The following abstracts were accepted by the Association of Pathology Chairs, without modification, for poster presentation at the 2020 APC Annual Meeting. This content was not peer reviewed by Academic Pathology.
Presenting authors’ names are bolded throughout.
Poster #01. Pathology Teaching in Different Undergraduate Medical Curricula Within and Outside the United States
K. A. Carnevale, MD1, R. Saxena, MD2, L. Nelson1, G. A. Talmon, MD3, A. Lin, MD4, O. Padilla, MD, MPH5, and R. A. Kreisle, MD, PhD6
1Des Moines University, Des Moines, IA, USA
2All Saints University School of Medicine, Roseau, Commonwealth of Dominica
3Department of Pathology, University of Nebraska Medical Center, Omaha, NE, USA
4College of Medicine University of Illinois, Chicago, IL, USA
5Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
6Purdue University, West Lafayette, IN, USA
Objectives: Pathology education is taught using different curricula in the United States and abroad. There are many different versions, but they are categorized into 3 main components that include integrated, semi-integrated, and traditional curricula. We evaluate and compare the hours spent in different forms of pathology teaching such as lectures, team-based learning (TBL), problem-based learning (PBL), and other methods to teach general and systemic pathology among different medical schools within the United States and outside the United States. Methods: Lecture hours, TBL hours, PBL hours, and hours spent in other forms of teaching pathology subjects were counted and compared in general pathology and systems pathology subjects in 7 US medical schools and 6 medical schools outside the United States. Results: The total number of lecture hours taught in general and systemic pathology was greater in outside schools than within the United States (141 vs 97.8 hours, respectively). The only subjects with more lecture hours taught in the United States were cardiac pathology, liver pathology, central nervous system pathology, and transfusion medicine. Most other subjects taught in general pathology and systems pathology had significantly less lecture hours in US schools compared to outside medical schools. The greatest difference was the hours spent in labs were significantly longer for both general and systems pathology in schools outside the United States. The overall utilization of PBL was much greater outside the United States compared to within the United States (average overall hours PBL—97.2 outside vs 16.5 in United States); however, the reverse was observed for using TBL to teach both general and systemic pathology (average overall hours TBL—59.5 outside vs 84.5 in United States). Average hours used with other methods of teaching was also greater in outside medical schools compared to US medical schools (80.8 vs 44 hours, respectively). Conclusions: Pathology teaching in both general and systemic pathology has more extensive lecture hours, laboratory hours, PBL, and other methods of teaching pathology in outside medical schools with different curricula than US medical schools. Team-based learning is utilized more extensively in US medical schools.
Poster #02. Social Media Transforming Pathology Pedagogy: #TwitterHomework During #PathElective
H. M. Hamnvåg, MD1, A. McHenry, MD1, A. Ahmed, MD1, L. Trabzonlu, MD1, C. A. Arnold, MD2, and K. M. Mirza, MD, PhD1
1Department of Pathology and Laboratory Medicine, Loyola University Health System, Maywood, IL, USA
2Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA
Objectives: In response to the emerging community of pathologists and pathology-related material on Twitter, we describe the implementation of #TwitterHomework—a means for medical students to use Twitter as a resource for education, networking, and professional development during pathology electives. Methods: We describe medical student use of this microblogging service and present qualitative data from 32 survey responders. Additionally, we used Twitter analytical software (Symplur Signals) to understand the frequency, distribution, and reach of this Twitter use. Results: From August 1, 2017, to January 2, 2019, elective medical students composed a total of 527 original tweets (14.2 tweets per user, mean = 14.2, median = 10) that generated 78 422 impressions. Participation varied, with 43.24% of the students composing <10 original tweets, 35.14% between 10 and 19 tweets, 16.22% between 20 and 29 tweets, and 5.41% composing 30 or more tweets. The network surrounding the hashtags was analyzed, and we found that 810 nonstudent users retweeted the students a total of 3399 times, and this engagement resulted in 6 360 731 impressions. Conclusions: Based on user biography, we discovered that most of the retweeting was done by pathologists and pathology residents. Respondents who used Twitter described their experience as positive overall. They found reliable pathology information on Twitter, described it as helpful in increasing their overall medical knowledge, and think it contributed positively toward their own professional development. To the best of our knowledge, this represents the first report describing the implementation and results of establishing a Twitter-related aspect to pathology education. Herein, we recommend the use of Twitter as a complement to traditional teaching to enhance a medical student’s experience and propose that this strategy may also benefit pathology residents, fellows, and established pathologists.
