Association of Pathology Chairs: Abstracts of the 2021 Annual Meeting July 25 to 28,2021

The following abstracts were accepted by the Association of Pathology Chairs, without modification, for poster presentation at the 2021 APC Annual Meeting. This content was not peer reviewed by Academic Pathology.

Presenting authors’ names are bolded throughout.

Poster #01. Peer Instruction: A Novel Educational Methodology That Dramatically Changes Pathology Residency Teaching

J. D. Reisler¹, T. D. James¹, M. B. Williams¹, and M. Afrouzian, MD²

¹School of Medicine, University of Texas Medical Branch, Galveston, TX, USA

²Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA

Objectives: Curricula for pathology residents vary across medical institutions, all utilizing and integrating forms of academic lectures and clinical experiences. Peer Instruction (PI) is an interactive teaching methodology with the purpose of initiating collaboration between the pathology residents and faculty. The PI format has proven beneficial for certain undergraduate and medical school courses, but to our knowledge has not been used in resident education. We report a pilot curriculum for pathology residents at the University of Texas Medical Branch (UTMB) in Galveston.

Methods: Four nephropathology lectures were adapted by a faculty nephropathologist to use the PI format via Zoom. Eighteen pathology residents were divided into groups A or B and experienced 2 PI and 2 non-PI (traditional lecture) sessions in a crossover manner (total of 4 PI and 4 non-PI sessions for both groups). During the PI sessions residents were exposed to 2 to 3 vignettes followed by difficult multiple-choice questions. For each question, residents were asked to respond to 2 polls using Poll Everywhere software. The first poll assessed the knowledge of individual residents, while the second poll assessed the residents’ response after a 2-minute peer-to-peer discussion. The results of both polls were then shared with the residents, followed by a detailed faculty discussion of all answers. At the end of each session, residents responded to a survey that consisted of 9 questions based on a 5-point Likert scale that assessed the residents’ experience with PI.

Results: The results of the survey show that residents mostly agreed or strongly agreed with statements that PI enhanced their quality of learning, that correct and incorrect answers were explained well, and that expectations for PI were clear. In addition, 80% of residents agreed or strongly agreed that PI was an effective learning tool.

Conclusions: Our study shows that PI is an effective method of educating pathology residents when compared to traditional lecture. PI enhanced learning gains and retention of the material while promoting peer-to-peer communication. Future directions will be aimed at integrating this teaching modality into presentations involving other areas of surgical pathology residency training.

Poster #02. Gross Room On-boarding: An Intensive Rotation to Teach Gross Examination Skills

R. Wiggins, PA-C¹, O. Snir, MD¹, and M. VanSandt, DO¹

¹Department of Pathology, Oregon Health & Science University, Portland, OR, USA

Objectives: New pathology learners have little to no experience performing surgical pathology tasks when they leave medical school and enter pathology residency. At OHSU, the surgical pathology rotation is structured as a 1-day cycle, meaning trainees are expected to gross, preview cases, and sign-out with an attending pathologist, all within a single day. The transition into a 1-day cycle is abrupt, demanding, and difficult for the new learner. To ease this transition, we developed a novel Gross Room On-boarding Rotation to give new learners direct experience in gross examination skills while briefly eliminating the competing tasks of a 1-day cycle. The aim of the Gross Room On-boarding Rotation is to provide the newest pathology learners with the basic gross examination skills necessary to successfully transition into a 1-day cycle on a surgical pathology rotation.

Methods: Four PGY-1 residents and 3 post-sophomore medical student fellows participated in a 2-week Gross Room On-boarding Rotation at the beginning of their academic year. These early learners were paired 1-on-1 with a Pathologists’ Assistant to learn laboratory safety, basic principles of gross examination, laboratory information system skills, and proper specimen identification, while also facing progressively increasing grossing responsibilities throughout the rotation. The temporary elimination of previewing and sign-out responsibilities allows a new learner to focus exclusively on grossing skills. All accomplished tasks were recorded in a newly created online form, which also serves as the record-keeping mechanism to document a learner’s progress toward grossing competency, as defined by the ACGME.

