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Rotation: Microbiology

Duration:   2 to 3 months as part of the Clinical Pathology core experience for Anatomic Pathology (AP)/Clinical Pathology (CP), or straight CP residents
1 to 6 months as elective for senior residents

When:   2 months in PGY-2 for AP/CP residents or PGY-1 for straight CP residents (core rotation)
1 additional month of core experience in PGY-2 (CP-only residents) or PGY-3 (AP/CP residents)
PGY-3 or 4 for senior electives

Goals and Objectives:

1. Review and become proficient with fundamental concepts for diagnostic clinical microbiology laboratory services in bacteriology, virology, mycology and parasitology by rotating through the microbiology service at several locations which present a diversity of clinical microbiology samples.
2. Become knowledgeable of appropriate sample types as well as bench techniques used in the processing and identification of specific microorganisms by observing clinical technologists and assuming responsibility for a subset of cultures.
3. Become familiar with current issues in infectious diseases and laboratory assays in support of patients by attendance in infectious disease rounds and other conferences.
4. Refresh and expand competencies in laboratory management activities in the Division.

Duties and Responsibilities:

1. General clinical responsibilities (attendance at required Division and Section Conferences, lab medicine call responsibility as assigned) are similar to other clinical pathology rotations. This affects primarily PGY-2 and PGY-1 straight CP residents. There is no anatomic pathology call responsibility for straight clinical pathology residents.
2. Participate in daily laboratory "plate rounds" at UPMC-Presbyterian. Follow-up interesting cases by performing textbook or literature searches and report back the following day.
3. Contact physicians or other hospital users when additional information is required to interpret the significance of a result or for further work-up of a sample.
4. Serve as a primary consultant to other clinical services at UPMC-Presbyterian. Round with the Infectious Disease team daily in the Microbiology lab conference area. Residents are expected to be familiar with cultures from patients whom the ID service is following. Residents also serve as anatomic pathology "consultants" to the ID service and are expected to review surgical specimens associated with the patients which the ID service is following and interesting ones to show to the infectious disease consult team.
5. Residents are required to attend at least one meeting of the infection control working group which meets weekly in the Clinical Microbiology Laboratory at UPMC-Presbyterian. For interested residents, a one-week elective rotation in infection control is also available.
6. Spend 1 full week (core material) in the virology laboratory learning the basics of clinical virology including cell culture, immunohistochemistry and molecular assays.
7. Spend 1 full week (core material) in the mycology area of the laboratory learning the basics of clinical mycology.
8. Spend 1 week (core material) at UPMC-Magee-Women's Hospital learning the microbiology of sexually transmitted diseases, including molecular applications in this area.
9. Spend 2 weeks (core material) at UPMC-Shadyside Hospital to gain an exposure to clinical microbiology as practices as a community hospital laboratory. This rotation also provides an exposure to automated microbiology methods. While at UPMC-Shadyside, residents also receive a series of slide-enhanced lectures in parasitology.
10. Present interesting cases and related surgical pathology specimens on ID patients at intra and extra-Division conferences including Infectious Diseases Grand Rounds at UPMC-Presbyterian.
11. Attend didactic sessions with individual teaching faculty (residents on core rotations) and do assigned readings and case study problems.
12. Electives for senior residents (1-6 months) are customized with the Rotation and Program Director depending on the resident's learning objectives which may range from learning general microbiology in greater detail or pursuing an advanced clinical research project in a specific area of microbiology. Interested senior residents may also assume a greater independent role in the daily consultative activities of the microbiology laboratory if the Director is comfortable with the knowledge level.

    Supervision of Residents:

    The resident experience is supervised by the rotation director with participation by teaching faculty in the context of scheduled individual assignments to cover the various laboratories and services. Lead and regular medical technologists also participate by demonstrating workflow and bench techniques to rotating residents and providing assistance if required with projects. Residents are also supervised individually by a faculty member if they are doing a laboratory project.

    Evaluation of Residents:

    1. Core rotation (2 months): twice; informally after 1 month with verbal feedback on strengths of needs for improvement; formally using Program Resident Evaluation Form at the end of the rotation with discussion by faculty and/or Rotation Director with the individual resident. Also formally at the end of the 3rd core months.
    2. Elective rotations (1-6 months): at least once every 3 months formally using Program Resident Evaluation Form and informally if need arises.
    3. Significant issues of concern are to be reported to the Pathology Residency Program Director.
    Teaching Staff responsible for supervision and instruction of residents:
    A. William Pasculle, Sc.D. (Rotation Director)
    Charles R. Rinaldo, Jr. Ph.D.
    Jeannette Dunn, M.D., UPMC-Shadyside Hospital
    Jeanne Jordan, Ph.D., UPMC-Magee-Women's Hospital
    

    Clinical Virology Laboratory Rotation

    We show below a sample of our one week rotation in the Clinical Virology Laboratory for the Pathology Residency Training Program.

    Monday:
    Introduction to Clinical Virology (Dr. Rinaldo)
    Clinical Virology self exam is given to the resident
    Tour of lab facilities
    Explanation of work flow (directed by individual technologists)
    

    Rotations:
    BC processing
    PCR for Chlamydia trachomatis
    Antigen immunofluorescence staining
    Special assays (read viral cultures, HSV typing, adenoclone,
      respiratory virus testing, etc.)
    Review of lab manual
    

    Tuesday:
    Resident is given specimens with unknown herpesvirus, respiratory virus and stool specimen for Rotaclone and C. difficile workup
    Discussion of results of special tests

    Wednesday:
    Identification of viruses by immunofluorescence
    Self exam answers are given to the resident

    Thursday:
    Discussion of self exam with Dr. Rinaldo
    Resident identifies viruses as necessary (i.e., chlamydia, direct staining of VZV and HSV, CMV shell vial p72 stains, and positive tube cultures)

    Friday:
    Flu virus RNA detection by NASBA (n.b.: seasonal)
    Completion of any unfinished work