1
|
Tay AZ, Tang PY, New LM, Zhang X, Leow WQ. Detecting residents at risk of attrition - A Singapore pathology residency's experience. Acad Pathol 2023; 10:100075. [PMID: 37095782 PMCID: PMC10121803 DOI: 10.1016/j.acpath.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/21/2023] [Accepted: 02/05/2023] [Indexed: 04/26/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Amos Z.E. Tay
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Corresponding author. Department of Anatomic Pathology, Singapore General Hospital, Academia, Level 10, Diagnostic Tower, 20 College Road, Singapore, 169856, Singapore.
| | - Po Yin Tang
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Lee May New
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
| | - Xiaozhu Zhang
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
| | - Wei-Qiang Leow
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| |
Collapse
|
2
|
Brunyé TT, Balla A, Drew T, Elmore JG, Kerr KF, Shucard H, Weaver DL. From Image to Diagnosis: Characterizing Sources of Error in Histopathologic Interpretation. Mod Pathol 2023; 36:100162. [PMID: 36948400 DOI: 10.1016/j.modpat.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
An accurate histopathologic diagnosis on surgical biopsy material is necessary for the clinical management of patients and has important implications for research, clinical trial design/enrollment, and public health education. This study used a mixed methods approach to isolate sources of diagnostic error while residents and attending pathologists interpreted digitized breast biopsy slides. Ninety participants including pathology residents and attendings at major United States medical centers reviewed a set of 14 digitized whole slide images of breast biopsies. Each case had a consensus-defined diagnosis and critical region of interest (cROI) representing the most significant pathology on the slide. Participants were asked to view unmarked digitized slides, draw their own participant region of interest (pROI), describe its features, and render a diagnosis. Participants' review behavior was tracked using case viewer software and an eye-tracking device. Diagnostic accuracy was calculated in comparison to the consensus diagnosis. We measured the frequency of errors emerging during four interpretive phases: 1) detecting the cROI, 2) recognizing its relevance, 3) using the correct terminology to describe findings in the pROI, and 4) making a diagnostic decision. According to eye tracking data, both trainees and attending pathologists were very likely (about 94% of the time) to find the cROI when inspecting a slide. However, trainees were less likely to consider the cROI relevant to their diagnosis. Pathology trainees were more likely (41% of cases) to use incorrect terminology to describe pROI features than attending pathologists (21% of cases). Failure to accurately describe features was the only factor strongly associated with an incorrect diagnosis. Identifying where errors emerge in the interpretive and/or descriptive process and working on building organ-specific feature recognition and verbal fluency in describing those features are critical steps for achieving competency in diagnostic decision making.
Collapse
Affiliation(s)
- Tad T Brunyé
- Center for Applied Brain and Cognitive Sciences, Tufts University, 177 College Ave., Suite 090, Medford, MA 02155; Department of Psychology, Tufts University, 490 Boston Ave., Medford, MA 02155.
| | - Agnes Balla
- Department of Pathology, University of Vermont and Vermont Cancer Center, 89 Beaumont Ave., Burlington, VT 05405
| | - Trafton Drew
- Department of Psychology, University of Utah, 380 S 1530 E Beh S 502, Salt Lake City, UT 84112
| | - Joann G Elmore
- David Geffen School of Medicine, Department of Medicine, University of California, Los Angeles, 885 Tiverton Drive, Los Angeles, CA 90095
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, 1705 NE Pacific Street, Seattle, WA 98195
| | - Hannah Shucard
- Department of Biostatistics, University of Washington, 1705 NE Pacific Street, Seattle, WA 98195
| | - Donald L Weaver
- Department of Pathology, University of Vermont and Vermont Cancer Center, 89 Beaumont Ave., Burlington, VT 05405
| |
Collapse
|
3
|
Nayar R, Chute D, Douglas A, Sandersfeld T, Johnson R. Harmonization of training, training program requirements, board certification, and the practice of cytopathology: data from the American Board of Pathology surveys. J Am Soc Cytopathol 2021; 10:447-458. [PMID: 34454871 DOI: 10.1016/j.jasc.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The American Board of Pathology (ABPath) has ongoing efforts to better align certification with graduate medical education, training program requirements, and pathology practice. The present study focused on the subspecialty of cytopathology. We evaluated the current content and scope of fellowship programs, practice patterns and needs of diplomates, and program director (PD) and diplomate perceptions of the ABPath certification examination to identify gaps and provide an evidence base to guide harmonization in these areas. METHODS Two surveys were administered: one directed to PDs of all 93 Accreditation Council for Graduate Medical Education (ACGME) cytopathology fellowship programs and the other to cytopathology diplomates submitting continuing certification reporting to the ABPath. RESULTS Most (86%) cytopathology diplomates work in smaller groups. Only 11% do >50% cytopathology in practice. Diplomates' cytopathology-related practice tasks varied, as did their perception of the content of fellowship training aligning with practice needs. In fellowship training programs, the specimen types, volumes, techniques of specimen acquisition, and graduated responsibility varied significantly. We identified areas in which current training and certification requirements are challenging for some programs. Diplomates and PDs had differing perceptions of the cytopathology examination; diplomates regarded image-based and microscopic glass slide questions as the best assessment of their knowledge. CONCLUSIONS First, fellowship training programs could benefit from shared resources and should provide more graduated responsibility for fellows. Second, the ACGME Review Committee could consider this data in future program requirement revisions. Finally, information from these surveys will be useful as the ABPath adjusts certification examination content and delivery.
