Graduated responsibility and competency-based education in pathology residency programs: a five-year semi-longitudinal landscape assessment on autonomy and supervision.

Pathology residency training has been criticized for having too little opportunities for resident autonomy. As graduate medical education moves to competency-based models measuring competency and giving autonomy for specific tasks will be important. To determine how much autonomy residents are currently granted we surveyed pathology residency directors with regard to a list of usual pathology tasks and compared responses with those of a similar survey from 2018. Among the 29 programs whose directors responded, we found a considerable range within which some programs give much autonomy and others very little. Most programs did not describe measuring competency before granting performance of specific activities. We urge that restrictive programs examine the more permissive programs to see how they can move toward granting more autonomy.

Leadership perspectives on osteopathic medical school applicants to pathology residency training.

The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.

The phenotype of pathology residency program directors.

Pathology residency programs vary greatly across the United States. To the authors' knowledge, little is formally known about the "phenotype" or career pathways of pathology residency program directors (PDs). PDs, former PDs (FPDs), and associate PDs (APDs) were surveyed, aiming to address whether or not dominant phenotypes or pathways to graduate medical education leadership exist. Several trends emerged including: 76% Whites, 70% females, 15% MD/PhDs, and more junior faculty (33% being <5 years in practice, another 24% being in practice <10 years, and 41% assistant professors at time of first PD/APD appointment). Anatomic and clinical pathology-certified individuals represented 79%. Sixty-two percent of respondents were on a nontenure employment track, with only 18% indicating tenure track. For subspecialty focus, cytopathology (25%), transfusion medicine (16%), and hematopathology (14%) represented the most common subspecialties practiced. A majority (65%) had served as a chief resident during residency, and most (61%) of PDs had served as APDs first. Most (60%) had not served as fellowship director. Most (65%) had not participated in any education leadership training, with 27% having participated in certificate programs or other educational professional development. Thematic analysis of perceived key criterion in selection for the role was passion for education, demeanor, emotional intelligence, and willingness to serve the department. This information may influence training or experience pursued by individuals aspiring to pathology graduate medical education leadership, inform chairs on qualities to look for, and supplement future educational sessions of the Association of Pathology Chairs Program Directors Council.

How influential are medical school curriculum and other medical school characteristics in students' selecting pathology as a specialty?

There has been a significant decline in the number of United States allopathic medical students matching to pathology residency programs. Data acquired from the American Association of Medical Colleges (AAMC) show sustained variation in the medical school production of students who go on to pathology residency. When divided into groups based on the medical school's historical volume of graduates entering pathology, the schools in groups labeled Group 1 and Group 2 produced significantly higher and lower proportions of pathology residents, respectively. This study aimed to identify what medical school curriculum elements and other medical school characteristics might explain the differences observed in the AAMC data. The Dean or another undergraduate medical education contact from the Group 1 and Group 2 schools was invited to participate in an interview. Pathology Program Directors and Pathology Department Chairs were also included in communications. Thirty interviews were completed with equal numbers from each group. Interview questions probed pathology experiences, existence, and structure of a pathology interest group, options for post-sophomore fellowships, recent curriculum changes, and the extent of mentoring programs. Surprisingly, the curriculum does not appear to be a predictor of a medical school's production of students who enter pathology residency. A significantly greater percentage of Group 1 schools are public institutions compared to Group 2 schools. Other factors that may increase the number of students who go into pathology include mentoring, active learning versus observation, and post-sophomore fellowships or other opportunities to work in the capacity of a new pathology resident.

Evaluating the impact of pass/fail United States Medical Licensing Examination Step 1 scoring on pathology residency selection.

Beginning 26 January 2022, the United States Medical Licensing Examination Step 1 changed from a numerical score to Pass/Fail. Historically, residency programs have used Step 1 scores as a valuable metric in assessing the competitiveness of applicants. We assessed how residency program criteria will change when evaluating applicants after Step 1 becomes Pass/Fail. A survey was distributed to the program directors of all 144 pathology residency programs accredited by Accreditation Council for Graduate Medical Education. Survey questions evaluated the importance of using Step 1 and Step 2 Clinical Knowledge (CK) scores when assessing applicants. Participants were asked to rank a list of applicant criteria used before and after Step 1 becomes Pass/Fail. Data were analyzed using chi-squared and paired t-tests with significance at P < 0.05. A total of 34 residency program directors (23.6%) responded to the survey. 76.5% (P< 0.001) of responders believed Step 1 scores were able to predict a resident's ability to pass their board exams, while 41.2% believed Step 2 CK could predict a resident's ability to pass board exams and perform clinically in pathology (P = 0.282). 61.8% of responders agreed that an applicant's medical school ranking would become more important (P = 0.001). There were no significant differences in the relative importance of 16 selection criteria after the change of Step 1 to Pass/Fail. It does not appear that Step 2 CK will become more important. Although results are constrained by a 23.6% response rate, it can be a start to guiding future students through residency applications.

