Pathology Residency Programs Research Articles

Postmortem cytology: Alive and well in the practice of autopsy and forensic pathology.

Postmortem cytology: Alive and well in the practice of autopsy and forensic pathology.

The Pathology Residency Program of the Johns Hopkins University School of Medicine: a model of its kind.

The Department of Pathology of the Johns Hopkins University pioneered in the late 19th century the application of the scientific method to the study of medicine and fostered the development of residency training programs. To trace the history of the Johns Hopkins Pathology Residency Program and assess with quantifiable outcomes the performance of former residents. Design .- We reviewed archival and departmental records from September 1899 to June 2014 to create a database of pathology residents. We then analyzed resident in-service examinations, American Board of Pathology examinations, and career paths. In 115 years the department trained 555 residents who came from 133 medical schools located in 23 countries. Residents performed well on the in-service examinations, obtaining mean scaled total scores that were significantly better (P = .02) than those of the national peer groups. Residents (371 of 396, 94%) passed their boards typically at the first attempt, a percentage pass that was higher than the national average for both anatomic (P < .001) and clinical (P = .002) pathology. Approximately half of the residents went into private practice, whereas a third followed an academic career. Of the latter group, 124 (75%) became professors of pathology, 31 (19%) chairs of pathology departments, 10 (6%) deans of medical schools, 5 (3%) were elected into the National Academy of Sciences, and 1 won the Nobel prize. While maintaining its original core values, the Johns Hopkins Pathology Residency Program has trained physicians to be outstanding researchers, diagnosticians, and leaders in pathology.

Confidence, knowledge, and skills at the beginning of residency. A survey of pathology residents.

To document the pathology learning experiences of pathology residents prior to residency and to determine how confident they were in their knowledge and technical skills. An online survey was distributed to all pathology residency program directors in the United States, who were requested to forward the survey link to their residents. Data were obtained on pathology electives, grossing experience, and frozen section experience. Likert scale questions assessed confidence level in knowledge and skills. In total, 201 pathology residents responded (8% of residents in the United States). Prior to starting residency, most respondents had exposure to anatomic pathology through elective rotations. Few respondents had work-related experience. Most did not feel confident in their pathology-related knowledge or skills, and many did not understand what pathology resident duties entail. Respondents gained exposure to pathology primarily through elective rotations, and most felt the elective experience prepared them for pathology residency. However, elective time may be enhanced by providing opportunities for students to increase hands-on experience and understanding of resident duties.

Environmental components and methods for engaging pathology residents in informatics training

Over the past several years, there has been increasing recognition of the importance of informatics in the practice of pathology, and this has led to initiatives that aim to integrate better and formalize instruction in informatics within the curriculum of pathology residency programs. The most notable of these programs is the Pathology Informatics Essentials for Residents resource developed by the Association of Pathology Chairs, Association of Pathology Informatics, and College of American Pathologists.[1] We believe that these initiatives are important. We also feel that the ultimate success of a residency-based informatics training program will depend greatly on the residency program's ability to interest and subsequently engage residents in informatics throughout the entire residency experience. In evaluating our own experience over the past 8 years, we feel that we have achieved a high level of success in supporting and cultivating resident interest in informatics, which has greatly aided the development of pathology informaticians. This development is distinct from, though related to, formal didactic training. Prior publications from our institution have proposed learning frameworks and teaching methodologies for teaching pathology informatics.[2] This manuscript differs in that we aim to both identify and describe the environment and the modalities that we believe have contributed to successfully engaging pathology residents in informatics education.

