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Tay AZ, Tang PY, New LM, Zhang X, Leow WQ. Detecting residents at risk of attrition - A Singapore pathology residency's experience. Acad Pathol 2023; 10:100075. [PMID: 37095782 PMCID: PMC10121803 DOI: 10.1016/j.acpath.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/21/2023] [Accepted: 02/05/2023] [Indexed: 04/26/2023] Open
Abstract
The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes. Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.
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Affiliation(s)
- Amos Z.E. Tay
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Corresponding author. Department of Anatomic Pathology, Singapore General Hospital, Academia, Level 10, Diagnostic Tower, 20 College Road, Singapore, 169856, Singapore.
| | - Po Yin Tang
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Lee May New
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
| | - Xiaozhu Zhang
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
| | - Wei-Qiang Leow
- Department of Anatomic Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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2
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Perez AN, Sharif KF, Guelfi E, Li S, Miller A, Prasad K, Sinard RJ, Lewis JS, Topf MC. Ex vivo 3D scanning and specimen mapping in anatomic pathology. J Pathol Inform 2023; 14:100186. [PMID: 36687529 PMCID: PMC9852486 DOI: 10.1016/j.jpi.2022.100186] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Structured light three-dimensional (3D) scanning is a ubiquitous mainstay of object inspection and quality control in industrial manufacturing, and has recently been integrated into various medical disciplines. Photorealistic 3D scans can readily be acquired from fresh or formalin-fixed tissue and have potential for use within anatomic pathology (AP) in a variety of scenarios, ranging from direct clinical care to documentation and education. Methods for scanning and post-processing of fresh surgical specimens rely on relatively low-cost and technically simple procedures. Here, we demonstrate potential use of 3D scanning in surgical pathology in the form of a mixed media pathology report with a novel post-scan virtual inking and marking technique to precisely demarcate areas of tissue sectioning and details of final tumor and margin status. We display a sample mixed-media pathology report (3D specimen map) which integrates 3D and conventional pathology reporting methods. Finally, we describe the potential utility of 3D specimen modeling in both didactic and experiential teaching of gross pathology lab procedures.
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Affiliation(s)
- Alexander N Perez
- Dept. of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kayvon F Sharif
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Sophie Li
- Vanderbilt University, Nashville, TN, USA
| | - Alexis Miller
- Dept. of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kavita Prasad
- Dept. of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Sinard
- Dept. of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James S Lewis
- Dept. of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael C Topf
- Dept. of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Mlika M, Laatar E, Braham E, Chebbi C, Hamzaoui A, Mezni F. The place of the bronchoalveolar lavage in the diagnosis of interstitial lung disease: a descriptive and qualitative study. LA TUNISIE MEDICALE 2022; 99:869-876. [PMID: 35261013 PMCID: PMC9003584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interstitial lung disease represents a challenge and consists in more than 200 entities. Their diagnoses are assessed through a multidisciplinary approach including pulmonologists, radiologists, pathologists and biologists. BAL analysis is useful mainly when clinical and radiological findings aren't suggestive of an etiology. Even if, the indication of BAL is consensual, its real place as a diagnostic mean remains non consensual. AIM To describe the BAL findings and to analyse the perceptions of the pulmonologists, anaesthesiologists and pathologists implicated in the interpretation of the BAL data, that are related to the presentation and the validity of the results. METHODS the authors performed a descriptive study about BAL results during an 8-year-period (2010-2018) and a qualitative study assessing the pulmonologists, anaesthesiologists and pathologists' opinions concerning the different results performed in the same institution. Two questionnaires were conceived with participation of different experts and satisfaction scores were calculated. RESULTS 2508 BAL were recorded including 1320 women (53%) and 1188 men (47%) with a sex-ratio (H/F) of 0,9. The mean age of the patients was 51 years. The mean response delay was 3.25 days. An accurate diagnosis was retained in 24.3%. It consisted in infection evoked in 13.89% cases. Eosinophilic pneumonia was evoked in 0.35% cases. 15.01% cases presented erythrophagocytosis with a golde score>100 favouring active alveolar haemorrhage with occult alveolar haemorrhage. Lipoproteinosis was diagnosed in 2 cases. Adenocarcinoma was retained in 1.04% cases and lymphoma in 0.16% cases. Langerhans cell histiocytosis was confirmed in 1.51% cases. In the other cases, cellular profile was not specific evoking tuberculosis or sarcoidosis in 316 cases with a CD4/CD8 ratio superior to 1,6 and the diagnoses of tuberculosis or hypersensitivity pneumonia in 202 cases with a CD4/CD8 ratio inferior to 1,2. Concerning the questionnaire-based study, 50 pulmonologists and anaesthesiologists attributed a mean score of 7.96/10 (DS=0.55) concerning the presentation of the results and 9.28/15 (DS=0.77) concerning the quality and validity of the results. On the other hand, the mean satisfaction score rated by pathologists reached 24/40. CONCLUSION BAL results could be helpful for the management of interstitial lung disease depending on the experience of pathologists and a good communication between pulmonologists, anaesthesiologists and pathologists.
