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Katsakhyan L, Devins KM, Jenkins TM, Song SJ. Transitioning From Trainee to Practicing Pathologist: A Prospective Multi-institutional Survey of the Challenges Early Career Anatomic Pathologists Encounter When Entering Independent Practice. Arch Pathol Lab Med 2024; 148:1063-1066. [PMID: 38180066 DOI: 10.5858/arpa.2023-0378-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
CONTEXT.— Pathology training programs generally prepare graduates well for the workforce, but there may be other aspects to navigating a job that make the transition from being a trainee to a practicing pathologist challenging. OBJECTIVE.— To identify perceived challenges of independent practice for early career pathologists and assess how these impressions evolve throughout their first year. DESIGN.— A survey was distributed to 12 anatomic pathology fellows from 4 institutions near the end of their final training year, and 6 months and 1 year after starting their first job. The surveys queried participants' comfort level with signing out cases independently and interacting with colleagues/trainees via Likert attitude scale questions, with free-text segments to elaborate on challenges experienced. RESULTS.— The response rate to all 3 surveys was 100%. Confidence and comfort level with different aspects of independent sign-out increased incrementally over time. Main challenges encountered at 6 months included a high case load, signing out cases in areas outside of their subspecialty, time management, balancing teaching while signing out, laboratory issues, and developing relationships with clinicians. At 12 months, main challenges included time management, high case load, understaffing, laboratory issues, and signing out cases in areas outside of their subspecialty. CONCLUSIONS.— This study identified real-time challenges faced by those adjusting to their first year of independent practice. By gaining a better understanding of the factors that make this transition challenging, we can find tailored ways to support our early career pathologists.
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Affiliation(s)
- Levon Katsakhyan
- From the Department of Pathology, Carolinas Pathology Group, Charlotte, North Carolina (Katsakhyan)
| | - Kyle M Devins
- the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Devins)
| | - Taylor M Jenkins
- the Department of Pathology, Virginia Commonwealth University Health System, Richmond (Jenkins)
| | - Sharon J Song
- the Department of Pathology, Spectrum Healthcare Partners, Portland, Maine (Song)
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2
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Harper EM, Henderson-Jackson E, Rosa M. Pathology Residents' Perceptions and Attitudes Toward Breast Pathology: A National Survey. Arch Pathol Lab Med 2024; 148:371-376. [PMID: 37270800 DOI: 10.5858/arpa.2022-0323-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 06/06/2023]
Abstract
CONTEXT.— Breast pathology (BP) is considered to be subject to interobserver variability among pathologists, emphasizing the need for adequate training. However, specifics of BP residency training have not been elucidated. OBJECTIVE.— To assess the characteristics of BP residency training in the United States. DESIGN.— A Qualtrics-managed online survey was emailed to program directors of all US pathology residency programs, requesting them to forward the survey link to their pathology residents. RESULTS.— One hundred seventeen residents' survey responses were evaluable. Most responses (92; 79%) came from residents in university hospital-based programs. Thirty-five respondents (30%) had a dedicated BP rotation in their program. Most respondents believed that BP was an important part of training (96 of 100; 96%) and pathology practice (95 of 100; 95%). Seventy-one respondents believed that their BP training was adequate overall (71 of 100; 71%). Forty-one percent of respondents indicated that they would not like BP to be a significant part of their future practice. The main reasons given were that they had a different preferred area of interest, that they lacked interest in BP, or that breast cases were time-consuming to sign out. CONCLUSIONS.— Our results show that in the United States, most programs do not offer a dedicated BP rotation, but breast cases are signed out by subspecialized or experienced breast pathologists. In addition, most respondents believed that they received adequate training and would be competent to independently sign out BP in the future. Additional studies addressing new-in-practice pathologists' proficiency in BP will further help elucidate the quality of BP training in the United States.
