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APC PRODS Explores the Challenges of Training the Pathologist of the Future

Monday, July 23, 2012

“The indispensable role for the pathologist, is synthesizing diagnostic data to achieve a diagnosis accurately and rapidly, spending the fewest dollars possible.” 
—Michael Laposata, MD, PhD, FASCP

Several sessions at the Annual Meeting of the Association of Pathology Chairs and Residency Program Directors (APC/PRODS), July 10–13, 2012, Monterey, Calif., addressed critical questions for training the pathologist of the future.

Ronald L. Weiss, MD, FASCP, Professor of Pathology at the University of Utah, Salt Lake City, set the stage for the session asking critical questions about new delivery, payment models, and new skill sets for the pathologist of the future. These pathologists will serve as effective stewards of patient data, be mindful of the best use of limited resources, and optimize clinical laboratory utilization protocols.

Expectations of the newly minted pathologist do not match what employers need or want, such as communications, leadership, practice management, and laboratory direction skills, according to Richard E. Horowitz, MD, FASCP, Clinical Professor of Pathology at the University of Southern California, Los Angeles. He also noted that experience varies depending on whether the new resident enters a practice in an academic or a community hospital setting.

Pathologists play a huge role in community hospitals, Dr. Horowitz said, where they are viewed as “the scientists” and the “quality management experts” and participate on hospital committees, much more so than in the academic setting. Thus, management training needs to be individualized both in content and timing, he said, because expectations vary greatly depending on practice setting.

The challenges of training residents for lab management in three to four years vary for residents in academic pathology and laboratory medicine, according to Michael Laposata, MD, PhD, FASCP, Pathologist-in-Chief at Vanderbilt University Hospital, Nashville, Tenn. Residents in academic pathology are taught by pathologists almost exclusively, learning is virtually all case based, and there is minimal exposure to lab activity. Residents in laboratory medicine are taught mostly by individuals with medical technology background, cases are not discussed in real time, and, while there is exposure to laboratory activity, content varies widely and may not provide enough experience to effectively direct lab operations or provide consultative advice.

“The indispensable role for the pathologist,” Dr. Laposata said, “is synthesizing diagnostic data to achieve a diagnosis accurately and rapidly, spending the fewest dollars possible.” In order to synthesize practical diagnostic information, residents need to learn: transfusion medicine, microbiology, clinical chemistry, coagulation, diagnostic immunology, hematology, and then “laboratory management to make it all possible.” 

Using Coagulation as an example, Dr. Laposata explained that if in one month 200 cases are brought forward, and an additional month is required for each of the six other areas listed above, equaling seven months, “this leaves at least another 11 months for additional lab medicine rotations to increase case experience.” Whereas with anatomic pathology, the challenge is not having time to see enough case material with true responsibility for creating a differential diagnosis to build diagnostic confidence in the many areas of laboratory medicine,” he said.  

Thus, with diagnostic teams organized to interpret complex clinical laboratory evaluations, residents will gain experience providing tentative interpretations to evaluate cases in real time and learn from the insights of the laboratory director in the finalization of the tentative report they prepare. With only a few cases per rotation, the residents cannot gain adequate experience to knowledgeably interpret clinical laboratory evaluations. A robust and active interpretive service in laboratory medicine that mirrors anatomic pathology without the microscope is essential for training residents to provide expert driven commentaries that are of value to the ordering physician, according to Dr. Laposata.

Christopher D. Stowell, MD, Associate Program Director, Massachusetts General Hospital, Boston, and current Chair of the PRODS Workgroup on Laboratory Management, presented the background of the development of the curriculum, which is available at www.lab-management.info.

He reported on a session held on July 12, during which representatives of several residency programs presented their ideas for effective ways to teach lab management. Among their methods, he described mock inspections; laboratory director apprenticeships; assigned exercises, such as preparing a proposal for a new service or test; and participation in utilization review activities. Most important, he stressed, was that exercises need to be real, case-based, and relevant.

The laboratory management sessions were based in part on the curriculum developed by the PRODS Workgroup on Laboratory Management and on articles published in AJCP in the November 2011, January 2012, and April 2012 issues. All three articles are posted on the ASCP website here


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