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

Graduate Medical Education in Pathology: A Scoping Review

CONTEXT.—

Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized.

OBJECTIVE.—

To chart the concepts, research methods, and publication patterns of studies on GME in pathology.

DATA SOURCES.—

This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases.

CONCLUSIONS.—

Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.

Detecting residents at risk of attrition - A Singapore pathology residency's experience

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.

Hot Seat Diagnosis: Competency-Based Tool Is Superior to Time-Based Tool for the Formative In-Service Assessment of Pathology Trainees

CONTEXT.—

Competency-based medical education relies on frequent formative in-service assessments to ascertain trainee progression. Currently at our institution, trainees receive a summative end-of-rotation In-Training Evaluation Report based on feedback collected from staff pathologists. There is no method of simulating report sign-out.

OBJECTIVE.—

To develop a formative in-service assessment tool that is able to simulate report sign-out and provide case-by-case feedback to trainees. Further, to compare time- versus competency-based assessment models.

DESIGN.—

Twenty-one pathology trainees were assessed for 20 months. Hot Seat Diagnosis by trainees and trainee assessment by pathologists were recorded in the Laboratory Information System. In the first iteration, trainees were assessed by using a time-based assessment scale on their ability to diagnose, report, use ancillary testings, comment on clinical implications, provide intraoperative consultation and/or gross cases. The second iteration used a competency-based assessment scale. Trainees and pathologists completed surveys on the effectiveness of the In-Training Evaluation Report versus the Hot Seat Diagnosis tool.

RESULTS.—

Scores from both iterations correlated significantly with other assessment tools including the Resident In-Service Examination (r = 0.93, P = .04 and r = 0.87, P = .03). The competency-based model was better able to demonstrate improvement over time and stratify junior versus senior trainees than the time-based model. Trainees and pathologists rated Hot Seat Diagnosis as significantly more objective, detailed, and timely than the In-Training Evaluation Report, and effective at simulating report sign-out.

CONCLUSIONS.—

Hot Seat Diagnosis is an effective tool for the formative in-service assessment of pathology trainees and simulation of report sign-out, with the competency-based model outperforming the time-based model.

Engaging Pathology Residents in Clinical Chemistry: The Essential Ingredient Is a Committed Teacher

BACKGROUND

Pathology residents are thought to show a lack of interest in clinical chemistry, therefore potentially graduating from training programs unprepared to function as laboratory directors and clinical consultants.

METHODS

A structured program of tutorials based primarily on Henry's textbook, supplemented by recent review articles; a question bank of about 600 questions to emphasize key concepts; requirement for performing and presenting quality improvement projects; participation in on-site CAP inspections; review of reference laboratory test requests; and involving residents in scholarly activity have resulted in sustained, transferable, and significant improvements in engagement, knowledge, competence, and examination scores.

RESULTS

The primary parameter for measuring change in resident competence and engagement were improvements in resident in-service examination (RISE) scores, publications in peer-reviewed journals, and receipt of awards. The revised program produced significant improvement in RISE scores in clinical chemistry, over and above the improvements in the general residency program. The residents were authors on 12 publications in peer-reviewed PubMed listed journals in the 5-year period since revision in the clinical chemistry curriculum compared to no publications in clinical chemistry in the 5-year period before the new curriculum. Over the past 2 years, 6 of the 11 publications by graduating residents were in clinical chemistry, and 6 of 7 awards for research were garnered by residents engaged in clinical chemistry investigations. All of the residents passed their clinical pathology boards on first attempt since the change compared to 2 failures in the prior 5-year period.

CONCLUSIONS

The structured program described here is important as a template that could be adopted by any pathology training program. The question bank developed by this program is a valuable and transferable aid. However, success of such a program is dependent on the commitment of a knowledgeable, dedicated, and passionate teacher.

Integration of Genomic Medicine in Pathology Resident Training

OBJECTIVES

To assess current pathology resident training in genomic and molecular pathology.

