montefiore pathology residency1 residency in anatomic & clinical pathology montefiore medical...

Montefiore Pathology Residency 1

Residency in Anatomic & Clinical Pathology

Montefiore Medical CenterAlbert Einstein College of Medicine of Yeshiva Univ,

Bronx, NYACCREDITATION AND GENERAL INFORMATION

Original Accreditation Date: March 8, 1956Original Accreditation Date: March 8, 1956

Accreditation Status: Continued Full Accreditation

Looking Forward to Fifty Years of Continuous FULL Accreditation


Who are we?


Introduction

• Theme & goal: kind, nurturingnurturing, competent yet visionary residency

• The major duty of the resident is to learnlearn

• 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


The Moodle RevolutionThe Moodle Revolution


ELEARNING PROGRAM (http MOODLE://moodle.org/) http://pathology-ed.aecom.yu.edu.

• Moodle is our course management systemcourse 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 pedagogysocial constructionist pedagogy. Moodle is Open Source software.

http://moodle.org/

http://pathology-ed.aecom.yu.edu/


MOODLE Philosophy (http://moodle.org/doc/?frame=philosophy.html):

• The design and development of Moodle is guided by a particular philosophyparticular philosophy of learning, a way of thinking that you may see referred to in shorthand as a "social "social constructionist pedagogy".constructionist pedagogy".


MOODLE 1. Constructivism:MOODLE 1. Constructivism:

• This point of view maintains that people actively constructactively construct new knowledgenew knowledge as they interact with their environmentenvironment.


MOODLE 2. Constructionism:MOODLE 2. Constructionism:

• Constructionism asserts that learning is particularly effective when constructing constructing something for others to experiencesomething for others to experience.


MOODLE 3. Social MOODLE 3. Social Constructivism:Constructivism:

• This extends the above ideas into a social a social group constructing things for one anothergroup constructing things for one another, collaborativelycollaboratively creating a small culture of shared artifactsshared artifacts with shared meaningsshared meanings. When one is immersed within a culture like this, one is learning all the time about how how to be a part of that culture, on many levelsto be a part of that culture, on many levels.


MOODLE 4. Connected and MOODLE 4. Connected and Separate:Separate:

• Separate behavior is when someone tries to remain 'objective' and 'factual'. In general, a healthy amount of connected behavior connected behavior within a learning communitywithin a learning community is a very powerful stimulant for learning, not only bringing people closer together but promoting deeper reflectiondeeper reflection and re-examination of their existing beliefs.


MOODLE 5. Teacher:MOODLE 5. Teacher:

• A 'teacher' can change from being 'the source of knowledge' to being an influencer influencer and role model of class cultureand role model of class culture, connecting with students in a personal way that addresses their own learning needsown learning needs, and moderating discussions and activities in a way that collectively leads students towards the learning goals of the class.


MOODLE 6. MOODLE 6. eLearningeLearning

• 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 educationcommunal education.


MOODLE 7. Curricula, Goals & MOODLE 7. Curricula, Goals & eTesteTest

• Residents are also supplied with Curricula, Curricula, Goals & eTestGoals & eTest (optimally before & after rotation) on MOODLE MONTEFIORE

• More “robust” information, e.g., ADDENDAADDENDA

• NB – and EVALUATIONSEVALUATIONS!


MOODLE 8. Evaluations:MOODLE 8. Evaluations:

• 1. EXAMPLE OF MOODLE REMINDERREMINDER FOR EVALUATION:

•

• 2. CUMULATIVE EMAIL WEEKLY UPDATEEMAIL WEEKLY UPDATE OF OUTSTANDING EVALUATIONS

•

• 3. Template – End of Rotation COMPETENCYEnd of Rotation COMPETENCY Evaluation of Residents

•

• 4. ProfessionalismProfessionalism – Self-Assessment

•

• 5. Communication Skills and Professionalism –360 EVALUATION360 EVALUATION

•

• 6. FINAL ASSESSMENTFINAL ASSESSMENT


MOODLE 9. Calendar - Weekly MOODLE 9. Calendar - Weekly conferences:conferences:

• CalendarCalendar: You will find a listing of the weekly conferences that occur on the East and West campuses when we review our MOODLE SITE.

• Email reminderreminder of conferences DAILY – required & suggested – to each resident & faculty member.