Anatomic and Clinical Pathology Boot Camps: Filling Pathology-Specific Gaps in Undergraduate Medical Education

The Liaison Committee on Medical Education began an initiative to change medical education across the United States in the early 2000s. With the explosion in medical science knowledge, the need arose to teach selected fundamental information both in a contextual and in an active learning manner. To identify ways to address gaps in training and knowledge that became apparent following implementation of learner-centered teaching methods, with devotion of more time to Internet-based learning and less emphasis on face-to-face lecture time. There was a dramatic departure from or de-emphasis of many traditional courses, such as embryology, gross anatomy, microscopic anatomy, and pathology, to the integration of these sciences into system-based active learning courses. This change in medical school curricula produces a medical graduate who hopefully thinks differently but certainly lacks subject-specific knowledge for a variety of medical specialties. Pathology residency programs have developed "boot camps" for the initial months of residency training both to provide the necessary foundation of pathology-specific medical science and to introduce basic skills and processes required for practice of anatomic pathology and laboratory medicine. The College of American Pathologists Graduate Medical Education Committee sent a questionnaire out on the Program Directors Section Listserv; the results are discussed and 3 boot camp programs are described. Boot camps have 2 purposes: (1) to teach or strengthen knowledge required to practice pathology and (2) to introduce basic skills and processes that will be used during the practitioner's career.

Topics From the Milestones Working Group, the American Board of Pathology and Association of Pathology Chairs (APC), and the Program Directors of Pathology Section of APC Working Groups in Genomics and Laboratory Management

The special section entitled “The Future of Pathology Training and Training Programs” will appear in 2 parts: part 1 in this issue of the Archives and part 2 in the April 2014 issue. The special section is comprised of 9 articles written by many distinguished individuals around the United States who are leaders in pathology education, including members of the Accreditation Council for Graduate Medical Education (ACGME) Milestones Working Group, who authored the cornerstone article entitled “The Pathology Milestones and the Next Accreditation System.”In addition to “The Pathology Milestones and the Next Accreditation System,” this issue contains articles that focus on the transition from medical school to residency—a national curriculum for pathology undergraduate medical education, “boot camps” in anatomic and clinical pathology, and an example rotation in autopsy pathology that integrates clinical and anatomic pathology results.The Pathology Milestones are an extension and outgrowth of the Outcomes Project at ACGME. The phase I group of programs began the Milestones implementation on July 1, 2013; pathology residency programs are included in phase II, and will implement the changes on July 1, 2014. The authors of “The Pathology Milestones and the Next Accreditation System” include all members of the Milestones Working Group, assembled for the first time in November of 2011, but with groundwork done initially at the July 2011 Association of Pathology Chairs (APC)/Program Directors (PRODS) annual meeting. The Milestones product owes a substantial amount of credit to all of the pathology educators around the country who provided comment, input and suggestions during these past 3 years, but especially to Steven P. Nestler, PhD, executive director of the Pathology Residency Review Committee for 25 years. Of course, many others at ACGME have been part of this process and are collectively recognized for their dedication to graduate medical education. This lead article elucidates the Milestones for Pathology and includes ideas to facilitate implementation effective July 2014.Also in this issue, there are 3 articles that focus on improvement in the continuum of undergraduate to graduate medical education. “Anatomic and Clinical Pathology Boot Camps: Filling Pathology-Specific Gaps in Undergraduate Medical Education” focuses on possible ways to assist in the transition from medical school to pathology residency. An article entitled “A Team-Based Approach to Autopsy Education: Integrating Anatomic and Clinical Pathology at the Rotation Level” illustrates possible ways to integrate the laboratory and anatomic pathology findings from the premortem status and the postmortem status to enhance clinical care. The article “National Standards in Pathology Education: Developing Competencies for Integrated Medical School Curricula” expounds on developing national standards for competencies in pathology education in the integrated medical school curriculum.In the April 2014 issue of the Archives, we will present 5 additional articles.“Progress Toward Improved Leadership and Management Training in Pathology” provides an update on resident education in management stemming from the Laboratory Management PRODS working group, and “Progress and Potential: Training in Genomic Pathology” covers resident education in genomics stemming from the PRODS Training Residents in Genomics Working Group. The article “Pathology Training in Informatics—Evolving to Meet a Growing Need” reviews the current state of informatics education, the upcoming American Board of Pathology certification examination, and the beginning of the development of program requirements for accredited training in informatics by the ACGME.This special section is rounded out by “The American Board of Pathology's Maintenance of Certification Program Update,” and a review of those subspecialty programs that do not currently require board certification—the so-called selective pathology programs—that includes data on funding support and placement of graduates, entitled “Selective Pathology Fellowships: Diverse, Innovative, and Valuable Subspecialty Training.”I thank Mark Sobel, MD, PhD, and Priscilla Markwood, who have not only managed the annual APC/PRODS meetings for many years, but also managed and monitored the APC and APC Council and PRODS and PRODS Council e-mail listserves. Finally, I thank Philip Cagle, MD, Editor in Chief, and the staff of the Archives of Pathology & Laboratory Medicine for their support.

