Clinical
The clinical activities of the Department of Laboratory Medicine and Pathology are well integrated into the education and research missions of the Department and the Medical School. Resident and fellow training is based in the hospital clinical and anatomical pathology laboratories as is the post-sophomore fellowship program and several medical student elective courses. Patient related research in pathology and much of the laboratory translational research in the Department evolves from or is dependent on the clinical services. The clinical services provided by the department have integrated well with the medical services systems of the University of Minnesota Medical Center and the University of Minnesota Physicians. The Department provides all campus clinical services in the broad areas of Anatomical and Clinical Pathology. More specifically defined, our clinical services include all aspects of medical directorship and pathology diagnostic and consultative services in all clinical laboratory and pathology units in UMMC-Fairview as well as responsibilities for laboratory and surgical pathology services at the Riverside Campus and the Maple Grove Clinic of Fairview. UMMC-Fairview clinical laboratories have become the central laboratories for the Fairview System. The department also provides outreach complex reference laboratory testing and tissue diagnostic consultation for local, state, regional, and national clients. Contents:
Fairview is a community-based health care system with seven hospitals, 50 primary care clinics, 37 specialty clinics, five urgent care clinics, and a wide range of specialty service centers across Minnesota. University of Minnesota Medical Center-Fairview (UMMC-F) is the center for specialty care for the Fairview System and also has a large referral network outside of the Fairview System, especially for highly complex diagnosis and treatments in specialty areas of medicine such as solid organ and bone marrow/stem cell transplantation, oncology, children’s diseases, cardiovascular disease, neuroscience and behavioral science. It consists of a large multi-specialty clinic system and a 1868 bed Hospital. In 2007 UMMC-Fairview experienced 469,506 patient clinic visits and 36,912 hospital admissions. UMMC-Fairview is heavily integrated into the education and clinical research missions of the Medical School. The hospital and clinics serve as the center for most of the Medical School’s under-graduate and graduate (resident) clinical training programs. Numerous clinical trials and clinical research programs are based in the hospital and clinics.
The Division of Clinical Pathology includes ten individual laboratories, which are organized in operational units. The Director of the Division is Dr. Anthony Killeen, MD, PhD. Twenty-two faculty members of the Department of Laboratory Medicine and Pathology serve as medical directors for these laboratories and their subsections and provide all professional medical oversight for their operations. Clinical Chemistry - Michael Steffes, MD (Professor): Medical Director
- John Eckfeldt, MD, PhD (Professor), Medical Director of Acute Care Laboratory
- Michael Tsai, PhD (Professor), UMMC Biochemical Genetics, Medical Director
- Anthony Killeen, MD, PhD (Associate Professor)
Virology - Henry Balfour, MD (Professor): Virology Laboratory, Medical Director
- Heather Vezina (Assistant Professor), PharmD
Microbiology - Patricia Ferrieri, MD (Professor): UMMC, Microbiology Laboratory, Medical Director
Special Hematology (includes Flow Cytometry) - Timothy Singleton, MD (Associate Professor): Section Director
- Adina Cioc, MD (Assistant Professor)
- Carol Holman, MD (Assistant Professor)
- Karen Larsen, MD (Assistant Professor) (part time)
- Vanessa Dayton, MD (Assistant Professor) (part time)
- Robert McKenna, MD (Professor), Vice-Chairman for Academic Affairs
Transfusion Medicine/Blood Bank - Robert Bowman, MD (Assistant Professor): Medical Director
- Jeff McCullough, MD (Professor): AHC Center for Cellular Therapy and Blood Bank
- David McKenna, MD (Assistant Professor): Cell Therapy Lab Director
- Nicole Zantek, MD (Assistant Professor)
Molecular Diagnostics - Xinjing Wang, MD (Assistant Professor): Medical Director
- Bharat Thyragarajan, MD, PhD (Assistant Professor): Molecular Diagnostics, Associate Medical Director
- Anthony Killeen, MD (Asociate Professor)
Cytogenetics - Betsy Hirsch, PhD (Associate Professor): Cytogenetics, Director
- Michelle Dolan, MD (Assistant Professor), Cytogenetics, Associate Director
Histocompatibility - David Maurer, PhD (Associate Professor), DABHI: Histocompatibility Laboratory, Medical Director