MOODLE MONTEFIORE & MOODLE MONTEFIORE & Community of Information:Community of Information:

• MOODLE MONTEFIORE & Community of Community of InformationInformation: The Residency maintains active bulletin boards on jobs, meetings, and issues in pathology and medicine. This coupled with numerous mailings on issues numerous mailings on issues like competencylike competency creates the connectivity glue that a thriving residency and faculty wants, benefit from and maintain spiritmaintain 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 communitysense of community.


MOODLE & Governance:MOODLE & Governance:

• The broad based inputbroad based input by residents and faculty, and checks & balanceschecks & balances in the governance of the residency are a great strengthgreat strength. Formal meetingsFormal meetings on the residency occur every two weeks with the Residency Advisory CommitteeResidency Advisory Committee and then with the Chair and Chief ResidentsChief Residents with Program Director in attendance. Decisions are typically communalcommunal, with the right to appealright to appeal and in most cases go directly to the representative RAC, which includes all the chief residents.


MOODLE MONTEFIORE – our “Virtual Community of MOODLE MONTEFIORE – our “Virtual Community of Learning” :Learning” :

• Over the past two year we have actively met monthlyactively 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 self-assessment/eTests. This is all via our MOODLE Site. This has been highly successful as a way of expanding our goals via the expanding our goals via the CompetenciesCompetencies, and impacting resident & faculty education. This modality has richly enhancedrichly enhanced all aspects of our educational initiative and could be a “Best Practice”“Best Practice” opportunity for all programs (we have shared this information with programs across North America & exhibited this at ACGME via posterACGME via poster & individual sessions with Drs. Leach, Nestler & the ACGME MIS group).


Moodle – eTesting & Course Development

• Course Management System (CMS)

• Web-based eTesting

• Web-based updating

• Automated record-keeping of testing & surveys

• E-Tests

• Course content

• Lessons

• Discussions


Moodle – Faculty Training

Time to Completion of Basic Moodle Training

(17 course leaders)

0

2

4

6

8

1 2 3 4 5 6 7 8

# of 1.5 hour sessions required

# o

f C

ou

rse

Lead

ers


The Dubler Residency Ethics CurriculumDubler Residency Ethics Curriculum: First in Pathology

• Chapter I: Ethical Foundations of Clinical Practice • A brief history of ethics in the clinical setting• • The role of ethics in clinical medicine• • Clinical ethics consultation• • Bioethics committees• • Fundamental ethical principles• • Respecting patient autonomy• • Beneficence• • Nonmaleficence• • Justice• • Principlism and alternative approaches• • Conflicting obligations and ethical dilemmas

•


The Moodle eTest


Moodle-Dubler’s eTest in Ethics


Moodle - Content

• Images

• PDF’s

• Lessons

• PowerPoint

• Word documents

• Discussions


The Moodle Site: pathology-ed.aecom.yu.edu

• http:// pathology-ed.aecom.yu.edu/moodlehttp:// pathology-ed.aecom.yu.edu/moodle


Leaders in National Pathology Recruitment Module for USA

Medical Schools

Career Opportunities in

PATHOLOGYThe Intersociety Committee on Pathology Information.


ORGANIZING for COMPETENCY -Managing the Web of Governance and Institutional Culture

Faculty, Residency & Associates of theDepartment of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY

ORGANIZING for COMPETENCY -Managing the Web of Governance and Institutional Culture

Faculty, Residency & Associates of theDepartment of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY

C om petency is an exercise in departm ental partnership & collaboration. To that end, the Faculty, R esidency & Associates of Pathology at A ECOM /M M C (600 staff with 84 faculty, 23 residents & fellows), a mid-sized organization, began on the road to competency tw o years ago. Initial stimuli stem m ed from the GM E C ommittee, relaying information from AC GM E generically & by specific involvem ent in AC GM E comm ittees. The AC GM E itself broadcast & unfurled it’s competency banner high. National m eetings (APC /PRO DS) held AC GM E competency seminars. The Greater N ew Y ork Hospital Association (GNY HA ) supplied critica l high profile seminars & hardcopy competency information that w ere invaluable. This information w as summ arily hardcop y circulated to all faculty with econom y, & residency responsible faculty in detail & repetitively. Email competency information was com municated with all parties in a similar m ode. C ompetency reports & news were verbally presented by the chair (a key supporter & catalyst), program director & resident representative at four layers of faculty/residency m eetings: general faculty meetings, departm ental executive sessions, divisional faculty m eetings, residency advisory & oversight meetings, i.e., residency “board of trustees.” Sm all goal oriented w orking groups are narrowly tasked to develop specific d ivisional “toolboxes” for com petency application, m anagem ent & m easurem ent. C omputer based learning & self-assessm ent 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 cityw ide, regional, national organization com mittees overseeing & instituting competency. In sum :competency developm ent & implem entation is a reflection (R orschach) of faculty/residents’ self-stud y, sense of community, & broader national influences. Implem entation 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.