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Affiliation(s)
- Erika M Harper
- From the Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Evita Henderson-Jackson
- From the Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marilin Rosa
- From the Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida
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3
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Schmidt RL, White SK, Timme KH, McFarland MM, Lomo LC. Graduate Medical Education in Pathology: A Scoping Review. Arch Pathol Lab Med 2024; 148:117-127. [PMID: 37014974 DOI: 10.5858/arpa.2022-0365-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 04/06/2023]
Abstract
CONTEXT.— Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized. OBJECTIVE.— To chart the concepts, research methods, and publication patterns of studies on GME in pathology. DATA SOURCES.— This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases. CONCLUSIONS.— Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.
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Affiliation(s)
- Robert L Schmidt
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Sandra K White
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Kathleen H Timme
- the Department of Endocrinology, Eccles Primary Children's Hospital, Salt Lake City, Utah (Timme)
| | - Mary M McFarland
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Lesley C Lomo
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
- ARUP Laboratories, Salt Lake City, Utah (Schmidt, Lomo)
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4
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Baranova K, Goebel EA, Wasserman J, Osmond A. A Survey on Changes to the Canadian Anatomical Pathology Certification Examination Due to Coronavirus Disease 2019 and Implications for Competency-Based Medical Education. Acad Pathol 2021; 8:23742895211060711. [PMID: 34926797 PMCID: PMC8679023 DOI: 10.1177/23742895211060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023] Open
Abstract
The coronavirus disease 2019 pandemic resulted in a dramatic change in the Royal
College of Physicians and Surgeons of Canada assessment process through
elimination of the oral and practical components of the 2020 Anatomical
Pathology examination. Our study sought to determine stakeholder opinions and
experiences on these changes in the context of the 2019 implementation of
competency-based medical education. Surveys were designed for residents and
practicing pathologists. In total, 57 residents (estimated response rate 29%)
and 185 pathologists (estimated response rate 19%) participated across Canada;
67% of pathologists disagreed with the 2020 Royal College examination changes,
compared with 30% for residents (P = <.00001). When asked whether the Royal
College examination should be eliminated, 95% of pathologists indicated they
would be against this, compared to only 34% of residents (P = <.00001).
Perceptions on changes to and importance of different components of assessment
in competency-based medical education were similar between pathologists and
residents, with participants perceiving assessment practices to have changed
fairly little since its implementation, with the exception of more frequent
feedback. Analysis of narrative comments identified several common themes around
assessment, including the need for objectivity and standardization and the
problem of failure-to-fail. However, residents identified numerous elements of
their performance that can be assessed only through longitudinal evaluation.
Pathologists, on the other hand, tended to view these aspects of performance as
laden with bias. Our results will hopefully help guide future innovation in
assessment by characterizing different stakeholder perspectives on key issues in
medical education.
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Affiliation(s)
- Katherina Baranova
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Emily A. Goebel
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Jason Wasserman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada
| | - Allison Osmond
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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5
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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] [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.
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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
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George MR, Johnson KA, Gratzinger DA, Brissette MD, McCloskey CB, Conran RM, Dixon LR, Roberts CA, Rojiani AM, Shyu I, Timmons CF, Hoffman RD. Will I Need to Move to Get My First Job?: Geographic Relocation and Other Trends in the Pathology Job Market. Arch Pathol Lab Med 2019; 144:427-434. [DOI: 10.5858/arpa.2019-0150-cp] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
There is an ongoing perception that the pathology job market is poor, which may be discouraging medical students from pursuing the specialty. Academic pathologists believe that jobs are available but relocation may be necessary.
Objective.—
To identify trends regarding the geographic relocation of pathologists taking their first job after training.
Design.—
The College of American Pathologists (CAP) Graduate Medical Education Committee has sent an annual job search survey from 2012–2016 to CAP junior members and fellows in practice for 3 years or less and seeking their first job. Data were analyzed across demographics and geographic domains consisting of the following: stayed at same institution/city, relocated within the same region, or relocated to a different region. Standard statistical methods were used.
