and abroad.
The clinical portion of this program is based at The Mount Sinai Medical Center. The fellow is expected to spend approximately 90 percent of the time in the clinical setting, with 10 percent of the time dedicated to research. Interpretation of native and allograft liver specimens are included in the fellow's responsibilities. To date, approximately 2,500 transplants have been performed at The Mount Sinai Medical Center. Each patient requires approximately three post-transplant liver biopsies for evaluation. In addition, there are a large number of biopsies performed in the adult and pediatric population for various medical disorders.
The fellow is supervised by three attending pathologists, specialized in liver pathology, who rotate on the service on a biweekly basis. Evaluation of the fellow's progress is undertaken every month. The fellow is expected during a routine day to examine the pathology slides for all cases of the day and write a preliminary diagnosis, examine, and process the specimens received for grossing with the residents, examine and discuss the slides for the day with the attending pathologists in the afternoon, and write the final diagnoses. In addition, the fellow has teaching responsibilities as follows: medical student teaching in the Liver Pathology Laboratories during the Pathology Course, at Mount Sinai and Sophie Davies City College, and pathology resident teaching during grossing, on a daily basis.
The fellow is also expected to attend and participate in various intra- and interdepartmental liver and gastrointestinal conferences, rounds, and other teaching exercises. Every week the fellow is expected to present findings from the previous weeks liver surgical cases to the physicians at the Hepatobiliary Surgical conference. On a monthly basis, the fellow is expected to participate in presenting the pathology aspects at the clinico-pathological correlation conference. There are several surgical pathology conferences, which the fellow is required to present during the academic year. The fellow has to organize also monthly unknown slide conferences with the pathology residents.
The fellow is required to interpret frozen section biopsies for organ donor evaluation during the daytime. Four blocks of one week of late evening and night frozen section call during the academic year are also included in the fellow's responsibilities. The frozen section call covers all late cases and donor organ evaluation for liver and kidney transplant.
Research may be undertaken as part of active interdepartmental research programs aimed at understanding the pathobiology and improving the diagnosis and management of hepatic diseases. Areas of particular emphasis include hepatitis B and C infection, acute and chronic rejection, and hepatic and bile duct malignancies. There are opportunities to work with research groups in the Department of Pathology and other departments such as the Transplantation Institute; the Center for Immunobiology; Medicine and its Division of Infectious Diseases; Pediatrics; Molecular, Cell and Developmental Biology; and Gene and Cell Medicine.
During the second year of the fellowship, the fellow will have more in-depth research activities, which is reflected in increased research time (10-30 percent). During this time, the fellow will select his or her own projects and will take advantage of the molecular pathology facilities offered by the Department of Pathology and the other departments to advance the knowledge of this fast moving area and to better understand the pathobiology of specific liver diseases.
The clinical responsibilities will also increase during the second year. The fellow will conduct the sign-out session of liver pathology cases one day a week with the clinicians and the liver pathologists. The fellow will also review and interpret frozen sections of surgical liver specimens, in addition to those of donor livers, and will not review and offer pathologic diagnoses of consultation cases from other medical centers.