Results: Five Pathologists’ Assistants served as supervisors during the rotation, and all 5 have subjectively observed that the new learners were more easily assimilated into the 1-day cycle of the surgical pathology rotation when compared with previous years. In addition, all 5 Pathologists’ Assistants support continuing the Gross Room On-boarding Rotation at the beginning of every academic year. The 7 new learners have also anecdotally expressed their appreciation for this intensive gross room training time and agree that it should be continued for all incoming pathology learners. This extremely positive response has prompted us to disseminate our experience to the greater pathology education community.

Conclusions: The Gross Room On-boarding Rotation provides an intensive learning experience that is valued by Pathologists’ Assistant supervisors and by new learners in pathology. Continuation of this rotation in future years is expected and will continue to place value on building a strong foundation of gross examination skills for all new learners in pathology at our institution.

Poster #03. Assessing Student Opinion on Autopsy as a Supplement to Undergraduate Medical Education

W. F. Wong, AB¹, and J. Chan, MD²

¹Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

²Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

Objectives: Medical schools have decreased the use of autopsy as a teaching tool in undergraduate medical education (UME). However, there are no recent data to understand how undergraduate medical students (UMS) value autopsies in their education, thus limiting suggestions for improving UME. This study aims to assess UMS opinion regarding the importance and utility of autopsies in their medical curriculum.

Methods: A 51-question survey was developed and distributed electronically to all UMS at Sidney Kimmel Medical College (n = 1082). Data were collected and analyzed using RedCap from August 2019 to January 2020.

Results: Of all, 9.5% (103) surveyed responded; 84.5% were preclinical students; 63.1% identified as female, 34% as male, and 2.9% as gender nonconforming or preferred not to answer; 7% had previously seen an autopsy, and 85.4% were interested in viewing an autopsy. On Likert scale (1 = strongly disagree; 5 = strongly agree) questions, third-year students (μ = 1.7, SD = 0.49) were significantly less likely than first-year students (μ = 2.6, SD = 0.93) to consider a career in pathology (P < .001). Similarly, second-year students (μ = 2.0, SD = 1.44) were significantly less likely than first-year students (μ = 2.6, SD = 0.93) to consider a career in pathology (P < .026). All respondents were neutral in their perceived importance of viewing an autopsy in their pathology (μ = 3.7) and overall medical (μ = 3.6) education. They agreed that witnessing an autopsy can improve anatomical knowledge (μ = 4.3), observational skills (μ = 4.1), and clinicopathological correlations (μ = 4.3). Respondents agreed that it can also increase understanding of the role of pathologists (μ = 4.3) and autopsy (μ = 4.3) in patient care. Respondents also reported low understanding of the logistics of autopsy, including cost to the patients’ family (79.6%), indications for autopsy requests (48.5%), and authority to request an autopsy for a patient (35%). In addition, 39.8% reported “I don’t know” for UMS eligibility to view an autopsy and 42.7% reported “I don’t know” for who to request permission to view an autopsy.

Conclusions: Overall, the data suggest that UMS earlier in their education are more likely to consider a career in pathology, with waning interest as they progress through UME. Additionally, UMS are interested in witnessing autopsies, believe it can improve knowledge and skill sets, but lack information on logistics. This implies UME will benefit from expanding access to the autopsy witness program. Such a program may also positively engage UMS earlier in their medical career when they are more likely to consider pathology as a career.

Poster #04. Prevalence of PCOS During the COVID-19 Pandemic: A “Meta-Analysis”

A. Tohid, MD, MPH¹, S. W. Siddiqui, MD², and M. Tauheed, MD³

¹Department of Pathology, University of Southern California, CA, USA

²Department of Pathology, Prince George Hospital Center, MD, USA

³Department of Pathology, Dow University of Health Sciences, Karachi, Pakistan

Objectives: High prevalence of cardiometabolic diseases, including diabetes, hypertension, and obesity in women with PCOS have a strong overlap with risk factors for severe COVID illness. Increased androgen activity in males and PCOS females is correlated with increased vulnerability to COVID. We conducted a meta-analysis to determine the effects of COVID on women with PCOS.