Poster #03. Medical Director Boot Camp: A Practical Approach to Medical Directorship Training for Residents
S. Flax, MD1, V. Mayor, BS1, M. Joshi-Guske, MBA1, B. Shaffer, BSBA1, and C. Fulger, MPA, BSMT(ASCP)1
1University of Florida College of Medicine, Gainesville, FL, USA
Objectives: Although residents are well prepared to practice in many areas of anatomic and clinical pathology, there are relatively fewer opportunities to practice laboratory directorship during residency. We developed a novel residency elective, Medical Director Boot Camp, to give residents direct experience in 4 key aspects of pathology practice management: accreditation and regulatory/legal compliance, financial management, human resources management, and laboratory operations. The aim of Medical Director Boot Camp is to provide senior residents with basic experience as medical directors of anatomic and clinical laboratories. Methods: Postgraduate year 4 residents participated in a 4-week elective rotation, Medical Director Boot Camp at the University of Florida Health Pathology Laboratories (UFHPL). During the 4-week rotation, the residents served as codirectors of assigned laboratories for all day-to-day operations. Each component of the elective included a reading assignment, tutorial, and an individual laboratory assignment. Examples of assignments have included the development of a position control budget for the lab, developing a position description and recruiting strategy, conducting a mock disciplinary action, determining a cost per test value, developing a request for proposal for the purchase of an instrument, developing a LEAN plan for the placement of instruments, evaluating a reagent rental contract, and interpreting a fixed versus flex budget. Weekly, the residents presented their assignments to the UFHPL staff and reviewed focused study questions with the group. Results: Prior to beginning the rotation, the residents were given an exam, of 200 questions, developed by the UFHPL participating staff related to laboratory management. At the end of the rotation, the residents were given the same exam. The average prerotation score for the 7 residents, who have completed the rotation thus far, was 56%. The average postrotation exam score was 90%. The most substantial improvement was seen in the areas of financial (36% prerotation vs 81% postrotation exam score) and human resources management (23% pre- vs 79% postrotation exam score). All residents (7/7) indicated that they were exposed to entirely new aspects of laboratory management. Conclusions: Medical Director Boot Camp provides a valuable and engaging experience in developing future medical directors of anatomic and clinical laboratories.
Poster #04. Consultative Interpretation for Lupus Anticoagulant by Expert Pathologists Reduces False-Positive Rates in the Era of Direct Oral Anticoagulants
S. Kitahara, MD1, A. Vivero, MD1, A. Runge, CLS, MT1, and O. Volod, MD1
1Department of Pathology and Laboratory Medicine, Cedars-Sinai, Los Angeles, CA, USA
Objectives: The diagnosis of antiphospholipid syndrome requires detection of antiphospholipid antibodies (aPL). A retrospective review of our testing practices revealed that societal recommendations for lupus anticoagulant (LA) testing as part of aPL testing are largely not followed by clinicians, and there was a high proportion of positive LA results. Increasing direct oral anticoagulant usage creates additional challenges in identifying LA. This prompted us to establish an order set that includes a pathologist consultation (“LA panel”) and testing algorithm in an effort to reduce false-positive LA and to ensure optimal LA identification and best practices for interpretation and follow-up. Methods: The laboratory database was reviewed to determine the number of LA tests ordered and rate of LA positivity before and after the LA panel was instituted. We assessed the impact of pathologist consultation to minimize false-positive findings and on following diagnostic guidelines. Results: Lupus anticoagulant panels were ordered for 1146 patients. Lupus anticoagulant was detected in 10% (111/1146) by dilute Russell viper venom time (dRVVT) normalized ratio (includes dRVVT screen [dRVVTs]-positive/lupus-sensitive partial thromboplastin time [PTT-LA]-positive and dRVVTs positive/PTT-LA negative) and 20% (228/1146) by Staclot-LA (includes dRVVTs negative/PTT-LA positive and dRVVTs positive/confirm negative). There was a reduction in false-positive LA by Staclot-LA, previously 48% positive. We saw increased cancellation of LA testing for interfering anticoagulants (6.8% [16/236] vs 14.4% [55/383]; P = .0061). There was also increased adherence to follow-up LA testing (3% [8/236] vs 13.8% [53/383]; P ≤ .001). Conclusions: Creating a predetermined order set and testing algorithm with pathologist consultation improved LA testing interpretation and diagnostic follow-up testing. References: Verna A, Velazquez AB, Laposata M. Reducing diagnostic errors worldwide through diagnostic management teams. Ann Lab Med. 2019;39:121-124. Moore GW. Recent guidelines and recommendations for laboratory detection of lupus anticoagulants. Semin Thromb Hemost. 2014;40:163-171. Adcock DM, Gosselin R. Direct oral anticoagulants (DOACs) in the laboratory. Thromb Res; 2015;136:7-12. Note: This study was accepted for publication in the Journal of Applied Laboratory Medicine.
