Pathology Residency Programs Research Articles

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.

Occupational Injuries in a Pathology Residency Program

Occupational Injuries in a Pathology Residency Program

Influence of a problem-based learning curriculum on the selection of pathology as a career: evidence from the Canadian match of 1993-2004

Since the introduction of problem-based learning (PBL) to North American medical education more than 30 years ago, there have been a number of analyses of its educational outcomes. Several authors have suggested that PBL may influence medical students' career choices. The balance of opinion in the pathology literature appears to assume that PBL curricula limit students' contact with pathologists and hypothesizes that PBL may impair recruitment into pathology residency programs. To evaluate this latter hypothesis, evidence from the 1993-2004 Canadian residency match was considered. During this period, 8 of 13 English-language medical schools in Canada changed from a non-PBL to a PBL curriculum; 1 had been using a PBL curriculum even before the 1993 start point and 4 remained using a non-PBL curriculum throughout the period under consideration. The proportion of medical school graduates ranking pathology first in their residency application match is compared between PBL and non-PBL medical schools. On average, 1.1% of non-PBL graduates and 1.2% of PBL graduates ranked a pathology residency program first. In general, there were proportionately slightly more pathology recruits from non-PBL schools at the beginning of the 1993-2004 period and slightly more pathology recruits from PBL schools toward the end of the period. In the absence of a nationally or internationally recognized standard for what constitutes a PBL school, this analysis must remain somewhat subjective. However, it does indicate that graduates from PBL schools are approximately as likely as those from non-PBL schools to rank pathology first in residency applications.

Pathology informatics questions and answers from the University of Pittsburgh pathology residency informatics rotation.

Effective pathology practice increasingly requires familiarity with concepts in medical informatics that may cover a broad range of topics, for example, traditional clinical information systems, desktop and Internet computer applications, and effective protocols for computer security. To address this need, the University of Pittsburgh (Pittsburgh, Pa) includes a full-time, 3-week rotation in pathology informatics as a required component of pathology residency training. To teach pathology residents general informatics concepts important in pathology practice. We assess the efficacy of the rotation in communicating these concepts using a short-answer examination administered at the end of the rotation. Because the increasing use of computers and the Internet in education and general communications prior to residency training has the potential to communicate key concepts that might not need additional coverage in the rotation, we have also evaluated incoming residents' informatics knowledge using a similar pretest. This article lists 128 questions that cover a range of topics in pathology informatics at a level appropriate for residency training. These questions were used for pretests and posttests in the pathology informatics rotation in the Pathology Residency Program at the University of Pittsburgh for the years 2000 through 2002. With slight modification, the questions are organized here into 15 topic categories within pathology informatics. The answers provided are brief and are meant to orient the reader to the question and suggest the level of detail appropriate in an answer from a pathology resident. A previously published evaluation of the test results revealed that pretest scores did not increase during the 3-year evaluation period, and self-assessed computer skill level correlated with pretest scores, but all pretest scores were low. Posttest scores increased substantially, and posttest scores did not correlate with the self-assessed computer skill level recorded at pretest time. Even residents who rated themselves high in computer skills lacked many concepts important in pathology informatics, and posttest scores showed that residents with both high and low self-assessed skill levels learned pathology informatics concepts effectively.

Management training for pathology residents: a regional approach.

Success in the practice of pathology demands proficiency in management, but management training for pathology residents is generally inadequate, with little agreement on an appropriate curriculum or competency assessment. Most residency training programs do not have faculty members who are interested and have expertise in management and who are dedicated to and have time available for teaching. To develop a didactic management training program for the residents from 6 separate pathology residency programs in Southern California, with a comprehensive curriculum taught by experts in each area without undue burden on any single training program. Faculty from the University of California-Los Angeles and the University of Southern California reviewed the literature and the management needs of practicing pathologists and devised the curriculum. Pathologist and nonpathologist speakers were identified who were working in important management positions both regionally and nationally. Seminars were presented in alternate months during a 2-year period. Sessions were videotaped, and each session was evaluated by the attendees. The curriculum consisted of 12 major topics, and seminars were delivered by 15 presenters from 6 institutions. Attendance was highest for residents in postgraduate years 2 and 3. The overall evaluation scores were exceedingly high (4.66 of a possible 5.0), and residents reported a significant increase in subject knowledge. Videotaping of presentations provided flexibility for residents who were unable to attend the seminars. This program was effective and could serve as a template for other pathology residency training programs to establish curriculum content and develop resident competency. Teaching responsibilities were less burdensome when spread among several programs and when supplemented by nonpathology faculty. Electronic and audiovisual support enhanced flexibility and access to the program.

