Cytopathology fellowship outcomes assessment

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for oversight of pathology residency and fellowship organizations in the United States. Residents must have successfully completed their training in an ACGME-accredited or Royal College of Physicians and Surgeons of Canada-accredited residency to be eligible to take the American Board of Pathology (ABP) examinations. For subspecialties like cytopathology, only ACGME-accredited fellowships are accepted. The ACGME is undergoing major restructuring with a shift to continuous accreditation and outcomes assessment, the “Next Accreditation System” (NAS). With the NAS, site visits will be extended to 10 years for those individual pathology and fellowship programs that are performing well. The episodic “biopsy” model for accredited programs will be replaced by annual data collection, and program information forms will be replaced by self-studies. Each ACGME review committee will monitor the program data and trends and will determine whether the program needs to submit additional data or take action. The annual data will include resident and faculty surveys, case log information, scholarly activity, and educational milestones data. The Milestones project is the keystone of the NAS, requiring discernible developmental stages in attaining proficiency at established times during training. The educational milestones are based on the six ACGME competencies, planned in a systematically progressive framework. Milestones for the pathology resident are now posted in draft form on the ACGME website, and those for cytopathology fellows are in draft form but not published at this time. Each milestone is arranged in numbered levels, with level 1 representing most fellows at the beginning of training, level 4 representing the graduating fellow target, and level 5 being aspirational or representative of a cytopathologist in practice several years. The fellow interpretive and diagnostic knowledge milestones at level 4 will most likely be worded to state that fellows accurately diagnose most cytology samples. The ACGME revised program requirements for cytopathology that are effective July 1, 2013 specifically state that cytopathology fellows must demonstrate diagnostic proficiency and that they must demonstrate competence in the application of additional diagnostic adjuncts, including molecular testing. Fellows must evaluate at least