The Continuing Fellowship Conundrum

The debate for a fair, equitable, and reasonable pathology fellowship application and selection process has been an ongoing issue with ebb and flow over approximately the past 10 years. The authors of this commentary have been closely involved with the fellowship issue over the past decade and have been part of the effort to achieve a workable solution with widespread support. Possible solutions to the concerns raised by various parties have included efforts to implement a uniform timeline, a formal match through the National Resident Match- ing Program (NRMP), a formal match through the San Fran- cisco Matching Program, and most recently (and the focus of this commentary) a Code of Conduct (Honor Code) and appli- cation clearing house overseen by the Association of Pathology Chairs (APC). Table 1 summarizes these efforts and their out- comes to date

The Continuing Fellowship Conundrum

The debate for a fair, equitable, and reasonable pathology fellowship application and selection process has been an ongoing issue with ebb and flow over approximately the past 10 years. The authors of this commentary have been closely involved with the fellowship issue over the past decade and have been part of the effort to achieve a workable solution with widespread support. Possible solutions to the concerns raised by various parties have included efforts to implement a uniform timeline, a formal match through the National Resident Match- ing Program (NRMP), a formal match through the San Fran- cisco Matching Program, and most recently (and the focus of this commentary) a Code of Conduct (Honor Code) and appli- cation clearing house overseen by the Association of Pathology Chairs (APC). Table 1 summarizes these efforts and their out- comes to date

Due Process in Medical Education: Legal Considerations

Throughout the medical education continuum, some students encounter difficulty in meeting academic or professional standards that leads to remediation or dismissal. Termination of a student without due process may lead to litigation by deprivation of a student’s property or liberty interest. This article outlines the concept of procedural and substantive due process as applied to litigated student dismissal cases in undergraduate and graduate medical education. Determination of the amount of due process owed is based on whether the dismissal is academic or nonacademic. The decision to dismiss a student where the entire student record has been reviewed, due process provided, and the institution complied with its own policies is usually upheld by the courts in litigation

Assessment and Management of Professionalism Issues in Pathology Residency Training

Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director’s meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors’ experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted

Development of Professionalism in Graduate Medical Education

Professionalism and physician well-being are important topics in academic medicine. Lapses in professional judgment may lead to disciplinary action and put patient’s health at risk. Within medical education, students and trainees are exposed to professionalism in the institution’s formal curriculum and hidden curriculum. Development of professionalism starts early in medical school. Trainees entering graduate medical education already have developed professional behavior. As a learned behavior, development of professional behavior is modifiable. In addition to role modeling by faculty, other modalities are needed. Use of case vignettes based on real-life issues encountered in trainee and faculty behavior can serve as a basis for continued development of professionalism in trainees. Based on the experience of program directors and pathology educators, case vignettes were developed in the domains of service, research, and education and subdivided into the areas of duty, integrity, and respect. General and specific questions pertaining to each case were generated to reinforce model behavior and overcome professionalism issues encountered in the hidden curriculum. To address physician burnout, cases were generated to provide trainees with the skills to deal with burnout and promote well-being

Entrustable Professional Activities for Pathology

Competency-based medical education has evolved over the past decades to include the Accreditation Council for Graduate Medical Education Accreditation System of resident evaluation based on the Milestones project. Entrustable professional activities represent another means to determine learner proficiency and evaluate educational outcomes in the workplace and training environment. The objective of this project was to develop entrustable professional activities for pathology graduate medical education encompassing primary anatomic and clinical pathology residency training. The Graduate Medical Education Committee of the College of American Pathologists met over the course of 2 years to identify and define entrustable professional activities for pathology graduate medical education. Nineteen entrustable professional activities were developed, including 7 for anatomic pathology, 4 for clinical pathology, and 8 that apply to both disciplines with 5 of these concerning laboratory management. The content defined for each entrustable professional activity includes the entrustable professional activity title, a description of the knowledge and skills required for competent performance, mapping to relevant Accreditation Council for Graduate Medical Education Milestone subcompetencies, and general assessment methods. Many critical activities that define the practice of pathology fit well within the entrustable professional activity model. The entrustable professional activities outlined by the Graduate Medical Education Committee are meant to provide an initial framework for the development of entrustable professional activity–related assessment and curricular tools for pathology residency training