Results.—
Of 501 respondents, 421 reported completing combined anatomic pathology (AP)/clinical pathology (CP) training, while 80 reported AP- or CP-only training. Of the 421 AP/CP respondents, 109 (26%) stayed at the same institution or city, while of the 80 AP- or CP-only respondents, 36 (45%) stayed at the same institution or city. One hundred ninety-nine respondents completed surgical pathology fellowships with 124 (62%) general/oncologic surgical pathology and 75 (38%) subspecialty surgical pathology trainees. Job seekers who completed general surgical pathology/surgical oncologic pathology fellowship accounted for 34 of 52 (65%) of those remaining at the same institution or city, while those with subspecialty training accounted for 40 of 77 (52%) of those relocating to a different region. Relocation did not demonstrate any significant trends in regard to other demographics studied.
Conclusions.—
The pathology job market appears stable with no precedent for geographic hardship.
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Affiliation(s)
- Melissa R. George
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Kristen A. Johnson
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Dita A. Gratzinger
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Mark D. Brissette
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Cindy B. McCloskey
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Richard Michael Conran
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Lisa R. Dixon
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Cory Anthony Roberts
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Amyn M. Rojiani
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Irene Shyu
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Charles Franklin Timmons
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
| | - Robert D. Hoffman
- From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Depart
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7
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Jajosky RP, Banks M, Jajosky AN. Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency. Heliyon 2019; 5:e02400. [PMID: 31528744 PMCID: PMC6742846 DOI: 10.1016/j.heliyon.2019.e02400] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/21/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022] Open
Abstract
From 2010 to 2019, 40.5% fewer senior students from United States (US) allopathic medical schools pursued pathology in the Main Residency Match. To possibly explain this trend, we sought to identify major concerns about pathology which were made during this time. Because the Student Doctor Network (SDN) website is widely used by students at American medical schools during the residency application process, SDN has been shown to influence career decisions. So, the 50 all-time most-viewed SDN pathology threads (as of February 2018) were analyzed. The words “job” and “jobs” were used in the title of 11 of the 50 (22%) threads, which altogether received more than 400,000 views. However, the term “job(s)” was rarely used by 14 other major medical specialties. Seven of the 11 (63.6%) job-related threads were created from 2009 to 2011, corresponding with the start of the decline in medical students pursuing pathology residency. It was reasoned that job-market concerns within SDN threads may have discouraged students from pursuing pathology. To test this hypothesis, 5 pathology residents were asked to read all 11 threads and then complete a survey. Most thread reviewers agreed that commenters, which included medical students, were concerned about the pathology job-market and that medical students who viewed the threads would be less likely to pursue pathology residency. Because more than 85% of SDN users are from the US, the threads likely had a greater impact on American medical students compared to foreign students. In conclusion, job-market concerns over the past decade are so prominent in the SDN pathology forum that they likely contributed to fewer seniors from US allopathic medical schools pursuing pathology residency. As of 2019, there are 12 job-related threads among the 50 all-time most-viewed, including threads created in 2016 and 2017. To improve recruitment, the pathology community should carefully review and address concerns about employment opportunities. Due to conflicting reports, additional studies are needed to determine if a mismatch in workforce supply and demand warrants prompt and thoughtful intervention.
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Affiliation(s)
- Ryan Philip Jajosky
- Emory University, Department of Pathology, Atlanta, GA, USA
- Biconcavity Inc., 1106 Spring Mill Dr. SW, Lilburn, GA 30047, USA
- Corresponding author.
| | - Mara Banks
- Augusta University Medical Center, Department of Pathology, 1120 15th Street, Augusta, GA 30912, USA
| | - Audrey N. Jajosky
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Department of Pathology, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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8
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Roth CG, Eldin KW, Padmanabhan V, Friedman EM. Twelve tips for the introduction of emotional intelligence in medical education. MEDICAL TEACHER 2019; 41:746-749. [PMID: 30032720 DOI: 10.1080/0142159x.2018.1481499] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Emotional intelligence (EI) is the ability to recognize, understand, and manage emotions in yourself and in others. EI has long been recognized as a critical component for individual and organizational success within the business realm, and there is emerging evidence that enhancing EI is equally important in the medical setting. EI can improve interpersonal communications, enable constructive conflict resolution, and promote a culture of professionalism. As healthcare becomes increasingly team-based, proficiency in EI will be required to build consensus among multidisciplinary stakeholders, and effect change in attitudes and behaviors that result in improved patient safety and clinical outcomes. Based on the existing literature and the authors' experiences, these 12 tips provide practical suggestions on how to introduce EI into a medical curriculum. These tips have broad applicability, and can be implemented in courses on topics such as professionalism, leadership development, empathy, patient safety, or wellness.