Factors influencing US osteopathic medical students to choose pathology as a specialty.

The decline in the number of US allopathic (Medical Doctor or M.D.) medical students matching to pathology residency has been a topic of much discussion at national pathology professional society meetings and in recent publications. A recent survey of fourth-year allopathic medicals students was conducted to better understand the rationale behind students' interest or lack thereof in pathology as a specialty. This study utilizes a similar survey tool gauging osteopathic (Doctor of Osteopathy or D.O.) student knowledge and interest in pathology, and offers insight into a possible growth market for the specialty. Similar to allopathic students, osteopathic students noted that clinical or research opportunities in pathology during medical school, autopsy observation/participation, and participation in pathology interest groups correlated with a greater likelihood of selecting pathology as a specialty. However, some key differences in osteopathic medical school curricular elements including microscope use, gross pathology specimen demonstrations, case-based learning by pathologists, exposure to pathology during other rotations, awareness of a pathology interest group, as well as an overall understanding of the everyday work of a pathologist were noted. Experiential exposure to pathology, and direct mentorship from pathologists may present an opportunity for pathology professional organizations, and pathology residency programs to partner with osteopathic medical schools to increase interest in the field, and aid in pipeline development.

Pathology Residency Program Special Expertise Tracks Meet the Needs of an Evolving Field.

Pathologists who enter the workforce must have a diverse skill set beyond that of clinical diagnostics alone. Anticipating this need, the Johns Hopkins Pathology Residency Program developed Special Expertise Tracks to enhance training in relevant subspecialty domains. Using a combination of discussions and surveys, we assessed: (1) our current resident curriculum; (2) perceived curricular strengths and needs; (3) resident career preferences and ultimate career paths; (4) perceived barriers to implementing an advanced elective curriculum; and (5) available departmental/institutional resources. Additionally, we utilized the Accreditation Council for Graduate Medical Education Pathology Milestones as a curricular guide. Six professional residency training Special Expertise Tracks were established: Education, Physician-Scientist Research, Informatics, Quality Improvement/Quality Assurance/Value-Based Care, Health Policy/Hospital Management and Global Health. After implementation in 2017, the Education track has had 4 residents complete the curriculum successfully; the Physician-Scientist Research track has had 2 residents and the Informatics and Global Health tracks have each had one resident successfully complete their respective curricula. Currently, 5 residents are pursuing the Education track, one is pursuing the Physician-Scientist Research track, one is pursuing the Informatics track, and 2 residents are pursuing the Global Health track. Five residents have completed long-term projects including developing several e-learning modules, an online free digital cytopathology atlas, peer-reviewed articles, book chapters, and books. The Johns Hopkins Pathology Resident Special Expertise Track program provides pathology residents an opportunity to gain meaningful experience and additional skills tailored to their individual career interests.

Pathology Residency Open-House Events: A Novel Marketing Paradigm.

OBJECTIVES: Due to the continued impact of coronovirus 2019 (COVID-19), residency programs were advised to offer virtual interviews in place of traditional in-person interviews for the 2021 match recruitment season. As a result, many pathology residency programs offered preinterview virtual open-house events to meet prospective applicants before the interview season. This article aims to understand applicants' perspective on those events during the residency recruitment season of 2020 to 2021. METHODS: We performed a cross-sectional survey-based study involving 95 pathology residency applicants. RESULTS: Our results demonstrated that applicants generally have a positive perception of open house events; 91% found virtual open-house events beneficial, 63.2% attended open-house events for programs they were not considering applying to. Considering the high number of offered virtual open house events, 17% of applicants felt overwhelmed by attendance and 30% felt obligated to attend. CONCLUSIONS: This brief report demonstrates the generally positive impact of these events.

