Diagnostic and Molecular Pathology

All of the pathologists are in one building, there is always an expert down the hall, and they are always willing to share their expertise.

It was an easy decision for Dr. Sean Rasmussen to choose residency training in pathology upon completing his medical degree. Dr. Rasmussen is in his fourth year of residency training in anatomical pathology at Dalhousie, and loving every minute of it.

“For me, the greatest joy comes from taking my time with a mystery, looking and looking at the specimen and doing the research, the thinking, the consultation, to get to the bottom of it.”

The bulk of specimens Dr. Rasmussen and his colleagues examine are tumours, many of which are cancerous. While some cases can be diagnosed accurately in minutes, others can take hours, days or even weeks to figure out. In any case, the investigation always begins with an examination of the gross anatomy of the specimen, followed by the microscopic examination of paraffin-fixed sections, sliced to a thickness of just four microns.

“It is really mentally engaging to examine the subtleties, to look beyond the immediately obvious,” Dr. Rasmussen says, adding that no two tumours are exactly the same and each one needs to be approached with fresh eyes. “It’s surprising how much a pathologist can determine about the dynamic progression of a disease, even though the specimen is fixed in time. We see features that offer predictive clues about the type of disease and how it’s likely to progress—for example, vascular invasion of the tumour or infiltration of cancer cells along a nerve.”

Sometimes the microscopic examination does not reveal the necessary prognostic information and this is where molecular pathology comes into play, revealing the genetic variants underlying the disease. “Molecular pathology is part of our training, although we do not work with it every day,” Dr. Rasmussen says. “Fortunately, our mentors are well-versed and we work together to prepare the detailed reports for the oncologists.”

Dr. Rasmussen enjoys the collegial atmosphere at Dalhousie and the willingness of people to share their time and their knowledge. “All of the pathologists are in one building, there is always an expert down the hall, and they are always willing to share their expertise,” he says. “And as teachers, they are so enthusiastic.”

This residency program is for 5 years. This program length meets the Royal College or College of Family Physicians of Canada standard.

Transition to Discipline (July of PGY1)

The first month of PGY1 is an Introductory Transition to Discipline curriculum that allows residents to obtain the Entrustable Professional Activities (EPAs) required by the Royal College Competence By Design training system. It is shared with GP residents and allows students to get to know faculty, other residents, and learn the basics of microscope function, slide scanning, grossing, and photography. The program is a mixture of didactic and hand-on activities. There is an end-of-rotation slide quiz and case presentation.

Foundations of Discipline (rest of PGY1)

There are 12 blocks in the remainder of PGY1, which allow residents to complete the EPAs in the Foundations stage of training:

PGY2 through PGY5 - Core and Transition to Practice stages

PGY2/3

The first 15 months of PGY2/3 consists of a core experience in surgical and autopsy pathology at the QEII Health Sciences Centre. The remaining time in PGY3 includes three 12-week subspecialty rotations in Neuropathology, Cytopathology and Pediatric Pathology. 

PGY4/5

The Forensic Pathology rotation is undertaken in one of the senior years and is eight weeks in duration. There is a required 12-week Anatomical Pathology rotation at the Saint John Regional Hospital (a large, regional hospital in New Brunswick). This serves as a senior resident rotation in the PGY4 or 5 year. Accommodation is provided.

The remaining months involve additional training in Diagnostic and Molecular Pathology, including mandatory training as follows:

In appropriate circumstances, up to one year of the program can be outside Diagnostic and Molecular Pathology and could include training in another branch of the laboratory, in research or in a clinical field. Most residents choose to do subspecialty anatomical pathology electives. Many residents complete a Medical Education elective (1 block) offered by the PGME. The elective time is very flexible and is utilized to strengthen skills and provide opportunities to explore potential career choices.