These laboratories provide a range of testing complexity from routine automated laboratory testing in the Acute Care sections to cutting edge new technologies. The clinical laboratories produce over three million test results per year and have an annual operating budget of approximately $50 million per year. Most specialized testing activity within the Fairview system is performed on the University campus of UMMC-Fairview. Basic laboratory testing is also provided on the Riverside campus for the medical and surgical adult patients admitted to that facility, as well as for the newborn intensive care unit, which is also on that campus. The UMMC-Fairview Clinical Laboratories also serve as a reference laboratory for Fairview's two other Twin Cities' hospitals (Southdale and Ridges) and to a lesser extent their four other hospitals in Minnesota. The Medical Center uses ARUP as its primary reference laboratory. The clinical laboratories are owned by Fairview, which employs the medical technologists. The most senior member of the Fairview-employed laboratory staff is Ms. Kathy Hansen who is the Director of Laboratory Operations. System-wide, Fairview has a President of Laboratory Services, Ms. Priscilla Cherry. These individuals report to senior management in Fairview. University faculty in Laboratory Medicine and Pathology serve as medical directors of individual laboratories, and Dr. Killeen serves as the Director of the Clinical Laboratories. Support for medical director salaries comes in the Part A contract between the Department of Laboratory Medicine and Pathology and Fairview, Part B professional billings, and research salary support. The list of pathologists on the Part A contract, their fractional effort, and the dollar amount of the Part A contract are negotiated on an annual basis by Departmental and Fairview leadership. Medical directors are responsible for all aspects of the medical oversight of the clinical laboratories, quality assurance, selection and development of new tests, reporting of results, liaison with clinical colleagues, and of course extensive interactions with the technical staff. There is a dual system of reports within the laboratory structure, with medical technologists reporting to Fairview leadership and LMP faculty reporting for clinical purposes to LMP leadership. In practice there is a good working relationship at all levels between Fairview and LMP staff. On the Fairview organizational chart, Ms. Hansen has a reporting line to Dr. Killeen. The Reference Laboratory services based in the Department have existed for more than 30 years. In 1997 after the merger of the University of Minnesota Hospital with Fairview Health System, a joint Outreach Program representing Fairview, the University of Minnesota Physicians, and the Department of Laboratory Medicine and Pathology was created. On June 1, 2002 a separate referral laboratory operated by the University of Minnesota Physicians, Department of Laboratory Medicine and Pathology was established. It is located on the University of Minnesota campus in Minneapolis. Specializing in innovative, complex, diagnostic testing, the laboratory offers clinical and interpretative medical laboratory direction from our department pathologists, doctoral scientists and other physicians. We have a separate CLIA license, in the name of the Medical Director of the referral laboratory, Patricia Ferrieri, MD, who is also the Medical Director for the Clinical Microbiology Laboratory. Dr. Ferrieri and the business manager, Janet Fennert, confer on our marketing strategies, reaching out to local, state, regional and national clients (some from major universities) who can avail themselves of our unique services. We also have some international clients, including sites in Europe that perform studies for a cardiac pacemaker company based in Minneapolis. The largest of the services are in the area of tissue typing and cross-matching with over 25,000 tests performed in 2007. The largest client of those services is the National Marrow Donor Program. Miscellaneous coagulation tests, specialized biochemical analyses, mycology specimens, chromosome analyses (as well as FISH interphase testing), cystic fibrosis mutation analyses, and other molecular genetics assays comprise our largest test volumes. The University of Minnesota has a long tradition of excellence in Clinical Pathology. The faculty of the Division of Clinical Pathology is heavily involved in both formal didactic and one on one teaching in the medical school and in residency and fellowship training programs. In addition many of the faculty participates in teaching of graduate students and/or allied health students. Educational programs are offered for medical students, post-sophomore fellows, residents, and fellows. Several residents are following CP-only training programs. Within the CP Division, ACGME-accredited fellowship programs are active in Transfusion Medicine/Blood Banking, Hematopathology, and Molecular Genetic Pathology. A COMACC-approved fellowship in Clinical Chemistry is active (this is designed for doctoral scientists who complete the American Board of Clinical Chemistry exams at the end of their training). Residents in AP/CP