Factors Influencing US Allopathic Medical Students to Choose Pathology as a Specialty.

The SARS-CoV-2 pandemic has highlighted the crucial role of pathologists in the health care system at a time of significant decline in the number of US medical students matching to pathology residency positions. To understand this decline, a national survey of fourth-year US allopathic medical students was conducted to assess experiences, knowledge, and attitudes of pathology and factors that impact specialty choice. Participating in a separate pathology course did not increase the probability of choosing pathology. Experiences significantly associated with choosing pathology included clinical or research opportunities in pathology during the last 2 years of medical school, autopsy observation/participation, and participation in pathology interest groups. Many respondents felt they were not sufficiently exposed to pathology to consider it as a specialty. Those who considered pathology but did not choose it were less likely to report understanding the activities of pathologists and being recruited by pathology faculty and more likely to express a preference for more direct patient contact as compared to those entering pathology. In general, respondents agreed that pathology has a good work-life balance and a satisfying degree of intellectual challenge. On the other hand, respondents generally agreed that information on social media and perception of the pathology job market do not seem to be positive and few agreed that pathology is a highly regarded specialty. We identify steps to address these issues and increase the number of US medical students choosing pathology as a specialty crucial to the future of medicine and public health.

Cross-Residency Radiologic/Pathologic Correlation Curriculum: Teaching Correlation of Surgical Specimens With Imaging.

The College of American Pathologists expects pathologists to attain competency in radiologic/pathologic correlation, including correlation of histopathologic findings with imaging findings. While pathology residents appreciate the importance of radiologic/pathologic correlation, their lack of experience and confidence in interpreting imaging studies deters them from obtaining specimen radiographs and reviewing preoperative imaging studies. Formal training in this domain is lacking. A cross-residency curriculum was developed to help pathology residents build basic skills in the correlation of surgical specimens with preoperative imaging and specimen radiographs. Didactic sessions were prepared by 3 pairs of radiology and pathology residents with guidance from radiology and pathology attendings in the subspecialty areas of breast, musculoskeletal, and head and neck. The authors describe the development, implementation, and assessment of the curriculum. A total of 20 pathology residents attended the sessions, with 7 completing both the pre- and postintervention surveys. These residents gained confidence in their ability to interpret specimen radiographs and to select specimens to evaluate with radiography. They gained an appreciation of the importance of collaboration with radiologists in evaluating specimens and of viewing preoperative imaging studies to guide gross examination and dissection. They reported obtaining specimen radiographs and viewing preoperative imaging studies more frequently after attending the sessions. Innovative solutions such as this cross-residency educational initiative offer a potential solution to fulfill the radiologic/pathologic correlation competency standard for pathology residents and may be replicable by other residency programs and academic institutions.

Entry of Graduates of US Pathology Residency Programs Into the Workforce: Cohort Data Between 2008 and 2016 Remain Positive and Stable.

The pathologist workforce in the United States is a topic of interest to the health-care community as a whole and to institutions responsible for the training of new pathologists in particular. Although a pathologist shortage has been projected, there has been a pervasive belief by medical students and their advisors that there are "no jobs in pathology." In 2013 and again in 2017, the Program Directors Section of the Association of Pathology Chairs conducted surveys asking pathology residency directors to report the employment status of each of their residents graduating in the previous 5 years. The 2013 Program Directors Section survey indicated that 92% of those graduating in 2010 had obtained employment within 3 years, and 94% of residents graduating in 2008 obtained employment within 5 years. The 2017 survey indicated that 96% of those graduating in 2014 had obtained employment in 3 years, and 97% of residents graduating in 2012 obtained positions within 5 years. These findings are consistent with residents doing 1 or 2 years of fellowship before obtaining employment. Stratification of the data by regions of the country or by the size of the residency programs does not show large differences. The data also indicate a high percentage of employment for graduates of pathology residency programs and a stable job market over the years covered by the surveys.

Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency.

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.

Training the Next Generation of Pathologists: A Novel Residency Program Curriculum at Montefiore Medical Center/Albert Einstein College of Medicine.