Training in pathology informatics: implementation at the University of Pittsburgh.

Pathology informatics is generally recognized as an important component of pathology training, but the scope, form, and goals of informatics training vary substantially between pathology residency programs. The Training and Education Committee of the Association for Pathology Informatics (API TEC) has developed a standard set of knowledge and skills objectives that are recommended for inclusion in pathology informatics training and may serve to standardize and formalize training programs in this area. The University of Pittsburgh (Pittsburgh, Pa) core rotation in pathology informatics includes most of these goals and is offered as an implementation model for pathology informatics training. The core rotation in pathology informatics is a 3-week, full-time rotation including didactic sessions and hands-on laboratories. Topics include general desktop computing and the Internet, but the primary focus of the rotation is vocabulary and concepts related to enterprise and pathology information systems, pathology practice, and research. The total contact time is 63 hours, and a total of 19 faculty and staff contribute. Pretests and posttests are given at the start and end of the rotation. Performance and course evaluation data were collected for 3 years (a total of 21 residents). The rotation implements 84% of the knowledge objectives and 94% of the skills objectives recommended by the API TEC. Residents scored an average of about 20% on the pretest and about 70% on the posttest for an average increase during the course of 50%. Posttest scores did not correlate with pretest scores or self-assessed computer skill level. The size of the pretest/posttest difference correlated negatively with the pretest scores and self-assessed computing skill level. Pretest scores were generally low regardless of whether residents were familiar with desktop computing and productivity applications, indicating that even residents who are computer "savvy" have limited knowledge of pathology informatics topics. Posttest scores showed that all residents' knowledge increased substantially during the course and that residents who were computing novices were not disadvantaged. In fact, novices tended to have higher pretest/posttest differences, indicating that the rotation effectively supported initially less knowledgeable residents in "catching up" to their peers and achieving an appropriate competency level. This rotation provides a formal training model that implements the API TEC recommendations with demonstrated success.

Informatics training in pathology residency programs.

Information management is crucial in pathology, and previous reports have stressed the needfor improved informatics training in pathology residency programs. We surveyed 150 US programs to assess informatics training with respect to types of training, proficiency expectations, and computing infrastructure. Seventy-two programs (48.0%) responded. Of the respondents, 67 (93%) reported offering informatics training; of these, 52 (78%) required it. Most programs integrated informatics into another rotation, usually management. In 37 programs (55%), the amount of informatics training has increased during the last 3 to 5 years. The most common instructional methods were hands-on training and self-study; 61 programs (91%) used multiple methods. In all but 2 programs, computers were designated for residents; 9 programs offered individual computers to residents. All programs provided productivity software. These data suggest progress in informatics training but that considerable room for improvement exists. Our data also document for the first time detailed computing resources available to residents.

Informed evaluation of pathology residency programs: A guide for pathology resident candidates

○ Objectives.-To identify resources and summarize important issues in anatomic and clinical pathology training and to assist the pathology resident candidate in evaluating potential training programs. Data Sources.-Published guides for medical residency applicants, recent literature discussing pathology education, and World Wide Web sites. Study Selection.-Resources perceived by the author as valuable for the pathology resident candidate. Data Extraction.-Key issues in pathology education are identified. Data Synthesis.-Issues are discussed from the perspective of a pathology resident candidate, and resources for further information are provided. Conclusions.-The pathology residency candidate faces unique challenges in the residency search process because of the breadth of pathology training and the limited exposure to the practice of pathology in medical school. General guides for residency applicants include little discussion of pathology-specific issues. Recent literature discussing pathology education is fragmented but provides invaluable insights for resident candidates. This review seeks to identify a wide variety of issues and resources as a starting point for evaluating potential training programs.

Informed evaluation of pathology residency programs.

To identify resources and summarize important issues in anatomic and clinical pathology training and to assist the pathology resident candidate in evaluating potential training programs. Published guides for medical residency applicants, recent literature discussing pathology education, and World Wide Web sites. Resources perceived by the author as valuable for the pathology resident candidate. Key issues in pathology education are identified. Issues are discussed from the perspective of a pathology resident candidate, and resources for further information are provided. The pathology residency candidate faces unique challenges in the residency search process because of the breadth of pathology training and the limited exposure to the practice of pathology in medical school. General guides for residency applicants include little discussion of pathology-specific issues. Recent literature discussing pathology education is fragmented but provides invaluable insights for resident candidates. This review seeks to identify a wide variety of issues and resources as a starting point for evaluating potential training programs.

