President’s Desk Column

It’s all about getting into the game

August 2004
Mary E. Kass, MD

A baseball fan might be inclined to think of July 1 as the day that medicine’s pitchers and catchers report for spring training. New talent, fresh from the minors. Let’s see what they can do.

When I had residents, I always spent the first two weeks of July in the cutting room. Walking them through the core skills. Torturing them with the Socratic method. Watching them grow in confidence as they perfected technique through endless repetition. Waiting patiently while they learned that they could make and defend a firm diagnosis. When the textbooks and laboratory work come together, there’s a lot going on. You’re in an exciting place.

Coincidentally or not, the College convened its first Future of Pathology Meeting in late June, on the cusp of residency training season. Leaders within the College called the pow-wow, inviting leaders of 10 pathology organizations to collaborate in shaping a collective vision for the future of our specialty. Our goal was to identify the key challenges we share and develop strategies to address those challenges. It was a fine meeting—intense, energetic, and productive.

We talked a lot about scope-of-practice topics, everything from credentialing of pathologists’ assistants to licensure of clinical laboratory personnel. We spent time considering the many venues where scope of practice is relevant and what actions we need to take in each case.

It occurs to me now that talking about scope of practice in terms of encroachment is confusing cause with effect. These things begin and end at home. Subordinates do what they are asked to do. Pathologists’ assistants take on gross specimen analysis because it is assigned to them. It’s like that child’s chant, "finder’s keepers." Pathologists who overdelegate have only themselves to blame if their traditional responsibilities come to fall within a subordinate’s scope of practice.

It all comes down to the level of engagement. A good pathologist is absolutely in the game 100 percent of the time. The best pathologists I know see themselves as members of the patient care team, offering input to clinicians on laboratory results and making themselves available for patient education at the bedside. They are committed members of the medical staff, on board and willing to contribute. They conduct gross examinations daily, and they supervise excisions done by others. Those who teach residents work closely with them, challenging them and nourishing the confidence that comes from experience-based competence.

Not surprisingly, resident training issues were also prominent. There is a lot of concern about the lack of uniformity in how we educate our residents and the fact that not all residents get sufficient hands-on time in the core competencies. We plan to put energy into creating mentoring programs and involving more pathologists more directly in training residents. Perhaps we should reinstate community-based rotations. Maybe we could create fellowships that would shepherd skills in leadership and professional collegiality.

In the end, we formed a working group on resident training. Before you read this, we will have attended the summer meeting of the Association of Pathology Chairs, where we will meet with professionals in residency education. We’ll talk about standardizing our training programs and how they are accredited and evaluated. We’ll discuss ways to measure core competencies and means to build skills in molecular diagnostics, informatics, and management. We’ll discuss outcomes surveys for private practice groups employing new graduates.

We covered a lot of ground that day; I’ve just skimmed the surface. Which is ironic, because this is one meeting where the undercurrents were the best part. We came together and worked as a team. Call it Team Pathology. Which reminds me of a story.

A friend of mine once had the opportunity to watch a baseball game in a box where a veteran player was also seated. For three hours, the retired player described what each man on the field was thinking and how he was positioning himself, always several plays ahead of the immediate action. That’s how games are won, he said. Thinking ahead and thinking about what the other guy is thinking.

The future of pathology is most certainly not a game, but it is very much about anticipation, perspective-taking, and teamwork. Today, we are at a crossroads. We are holding our position, but time grows short. Defining our future is something that will happen where it always has, at the grassroots in individual laboratories. Each of us needs to think about our smallest management decisions in terms of the future of our specialty. Each of us needs to make a commitment to training the next generation. And each of us needs to be in the game 24/7. For pathology right now, every day is the first day of spring training.

Dr. Kass welcomes communication from CAP members. Send your letters to her at president@cap.org. The following groups sent representatives to the first Future of Pathology Meeting: American Board of Pathology, American Pathology Foundation, American Society for Clinical Pathology, American Society of Cytopathology, Association for Molecular Pathology, Association of Directors of Anatomic and Surgical Pathology, Association of Pathology Chairs, National Association of Medical Examiners, and U.S. and Canadian Academy of Pathology. The CAP initiated and hosted the meeting. A resident physician representative attended.