METHODS

The Training Residents in Genomics (TRIG) Working Group has developed survey questions for the pathology Resident In-Service Examination (RISE) since 2012. Responses to these questions, as well as knowledge questions, were analyzed.

RESULTS

A total of 2,529 residents took the 2019 RISE. Since 2013, there has been an increase in postgraduate year 4 (PGY4) respondents indicating training in genomic medicine (58% to approximately 80%) but still less than almost 100% each year for molecular pathology. In 2019, PGY4 residents indicated less perceived knowledge and ability related to both genomic and traditional molecular pathology topics compared with control areas. Knowledge question results supported this subjective self-appraisal.

CONCLUSIONS

The RISE is a powerful tool for assessing the current state and also trends related to resident training in genomic pathology. The results show progress but also the need for improvement in not only genomic pathology but traditional molecular pathology training as well.

Correlating Transfusion Medicine In-Service Examination Scores With Outcomes of the American Board of Pathology Transfusion Medicine Subspecialty Certifying Examination

OBJECTIVES

The Transfusion Medicine In-Service Examination (TMISE) is offered twice a year to transfusion medicine (TM) fellows. We examined the relationship between TMISE scores and outcomes of the American Board of Pathology (ABP) TM subspecialty certifying examination (TM boards).

METHODS

TM fellowship programs were contacted to provide anonymous data about TM fellows, their scores on TMISE, and outcome of TM boards.

RESULTS

Of 48 TM fellowship programs contacted, 24 (50%) responded with data for 170 fellows. Average TMISE score of fellows who passed their first TM boards attempt was 71.3, while the average TMISE score of fellows who failed their first TM boards attempt was 64.3 (P = .009).

CONCLUSIONS

TMISE scores correlated with passing TM boards on the first attempt. Fellows who took the TM boards the same year that they graduated from TM fellowship had a significantly higher first-time pass rate than fellows who delayed taking TM boards.

Correlation of Mock Board Examination Scores During Anatomic Pathology Residency Training with Performance on the Certifying Examination

Mock board exams are common in residency programs across many disciplines. However, the value of mock board results in predicting success on the actual certifying examination is largely anecdotal and undocumented. The University of Tennessee anatomic pathology residency program has a long history of giving mock board exams twice a year during the course of the 3-year diagnostic training program. The mock exams give residents a sense of the types of questions that may appear on the actual certifying examination. The resulting scores serve to help identify improvement areas to focus additional study. In addition, by providing residents the mental and physical experiences designed to mimic the test day, we hope to better prepare these trainees for optimal performance on the certifying examination. This study correlated mock board results of 16 anatomic pathology residents, from July 2006 through January 2016, with their subsequent performance on the certifying exam. The results of these biannual exams were significantly correlated (p < .001) with results for the American College of Veterinary Pathologists Certifying Examination.

Quantification of the Effectiveness of a Residency Program Using the Resident In-Service Examination

This study describes a quantitative tool in the assessment of residency programs, in which national ranking of residents after the resident in-service examination in postgraduate year 4 is compared to that in postgraduate year 1. The relationship between training and changes in ranking, resident in-service examination results before and after training in specific areas are also compared. To illustrate the use of this novel approach, data from a large residency program were analyzed. The 70 residents were ranked as a postgraduate year 1 group at the 50th national percentile. As postgraduate year 4 residents, they were ranked at the 59th percentile, a significant (P < .003) improvement. There was moderate correlation between performance in postgraduate year 1 and that in postgraduate year 4 (0.61); however, initial ranking was no indication of the final (R2 = .34), with the exception of high performers. Training in specific areas improved ranking, demonstrating association between training and performance. In conclusion, the effectiveness of training provided by a residency program can be quantified using the resident in-service examination. This should provide a quantitative tool in the assessment of postgraduate programs.

Cytology cases of the week: an educational tool that improves trainee exposure to cytology

INTRODUCTION

The Accreditation Council for Graduate Medical Education requires residents to examine 1500 cytology specimens by the end of residency. Cytology cases of the week (COWs) were instituted in 2010-2011 in an effort to increase trainee exposure to cytology.