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Affiliation(s)
- Christine G Roth
- a Department of Pathology & Immunology , Baylor College of Medicine , Houston , Texas , USA
| | - Karen W Eldin
- a Department of Pathology & Immunology , Baylor College of Medicine , Houston , Texas , USA
| | | | - Ellen M Friedman
- b Center for Professionalism , Baylor College of Medicine , Houston , Texas , USA
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9
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The Implementation of an Introductory Surgical Pathology Didactic Series to Transition First Year Residents and Facilitate Upper Level Resident Teaching. Adv Anat Pathol 2019; 26:210-214. [PMID: 30789357 DOI: 10.1097/pap.0000000000000229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The increasing complexity of the practice of pathology and health care in general requires that pathology residents acquire a vast number of skills during their training. This has been reflected by the broad range of skills addressed in the Accreditation Council for Graduate Medical Education (ACGME) milestones. In order to address some of these milestones, our residency program instituted an introductory didactic series in surgical pathology that focused on 2 objectives. First, the didactics provided basic grossing and histology training to first year residents transitioning from medical school. Second, the sessions allowed upper level residents to refine their teaching and communication skills at the microscope and therefore served as an important career development tool. Surveys of both first year residents and the upper level residents that led these sessions confirm the utility of these didactics and the use of upper level residents to teach junior trainees. In addition, these sessions led to a dramatic increase in RISE scores among first year trainees. An introductory series with upper level residents leading slide sessions could easily be replicated at other institutions and provide similar benefits.
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10
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Conran RM, Powell SZE, Domen RE, McCloskey CB, Brissette MD, Cohen DA, Dixon LR, George MR, Gratzinger DA, Post MD, Roberts CA, Rojiani AM, Timmons CF, Johnson K, Hoffman RD. Development of Professionalism in Graduate Medical Education: A Case-Based Educational Approach From the College of American Pathologists' Graduate Medical Education Committee. Acad Pathol 2018; 5:2374289518773493. [PMID: 30014035 PMCID: PMC6039899 DOI: 10.1177/2374289518773493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Professionalism and physician well-being are important topics in academic medicine. Lapses in professional judgment may lead to disciplinary action and put patient's health at risk. Within medical education, students and trainees are exposed to professionalism in the institution's formal curriculum and hidden curriculum. Development of professionalism starts early in medical school. Trainees entering graduate medical education already have developed professional behavior. As a learned behavior, development of professional behavior is modifiable. In addition to role modeling by faculty, other modalities are needed. Use of case vignettes based on real-life issues encountered in trainee and faculty behavior can serve as a basis for continued development of professionalism in trainees. Based on the experience of program directors and pathology educators, case vignettes were developed in the domains of service, research, and education and subdivided into the areas of duty, integrity, and respect. General and specific questions pertaining to each case were generated to reinforce model behavior and overcome professionalism issues encountered in the hidden curriculum. To address physician burnout, cases were generated to provide trainees with the skills to deal with burnout and promote well-being.
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Affiliation(s)
- Richard M. Conran
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Ronald E. Domen
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Cindy B. McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - David A. Cohen
- Emory University Hospital, Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Lisa Ross Dixon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melissa Robin George
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Dita A. Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Miriam D. Post
- Department of Pathology, University of Colorado—Anschutz Medical Campus, Aurora, CO, USA
| | | | - Amyn M. Rojiani
- Department of Pathology, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | | | | | - Robert D. Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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11
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Mehr CR, Obstfeld AE, Barrett AC, Montone KT, Schwartz LE. Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center. Acad Pathol 2017; 4:2374289517736344. [PMID: 29209658 PMCID: PMC5704696 DOI: 10.1177/2374289517736344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/23/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022] Open
Abstract
Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.