Academic autopsies in Brazil--a national survey.

To investigate the number and rate of academic autopsies, general organization, educational and research in Brazilian academic services. Standardized questionnaires were sent to Brazilian medical schools (n=177) and active pathology residency programs (n=53) from March to June 2009. Data were collected for years 2003 to 2008. Thirty-two academic services in 11 Brazilian states answered the survey. Twenty-one (65.6%) perform less than a hundred autopsies for natural causes and less than fifty pediatric or fetal autopsies/year. Twenty-four (75%) perform less than a hundred adult autopsies/year. Many institutions (46.9%) reported a drop in the number of autopsies in a six-year period. The total autopsy count and autopsy rate in 2008 ranged 1-632 (median = 80), and 0-66% (mean = 10.6%), respectively. A steady decrease in the total count of autopsies in a pool of 19 institutions was observed (p<0.01). Median autopsy rates have fallen from 19.3%, in 2003, to 10.6%, in 2008 (p=0.07). Significant discrepancies at autopsies led to changes in institutional healthcare practice in 37.5% of the services. The low number of autopsies was a limiting factor in undergraduate education for 25% of respondents. A minimum number of autopsies is required to complete the pathology residency program in 34.6% of the services. The total number and the rate of academic autopsies have decreased in Brazil between 2003 and 2008. The number of autopsies and the general organization of academic services must be enhanced to improve medical education, research, and the quality control of patient care.

TRIG on TRACK: educating pathology residents in genomic medicine.

Genomic technologies are dramatically changing the practice of medicine. Next-generation sequencing has allowed prognostic stratification of cancer patients, personalized drug therapy and the identification of genetic risk factors for a multitude of diseases. As the physicians who oversee tissue- and laboratory-based diagnostic testing, pathologists must understand and utilize this new technology for the benefit of patients; however, only a minority of pathology residency programs currently provide training in genomics. In response to this urgent need, the Training Residents in Genomics (TRIG) Working Group has made significant progress towards creating, implementing, evaluating and disseminating a national curriculum in genomic pathology. Although presented in the context of pathology training, the approach described in this review can serve as model for education in genomic medicine of students, trainees or professionals in other areas of healthcare.

United States Medical Licensing Examination Step 1 Two-Digit Score: A Correlation With the American Board of Pathology First-Time Test Taker Pass/Fail Rate at the University of Pittsburgh Medical Center

Factors that correlate with success or failure on the American Board of Pathology (ABP) examination are not known. Other medical residency programs have shown that standardized test scores correlate with specialty board examination scores; however, data from pathology programs are lacking. To investigate whether the 2-digit score on step 1 of the United States Medical Licensing Examination (USMLE) was correlated with ABP examination performance at a large university pathology program. Nine years of data (2001-2009) from pathology residents (n = 72) at the University of Pittsburgh Medical Center (UPMC, Pittsburgh, Pennsylvania) was collected from existing files and deidentified. Step 1 USMLE 2-digit scores and ABP failure rates for first-time test takers were compared. Results are reported as the percentage of residents who failed either the anatomic pathology or clinical pathology part of the ABP examination in cohorts by their USMLE 2-digit score (≤80, 81-85, 86-89, ≥90). The rolling 5-year (2005-2009) ABP average failure rate for first-time test takers of the anatomic pathology examination was 3.1% (UPMC) and 14.1% (nationally); in clinical pathology, it was 13.8% (UPMC) and 23.6% (nationally). At UPMC, no resident failed the anatomic pathology or clinical pathology parts of the ABP examination if his or her 2-digit USMLE step 1 score was 90 or more across 9 years of training (2001-2009). In the UPMC pathology program, 2-digit scores on USMLE step 1 of 90 or more and 80 or less were strong measures of ABP first-time pass/failure rates, whereas scores of 81 to 89 were less-accurate measures. The USMLE step 1 score is one of many criteria that can be used for screening applicants for a pathology residency program.