Goals and Objectives for Molecular Pathology Education in Residency Programs

Increasing knowledge of the molecular basis of disease and advances in technology for analyzing nucleic acids and gene products are changing pathology practice. The explosion of information regarding inherited susceptibility to disease is an important aspect of this transformation. Pathology residency programs are incorporating molecular pathology education into their curricula to prepare newly trained pathologists for the future, yet little guidance has been available regarding the important components of molecular pathology training. We present general goals for pathology training programs for molecular pathology education. These include recommendations to pathology residents for the acquisition of both basic knowledge in human genetics and molecular biology and specific skills relevant to microbiology, molecular oncology, genetics, histocompatibility, and identity determination. The importance of residents gaining facility in integrating data gained via nucleic acid based-technology with other laboratory and clinical information available in the care of patients is emphasized.

Survey of Management Training in United States and Canadian Pathology Residency Programs

One hundred seventy-six United States and Canadian pathology residency programs were surveyed to assess the status of management training for residents. Specific questions in the survey concerned approaches to management, instructional methods used, topics covered, and length of management rotations. Eighty-four programs (48%) responded to the survey. This group represented a cross section of all programs as to location, size, and type of program. Of the 84 programs, 81 (96%) offered management training, while 54 programs (64%) offered a management course. Management training usually occurred in combination with other rotations, most frequently clinical pathology subspecialties. A dedicated management rotation was reported in 19 programs (23%). The most common method of instruction was apprenticeship/mentor followed by didactic lecture. A majority of programs used multiple instructional methods. The five most frequently covered topics were budgets, personnel issues, quality assurance, utilization, and instrument evaluation, but a wide variety of topics were included in management curricula surveyed. There was an emphasis on clinical laboratory administration. Nonpathologist instructors, such as medical technologists, hospital administrators, and business executives, were used for formal didactic exercises, while teaching by pathologists occurred predominantly by mentoring during clinical pathology rotations.

A Leadership-Management Training Curriculum for Pathology Residents

Leadership and management skills are increasingly critical to the success of pathologists in and outside of academic centers. We describe a leadership and management curriculum in a combined anatomic and clinical pathology residency program. The mentor-based approach incorporates leadership and management skills throughout the residency with a dedicated 2-month rotation during the final year of training. This 2-month rotation is led by a senior faculty pathologist mentor and includes active participation in management activities, small group discussions, reading, and a management process project. The topics for the small group discussions, reading list, mentor-based activities, and completed management process projects are described. Outcomes and evaluations are reported for residents who have completed this curriculum in leadership and management.

The ASCP Resident Physician Section: results of surveys pertaining to "graduated responsibility for residents in anatomic pathology". American Society of Cytopathology.

Graduated responsibility for residents in anatomic pathology has been the subject of discussion among supervising staff and residents during the past few years. Presently a wide variation exists within pathology residency programs in the United States both in the degree of autonomy given to residents and in the areas of anatomic pathology (ie, surgical pathology, cytopathology, and autopsy pathology) within which the autonomy is granted. Recent surveys of supervising staff and residents have indicated a willingness to increase the level of independence for residents, especially at senior levels. Impediments include reimbursement, credentialing, and medicolegal issues. The results of the ASCP-Resident Physician Section (RPS) surveys pertaining to graduated responsibility for residents in anatomic pathology are discussed.

Medical informatics training in pathology residency programs.

Computers and information technology are increasingly used by pathologists, necessitating training in such technology in pathology residency programs. We surveyed 176 programs in the United States and Canada to assess informatics training in terms of instructional methods used, computer availability, and type of training offered. Eighty-four programs replied, for a response rate of 48%. Ninety percent of programs reported offering formal informatics training, but only 68% of programs required it. A rotation dedicated to teaching informatics was provided in 24% of the programs; in 44% of programs, informatics was integrated with other rotations. The most common instructional methods used were hands-on experience with microcomputers and the use of tutors. In 94% of programs, computers were available for resident use; in 60%, residents had individual computers assigned to them. Five programs offered a dedicated informatics rotation but did not provide residents with individual computers, and 22 programs required informatics training but did not provide residents with individual computers. Comparison of these data with data from 1993 shows an increase in programs offering (90% vs 84%) or requiring (68% vs 59%) informatics. Fewer programs offer a dedicated rotation (24% vs 31%) or integrate informatics training with other rotations (44% vs 69%). These data suggest that although informatics training is considered important by most training programs, inadequate resources and lack of formal, structured programs may limit training.