MATERIALS AND METHODS

Images of 2 to 5 cases with basic clinical information are sent to residents weekly. Residents have 1 week to respond by e-mail; after which, correct answers are e-mailed. Cytology resident in-service examination (RISE) scores were used to assess the effectiveness of COWs. Additionally, a feedback survey was distributed to trainees to determine the perception of COWs as a teaching tool.

RESULTS

An unpaired two-sided t test showed residents who participated in COWs scored 15.4% higher on the RISE than residents who participated minimally or not at all over the 5-year period (P < 0.05). In 2014-2015 and 2015-2016, when COWs were minimally and not at all offered, we saw a significant decrease in average cytology RISE scores compared with prior years when COWs were offered (P < 0.05). There was no correlation between percentage of correctly submitted answers for COWs and RISE scores. The vast majority (83%) of trainees reported participating in COWs for self-study, and the majority (86%) felt participation in COWs increased their cytology knowledge. Major reasons for not participating included technical challenges and time limitations.

CONCLUSIONS

COWs are an effective educational tool that increase resident fund of knowledge in cytology. Residents who participate in COWs perform higher on the RISE, regardless of percentage of correctly submitted answers.

Success in Implementation of a Resident In-Service Examination Review Series

OBJECTIVES

Primary pathology board certification has been correlated with senior resident in-service examination (RISE) performance. We describe our success with an annual, month-long review series.

METHODS

Aggregate program RISE performance data were gathered for 3 years prior to and 3 years following initiation of the review series. In addition, mean United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge scores for residents participating in each RISE examination were obtained to control for incoming knowledge and test-taking ability. Linear models were used to evaluate differences in average RISE performance prior to and following the initiation of the review series in addition to controlling for relevant covariates.

RESULTS

Significant improvement was noted in the grand total, anatomic pathology section average, clinical pathology section average, and transfusion medicine section. Although not statistically significant, improvement was noted on the cytopathology and clinical chemistry sections. There was no significant difference in scores in hematopathology, molecular pathology, and the special topics section average. In addition, improvement in primary pathology board certification rates was also noted.

CONCLUSIONS

Institution of a month-long RISE review series demonstrated improved overall performance within our training program. The success could easily be replicated in any training program without significant disruption to an annual didactic series.

The Predictive Validity of the National Board of Osteopathic Medical Examiners' COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations

PURPOSE

To examine the predictive validity of the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series with regard to the American Board of Family Medicine's (ABFM's) In-Training Examination (ITE) and Maintenance of Certification for Family Physicians (MC-FP) Examination.

METHOD

A repeated-measures design was employed, using test scores across seven levels of training for 1,023 DOs who took the MC-FP for the first time between April 2012 and November 2014 and for whom the ABFM had ITE scores for each of their residency years. Pearson and disattenuated correlations were calculated; Fisher r to z transformation was performed; and sensitivity, specificity, and positive and negative predictive values for the COMLEX-USA Level 2-Cognitive Evaluation (CE) with regard to the MC-FP were computed.

RESULTS

The Pearson and disattenuated correlations ranged from 0.55 to 0.69 and from 0.61 to 0.80, respectively. For MC-FP scores, only the correlation increase from the COMLEX-USA Level 2-CE to Level 3 was statistically significant (for Pearson correlations: z = 2.41, P = .008; for disattenuated correlations: z = 3.16, P < .001). The sensitivity, specificity, and positive and negative predictive values of the COMLEX-USA Level 2-CE with the MC-FP were 0.90, 0.39, 0.96, and 0.19, respectively.

CONCLUSIONS

Evidence was found that the COMLEX-USA can assist family medicine residency program directors in predicting later resident performance on the ABFM's ITE and MC-FP, which is becoming increasingly important as graduate medical education accreditation moves toward a single aligned model.

Does Taking the Fellowship In-Service Hematopathology Examination and Performance Relate to Success on the American Board of Pathology Hematology Examination?