Heterogeneity of publicly accessible online critical values for therapeutic drugs

Introduction: Critical values are reported to clinicians when laboratory values are life threatening and require immediate attention. To date no definitive critical value limit recommendations have been produced regarding therapeutic drug monitoring. Some laboratories choose to publish critical value lists online. These publicly available values may be accessed and potentially utilized by laboratory staff, patient care providers, and patients. Materials and Methods: A web-based search of laboratories associated with the Accreditation Council for Graduate Medical Education pathology residency programs was initiated to determine which therapeutic drugs had critical values and to examine the degree of variation in published critical values for these institutions. Results: Of the 107 institutions with university-based pathology training programs, 36 had published critical values online for review. Thirteen therapeutic drugs were investigated and the number of institutions reporting critical value limits for the drug, as well as the median, range, standard deviation, and the coefficient of variation of critical value concentration limits for each drug were determined. A number of the online critical value limits were deemed to be erroneous, most likely due to incorrectly listed units of measurement. Conclusions: There was a large degree of heterogeneity with regard to the chosen critical value limits for therapeutic drugs. This wide variance in critical values appears to be greater than that observed in interassay proficiency testing. Institutions should reexamine the rationale for their current critical value parameters and ensure that critical value limits and associated units are accurately published online.

Use of a Resident On-Call Database to Characterize Failures in Communicating Critical Laboratory Results

The Clinical Laboratory Improvement Amendments require that laboratories have a procedure for reporting “imminent life-threatening results” to caregivers. Although this system has improved timely intervention, inability to reach care providers undermines its impact (1). Prior analysis of critical result reporting practices has identified qualitative factors that lead to delays in critical result reporting, such as patient location, missing provider information, patient heterogeneity, and nonideal “panic” values (2). However, we have not found reports quantifying sources of communication failures in critical result reporting. Here we report sources of communication failures in reporting critical results in our healthcare system, which has 950 beds equally divided between a university and county hospital. In our system, more than 99% of the time, critical results are called to a care provider by a medical technologist. If this method is unsuccessful, the technologist elicits assistance from the laboratory medicine resident on call to ensure that the value is communicated and appropriate action taken. In 2004 our Clinical Pathology residency program began maintaining an online database of all calls to the on-call laboratory …

Perceptions of Stress Among Pathology Residents

We conducted a survey to attempt to identify stressors perceived by pathology residents. A comparison of survey results from pathology residents with stressors perceived by residents in other specialties was done to evaluate whether the stressors in pathology are unique. A confidential e-mail survey of residency programs in the United States generated a response rate from program directors of 23.3% and a resident response rate of 6.4%. Although the study is limited by response rates and the data are primarily from university-based residency programs, the concordance between the identifiable risk factors for stress by the resident and program director groups validates the importance of this issue among pathology residency programs. Both groups identified variability in faculty expectations and work overload that inhibits optimal learning as the top 2 stressors for residents. We discuss various factors that contribute to stress and some strategies that pathology residency programs can implement to address the stressors.

Non-neoplastic Renal Diseases are Often Unrecognized in Adult Tumor Nephrectomy Specimens