American Society of Clinical Pathologists–Resident Physician Section:Results of Autopsy Survey (Winter 1994–1995)

The recent debate on autopsy and the role of this unique doctor-patient relationship in the modern medical profession prompted the Resident Physician Section of the American Society of Clinical Pathologists to conduct a survey on postmortem practice as it relates to pathology residents. A total of 102 of 176 (58%) Resident Physician Section (RPS) liaisons from pathology residency programs in the United States, Canada, and Puerto Rico responded to a survey that consisted of 30 questions. The findings of the survey confirm the decrease in autopsy numbers, highlighting the problem of providing sufficient autopsy training to pathology residents. Interestingly, the majority of programs showed a striking similarity with regard to basic autopsy protocol procedures. Liaisons identified incorporation of clinical pathology, basic science, and clinicopathologic interaction as areas of weakness. In the final analysis, the majority of liaisons had a favorable opinion of their autopsy experience.

Fine needle aspiration of the breast: review of the technique and a comparison with excisional biopsy

Fine needle aspiration of the breast: review of the technique and a comparison with excisional biopsy

Current status of US programs for training clinical laboratory scientists and anticipated impact of healthcare reform

We surveyed directors of medical technology (MT) and postdoctoral clinical chemistry (CC) training programs and of clinical pathology (CP) and combined anatomic/clinical pathology (AP/CP) residency programs regarding the number, quality, training emphasis, and job-placement experience of trainees for 1985-95 as well as the directors' opinions on the impact of "healthcare reform." Responses were received from directors of 94 of 249 (38%) MT programs, 14 of 15 (93%) CC programs, and 63 of 138 (46%) pathology residency programs. In all four categories the numbers of trainees have increased steadily over the last 5 to 7 years but are expected to remain stable or decrease slightly. Directors of MT and CC programs expect increasing difficulty placing their graduates; directors of AP/CP and CP residency programs do not. Although > 60% of MT graduates have entered private hospitals, this is anticipated to decrease, with a concomitant increase in university hospital placements. Of the AP/CP residents, > 60% and < 5% accepted service- and research-oriented positions, respectively. In contrast, 83% of CP residents entered university hospitals, with half of these taking research-oriented positions. Among CC graduates, 41% joined university hospitals and 10-15% accepted positions in each of either private hospitals or industry or reference laboratories. The emphasis of training varies, with clinical service and pathophysiology the major focus in AP/CP programs. CP and CC programs take two distinct approaches--some accentuating management, and others emphasizing research. Finally, MT program directors appear the most optimistic regarding the opportunities that healthcare reform may present.

A quality assurance program for clinical pathology residents.

A quality assurance study was undertaken to examine the clinical pathology residency program at Cedars-Sinai Medical Center. During a three-month period, clinical pathology residents kept a log of all the problems encountered while "on-call." A staff pathologist rated the performance of the resident in terms of how well he or she solved each problem. Of the 109 calls evaluated, one was judged to have been handled incorrectly, and 7 others were considered to have been answered in a conditional manner. The Blood Bank generated the largest number of calls (66), and requests for blood products were the single most common call (29). The review of all on-call problems with staff pathologists proved to be a valuable educational tool, both for the residents and staff. In addition, the study served as an impetus for development of a useful program for evaluating and, if necessary, correcting decisions made by pathology residents.

Megatrends in pathology practice: implications for residency training. Ninth Conference for pathology residency program directors--a summary.

The participants at the Ninth Conference for Pathology Residency Program Directors clearly identified the important trends, the problems, and the opportunities now confronted by the specialty of pathology. Equally important, the speakers identified changes that should be incorporated into residency programs if we are to provide the training and education for practice in a changing medical environment. Evaluations of the program by the participants indicated it had been a valuable conference and it should be maintained as a part of each annual American Society of Clinical Pathologists/College of American Pathologists Fall Meeting.

First national in-service examination for pathology residents.

To fulfill an identified need in pathology residency program training, in 1983 the American Society of Clinical Pathologists introduced the first national in-service examination for pathology residents. This 175-item objective examination structured with seven subtest categories for various clinical rotations was administered to 1,200 residents-in-training representing 145 training programs, 40 states, and the District of Columbia. Individual norm-referenced results reports returned to each examinee, and program reports to each residency program director, indicated rank of individual examinee performance in each category and in all categories as well as with defined peer groups. Anonymity of individual results was optional to program directors. The data indicate that although performance improves with each subsequent year of residency training, the improvement is not so great as expected and that the level of performance of residents entering training was higher than anticipated. Postexamination evaluation indicated the need for this effort to continue.