Poster #05: A Pilot Communication Skills Curriculum for Pathology Residents Using Simulated Phone Calls
A. R. Peedin, MD1, and J. S. Y. Chan1
1Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
Objectives: Communication with other physicians is critical to the daily activities of pathologists. Many pathology milestones from the Accreditation Council on Graduate Medical Education (ACGME), upon which residents are regularly assessed, include specific communication skills. However, very few publications describe curricula to teach these skills to pathology trainees. Other medical specialties have created simulation programs for communication skills. We created a pilot curriculum to teach communication skills to pathology residents using simulated phone calls with other physicians. Methods: Communication-related ACGME Pathology Milestones were adapted into an evaluation checklist. Three scripts were written to simulate common or high-stakes conversations that pathologists have with other physicians. Professional actors who typically portray standardized patients were trained to portray standardized physicians (SPs) during a 3-hour training session. With institutional review board exemption, each resident completed all 3 encounters in a dedicated simulation center, using Google Hangouts to make audio-only calls. Residents received face-to-face feedback from the SPs after each encounter. The encounters were video recorded for residents to review after the activity. The SPs and one pathologist completed the checklist for each resident in each scenario. Debriefing was held after all simulations were completed, during which the residents provided narrative evaluation of the exercise. The residents completed a retrospective pre-/post-self-evaluation of their own communication skills; this evaluation was based on a previously validated 10-item tool for residents. Results: Five postgraduate year 2 (PGY-2) pathology residents participated in the simulation. The self-evaluations revealed an increase in average rating for all 10 items. During debriefing, all participants expressed that this was a useful learning opportunity. All believed that the calls were of an appropriate level of difficulty for PGY-2 residents. Many stated that this experience should be required for all pathology residents at our institution. Conclusions: This pilot curriculum to teach communication skills through simulated phone calls was well received by pathology residents. Future efforts will include repeating the curriculum for subsequent PGY-2 residents in our program to validate the evaluation checklist. References: Accreditation Council for Graduate Medical Education. Pathology Milestones. 2019. https://www.acgme.org/Specialties/Milestones/pfcatid/18/Pathology. Symons AB, et al. A tool for self-assessment of communication skills and professionalism in residents. 2009. BMC Medical Education, 9(1):1.
Poster #06. Face-to-Face Feedback: A Survey of Resident Attitude and Perception
D. Daniel, MD1, and J. Libien, MD, PhD1
1Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
Objectives: To evaluate pathology resident attitudes toward face-to-face feedback with attendings in a large pathology residency. Methods: All current pathology residents of SUNY Downstate Medical Center were sent a survey via email, 5 months into the academic year. Google Forms was used to anonymously collect survey responses. Survey responses were provided on a 5-point Likert-type scale, addressing resident satisfaction with frequency and quality of face-to-face feedback provided by attending pathologists. Residents also reported the regularity with which they receive face-to-face feedback and were given the option to provide free-text comments. Results: Nineteen (of 24 invited) residents responded to the survey, with a response rate of 79%. Of note, 95% of the postgraduate year 1 (PGY1), 2, and 3 classes responded. The number of residents “somewhat satisfied” or “very satisfied” with the quality and frequency of feedback provided by attendings varied by PGY. While 75% of third-year residents were satisfied with the quality of attending feedback, only 33% of PGY1 and 38% of PGY2 residents expressed satisfaction. This is similar to resident opinions of the frequency with which feedback is provided. While 75% of PGY3 residents were satisfied with the frequency of feedback provided, only 50% of PGY1 and 33% of PGY2 residents were satisfied. Additionally, the frequency of which feedback is received increased with PGY. This ranged from 50% of first-year residents never receiving any face-to-face feedback to 87% of third-year residents receiving feedback at least once per rotation. During face-to-face feedback, only 26% of residents stated they identified an area to improve, established a goal, and formulated a plan to achieve that goal. Of the residents who did establish a goal and plan, the majority (60%) were senior residents. Conclusions: Directly and frequently providing feedback is a key step in the acquisition of new skills as well as an ACGME common program requirement. In this large academic pathology training program, residents were dissatisfied with both the quality and the frequency of feedback provided. Senior residents received feedback more frequently than junior residents and were more satisfied with the quality of feedback. Moreover, senior residents obtained better quality feedback (ie, setting goals, establishing plans, and so on) than junior residents. This study prompts the organization of scheduled, structured feedback sessions to improve the quality and frequency of resident feedback. Future steps include evaluating attending opinions as well as expanding to a longitudinal study.
Poster #07. Competency by Design (CBD) Implementation in the Division of Anatomical Pathology Program at The Ottawa Hospital
O.A. Khan, MD, BHSc1, and S. Islam MD, PhD, FRCPC, FCAP1
1Division of Anatomical Pathology, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Objectives: The Anatomical Pathology (AP) residency program at the University of Ottawa (UofO) is a subspecialty sign-out system. In 2016, formal measures were taken to implement competency-based medical education (CBME) in the AP program. Here, we discuss the steps taken for the rollout of Competency by Design (CBD) on July 1, 2019, and to evaluate its successful implementation. Methods: Three meetings were held over a 2-year period at the Royal College of Physicians and Surgeons for the transition of CBD in AP at the UofO. The core competencies were developed, and the AP program website was redesigned to incorporate all the CBME documents. The Clinical Competence Committee (CCC) who will be responsible for resident transition through the competencies was formed. The entrustable professional activities (EPAs), milestones, and assessment tools were integrated into Elentra, the electronic platform for CBME evaluation. The Curriculum Map (the rotation schedule to align with the stages of CBD and the postgraduate year levels) was created, and residents played an integral role in creating clinical scenarios to align with the EPAs. Four lunch/learn sessions took place from April to June 2019 with the PGME office to trial Elentra. A pilot study was initiated involving the residents and the CCC to perform work-based assessments on the EPAs. Competency by Design was officially rolled out at our institution on July 1, 2019. Results: A questionnaire was sent to the AP program 1 month post CBD implementation. Forty-two respondents including staff and residents participated. The questionnaire consisted of 9 questions on a 5-point Likert-type scale covering various topics including EPA integration into Elentra and learner feedback. Respondents mostly agreed (4 out 5) with statements covering the above areas. Respondent feedback focused on increased time commitments and EPA/milestone optimization. Conclusions: We have outlined the process of CBD implementation in the AP program at the UofO. This was a collaborative undertaking involving administration, residents, and staff. Our 1-month questionnaire revealed staff and residents have had a positive experience thus far with CBD. We plan on sending out additional questionnaires at 6 and 12 months and setting up a resident focus group to obtain more data on the CBD process to date. References: The University of Ottawa. Anatomical Pathology Residency Program. https://med.uottawa.ca/pathology/education/postgraduate-medical-education/anatomical-pathology. Royal College of Physicians and Surgeons. Accessed December 8, 2019. Competence by Design. http://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e.
