Authors: Sara E. Monaco, MD & Zubair Baloch, MD, PhD

This has been an unprecedented spring with a myriad of challenges and changes for cytopathology fellowship training programs, as they try to modify and enhance their programs to incorporate more remote learning materials and to change practices to protect the safety of employees.  Although early on in the COVID-19 pandemic, fellowship programs were dealing with trainees that had over 6 months of training, were well acclimated to the training program logistics, and progressing to be more independent in their review of cases and self-directed learning. In the current era of social distancing and restrictions posed by individual states and institutions due to COVID-19 pandemic, the fellowship programs are now facing additional challenges in regards to the training of incoming cytopathology fellows starting their training for the current academic year and the recruitment of future cytopathology fellows.

For the current class (2020-2021) of cytopathology fellows, the training programs have to now prepare for the following:

  • Implement new policies and procedures regarding personal protective equipment (PPE) and processing of potentially infectious cases. [Pambuccian S. JASC 2020]
  • Most hospitals have now implemented mandatory pre-procedural and/or pre-surgical COVID-19 testing, these results are displayed in the patient’s electronic medical record. For cytopathology fellows attending FNA procedures, this is an important piece of information to gather when reviewing patient’s medical record before the procedure.
  • It is important, to make sure that the cytopathology fellows are well-versed in the institutional and department policies and procedures for PPE, obtaining and handling specimens from a potential or confirmed COVID-19 positive case.
  • The cytopathology fellowship program can supplement the education of cytopathology fellows with the online educational materials, including the ones provided by the American Society Cytopathology.
  • At present, most academic institutions are faced with the new recommendations from the Accreditation Council for Graduate Medical Education (ACGME) regarding away rotations and interviews that was recently announced in May 2020. These recommendations discourage away rotations (except in the situations where a trainee does not have access to specific training in their current health system), and committing to virtual interviews and institution tours to promote public safety and mitigate pandemic-related disruptions. This has been a big focus at many medical centers, given that virtual interviews require the creation of a digital toolbox that will help staff to conduct the interviews and that will help the institution show what they can offer (e.g. videos of the hospital, videos of the pathology department or subspecialty experience, engagement with current trainees and faculty).  Delivering this content using videos, or slide shows with voice over capability can be fun and engage multiple staff members, particularly those with special interests in video editing or digital programming, but can also be time consuming and stressful to do in a professional way.  See Table 1 for some tricks on how to prepare professional digital content. [TABLE 1]  Given that all residency and fellowship programs are dealing with the same challenges, most institutions are now providing materials that can be used as part of the virtual interview, including videos about the hospital overall, living in the particular city where training occurs, and other community resources or items of interest.  Despite the challenge in changing our prior interview practice, virtual recruitment saves money for the program and the applicant, and also expedites the time frame in the sense that there is little preparation that needs to happen given that travel arrangements are now avoided.


TABLE 1. Tricks for creating digital content for virtual interviews

  1. For videos, hold the camera horizontally, instead of vertically.
  2. For interviews and videos of individuals, choose a background free of clutter or distractions without any patient identifiers or other patient information, and move your subject a few feet away from the wall in order to minimize shadows.
  3. Choose locations with good lighting and avoid harsh overhead lights. If you are the videographer, try to position your subject so that they are facing a window with good natural light and stand between the subject and the window to film (so that the window is at your back).
  4. Avoid video footage that has a great deal of shaking, or high background noise. Try to hold the camera or phone with both hands and steady them by resting your elbows against a flat surface or holding your arms close to your body.  You can also stabilize with a device (e.g. tripod, etc).  To get good audio quality, chose a quiet location and consider a separate external microphone (e.g. lavalier mic or headphones with a microphone) opposed to the built-in microphones.
  5. For clean quotes that are easier to edit for videos, try to avoid interrupting the speaker and pause after the speaker finishes their thought, before asking the next question.
  6. For increased engagement during interviews, encourage the use of camera and audio functions, opposed to turning the camera off, and try to create a professional virtual environment.

For more advice, see available online resources example:


Strategies for Holding Virtual Interviews for Cytopathology Fellowship

Conducting virtual interviews is becoming the new norm in the current era of social distancing policies, which are recommended preventing the spread of COVID-19. The other reasons for conducting virtual interviews are:

  1. Ensuring a meeting with all eligible candidates in a timely fashion, especially those with excellent qualifications. Even difficult to comprehend, some individuals may be hesitant to attend an in-person interview and pass on or postpone the interview. This can result in missing out on a suitable candidate.
  2. Saving money on travel or accommodating asynchronous schedules to comply with social distancing mandates and protect the health of employees and communities.
  3. Conducting highly effective virtual interviews can be a beneficial for both employers and candidates.

The following are listed as best practices (references) that can be employed to make the most of your virtual meetings with potential candidates for Cytopathology Fellowship:

