Residency in Anatomic & Clinical
Pathology
Montefiore Medical Center
Albert Einstein College of Medicine of Yeshiva Univ,
Bronx, NY
ACCREDITATION AND GENERAL INFORMATION
Original Accreditation Date: March 8, 1956
Accreditation Status: Continued Full Accreditation
Looking Forward to Fifty Years of Continuous
FULL Accreditation
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Who are we?
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Introduction
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Theme & goal: kind, nurturing, competent yet visionary residency
The major duty of the resident is to learn
One of largest pathology residencies in US
ACGME/RRC Fully & Continuously Approved: Pathology,
Neuropathology, Hematopathology, Cytopathology; also GYN,
Renal/GU, & Surgical Pathology (non-RRC)
• Forward looking “competencies” included in residency and
evaluations
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The Moodle Revolution
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ELEARNING PROGRAM (http MOODLE://moodle.org/)
http://pathology-ed.aecom.yu.edu.
• Moodle is our course management system - a
software package designed to help educators
create quality online courses. Such e-learning
systems are sometimes also called Learning
Management Systems or Virtual Learning
Environments. One of the main advantages of
Moodle over other systems is a strong grounding
in social constructionist pedagogy. Moodle is
Open Source software.
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MOODLE Philosophy
(http://moodle.org/doc/?frame=philosophy.html):
• The design and development of Moodle is
guided by a particular philosophy of
learning, a way of thinking that you may see
referred to in shorthand as a "social
constructionist pedagogy".
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MOODLE 1. Constructivism:
• This point of view maintains that people
actively construct new knowledge as they
interact with their environment.
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MOODLE 2. Constructionism:
• Constructionism asserts that learning is
particularly effective when constructing
something for others to experience.
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MOODLE 3. Social
Constructivism:
• This extends the above ideas into a social
group constructing things for one another,
collaboratively creating a small culture of
shared artifacts with shared meanings.
When one is immersed within a culture like
this, one is learning all the time about how
to be a part of that culture, on many levels.
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MOODLE 4. Connected and
Separate:
• Separate behavior is when someone tries to
remain 'objective' and 'factual'. In general, a
healthy amount of connected behavior
within a learning community is a very
powerful stimulant for learning, not only
bringing people closer together but
promoting deeper reflection and reexamination of their existing beliefs.
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MOODLE 5. Teacher:
• A 'teacher' can change from being 'the
source of knowledge' to being an influencer
and role model of class culture, connecting
with students in a personal way that
addresses their own learning needs, and
moderating discussions and activities in a
way that collectively leads students towards
the learning goals of the class.
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MOODLE 6. eLearning
• We have made dramatic strides in our
eLearning, and web based self-assessment
(MOODLE MONTEFIORE), which will
allow both residents and faculty to be more
consistently and strongly involved in this
type of communal education.
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MOODLE 7. Curricula, Goals &
eTest
• Residents are also supplied with Curricula,
Goals & eTest (optimally before & after
rotation) on MOODLE MONTEFIORE
• More “robust” information, e.g.,
ADDENDA
• NB – and EVALUATIONS!
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MOODLE 8. Evaluations:
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1. EXAMPLE OF MOODLE REMINDER FOR EVALUATION:
2. CUMULATIVE
EVALUATIONS
EMAIL
WEEKLY
UPDATE
OF
OUTSTANDING
3. Template – End of Rotation COMPETENCY Evaluation of Residents
4. Professionalism – Self-Assessment
5. Communication Skills and Professionalism –360 EVALUATION
6. FINAL ASSESSMENT
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MOODLE 9. Calendar - Weekly
conferences:
• Calendar: You will find a listing of the
weekly conferences that occur on the East
and West campuses when we review our
MOODLE SITE.
• Email reminder of conferences DAILY –
required & suggested – to each resident &
faculty member.
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MOODLE MONTEFIORE &
Community of Information:
• MOODLE MONTEFIORE & Community of
Information: The Residency maintains active bulletin
boards on jobs, meetings, and issues in pathology and
medicine. This coupled with numerous mailings on issues
like competency creates the connectivity glue that a
thriving residency and faculty wants, benefit from and
maintain spirit. The numerous events as the residents’
research night, the pathology annual retreat, the winter
gala, the farewell and awards dinner, and the incoming
breakfasts maintains this sense of community.
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MOODLE & Governance:
• The broad based input by residents and faculty,
and checks & balances in the governance of the
residency are a great strength. Formal meetings on
the residency occur every two weeks with the
Residency Advisory Committee and then with the
Chair and Chief Residents with Program Director
in attendance. Decisions are typically communal,
with the right to appeal and in most cases go
directly to the representative RAC, which includes
all the chief residents.
