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CARDIOVASCULAR PATHOLOGY TRAINING IN NORTH AMERICA L

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CARDIOVASCULAR PATHOLOGY TRAINING IN NORTH AMERICA L. Maximilian Buja, M.D. Survey of Membership 17 Responses 15 U.S.A. 2 Canada 9 Programs Identified Type of ... – PowerPoint PPT presentation

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Title: CARDIOVASCULAR PATHOLOGY TRAINING IN NORTH AMERICA L


1
CARDIOVASCULAR PATHOLOGY TRAINING IN
NORTH AMERICA
  • L. Maximilian Buja, M.D.

2
Survey of Membership
  • 17 Responses
  • 15 U.S.A.
  • 2 Canada
  • 9 Programs Identified

3
Type of Training Program
  • Separate CV Pathology Fellowship - 5
  • Diagnostic Component - 5
  • Research Component - 5 (encouraged)
  • Duration - 1-2 years
  • CV Training/Elective as part of AP Residency - 4

4
Separate CV Pathology Fellowships
  • No. Trainees No. Trainees
  • Institution Last 5 Years Currently
  • Massachusetts General Hospital 1 0
  • Brigham and Womens Hospital 3 0
  • Mayo Clinic 2 0
  • Office of Chief Medical Examiner - 2
  • of the City of New York (combined
    forensic CV path/neuropath)
  • Texas Heart Institute/UTHSC-H 0 0

5
CV Training/Elective as Part of AP Residency
  • No. Trainees No. Trainees
  • Institution Last 5 Years Currently
  • Washington University ? ?
  • Mt. Sinai, New York ? ?
  • University of Toronto/
  • Toronto General Hospital 2 0
  • University of Minnesota 5 1
  • University of Ottawa/
  • Ottawa Hospital ? ?

6
Components of Training
  • Review in-house and referral CV cases
  • Sign-out with attending faculty all CV surgical
    material
  • Act as CV pathology consultant to autopsy service
  • Act as CV pathology consultant to clinicians
  • Attend and participate in clinical cardiovascular
    and pathology rounds and conferences
  • Develop and present review papers on selected
    topics and case material with publication as
    desired outcome
  • Perform research project with publication as
    desired outcome

7
Components of Training
  • Autopsy cases congenital heart disease,
    acquired heart disease, including cases with and
    without previous interventional procedures
  • Endomyocardial biopsies general diagnostic
    and transplant cases
  • Native and prosthetic heart valves
  • Aortic, arterial and other vascular specimens
  • Explanted hearts
  • Explanted devices
  • Other

8
Components of Training
  • Standard gross and light microscopic approaches
  • Electron microscopy
  • Immunocytochemistry
  • Molecular diagnostic techniques

9
Components of Training
  • Pathology of congenital heart disease
  • Pathology of acquired cardiovascular disease
  • Pathology of medical and surgical interventions
    in cardiovascular disease
  • Pathology of molecular cardiology and gene
    therapy
  • Pathology of regenerative cardiology and stem
    cell biology

10
Accreditation and Certification
  • Prior to 2002
  • Pathology RRC/ACGME
  • AP/CP-4, AP-3, CP-3
  • American Board of Pathology
  • AP/CP-4, AP-3, CP-3 plus an additional
    credentialing year requirement
  • Since 2002
  • Pathology RRC/ACGME
  • AP/CP-4, AP-3, CP-3
  • American Board of Pathology
  • AP/CP-4, AP-3, CP-3

11
Accreditation of Training Programs
  • Pathology Residency Review Committee of the
    Accreditation Council for Graduate Medical
    Education
  • APCP-4 4-year program in anatomic
    pathology and clinical pathology
  • AP-3 3-year program in anatomic
    pathology
  • CP-3 3-year program in clinical
    pathology
  • PCP-1 1-year program in cytopathology

12
Accreditation of Training Programs
  • Pathology Residency Review Committee of the
    Accreditation Council for Graduate Medical
    Education
  • BB-1 1-year program in blood banking
  • DP-1 1-year program in dermatopathology
  • FP-1 1-year program in forensic pathology
  • HMP-1 1-year program in hematology

13
Accreditation of Training Programs
  • Pathology Residency Review Committee of the
    Accreditation Council for Graduate Medical
    Education
  • MM-1 1-year program in medical
    microbiology
  • NP-2 2-year program in neuropathology
  • PP-1 1-year program in pediatric pathology
  • PCH-1 1-year program in chemical pathology
  • SP 1-year program in selective pathology

14
Accreditation of Training Programs
  • APCP-4 programs must include 18 months of formal
    education in anatomic pathology and 18 months of
    formal education in clinical pathology. The
    remaining 12 months of training may be a
    continuation of structural anatomic pathology or
    clinical pathology education, or may be devoted
    to a specialized facet of pathology.

15
Accreditation of Training Programs
  • AP-3 and CP-3 programs must include 24 months of
    anatomic pathology or clinical pathology
    education. The remaining 12 months of training
    may be a continuation of structured anatomic
    pathology and/or clinical pathology education, or
    may be devoted to a specialized facet of
    pathology.

16
Certification of Trainees
  • The American Board of Pathology
  • Primary certification
  • Anatomic and Clinical Pathology, Anatomic
    Pathology, Clinical Pathology
  • Subspecialty certification
  • Blood Banking/Transfusion Medicine, Chemical
    Pathology, Cytopathology, Dermatopathology,
    Forensic Pathology, Hematology, Medical
    Microbiology, Molecular Genetic Pathology,
    Neuropathology, Pediatric Pathology
  • Combined Primary and Subspecialty Certification

17
Certification of Trainees
  • Combined AP/CP Certification
  • Four (4) full years of full-time, approved
    training in an accredited APCP-4 program that
    includes at least 18 months of structured
    training in anatomic pathology and 18 months of
    structural training in clinical pathology, and
    either an additional 12 months of full-time,
    continued training in anatomic pathology and/or
    clinical pathology, or 12 months of full-time,
    approved training in other areas of pathology as
    part of the defined four-year accredited AP/CP
    training program.

18
Certification of Trainees
  • AP Certification
  • Three (3) full years of full-time, approved
    training in anatomic pathology in an accredited
    APCP-4 or AP-3 program that includes at least 24
    months of structured training in anatomic
    pathology, and either an additional 12 months of
    full-time, continued training in anatomic
    pathology, or 12 months of full-time, approved
    training in other areas of pathology as part of
    the defined accredited training program.

19
Observations
  • Reported numbers of CV Pathology Training
    Programs and reported number of trainees in the
    USA and Canada are very small.
  • Better data are needed for numbers of CV
    Pathology Training Programs and trainees.

20
Observations
  • Perceived impediments to individuals choosing CV
    Pathology as a career
  • ACGME does not accredit training programs in CV
    Pathology
  • ABP does not grant subspecialty certification in
    CV Pathology
  • CV Pathology is a purely academic discipline
    without a corresponding private practice
    opportunity.

21
Observations
  • The new flexibility in Pathology RRC/ACGME and
    American Board of Pathology requirements can be
    explored for possible recruitment and training
    opportunities for CV Pathology within the general
    pathology training programs.

22
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