Pathology residency training is currently a time-intensive process, frequently extending up to 6 years in duration as residents complete 1 or 2 fellowships following graduation. Innovative training curricula may help address the impending changes in the health-care landscape, particularly future shortfalls in pathology staffing and changing health-care models that incorporate more work within interdisciplinary teams. Montefiore has created a novel residency training program aimed at accelerating the acquisition of competency in pathology, preparing residents for independent practice at the completion of residency training, and providing residents with the requisite adaptability and consultative skills to excel wherever they choose to practice. We describe the implementation of this novel pathology residency training curriculum at Montefiore Medical Center/Albert Einstein College of Medicine and the perception of residents in both the old curriculum and the new curriculum.

How to Foster Professional Values during Pathology Residency.

The importance of professional and ethical behavior by physicians both in training and in practice cannot be overemphasized, particularly in pathology. Professionalism education begins in medical school, and professional attitudes and behaviors are further internalized during residency. Learning how to be a professional is a vital part of residency training. While hospital- or institution-based lecture style educational programs exist, they are often ineffective because the curriculum is not applicable to all specialties, although the basic concepts are the same. In this paper, the author suggests ways for institutions to develop professional attitude assessments and to survey residents' responses to various unprofessional situations using case scenarios.

Learning Styles in Pathology: A Comparative Analysis and Implications for Learner-Centered Education.

Initiatives like "American Medical Association (AMA)-Reimagining Residency" and "Accreditation Council for Graduate Medical Education (ACGME)-Next Accreditation System" are examples of a paradigm shift toward learner-centered pedagogy in resident education. Such interventions require an understanding of the basics of the learning process itself. This study aimed to identify preferred learning styles in pathology with the intent to use specialty-specific pattern data, if any, to improve pathology training modalities. Kolb's learning tool questionnaire was sent to pathology-inclined medical students, pathology residents, fellows, and faculty in 5 academic programs. Data from 84 respondents (6 students, 37 residents, 12 fellows, 29 attendings) were analyzed. There was remarkable similarity in learning styles of fellows and faculty, revealing a dominance of observational learning styles ("assimilating" and "diverging") that was consistent with pathology being a visual field. In contrast, residents showed dominance of "learn by doing" styles ("converging" and "accommodating"). Residents' stratification by training year showed a scattered distribution with an upward trend toward "learn by doing" behavior. While the difference in styles between residents and faculty/fellows may be due to a generational gap, transition from medical school, or acquisition of technical skills required for grossing specimens, this is an opportunity for adopting blended learning models and active learning processes to cater to residents' different styles and to allow for flexibility to use all styles as and when needed. Based on these findings, we hypothesize that partnering juniors and seniors with similar styles has a potential for successful mentorship and exploration of other psychometrics is recommended for further understanding and improvement of pathology training.

A Strategy for Wellness in a Pathology Residency Program: Enhancing Chances of Success During an Epidemic of Burnout.

Physician burnout is a national crisis with medicine among occupations with higher suicide risk, at 1.8 times the national average. Few pathology departments address this issue, and even fewer residency programs offer formal resiliency training. We implemented a high-stress environment resiliency strategy and an Accreditation Council for Graduate Medical Education-compliant curriculum to our residency program. Its purpose was to apply initiatives employed in the finance industry, then to measure their effectiveness. Utilizing methods from financial companies such as Goldman Sachs, we adopted the following initiatives in our residency program: (1) approach burnout as a dilemma requiring a tridimensional strategy: providing wellness training for the individual, programmatic group strategies, and an institutional wellness plan; (2) formalize a wellness curriculum, implementing wellness talks focused on stress prevention, management, and treatment; (3) offer free sessions with resilience coaches, psychological help, Employee Assistance Program, and chaplain services; (4) modify our mentorship program, pairing first-year residents with senior residents; (5) implement mindfulness practices; (6) provide easy access to volunteer opportunities and networking; (7) offer fitness center discounts. Effectiveness was measured through 2 surveys of 13 residents representing day 0 (before wellness initiatives were implemented) and at 1 year. Results indicate a significant improvement in utilization of wellness tools. This study demonstrates that wellness and resilience can be taught. Our ultimate goals are to increase wellness among pathology residents, to prepare them for a high-stress environment before entering the workforce, and to prepare them to incorporate the tools they have learned into their new workplaces.

Training Aspects of Laboratory-Based Decision Support.