OBJECTIVE STANDARDS

CLIN ICALLY CORRELATED CASES AND ENTITIES APPROPRIATE FOR LEVEL OF TRAIN ING

COMPUTER BASED LEARN ING TOOLS AND SELF-ASSESSMENT

CUTTIN G ROOM PROTOCOLS AND PROCEDURES (CRPP)

REDESIGNED D IDACTIC LECTURE SERIES

NUMEROUS SPECIALTY CONFERENCES

RESIDEN T-FELLOW LED CONFERENCES

ABSTRACT SKILLS KNOWLEDGE

PROFESSIONALISM

CONCLUSIONS

SURGIC AL PATHOLOGY

HEM ATOLOGY

AUTOPSY MEDIC INE

M ICROBIOLOGY

CYTOLOGY

SKILL NeedsRemediation

Competent Outstanding

Demonstrates ability toadequately describe grossspecimen and obtainappropriate tissue sectionsDemonstrates technical ability,timeliness, and appropriatecommunication whenperforming frozen sectionsIs organized and prepared forslide sign-out, includingacquisition of previouspathology materialDemonstrates the ability tocommunicate effectively withclinicians and other membersof the health care environment



Interprets peripheral smearsPerforms manual differentialInterprets CBC cytogramsDemonstrates understandingof principles of hemostasisInterprets coagulationprofilesInterprets hemoglobinelectrophoresisInterprets SPEP’s, UPEP’s,and IFE’sDemonstrates understandingof principles of QC



Evaluates “consent” formthoroughly prior toproceedingContacts and discusses casewith clinician prior to andfollowing the autopsyUses proper method(s) ofidentification of patient priorto commencingSubmits and examinesroutine and pathologicsectionsCompletes PAD within 48-72hours post-autopsyPresents each adult autopsyat weekly Morgue conference



Performs and interpretsGram stainsPerforms and interprets AcidFast stainsDemonstrates understandingof and can advise cliniciansas to specimen collection andprocessingCan identify fungi in vitro andin vivoDemonstrates understandingof immune response tovarious pathogensDemonstrates understandingof antimicrobial resistanceand susceptibilities


Competent O utstanding

Demonstra tes ability todetermine specimenadequacy on a slideDemonstra tes ability in FNApalpation, aspira tion andsmear techniquesDemonstra tes understandingof when and how to use Diff-quick vs Pap stainShows ability to investigatecases utilizing texts, journalarticles and in ternetDemonstra tes ability tosuggest/order appropria te ,and in terpret results ofspecial and immunohisto-chemical stains

C H A R A C T E R I S T I C N e e d sR e m e d i a t i o n

C o m p e te n t O u t s t a n d i n g

D e m o n s t r a t e s c o m m i t m e n tt 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 no f c a r e )D e m o n s t r a t e sa c c o u n t a b i l i t 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 nD e m o n s t r a t e s c o m m i t m e n tt o p r o f e s s io n a ld e v e lo p m e n t a n de x c e l l e n c eD e m o n s t r a t e s s e n s i t i v i t y t op a t ie n t d iv e r s i t y ( e . g . a g e ,c u l t u r e , g e n d e r , d i s a b i l i t y )

• PATIENT CARE

• MEDICAL KNOWLEDGE

• PRACTICE-BASED LEARNING AND IMPROVEMENT

• PROFESSIONALISM

• INTERPERSONAL AND COMMUNCATION SKILLS

• SYSTEMS-BASED PRACTICE

ACGME GENERAL COMPETENCIES

National Leadership in GME & Competency – Few in Pathology


Competency: The Resident Perspective

Patient CareInterpersonal & Communication

Skills

Systems Based Practice

Professionalism

Practice-Based Learning & Improvement

Medical Knowledge


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


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


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


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


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!!


Thanks for Presentation Help….

• Dr. Tylis Chang – Moodle Presentation

• Dr. Samson Fine – Competency Presentation

• Ms. Betty Edwards – Residency Information


Half-a-Century of Educational Excellence: Past, Present &

Future


The espirit

montefiore pathology residency1 residency in anatomic & clinical pathology montefiore medical...

Documents

moodle revolution slide

accreditation slide

development of moodle

evaluations slide

largest pathology residencies

learning management

main advantages of moodle

social constructivism