Poster #08. Development of a Resident Chosen Curriculum in Laboratory Management and Informatics for Pathology Residents at the University Health–San Antonio
R. Alkhateb, MD1, H. Tariq, MD1, S. Ranjan, MD1, A. Ghezavati, MD1, J. Daniels, DO1, and L. Greebon, MD1
1Department of Pathology and Laboratory Medicine, University Health–San Antonio, TX, USA
Objectives: In the promptly changing field of health care, the scope of practice of pathology has been expanded to include computerized information management. Pathology residency training should have a unique well-designed laboratory management and informatics curriculum that includes information management activities and electronic tools that will benefit and be congruent with the scope of practice of a pathologist. Currently, at our institution, certain aspects of lab management and informatics are present within didactics and during experiences on rotations. However, a more structured platform is essential to create a consistent and reproducible experience for residents. Methods: In August 2019, our pathology residency directors elected a group of 4 residents, comprised of representatives for each postgraduate year (PGY) level, to develop a lab management and informatics curriculum. The committee performed a literature and educational materials search to identify and define appropriate objectives, resources, and activities to be utilized in the curriculum. Additionally, a structured time line for completion of required materials was established. Results: The curriculum includes 2 distinct subcurriculums: lab management and informatics. The curriculum was elected to be predominantly self-study from resources provided by the residency program. The lab management curriculum was divided into 4 modules that were designed based on the resident’s PGY level. An itemized list of specific topics within each module and suggested educational resources were defined (References 1 and 2). Corresponding questions were assigned in PathPrimer to demonstrate understanding and serve as a marker of completion of the content. The informatics curriculum was based on an online subscription for the ASCP University of Pathology Informatics modules (UPI) (Reference 3). The UPI is a new self-paced online certificate program that comprises 27 modules. The modules and topics were categorized based on the resident’s PGY level to ensure that the required modules to be achieved in the first 2 years. In addition to current didactics, new biannual sessions and simulated events will be performed to solidify and demonstrate concepts covered in this self-study curriculum. Conclusions: A resident committee was formed to enhance and standardize curriculum for lab management and informatics. A pilot will begin on January 01, 2020, with a full formalized roll out July 1, 2020. This resident-driven curriculum is a novel approach, as it offered us (as residents) the opportunity to prompt our thoughts regarding the feasibility of the contents, significance, and pertinence during the residency. In addition, it was a great to experience the challenges of creating a new curriculum that meets our needs and be applicable in real life given the current duty hours and the work load. References: 1. McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods book. 2. https://www.expertpath.com/ 3. https://www.ascp.org/content/learning/certificate-programs?promo=cphl
Poster #09: A Department-Sponsored, Hospital-Based Pathology Education Symposium Is a Cost-Effective Method to Provide Laboratory Staff With Highly Rated Continuing Education Experiences
E. A. Gehrie, MD1, L. N. Blagg, MA1, and R. H. Hruban, MD1
1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Objectives: Continuing education improves the quality of medical care and is an important responsibility for all health-care providers. While a variety of educational modules are available online, remote activities can be expensive, time-consuming, and may have limited applicability to local practice. We sought to assess the ability of an annual, locally produced, department-wide pathology educational symposium to efficiently meet continuing education needs for employees of a large health system. Methods: With the support of departmental and hospital leadership, a free, multiday continuing education symposium was produced by the department of pathology annually from 2013 to 2019. Continuing education credits were provided to attendees. Metrics related to attendance, number of educational sessions available for registration, and participant satisfaction were tabulated and compared to similar metrics gathered from an external continuing education conference which was offered to employees from 2011 to 2012. Results: The departmental educational symposium attracted more than twice the attendance of the externally produced educational offerings (mean of 635 annual attendees from 2013 to 2019 vs 247 annual attendees from 2011 to 2012). The mean cost per attendee for the departmental educational program was $51 compared to $140 for the external continuing education program. The mean number of educational programs produced for the departmental symposium was 39 per year, compared to 12 per year for the external program. Technical staff, residents, fellows, and faculty all contributed to departmental educational programming. Enhancements, such as remote-viewing (2014), networking (2014), and poster session (2015) activities, were added to the departmental program over time. Overall participant satisfaction was 96.2% (mean rating of 4.43 on a 5-point scale, 2013-2019) for the departmental program. Conclusions: Development of an internal, department-wide educational pathology symposium led to cost-efficient distribution of continuing education credits to a large number of laboratory staff, with high participant satisfaction. Reference: McMahon GT. The leadership case for investing in continuing professional development. Acad Med. 2017; 92:1075-1077.