Collapse
Affiliation(s)
- Ritu Nayar
- Professor and Vice Chair, Departments of Pathology and Medical Education, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
| | - Deborah Chute
- Associate Professor and Residency Program Director, Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Aaron Douglas
- Former Psychometrician, American Board of Pathology, Tampa, Florida
| | - Tyler Sandersfeld
- Current Psychometrician, American Board of Pathology, Tampa, Florida
| | - Rebecca Johnson
- Chief Executive Officer, American Board of Pathology, Tampa, Florida
| |
Collapse
|
4
|
Black-Schaffer WS, Robboy SJ, Gross DJ, Crawford JM, Johnson K, Austin M, Karcher DS, Johnson RL, Powell SZ, Sanfrancesco J, Cohen MB. Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications. Acad Pathol 2021; 8:23742895211002816. [PMID: 33889716 PMCID: PMC8040604 DOI: 10.1177/23742895211002816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.
Collapse
Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David J Gross
- College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Melissa Austin
- Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Donald S Karcher
- George Washington University Medical Center, Washington, DC, USA
| | | | - Suzanne Z Powell
- Weill Cornell Medical College Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
5
|
Ju JY, Wehrli G. The effect of entrustable professional activities on pathology resident confidence in blood banking/transfusion medicine. Transfusion 2020; 60:912-917. [PMID: 31970781 DOI: 10.1111/trf.15679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education requires milestone reporting of the Six General Core Competencies. Additionally, Graduate Medical Education (GME) is transitioning to adopt competency-based education methodologies including entrustable professional activities (EPAs) for objective, observable, and measurable milestone progression. The College of American Pathologists published 19 EPAs, including one for transfusion-related adverse events. This survey study includes developing EPAs for transfusion reaction evaluation and assessing residents before and after implementing these EPAs. STUDY DESIGN AND METHODS Three transfusion reaction EPAs were developed and implemented in July 2018 for the Postgraduate Year (PGY) 2 pathology residents. An online, anonymous survey was sent to all 21 pathology trainees before and one year after EPA implementation. In July 2018 and August 2019, each survey included the same six multiple-choice, single-response, confidence questions, with a rating scale of extremely, very, slightly, or not at all confident. This study was approved by the hospital's Institutional Review Board for Health Sciences Research and GME Committee. RESULTS Analysis was performed on PGY2-4 residents. In 2018, 13 of 20 participants were analyzed. In 2019, 15 of 19 participants were analyzed. Number and percentage of responses were reported. The results showed an increase in trainee confidence, with the greatest improvement among the first class to use the EPAs. CONCLUSION EPAs provide an effective framework for objective and measurable progression of trainees. One year after the implementation of transfusion reaction EPAs at our site, the trainees showed enhanced confidence levels in handling Blood Bank and Transfusion Medicine Services coverage.
Collapse
Affiliation(s)
- Jennifer Y Ju
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
| | - Gay Wehrli
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
| |
Collapse
|
6
|
Marks E, Prystowsky MB, Fox AS. How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents. Acad Pathol 2019; 6:2374289519884711. [PMID: 31799380 PMCID: PMC6859677 DOI: 10.1177/2374289519884711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/07/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.
Collapse
Affiliation(s)
- Etan Marks
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Amy S Fox
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
7
|
Findik S, Cihan FG. Pathology awareness in patients and patient's relatives applying to a pathology laboratory. Saudi Med J 2019; 40:1150-1157. [PMID: 31707413 PMCID: PMC6901770 DOI: 10.15537/smj.2019.11.24631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022] Open
Abstract
Objectives: To investigate pathology awareness in patients applying to a pathology laboratory. Method: This cross-sectional study included 150 patients and patients’ relatives. A questionnaire, prepared by the researchers according to the literature, was administered at the Pathology Laboratory, Necmettin Erbakan University, Konya, Turkey on May 2018. Results: Of the participants, 79 (52.7%) were female and 71 (47.3%) were male. The mean age was 39.56±14.16 years old. Ninety-eight (65.3%) of them thought that patients do not have right to choose their pathologist. Of the participants, 24 (16%) did not know that the medical school had to be completed in order to become a pathologist and 73 (48.7%) of them did not know that 4 years postgraduate training was required. Fifty-nine (39.3%) of the participants did not know the pathologists were a medical doctor. While 89 participants (59.4%) had no idea what “frozen section” means, 66 people (44%) did not know that the pathologist uses microscope and 64 (42.7%) of them thought that all diseases could be diagnosed 100% by pathological examination. Forty-six (30.7%) of the participants thought that all specimens are not needed to be examined. Conclusion: The knowledge and awareness of the participants about the pathology discipline came out to be inadequate.
Collapse
Affiliation(s)
- Siddika Findik
- Department of Pathology, Meram Medical School,Necmettin Erbakan University Konya, Turkey. E-mail.
| | | |
Collapse
|