All Anatomic Pathology residents are required to do a total of 4 months of research.

2. Training Goals and Objectives

1. Patient Care
   1. Technical Skills
      In the course of performing research, the resident will develop expertise and skills that will not only have immediate relevance to the practice of pathology today, but which will serve as the foundation to advance patient care as these research approaches become incorporated into the corpus of the practice of pathology. For example, laser capture microscopy, quantitative confocal microscopy, various in situ methods for the analysis of nucleic acids and proteins are all front learn research methods with obvious potential applications to the evaluation of patient materials. Similarly, the innovative computational methods for analyzing research data will likely become streamlined and incorporated into the practice of pathology. Trouble shooting experimental methods into the preparation and processing of biological materials will provide precedent for dealing with difficult biological materials obtained from patients. The resident will master the technical skills and principles for research. These same principles (biochemistry, molecular biology, microbiology, genetics, cell biology, systems biology, etc.) provide an intellectual, material and technical infrastructure for much of pathology.
      
      
   2. Clinical Consultation
      The resident will learn to present his/her research in formal lab meetings presentations, and publications. The resident learns to present complex scientific issues in a clear and concise manner to fellow researchers and receives valuable training for communicating with medical professionals. The resident will learn to communicate in a manner that provides all the relevant information while inviting effective dialog with clinicians and other health care providers. The resident will learn to provide advice and explain diagnostic tests, and assist in the differential diagnosis and interpretation of test results.
      
      
2. Medical Knowledge
   1. Fund of Medical Knowledge
      The resident will augment their fund of general medical knowledge by learning the principles at play in the design of experiments and in mastering the principles behind the many techniques used in laboratory research involving biochemistry, cell biology, genetics, microbiology, genetics, etc. Residents with a strong clinical focus will hone skills involving statistical and computational methods used to extract medical principles and useful information from appropriate patient materials and records. Both laboratory and clinical research will improve an understanding of basic concepts of disease; the pathophysiology of common disorders; the epidemiologic, clinical, morphologic, biochemical, and/or molecular genetic features of common disorders; the prognostic and general therapeutic implications of common disease states; and the societal impact and preventative aspects of common diseases.
      
      
   2. Application of Medical Knowledge in the Practice of Pathology
      In research, the resident learns to project medical knowledge from the known to the unknown. They will learn to design laboratory experiments to test the best available hypothesis. Similarly, in practice, in a difficult case, the resident must learn to build on features of the clinical history and patient materials that are certain to develop an explanation of the more problematic features of the case. Deciding which special studies to perform to make a diagnosis is essentially a hypothesis driven experiment.
      
      
3. Practice-Based Learning and Improvement
   1. Evidence-Based Practice
      The resident will learn to make effective use of conferences, lectures, and reading of the scientific and medical literature (texts, journals, and other medical databases) in the design and interpretation of her/his experiments. The resident learns to work with databases and apply principals of computational methods that are often right at the cutting edge. The resident will understand the familiarity, precedence and utilization of databases and principles incorporated into the practice of pathology. Moreover, performing experimental studies founded on the work of others enables one to develop a sense of how solid or fragile current knowledge is in a discipline or sub-discipline. Learning to assess the quality of evidence objectively rather than as doctrine is imperative, both in the lab and at the bedside. The resident develops the ability to critically evaluate the quality of research studies and discriminate in the selection of information sources used to support medical decision making.
      
      
   2. Use of Information Technology
      The resident will learn to use a variety of information technologies to design, execute and interpret experiments. Modern research is completely dependent on information technology at all of these stages. The resident must inform and improve his/her day-to-day skills and understanding in order to acquire, store and retrieve data in all sorts of formats. The resident masters information technologies such as electronic databases of gene expression, proteomic databases, CGH databases, and other bioinformatics applications. The resident will learn to adapt, modify, revise or troubleshoot various programs. In order to accomplish this the resident must learn enough of the basics of computation and statistics to interact with information support staff if not enough to do this him/herself. Web-based information sources, and computer-based resources (CDs and other media) are used constantly both bench and clinical research.
      
      
4. Interpersonal and Communication Skills
   1. Communication Skills
      The resident will learn to communicate effectively and courteously with senior scientists, technicians, postdoctoral fellows, graduate students, veterinarians, animal care staff, collaborators, and technical experts maintaining various sorts of equipment and instruments, etc., to be effective in research. Most research projects are highly collaborative which means learning to share labor, responsibility and credit. Effective teamwork is critical for research progress. For clinical research, the resident must also interact with various healthcare providers, laboratory staff members, possibly patients, and other individuals in the course of her/his project. These communications will include verbal (face-to-face and telephone conversations) and written (written reports, notes, e-mail messages, etc.) formats. The resident must strive to communicate in a clear, concise, accurate, and appropriately focused manner. Regarding the production of written manuscripts, the ultimate goal is for the resident to produce essentially letter-perfect reports that require minimal or no modification by the principal investigator and that convey essential information in a clear and concise manner.
      
      
   2. Teamwork
      The resident will learn to work as an effective member of the research team in the course of his/her project. The resident must strive to perform her/his tasks in a responsible and timely fashion, facilitate the tasks of other team members, and be cooperative in his/her interactions with team members.
      