Pathology has a large role to play in the proper development, implementation, and optimization of clinical decision support (CDS). CDS training must be supported by an educational foundation in clinical and pathology informatics. Educational opportunities are currently limited, but expanding, in the pathology residency space with Pathology Informatics Essentials for Residents. The use of an educational version of electronic clinical systems is an important educational tool to support the needed outcomes-driven and exercise-based informatics and CDS training. With the multidisciplinary nature of informatics, it is advantageous to include laboratory professionals in the training exercises as appropriate.

A Professionalism and Mentoring Curriculum for Pathology Residents in Training.

Professionalism is a core Accreditation Council for Graduate Medical Education competency. The Mentoring and Professionalism in Training Program was developed to promote humanism in health-care professionals in our health system. A modified version was implemented in the pathology residency program for professionalism competency. Twenty-one trainees were divided into 3 groups, with a facilitator who was a graduate of the system Mentoring and Professionalism in Training Program. Five sessions included topics on appreciative inquiry, active role modeling, conflict resolution, team building, feedback, mindfulness, and physician well-being. Participants completed pre- and postsurveys. Qualitative responses were very positive, for example, one participant felt the sessions helped "understand intricacies of workplace relationships and ways of effective, respectful, communication." The Mentoring and Professionalism in Training is a curriculum that teaches team building, conflict resolution, and feedback along with strategies to balance well-being with professional commitments and growth. It is an effective educational tool that can satisfy the Accreditation Council for Graduate Medical Education professionalism curriculum.

Interesting Gross Case Workshop to Remedy Disconnect in Surgical Pathology Curriculum.

Introduction: This workshop was created by pathologists' assistants (PAs) who undertake specialized training programs heavily focused on grossing, which is the macroscopic inspection, evaluation, and sampling of pathology specimens for histologic evaluation by a surgical pathologist. Typically, pathologists or their trainees, during training, focus upon microscopic features, with less emphasis on the macroscopic appearance of disease. Methods: We developed monthly hour-long "interesting gross case workshops" (IGCWs) led by PAs to aid in the process of educating and refining pathology residents' grossing skills and abilities to diagnose at a macroscopic level. Our workshops include gross photography, grossing vocabulary, reference to standardized sampling manuals, and viewing of a specimen library to reinforce subject matter. This workshop was designed to train multilevel pathology providers including PA students, residents, fellows, and medical students, in addition to actively practicing PAs. This resource offers the audience preparation materials to host a workshop in any medical training facility. Results: Our use of the IGCWs has been evaluated positively over a 3-year period, with 78 of 150 participants stating they have increased confidence and capabilities to accurately assess and diagnose at the macroscopic level. Discussion: Utilizing this workshop can be valuable to teach the importance of a thorough gross description and tissue sampling for the diagnostic process. Future work includes expansion to additional pathology learners, improving photography database quantity and quality, and incorporating microscopic correlation when necessary.

Fewer seniors from United States allopathic medical schools are filling pathology residency positions in the Main Residency Match, 2008-2017.

Some pathologists have observed that fewer trainees from US medical schools are entering pathology residency. This trend was measured and further explored using Main Residency Match (MRM) data from 2008 to 2017, obtained from the National Resident Matching Program (NRMP). Over the past decade, there was an increase of 93 (508 in 2008 versus 601 in 2017, an 18.3% increase) pathology positions offered in the MRM. However, the proportion of pathology residency positions filled in the MRM which were taken by trainees from US medical schools decreased from 77.7% to 50.1% over this timespan. This was primarily due to fewer seniors from US allopathic medical schools filling pathology positions in the MRM (298 in 2008 versus 216 in 2017, a 27.5% decrease). Compared to 14 other medical specialties, pathology had the largest decline in the proportion of residency positions filled in the MRM which were taken by seniors from US allopathic medical schools (63.8% in 2008 versus 39.6% in 2017). Furthermore, pathology now has the lowest percentage of residency positions filled in the MRM, which were taken by seniors from US allopathic medical schools. The primary reason for this decline was because fewer seniors from US allopathic medical schools participated in the MRM for pathology positions (326 in 2008 versus 232 in 2017, a 28.8% decrease); however, the underlying reasons for this decline are unknown. In conclusion, over the past decade, substantially fewer seniors from US allopathic medical schools sought/filled pathology residency positions in the MRM. These findings are relevant for pathology residency recruitment, especially in the context of a projected decline in US pathologist workforce.