Methods: We did a meta-analysis and searched databases including PubMed, SpringerLink, Google Scholar, and PsychInfo for words “PCOS, COVID-19, and pandemic.” We reviewed 40 articles and included 5 in this review describing PCOS prevalence during the pandemic. Women (146 PCOS and 97 controls) presenting to the Department of Endocrinology, Hull and East Yorkshire Hospitals NHS Trust were recruited to the local PCOS biobank. Cohorts were matched for age. A literature review consisting of articles on PCOS and COVID-19. Demographics included Black, Asian and Minority Ethnic (BMES) groups. A population-based closed cohort study was done at a primary care database in the United Kingdom between January 31, 2020, and July 22, 2020. A literature review on PCOS and youth’s physical activity.

Results: Many important protein biomarkers described for COVID-19 severity were found in women with PCOS. There is RAS system overactivity in PCOS and women with PCOS may be predisposed to more severe COVID-19 infection. There is a very high prevalence of multiple cardiometabolic conditions, including type 2 diabetes, obesity, and hypertension in women with PCOS, which increases the risk for COVID-19-related consequences. Women with PCOS had a 28% increased risk of COVID-19; COX proportional hazards regression model was used with addition of variables, including age, BMI, increased androgen, impaired glucose levels, anovulation, vitamin D deficiency, cardiovascular disease, and hypertension providing adjusted and unadjusted hazard ratios. The lifestyle changes associated with COVID-19 might increase the risk of PCOS in adolescents. It is recommended to avoid unhealthy habits, to sleep well, to eat healthy, and to increase physical activity.

Conclusions: There is a high risk of severe COVID-19 infection among women with PCOS. PCOS women should be particularly motivated to comply with COVID-19-related preventive measures. Isolation related to the SARS-CoV-2 pandemic is associated with lack of social support and decreased activity, which can lead to PCOS in adolescents. Therefore, during the pandemic, the physicians should recommend healthy behaviors such as healthy meals and increased physical activity to women with PCOS.

Poster #05. You Can Take That to the Bank: A Departmental and Openly Available Intelligent Question Bank Application for Graduate Pathology Education

R. E. Landvater, MD, MEng¹, U. Balis, MD¹, and C. F. Farver, MD¹

¹Department of Pathology, University of Michigan, Ann Arbor, MI, USA

Objectives: Current medical education—pathology being no exception—can be conceptualized as learning sessions that exist along a spectrum of participation ranging from passive (lectures and books) to active (questions and discourse). Contemporary education research consistently points to the need to restructure curricula to include a combination of both active and passive learning strategies; to these ends, many medical schools are introducing “flipped-classroom” activities wherein passive learning is performed independently and subsequent in-person learning employs active strategies (McLaughlin, 2014). Pathology departments develop their own graduate education curricula, most of which exists in the form of faculty authored lectures. Research shows that attention declines rapidly after the first 10 minutes of a lecture; therefore, it is unsurprising that passive learning during hour-long lectures only yields only about 20% of material retained (McLaughlin, 2014; Hartley, 1978). Question quiz applications (“banks”) are independently becoming a core resource for trainees seeking active learning opportunities outside of departmental lectures.

Methods: We have developed, and continue to improve upon, a question bank application in the form of an application-server, analytics tool set, and paired client-application that is openly available for use by the educational team and informatics department of sibling institutions to be used in the development of active learning sessions, independent learning (such as is done by third-party question bank study aids), and clinical rotation preparedness.

Results: The application server is conveniently containerized using Docker (Merkel, 2014) for ease of deployment and is written in highly optimized C++ code, reducing the hardware requirements of any institution requesting its use. The non-SQL database, MongoDB, is used for data storage and can be configured to run in a Docker container on the same server or as a freely hosted remote cluster. The paired client application is constructed using the open-source Qt framework and is itself open-source, allowing for customization, branding, and further “forked” development by interested pathology departments. The analytics tool, in early development, will offer a Python interface for educational research. Preliminary usage data and anecdotal reports on approximately 100 tests taken in the early testing phase praise the ease of use and intuitive design.

Conclusions: We are proud to introduce a virtual active learning “question bank” tool developed specifically for postgraduate pathology education. The application is designed to augment lecture series (a core element of residency) and clinical rotations in an intuitive physician-centered design. The system is constructed and “packaged” in using contemporary deployment technologies (Docker), and the user application source code is available for institution-specific implementations.