OBJECTIVES

The biannual Fellow In-Service Hematopathology Examination (FISHE) assesses knowledge in five content areas. We examined the relationship between taking the FISHE and performance on it with outcomes on the first attempted American Board of Pathology Hematology subspecialty certifying examination (ABP-HE).

METHODS

The pass rate between the ABP-HE candidates who took the spring FISHE and those who did not were compared. The likelihood of fellows passing the ABP-HE based on their percentiles on the FISHE was also assessed.

RESULTS

ABP-HE candidates who took the spring FISHE had a higher pass rate (96.4%) than those who did not (76.1%, P < .001). Spring FISHE performance, including total percentile and percentiles in four of five FISHE content areas, was only a weak predictor of passing the ABP-HE.

CONCLUSIONS

Candidates who take the spring FISHE do better on the ABP-HE than those who do not. Most fellows passed the first attempted ABP-HE regardless of FISHE performance. Whether this is due to fellows making use of the FISHE as a self-evaluation tool to help identify and then correct their knowledge deficiencies remains to be determined.

Does the Physical Medicine and Rehabilitation Self-Assessment Examination for Residents Predict the Chances of Passing the Part 1 Board Certification Examination?

BACKGROUND

Each year, residents in accredited United States Physical Medicine and Rehabilitation (PMR) residency programs can take the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Self-Assessment Examination for Residents (SAE-R). This 150-question, multiple-choice examination is intended for self-assessment of physiatric knowledge, but its predictive value for performance on the part 1 American Board of Physical Medicine and Rehabilitation Certification Examination (ABPMR-CE) is unknown.

OBJECTIVE

To investigate the predictive value of the SAE-R in relation to the part 1 ABPMR-CE.

DESIGN

Retrospective study.

METHODS

Data were analyzed from first time takers of the part 1 ABPMR-CE during a 5-year period from 2010 through 2014 who took at least 1 SAE-R in the third or fourth postgraduate year (PGY) of residency.

MAIN OUTCOME MEASUREMENTS

Raw scores from the SAE-R were compared with scaled scores on the part 1 examination. Regression models analyzed the predictive value of the SAE-R total score for each PGY level.

RESULTS

SAE-R raw scores increased an average of 5.5 points between the PGY 3 and PGY 4 year. PGY3 SAE-R raw scores accounted for 24.8% and PGY4 SAE-R scores for 27.1% of the variance in part 1 ABPMR-CE scores (P < .0001). Residents who obtained a raw score greater than 80 (53% correct) on the SAE-R had an 80% or greater chance of passing the ABPMR-CE. Scores greater than 90 (60% correct) on the SAE-R were associated with a 95% chance of passing the ABPMR-CE.

CONCLUSION

The SAE-R scores provide some information regarding the likelihood of passing the part 1 certification examination. This study supports the SAE-R as a means of providing PMR residents with feedback regarding their level of knowledge.

Predicting Performance on the American Board of Physical Medicine and Rehabilitation Written Examination Using Resident Self-Assessment Examination Scores

BACKGROUND

Studies across medical specialties have shown that scores on residency self-assessment examinations (SAEs) can predict performance on certifying board examinations.

OBJECTIVE

This study explored the predictive abilities of different composite SAE scores in physical medicine and rehabilitation and determined an optimal cut-point to identify an "at-risk" performance group.

METHODS

For our study, both predictive scores (SAE scores) and outcomes (board examination scores) are expressed in national percentile scores. We analyzed data in graduates of a physical medicine and rehabilitation residency program between 2008 and 2014. We compared mean, median, lowest, highest, and most recent score among up to 3 SAE scores with respect to their associations with the outcome via linear and logistic regression. We computed regression/correlation coefficient, P value, R (2), area under the curve, sensitivity, specificity, and predictive values. Identification of optimal cut-point was guided by accuracy, discrimination, and model-fit statistics.

RESULTS

Predictor and outcome data were available for 88 of 99 residents. In regression models, all SAE predictors showed significant associations (P ≤ .001) and the mean score performed best (r = 0.55). A 1-point increase in mean SAE was associated with a 1.88 score increase in board score and a 16% decrease in odds of failure. The rule of mean SAE score below 47 yielded the highest accuracy, highest discrimination, and best model fit.