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MOODLE MONTEFIORE – our “Virtual Community of
Learning” :
• Over the past two year we have actively met monthly, met
as a group and had a retreat to institute construction,
fielding, implementation, usage, and analysis of our
Competency evaluations, goals & curricula, and selfassessment/eTests. This is all via our MOODLE Site. This
has been highly successful as a way of expanding our
goals via the Competencies, and impacting resident &
faculty education. This modality has richly enhanced all
aspects of our educational initiative and could be a “Best
Practice” opportunity for all programs (we have shared
this information with programs across North America &
exhibited this at ACGME via poster & individual sessions
with Drs. Leach, Nestler & the ACGME MIS group).
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Moodle – eTesting & Course
Development
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Course Management System (CMS)
Web-based eTesting
Web-based updating
Automated record-keeping of testing & surveys
E-Tests
Course content
Lessons
Discussions
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Moodle – Faculty Training
Time to Completion of
Basic Moodle Training
(17 course leaders)
# of Course
Leaders
8
6
4
2
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1
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# of
1.5 hour
sessions
required
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Pathology
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The Dubler Residency Ethics Curriculum: First in
Pathology
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Chapter I: Ethical Foundations of Clinical Practice
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A brief history of ethics in the clinical setting
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The role of ethics in clinical medicine
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Clinical ethics consultation
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Bioethics committees
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Fundamental ethical principles
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Respecting patient autonomy
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Beneficence
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Nonmaleficence
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Justice
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Principlism and alternative approaches
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Conflicting obligations and ethical dilemmas
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The Moodle eTest
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Moodle-Dubler’s eTest in Ethics
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Moodle - Content
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Images
PDF’s
Lessons
PowerPoint
Word documents
Discussions
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The Moodle Site:
pathology-ed.aecom.yu.edu
• http:// pathology-ed.aecom.yu.edu/moodle
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Leaders in National Pathology
Recruitment Module for USA
Medical Schools
Career Opportunities in
PATHOLOGY
The Intersociety Committee on Pathology Information.
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National Leadership in GME &
Competency – Few in Pathology
ORGANIZING for COMPETENCY Managing the Web of Governance and Institutional Culture
Faculty, Residency & Associates of the
Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
ABSTRACT
Competency is an exercise in departmental partnership
& collaboration. To that end, the Faculty, Residency &
Associates of Pathology at AECOM/MMC (600 staff
with 84 faculty, 23 residents & fellows), a mid-sized
organization, began on the road to competency two years
ago. Initial stimuli stemmed from the GME Committee,
relaying information from ACGME generically & by
specific involvement in ACGME committees. The
ACGME itself broadcast & unfurled it’s competency
banner high. National meetings (APC/PRODS) held
ACGME competency seminars. The Greater New York
Hospital Association (GNYHA) supplied critical high
profile seminars & hardcopy competency information
that were invaluable. This information was summarily
hardcopy circulated to all faculty with economy, &
residency responsible faculty in detail & repetitively.
Email competency information was communicated with
all parties in a similar mode. Competency reports & news
were verbally presented by the chair (a key supporter &
catalyst), program director & resident representative at
four layers of faculty/residency meetings: general faculty
meetings, departmental executive sessions, divisional
faculty meetings, residency advisory & oversight
meetings, i.e., residency “board of trustees.” Small goal
oriented working groups are narrowly tasked to develop
specific divisional “toolboxes” for competency
application, management & measurement. Computer
based learning & self-assessment devices (Etests) are
being developed. Divisional faculties are now reaching
out to discipline specific colleagues to share & develop
tools. Lastly, faculty/residents are involved in citywide,
regional, national organization committees overseeing &
instituting competency. In sum:competency development
& implementation is a reflection (Rorschach) of
faculty/residents’ self-study, sense of community, &
broader national influences. Implementation can be
enhanced by understating that a complicated social
structure exists defining an academic & clinical faculty.
Recognition of this complex reality is a determinant of
competency success.