Poster #06. Team-Based Learning at Duke-NUS—From Physical to Virtual to Hybrid System Across Two First-Year Medical Cohorts

S. H. Lai, MD^1,2, P. Y. Wong, PhD¹, and I. C. J. Lee, PhD¹

¹Office of Education, Duke-National University of Singapore (NUS) Medical School, Singapore

²Department of Anatomical Pathology, Singapore General Hospital, SingHealth, Singapore

Objectives: This presentation highlights challenges and adaptations in curriculum management, student and faculty engagement, assessments, and student support across 2 cohorts of first-year medical students at Duke-NUS Medical School during the peak of the COVID-19 pandemic in Singapore. COVID-19 hit in January 2020, leading to nationwide restrictions in group activities across all sectors including education. For tertiary education, classes with more than 50 persons were prohibited to be conducted physically.

Methods: At Duke-NUS, we were able to quickly convert our classroom from physical to virtual across a weekend for the 81 students.

Results: The class adapted well for most of the second semester from February 2020, troubleshooting and learning along the way. The virtual classroom continued for the next intake of July 2020.

Conclusions: As restrictions were lifted toward the end of 2020, we cautiously brought students back to the classroom in small groups as permitted. By January 2021, we were running a hybrid classroom which shall continue to end of the academic year. As the time of preparation of this article, we are preparing to start the next intake in July 2021 in a hybrid model.

Poster #07. The #Path2Path Virtual Landscape During the COVID-19 Pandemic: Preparing for the 2020 Pathology Residency Recruitment Season

H. Cutshall, BS¹, R. Hattaway, BS¹, N. P. Singh, BS¹, S. Rais-Bahrami, MD², and B. McCleskey, MD³

¹School of Medicine, University of Alabama at Birmingham, AL, USA

²Department of Urology, University of Alabama at Birmingham, AL, USA

³Department of Pathology, University of Alabama at Birmingham, AL, USA

Objectives: On May 11, 2020, the Association of American Medical Colleges released recommendations discouraging in-person activities for away rotations and mandating virtual-only residency recruitment interviews. This article focuses on how residency programs have attempted to adjust to this vastly different application cycle by using social media to reach their applicants.

Methods: A total of 138 programs were identified through the Electronic Residency Application Services. The presence of Departmental/Residency program Twitter, Instagram, and Facebook, as well as web pages offering virtual opportunities were recorded for each program on October 30, 2020.

Results: A total of 132 social media accounts were found; the majority of which were on Twitter while fewer were on Instagram and Facebook. All 138 pathology residency programs had websites. Sixteen (11.5%) of those advertised virtual open houses and 2 (1.4%) advertised virtual subinternships; social media was more often used for advertisement of these virtual experiences. A total of 58 open house opportunities were advertised on Twitter, 21 on Instagram, and 20 on Facebook. Innovative virtual subinternships ranging from 2 to 4 weeks were developed, but only represented 6% of the usual 126 away rotations available.

Conclusion: Pathology programs across the country utilized websites and social media as a method of communication to interact with applicants as part of the #Path2Path in 2020 and to provide virtual opportunities in preparation for a drastically different recruitment cycle.

Poster #08. The Role of an Online-Based Clerkship on Medical Students’ Perspective of Pathology During the COVID-19 Pandemic

H. O. Fasanya, PhD¹, K. Tew¹, A. M. Tuzzolo, MD¹, J. L. Kresak, MD¹, and S. G. Beal, MD¹

¹Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA

Objectives: The field of pathology has limited interest from US medical students due to negative perceptions about the field. The unique challenges in medical education created by the COVID-19 offered an opportunity to educate medical students about the field of pathology through the utilization of a virtual clinical course. We had a 2-fold aim to evaluate whether an online, asynchronous, pathology elective course increased medical students’ (1) knowledge of pathologists’ responsibilities and (2) interest in pathology as a career. The objectives of this course were to teach the fundamentals of pathology as well as introduce students to how pathology integrates into patient care.

Methods: We analyzed self-reported data collected from students when they turned in their final assignment. From May 2020 to March 2021, 63 students participated in the course. The full course curriculum can be viewed here. In brief, in addition to a core set of activities, students chose from a variety of activities including reviewing pathology cases, watching pathology lecture videos, listening to podcasts, and reading articles related to several aspects of the field.

