The pathology milestones and the next accreditation system.

CONTEXT: In the late 1990s, the Accreditation Council for Graduate Medical Education developed the Outcomes Project and the 6 general competencies with the intent to improve the outcome of graduate medical education in the United States. The competencies were used as the basis for developing learning goals and objectives and tools to evaluate residents' performance. By the mid-2000s the stakeholders in resident education and the general public felt that the Outcomes Project had fallen short of expectations. OBJECTIVE: To develop a new evaluation method to track trainee progress throughout residency using benchmarks called milestones. A change in leadership at the Accreditation Council for Graduate Medical Education brought a new vision for the accreditation of training programs and a radically different approach to the evaluation of residents. DATA SOURCES: The Pathology Milestones Working Group reviewed examples of developing milestones in other specialties, the literature, and the Accreditation Council for Graduate Medical Education program requirements for pathology to develop pathology milestones. The pathology milestones are a set of objective descriptors for measuring progress in the development of competency in patient care, procedural skill sets, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. CONCLUSIONS: The milestones provide a national standard for evaluation that will be used for the assessment of all residents in Accreditation Council for Graduate Medical Education-accredited pathology training programs.

Senior pathology resident in-service examination scores correlate with outcomes of the American Board of Pathology certifying examinations.

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

Certification and maintenance of certification: updates from the American Board of Pathology.

The American Board of Pathology continues to update the certification process to ensure that all candidates have appropriate training and credentials and meet the competency requirements of the Accreditation Council for Graduate Medical Education. The maintenance of certification process, instituted in 2006, has gone through 2 reporting cycles; and the American Board of Pathology is preparing for administration of the first maintenance of certification examination in 2014. This article updates the pathology community on these changes.

Certification from the American Board of Pathology: getting it and keeping it.

In the last 5 years, there have been significant changes in the process of obtaining (and maintaining) certification in anatomic and/or clinical pathology and in pathology subspecialties. These changes include the elimination of the requirement for a "credentialing year" with its attendant "double class" of residents; the implementation of a mandatory maintenance-of-certification program for all persons certified by the American Board of Pathology, Tampa, Fla, on or after January 1, 2006; and the alterations in format and manner of grading for the certifying examinations. This article updates the pathology community regarding these changes and provides references where candidates and diplomates can find the most recent information regarding all aspects of certification and maintenance of certification.

Reference test review by pathology house staff: a cost-containment strategy for the clinical laboratory.

In this era of fiscal responsibility in health care, new strategies are evolving to decrease costs in the clinical laboratory. At our institution, one such strategy implemented in 1994 consisted of the review by pathology housestaff of all send-out tests that cost more than $75 to ensure that an appropriate diagnostic test hierarchy was being used and that clerical misorders were corrected. Throughout the first fiscal year this system was implemented, the annual institutional reference laboratory costs decreased by 10% ($24,784), and the number of send-out tests decreased by 23% (2,707 tests). Over the next 2 fiscal years, the number of sendout tests maintained a level approximately 25% lower than the original pre-review level and the reference laboratory costs remained 4% to 13% below the pre-review level. A major factor preventing a more extensive cost reduction over this time period was the increased frequency of orders for expensive molecular studies. Even with the increased use of these relatively expensive tests, however, our annual reference laboratory budget and number of send-out tests have remained consistently below the levels of 1994. Implementation of similar test review systems in other health-care laboratories could provide useful budgetary reductions.