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Affiliation(s)
- Mona Mlika
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Emna Laatar
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Emna Braham
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Chokri Chebbi
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Agnès Hamzaoui
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
| | - Faouzi Mezni
- 1. Hôpital Abderrahman Mami. Ariana /faculté de médecine de Tunis
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PÉREZ-DE-OLIVEIRA ME, HEERDEN WV, MOTTA ACF, RODRIGUES-FERNANDES CI, ROMAÑACH MJ, AGOSTINI M, GUEIROS LAM, VARGAS PA, LOPES MA, RIBEIRO ACP, BRANDÃO TB, ALMEIDA OPD, KHURRAM SA, SANTOS-SILVA AR. The need for communication between clinicians and pathologists in the context of oral and maxillofacial diseases. Braz Oral Res 2022; 36:e008. [DOI: 10.1590/1807-3107bor-2022.vol36.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022] Open
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Rohr JM, Mukherjee M, Donnelly A, Sprinkle S, Martinez Duarte E, Yuil Valdes A. Successful integration of thyroid cytopathology and surgical pathology education in an E-module format. J Pathol Inform 2022; 13:100124. [PMID: 36268066 PMCID: PMC9577056 DOI: 10.1016/j.jpi.2022.100124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Context The shift to digital learning in medicine is well underway and in fact spurred by the COVID-19 pandemic. The didactic portion of our institution's cytotechnology (CT) education program is online and delivered to learners across the nation. With CT education elevating to the master’s degree level, there is a need to expand cytologic correlation with surgical resection specimens. We also wanted to afford pathology residents the same. Methods We developed an online cytologic–histologic correlation digital learning module (e-module) addressing thyroid fine needle aspirations (FNAs) and surgical thyroidectomy specimens which was administered as part of coursework in the CT education and pathology residency programs. The module was 35 min long and consisted of guided narration with both formative and summative interactive quizzes. After completion of the module, participants were invited to fill a brief survey comprised of multiple choice, Likert, and free response questions. This study was approved by the institutional review board. Results The 29 respondents were comprised of 22 CT students and 7 residents. CT students had minimal experience thyroid pathology prior to the module; residents were mixed. Twenty-three (79.3%) ranked the highest tiers for learning cytopathology through this module, 24 (82.8%) for learning thyroid surgical pathology, and 25 (86.2%) for cytologic–histologic correlation. All respondents stated they would like similar activities in the future. Conclusions Teaching cytology–histology correlation for thyroid in an electronic format was effective and well-received by participants. There is a demand for these activities among current learners, suggesting that expanding the available repertoire will be beneficial.
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Affiliation(s)
- Joseph M. Rohr
- Department of Pathology & Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Corresponding author at: University of Nebraska Medical Center, Department of Pathology and Microbiology, 983135 Nebraska Medical Center, Omaha, NE 68198-3135, USA.
| | - Maheswari Mukherjee
- Cytotechnology Education, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amber Donnelly
- Cytotechnology Education, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah Sprinkle
- Cytotechnology Education, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ernesto Martinez Duarte
- Department of Pathology/Immunology/Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Ana Yuil Valdes
- Department of Pathology & Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Radick AC, Reisch LM, Shucard HL, Piepkorn MW, Kerr KF, Elder DE, Barnhill RL, Knezevich SR, Oster N, Elmore JG. Terminology for melanocytic skin lesions and the MPATH-Dx classification schema: A survey of dermatopathologists. J Cutan Pathol 2020; 48:733-738. [PMID: 32935869 DOI: 10.1111/cup.13873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Diagnostic terms used in histopathology reports of cutaneous melanocytic lesions are not standardized. We describe dermatopathologists' views regarding diverse diagnostic terminology and the utility of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) for categorizing melanocytic lesions. METHODS July 2018-2019 survey of board-certified and/or fellowship-trained dermatopathologists with experience interpreting melanocytic lesions. RESULTS Among 160 participants, 99% reported witnessing different terminology being used for the same melanocytic lesion. Most viewed diverse terminology as confusing to primary care physicians (98%), frustrating to pathologists (83%), requiring more of their time as a consultant (64%), and providing necessary clinical information (52%). Most perceived that adoption of the MPATH-Dx would: improve communication with other pathologists and treating physicians (87%), generally be a change for the better (80%), improve patient care (79%), be acceptable to clinical colleagues (68%), save time in pathology report documentation (53%), and protect from malpractice (51%). CONCLUSIONS Most dermatopathologists view diverse terminology as contributing to miscommunication with clinicians and patients, adversely impacting patient care. They view the MPATH-Dx as a promising tool to standardize terminology and improve communication. The MPATH-Dx may be a useful supplement to conventional pathology reports. Further revision and refinement are necessary for widespread clinical use.