CONCLUSIONS
KNOWLEDGE
SKILLS
SKILL
Needs
Remediation
Competent
Outstanding
Demonstrates ability to
adequately describe gross
specimen and obtain
appropriate tissue sections
Demonstrates technical ability,
timeliness, and appropriate
communication when
performing frozen sections
Is organized and prepared for
slide sign-out, including
acquisition of previous
pathology material
Demonstrates the ability to
communicate effectively with
clinicians and other members
of the health care environment
 CLINICALLY CORRELATED CASES AND
ENTITIES APPROPRIATE FOR LEVEL OF
TRAINING
SKILL
SURGICAL PATHOLOGY
SKILL
Needs
Remediation
Competent
Outstanding
Evaluates “consent” form
thoroughly prior to
proceeding
Contacts and discusses case
with clinician prior to and
following the autopsy
Uses proper method(s) of
identification of patient prior
to commencing
Submits and examines
routine and pathologic
sections
Completes PAD within 48-72
hours post-autopsy
Presents each adult autopsy
at weekly Morgue conference
Needs
Competent
Remediation
Outstanding
Interprets peripheral smears
Performs manual differential
Interprets CBC cytograms
Demonstrates understanding
of principles of hemostasis
Interprets coagulation
profiles
Interprets hemoglobin
electrophoresis
Interprets SPEP’s, UPEP’s,
and IFE’s
Demonstrates understanding
of principles of QC
ACGME GENERAL
COMPETENCIES
• MEDICAL KNOWLEDGE
• PRACTICE-BASED LEARNING
AND IMPROVEMENT
• PROFESSIONALISM
SKILL
Needs
Remediation
Competent
Performs and interprets
Gram stains
Performs and interprets Acid
Fast stains
Demonstrates understanding
of and can advise clinicians
as to specimen collection and
processing
Can identify fungi in vitro and
in vivo
Demonstrates understanding
of immune response to
various pathogens
Demonstrates understanding
of antimicrobial resistance
and susceptibilities
Outstanding
 COMPUTER BASED LEARNING TOOLS AND
SELF-ASSESSMENT
 CUTTING ROOM PROTOCOLS AND
PROCEDURES (CRPP)
 REDESIGNED DIDACTIC LECTURE SERIES
• PATIENT CARE
HEMATOLOGY
AUTOPSY MEDICINE
SKILL
 OBJECTIVE STANDARDS
Needs
Remediation
Demonstrates ability to
determine specimen
adequacy on a slide
Demonstrates ability in FNA
palpation, aspiration and
smear techniques
Demonstrates understanding
of when and how to use Diffquick vs Pap stain
Shows ability to investigate
cases utilizing texts, journal
articles and internet
Demonstrates ability to
suggest/order appropriate,
and interpret results of
special and immunohistochemical stains
Competent
Outstanding
• INTERPERSONAL AND
COMMUNCATION SKILLS
• SYSTEMS-BASED PRACTICE
 NUMEROUS SPECIALTY CONFERENCES
 RESIDENT-FELLOW LED CONFERENCES
PROFESSIONALISM
C H A R A C T E R IS T IC
Needs
R e m e d ia ti o n
C o m p e te n t
O u ts ta n d in g
D e m o n s t r a t e s c o m m it m e n t
t o e t h i c a l p r i n c ip le s ( e . g .
p a t ie n t c o n f id e n t i a l i t y ,
i n f o r m e d c o n s e n t , p r o v is io n
o f c a re )
D e m o n s tra te s
a c c o u n t a b i l it y t o p a t ie n t s ,
s o c ie t y a n d p r o f e s s io n
D e m o n s t r a t e s c o m m it m e n t
t o p r o f e s s io n a l
d e v e lo p m e n t a n d
e x c e l le n c e
D e m o n s t r a t e s s e n s it i v it y t o
p a t ie n t d iv e r s it y ( e . g . a g e ,
c u lt u r e , g e n d e r , d i s a b i l it y )
CYTOLOGY
MICROBIOLOGY
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Patient Care
Professionalism
Interpersonal & Communication Skills
Competency:
The Resident Perspective
Practice-Based Learning & Improvement
Systems Based Practice
Medical Knowledge
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Competency: Where we are….
• Competency Working Group
• Evaluations, eTests, Curriculum
• Opportunities for Resident Input
– Residency Town Hall Meetings
– CP Town Hall Meeting
– Resident Surveys
• Opportunities to provide feedback
– Mid-year review
– Chief Residents Meetings
– End-of-rotation evaluation of rotation and faculty
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National Resident Perspective:
Our Participation
• AAMC – Organization of Resident
Representatives
• USCAP, ASCP – future directions
• CAP – Residents Forum
– Retreats with residents involved in revising/modifying
goals & objectives
– Addition of Ethics, Professionalism, and Health Care
Delivery & Management to Didactic Lecture Series
– Re-structuring of Departmental Conferences
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Future Directions (1)
• Patient Care (Related Activities)
– Practicum-based evaluations
– Conferences that document “Learning Curve”
• Medical Knowledge
– DETAILED CORE
– Full cadre of Etests
• Practice Based Learning & Improvement
– Resident Portfolios
– Quality Assurance/Improvement Studies
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Future Directions (2)
• Interpersonal & Communication Skills and
Professionalism
– 360° evaluations – support staff, techs, supervisors, lab
managers, clinicians from other services, as well as
supervising Pathology attending(s)
– Simulated “professional” interactions
– Ethics
• Systems-Based Practice
– Expanded Laboratory Management Component with
emphasis on Pathology’s role in health care delivery
– More inclusive Didactic Lecture Series
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Competency Leadership:
Why us?
In a few short years residents and fellows will be
Attending Pathologists at institutions with
residency training programs and will be (to some
extent) responsible for that program remaining
accredited on the basis of their ability to produce
“COMPETENT” pathologists.
If we are part of the process now, we will
understand and control what we need to do
later!!
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Thanks for Presentation Help….
• Dr. Tylis Chang – Moodle Presentation
• Dr. Samson Fine – Competency
Presentation
• Ms. Betty Edwards – Residency
Information
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Half-a-Century of Educational
Excellence: Past, Present &
Future
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The espirit
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