residents forum at cap ‘11 saturday, september 10, 2011 grapevine, texas morning joint session...

Residents Forum at CAP ‘11

Saturday, September 10, 2011

Grapevine, Texas

• Morning Joint Session with House of Delegates

• Residents Forum Morning Session

• Joint Lunch sponsored by PathPAC

• Residents Forum Afternoon Session

© 2011 College of American Pathologists. All rights reserved. 2

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@pathologists

Town Hall• Betsy D. Bennett, MD, PhD, FCAP

Executive Vice PresidentAmerican Board of Pathology (ABP)

• William F. Hickey, MD, FCAPCAP Governor

• Henry M. Rinder, MD, FCAPAmerican Society for Clinical Pathology (ASCP) Resident In-Service Examination (RISE) Committee Chair

• Suzanne Z.E. Powell, MD, FCAPAPC Program Directors Section (PRODS) ChairAccreditation Council for Graduate Medical Education (ACGME) Residency Review Committee Chair

• Michael L. Talbert, MD, FCAPCAP Graduate Medical Education Committee ChairAssociation of Pathology Chairs, Inc. (APC) Representative


RISE correlation with ABP outcomes

454 residents graduating in 2008 424 graduating in 2009 All were first-time takers of 2008 and/or

2009 ABP certifying examinations in AP and/or CP

All had evaluable data from their senior RISE in spring 2008 or 2009

We correlated RISE scores with pass/fail results on AP/CP certifying exams

Appears in Oct AJCP issue

AP BOARD - PASSED VS FAILED

200

400

600

800

1000

PASSED FAILED PASSED FAILED PASSED FAILED

Autopsy Forensic Pathology Cytopathology Surgical Pathology

2008 RISE AP Sections

RIS

E S

core

Q1

MIN

MEDIAN

MAX

Q3

*P<0.001 *P<0.001

2008 AP RISEsections

P=0.07

CP BOARD - PASSED VS FAILED

200

400

600

800

1000

PASSED FAILED PASSED FAILED PASSED FAILED PASSED FAILED

Clinical Chemistry Hematology Microbiology Transfusion Medicine

2008 RISE CP Sections

RIS

E S

core

Q1

MIN

MEDIAN

MAX

Q3

2008 CP RISEsections

*P<0.001 for all

RISE score quartiles

Exam pass rate (n=454) for 2008 graduates and RISE score range

Exam pass rate (n=424) for 2009 graduates and RISE score range

1st quartile 97%, 565 100%, 533

2nd quartile

92%, 532-564 99%, 500-532

3rd quartile

86%, 505-531 94%, 473-499

4th quartile

46%, < 505 66%, < 472

Fewer than half of 2008 graduating residents in the bottom quartile passed all of their certifying examinations.

In a post-hoc analysis, we found that slightly more than two-thirds (69%) of 2008 graduating residents who were in the lowest quartile for the 2008 RISE were also in the lowest quartile for their 2007 (junior) RISE scores

RISE quartiles & pass rates for ABP

Conclusions

RISE and most sectional mean scores were between 45 to 75 points higher for those passing the certifying examinations but even greater gap in Surgical Pathology section

Passing rates for the certifying examinations declined with each quartile of overall RISE scoring

RISE scores under the 50th percentile – some risk of failing a certifying exam

Bottom quartile of RISE results – definitely an at-risk group for failing

Junior year’s RISE results – may identify 2011 Fellowship/Job Market Survey results:

www.ascp.org/residents

http://www.ascp.org/residents

Newly Elected RFEC Members

• Chairo Nicole Riddle

• Vice Chairo Roseann Wu

• Secretaryo Christine

Jabcuga

• Alt Del to AMA RFSo Daniel Wimmer

• Alt Del to CAP HODo Erin Consamus

• Member-at- Largeo Lauren King


Continuing RFEC Members

• Immediate Past Chairo Jerad Gardner

• Del to AMA RFSo Crystal Trujillo

• Del to CAP HODo Ricardo Mendoza


HOD/RF and Networking• Interactive joint sessions at

meetingso Speaker panelo Round table discussion

• Networking reception at meetings

• More residents involved in HOD AGs


Training Program Issues• ACGME Duty Hours

• Met with members of ACGME and Pathology RRC

• Led discussions on Wiki and via email on how to implement new duty hours guidelines

• New goals to be decided based on residents’ concerns

• Examples to of how programs are implementing ACGME changes to be posted on Wiki


External Electives• ACGME does allow

o Requires proper documentation

• CMS does technically allowo Only non-provider sites (???)o Or fill out official paperwork

• CMS does not allow just leaving your institution unofficially.