CONCLUSIONS

Mean SAE score may be used to predict performance on the American Board of Physical Medicine and Rehabilitation-written examination. The optimal statistical cut-point to identify the at-risk group for failure appears to be around the 47th SAE national percentile.

Correlation of the emergency medicine resident in-service examination with the American Osteopathic Board of Emergency Medicine Part I

Introduction: Eligible residents during their fourth postgraduate year (PGY-4) of emergency medicine (EM) residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM) Part 1 Board Certifying Examination (AOBEM Part 1). All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE) annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year.

Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME). The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC) curve was generated to depict the relationship.

Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r=0.61, 95% confidence interval [CI] 0.54 to 0.66). Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65^th percentile score on the RISE.

Conclusion: We have shown there is a strong correlation between a resident's percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well prepared they are for the AOBEM Part 1 Board Certifying Examination.

Initial Validity Analysis of the Emergency Medicine Milestones

OBJECTIVES

The Accreditation Council for Graduate Medical Education (ACGME) Milestones describe behavioral markers for the progressive acquisition of competencies during residency. As a key component of the Next Accreditation System, all residents are evaluated for the acquisition of specialty-specific Milestones. The objective was to determine the validity and reliability of the emergency medicine (EM) Milestones.

METHODS

The ACGME and the American Board of Emergency Medicine performed this single-event observational study. The data included the initial EM Milestones performance ratings of all categorical EM residents submitted to the ACGME from October 31, 2013, to January 6, 2014. Mean performance ratings were determined for all 23 subcompetencies for every year of residency training. The internal consistency (reliability) of the Milestones was determined using a standardized Cronbach's alpha coefficient. Exploratory factor analysis was conducted to determine how the subcompetencies were interrelated.

RESULTS

EM Milestone performance ratings were obtained on 100% of EM residents (n = 5,805) from 162 residency programs. The mean performance ratings of the aggregate and individual subcompetency scores showed discrimination between residency years, and the factor structure further supported the validity of the EM Milestones. The reliability was α = 0.96 within each year of training.

CONCLUSIONS

The EM Milestones demonstrated validity and reliability as an assessment instrument for competency acquisition. EM residents can be assured that this evaluation process has demonstrated validity and reliability; faculty can be confident that the Milestones are psychometrically sound; and stakeholders can know that the Milestones are a nationally standardized, objective measure of specialty-specific competency acquisition.

Genomic oncology education: an urgent need, a new approach

Genomic testing has entered oncology practice. With reduced cost and faster turnaround times, clinical applications for next-generation sequencing-based assays will only continue to increase. As such, there is an urgent need for health professional education to allow implementation of these new diagnostic tools. However, current medical school, residency, and fellowship training has had limited success in educating physicians in the fundamentals of single-gene testing, let alone genomic methods. In this review, we describe the novel approach the pathology community has taken in genomic education and the potential for application to oncology trainees.

The Pathology Residency Program of the Johns Hopkins University School of Medicine: a model of its kind

CONTEXT

The Department of Pathology of the Johns Hopkins University pioneered in the late 19th century the application of the scientific method to the study of medicine and fostered the development of residency training programs.

OBJECTIVE

To trace the history of the Johns Hopkins Pathology Residency Program and assess with quantifiable outcomes the performance of former residents. Design .- We reviewed archival and departmental records from September 1899 to June 2014 to create a database of pathology residents. We then analyzed resident in-service examinations, American Board of Pathology examinations, and career paths.

RESULTS

In 115 years the department trained 555 residents who came from 133 medical schools located in 23 countries. Residents performed well on the in-service examinations, obtaining mean scaled total scores that were significantly better (P = .02) than those of the national peer groups. Residents (371 of 396, 94%) passed their boards typically at the first attempt, a percentage pass that was higher than the national average for both anatomic (P < .001) and clinical (P = .002) pathology. Approximately half of the residents went into private practice, whereas a third followed an academic career. Of the latter group, 124 (75%) became professors of pathology, 31 (19%) chairs of pathology departments, 10 (6%) deans of medical schools, 5 (3%) were elected into the National Academy of Sciences, and 1 won the Nobel prize.