      
5. Professionalism
   1. Courtesy and Collegiality
      The resident must learn to treat colleagues at all levels, including technicians, support staff, physicians, research (i.e., non-M.D.) scientists, secretaries, purchasing agents, etc. courteously and respectfully. The resident must learn to be collegial in all interactions with other members of the research team. Clinical research will obviously involve similar interactions with healthcare providers.
      
      
   2. Professional Responsibility
      The resident learns to take responsibility for the accuracy and reproducibility of data and produces notebooks and/or data files plainly described, securely stored and properly maintained. The resident learns to share protocols for published results, reagents and other materials within the scientific community. The resident understands and acknowledges problems with experiments and materials and trouble shoots issues in consultation with other investigators. The resident is responsible for keeping up with the literature as it pertains to their project. The resident is responsible for teaching acquired skills to other lab members and colleagues. The resident learns to be proactive about maintaining equipment and ordering supplies and materials and reporting problems with common equipment and materials. These same research responsibilities will stand in good stead for the practice of pathology. The resident should strive to approach each of these responsibilities with enthusiasm and complete all tasks and assignments effectively and in a timely fashion.
      
      
6. Systems-Based Practice
   1. The Health Care System and the Role of Pathology
      The resident must acquire knowledge of practice and health care delivery systems and an awareness of the role of pathology in the context of the greater health care system. The resident will develop a working knowledge of different in-patient and out-patient delivery systems and the general regulatory and financial aspects of health care delivery. The resident must learn the importance of providing effective and timely consultation to clinicians, advising health care providers in the provision of cost-effective care, while cognizant and in accord with patient privacy and confidentiality. The resident should learn to provide coding, statistical and other relevant data, as needed in support of quality care and the Institution.
      
      
   2. General Laboratory Administration
      The resident develops a general administrative understanding of research. The resident learns to understand and apply the principles of quality control, reproducibility, accuracy and precision. The resident will develop a working knowledge of the staffing and pace of projects, laboratory instrumentation, budget, and of the changing demands for materials and services as a project progresses.

3. Overview

Residents are exposed to, and encouraged to participate in, clinical and laboratory research throughout the program. The National Institutes of Health (NIH) is the premier medical research institution in the United States. The residents can attend weekly departmental research conferences and data sessions, as well as numerous clinical and research conferences throughout the NIH campus. During the Residency Orientation, the residents rotate through the investigative laboratories within the department. They are provided with a written update of the departmental research activities. When the resident has chosen a research project and a scientific mentor, the project is reviewed and approved by the Program Directors.

Residents receive laboratory space, reagents, access to equipment, technical support, and guidance appropriate to fully support their research projects. They are encouraged to publish their research findings and continue the research independently in the future. Travel funds are provided for each resident to present his or her research findings at one national clinical or scientific meeting per year.

The Residency Training Program offers research training opportunities virtually unmatched internationally. Each resident develops a research program with any of the world-renowned scientists in the Laboratory of Pathology, CCR, NCI. Each resident plans a research project with a designated mentor and reviews the experimental plan with the Program Director. The residents are encouraged to choose exploratory projects, which lead to new discoveries and open new fields.

Residents are expected to serve as consultants and collaborators for clinical studies and case studies, which stem from findings made during routine diagnosis. During research rotations, each resident is provided with laboratory space, equipment, reagents and technical support. They show their research findings in weekly data clubs, and brainstorm ideas in weekly conferences and journal clubs. Research electives are concentrated in the later stages of the residency program. Residents receive 2 months of elective in the first year, 3 months of elective in the second year, and usually 5 months of elective in the third year. These elective periods may be used for research rotations, or further clinical electives, depending on the needs and interests of the resident.

Each resident is provided with travel funds to attend one scientific conference per year. At that time, the resident is responsible for a poster or platform presentation. Our residents have been highly successful at national meetings, and have been the recipients of numerous awards, including the Stowell-Orbison Award for the best resident presentation at the United States and Canadian Academy of Pathology Meeting. Residents also compete for and obtain sponsorship for outside research electives. This year, one of our residents was awarded the Arthur Purdy Stout Stipend allowing him to travel to Emory University to complete a collaborative research project between the NIH and their Department of Pathology. He will conduct an investigative study of inflammatory pseudotumors.

The type of project undertaken by residents has ranged from basic molecular genetics to applied hematopathology, surgical pathology case reviews, and pediatric tumor cell biology. Residents in our program have access to modern and sophisticated research laboratories. They receive instruction in the use of the laser capture dissection microscope in order to obtain purified cell populations for genomic and proteomic studies. The NCI has a gene microarray facility that permits residents to study patterns of gene expression in purified cell populations. All residents are fully funded for any research projects that they undertake during years 1-3 of the residency program. They may pursue these studies in the Laboratory of Pathology, NCI, or in any other research laboratory on the NIH campus, allowing them the flexibility to pursue their personal research interests.

4. Sections

Residents may review the research interests of program faculty and contact the investigator for more information. Research interests are briefly outlined below, by section.

a. Biochemical Pathology Section:   Dr. David Roberts is conducting research on cell surface receptors and signal transduction pathways through which extracellular matrix proteins regulate cell behavior in several disease states. These studies will identify new molecular targets and provide a basis for designing novel pharmacological agents. The primary research projects in the laboratory are: 1) regulation of tumor angiogenesis by thrombospondins, 2) regulation of immune responses by thrombospondins, and 3) defining the host-pathogen interactions required for establishing disseminated infections by the yeast Candida albicans.