Results: In all, 83% of the medical students who took this course reported that they were “not at all” or “slightly” familiar with the practice of pathology prior to taking the course. At the conclusion of the course, 0% remained “not at all” or “slightly” familiar and 63.5% reported that they were “very” or “extremely” familiar with the practice of pathology. The average chance of applying to a pathology residency was 14.1% prior to taking the course, compared with 24.3% after completion. Internal medicine had the highest level of career interest with 28.5% (n = 18) followed by surgical specialties at 23.8% (n = 15). Only 8% of students indicated a specific interest in pathology (n = 5).

Conclusions: Medical students have limited opportunities to learn about the field of pathology during the preclinical and clinical years. Our online pathology course elective provided a unique opportunity for medical students to learn about the field of pathology and consider it as a career option, while also learning the pathology of a wide variety of entities.

Poster #09. The Feasibility of an Entrustable Professional Activity to Support and Assess Frozen Section Training in Pathology Residency: Moving Toward Entrustment Decisions

B. Bryant, MD¹

¹Department of Pathology, University of Vermont, Burlington, VT, USA

Objectives: Entrustable professional activities (EPAs) are an intuitive form of workplace-based assessment that can support competency-based medical education. Many EPAs have been written and published, but few studies describe the feasibility or implementation of EPAs in graduate medical education.

Methods: The frozen section EPA was introduced into the pathology residency training at the University of Vermont for PGY1s at the start of their training in frozen section. The feasibility of the EPA was evaluated based on utilization and support of frozen section training and generating data to support entrustment decision about residents’ readiness to take call.

Results: The EPA was well-utilized and satisfactory to residents, faculty, pathologists’ assistants, and clinical competency committee members. The clinical competency committee reported more sufficient data and higher confidence in assessing resident readiness to take call with the addition of EPA to the residents’ assessment portfolio. Residents did not endorse it helped them prepare for call; however, the interruption to frozen section training due to the COVID pandemic was a significant contributing factor.

Conclusions: The EPA is a feasible addition to pathology resident training to support graduated responsibilities. The implementation and integration of the EPA into pathology training at our institution is described with discussion of adjustments for future use.

Poster #10. Enhancing Diversity, Equity, and Inclusion in Pathology: Advancing Our Goals Through Philanthropic Initiatives

A. D. Ware, MD¹, R. H. Hruban, MD¹, and M. J. White, MD¹

¹Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Objectives: There is an increasing emphasis on anti-racism, diversity, equity, and inclusion (DEI) in education across all medical fields including pathology, grounded by national conversations on eliminating violence and racism against racial and ethnic minorities. To this effect, many institutions are implementing or expanding initiatives to support DEI in medical education including DEI leadership roles, anti-racism programming, deliberate recruitment, active outreach to trainees and prospective applicants, funded training experiences, holistic review processes, and career development programs. Adequate funding is critical to the success of these initiatives. Despite existing private and federal opportunities for DEI funding, securing consistent philanthropic funding presents a challenge as DEI has not been a consistent fundraising focus. Herein, we detail our Department’s experience with the establishment and expansion of philanthropic DEI funding.

Methods: A record of DEI donation from fiscal years 2010 through March 2021 was obtained from the Johns Hopkins Department of Pathology (JHDP). Fundraising methods, fund use, and mechanisms of donor follow-up were obtained from the Department Director and members of the Johns Hopkins Diversity Committee.

Results: In 2010, US$200 000 from JHDP reserves were used to establish an endowed fund for department DEI initiatives. From 2012 to 2019, DEI fund annual donations ranged from US$200 to US$2700, obtained primarily through passive means (ie, letter, e-mail, and web campaigns). Following the tragic events of 2020, the Director utilized a direct and personal approach, where prospective donors were presented with specific short- and long-term DEI funding needs to support ongoing efforts to recruit and retain a diverse faculty. With the transition to active outreach, DEI-directed donations increased to approximately US$3 600 000. This effort made JHDP eligible for additional funding supplements through the university, adding to the total funds available to support DEI. The progress and impact of ongoing and future initiatives are shared through personal follow-up, the JHDP diversity website, and peer-reviewed publications.