Poster #10. Assessing Impostor Syndrome in an Academic Pathology Program
N. Hardy, MD1, R. M. Koka, MD, PhD1, and K. Stashek, MD1
1Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
Objectives: Impostor syndrome (IS) is characterized by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud, despite external evidence of accomplishments or skills. It has been shown to disproportionately affect women and minority groups, where it can not only lead to setbacks in personal career advancement but also unintentionally impact productivity in the workplace setting. The purpose of this study was to identify the prevalence of IS in pathology MDs at an academic medical center as well as identify demographic differences in those experiencing IS. Methods: An anonymous IS screening questionnaire was administered in September 2019 to pathology trainees and faculty, with demographic data limited to career stage and gender. The questionnaire utilized the Clance IP Scale, which is a Likert-type scale measuring degree of IS characteristics. Scores were totaled for each participant and translated according to the following: <40 = few IS characteristics, 41 to 60 = moderate IS, 61 to 80 = frequent IS, and >80 = intense IS. The mean scores across the demographic data were compared using t tests. Results: Twenty participants completed the questionnaire. All participants scored greater than 40, regardless of sex or career status. Female gender was significantly associated with increased feelings of IS (t = 2.08, P = .05), with women displaying frequent impostor feelings compared to their male counterparts, who on average experienced moderate IS (a mean of 72.9 compared to 58.8, respectively). Interestingly, when stratifying by career status, faculty had higher IS characteristics when compared to their male and female counterpart trainees, although this did not reach statistical significance (t = 0.57, P = .58). Conclusions: Impostorism is common in academic attending and resident pathologists and is pervasive, regardless of sex and gender, although women suffer from IS to a greater degree. These characteristics may actually worsen with experience and training. Given its pervasiveness and the association with physician job dissatisfaction and burnout, IS should be addressed on a systems level. Residency programs should implement initiatives like professional development programs and strong mentoring relationships in an effort to combat IS. The fact that women experience IS to a greater degree also suggests that an environment actively promoting and encouraging women for their accomplishments is necessary and that leadership training in addition to other development and mentoring opportunities may be helpful. References: Barr-Walker J et al. Measuring impostor phenomenon among health sciences librarians. J Med Libr Assoc. 2019;107(3):323-332. Haney T. et al. A Workshop for addressing the impact of the imposter syndrome on clinical nurse specialists. Clin Nurse Spec. 2018;32(4):189-194. Mak, K et al. Imposter phenomenon measurement scales: a systematic review. Front Psychol. 2019;10:671 Mullangi S et al. Imposter syndrome: treat the cause, not the symptom. JAMA. 2019;322(5):403-404. Persky AM. Intellectual self-doubt and how to get out of it. Am J Pharm Educ. 2018; 82(2):6990 Villwock J et al. Imposter syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016;7:364-369
Poster #11. Elective Certificate Tracks in Pathology Residency Training Meet the Needs of an Evolving Field
L. M. Wake, MD1, D. B. Allison, MD1, A. D. Ware, MD1, J. E. Hooper, MD1, A. S. Baras, MD, PhD1, E. M. Bloch MBChB, MS, MD1, W. Clarke, PhD1, K. H. Burns, MD, PhD1, M. J. Borowitz, MD, PhD1, C. Steenbergen, MD, PhD1, M. K. Halushka, MD, PhD1, R. H. Hruban, MD1, and M. J. White, MD1
1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Objectives: In the past, pathology residents were offered 2 tracks: standard clinical training with or without a research emphasis. Today, pathologists are stakeholders in quality improvement and assurance, value-based care, health policy, global health, informatics, and biomedical education. Pathologists who enter the workforce are expected to have a diverse skillset beyond that of clinical diagnostics, and therefore, pathology residency training and curricula must evolve to provide opportunities to gain exposure in these other domains. We sought to assess evolving resident educational needs based on career preferences and future job expectations. With this information, the Johns Hopkins Pathology Residency Program developed elective certificate tracks to provide residents with basic skills that are important to modern pathology. Methods: With a goal of aligning our training program with an evolving field, we assessed (1) current resident curriculum, (2) perceived curricular strengths and needs, (3) barriers to implementing elective skills curricula, (4) available resources, and (5) resident career preferences. Methods of assessment included faculty and resident discussion groups using The Accreditation Council for Graduate Medical Education Pathology Milestones as a curricular guide. We also referenced published data from a longitudinal analysis of our residency program to assess prior resident career paths. Results: Six residency training certificate tracks were established: Education, Physician-Scientist Research, Informatics, Quality Improvement/Quality Assurance/Value-Based Care, Health Policy/Hospital Management, and Global/Community Health. Together with resident leaders, assigned faculty directors developed formal curricula with objectives, core educational content, and expectations, including execution of project(s). While it is too early to meaningfully assess outcomes, there have been early successes: the Informatics, Physician-Scientist Research, Global/Community Health, and Education tracks have each had one resident complete their respective curricula. Currently, 7 residents are on the education track and 3 are pursuing the global health track. Completed resident projects include e-learning modules, an online digital atlas, books, and book chapters. Conclusions: The Johns Hopkins Resident Certificate Track program provides pathology residents an opportunity to gain meaningful experience in professional skills that are rapidly becoming core elements in pathology practice. References: Black-Schaffer WS, et al. Evidence-based alignment of pathology residency with practice: methodology and general consideration of results. Acad Pathol. 2018.
