To fill gap, histology primer in development
Valerie Neff Newitt
June 2023—Three initiatives are underway at the American Board of Pathology, one of which its CEO Gary Procop, MD, MS, describes as “a new era of transparency and collaboration.”
When Dr. Procop became CEO in January 2022, he brought with him plans for change that he and others have been working on since.
The first initiative and the one closest to completion is development of a histology primer, to be available at no cost. “There’s good evidence that medical school curricula have changed,” Dr. Procop says, citing only the latest of such studies, one from the University of Michigan that “demonstrates that the new integrated curricula decrease the amount of students’ exposure to histology” (Gribbin W, et al. Anat Sci Educ. 2022;15[4]:671–684). The ABPath last year surveyed residency program director members of the Association of Pathology Chairs, and that survey found that incoming pathology residents “do not have the histology knowledge they should,” he says.
Dr. Procop
The ABPath is stepping up to address this gap between undergraduate and graduate medical education, Dr. Procop says. “We believe that the competency of pathologists begins with the training of pathologists, so we’re building a histology primer that will contribute important foundational knowledge to students entering pathology residency—actually it will be available to all medical students or anyone with an interest in this topic. And it will be free to access.” The hope, he adds, is that incoming residents will use the primer to “firm up the knowledge they need to have going into pathology.”
The primer, which Dr. Procop expects to complete by year’s end, will consist of a written section and accompanying lectures, as well as virtual microscopy so users can view and navigate actual slides of normal histologic sections. There will be a voluntary quiz so the user can test their knowledge and review and fill gaps, if any. When the user signs in, they will be asked if they’re a pathology resident, medical student, or other. Medical students will be provided with links to the CAP and other ABPath cooperating societies, whose sites will provide information about pathology as a career.
Dr. Procop describes the second initiative as “a clear and transparent content outline of the expectations for ABPath certification,” one that signals the new era.
“Students of pathology should not have to guess what’s important,” he explains. “In modern education theory, we have rubrics that inform students of exactly what they need to know and what is expected of them. Students then go and learn it, and then they’re tested on what they were told to learn.” He uses pilot training as an example: “You don’t want a pilot guessing how to land a plane. You tell them how to land a plane. You give them the education and training on how to land a plane. And eventually there’s a final exam: They have to actually land a plane. But you don’t make them guess how to do it.”
A collaborative pathology community approach is being used to develop the content outline of expectations, starting with members of the ABPath’s test development and advisory committees, which are the groups that write the examination questions. Those groups will work on drafts until they feel the draft reflects accurately the expectations for certification. “Then this draft document will be shared with the world. It will be open to public review—we will solicit edits, input, and advice from our cooperating societies, program directors, pathology chairs, ACGME, everyone,” Dr. Procop says. “We want feedback on what’s right and what’s wrong.” Agreements and disagreements are to be expected, he adds. “And that’s fine. I want to hear everybody’s voice on this.”
Ultimately, the final document will be brought to the ABPath trustees and “published transparently on the website. And every year we will ask our cooperating societies and our test committee members, ‘What has changed in your field? What needs to be updated on this list?’ It’ll really be a living document.” When it goes live, residents will know precisely the content the ABPath believes to be important for them. “This isn’t just about passing a test,” Dr. Procop says. “It’s about practicing safely and effectively and delivering high-quality patient care.”
“If everyone knows the material, great!” he says. “Congratulations. I don’t want a certain percentage of people to have to fail. Let’s turn out a lot of great pathologists into the community.”
The ABPath isn’t the first to do this, he notes, citing dermatology, radiology, and pediatrics as examples of where detailed content outlines are in place. All these boards have clear content outlines, “which is in sync with modern education theory,” he says.
He can’t predict a completion date but he’s hoping for late 2024.
The third initiative, one Dr. Procop says is “further down the road,” is a voluntary, formative, competency-based in-training assessment pilot that will enable performance feedback. “Learners won’t have to wait to take a high-stakes exam and find out they have significant deficiencies in their ability. We would much rather people know their educational gaps ahead of time and have a chance to fill those gaps, then pass the Board exam and go out and be successful in the community.” The pilot, he says, will help inform ABPath with respect to the possible incorporation of competency-based assessment into the certification process.
He stresses that the ABPath is not creating another RISE exam. Instead, it is competency the ABPath wants to zero in on. “The ability to sit down at a microscope and make a diagnosis,” he explains. Breast pathology will be the focus of the pilot, “with a library of virtual microscopic slides that contain important breast pathology diagnoses.” When a program director agrees that a resident is prepared fully for a breast pathology sign-out, then the resident will be able to log in to the ABPath website to do a simulated sign-out “and test their mettle,” Dr. Procop says. The cases will be presented in a random manner; the resident will get a random selection—15 of 100 cases, for example. “They won’t know what’s in the stack of slides,” whether a breast cancer or a benign lesion, an infection or normal tissue.
They will be expected to be able to make every diagnosis in their simulated sign-out, “just like in actual practice. They’ll get the diagnoses right or wrong, and what they’ll also get is an educational critique that accompanies the slides. The idea is we want people to know where their gaps are so they can fill them prior to certification and independent practice.”
He likens it to a batting cage: “If you want people to be able to hit the ball hard and far, then let them get in the batting cage as much as they like.” How often can a person do the simulated sign-out? “As many times as possible. If you really want good pathologists, let them practice in the ‘flight simulator’ as much as needed to master the skills required for safe and effective practice.”
“It’s all about where learning meets assessment,” he says, but it’s about testing more than book knowledge. “And competency-based assessment goes hand in glove with competency-based education, which is a hot topic in the pathology education community.”
The theme of the changes that are underway is that the ABPath is a partner in lifelong medical education, Dr. Procop says, from residency to continuing certification, “and in helping pathologists be their best. We’re going to keep pushing in that direction.”
Valerie Neff Newitt is a writer in Audubon, Pa.