From training to first jobs, can the transition be made easier?

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The fellows released 59 preliminary reports out of 101 cases reviewed and showed the remainder to an attending pathologist without releasing a preliminary report. They shared cases with a subspecialty pathologist before releasing the preliminary report in 20 of 59 preliminary cases (34 percent), which the authors say compares with a share rate of about 20 percent for general surgical pathology attendings on the same service.

The process as of 2021 became a permanent one, based on pilot data and the endorsement and approval of practice leadership. Of 182 preliminary reports released in the pilot and in the first six months after implementation, there was only one case in which the difference in diagnosis between the preliminary and final reports was deemed potentially significant, but the authors say it did not adversely affect patient care.

Dr. Boland

Feedback from Mayo’s trainees on their evaluations and postgraduate surveys about their desire for more independence and autonomy is what led to the pilot, coauthor Jennifer Boland, MD, consultant in Mayo’s Division of Anatomic Pathology and professor of laboratory medicine and pathology, Mayo Clinic College of Medicine and Science, tells CAP TODAY.

“We recognize that giving our trainees more independence will ease their transition to practice, so it was something we wanted to find a way to accomplish,” Dr. Boland said by email. “Having the confidence and decisiveness to make routine case management decisions is undoubtedly one of the largest challenges trainees face when entering practice. It certainly was for me.”

She says the fellows chosen for the pilot had to be board certified, complete at least one surgical pathology rotation before releasing preliminary reports, and be approved by the clinical competency committee.

The main lesson learned since the process became standard practice in 2021: “Some fellows need more encouragement and support to release preliminary reports. So monitoring practice habits, setting reasonable and clear expectations, and checking in with the trainees during the preliminary report experience has been important to ensure trainees take full advantage of this opportunity and feel they are doing so within a safe environment,” Dr. Boland says.

The Mayo Clinic approach is not meant to be one-size-fits-all, she says, but she hopes it “will inspire programs to think about a plan that works for them.” For those who might wish to create a similar program, the authors advise carefully considering the types of cases for which preliminary reports can be released “and what implication that might have for the clinical teams and patients.”

Dr. Varshney of the University of Mississippi would like to see more programs do something similar, and she says the survey of the 12 fellows Dr. Katsakhyan and coauthors conducted is “a very good start” to something larger.

The CAP New In Practice Committee is working on a more expansive survey, she says, to help uncover more problems and barriers so it can help solve them. The committee is now tackling what it can by way of podcasts, blogs, roundtables, and other resources (www.cap.org/member-resources/new-in-practice). In addition, “We just received the green light to create a boot camp for new-in-practice people to teach both soft and hard pathology skills to help them transition and help them build their confidence.”

Her advice for job seekers: “Find a job where you can feel safe asking even the stupid questions. Go where there is good mentorship and a supportive environment, where you can showcase your gradual overall improvement.” A designated mentor to whom the new-in-practice pathologist is assigned for three to six months would be helpful, she adds.

For those transitioning to practice, she advises: “Don’t stress out, and ask for help when you need to. Don’t feel ashamed of asking for help.”

And for those who bring in new group members out of residency and fellowship, she urges giving them time and support because the transition can be difficult, professionally and personally. “Give them graduated responsibility as well and whatever help you can, whether assigning a mentor or a senior resident in the initial months,” someone who can help them navigate all that’s new.

Valerie Neff Newitt is a writer in Audubon, Pa.