Resident In-service Examination Research Articles

Detecting residents at risk of attrition – A Singapore pathology residency's experience

The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes.Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.

Resident Physician “Moonlighting” for On-call in Transfusion Medicine: Educational Impact and Preparedness for Practice

Abstract Introduction/Objective Resident physician moonlighting is controversial and uncommon in Pathology, usually limited to anatomic pathology grossing support. Due to an acute staffing shortage in our department, we offered senior AP/ CP residents in our program a “moonlighting” opportunity involving partnership with attendings to supervise junior residents for transfusion medicine on-call (TMO) . Given the conflicting claims of educational benefit and detriment of moonlighting, we sought to evaluate impact of TMO moonlighting activities on residents' educational experience and preparedness for clinical practice. Methods/Case Report Residents selected for moonlighting TMO were PGY-3/4, “exceeded expectations” on their transfusion medicine rotation and had taken resident TMO. After initial “boot camp” exercises involving common TMO scenarios, they were added to the attending on-call schedule with a fair financial incentive. They were the first resource and provided in-person support for the TMO resident. Attendings were available for consultation via a secure communications platform (phone and text). After one year, residents were surveyed regarding overall experience, sense of graduated responsibility, impact of financial incentive, preparedness for future practice, and impact on day- time service commitment. "Resident In-Service Examination" (RISE) score was used to estimate impact of TMO on medical knowledge. Results (if a Case Study enter NA) NA. Conclusion Four out of the five residents took the survey. All 4 responded “definite” for positive experience, feeling of graduated responsibility and preparedness for practice. Financial incentive was assessed favorably. No resident reported an adverse impact on their daytime service responsibility. The group median score on RISE transfusion medicine 2022 was 75th percentile with median increase in 10 percentile points. As pathology moves towards sub- specialty practice, working fluency in some areas such as TMO remains a necessity for smaller group practices. Our experience (albeit with a small group of residents) suggests that TMO moonlighting activities may better prepare the residents for this unmet need.

The Northwestern University Novel Urology Residency Curriculum: Updated Outcomes from a 13-Year Experience with Flexible Residency Training and Electives.

We evaluated educational outcomes and satisfaction following institution of a novel, flexible and urology-driven resident curriculum. A new urology resident curriculum was instituted at Northwestern University in 2006. Rotation schedules and resident electives were recorded annually. Operative case logs and American Urological Association In-Service Examination scores were collected prospectively. Residents and faculty rated satisfaction with the residency program on a 5-point Likert scale from "poor" to "outstanding." Differences in cases logged, In-Service Examination scores and satisfaction ratings under the new and prior curricula were compared. Curriculum changes included full 5-year urology oversight of the residency curriculum by the program director, 8 months of urology rotations in the first postgraduate year and 2 months of general surgery during the second postgraduate year. General surgery rotations were modified annually based on educational rationale and feedback. Cases logged per resident and In-Service Examination scores were comparable between old and new curricula groups. All residents matriculating under the new curriculum took and passed their written boards. The percentage of faculty and residents describing the program as "outstanding" increased from 50% in 2004‒2005 to 82% in 2017‒2018. Program satisfaction increased significantly when comparing the first and last 6 years (percent rating "outstanding": 56.1±2.1% vs 71.6±10.0%, p=0.028). After 13 years with the novel curriculum, resident case numbers and In-Service Examination scores remained similar while faculty/resident satisfaction increased. Direct control of general surgery rotations enabled adjustments based on educational rationale. These results demonstrate that a urology-directed and flexible residency program can be instituted without compromising learner outcomes.

EDITORIAL COMMENT

Critically analyzing the state of training in urology residencies and looking for areas of improvement is a vital area of research to ensure we are passing the baton into reliable hands. In this manuscript, the authors attempt to evaluate the effect of the presence of a fellowship trained andrology and sexual medicine specialist (FTAUS) to resident in-service examination (ISE) scores. This is a follow up study from their previous broader study investigating areas of poor subject performance on the ISE.