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Affiliation(s)
- Chelsea R Mehr
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amrom E Obstfeld
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda C Barrett
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren E Schwartz
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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12
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Gratzinger D, Johnson KA, Brissette MD, Cohen D, Rojiani AM, Conran RM, Hoffman RD, Post MD, McCloskey CB, Roberts CA, Domen RE, Talbert ML, Powell SZ. The Recent Pathology Residency Graduate Job Search Experience: A Synthesis of 5 Years of College of American Pathologists Job Market Surveys. Arch Pathol Lab Med 2017; 142:490-495. [PMID: 29210592 DOI: 10.5858/arpa.2017-0207-cp] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Pathology residents and fellows tailor their training and job search strategies to an actively evolving specialty in the setting of scientific and technical advances and simultaneous changes in health care economics. OBJECTIVE - To assess the experience and outcome of the job search process of pathologists searching for their first non-fellowship position. DESIGN - The College of American Pathologists (CAP) Graduate Medical Education Committee has during the past 5 years sent an annual job search survey each June to CAP junior members and fellows in practice 3 years or less who have actively searched for a non-fellowship position. RESULTS - Job market indicators including job interviews, job offers, positions accepted, and job satisfaction have remained stable during the 5 years of the survey. Most survey respondents who had applied for at least 1 position had accepted a position at the time of the survey, and most applicants who had accepted a position were satisfied or very satisfied. However, most attested that finding a non-fellowship position was difficult. Despite a perceived push toward subspecialization in surgical pathology, the reported number of fellowships completed was stable. Respondent demographics were not associated with job search success with 1 significant exception: international medical school graduate respondents reported greater perceived difficulty in finding a position, and indeed, fewer reported having accepted a position. CONCLUSIONS - Pathology residents and fellows seeking their first position have faced a relatively stable job market during the last 5 years, with most accepting positions with which they were satisfied.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Suzanne Z Powell
- From the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Cohen and Powell); the Department of Pathology, Augusta University-Medical College of Georgia, Augusta (Dr Rojiani); the Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk (Dr Conran); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, University of Colorado-Anschutz Medical Campus, Aurora (Dr Post); the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Drs McCloskey and Talbert); ProPath Associates, Dallas, Texas (Dr Roberts); and the Division of Laboratory Medicine, Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr Domen)
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13
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How does it feel to be a pathology resident? Results of a survey on experiences and job satisfaction during pathology residency. Virchows Arch 2017. [DOI: 10.1007/s00428-017-2167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hanley T, Sowder AM, Palmer CA, Weiss RL. Teaching Laboratory Management Principles and Practices Through Mentorship and Graduated Responsibility: The Assistant Medical Directorship. Acad Pathol 2016; 3:2374289516678972. [PMID: 28725781 PMCID: PMC5497864 DOI: 10.1177/2374289516678972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
With the changing landscape of medicine in general, and pathology in particular, a greater emphasis is being placed on laboratory management as a means of controlling spiraling medical costs and improving health-care efficiency. To meet this challenge, pathology residency programs have begun to incorporate formal laboratory management training into their curricula, using institutional curricula and/or online laboratory management courses offered by professional organizations. At the University of Utah, and its affiliated national reference laboratory, ARUP Laboratories, Inc, interested residents are able to supplement the departmental lecture-based and online laboratory management curriculum by participating in assistant medical directorship programs in one of several pathology subspecialty disciplines. The goals of many of the assistant medical directorship positions include the development of laboratory management skills and competencies. A survey of current and recent assistant medical directorship participants revealed that the assistant medical directorship program serves as an excellent means of improving laboratory management skills, as well as improving performance as a fellow and practicing pathologist.
