Preparing residents for practice. An opportunity to teach professionalism and communication skills as well as diagnostic criteria

Perceptions of Unprofessional Attitudes and Behaviors: Implications for Faculty Role Modeling and Teaching Professionalism During Pathology Residency

CONTEXT

- Changes occurring in medicine have raised issues about medical professionalism. Professionalism is included in the Core Competencies and Milestones for all pathology residents. Previous studies have looked at resident professionalism attitudes and behaviors in primary care but none have looked specifically at pathology.

OBJECTIVE

- To examine behavior and attitudes toward professionalism within pathology and to determine how professionalism is taught in residency programs.

DESIGN

- Surveys were sent to all College of American Pathologists junior members and all pathology residency program directors, and responses were compared.

RESULTS

- Although no single behavior received the same professionalism rating among residents and program directors, both groups identified the same behaviors as being the most unprofessional: posting identifiable patient information or case images to social media, making a disparaging comment about a physician colleague or member of the support staff on social media or in a public hospital space, and missing work without reporting the time off. Faculty were observed displaying most of these behaviors as often or more often than residents by both groups. The most common means to teach professionalism in pathology residencies is providing feedback as situations arise and teaching by example. Age differences were found within each group and between groups for observed behaviors and attitudes.

CONCLUSIONS

- As teaching by example was identified as a common educational method, faculty must be aware of the role their behavior and attitudes have in shaping resident behavior and attitudes. These results suggest a need for additional resources to teach professionalism during pathology residency.

The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice

Understanding and embracing uncertainty are critical for effective teacher–learner relationships as well as for shared decision-making in the physician–patient relationship. However, ambiguity has not been given serious consideration in either the undergraduate or graduate medical curricula or in the role it plays in patient-centered care. In this article, the author examines the ethics of ambiguity and argues for a pedagogy that includes education in the importance of, and tolerance of, ambiguity that is inherent in medical education and practice. Common threads running through the ethics of ambiguity are the virtue of respect, and the development of a culture of respect is required for the successful understanding and implementation of a pedagogy of ambiguity.

Employer Expectations for Newly Trained Pathologists: Report of a Survey From the Graduate Medical Education Committee of the College of American Pathologists

CONTEXT

-Multiple sources have identified challenges that training programs face in preparing graduates for the "real world" practice of pathology, and many training programs have sought to decrease the gap between skills acquired during training and those required in practice. However, there exists the possibility that some of the difficulty experienced by newly trained pathologists and employers might arise from differences between employer expectations of new hires and what applicants expect from their first job.

OBJECTIVE

-To define the constellation of skills and attributes employers prioritize when hiring newly trained pathologists.

DESIGN

-A survey of fellows of the College of American Pathologists in practice for 5 or more years in the United States was administered and the results were analyzed.

RESULTS

-A total of 630 pathologists who were responsible for hiring a new-in-practice pathologist completed the survey. Regardless of practice setting, certain skills and attributes were rated critically important in new hires, including ethics/integrity, work ethic, and professionalism. Seventy-one percent reported having some difficulty hiring entry-level pathologists and cited inadequate training/experience during residency, and applicants having unrealistic expectations regarding work load/hours as the most common reasons.

CONCLUSIONS

-Prospective employers not only expect well-developed diagnostic skills in their job applicants, but also require evidence of a strong work ethic and outstanding professionalism. Successful applicants must display willingness to assume responsibilities and flexibility regarding existing and new responsibilities. A secondary but important finding of this survey was that most jobs are garnered through word-of-mouth recommendations; therefore, it is crucial for pathologists-in-training to hone their networking skills.

An analysis of clinical consultation activities in clinical pathology: who requests help and why

OBJECTIVES

To examine the distribution of callers who made consultation requests and to identify associations between caller categories and consultation topics.

METHODS

Review of prospectively collected database of consultations.

RESULTS

Direct care personnel made more consultation requests than non-direct care personnel. Consultation topics varied by caller type. Direct care personnel requested more consultations on test interpretation and few consultations on test selection than laboratory personnel. Differences in consultation requests by primary care physicians and specialists were significant.

CONCLUSIONS

At our laboratory, consultation requests primarily originate from primary care physicians. Consultation requests vary by caller type.

An Analysis of Clinical Consultation Activities in Clinical Chemistry: Implications for Transformation and Resident Training in Chemical Pathology

Context.—Clinical consultation is a key role of pathologists. Many have advocated that pathologists expand their consulting activities to improve laboratory utilization. Although many have suggested that residency programs need to provide experience in clinical consultation, little has been written on the nature of consultation or on the methods of training.

Objective.—To characterize the content of consultations and to describe training in consultation in chemical pathology within the residency program at the University of Utah, Salt Lake City.

Design.—Retrospective review of the consultation database for the period between July 2011 and July 2012.

Results.—Residents performed an average of 159 consultations a month covering 276 topics during the course of a year. Each topic involved 1 or more specific tests. Eighty percent of the topics received fewer than 12 calls. The most common topics involved virus testing (eg, hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Consultations most often involved test interpretation (53%), selection (38%), and performance characteristics (21%). Twenty-seven percent of consultations involved 2 or more consultation categories (eg, interpretation and performance).

Conclusions.—Consultation calls in chemical pathology are widely distributed across topics. Consultations most often involve test interpretation and selection. Methods to assess the effectiveness of consultations and resident teaching should be devised.