Impact of Fellowship-Trained Andrology and Sexual Medicine Specialists on Performance on the Annual American Urological Association In-Service Examination

To demonstrate the distribution and impact of fellowship-trained andrology and/or sexual medicine urological specialists (FTAUS) on resident in-service examination (ISE) performance. Residency program websites were accessed to create a database of FTAUS in the United States between 2007 and 2017. This database was reviewed by three separate FTAUS and cross referenced with membership lists to the Sexual Medicine of North America Society and the Society for the Study of Male Reproduction. De-identified ISE scores were obtained from the American Urological Association from 2007-2017 and scores from trainees at programs with a FTAUS were identified for comparison. Resident performance was analyzed using a linear model of the effect of a resident being at a program with an FTAUS, adjusting for post-graduate year. ISE data from 13,757 residents were obtained for the years 2007-2017. The number of FTAUS in the United States increased from 40-102 during this study period. Mean raw scores on the "Sexual Dysfunction, Endocrinopathy, Fertility Problems" (SDEFP) section of the ISE ranged from 52.1% ± 17.7% to 65.7% ± 16% (mean ± SD). Throughout the study period, there was no difference in performance within the SDEFP section (P < .01). Residents at a program with a FTAUS answered 0.95% more questions correctly in the SDEFP than those without a FTAUS (P < .001). For these residents, there was an improvement of approximately 0.66% on the percentage of questions answered correctly on the ISE overall (P < .001). Performance improved significantly as residents progressed from PGY-2-PGY-5. There is a small but statistically significant improvement in overall ISE and SDEFP sub-section performance.

Hot Seat Diagnosis.

Competency-based medical education relies on frequent formative in-service assessments to ascertain trainee progression. Currently at our institution, trainees receive a summative end-of-rotation In-Training Evaluation Report based on feedback collected from staff pathologists. There is no method of simulating report sign-out. To develop a formative in-service assessment tool that is able to simulate report sign-out and provide case-by-case feedback to trainees. Further, to compare time- versus competency-based assessment models. Twenty-one pathology trainees were assessed for 20 months. Hot Seat Diagnosis by trainees and trainee assessment by pathologists were recorded in the laboratory information system. In the first iteration, trainees were assessed by using a time-based assessment scale on their ability to diagnose, report, use ancillary tests, comment on clinical implications, and provide intraoperative consultation and/or gross cases. The second iteration used a competency-based assessment scale. Trainees and pathologists completed surveys on the effectiveness of the In-Training Evaluation Report versus the Hot Seat Diagnosis tool. Scores from both iterations correlated significantly with other assessment tools including the Resident In-Service Examination (r = 0.93, P = .04 and r = 0.87, P = .03). The competency-based model was better able to demonstrate improvement over time and stratify junior versus senior trainees than the time-based model. Trainees and pathologists rated Hot Seat Diagnosis as significantly more objective, detailed, and timely than the In-Training Evaluation Report, and effective at simulating report sign-out. Hot Seat Diagnosis is an effective tool for the formative in-service assessment of pathology trainees and simulation of report sign-out, with the competency-based model outperforming the time-based model.

Levering adult learning principles into a residency core curriculum.

Levering adult learning principles into a residency core curriculum.

Engaging Pathology Residents in Clinical Chemistry: The Essential Ingredient Is a Committed Teacher.

Pathology residents are thought to show a lack of interest in clinical chemistry, therefore potentially graduating from training programs unprepared to function as laboratory directors and clinical consultants. A structured program of tutorials based primarily on Henry's textbook, supplemented by recent review articles; a question bank of about 600 questions to emphasize key concepts; requirement for performing and presenting quality improvement projects; participation in on-site CAP inspections; review of reference laboratory test requests; and involving residents in scholarly activity have resulted in sustained, transferable, and significant improvements in engagement, knowledge, competence, and examination scores. The primary parameter for measuring change in resident competence and engagement were improvements in resident in-service examination (RISE) scores, publications in peer-reviewed journals, and receipt of awards. The revised program produced significant improvement in RISE scores in clinical chemistry, over and above the improvements in the general residency program. The residents were authors on 12 publications in peer-reviewed PubMed listed journals in the 5-year period since revision in the clinical chemistry curriculum compared to no publications in clinical chemistry in the 5-year period before the new curriculum. Over the past 2 years, 6 of the 11 publications by graduating residents were in clinical chemistry, and 6 of 7 awards for research were garnered by residents engaged in clinical chemistry investigations. All of the residents passed their clinical pathology boards on first attempt since the change compared to 2 failures in the prior 5-year period. The structured program described here is important as a template that could be adopted by any pathology training program. The question bank developed by this program is a valuable and transferable aid. However, success of such a program is dependent on the commitment of a knowledgeable, dedicated, and passionate teacher.