Poster #12. Development of a Pathology Resident Wellness Initiative in a Large Academic Pathology Residency Training Program
A. D. Ware, MD1, K. Davis, MD1, M. Butcher, MD1, J. S. Nix, MD, PhD1, C. Kim, MD1, R. Kwon, MD1, D. Borzik, MD1, S. Tabibi, MD1, H. Kaur, MD1, J. Stein, MD1, G. Bailey, MD1, A. Graham, MD1, K. Schultz1, N. Nath1, C. Steenbergen, MD, PhD1, R. H. Hruban, MD1, and M. J. White, MD1
1Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Objectives: Discussions surrounding physician wellness and burnout have gained significant attention in the medical literature and lay media, with an emphasis on promoting resident well-being and reducing burnout. The rate of burnout among pathology residents is estimated to be 46% to 52%, although studies focused on pathology residents are limited. While our department previously provided several wellness interventions, we sought to create a Pathology Resident Wellness Initiative that caters to the unique well-being needs of our pathology residents. Methods: A 4-question well-being survey was distributed to the pathology residents. Based on the results, a proposal and budget were drafted and submitted to the Pathology Administration. Proposed interventions included an annual resident retreat, the provision of healthy snacks in resident common areas, resident birthday gifts, a peer mentorship program, wellness resources on the Department website, resident social events, and lectures on well-being topics. The proposal was approved by the Department, and the Pathology Resident Wellness Committee was established in Spring 2018. This effort supplemented an existing meal delivery program. Results: Since Spring 2018, nonperishable healthy snacks have been provided in the resident common areas. A peer mentorship program was established to provide an upper-level resident mentor to each incoming 1st-year resident. Each resident receives a small birthday gift. There have been 2 resident retreats to reinforce team building. Three at-work social events were held to build stronger relationships between residents and staff, and 2 resident social outings were held yearly. Three guest lecturers were invited to speak on topics including mindfulness, meal preparation, and yoga. Each of our 35 residents has attended at least 1 event. Residents have reported developing vital stress relief skills and a stronger sense of belonging with peers. Conclusions: Pathology residents have unique experiences, and their wellness needs differ from residents in other specialties. A targeted wellness program can improve the overall sense of belonging and help to foster resiliency in pathology trainees. References: 1. Ishak WW, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;1(2). 2. Daly KD, et al. Bridging the gap: training and education in the pathology and cytopathology sphere. Cancer Cytopathology. 2018. 3. Lefebvre DC. Perspective: resident physician wellness: a new hope. Acad Med. 2012;87(5). 4. Ziegelstein RC. Creating structured opportunities for social engagement to promote well-being and reduce burnout in medical students and residents. Acad Med. 2017.
