National pilot of entrustable professional activities in pathology residency training

Making Pathologists Ready for the New Artificial Intelligence Era: Changes in Required Competencies

In recent years, there has been an increasing interest in developing and using artificial intelligence (AI) models in pathology. Although pathologists generally have a positive attitude toward AI, they report a lack of knowledge and skills regarding how to use it in practice. Furthermore, it remains unclear what skills pathologists would require to use AI adequately and responsibly. However, adequate training of (future) pathologists is essential for successful AI use in pathology. In this paper, we assess which entrustable professional activities (EPAs) and associated competencies pathologists should acquire in order to use AI in their daily practice. We make use of the available academic literature, including literature in radiology, another image-based discipline, which is currently more advanced in terms of AI development and implementation. Although microscopy evaluation and reporting could be transferrable to AI in the future, most of the current pathologist EPAs and competencies will likely remain relevant when using AI techniques and interpreting and communicating results for individual patient cases. In addition, new competencies related to technology evaluation and implementation will likely be necessary, along with knowing one's own strengths and limitations in human-AI interactions. Because current EPAs do not sufficiently address the need to train pathologists in developing expertise related to technology evaluation and implementation, we propose a new EPA to enable pathology training programs to make pathologists fit for the new AI era "using AI in diagnostic pathology practice" and outline its associated competencies.

Entrustable professional activities for cytopathology fellowship

Entrustable professional activities (EPAs) are an educational tool in the framework of competency-based medical education. EPAs are a relatively new concept in pathology. No studies to date exist on the utilization of EPAs during cytopathology fellowship training. This article reviews the recent literature on this topic and shares our institutional experience with the implementation of an EPA for fine needle aspirations and rapid on-site evaluations. While EPAs allow for tracking the competence of the cytopathology fellow toward independent practice for fine needle aspirations and rapid on-site evaluations, the required amount of documentation may represent a potential barrier for the widespread adoption of this new tool.

Entrustable professional activities (EPAs) in surgical pathology: implementation experience and longitudinal observations of resident development

Entrustable professional activities (EPAs) have been implemented in various medical specialties, and the Pathology National EPA Working Group has piloted the implementation of four pathology EPAs. We recently published the development of EPAs within our surgical pathology rotation. Following a six-month pilot, a survey demonstrated that faculty and residents found the forms helpful and easy to use and easy to understand, and EPAs have been fully incorporated into our surgical pathology rotation. Here, we discuss our experience, challenges, and results of resident EPA performance for intraoperative consultations (IOC) and sign-out (SO) after 21 months of implementation. Between June 2022 and March 2024, 24 residents were evaluated by 13 faculty members, resulting in 136 IOC and 298 SO EPA forms. Paper forms were predominantly used, with only five electronic forms submitted. EPA performance scores for SO increased from 2.4 ± 0.8 in Block 1 to 4.6 ± 0.2 in Block 14 (p < 0.0001), whereas performance scores for IOC increased from 2.7 ± 1.0 in Block 1 to 4.8 ± 0.2 in Block 14 (p < 0.0001). The progressive decrease in the standard deviation throughout residency denotes higher competence homogeneity as residency graduation approaches. Overall, our EPA evaluation method showed ease of use, provided valuable tracking tools, and long-term feasibility. EPAs are robust tools for tracking resident progression toward independent practice in surgical pathology, offering valuable insights for program and rotation directors to assess and track individual EPA skills, identify intervention points, and provide an opportunity for immediate, actionable feedback based on current performance.

Leveraging faculty development to support validation of entrustable professional activities assessment tools in anatomic and clinical pathology training

Entrustable professional activities (EPAs) are observable activities that define the practice of medicine and provide a framework of evaluation that has been incorporated into US medical school curricula in both undergraduate and graduate medical education. This manuscript describes the development of an entrustment scale and formative and summative evaluations for pathology EPAs, outlines a process for faculty development that was employed in a pilot study implementing two Anatomic Pathology and two Clinical Pathology EPAs in volunteer pathology residency programs, and provides initial validation data for the proposed pathology entrustment scales. Prior to implementation, faculty development was necessary to train faculty on the entrustment scale for each given activity. A "train the trainer" model used performance dimension training and frame of reference training to train key faculty at each institution. The session utilized vignettes to practice determination of entrustment ratings and development of feedback for trainees as to strengths and weaknesses in the performance of these activities. Validity of the entrustment scale is discussed using the Messick framework, based on concepts of content, response process, and internal structure. This model of entrustment scales, formative and summative assessments, and faculty development can be utilized for any pathology EPA and provides a roadmap for programs to design and implement EPA assessments into pathology residency training.