Options• If program has more residents than allotted – Not CMS

funded• Vacation/sick leave (last resort!)Remember• Numerous grants available• CAP, ASCP, and independent labs

14© 2011 College of American Pathologists. All rights reserved.

Board Prep: ApplicationSpring 2012 AP/CP Exams:• www.abpath.org - PATHway• Registration opens Sept 2011 • Final filing date Jan 15, 2012• Final late filing date Feb 15, 2012• Program Director approvals and evaluations due Feb 1, 2012 • Date assignments Mar 2012 • Cancellations• Exams begin May 14, 2012 • Results posted 4 to 6 weeks after the final week of examinations


Board Prep: Requirements• Complete training by July 1 for the spring exam and November 1 for the fall exam. • Hold a non-restricted medical license.• 50 autopsies

oAge, sex, primary diagnosis, and date performed

• Change for 2013 exam: Fetopsieso Autopsy consent, intact fetus,

placenta includedo No more than 5 IUFD only, no more

than 2 macerated


Board Prep Survey: Top 3 ResourcesAP• Lefkowitch Anatomic Pathology Board

Review• Osler Pathology Board Review Course • Surgical Pathology Unknown ConferenceCP• Osler Pathology Board Review Course• ASCP Resident Review Course • Koneman’s Color Atlas and Textbook of

Diagnostic Microbiology


Board Prep Survey: Review Courses

• Osler Pathology Board Review Course

• ASCP Review Course

• 47.9% took a review course.

• 60% recommend using resources from a review course.

• 1 to 6 months prior to the exam

Familiarize yourself with virtual microscopy!


Board Prep Timeline


Board Travel:Transportation and Hotel• Airports

o Tampa Internationalo St Pete/Clearwatero Orlando

• Ground Transportationo Hotel shuttle, car rental

• Arrive the day before, or earlier• InterContinental Hotel

o Recommended hotel, connected to test siteo ABP rate

• Ramada Westshore Tampa


Board Exam: Necessities• Photo ID

• ABP-provided blue exam ID card


Board ExamBring to cubicle

• Earplugs

• Facial tissue

• Polarizers

• Layered clothing


Bring to exam center

• Cell phone, pager, laptop

• Drinks

• Food/snacks

• Medications

22© 2011 College of American Pathologists. All rights reserved.

Board Exam: Virtual Tour


Board Exam• ABP blue ID card on desk• Blank paper for notes/calculations• Microscope• Adjustable chair• Sample questions

Time Management:• Prepare early/schedule/plan.• Answer questions you know first.• Save calculations for last.• Watch time/pace yourself.• Go fast.• Some had no issue with time.


After the Board Exam

• Keep contact information updated on ABP website!

• Time Limited Certificates

• Maintenance of Competence

• CME


Decreasing Hospital Autopsies


Burton, JL and Underwood, J, “Clinical, educational, and epidemiological value of autopsy.” Lancet 2007, 369:1471-80.De Vlieger, GYA, et al. “Clinical review: What is the role for autopsy in the ICU?” Critical Care 2010, 14:221.Hull, MJ, et al. “Resident physician opinions on autopsy importance and procurement.” Human Pathology 2007, 38: 342-350.

Autopsy Survey Methods• 2010 Survey to PRODs

• 2011 Survey to Residents & Fellowso April 2011o 206 surveys completed by junior panel members

o 90% confidence that responses were +/- 5% accurate


2011 Autopsy SurveyParticipants' Profile• 20% First Year Residents• 16% Second Year Residents• 13% Third Year Residents• 11% Fourth Year Residents• 40% Fellows

• 79% work in university hospitals.• 14% work in community hospitals

(university affiliated).


Autopsy Survey Results• The majority of the participants received 4-5

months of Autopsy (including forensics) during their residency training.

• Who obtained the autopsy permit?o Decedent affairs: >41%o Resident: 31%

• Overall, 80% felt that they had sufficient training to perform autopsies in clinical practice.

• About 50% agreed or strongly agreed that if they were to perform less than 50 autopsies, they would still be competent.


Autopsy Survey Results• About 58% did not share autopsies.