The pathologic evaluation of tumor nephrectomy specimens focuses on the diagnosis, grading, and staging of the neoplasm. The presence of coincidental non-neoplastic diseases in these specimens may have significant implications for patient outcomes. The purpose of this study is to determine the spectrum of non-neoplastic disease processes that may be overlooked in tumor nephrectomies, and to ascertain the extent to which surgical pathologists are trained to recognize these lesions. We reviewed the hematoxylin and eosin-stained slides of 246 adult tumor nephrectomy specimens with an emphasis on the non-neoplastic renal parenchyma. Further analysis of cases with pathologic alterations included special stains and direct immunofluorescence microscopy. The surgical pathology reports were reviewed to determine whether the non-neoplastic lesions were originally identified. We also surveyed United States pathology residency programs to determine how many require training in medical renal pathology. Forty-one cases (16.7%) had alterations, such as diffuse and/or nodular mesangial sclerosis, mesangial hypercellularity, or glomerular basement membrane thickening that warranted further study. After further work-up and clinical correlation, the pathologic changes in 24 cases were categorized as follows: diabetic nephropathy (19 cases) of which one demonstrated atheroembolic disease, thrombotic microangiopathy (3 cases), sickle cell nephropathy (1 case), and focal segmental glomerulosclerosis (1 case). Twenty-one (88%) of these diagnoses were not identified at initial pathologic evaluation. Only 35 of 98 pathology residency programs that responded to our survey require any formal training in medical renal pathology. Although accurate pathologic evaluation of renal neoplasms remains essential, surgical pathologists should be aware that coincidental non-neoplastic renal diseases are common, often not recognized, and may have important implications for patient care. Further consideration should be given to the training requirements of pathology residents and the guidelines for evaluation of nephrectomy specimens to avoid missing non-neoplastic renal lesions.

Critical Leadership and Management Skills for Pathology Practice

Managed care has changed the nature of medical practice. The practice of pathology has also changed and is likely to undergo further modification. Additional skills in leadership and management are needed to perform optimally in the current medical marketplace. To determine whether pathologists view business and informatics skills as being important and valuable in their practices. A survey was sent electronically (via e-mail) to 2566 pathologists and pathology administrators. Two hundred sixteen survey recipients (8.4%) responded to the survey. The response rate to individual questions ranged from 86% to 99% (186 to 214 of 216 total respondents). Most who took the survey ranked communication (203/209; 97%), leadership skills (165/209; 79%), and systems thinking skills (155/209; 74%) as either "very important" or "essential." Fewer respondents were willing to offer salary premiums for marketing (108/196; 55%), business or finance (92/196; 47%), or staff leadership (95/196; 48%) skills unless the candidate had a track record of measurable achievement using these skills. Those practicing in academia as well as those making hiring decisions by themselves were more likely to value leadership and management skills. Fewer than 1% of respondents in any category considered current pathology residency training in leadership and management to be adequate. Prospective employers value leadership and management skills. Pathology residency programs must include meaningful training in pathology practice management and informatics to satisfy the demand for these skills in the modern pathology marketplace.

A proposal for curriculum content in transfusion medicine and blood banking education in pathology residency programs

T he fields of blood banking (BB) and transfusion medicine (TM), like other areas of medicine, have evolved into specialties with a diverse array of areas of knowledge. These areas include advances in the detection of pathogens in donated blood, advances in methods to collect and manipulate progenitor cells, advances in blood conservation techniques, and advances in treatments for both the acutely and the chronically ill patient, among many others. As a consequence, the knowledge base that a resident trainee in pathology is expected to master has expanded well beyond the mere understanding of compatibility testing and inventory management. In the past several years, guidance regarding pathology residency training has been published for clinical pathology and anatomic pathology, as well as in some subspecialty areas. Although intended for medical students, an NIH-funded transfusion medicine curriculum initiative also provided a comprehensive overview of areas of knowledge relevant to pathology resident training. A survey of TM fellowships was also performed with implications for residency training, as have recent commentaries regarding the role of physicians in blood centers and hospital transfusion services. There is no document that specifically addresses pathology residency training in BB and/or TM, however, and the current requirements of the Accreditation Council for Graduate Medical Education (ACGME) on general competencies in residency training. Recently, the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) and the members of the Children’s Health Initiative through Laboratory Diagnostics (CHILDx) separately produced comprehensive clinical pathology residency training documents of which BB and/or TM was a subsection. As a follow-up to the activities of ACLPS and the new requirements of the ACGME regarding general competencies, a task force was created by the AABB to address the needs for a residency curriculum on this subject. The rotation objectives outlined below for BB and TM were adapted from the subsection on BB and/or TM from the ACLPS document and further expanded. The task force further elaborated on these objectives by including additional guidance on the different needs of the general anatomic pathology– and clinical pathology–trained pathologist, who has either minimal or infrequent supervision of a transfusion service, compared with the specialist whose responsibilities might include directing a blood collection center, a cell therapeutics laboratory, or a high-complexity transfusion service. The task force further designated what each specific rotation ABBREVIATIONS: ACGME = Accreditation Council for Graduate Medical Education; BB = blood banking; CAP = College of American Pathologists; FACT = Foundation for the Accreditation of Cellular Therapy; IC = interpersonal and communication skills; JCAHO = Joint Commission on Accreditation of Healthcare Organizations; MK = medical knowledge; PC = patient care; PL = practice-based learning and improvement; PR = professionalism; SP = systems-based practice; TM = transfusion medicine.

