Stanley J. Robboy, MD

October 2012

Stanley J. Robboy, MD

A parade of learning possibilities

The number of new learning options released in recent months brings to mind clowns tumbling out of a Volkswagen—a joyful sight. CAP ’12, our 10th independent annual meeting, just wrapped up. There were more of us than ever before: 1,371 pathologists registered to attend. We descended on San Diego for a five-day celebration of science and medicine viewed through the prism of this rich specialty and enjoyed the generosity of 149 expert faculty who presented 105 courses, every one useful, focused, and framed for today’s practices.

The annual meeting curriculum is complemented by an array of learning choices available to pathologists year-round, including well-established options, such as the CAP self-assessment modules, and many recent additions. The CAP Pathology and Laboratory Quality Center generates practice guidelines that inform our education programming and permit us to partner productively with other specialists on patient-centered quality and safety initiatives.

The CAP Learning Portal is a terrific tool with which members can evaluate what they need, review learning options from the CAP and other groups, chart a course to meet competency goals, and track progress toward Maintenance of Certification.

We’ve produced 29 free CAP personalized health care webinars since December 2009. These reside on the Transformation Program Office Website (click the butterfly at the bottom of the home page). They’re also linked to the Learning Portal, if you’re starting from there. CAP members have signed on to attend a live webinar more than 8,000 times and to watch an archived webinar more than 2,000 times. 

Jill Kaufman, PhD, director of personalized health care initiatives, works with the Personalized Health Care Committee to produce the Hot Topics in Pathology Webinar Series. These are often collaborations with different groups of the College. For example, the Biospecimens and Biorepositories for the Community Pathologist webinar was a project of the committee and the Laboratory Accreditation Program. (Related papers were published recently in print and online in the Archives of Pathology & Laboratory Medicine, and a Biorepository Accreditation Program has been introduced. See story, page 5.)

The Transformation Case for Change Module 2A Working Group launched the Service Innovations Webinar Series to introduce examples of transformational activities already taking place in pathology departments across the country. These webinars feature pathologists who describe innovative services and the concrete steps required to provide them, and at the end of each, participants are invited to join a LinkedIn discussion group to continue the conversation. For example, The Integrated Pathologist is a service innovations webinar presented by David G. Hicks, MD, a breast pathologist and director of surgical pathology at the University of Rochester Medical Center. Dr. Hicks describes a specimen handling project launched in collaboration with the URMC operating room staff and perioperative safety committee. The lab team audited tissue collection-to-fixation start time and found that time to fixation independently predicted the estrogen receptor negative rate. Then, Dr. Hicks says, they agreed to do what he calls an intervention. Instead of relying on hospital messengers, they put lab staff in the OR to check requisitions and to label and transport specimens. Long story short, the collection-to-fixation time has dropped from 139 to 41 minutes. Today nearly every specimen is in formalin 60 minutes after collection.

“What strikes me about these initiatives,” Dr. Hicks tells the webinar audience, “is how simple they are.”

We have also been active in education around accountable care organizations. “Contributions of Pathologists in Accountable Care Organizations,” a white paper written by CAP Policy Roundtable director David Gross, PhD, is now posted on the Transformation Web site. The most recent CAP webinar about ACOs, Thriving in an ACO: How Pathologists Can Confront Challenges and Maximize Opportunities (posted at www.cap.org/aco), features Dr. Gross and David Scamurra, MD, of Catholic Health in New York, whose team is developing pathology-related performance measures. The Pathologist’s Role in an Accountable Care Organization, also posted on the Transformation Program Office Web site, is a service innovations webinar presentation by Conrad Schuerch, MD, who chairs the Department of Laboratory Medicine at Geisinger Health System. Dr. Schuerch describes the integral role of pathologists in an organization that has been developing itself as an ACO model for about 20 years.

The Advanced Practical Pathology Programs (AP³) offer experiential learning that’s built around new knowledge of how people like to learn and what it takes to make it stick. In May, we were informed that the CAP Ultrasound-Guided Fine-Needle Aspiration AP³ had received a prestigious 2011 American Society of Training and Development Excellence in Practice Award. (The Breast Predictive Factors Testing AP³ received an ASTD citation at the same time.) Two more AP³s are available—one to sharpen skills of laboratory medical directors and another on multidisciplinary approaches to breast pathology.

The Personalized Health Care Committee released at CAP ’12 five Short Presentations on Emerging Concepts. These SPECs are prewritten PowerPoints on diseases in which molecular tests play a key role in patient management. CAP members can customize the SPECs and use them for talks before tumor boards and other medical groups. The first SPECs are on colorectal cancer, metastatic melanoma, thyroid cancer, polycythemia and thrombocythemia: JAK2, and hereditary nonpolyposis colorectal cancer.

We now have four CAP pathology resource guides, also released at CAP ’12 and designed to enhance community pathologists’ working knowledge of new technologies. These guides explain the basics, share insights from early adopters, contain summaries of journal articles, and list other useful resources. The Personalized Health Care Committee created a resource guide on molecular diagnosis to help pathologists develop skills as molecular consultants. Members of the former Transformation Module 4 group interviewed pathologists who are using the latest technologies to create resource guides on genomic analysis, digital pathology, and in vivo microscopy.

The Next-Generation Sequencing Working Group was appointed to address practical issues related to the use of NGS for clinical testing. Its first work product was a new 18-item section of the molecular pathology checklist to address clinical laboratory accreditation requirements. Nazneen Aziz, PhD, director of molecular medicine and staff lead for the working group, says they are now collaborating with the CAP Proficiency Testing Division to develop a product for NGS proficiency testing. The group’s mission is to develop genomic tools and standards that will allow members of the diagnostic medicine community to bring this technology into their clinical practices.

There’s more good news on CAP education: an agreement with the Association of Pathology Chairs to collaborate on development of medical education for pathologists and pathology residents, and innovations within the Archives of Pathology & Laboratory Medicine that will launch in January. We’ll talk about both next month. Our educators and communicators are prolific and productive and terrific at once; they’re generating a lot more than I can squeeze into one column. I’ve always liked those tumbling clowns, but we can’t get another one into this Volkswagen.