Integration of Genomic Medicine in Pathology Resident Training.

To assess current pathology resident training in genomic and molecular pathology. The Training Residents in Genomics (TRIG) Working Group has developed survey questions for the pathology Resident In-Service Examination (RISE) since 2012. Responses to these questions, as well as knowledge questions, were analyzed. A total of 2,529 residents took the 2019 RISE. Since 2013, there has been an increase in postgraduate year 4 (PGY4) respondents indicating training in genomic medicine (58% to approximately 80%) but still less than almost 100% each year for molecular pathology. In 2019, PGY4 residents indicated less perceived knowledge and ability related to both genomic and traditional molecular pathology topics compared with control areas. Knowledge question results supported this subjective self-appraisal. The RISE is a powerful tool for assessing the current state and also trends related to resident training in genomic pathology. The results show progress but also the need for improvement in not only genomic pathology but traditional molecular pathology training as well.

Quantification of the Effectiveness of a Residency Program Using the Resident In-Service Examination

This study describes a quantitative tool in the assessment of residency programs, in which national ranking of residents after the resident in-service examination in postgraduate year 4 is compared to that in postgraduate year 1. The relationship between training and changes in ranking, resident in-service examination results before and after training in specific areas are also compared. To illustrate the use of this novel approach, data from a large residency program were analyzed. The 70 residents were ranked as a postgraduate year 1 group at the 50th national percentile. As postgraduate year 4 residents, they were ranked at the 59th percentile, a significant (P < .003) improvement. There was moderate correlation between performance in postgraduate year 1 and that in postgraduate year 4 (0.61); however, initial ranking was no indication of the final (R 2 = .34), with the exception of high performers. Training in specific areas improved ranking, demonstrating association between training and performance. In conclusion, the effectiveness of training provided by a residency program can be quantified using the resident in-service examination. This should provide a quantitative tool in the assessment of postgraduate programs.

Cytology cases of the week: an educational tool that improves trainee exposure to cytology

The Accreditation Council for Graduate Medical Education requires residents to examine 1500 cytology specimens by the end of residency. Cytology cases of the week (COWs) were instituted in 2010-2011 in an effort to increase trainee exposure to cytology. Images of 2 to 5 cases with basic clinical information are sent to residents weekly. Residents have 1 week to respond by e-mail; after which, correct answers are e-mailed. Cytology resident in-service examination (RISE) scores were used to assess the effectiveness of COWs. Additionally, a feedback survey was distributed to trainees to determine the perception of COWs as a teaching tool. An unpaired two-sided t test showed residents who participated in COWs scored 15.4% higher on the RISE than residents who participated minimally or not at all over the 5-year period (P < 0.05). In 2014-2015 and 2015-2016, when COWs were minimally and not at all offered, we saw a significant decrease in average cytology RISE scores compared with prior years when COWs were offered (P<0.05). There was no correlation between percentage of correctly submitted answers for COWs and RISE scores. The vast majority (83%) of trainees reported participating in COWs for self-study, and the majority (86%) felt participation in COWs increased their cytology knowledge. Major reasons for not participating included technical challenges and time limitations. COWs are an effective educational tool that increase resident fund of knowledge in cytology. Residents who participate in COWs perform higher on the RISE, regardless of percentage of correctly submitted answers.

Success in Implementation of a Resident In-Service Examination Review Series.

Primary pathology board certification has been correlated with senior resident in-service examination (RISE) performance. We describe our success with an annual, month-long review series. Aggregate program RISE performance data were gathered for 3 years prior to and 3 years following initiation of the review series. In addition, mean United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge scores for residents participating in each RISE examination were obtained to control for incoming knowledge and test-taking ability. Linear models were used to evaluate differences in average RISE performance prior to and following the initiation of the review series in addition to controlling for relevant covariates. Significant improvement was noted in the grand total, anatomic pathology section average, clinical pathology section average, and transfusion medicine section. Although not statistically significant, improvement was noted on the cytopathology and clinical chemistry sections. There was no significant difference in scores in hematopathology, molecular pathology, and the special topics section average. In addition, improvement in primary pathology board certification rates was also noted. Institution of a month-long RISE review series demonstrated improved overall performance within our training program. The success could easily be replicated in any training program without significant disruption to an annual didactic series.