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Affiliation(s)
- Andrea C Radick
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Lisa M Reisch
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Hannah L Shucard
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Dermatopathology Northwest, Bellevue, Washington, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond L Barnhill
- Department of Pathology, Institut Curie, Paris Sciences and Letters Research University, Paris, France.,Department of Translational Research, Institut Curie, Paris Sciences and Letters Research University, Paris, France.,Faculty of Medicine, University of Paris Descartes, Paris, France
| | | | - Natalia Oster
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joann G Elmore
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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Kim J, Kong SY, Han SH, Kim JW, Jeon CH, Yoo J. Genetic Counseling Status and Perspectives Based on a 2018 Professional Survey in Korea. Ann Lab Med 2019; 40:232-237. [PMID: 31858763 PMCID: PMC6933060 DOI: 10.3343/alm.2020.40.3.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/20/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetic counseling (GC) provides many benefits, including the identification of patients appropriate for testing, patient education, and medical management. We evaluated the current status of and challenges faced by GC practitioners in Korean hospitals. METHODS An electronic survey was designed and conducted in 52 certified laboratory physicians belonging to the Korean Society of Laboratory Medicine, from August to September 2018. The questionnaires addressed three main categories of information: (1) current status of GC in hospitals; (2) essential qualifications of GC practitioners; and (3) challenges and perspectives for GC. Fisher's exact test was applied to analyze categorical data. RESULTS Among a total of 52 participants who initially responded, 12 (23.1%) were performing GC either by direct or indirect care. GC clinics were opened regularly for one (33.3%) or more than three sessions (25.0%) per week; most respondents spent more time for pre-visit activities than in-person visits, both for a initial visit patient and for a follow-up visit patient. All laboratory physicians provided genetic information to their patients. Most recommended family genetic testing when indicated (91.7%), discussed disease management (75.0%), and/or ordered additional genetic testing (58.3%), and some referred patients to other specialists (8.3%). CONCLUSIONS Both patients and laboratory physicians concede the advantage of GC performed by clinical geneticists; however, the practice of GC involves several challenges and raises some concerns. The cost and support required to implement GC need to be addressed in order to provide qualified GC in Korea.
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Affiliation(s)
- Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sun Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Department of Laboratory Medicine, National Cancer Center, Goyang, Korea
| | - Sung Hee Han
- BioCore Co. Ltd., Division of Biotechnology, Yongin, Korea
| | - Jong Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Ho Jeon
- Department of Laboratory Medicine, Daegu Catholic Medical Center, Daegu, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea.
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Gibson B, Bracamonte E, Krupinski EA, Briehl MM, Barker GP, Weinstein JB, Weinstein RS. A "Pathology Explanation Clinic (PEC)" for Patient-Centered Laboratory Medicine Test Results. Acad Pathol 2018; 5:2374289518756306. [PMID: 29582001 PMCID: PMC5862367 DOI: 10.1177/2374289518756306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 01/04/2018] [Indexed: 11/15/2022] Open
Abstract
This concept paper addresses communication issues arising between physicians and their patients. To facilitate the communication of essential diagnostic pathology information to patients, and address their questions and concerns, we propose that "Pathology Explanation Clinics" be created. The Pathology Explanation Clinics would provide a channel for direct communications between pathologists and patients. Pathologists would receive special training as "Certified Pathologist Navigators" in preparation for this role. The goal of Pathology Explanation Clinics would be to help fill gaps in communication of information contained in laboratory reports to patients, further explain its relevance, and improve patient understanding of the meaning of such information and its impact on their health and health-care choices. Effort would be made to ensure that Certified Pathologist Navigators work within the overall coordination of care by the health-care team.
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Affiliation(s)
- Blake Gibson
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Margaret M Briehl
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Gail P Barker
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA.,Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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