Roxanne Florence, MD
Baystate Health, Springfield, MA

In recent years, Cytopathology Fellowship openings have been posted frequently on the ASC listserv and other sites. This includes positions beginning within 6 months to a year of the advertisement. Are we having more trouble recruiting applicants to cytopathology fellowship(s)?

Section III.A.1.b) of the ACGME’s Cytopathology Program requirements states that prior to appointment in a Program, fellows must have one of the following:  certification by the American Board of Pathology or the American Osteopathic Board of Pathology in either anatomic and clinical pathology or in anatomic pathology, or successful completion of at least two years of a pathology residency that satisfies the requirements in Section III.A.1 (basically, two years of an ACGME accredited residency program or its equivalent). Filling an open cytology fellowship position with an interested resident currently completing their second or third year from your own AP or AP/CP core program is poorly publicized but a viable option.

It is unknown how frequently Cytopathology Programs fill open spots in this manner, as the ACGME does not track this data. Other unknowns include how cytology fellows, who do their training prior to completion of their general residency, adapt to returning to a PGY-3 or PGY-4 position the following year, or if the AP, AP/CP, or cytopathology board pass rates differ from those whom complete a cytology fellowship after doing a full residency in the traditional manner.

Prior to making this offer to a third year resident, discussions with the core pathology program director, and perhaps the Department Chair, the institution’s graduate medical education committee, and its designated institutional official are necessary. Topics that must be discussed include how removing a pathology resident from scheduled rotations and call would affect the remaining residents, how to balance incoming class sizes, when the fellow would be eligible to take both the AP/CP and cytology board exams, and if the candidate would feel pressured to comply to assist the department.

There are potential benefits to the fellow of this arrangement, which can be selling points when recruiting one of your residents to interrupt their general residency training with a fellowship year. Sitting for the AP or AP/CP boards having a greater depth of knowledge of cytology than the average candidate may increase their chances of passing on the first attempt. Increased levels of responsibility including working up and writing up cases independently and handling a daily large volume are skills which will be useful for any future remaining surgical pathology residency rotations.  Successful completion of a cytology fellowship may make them a more desirable candidate when applying for any further fellowships.  A potential downside of this option, as mentioned earlier, is disruption to the existing core residency program schedule.

Other tricks to avoid vacancies include using every available resource to advertise a fellowship (including fellowship fairs, listservs, Pathology Outlines, word of mouth, etc.), growing your internal applicant pool with great cytology teaching and personal excitement about the field, being creative in how you teach and evaluate fellows, and offering experiences in your Program that are not uniformly available. Examples of the latter could be integrating core biopsy cases into cytology sign out of which touch preps were interpreted by the fellow at rapid on site evaluation (ROSE), ultrasound guided fine needle aspiration training, opportunities to lecture at regional meetings, etc.

At my institution, our 2018-2019 cytology fellow began after completing his third year of AP/CP training and has now rejoined our core residency as a PGY-4. As both he and I (his cytology fellowship director) consider the endeavor successful, I would again explore this option to fill a vacancy. I plan to continue to ask for feedback on his decision to complete fellowship early over the next few years.