Poster #13. The MGH Passport: A Management Platform for the Accreditation Council for Graduate Medical Education Milestones Program
E. Madrigal, DO1, L. P. Le, MD, PhD1, and W. S. Black-Schaffer, MD1
1Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
Objectives: Starting in 2014, the Accreditation Council for Graduate Medical Education (ACGME) Milestones Project has included anatomic pathology and clinical pathology (AP/CP) residency programs to guide curriculum development and facilitate better feedback for professional growth. How evaluations are initiated, documented, and analyzed is left to the discretion of participating programs. Many programs have relied upon paper-based or nondatabase solutions, hindering the ability to extract insight from evaluations by residents, faculty, and the Clinical Competency Committee (CCC). To that end, we developed an interactive web-based ACGME milestones management platform, henceforth referred to as the Massachusetts General Hospital (MGH) Passport, to facilitate documentation and reporting of milestones. Methods: Leveraging our department’s residency management platform, based on a MediaWiki stack, we designed several SQL tables and built custom queries to develop one milestone evaluation system with different views for residents and faculty. One view provides residents with the opportunity to prompt a milestone-linked, rotation-specific evaluation when they deem that they have achieved any of the 1123 binary, granular, attainments. Faculty can record milestones as attained or not and provide comments. The MGH Passport relies on preexisting profiles for residents to indicate the post-graduate year (PGY) and residency track; faculty profiles were used to determine subspecialty assignments. Annual academic schedules were necessary for analytics. Using our institution’s access protocol, we limited access to individual users. An instructional video was produced and embedded in the evaluation page as a resource. Results: Over 11 000 milestone attainments were imported from a previous version of the MGH passport. An initial pilot of the new system assessed PGY1 residents resulting in 496 completed evaluations by 12 faculty members across 10 subspecialties. Residents initiated 241 evaluations, 89% (215/241) of which were verified as attained. The instructional video was accessed 29 times. An analytics dashboard was developed for the CCC with 6 filters, including PGY, residency track, subspecialty service/clinical laboratory, and milestone category and level. Conclusions: By creating the MGH Passport, it becomes feasible to present actionable insight for our department’s CCC. This new platform will help guide curriculum development, support better self-assessment, and enhance the public accountability of our AP/CP residency program. Our next step will be to make the platform available to all PGYs and provide individual and anonymized analytics. References: Naritoku WY, Alexander CB, Bennett BD, et al. The pathology milestones and the next accreditation system. Arch Pathol Lab Med. 2014; 138(3):307-315. PMID:24576024. Naritoku WY, Powell SZ, Black-Schaffer WS. Evolution of the pathology residency curriculum: preparing for a positive future. Acad Pathol. 2016;3:2374289516667746. Yarris LM, Jones D, Kornegay JG, Hansen M. The Milestones Passport: a learner-centered application of the milestone framework to prompt real-time feedback in the emergency department. J Grad Med Educ. 2014;6(3):555-560. doi:10.4300/JGME-D-13-00409.1
Poster #14: Implementation of Clinical Pharmacogenomic Testing and Point-of-Care Genomic Decision Support via Multispecialty Collaboration
R. A. Pulk PharmD, MS1, D. Ferguson, BS2, N. Price, BS2, C. Torre Jr, BS, MHA2, L. Miller, PharmD, MS1, M. Renauer, PharmD, MBA1, and W. L. Schulz, MD, PhD3,4
1Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
2Information Technology Services, Yale New Haven Health, New Haven, CT, USA
3Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
4Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
Objectives: The primary objective was to deploy a chip-based pharmacogenomic testing platform and integrate point-of-care genomic decision support within the electronic health record (EHR). The clinical goal was to allow for routine use of a pharmacogenomic panel and to replace single-gene testing when appropriate. Common genetic polymorphisms are known to affect the safety and efficacy of medications, yet limited access to testing, uncertain reimbursement, lack of provider education, and the complexity of clinical testing in the context of rapidly evolving clinical interpretations have limited the use of pharmacogenomic screening. Methods: An interprofessional group comprising pharmacists, clinical pathologists, clinical informaticists, geneticists, and administrators was assembled to launch a clinical pharmacogenomics program in a large, academic health system. Acting as an oversight committee, this group developed testing guidelines and coordinated integration with existing health system governance. An array-based genotyping approach was implemented via a reference laboratory and results integrated into the EHR via a commercial point-of-care knowledgebase. A subset of 15 pharmacogenes was compiled as a standardized return list and clinical pilots deployed in collaboration with care teams in cardiology, solid organ transplantation, and bone marrow transplantation. Results: Within 9 months, 432 patients across 4 hospitals and affiliated outpatient laboratories have benefited from panel-based pharmacogenomic testing. Each resulted patient has undergone medication profile review by a clinical pharmacist with entry of an interpretive consult note into the EHR. In our sample, 92.9% of patients carry at least one actionable finding. Reactive testing in cardiology revealed 34% of patients carried loss-of-function polymorphisms correlated with decreased efficacy of their prescribed antiplatelet agent. Preemptive testing in the kidney and bone marrow transplant populations allowed for personalization of posttransplant treatment for 70% or 54% of patients, respectively. Customization of the third-party reporting interface has ensured reliable result reporting and regulatory compliance. Conclusions: The success and rapid implementation of this program has grown from leveraging the unique perspectives of clinicians within laboratory medicine, clinical pharmacy, and informatics to enable clinical pharmacogenomics. Ongoing work, in partnership with primary clinical providers, will continue to offer these important clinical results to patients as evidence is built to assess the impact and cost-effectiveness of pharmacogenomic testing.