or CP-only rotate through all sections of the clinical laboratories with the exception of the HLA laboratory which is currently developing an elective. Resident responsibilities vary according to the rotation, but on each rotation there is extensive interaction with faculty members. In the last 5 years, the residents have achieved a 97% passing rate in the American Board of Pathology exams, significantly above the national average. The Clinical Pathology case conference is held every Tuesday from noon to 1 p.m., year around, with lunch provided. This is a major conference for the division and all residents on CP rotations are expected to attend. CME credits are available for faculty attendees. The conference format is either a journal club (once per month) or two 30-minute presentations, which have a strong clinical focus. The majority of presentations are by residents and fellows. Each faculty member presents approximately once per year. CP faculty regularly present at interdepartmental conferences such as hematology/oncology, infectious diseases, transfusion medicine, genetics and at major conferences such as Grand Rounds both in Laboratory Medicine and Pathology and in other departments (Medicine, Surgery, Pediatrics). Detailed descriptions of the teaching activities in clinical pathology can be found in the Undergraduate Education and Residency Program sections. The faculty of the Division is highly visible nationally in clinical pathology translational research, in keeping with a long tradition. A description of research in the Clinical Pathology Division and the specific research interests of faculty members, along with a listing of publications, is found in the Research Section, as well as in the faculty biosketches. Service in State and National Advisory Councils, Professional Associations and Journals and Department, Medical School and University Committees Most Clinical Pathology faculty members participate in one or more Departmental, Medical School, University or Hospital Committees. In addition, faculty members hold or have held leadership positions in professional societies. Some faculty members serve or have recently served on committees at state and national levels. Many of the faculty in Clinical Pathology serve on Editorial Boards and ad-hoc reviewers for Research/Pathology journals -- a listing of these activities can be found in the individual biosketches.
The Division of Anatomic Pathology includes four sections: Surgical Pathology, Autopsy Pathology, Cytopathology, and Neuropathology. The Director of the Division is Dr. J. Carlos Manivel, MD. Administration of the Division of Anatomical Pathology The Section of Surgical Pathology includes the following pathologists: - Dr. Jose Jessurun (Professor)
- Carlos Manivel (Professor)
- Stefan Pambuccian (Professor)
- Evin Gulbahce (Associate Professor)
- Alexander Truskinovsky (Assistant Professor)
- Stephen Schmechel (Assistant Professor)
- Behzad Najafian (Assistant Professor)
- Deniz Aslan (Assistant Professor)
The Section of Autopsy Pathology includes two pathologists: - Alan Rose (Professor)
- Ralph Powell (Professor)
The Section of Cytopathology includes four pathologists, who also participate in Surgical Pathology sign-out: - Dr. Stefan Pambuccian
- Dr. Evin Gulbahce
- Dr. Steve Schmechel
- Dr. Deniz Aslan
The Section of Neuropathology includes (Faculty in this section are responsible for surgical and autopsy neuropathology): - Dr. Brent Clark (Professor)
- Dr. Karen SantaCruz (Assistant Professor)
The estimated time allocation for clinical/patient care activities by each pathologist ranges from 0.4 to 1 FTE. Faculty members who dedicate less than 1FTE to service activities have protected time for research (Drs. Gulbahce, Schmechel, and Najafian); Dr. Aslan has a combined appointment with the Minneapolis VA Hospital where he is based at 0.6 FTE. The Division of Anatomic Pathology provides service to both campuses of UMMC (University Campus and Riverside Campus) and to the Maple Grove Clinic of Fairview. The workload has increased significantly in recent years. In 1999, the year prior to the last External Review the total workload for Surgical Pathology was 9,492 cases (including 8479 surgicals and 1013 consults/referrals). At that time, UMP pathologists were not responsible for pathology services at Riverside Medical Center and Maple Grove Clinic, so the number of surgicals refers only to specimens obtained at the University Campus. In 2007 the total workload was 17,135 cases (including 15,691 surgicals from both campuses, Riverside and University, and 1,444 consults/referrals). The above data indicate an increase of 80.5% above the levels at the time of the last External Review (from 9,492 cases in 1999 to 17,135 cases in 2007) Surgical Pathology University of Minnesota Medical Center: At this campus, the sign-out responsibilities are organized by weekly rotations; these include: - Biopsies