CONCLUSIONS

While maintaining its original core values, the Johns Hopkins Pathology Residency Program has trained physicians to be outstanding researchers, diagnosticians, and leaders in pathology.

Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment

BACKGROUND

Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care.

STUDY DESIGN AND METHODS

Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine.

RESULTS

A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful.

CONCLUSION

Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education.

Neuropathology training worldwide-evolution and comparisons

Training of neuropathologists varies worldwide. Systems range from highly organized specialist and subspecialist education with national certification, to regulated training with diploma recognition, to informal apprenticeships in neurological hospitals and no formal recognition. This overview compiles and summarizes the history of regulated training systems, the status of neuropathology within various countries' medical systems and the manner in which neuropathologists are trained. Anecdotal evidence suggests that countries with regulated systems of neuropathology training and an active professional organization are more likely to have an adequate supply of diagnostic specialists and a vibrant research community. The different training systems reflect the style of medical services delivery in the respective countries. In general, the existence of formal neuropathology training systems occurs only in countries with relatively high levels of per capita health expenditures, reflecting the development of medical specialization overall. Evolving diagnostic technologies and major international research endeavors, whose goals are to understand structure and function of the human brain, demand that neuropathology training is more than simply diagnostic histopathology.

The current state of resident training in genomic pathology: a comprehensive analysis using the resident in-service examination

OBJECTIVES

To determine the current state of pathology resident training in genomic and molecular pathology.

METHODS

The Training Residents in Genomics (TRIG) Working Group developed survey and knowledge questions for the 2013 pathology Resident In-Service Examination (RISE). Sixteen demographic questions related to amount of training, current and predicted future use, and perceived ability in molecular pathology vs genomic medicine were included, along with five genomic pathology and 19 molecular pathology knowledge questions.

RESULTS

A total of 2,506 pathology residents took the 2013 RISE, with approximately 600 individuals per postgraduate year (PGY). For genomic medicine, 42% of PGY-4 respondents stated they had no training, compared with 7% for molecular pathology (P < .001). PGY-4 residents' perceived ability, comfort in discussing results, and predicted future use as a practicing pathologist were reported to be less in genomic medicine than in molecular pathology (P < .001). Based on PGY, knowledge question scores showed a greater increase in molecular pathology than in genomic pathology.

CONCLUSIONS

The RISE is a powerful tool for assessing the state of resident training in genomic pathology and current results suggest a significant deficit. The results also provide a baseline to assess future initiatives to improve genomics education for pathology residents such as those developed by the TRIG Working Group.

Strong performance on the Progressive Evaluation of Competency fellowship final examination predicts American Board of Pathology Certification

INTRODUCTION

The Progressive Evaluation of Competency (PEC) program was developed to help cytopathology fellowship directors evaluate the progress of fellows before program completion. There are no data on how PEC examination results compare with American Board of Pathology (ABP) certification status.

MATERIALS AND METHODS

PEC final examination results from the 2011/2012 academic year were compared with performance on the ABP cytopathology examination. The total and section PEC scores were compared with ABP scaled written and practical scores, and individuals who failed the certification examination were analyzed in detail.

RESULTS

Of the 103 fellows who took the final PEC examination in spring of 2012, 88 took the ABP examination, and 79 became certified. The total and the fine-needle aspiration scores on the PEC exam were positively and significantly correlated with performance on both ABP exam sections. Every fellow who scored in the upper one-third on the PEC exam became certified. The failing candidates scored significantly lower in both total scores and the fine-needle aspiration section of the PEC exam.

CONCLUSIONS

The PEC final examination performance is positively correlated with ABP certification status, and fellows who score in the top one-third of the PEC examination become certified. These findings can help provide guidance to both fellowship directors and fellows on competency and readiness for board certification.