Conclusions: Secure philanthropic funding is an essential component for the long-term success of robust DEI initiatives. In our experience, the quantity of DEI-directed donations increased significantly when there was active and personal outreach with specific short- and long-term needs. These efforts are particularly effective when coupled with public events which highlight the need. Efforts can then be maximized by coupling with existing institutional DEI funding supplement initiatives.

Poster #11. Group Coaching as an Intervention to Decrease Levels of Impostor Syndrome in Medical Students

J. L. Chung¹, and J. L. Hunt, MD²

¹Department of Psychology, Rhodes College, Memphis, TN, USA

²Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA

Objectives: Medical students are known to experience relatively high levels of impostor syndrome that likely affects performance and student experience. This study was a pilot of a group coaching workshop to teach tools and skills for self-efficacy. This program was funded by a grant from the Arkansas Medical Society.

Methods: The workshop content was extracted from an established group coaching program for women physicians designed to target impostor syndrome in the professional setting. Two live 3-hour workshops focused on managing negative self-talk and overcoming unhealthy perfectionism. Skills were taught and practiced during the workshops and participants used workbooks to track their activities and progress after the program. A total of 12 women (7 first-year students and 5 second-year students) signed up to participate from first- and second-year medical school classes. The program was subjectively evaluated. In addition, well-validated assessments for self-efficacy were given before and 3 months after the program to examine levels of impostor syndrome, satisfaction with life, optimism, self-esteem, burnout, and gratitude.

Results: The subjective assessments of the program’s effectiveness were high and specific examples of enhanced self-efficacy were noted by the participants. Average levels of impostor syndrome dropped from 67% before the program to 51% after the program. Preprogram to post-program results for the self-efficacy measures increased: satisfaction with life (42%-61%), optimism (43%-55%), self-esteem (32%-49%), and gratitude (65%-76%). Levels of burnout decreased from an average of 63% before the program to 46% after the program.

Conclusions: This pilot program teaching skills and tools to enhance self-confidence and decrease perfectionism had positive outcomes for first- and second-year medical students both from subjective analysis and from measures of self-efficacy. The assessment data showed decreased levels of impostor syndrome and burnout and increased satisfaction with life, optimism, self-esteem, and gratitude. A larger sample size, longer longitudinal interventions, and 6- and 12-month post-program follow-up would be useful to assess this group coaching program as a model to improve medical student self-efficacy during the first 2 years of medical school.

Poster #12. Rapid Development of a COVID-19 Biorepository at an Urban Safety Net Hospital

E. R. Duffy, MA¹, M. R. Cole, MS¹, K. de la Cena, MS¹, E. J. Ragan, MPH¹, V. M. Gibson, MS¹, N. S. Miller, MD¹, Y. Kataria, PhD¹, B. Orr, MS¹, A. Berens, MBA¹, J. Tagala, BS¹, C. McCallum, MPH², T. Flack, BS¹, N. Bhadelia, MD², S. Pelton, MD³, and C. D. Andry, PhD¹

¹Department of Pathology and Laboratory Medicine, Boston Medical Center, MA, USA

²Department of Medicine, Boston University School of Medicine, MA, USA

³Department of Pediatrics, Boston Medical Center, MA, USA

Objectives: The spread of the novel SARS-CoV-2 virus to Boston, Massachusetts, in March 2020 led to the immediate need to retain patient samples beyond clinical utility for in-house assay development and validation, and research of SARS-CoV-2. Rapid and extensive changes in our clinical laboratory operations allowed us to establish novel mechanisms to identify, track, and retain clinical samples from COVID-19 patients. The result of these early efforts was a new COVID-19 biorepository that provides high-quality samples to research scientists. We describe the process of establishing laboratory infrastructure to support this resource under unprecedented circumstances.

Methods: Setting: Boston Medical Center is New England’s largest safety-net hospital and serves a diverse patient population, with >80% publicly insured/uninsured, >50% identifying as African American/black, and >20% identifying as Hispanic/LatinX. Samples: Sample collection is performed with approval of the institutional review board (IRB). Discarded respiratory swabs in transport media and blood samples (plasma and serum) are retrieved from the Clinical Laboratory, with swabs stored intact and blood aliquoted. From autopsy patients, lung, kidney, liver, and spleen samples are collected and formalin-fixed or snap-frozen in vapor phase of liquid nitrogen. All samples are stored at −80 °C or vapor phase of liquid nitrogen until transfer to a recipient scientist. Data and Sample Management: FreezerPro and Microsoft Excel are used for organization and storage of individual samples. Limited electronic medical record data associated with discarded clinical and autopsy samples (eg, age, sex, testing date, COVID-19 status) are available.

