Pathology Residency Training Programs Research Articles

Q-tracks: a College of American Pathologists program of continuous laboratory monitoring and longitudinal tracking.

Continuous monitoring of key laboratory indicators of quality by hundreds of laboratories in a standardized measurement program affords an opportunity to document the influence of longitudinal tracking on performance improvement by participants focused on that outcome. To describe the results of the first 2 years of participation in a unique continuous performance assessment program for pathology and laboratory medicine. Participants in any of 6 modules in the 1999 and 2000 College of American Pathologists (CAP) Q-Tracks program collected data according to defined methods and sampling intervals on standardized input forms. Data were submitted quarterly to CAP for statistical analysis. Interinstitutional comparison reports returned in 6 weeks provided each laboratory with its performance profile of key indicators and its percentile ranking compared with all participants in that quarter. This also included longitudinal comparisons of performance during previous cumulative quarters. Control charts graphically displayed data with flags identifying performance points that were out of statistical control. Hospital-based laboratories in the United States (98%), Canada, and Australia. Voluntary subscriber laboratories in the CAP Q-Tracks performance measurement program: roughly 70% from hospitals of 300 occupied beds or fewer, 65% from private, nonprofit institutions, slightly more than half located in cities, one third from teaching hospitals, and 20% with pathology residency training programs. Each module measured several major and additional minor quality indicators and unbenchmarked individualized data for internal use. Participants in 4 of 6 Q-Tracks continuous monitors demonstrated statistically significant performance improvement trends in 1999 and 2000, which were most marked for laboratories that continued participation throughout both years. These monitors were wristband patient identification, laboratory specimen acceptability, blood product wastage, and intraoperative frozen section consultation. Key continuous indicators chosen on the basis of a decade's experience in the CAP Q-Probes quality improvement program are useful measurement and benchmarking tools for laboratories to improve performance. In general, measures in which there is a broad range of demonstrable performance initially are most optimal for subsequent improvement using continuous monitoring. These studies have shown that quality is not static, but rather is a moving benchmark of performance as seen in the redefinition of benchmarks over time by participants in the first 2 years of the CAP Q-Tracks program.

Ethical and professional issues in pathology: A survey of current issues and educational efforts

Professionalism, including ethics, has assumed greater importance in residency education, and the Accreditation Council for Graduate Medical Education now requires its incorporation into residency training. Insight into current ethics education, as well as those ethical issues important to pathology, would be efficacious. A mail survey was sent to all members of the Association of Pathology Chairs that asked for specific information related to pathology resident education in ethics and identification of important ethical issues in the current practice of pathology. A total of 148 surveys were mailed, and 53 (35.8%) were returned. Formal instruction in ethics is provided by approximately 62% of pathology residency training programs, and 94% provide informal ethics education. However, 84% of programs believed that ethical issues were underrecognized, and 38% believed that current ethics training was inadequate. Issues regarding the use of tissue for research, confidentiality and privacy, and professionalism were identified as the most important ethical issues currently encountered in pathology. HUM PATHOL 33:779-782. Copyright 2002, Elsevier Science (USA). All rights reserved.

Management training for pathology residents. I. Results of a national survey.

The professional activities of anatomic and clinical pathologists involve, to a large extent, management issues. To evaluate the management training received by pathology residents, the authors surveyed pathology residency training programs in the United States. Responses were collected from 138 of 187 programs (73.8% response rate). Of the 138 programs, 61 reported that they had a formal training program in management, with an average of 26.8 +/- 4.9 (standard error) hours/year devoted to this discipline. Directors of 64.5% of the programs felt that management training should be expanded. Lectures were used in 61% of the programs, some in combination with case studies. Elements of training in fiscal management were present in 52.8% of the programs, and the presence of fiscal management training was associated significantly with a greater number of hours spent in management training (P < .001). Training in traditional laboratory management and quality control was included in 91.5% of the programs. The principles of total quality management were discussed in only 31.7% of the programs, but 80.6% of the programs encouraged residents' participation in departmental or institutional total quality management activities. These data indicate that there are major differences in the quality of and emphasis on management training for pathology residents in the United States.

Residency training in clinical chemistry: a review of behavioral objectives.

This is a discussion of behavioral objectives as they apply to the cognitive domain for the clinical chemistry component of a pathology residency training program. Emphasis is placed upon those objectives most characteristic of this hybrid specialty: and although they are formulated in broad terms, specific typical examination questions are offered under each of the categories, which include: setting priorities in selecting and instituting new laboratory tests; choosing between alternative instruments and methods; setting tolerance limits for quality control results; correctly implementing quality control, including all of the various methods; proceeding independently with follow-up procedures when indicated; consulting with medical students, hospital house staff, and attending staff with specific diagnostic and prognostic problems related to specific patients. Attention is also given to more purely technical behavior, such as trouble-shooting methods and instruments, and mathematical problem solving.