• 68% strongly disagreed or disagreed that sharing cases lead to inadequate autopsy skills.

• 74% stated that sign out was with faculty non-boarded in forensics.

• 81% agreed or strongly agreed that they could easily meet the ACGME requirement at their institution.

• Most stated that 50 autopsy requirement could be maintained.

• 31% wanted the requirement decreased to less than 50.

• 21% wanted it eliminated.


Selected Comments• “[Autopsy's] value as a clinical service is over-

emphasized. Residency training is short and with only 4 years to become competent in general surg path, cytopath, heme path, derm path, clin path, etc, 6 months is too much time....”

• “I think that autopsies will continue to decrease and eventually be replaced with whole body CT scanning with minimally invasive autopsies and limited tissue sampling.”

• “The number of cases should remain at 50. If programs are having difficulties attaining that number, lobbying should be done by pathology organizations to emphasize the need for autopsies so that appropriate funding can be obtained.”


Results of 2011 vs 2010Autopsy Surveys• Residents with significantly lower perception

vs PRODs

• Ability to complete 50 autopsies at their institution

• Ability to perform autopsies as paramount to finding good employment

• Sharing autopsies results in residents with inadequate autopsy skills.

• Maintaining autopsies at or increasing the number to greater than 50


Results of 2011 vs 2010Autopsy Surveys

• Residents with significantly higher perception vs PRODs

• Decreasing the number of autopsies to less than 50

• If number were less than 50, should still be able to perform competent clinical autopsies


Suggestions for Improvement• Increase awareness through presentations,

pamphlets with scripts for residents to use

• Develop interdepartmental Autopsy conferences

• Improve quality of report and make it more patient-friendly

• Survey clinician and patient attitudes toward autopsy

• Propose limited autopsy to patients



www.pathinfo.wikia.com

Pathology Wiki (www.pathinfo.wikia.com)• Directory of path residency/fellowship

programso Goal: Complete and Up-to-dateo Links to program websiteso Reviews of programs

• Immunostain wiki

• Board prep info

• Pathology links

• Directory of private and academic practices


Job Hunting and Contract Negotiations Panelists

• Chad R. Rund, DO, FCAPHead of Gastrointestinal Pathology Services - Greensboro Pathology Associates, Greensboro, NCGeneral Surgical, Gastrointestinal and Liver Pathology (Private)

• Miriam Post, MD, FCAPAssistant Professor, University of Colorado - Denver, COGynecologic and Obstetric Pathology (Academic)

• Noel A. Brownlee, MD, PhD, FCAPPathologist - Upstate Pathology, PA - Greenville, SC and Associate Professor of Pathology - VCOM Carolinas CampusPulmonary, Urologic and Molecular Pathology – (Private + Academic)

• Amanda E. Wehler, DO, FCAPMedical Director, Transfusion Medicine - Geisinger Medical

Center, Danville, PATransfusion Medicine (Private)

• Jack R. Bierig, JDSidley Austin, LLC, Chicago, IL

General Counsel for CAP for 25 years, represents a number of pathology practices, teaches Health Law and Policy at the University of Chicago

Job Hunting and Contract Negotiations

10 things to consider during job hunting:

1. How cutting edge is the work the group does? A group that is in the forefront of new procedures is more likely to succeed.

2. How involved are they with the medical staff and administration? A group that is involved is more likely to retain its relationships

3. How is the group compensated? A group that is less dependent on the hospital for all its revenues is more likely to do well.



4. How entrepreneurial/innovative is the group? A group that is looking for new business opportunities is also more likely to succeed.

5. What happened to young hires? The experience of your predecessors is the best predictor of what will happen to you.

6. Will you be working at the main hospital or satellite location? You should have an understanding of where your principal practice will be.



7. What percentage of your practice will be in the specialty of your choice? You may want to know the extent to which you can specialize.

8. What are the salary and benefits? This point needs no explanation.

9. Try to get any "non-compete" clause removed or limited. You don’t want to be barred from practicing in the same area if things don’t work out.



10. What are the people like in the group? This is probably the most important point.

You want to work with good people whom

you like and respect.

Networking Tips

• Break the ice

• Make yourself memorable

• Close the deal

• Follow up

• Use orange bold to emphasize text.

• Avoid over-formatting.

• Do not use all capital letters.


residents forum at cap ‘11 saturday, september 10, 2011 grapevine, texas morning joint session...

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