Results: To date, the biorepository has retained over 72 000 clinical discard samples (12 000 swabs and 60 000 blood) from 10 500 patients, and over 100 samples from 18 patient autopsies. Contributing patient demographics match the diversity of the hospital patient body. Over 725 samples have been distributed to 5 different research laboratories.

Conclusions: Through innovation and rapid modification of normal clinical process, we established near real-time collection and retention of otherwise discarded patient samples. Leveraging biobanking best practices, we built an extensive high-quality COVID-19 biorepository with both positive and negative specimens to enhance institutional resource and understanding of this novel virus in a patient population underrepresented in research.

Poster #13. Flipping the Traditional Preclinical Medical Student Classroom for Congenital Heart Disease Pathology and Murmur Instruction

P. J. Boyer, MD, PhD¹, J. R. Jackowski, MD¹, M. P. Jester, BS¹, W. H. McAllister, MD¹, and A. T. Ray, MD¹

¹Department of Pathology, East Carolina University, Greenville, NC, USA

²Brody School of Medicine, East Carolina University, Greenville, NC, USA

Objectives: “Flipped” classrooms have been increasingly used as a pedagogical alternative to traditional lecture-based presentation of content with the goal of promoting active and learner-centric education and student engagement. The pathology component of the preclinical curriculum at the East Carolina University Brody School of Medicine remains largely lecture-based, augmented with laboratory sessions. The primary objective of this project, as a proof of concept, was to transition a single pathology lecture, summarizing congenital heart disease (CHD) and augmented with new murmur instruction, to a flipped classroom session and gauge participant feedback.

Methods: Didactic CHD and cardiac murmur content was made available for student preview including (1) PowerPoint files with associated voice over narration using Screencast-O-Matic (https://screencast-o-matic.com); (2) a Word document with CHD objectives, key words, and textual didactic material; and (3) a Word document with a concise summary of murmur types and associated pathology. An optional 50-minute classroom session was conducted with students split into groups of 6 to 8 with, (1) in small groups, discussion of 6 unknown cases provided by PowerPoint files including presentation, questions focusing student discussion, the associated murmur (Current Medical Diagnosis & Treatment, accessmedicine.com, and other sources), and an online 3-dimensional model of the defect (https://sketchfab.com/ 3 d-models) and (2), with the full class, a summary of the case for the class by a representative of one of the groups, and a demonstration and discussion of the characteristic murmur for the defect. A survey of students was undertaken (https://docs.google.com/forms). A literature search was conducted with relevant key words.

Results: Although optional, 82 of 85 students attended the session. A survey completed by 50 of 85 students found that 56% of students preferred the flipped classroom format, 14% preferred a lecture format, and 30% content with either format. Most students ranked the components of the flipped classroom as helpful (4 or 5 on 5-point scale): prerecorded content (80%), small group discussions (86%), range of cases (94%), and combination of pathology and murmur content (94%). The number of cases was considered “just right” by 82% of students and “too few” by 18% of students. No literature describing the use of flipped classrooms in cardiovascular pathology teaching in the preclinical medical student curriculum was identified.

Conclusions: The flipped classroom session was well received by students and considered preferable to a lecture-based presentation by a majority of students.