Adequacy of Pathology Resident Training for Employment: A Survey Report From the Future of Pathology Task Group

The recent change in accreditation requirements for anatomic pathology and clinical pathology residency training from 5 to 4 years and the rapid advances in technologies for pathology services have sparked a renewed debate over the adequacy of pathology residency training. In particular, perceived deficiencies in training have been declared from a variety of sources, both in the form of recent editorial opinions and from surveys of community hospital pathologist employers in 1998, 2003, and 2005 by Dr Richard Horowitz. To obtain more comprehensive data on the perceptions of strengths and weaknesses in pathology residency training. The College of American Pathologists conducted a survey of potential pathology employers (senior College of American Pathologists members, members designated as head of group, and members of the Association of Directors of Anatomic and Surgical Pathology). Also surveyed were recent graduates of pathology residency programs, who were identified as being junior members of the College of American Pathologists, were recent recipients of certification from the American Board of Pathology, or were contacted through their directors of pathology residency programs. There were 559 employer respondents, of whom 384 were responsible for hiring and/or supervising new pathologists. There were 247 recent graduates of pathology residency training programs who responded. From the employers' standpoint, the majority expressed overall satisfaction with recent graduates, but almost one third of employers indicated that new hires had a major deficiency in a critical area. Specific areas of deficiency were clinical laboratory management and judgment in ordering special stains and studies. In addition, one half of employers agreed that more guidance and support for newly trained pathologists is needed now than was required 10 years ago. Academic employers generally were more satisfied than private sector employers. Newly trained pathologists did not appear to be inappropriately overconfident in their abilities. In addition, their perceptions of those specific areas in which they are most and least prepared are very similar to the ratings provided by employers. On average, newly trained pathologists' ratings of their own preparedness are highest for specific aspects of general pathology and anatomic pathology, and lowest for specific aspects of clinical pathology and administration. In selecting new pathologists, employers perceived medical knowledge and interpersonal skills as the most important discriminating applicant characteristics. When new employees were asked why they thought they were offered their position, the discriminating qualifications cited most often were academic background and training, as well as completion of a fellowship and subspecialty training. It is our hope that the results of this survey can be used as input for further discussions and recommendations for training of pathology residents so as to further advance the ability of pathologists to provide quality patient care upon their graduation from training.

Adequacy of pathology resident training for employment: a survey report from the Future of Pathology Task Group.

Abstract Context.—The recent change in accreditation requirements for anatomic pathology and clinical pathology residency training from 5 to 4 years and the rapid advances in technologies for pathology services have sparked a renewed debate over the adequacy of pathology residency training. In particular, perceived deficiencies in training have been declared from a variety of sources, both in the form of recent editorial opinions and from surveys of community hospital pathologist employers in 1998, 2003, and 2005 by Dr Richard Horowitz. Objective.—To obtain more comprehensive data on the perceptions of strengths and weaknesses in pathology residency training. Design.—The College of American Pathologists conducted a survey of potential pathology employers (senior College of American Pathologists members, members designated as head of group, and members of the Association of Directors of Anatomic and Surgical Pathology). Also surveyed were recent graduates of pathology residency programs, who were identifie...

