Pathology, professionalism, portfolios and progress

Abstract Community-driven standards of professionalism must be addressed, worldwide, at all levels of medical education. The imperative to implement robust strategies to ensure that doctors embrace these standards to justify the autonomy afforded to the medical profession has been a key concern of specialist medical colleges in recent years. Pathologists face unique challenges. Rapid technological change and increasing commercialisation have distanced them further than ever before from patients and other clinicians, resulting in negative stereotypes that impede understanding of professional roles that may have adverse consequences for interdisciplinary communication and patient care. This study explores the socio-cultural and educational factors impacting on the development of professional identity in pathology specialist training in Australia and New Zealand, with the aim of recommending an educational model for the attainment of professionalism. Theories of social identity and education relating to self-regulated and situated learning informed the study and model. Textual data from interviews, surveys and discussions were captured over the course of a professional, college-led intervention that included a new curriculum addressing standards of professionalism in pathology, and an associated portfolio designed as a formative assessment tool. Based on these texts, hermeneutic phenomenological strategies were used to explore the experiences of pathology trainees, their supervisors, educators and clinicians. A pathologist’s professional identity is a self-constructed schema involving value orientations and commitment to goals that reflect beliefs about what it means to be a good pathologist. For many, these values do not correspond to the ideals of professionalism constructed by the community at large. In the face of many social and political pressures, pathologists have developed an identity that conforms to a stereotype in which technical knowledge and skills are strong values that may be detached from the need for competence in the broader, non-technical areas. This identity may be partly founded in career selection, but is perpetuated through interdisciplinary discourse, internalisation, role modelling, work practice and a curriculum and assessment structure that de-emphasises non-technical roles. Trainees are strongly influenced by the values displayed and feedback provided by supervisors who themselves may be subject to the influences of a negative culture. Conflicts between goals and values in technical and non-technical aspects of training can be de-motivating and may constrain the development of a reflective identity that embraces professionalism. Whilst competency-based frameworks such as CanMEDS have been invaluable in drawing attention to the place of non-technical competencies in formal curricula, they do not necessarily take account of the complex and powerful hidden curriculum that lies behind the formal curriculum and exists at the level of role-modelling, stereotyping, work practice and institutional policies. Developing a model of professionalism fit for the purpose of pathology training has involved deconstruction of the CanMEDS model and self-regulated learning processes to carefully examine their parts. The new model reassembles these elements in the situated learning environment and broader cultural and organisational structures applying to pathology. It emphasises alignment of goals, values and processes at all levels of the curriculum, both formal and hidden. The curriculum should integrate and operationalise technical and non-technical competencies with concretely-defined outcomes that are meaningful in the context of pathologists’ roles. Learning portfolios should be simple and flexible, requiring of more than tick-boxes to facilitate reflection. Formative assessment and guided self-assessment from supervisors are critical for the trainee to identify learning needs and to support development of capacity for self-regulation. Onerous formal assessments that devalue professionalism should be reviewed. The College and training institutions must demonstrate commitment to professional values through policy and provision of resources. The approach in this study, which strongly links professional identity development to the attainment of professionalism in medical specialty training, has implications for educators in understanding the many social and educational factors that must be considered in developing curricula for medical professionalism relevant to other disciplines and settings

Learning Microscopic Pathology: Scaffolding the Early Development of Expertise in Medical Image Interpretation

Siirretty Doriast

ESC core curriculum for the general cardiologist (2013)

[No abstract available

Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training

Background: Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS). Methods: Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was ≥50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%. Results: All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence. Conclusion: Our study suggests that 30-40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees

Head to toe ultrasound: a narrative review of experts’ recommendations of methodological approaches

Critical care ultrasonography (US) is widely used by intensivists managing critically ill patients to accurately and rapidly assess different clinical scenarios, which include pneumothorax, pleural effusion, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis. Basic and advanced critical care ultrasonographic skills are routinely used to supplement physical examination of critically ill patients, to determine the etiology of critical illness and to guide subsequent therapy. European guidelines now recommend the use of US for a number of practical procedures commonly performed in critical care. Full training and competence acquisition are essential before significant therapeutic decisions are made based on the US assessment. However, there are no universally accepted learning pathways and methodological standards for the acquisition of these skills. Therefore, in this review, we aim to provide a methodological approach of the head to toe ultrasonographic evaluation of critically ill patients considering different districts and clinical applications

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

NSU Health Professions Division 2023-2024 Course Catalog

Nova Southeastern University Health Professions Division: Dr. Kiran C. Patel College of Osteopathic Medicine College of Pharmacy College of Optometry Dr. Pallavi Patel College of Health Care Sciences College of Dental Medicine Ron and Kathy Assaf College of Nursing Dr. Kiran C. Patel College of Allopathic Medicin