Forensic Pathology Education in Pathology Residency: A Survey of Current Practices, a Novel Curriculum, and Recommendations for the Future

Forensic pathology is a fundamental part of anatomic pathology training during pathology residency. However, the lack of information on forensic teaching suggests the highly variable nature of forensic education. A survey of pathology residency program directors was performed to determine key aspects of their respective forensic rotations and curriculum. A total of 38.3% of programs from across the country responded, and the survey results show 5.6% don’t require a forensic pathology rotation. In those that do, most forensic pathology rotations are 4 weeks long, are done at a medical examiner’s office, and require set prerequisites. A total of 21.1% of responding programs have residents who are not receiving documented evaluations for this rotation. While 39.6% of programs have a defined forensics curriculum, as many as 15% do not. Furthermore, nearly 43% of programs place no limit on counting forensic autopsies when applying for pathology board examinations. Our survey confirmed the inconsistent nature of forensic pathology training in resident education. Additionally, our curriculum was reorganized to create a more robust educational experience. A pre- and post-forensic lecture quiz and Resident In-Service Examination scores were analyzed to determine our curriculum’s impact and effectiveness. Analysis of our pre- and post-lecture quiz showed an improved overall average as well as an increase in Resident In-Service Examination scores, indicating improved general forensic pathology knowledge. Using this knowledge, along with changes in our curriculum, we generated a number of recommendations for improving forensic pathology education in pathology residency.

Correlation Between Scores on Weekly Quizzes and Performance on the Annual Resident In-Service Examination.

Medical residency education relies heavily on the use of written and oral testing as a means of assessing a learner's knowledge acquisition. In the United States, osteopathic emergency medicine residents take an annual specialty-based resident in-service examination (RISE) for this purpose. Their performance on the RISE helps direct educators' approach to teaching and training. To determine the correlative strength of residents' cumulative performance on a series of weekly in-house quizzes with their performance on the RISE. In this prospective study, emergency medicine residents took a series of 15 quizzes between August 2013 and January 2014. The quizzes were administered using slides integrated with an audience-response system. Quizzes comprised questions gathered from various question banks and commercial test review resources specific to the specialty of emergency medicine. Effort was made to select questions covering topics tested on the RISE. Scores from each of the quizzes were recorded, and these data were analyzed for correlation with residents' scores on the RISE. Sixteen emergency medicine residents from all 4 postgraduate years participated in the study. For various reasons (vacation, illness, away rotations), not all 16 residents participated in each quiz. The mean participation rate over all 15 quizzes was 76.7%, with a mean quiz score of 57.8%. A correlation analysis was conducted between the achieved RISE score and the mean quiz score (excluding any quizzes not taken). Graphical analysis revealed a sufficiently linear relationship between the 2 variables, with no outliers. Both variables were normally distributed, as assessed by the Shapiro-Wilks test (P>.05). A strong positive correlation was found between RISE score and mean quiz score (r[14]=0.75; P=.001), with the mean quiz score over the quizzes taken explaining about 57% of the variance in the achieved RISE score. The results of this study imply that performance on weekly didactic quizzes may be strongly predictive of RISE performance and as such tracking these data may provide insight to educators and learners as to the most effective direction of their educational efforts.

The current state of resident training in genomic pathology: a comprehensive analysis using the resident in-service examination.

To determine the current state of pathology resident training in genomic and molecular pathology. The Training Residents in Genomics (TRIG) Working Group developed survey and knowledge questions for the 2013 pathology Resident In-Service Examination (RISE). Sixteen demographic questions related to amount of training, current and predicted future use, and perceived ability in molecular pathology vs genomic medicine were included, along with five genomic pathology and 19 molecular pathology knowledge questions. A total of 2,506 pathology residents took the 2013 RISE, with approximately 600 individuals per postgraduate year (PGY). For genomic medicine, 42% of PGY-4 respondents stated they had no training, compared with 7% for molecular pathology (P < .001). PGY-4 residents' perceived ability, comfort in discussing results, and predicted future use as a practicing pathologist were reported to be less in genomic medicine than in molecular pathology (P < .001). Based on PGY, knowledge question scores showed a greater increase in molecular pathology than in genomic pathology. The RISE is a powerful tool for assessing the state of resident training in genomic pathology and current results suggest a significant deficit. The results also provide a baseline to assess future initiatives to improve genomics education for pathology residents such as those developed by the TRIG Working Group.