- Large specimen
- Kidney “rush” and routine
- Referral
- Frozen Sections
- Cytology
Some rotations are frequently combined, depending of faculty availability and expertise; examples include frozen sections and cytology, frozen sections and kidney, kidney and referrals, cytology and referrals, biopsies and kidney, or large specimens and kidney. Riverside Medical Center: One pathologist provides service at this campus as part of the weekly rotation schedule. This pathologist is responsible for the interpretation of frozen sections, surgical pathology sign-out, non-renal “rush” specimen sign-outs, immediate cytologic interpretation of CT-guided and FNA biopsies, and consultations with clinical and surgical colleagues. UMP pathologists are responsible for all biopsies obtained at Riverside Medical center and for biopsies obtained at the Maple Grove Clinic, which are referred to Riverside for processing and interpretation. The total number of biopsies signed out by UMP pathologists at Riverside in 2007 was 3,559. In addition to sign-out responsibilities, pathologists have other service duties; these include consultations from other pathologists in the division and from other institutions, coverage for other on-service pathologists when required, conference presentations, teaching residents and students, and consultations with clinicians. An “open door” policy is maintained to accommodate requests from trainees, other pathologists and clinical colleagues to review or discuss cases whenever requested. Cytopathology The cytopathology laboratory processes specimens for all of the Fairview Health System (63,495 specimens in 2007), the slides are returned to the originating hospital for interpretation. Dr. Pambuccian is the Medical Director for the Laboratory of Cytopathology. Cytopathology work-load for UMP pathologists for 2007 included 11,900 cases (8,082 Gyn cytologic specimens and 3,818 non-gyn cytologic specimens). Cytopathology services for UMMC-Fairview is provided by Dr. Pambuccian and three other staff pathologists who also provide service in surgical pathology; they include Drs. Schmechel, Aslan and Gulbahce. Service is covered on a weekly rotation schedule. Autopsy Pathology The number of autopsies performed by faculty has been relatively stable over the past decade. The annual number of autopsies for each year since 2000 is listed below. | Year | Autopsies
Performed | | 2000 | 117 | | 2001 | 108 | | 2002 | 126 | | 2003 | 101 | | 2004 | 129 | | 2005 | 126 | | 2006 | 120 | | 2007 | 136 | Approximately 50% of autopsy cases are reviewed and signed out by the Autopsy Director, Dr. Alan Rose and the remainder by Dr. Ralph Powell. These pathologists alternate service coverage of weekend and holiday on-call autopsies. On rare occasion, when both pathologists are unavailable, surgical pathologists or a neuropathologist attends on-call autopsies. All autopsies are performed either by the resident assigned to this rotation or by a pathologist assistant, and reviewed by the staff attending pathologist. Preliminary diagnoses are made available though the hospital computer system within 24 hours. All cases are presented by the prosecutor at the weekly autopsy conference (Tuesdays 8:45-9:30 AM); clinical and surgical colleagues involved in the case are invited to attend. Autopsy reports are available through the hospital computer system. The neuropathology examination of autopsy cases is performed by the neuropathology staff (see below). Expected turn-around time for autopsy sign-out is within 30 working days after performance of the autopsy. Neuropathology The director of neuropathology is Brent Clark, M.D., PhD; the second neuropathologist is Dr. Karen SantaCruz. They share equally in service responsibilities, including Surgical Neuropathology and Autopsy Neuropathology. Their outreach service includes the Veterans Affairs Medical Center and Hennepin County Medical Center. Neuropathology cases are signed out with Surgical Pathology and Autopsy residents. Drs. Clark and SantaCruz are also responsible for neurosurgical frozen sections during the week and have on-call responsibilities nights, week-ends, and holidays for interpretation of neurosurgical cases. Dermatopathology The director of Dermatopathology is Dr. Desiree Langel who works part time (60% FTE); she provides service exclusively for this section and is responsible for the diagnosis of all skin biopsies submitted by the department of dermatology. Skin biopsies from other departments are usually signed out by the pathologist on the biopsy rotation in consultation with Dr. Langel, if necessary. Preliminary diagnoses on skin “Rush” biopsies are provided by the director of surgical pathology or the director of anatomic pathology on days when Dr. Langel is not available (Tuesdays, Thursdays, week-ends). The Division has responsibility for the Biological Materials Procurement Network (BioNet), a centralized effort to