Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Challenges facing early career anatomic pathologists when entering independent practice
November 2024—Pathology training programs are meant to prepare trainees for the workforce by imparting medical knowledge and developing skills in diagnostic interpretation in anatomic pathology. Yet transitioning to the workforce can be challenging for some new graduates. To address this, many training programs have begun teaching management and leadership skills that are required on the job. In addition, the College of American Pathologists New in Practice Committee developed online educational material to provide practical advice for those starting their pathology careers. However, this advice is sometimes anecdotal and based on the experience of only one person. The authors surveyed a multi-institutional cohort of trainees in their final year of training to identify the challenges the trainees expected to encounter during their first job and then to assess how these expectations evolved over their first year of practice. They distributed an electronic survey to 12 anatomic pathology fellows from four institutions toward the end of their final training year and six months and one year after starting their first job. The survey included questions designed to assess respondents’ comfort with signing out cases independently, as well as interacting with colleagues and trainees. The survey used Likert attitude scale questions, with free-text segments for elaborating on the challenges respondents experienced. All three surveys had a response rate of 100 percent. The survey results indicated that the pathologists’ comfort level with sign-outs increased incrementally over time. The main challenges the respondents encountered at six months were high case load, signing out cases outside of their subspecialty, time management, balancing teaching with workload, laboratory issues, and developing relationships with clinicians. At 12 months, the challenges that were emphasized included time management, high case load, understaffing, laboratory issues, and signing out cases in areas outside of their subspecialty. The authors noted that factors such as high case load volume can be addressed by enforcing daily slide limits or developing case load-management algorithms that incorporate subspecialty preferences and case complexity. The authors concluded that the study identified real-time challenges that junior pathologists face when transitioning from training to their first job. By better understanding these challenges, pathology decision-makers can better support these early career pathologists.
Katsakhyan L, Devins KM, Jenkins TM, et al. Transitioning from trainee to practicing pathologist: A prospective multi-institutional survey of the challenges early career anatomic pathologists encounter when entering independent practice. Arch Pathol Lab Med. 2024;148:1063–1066.
Correspondence: Dr. Levon Katsakhyan at levon.katsakhyan@atriumhealth.org
Modeling blood donor deferrals under a policy of risk assessment for HIV sexual behavior
The FDA released final guidance on blood donor eligibility in May 2023 to eliminate the three-month deferral for men who have sex with men and for women who have sex with the men who have sex with men. The guidance initiated a risk-assessment policy of asking all presenting blood donors, regardless of sex or gender, if they had sex with a new partner or multiple partners in the last three months in order to defer those who reported anal sex during that period. This change was implemented because the practice of indefinite deferral of men who have sex with men was considered discriminatory by some, although it was shown to reduce the risk of HIV transmission by blood and blood products. Adoption of highly sensitive HIV antibody screening assays and nucleic acid tests also reduced transmission of HIV-infected blood to one in 1.6 million donations. The United Kingdom and Canada were the first to implement revised blood donor deferral policies based on individual risk in lieu of general time-based deferral policies. The FDA followed with its own individual risk-based approach, which included deferring potential donors taking pre-exposure prophylaxis to prevent HIV infection or post-exposure prophylaxis to treat HIV. It also deferred blood donors who reported a new sexual partner or more than one partner and anal sex in the past three months. The authors described their development of a computational model to estimate the impact on U.S. blood donor deferrals of a change in policy from a three-month deferral specific to men who have sex with men to an individual risk assessment that does not take into consideration sex, gender, or sexual orientation. To develop their model, they conducted two independent analyses. The first involved blood donor deferral modeling and included published information about donors and sexual behaviors. The blood donor data were obtained using the Transfusion-Transmissible Infections Monitoring System (TTIMS) program, which represents approximately 60 percent of the U.S. blood supply. For the first analysis, data on number of sexual partners were extrapolated over the past year. The second analysis used unpublished 2022 U.S. National Survey of Sexual Health and Behavior data that were designed to address the specific sexual behavior questions among participants with a history of blood donation. These data did not need to be extrapolated. Using the framework of the new FDA rule, both analyses found that approximately 1.2 percent of U.S. blood donors would be deferred under the individual HIV risk-assessment program. The results also showed that the estimated proportions of new partners or multiple partners were just above six percent, and anal sex rates were close to 20 percent. These figures were highly consistent between the two analyses. However, the overall deferral estimate of 1.2 percent was slightly higher than the Canadian Blood Services’ estimate of 0.7 percent when using the same behavior-based screening questions. The authors noted that these differences may be due to a finding that 17 percent of Canadian donors were uncomfortable with questions about anal sex, which may have led to underreporting. Overall, the study showed that an estimated 1.2 percent increase in U.S. blood donor deferrals resulting from individual HIV risk assessment is unlikely to result in blood shortages. The authors concluded that their model predicts a minor effect from replacing the time-based deferral for men who have sex with men with individual risk-based deferral criteria for sexual behavior.
Whitaker BJ, Huang Y, Gubernot D, et al. Modeling US blood donor deferrals under a policy of individual risk assessment for HIV risk sexual behavior. Transfusion. 2024;63:1459–1468.
Correspondence: Dr. Yin Huang at yin.huang@fda.hhs.gov