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Affiliation(s)
- Timothy Hanley
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Aleksandra M Sowder
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cheryl Ann Palmer
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Ronald L Weiss
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
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Domen RE, Johnson K, Conran RM, Hoffman RD, Post MD, Steinberg JJ, Brissette MD, Gratzinger DA, McCloskey CB, Raciti PM, Roberts CA, Rojiani AM, Powell SZ. Professionalism in Pathology: A Case-Based Approach as a Potential Educational Tool. Arch Pathol Lab Med 2016; 141:215-219. [DOI: 10.5858/arpa.2016-0217-cp] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Professionalism issues in residency training can be difficult to assess and manage. Generational or role-based differences may also exist between faculty and residents as to what constitutes unprofessional behavior and how to manage it.
Objective.—To examine and compare how faculty and residents would approach the same 5 case scenarios detailing various aspects of unprofessional behavior.
Design.—Five case scenarios highlighting various unprofessional behaviors were presented in a workshop at an annual meeting of pathology department chairs, residency program directors, and undergraduate pathology medical educators (ie, pathologists involved in medical student pathology education). The same cases were presented to a cohort of pathology residents currently in training. A standard set of responses were offered to the participants, polling results were collected electronically, and results were compared.
Results.—Faculty and residents were fairly consistent within their respective groups. In a subset of cases, faculty were more likely to favor working with the individual in the scenario, whereas resident respondents were more likely to favor either no response or a severe response. Generational or role-based differences were also potentially evident.
Conclusions.—Assessing expectations and differences around professionalism for both faculty and residents should be considered as part of any educational and management approach for professionalism. Although a level of generational differences appears to be evident in this study regarding the recognition and management of unprofessional behavior, there was also agreement in some cases. Further exploration into the discrepant responses between faculty and residents may prove useful in developing educational, assessment, and remediation resources.
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16
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Gronowski AM, McGill MR, Domen RE. Professionalism in Residency Training: A Compilation of Desirable Behaviors and a Case-Based Comparison Between Pathologists in Training and Practice. Acad Pathol 2016; 3:2374289516667509. [PMID: 28725778 PMCID: PMC5497910 DOI: 10.1177/2374289516667509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022] Open
Abstract
Professionalism is one of the most important competencies for physicians but is also the most difficult to teach, assess, and manage. To better understand professionalism in pathology, we surveyed practicing pathologists and pathology residents and fellows in training. We identified 12 key desirable attributes of professionalism. In addition, 8 case scenarios highlighting unprofessional behavior were presented, and results between pathologists in practice and in training were compared. No significant differences between attending pathologists and residents were identified in how these cases should be managed. Our study demonstrated remarkable concordance between practicing pathologists and residents as to what constitutes professionalism and how to manage unprofessional behavior. Our case-based approach can be a useful technique to teach professionalism to both pathologists in practice and in training.
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Affiliation(s)
- Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Mitchell R McGill
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Ronald E Domen
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
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Domen RE, Talbert ML, Johnson K, Post MD, Brissette MD, Conran RM, Hoffman RD, McCloskey CB, Raciti PM, Roberts CA, Rojiani AM, Tucker JA, Powell SZE. Assessment and Management of Professionalism Issues in Pathology Residency Training: Results From Surveys and a Workshop by the Graduate Medical Education Committee of the College of American Pathologists. Acad Pathol 2015; 2:2374289515592887. [PMID: 28725747 PMCID: PMC5479457 DOI: 10.1177/2374289515592887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director’s meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors’ experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.
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Affiliation(s)
- Ronald E Domen
- Division of Laboratory Medicine, Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Michael L Talbert
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Miriam D Post
- Department of Pathology, Anschutz Medical Campus, University of Colorado-Denver, Aurora, CO, USA
| | | | | | - Robert D Hoffman
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cindy B McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Patricia M Raciti
- Department of Pathology and Cell Biology, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | | | - Amyn M Rojiani
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - J Allan Tucker
- Department of Pathology, University of South Alabama, Mobile, AL, USA
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