obtain and store human biological materials, and to provide pathologist expertise in the selection and utilization of these materials in research. BioNet is housed in LMP and serves research needs of the broad array of programs, centers, institutes and departments across the institution. Central to the BioNet effort are: (a) the development of an IRB-approved global patient consenting process to allow links between banked specimens and selected clinical data, including information derived from the electronic medical record, researcher-derived special types of data, and direct contact with patients to obtain clinical follow-up information, (b) centralized specimen processing to ensure high quality control, and (c) a robust web-enabled database that allows researchers to readily inquire about the types of specimens and matched clinical data that are available for use. The department works closely with the IRB to ensure that BioNet methods are compliant with regulations designed to protect patient confidentiality. All specimens and data provided for research are anonymous. The director of the BioNet is Dr. Steve Schmechel. There are numerous Divisional and interdepartmental conferences each week throughout the year. These vary from strictly educational conferences for students and housestaff to Journal Club to working conferences on current cases and clinicopathology conferences. Education in Anatomical Pathology Teaching is involved in most activities in the Division of Anatomic Pathology. Teaching activities that do not include a service or research component; such as lectures and laboratory proctoring for specific curricula, are allocated at between 5-20% of professional effort by different faculty members. Teaching in the Division takes two main forms, formal didactic and informal service related. Individual AP faculty members give between one and six lectures per year in the Medical Student Year 1 and 2 Pathology courses. In addition, AP faculty members proctor from 10 to 25 laboratory sessions per year. AP faculty members also give lectures in the Dental School and Allied Health Sciences Pathology courses. Other formal teaching involvement is in Graduate Programs in Molecular Pathology and Neuroscience, Mortuary Sciences, and Mechanical Engineering. Dr. Alan Rose, Director of the Autopsy Service is also the Director of the Year 1 and 2 Pathology Course for Medical Students (General and Systemic Pathology, LAMP 6101 and LAMP 6300-6305). Other AP faculty members are directors of several modules in the Pathology Course, which requires yearly updating of hand-outs, creation of exam questions, providing representative mini-cases and slides for laboratories, updating the manuals, and updating the curriculum for that module. AP faculty members lecture regularly to Pathology Residents (Residents' Specialty Conference, Fridays 8:00-9:00 AM). On average, each AP faculty member gives 6 lectures per year for this conference. In addition, AP faculty members are responsible for thirty-six regular intradepartmental and interdepartmental conferences. The Director of Anatomic Pathology is responsible for the annual organization of the Bell Symposium of Pathology, the main continuing medical education offering by the Department, and has co-responsibility for the organization of the Annual Fall Seminar of the Minnesota Society of Pathologists. Other AP faculty members also contribute regularly to the Bell Symposium. The Director of AP is responsible for the Surgical Pathology Elective Rotation for Medical Students (3,4,6 weeks) and for the Surgical Pathology Rotation for the Residents at UMMC (two months per resident). The Autopsy Director is responsible for the Autopsy Elective Rotation for Medical Students (3,4,6 weeks) and for the Autopsy Rotation for Residents at F-UMC (one month per resident). Anatomic Pathology faculty members are responsible for at least one Departmental Grand Rounds per year and frequently help residents prepare Grand Rounds Conferences. Details of the teaching activities in anatomical pathology including specific medical school courses and of the residency program are found in the Education section. For detailed information on teaching activities of individual faculty members please refer to the Faculty Biosketches. The faculty of the Division is highly productive and visible nationally in anatomical pathology translational research. Faculty members in Anatomic Pathology have published between 2 and 40 peer-reviewed articles since 2002. A total of 204 peer-reviewed articles have been published AP faculty since 2002. Fourteen articles were published in non-peer reviewed journals (See individual biosketches for detailed information). The studies include both those that were generated by Division faculty and collaborations with clinical colleagues. In forty articles the first author is an AP faculty member.
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