The autopsy as a performance measure and teaching tool

A survey of pathology training programs about current operations and attitudes revealed that the autopsy is underused in medical student and pathology resident teaching, is inadequately reported, often does not have a dedicated faculty, is not championed by pathologists or clinicians, is not valued as a performance measure, and is barely used as a resource for medical research. The autopsy can be reestablished as a teaching tool and performance measure, but this will require that the autopsy be recognized as a credible and valuable medical procedure. The autopsy must then be funded; and new sources of both volume and funding, such as incorporating autopsies into payment schedules, into clinical trials, and in pay-for-performance initiatives, must be solicited. Once there is reimbursement for autopsies, pathologists, clinicians, and health care administrators will embrace the autopsy as a new source of revenue and as a valid measure of physician, hospital, and health system performance. Pathologists and the pathology specialty societies must take the lead in the reestablishment of the autopsy and must, at the same time, encourage innovations such as centralization, greater use of Pathology Assistants, and application of molecular techniques. New tools for using the autopsy in medical student teaching should be embraced, and the role of the autopsy in pathology residency programs must be reevaluated.

Teaching Pediatric Laboratory Medicine to Pathology Residents

Laboratory data are essential to the medical care of fetuses, infants, children, and adolescents. However, the performance and interpretation of laboratory tests on specimens from these patients, which may constitute a significant component of the workload in general hospitals and integrated health care systems as well as specialized perinatal or pediatric centers, present unique challenges to the clinical pathologist and the laboratory. Therefore, pathology residents should receive training in pediatric laboratory medicine. Children's Health Improvement through Laboratory Diagnostics, a group of pathologists and laboratory scientists with interest and expertise in pediatric laboratory medicine, convened a task force to develop a list of curriculum topics, key resources, and training experiences in pediatric laboratory medicine for trainees in anatomic and clinical pathology or straight clinical pathology residency programs and in pediatric pathology fellowship programs. Based on the experiences of 11 training programs, we have compiled a comprehensive list of pediatric topics in the areas of clinical chemistry, endocrinology, hematology, urinalysis, coagulation medicine, transfusion medicine, immunology, microbiology and virology, biochemical genetics, cytogenetics and molecular diagnostics, point of care testing, and laboratory management. This report also includes recommendations for training experiences and a list of key texts and other resources in pediatric laboratory medicine. Clinical pathologists should be trained to meet the laboratory medicine needs of pediatric patients and to assist the clinicians caring for these patients with the selection and interpretation of laboratory studies. This review helps program directors tailor their curricula to more effectively provide this training.

Longitudinal Case-Based Evaluation of Diagnostic Competency Among Pathology Residents: A Statistical Approach

Accreditation Council for Graduate Medical Education guidelines require the evaluation of residents in 6 competencies. Pathology residents demonstrate medical knowledge, patient care, communication, and practice-based learning competencies in their attainment of competency in surgical pathology diagnosis. To implement a prospective case-based approach to longitudinally evaluate the acquisition of competency in surgical pathology diagnosis by trainees. Each resident made his or her surgical pathology diagnosis on cases before faculty review of the cases. Faculty members scored each resident diagnosis as to whether they agree, partially agree, or disagree with the diagnosis. Forty-three months of surgical pathology reports (August 2001 through January 2005) and 22,252 surgical pathology cases were analyzed. Pathology residency program. Thirteen faculty members and 21 trainees. Time and training year trends for the number of cases reviewed and the percent agreement between faculty and trainees on the diagnoses. A mean of 146 cases (range, 12-327 cases) was reviewed during each month-long rotation. The number of cases reviewed increased through postgraduate year 4. The percent agreement on the diagnoses was 78% (range, 56%- 99%) for all trainees, with improvement by postgraduate year, although the improvement attenuated by postgraduate year 3. Residents were less likely to preview the most complex cases. Faculty rank and sex and resident sex did not significantly affect outcomes. The overall agreement on the diagnoses increased over time. Residents experiencing difficulty could be identified clearly and early. Individual resident performance was easily tracked over time. The review of hundreds of reports increases systems accountability and allows more objectivity than traditional evaluations. The use of case-based evaluation fosters earlier identification and remediation of deficiencies.