Correlation of the Emergency Medicine Resident In-Service Examination with the American Osteopathic Board of Emergency Medicine Part I

Introduction: Eligible residents during their fourth postgraduate year (PGY-4) of emergency medicine (EM) residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM) Part 1 Board Certifying Examination (AOBEM Part 1). All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE) annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year.Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME). The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC) curve was generated to depict the relationship.Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r=0.61, 95% confidence interval [CI] 0.54 to 0.66). Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65th percentile score on the RISE.Conclusion: We have shown there is a strong correlation between a resident's percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well prepared they are for the AOBEM Part 1 Board Certifying Examination.

A compulsory examination in pathology: redundant or necessary?

In this issue Lehr et al. describe the compulsory examination used by the Swiss Society of Pathology to assess senior residents, and thereby assure the professional competence of its future qualified members [1]. With this examination, Switzerland is, with Britain, one of the few European countries with a comprehensive examination (lasting several days) that tests the full range of theoretical and practical competencies required of a medical specialist-pathologist. There is considerable variation across Europe in the way that the final competencies of pathology trainees are assessed [2]. The reason for this variation is the fact that European countries are all entirely autonomous with regard to training, licensing and the issuing of specialty diplomas in postgraduate medical education. For example, in pathology six countries do not require any form of testing at all at the end of specialty training. In the remaining 26 there is considerable heterogeneity of testing [2], with autopsy competency tested in 11, gross specimen examination and sampling in 9 and cytology in 18. No exact data about the duration of these examinations are known. Harmonization of training and the assessment of its effectiveness in producing competent specialists has proven to be very difficult because very few countries are willing to give up their autonomy to decide on the competencies of their medical specialists, to be acquired during residency training. This is in stark contrast to many countries where obligatory specialty examinations, sometimes with considerable failure rates, are the norm. Examples include the North American specialty boards and the examinations of the British Royal Colleges [3, 4]. For the Royal College of Pathologists, examinations are one of the principal benchmarks by which trainees are judged to have reached professional competence. The British examinations are still copied in one form or another by their old colonies (e.g. Australia, Canada, many African countries). When one of us (JGvdT) was an external examiner in Zimbabwe in the 90’s it was much more difficult to become a pathologist there (or indeed a specialist in any medical discipline) than in the Netherlands and many other European countries. The same applies e.g. to Tanzania where, to progress further in the specialty, residents have to pass a general pathology examination already after 6 months of training. To tackle this diversity in training and testing in 1997 the European Board of Pathology (EBP) of the European Union of Medical Specialists (UEMS), introduced an annual voluntary examination for senior pathology residents, based upon a similar examination successfully introduced by the European Board of Urology. Although introduction of the examination was supported by a large majority of the members of EBP, due to the lack of any consequence of failing, and poor support by senior pathologists, the test never really got off the ground and is currently taken by only a handful of people, mainly those from outside the EU hoping to increase their prospect of finding work as pathologist in Europe. The only exception is Malta where since 2011 the UEMS examinations are officially recognized for all medical specialisms. With support of a grant from the EU, the European Association of Pathology Chairs and Program Directors (EAPCP) developed a voluntary progress test (EUROPALS) [5], comparable to the American RISE (Resident In Service Examination). The latter test is given for all medical specialties in the USA and is for pathology a good outcome predictor for the American Board Examination [6]. This EUROPALS test had a high participation rate and is now, thanks to the support of the European Society of Pathology being developed as an official progress test, not only for residents but also for specialised pathologists and subspecialists. The relevant question here of course is why trainee medical specialists, including in pathology, in so many countries in Europe are not thoroughly tested at the end of their training. This is relevant in view of the results of the American and British examinations, showing that a proportion of advanced residents do not have the core competencies, as defined by senior members of the profession, considered necessary for practicing safely. As there is no suggestion that the training in the UK or USA is substandard, the question is relevant whether introduction of similar assessments across Europe would demonstrate lacunar competencies in some of the examined residents. That is not to suggest that trainees across Europe might be less competent than their North American or UK homologues, merely that as the experience in the e.g. USA and UK indicates, assessment stimulates learning. Creating a knowledgeable, thoughtful and competent pool of specialists is surely the fundamental goal of any postgraduate medical training programme.