Poster #15. Use of a Co-Enrollment Course to Improve Pathology Exposure in UME
B.C. McCleskey, MD1
1Department of Pathology, University of Alabama at Birmingham, AL, USA
Objectives: In recent years, there has been a downward trend in interest among medical students pursuing careers in pathology. This decline is partly related to the absence of adequate pathology exposure, especially as a clinical specialty, in the undergraduate medical education (UME) curriculum. The paucity of pathologists involved in UME not only impacts the number of students entering pathology but also the number of clinicians who have awareness of pathology’s role in patient care. Aims include sharing the experience with development of a co-enrollment (CE) course, presenting student feedback, and considering the potential positive impact pathology-focused educators can have on UME. Methods: The Department of UME at the University of Alabama at Birmingham (UAB) offers CE electives that occur concurrently with required courses. The goal is to offer a wide variety of issues/topics in medicine and partially fulfill the elective requirement for graduation. With this format in mind, a course focused on forensic pathology and public health was developed. An attention-grabbing course title with a variety of session topics was submitted. Enrollment size was limited and open to those in their second year and beyond. Sessions included presentations on pathology as a career, aspects of forensic pathology, medicolegal concepts, death certification and public health, experiences related to the opioid epidemic, teaching at the microscope, and prevention of infant deaths. In addition to attending regular sessions, students were required to attend an autopsy, complete a death certificate, author a condolence card, and present to the class on an assigned topic. Students were surveyed after completion of the course in addition to completing the standardized evaluation. Results: During enrollment, a waitlist formed and 13 spots were filled. Sessions were taught by forensic pathologists, pathology residents, a pediatrician, a biostatistician, and recovering opioid addicts. The students also observed an autopsy on the weekend at the medical examiner’s office. In addition to the autopsy observation, students completed a death certificate for the decedent and authored a condolence card for families. Students evaluated the course content as 4.5/5, variety of activities as 4.67/5, and overall as 4.58/5. Students agreed that the course allowed for greater appreciation of the relevance of pathology to their profession (4.92/5.00). Conclusions: Utilizing a CE course to improve medical student exposure to pathology as a career is a valuable tool. This experience allowed the opportunity to learn about how a pathologist interacts with patient care and public health as well as the opportunity to be involved in an autopsy. The autopsy requirement of the course was received with enthusiasm and provided an invaluable learning experience. Patient-led education from recovering opioid addicts was memorable, impactful, and inspiring for these students. Student feedback can help educate future iterations of this course both at UAB and beyond.
Poster #16. Integrating Programming Skills Into Residency Education Using Open Source Resources
N. Krumm, MD, PhD1, and P. C. Mathias, MD, PhD1
1Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, USA
Withdrawn
Poster #17. Regional Interviews for Residency Program Recruitment: Is It Time?
L. M. Schiffhauer, MD1, L. Antinarella1, C. Piazza1, B. Bushen1, B. L. Wilson, MD1, A. Israel, MD1, W. R. Burack, MD, PhD1, J. J. Findeis-Hosey, MD1, and B. R. Smoller, MD1
1Department of Pathology and Laboratory Medicine, University of Rochester, NY, USA
Objectives: When evaluating the recruitment process for our Pathology Residency Program at the University of Rochester, we observed that some invited candidates do not schedule interviews and some candidates who schedule interviews cancel at times with short notice. Although many possible explanations for this behavior exist, based on prior experience and recent literature, we speculate that geographic location and cost play a large role. In an attempt to alleviate some financial burden and address a potential geographic barrier for invited applicants, during the 2019-2020 recruitment season, we offered a regional interview option modeled after one faculty members’ prior experience recruiting for medical student education. Here, we describe our experience with the regional interview. Methods: In May 2019, a committee composed of faculty and residents was formed to review the recruitment process for the Pathology Residency Program. The idea of a regional interview was raised and a recommendation to explore the idea was agreed upon. After literature review and review of the National Resident Matching Program policies, the idea was discussed with our Designated Institutional Official for Graduate Medical Education and a decision was made to offer a regional interview option during the 2019-2020 recruitment season. In August 2019, a working group planned the details. In September to October 2019, the regional interview option was offered to all applicants selected through the Electronic Residency Application Service (ERAS) and invited for an interview through the Thalamus scheduling platform. Recruitment materials were created to showcase our facilities and community, and in November 2019, a 1-day regional interview was conducted. At the conclusion of the interview, a written survey was given to the applicant attendees. Results: Of the 82 applicants invited for an interview, 14 (17%) initially scheduled the regional interview and 9 (64%) subsequently canceled the regional interview. Of those who canceled, 4 (44%) rescheduled and completed a local interview. The regional interview was carried out by a 7-member team at the Hilton Chicago O’Hare Airport Hotel. All 5 (100%) applicants who attended the regional interview completed the written survey. Survey responses indicated that all 5 selected the regional interview for geographic convenience. Survey comments included: “very informative and highly professional,” “very creative,” and “I loved the experience.” Areas for improvement included invite more residents (4/5), conduct longer interviews (3/5), provide more resources related to the workplace and community (2/5), and consider adding other cities (2/5). Conclusions: Regional interviews can be successfully incorporated into a residency program’s recruitment process and some applicants will choose to attend a regional interview if offered. From the applicants’ perspective, items to consider include selecting different and/or additional interview sites, having an appropriate amount of time per interview, providing adequate resources about the local site, and including more than 1 resident on the team. References: 1. Black CC. Examination of the residency interview process for academic pathology departments: how to make the most of a resource-heavy process. Acad Pathol. 2016;3:1-6. 2. Callaway P, et al. Financial and time burdens for medical students interviewing for residency. Family Med. 2017. 49(2):137-140. 3. Fogel HA, et al. The economic burden of residency interviews on applicants. Iowa Orthop J. 2018;38:9-15. 4. Nikonow TN et al. Survey of applicant experience and cost in the urology match: opportunities for reform. J Urol. 2015;194(4):1063-1067.