Progress and potential: training in genomic pathology

CONTEXT

Genomic medicine is revolutionizing patient care. Physicians in areas as diverse as oncology, obstetrics, and infectious disease have begun using next-generation sequencing assays as standard diagnostic tools.

OBJECTIVE

To review the role of pathologists in genomic testing as well as current educational programs and future training needs in genomic pathology.

DATA SOURCES

Published literature as well as personal experience based on committee membership and genomic pathology curricular design.

CONCLUSIONS

Pathologists, as the directors of the clinical laboratories, must be prepared to integrate genomic testing into their practice. The pathology community has made significant progress in genomics-related education. A continued coordinated and proactive effort will ensure a future vital role for pathologists in the evolving health care system and also the best possible patient care.

Delaying the American Board of Emergency Medicine qualifying examination is associated with poorer performance

OBJECTIVES

The initial step in certification by the American Board of Emergency Medicine (ABEM) requires passing a multiple-choice-question qualifying examination. The qualifying examination is typically taken in the first year after residency training. This study was undertaken to determine if a delay in taking the qualifying examination is associated with poorer performance. The authors also examined the relationship between in-training examination scores and qualifying examination scores.

METHODS

This was a pooled time-series cross-section study. Primary measurements were initial qualifying examination scores, the timing of the qualifying examination, and in-training examination scores. The three groups, based on qualifying examination timing, were immediate, 1-year delay, and ≥2-year delay. In-training examination scores were analyzed to determine the relationship between intrinsic ability, examination timing, and qualifying examination scores. For analysis, a generic pooled ordinary least-squares dummy variable model with robust standard errors was used. A pre hoc level of significance was determined to be α < 0.01.

RESULTS

There were 16,353 qualifying examination test administrations between 2000 and 2012. In-training examination scores were positively correlated with qualifying examination scores (p < 0.001). The group pass rates were 98.9% immediate, 95.6% 1-year delay, and 86.6% ≥2-year delay. After controlling for in-training examination scores, delay taking the qualifying examination of 1 year was associated with a decrease in score of -0.6 (p = 0.003). A delay in taking the qualifying examination ≥2 years was associated with a decrease in score of -2.5 points (p < 0.001).

CONCLUSIONS

After accounting for innate ability using in-training examination scores, delay taking the qualifying examination was associated with poorer performance. This effect was more pronounced if the delay was ≥2 years.

Relationship between performance on child and adolescent psychiatry in-training and certification examinations

BACKGROUND

Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents.

OBJECTIVE

This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP).

METHODS

Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows.

RESULTS

Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows.

CONCLUSIONS

The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.

Teaching residents genomic pathology: a novel approach for new technology

Genomics-based diagnostics have become part of patient care. As pathologists have the expertise in clinical laboratory testing as well as access to patient samples, all genomic medicine is genomic pathology. This article will review the evidence that there is a critical need for pathology resident training in genomics. Several individual program curricula are described as well as the progress of the Training Residents in Genomics Working Group. This group has made significant advances toward developing, implementing, and evaluating a national curriculum in genomics for pathology residents. The novel approach of the Training Residents in Genomics Working Group can be used as a model for training pathology professionals in any new technology.

TRIG on TRACK: educating pathology residents in genomic medicine

Genomic technologies are dramatically changing the practice of medicine. Next-generation sequencing has allowed prognostic stratification of cancer patients, personalized drug therapy and the identification of genetic risk factors for a multitude of diseases. As the physicians who oversee tissue- and laboratory-based diagnostic testing, pathologists must understand and utilize this new technology for the benefit of patients; however, only a minority of pathology residency programs currently provide training in genomics. In response to this urgent need, the Training Residents in Genomics (TRIG) Working Group has made significant progress towards creating, implementing, evaluating and disseminating a national curriculum in genomic pathology. Although presented in the context of pathology training, the approach described in this review can serve as model for education in genomic medicine of students, trainees or professionals in other areas of healthcare.