Senior Pathology Resident In-Service Examination Scores Correlate With Outcomes of the American Board of Pathology Certifying Examinations

The Resident In-Service Examination (RISE) addresses 1 area of the Accreditation Council for Graduate Medical Education Outcome Project; RISE results demonstrate progressive attainment of pathology knowledge during training. We compared RISE scores with primary pathology board certification success for residents graduating in 2008 and 2009. Overall RISE and nearly all sectional scores in anatomic and clinical pathology were significantly higher for residents passing all certifying examinations at the first attempt vs residents who failed any examination. The risk of failing increased with each lower quartile of overall RISE score, such that 34% (2009) and 54% (2008) of residents in the lowest quartile failed at least 1 certifying examination. Two thirds of graduating residents with lowest quartile scores had a similar quartile ranking in the previous RISE, identifying them as at risk. Residents passing the American Board of Pathology certifying examinations have a higher level of medical knowledge in general and specific pathology disciplines as assessed by senior RISE scores.

Matching Residents to Pathology Fellowships

Mandates for pathology training are a topic sure to surface “hot button” issues whatever the venue or whatever the combination of viewpoints gathered around the water cooler. A national pathology fellowship match administered by the National Residency Matching Program (NRMP) is the latest in a series of controversies affecting residents preparing for a future in our discipline and the programs entrusted with their education and professional development. Crawford and coauthors,1 representing the Association of Pathology Chairs (APC) and its program directors section (PRODS), argue in this issue of the Journal that a pan-pathology fellowship match is the best solution for problems exacerbated by changes in credentialing requirements for board certification in pathology. Other opinion leaders and organizations, including the Association of Directors of Anatomic and Surgical Pathology (ADASP), are unconvinced. The primary rationale for a pan-pathology fellowship match offered by Crawford and colleagues1 is the perception of “widespread dissatisfaction” among affected residents driven primarily by a single event in 2007 at which only a small fraction of the national resident pool was present and fewer still accounted for the residents sufficiently motivated to “overrun” the microphone. More inclusive data drawn from American Society for Clinical Pathology (ASCP) Resident In-Service Examination surveys showed that, in fact, only a minority of pathology residents were in favor of a fellowship match when asked in 2007 (39%), 2008 (26%), and 2010 (47%).1 Paradoxically, the same survey results showed that a consistent majority supported having a uniform fellowship application timeline. In an independent survey targeting members of the College of American Pathologists (CAP) Residents Forum and the ASCP Resident Liaison Network, only 43% of resident respondents were in favor of a match despite also identifying absence of clear and consistent application deadlines as an issue for fellowship applicants.2 These results resonate …

Legal Aspects of Laboratory Medicine and Pathology for Residents and Fellows: A Curriculum for Pathology Training Programs

Preparing residents and fellows to manage laboratories and pathology practices increasingly requires awareness of the law and a framework within which to manage legal risk in dealing with compliance, malpractice, and human resources issues. To describe a curriculum for pathology and laboratory medicine residents and fellows that highlights activities most likely to result in adverse legal outcomes and to help trainees understand when the services of an attorney may be required. The 3-hour course evolved as part of a comprehensive leadership and management curriculum designed to help meet systems-based practice and professionalism requirements. Didactic lectures and interactive case scenarios were presented, and participants then evaluated the course content and speakers on a 5-point scale (5 = high). Short-term knowledge accumulation was assessed by comparison of performance on the laboratory administration section of the Resident In-Service Examination between junior residents who had not taken the course and senior residents who did take the course. The course was evaluated by 72 trainees during a 5-year period (2004-2008); the mean overall rating was 4.6 (range, 3.5-5.0). Senior residents (n = 37) had a mean (SD) score on the Resident In-Service Examination laboratory administration section of 521 (67) for 2004 through 2008. Junior residents (n = 51), who had not yet completed the course, scored 470 (70) (P < .001) for the same period. This curriculum met the needs of professionals entering careers in laboratory medicine and pathology and can be modified for other pathology and laboratory medicine training programs.