Department of Pathology

Neuropathology Fellowship

Program Director

Jacob J. Steinberg, MD
Phone: 718.920.6573
Fax: 718.547.8349
Email: jsteinbe@montefiore.org 

Montefiore Medical Center
Department of Pathology
111 East 210th Street
Bronx, NY 10467

 
 
 

Program Description

The Neuropathology Training Program, fully accredited by the ACGME, provides two years of intensive training in various aspects of Neuropathology.  An optional third year as a fellow is also offered.  Albert Einstein College of Medicine has long been known for its strength in neurosciences, including neuropathology.  A large number of brains are sent to Einstein as part of ongoing studies in aging, dementia, and AIDS.  Many specimens, especially cases of AIDS, neoplasia, motor neuron disorders, dementia, storage disease, and demyelinating conditions, are received each year for consultation.  The diagnostic and research facilities include fully equipped laboratories for neurohistology, EM, immunocytochemistry, histochemistry, biochemistry, molecular biology, immunology, and tissue culture.  The faculty members are active in research on aging, dementia, motor neuron disease, demyelinating disease, developmental neuropathology, neurovirology, and neurotoxicology.  Each year about 650 brains (autopsy) and neurological biopsy specimens are processed.

The resident/fellow is responsible for neurosurgical specimens, nerve and muscle biopsies, and for removal and examination of brains and spinal cords in autopsies of neuropathological interest.  The first year is largely devoted to diagnostic neuropathology.  During this period, the trainee plans and begins a research project that is carried into the second year, with a remaining service commitment.  In addition, the resident/fellow participates in medical student and resident (pathology and neurology) teaching.

The program has been in existence since 1946. Since 1988, nine fellows have successfully completed this fellowship program. The approximate program completion rate is 80%.

Prerequisite Training/Selection Criteria

The program requires a minimum of two years of prior graduate medical education, usually in the field of Anatomic Pathology. Foreign medical graduates must be ECFMG certified. Fellows are chosen based on interviews and recommendations.

Training Goals and Objectives

The objective of the Neuropathology Training Program is to produce academic neuropathologists skilled in clinical diagnosis, research and teaching. These goals have been met by providing fellows with the opportunity to study a wide variety of neurology and neurosurgical cases under the guidance of several experienced faculty members.

Trainees assist the attending staff with intra- and extra-departmental teaching activities involving the medical staff, residents and medical students. The program is designed with an initial emphasis on diagnostic neuropathology and subsequent opportunities for clinical and/or basic science research. The program focuses on ensuring competency in the fields of patient care, medical knowledge, practice-based learning and improve-ment, interpersonal and communication skills, professionalism and systems-based practice as they apply to neuropathology.

Program Certifications

The program is accredited by the American Council for Graduate Medical Education.

Physician Faculty

Karen M. Weidenheim, MD, Professor, Program Director
Diagnostic neuropathology, developmental neurobiology and electron microscopy studies

Christian Keller, MD, Assistant Professor
Diagnostic neuropathology, clinicopathologic studies

Asao Hirano, MD, Professor, Associate Program Director
Diagnostic neuropathology, electron microscopy studies

Sunhee C Lee, MD, Professor
Diagnostic neuropathology, glial immunobiology

Alfred J Spiro, MD, Professor
Muscle pathology

Participating Institutions

Montefiore Medical Center
Henry and Lucy Moses Division 
111 East 210th Street
Bronx, NY  10467

Jack D. Weiler Hospital of the Albert Einstein College of Medicine
1825 Eastchester Road
Bronx, NY  10461

Clinical and Research Research Opportunities

The program is designed with an initial emphasis on diagnostic neuropathology and subsequent opportunities for clinical and/or basic science research. Instruction in Neuropathology is accomplished using a combination of case-based learning, didactic conferences and study based on educational objectives. For the former, the fellow is given graded responsibility for the work-up of all aspects of neuropathology and autopsy specimens, with particular attention to thorough gross and microscopic study. A case log is maintained. Sufficient case material is available on the service for the fellow to competently evaluate and diagnose patient material at the end of the two-year training period. Archival study sets are also available for review. The fellow is expected to complete defined educational objectives in Neuroanatomy and Neurohistology, Central Nervous System Autopsies, Tumor Neuropathology, Trauma, Infections, Vascular Diseases, Degenerative Diseases, Demyelinating Diseases, Metabolic Diseases, Toxins, Malformations, Perinatal Pathology and Diseases of Muscle and Nerve. Electives are available in Opthalmic Pathology, Dementia and Brain Banking, and Forensic Neuropathology. These educational objectives are designed to supplement clinical experience by emphasizing pertinent epidemiologic, prognostic, therapeutic and etiologic details about the various entities encountered in the course of case- based learning. The fellow is encouraged to participate in both clinically-based translational and basic science studies. The fellow usually develops projects with the neuropathology faculty or faculty in related fields. The Pathology Department provides small grants ($2,000) for pilot projects.

Supervisory and Patient Care Responsibilities

The fellow participates in administration and management in a manner consistent with his or her level of expertise. He or she participates in scheduling and choosing material for conferences, assists with preparations for department inspections by various regulatory bodies and in the preparation of procedure manuals, safety manuals, and quality control manuals. The fellow has a supervisory role in the education of rotating residents and medical students. In order to provide optimal patient care, the fellow must ensure prompt and appropriate grossing of all neurosurgical specimens and timely work-up of all cases, especially frozen section specimens. The fellow is instructed to maintain patient confidentiality in compliance with the Health Insurance Portability & Accountability Act of 1996. The Department of Pathology provides instruction in medical ethics.

Procedural Requirements

The fellow must acquire and demonstrate appropriate technical skills in neuropathology specimen grossing, brain cutting, touch preparation, frozen section performance, histochemistry, electron microscopy and nerve teasing.

Didactic Components

The required weekly didactic conferences which total 8 hours a week include Diagnostic Neuropathology Conferences, Neuropathology Microscopic Conference, Neurology Grand Rounds, Neuromuscular Rounds, Interesting Case Conference and Electron Microscopy Conference.

Progression in Responsibilities

Once the fellow has demonstrated competence during initial training, he or she is responsible for the unsupervised performance of brain and spinal autopsies, grossing of all neurosurgical specimens and the work-up of all neuropathology cases. With increasing experience, the fellow is responsible for case presentations at inter- departmental conferences and the teaching of medical students and rotating residents.

Neuropathology Fellowship Evaluation

Each fellow is evaluated quarterly, and more often, if warranted, by Neuropathology Attending Physicians.  Evaluations are based on observation of the fellow's day-to-day interactions as work is accomplished by team effort and include:

  • competence in technical skills including gross dissection, frozen sections
  • case analysis including clinical data, gross and microscopic appearance
  • formulation and work up of a differential diagnosis
  • accuracy in writing final reports
  • ability to present cases in conference
  • professional behavior 

Evaluations will include written examinations. Each written evaluation is discussed with and signed by
the resident.  At the completion of the training program, a summary evaluation is written by the program director. The fellow also has the opportunity to evaluate the program in writing.  Evaluation forms are filed in the Residency Training Program Office of the Department of Pathology.

 

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