Poster #14. Virtual Autopsy Experience: A COVID-19 Era Adaptation of a Required Medical School Pathology Curriculum Component

P. J. Boyer, MD, PhD¹, B. B. Buchanan, BS², J. Awuku, MD², J. R. Butler, BS², K. M. Beasley, BS², B. A. Zeches, MD¹, G. B. Allen, BS², J. B. Spears, BS¹, D. M. Flood, MD², K. Kennamer, BS², S. Kazemzadeh, BS², T. A. Sporn, MD¹, R. K. Falls Jr, MD¹, A. Mahmood, BS², G. S. O’Brien, BS², A. Veeragandham, BS², and K. L. Kelly, MD¹

¹Department of Pathology, East Carolina University, Greenville, NC, USA

²Brody School of Medicine, East Carolina University, Greenville, NC, USA

Objectives: The COVID-19 pandemic forced an abrupt transition of most preclinical medical education session from in-person events to largely online delivery alternatives, requiring the rapid implementation of alternative sources of delivery of course content to students. The goals of this study included implementation and evaluation of a required virtual autopsy experience as an alternative to an in-person autopsy experience for preclinical medical students.

Methods: Second-year medical students were assigned to one of 10 groups to attend virtual autopsy experiences, including (1) viewing of an autopsy, (2) microscopic review of histologic preparations of organs sampled at autopsy with discussion of the cause and manner of the decedent’s death, and (3) generation of a group report along with a self-directed learning exercise conducted by each student. Autopsy and microscopic sessions were streamed using secure WebEx sessions. The virtual autopsy employed a Logitech C930e webcam and a Revolabs wireless microphone. The virtual microscopic session employed a Philips IntelliSite digital imaging platform. As a control, a group of 9 students volunteered to also attend an in-person autopsy and multiheaded microscope histology session with appropriate safety precautions deployed including the use of surgical masks and, in the autopsy room, face shields. A SurveyMonkey.com survey of students was administered following the autopsy experience.

Results: All 80 students participated in the virtual sessions. The control group participated in the first virtual autopsy and histology sessions and attended subsequent autopsy and histology sessions in person. Pros of the virtual autopsy included the ability to meet COVID-19 safeguards, the convenience of viewing the session from home, and close-up view of elements of the autopsy, whereas cons included the possibility of breach of patient confidentiality given the streaming nature of the autopsy. Pros of the virtual microscopic session included the opportunity to view digitized glass slides without the barriers of focusing eyepieces and visualizing the images on a multiheaded microscope. Cons for both virtual sessions included the potential for distraction by social media and communication barriers inherent to virtual sessions where students’ microphones are muted to optimize sound quality.

Conclusions: A combination of virtual autopsy and histology sessions allowed second-year medical students to experience what had been, based on annual course surveys, one of the most highly rated components of the Brody School of Medicine pathology course.

Poster #15. Pandemic-Pivoting in Pathology Resident Education: Implementation of Interesting Case Conferences in Response to COVID-19

M. S. Dinehart, MD, MEd¹, and B. H. Bryant, MD¹

¹Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA

Objectives: The COVID-19 pandemic has caused large-scale disruptions in graduate medical training across all specialties. In mid-March of 2020, the simultaneous implementation of social distancing and temporary decrease in surgical pathology specimen volume tied to the initial wave of shutdowns within the United States effectively halted normal day-to-day activities within the University of Vermont Medical Center Division of Anatomic Pathology, including a pause in normal resident educational activities. In response, a curriculum overhaul was rapidly performed, with synchronous, virtual interesting case conferences (ICCs) serving as a cornerstone.

Methods: We describe this innovative approach to recreating the classic “scope-to-scope” teaching that is so integral to surgical pathology education and present qualitative data regarding its design, reception, and areas for improvement gleaned from pathology residents/student fellows via a survey distributed on April 15, 2020 (approximately a month after ICCs debut, after averaging approximately 4-5 ICCs per week).

Results: Eleven of 18 (61% response rate) pathology residents/student fellows responded to the survey. The overall reaction to ICCs was positive, with the majority of respondents grateful for the supplemental education in such a difficult, challenging time. Other comments mentioned the high-yield nature of the cases presented and the increased breadth of exposure these conferences afforded trainees, even when compared with regular pre-COVID surgical pathology sign-outs. Areas for improvement included adjustments in the speed at which presenters manipulated slides to prevent motion sickness as well as adjustments in ICC time lengths to maximize participant attentiveness and retention of information.

Conclusions: Overall, ICCs are a valuable tool for overcoming many of the obstacles presented by the COVID-19 pandemic. The strengths provided by ICCs not only offer a sliver of normalcy for trainees but may also serve as a means to increase exposure to interesting, educational cases in the future as pathology education equilibrates to our new status quo.