  1. Provide the interviewee time to prepare for the Virtual Meeting
    1. Candidates should have ample time to mentally prepare for the virtual interview. This practice ensures they are confident and at their best when you do hold the interview.
    2. This should be considered a courtesy and demonstrates your professionalism and thoughtfulness in terms of the interview process.
  2. Comply with the standardized rating system as you would have used during in-person interview.
  3. Dress professionally.
  4. Conduct your interviews in a quiet location, free from distractions:
    1. If you need to conduct your interviews from home, choose a quiet room and let your housemates know you will be holding an interview to avoid distractions.
    2. Your environment should have a neutral background so the candidate is not distracted by your surroundings.
    3. Try to keep your space as professional as possible to mimic the setting of an in-person interview.
  5. Communicate openly:
    1. Especially with a virtual interview experience where a candidate is not within a warm, in-person meeting, it is important to keep your candidate informed. When the fellowship candidates are fully aware of the agenda items and timeline, they feel their need and value to the potential cytopathology fellowship program.
    2. It is a good idea to start the interview with good etiquette and to inform the candidate if the session is being recorded or not.  Good etiquette in virtual meetings can also be a topic of discussion for faculty development this year.
  6. Prepare for the interview by outlining questions:
    1. Review beforehand the candidate’s information, including their resume, personal statement, recommendation letters and any additional documentation they provided.
    2. Think thoroughly in advance about the skills, attributes and competencies you’re looking for in a candidate, and design specific questions to ask.
    3. Have a list of several training-related questions that you ask every candidate to make an informed decision.
  7. It is important that an interviewer should be aware of questions that you can or cannot ask:
    1. Questions you can ask:
      1. Tell me about yourself and what do you know about the fellowship program. This is your interview “elevator pitch.” In a concise manner, highlight the skills, experiences, and relevant personality traits that align you with the requirements of cytopathology fellowship.
      2. What are your strengths and weaknesses.
  • Career plans after the completion of cytopathology fellowship.
  1. Training-related probing questions:
    1. In many cases, applicants do not provide enough information in their initial response, so the interviewer may need to lead or ask follow-up questions.
    2. Asking a follow-up question such as:
      1. “Could you be more specific?” or “Could you tell me more about that?” is helpful in gathering as much information as possible without leading the applicant to an answer.
    3. If leading questions are used, they should be used consistently with all applicants that everyone has the same opportunity to explain a response to ensure consistency and transparency.
    4. Be aware that asking too many leading questions provides a cue to applicants about the types of answers you are looking for and may increase the likelihood of faking a response.
  2. Questions to avoid:
    1. Demographics: Age, race, religion, socioeconomic status, ethnicity, sexual orientation, gender identity, national origin
    2. Family: Lineage, ancestry, primary or native language, marital status, maiden name or family surname, relationships or people applicant lives with, family issues (parental status, age of dependents, plans for children)
    3. Personal: Height and weight, physical and mental disabilities, physical appearance, personal activities that probe for personal affiliations
    4. History: Military discharge, arrests, criminal convictions
    5. Applying to other programs or specialties, and ranking plans: Information about other programs or specialties to which they might be applying and/or how the applicant plans to respond to an acceptance offer from your program.
  3. Give the interviewee time to answer:
    1. At times, there may be a time lag when using a computer or mobile device to conduct an interview. To account for this time lag, provide the candidate with plenty of time to respond.
    2. If the candidate drops out during their response, ask them to repeat their answer to ensure you hear everything the interviewee has to say.
  4. Reinforce your brand i.e. your fellowship and institutional mission:
    1. It is recommended that all interviewers are aligned on the following key facts about the organization and position, for example:
      1. Mission and function of institution, department and cytopathology division
      2. Fellowship responsibilities
  • Reporting structure
  1. What constitutes cytopathology team
  2. Educational content (type and delivery)
  3. Future initiatives of cytopathology division
  • General timeline for the hiring process


Virtual Strategies in Cytopathology Education Session at the ASC Annual Scientific Meeting

               As announced recently by the ASC, the 2020 Annual Scientific Meeting will be delivered in a virtual format to align with current pandemic-related safety guidelines.  This will have the added benefits of decreasing meeting costs for travel, lower registration fees, and less time away from the home/office for travel.  In addition, the planning committee for the Strategies in Cytopathology Fellowship Education session is hoping that the virtual format on Sunday, November 8th, will increase attendance of program directors around the country.  The Committee is planning to incorporate polling questions throughout their presentations and to have moderated panel discussions via chat module that can then be shared with the speaker panel.  The plan is to create documents summarizing the best practices and information that prove to be beneficial to all cytopathology fellowship programs.

Although these difficult times have challenged us to rethink every component of our training programs in a virtual format, the ongoing guidance from the ACGME and subspecialty organizations, such as ASC, will help to improve their programs and adapt in this new environment to promote the health and safety of our trainees, staff, and the community we interact with.



  1. Pambuccian S. The COVID-19 Pandemic: Implications for the cytology laboratory. Journal of the American Society of Cytopathology
  2. Online resources:



Other items for Communicator

Join us for the 2020 ASC Virtual Annual Scientific Meeting

The cytopathology fellowship program director session, Strategies in Cytopathology Fellowship Education, is free with meeting registration and will be delivered virtual with ample time for questions and panel discussions.  Please join us!  See you “virtually” there in November.

Sunday, November 8th, 10:30am-12pm & 12:30-2pm (3 hours of programming)

ASC Strategies in Cytopathology Fellowship Education


Part 1:  Updates from the ACGME & ABPath for Cytopathology Fellowship Programs

  1. ACGME Update: Kate Hatlak, ACGME Pathology Executive Director
  2. ABPath Update: Ritu Nayar MD, Trustee of the ABPath
  3. Q&A with Speakers, Moderated by Sara Monaco

Part 2:  Pearls of wisdom from implementing changes in Cytopathology Fellowship Programs

  1. Speakers: Zubair Baloch, Elizabeth Morency, Jean-Marc Cohen, Kate Dyhdalo, Britt-Marie Ljung, Sara Monaco
  2. Panel Discussion



CALL for CELL Talks!

Please encourage any interested cytopathology fellows to submit CELL Talks for consideration for the December 2nd, 2020 deadline.  Visit our website to see prior CELL Talks


ICYMI  (In case you missed it)

Check out the Recommendations for Away Rotations and Interviews for GME Fellowship Applicants in the 2020-2021 Academic Year

Innovative Practices in Cytopathology

Article about survey for cyto fellowship interest among trainees- Dr. Israh Akhtar (submit by 8/10)