Training Program Standardization Role of the ABP

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Training Program Standardization Role of the ABP

• Betsy D.
  Bennett, M.D., Ph.D.
• Executive Vice
  President
• American Board
  of Pathology

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American Board of Pathology

• Mission - To promote the health of the public by
  advancing the science and practice of pathology

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American Board of Pathology

• Principal activities
• establish certification standards
• assess qualifications of those seeking to
  practice pathology
• conduct voluntary primary and subspecialty
  examinations and award certificates to successful
  candidates

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American Board of Pathology

• Principal activities (cont)
• encourage the maintenance of certification of
  those practicing pathology
• participate in review of pathology training
  programs and support directors and trainees of
  these programs
• maintain a registry of diplomates

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Training Program Standardization

• Assess qualifications of those seeking to
  practice pathology
• Review of applications
• Exam exit surveys
• Participate in review of pathology training
  programs and support directors and trainees of
  these programs
• Program Director Reports
• Transmission of other appropriate information to
  RRC and Program Directors

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Review of Applications

• Program Requirement for Anatomic Pathology
• While the quality of an educational program is
  not based upon volume of teaching material alone,
  programs should have sufficient volume and
  variety of material available for educational
  purposes to ensure that all residents . . .
  examine at least 1,500 cytologic specimens during
  the program

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Review of Applications

• For the June, 2005 exam
• 82 programs had candidates taking the exam who
  had seen lt1500 cytopathology specimens
• Of the 263 residents from these programs, 182
  (69) had seen lt1500 cytopathology specimens

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Review of Applications

• Of the 82 programs, 33 programs had 4 or more
  candidates taking the exam
• 7 programs had only 1 resident with lt1500
  cytologies
• 26 programs had 2 or more residents with lt1500
  cytologies

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Review of Applications - Cytopathology

• How common is this issue in these 26 programs?
• 6/7, 2/6, 3/5, 7/8, 4/4, 3/4, 3/4,
• 9/10, 2/7, 5/6, 6/8,4/4, 4/5, 2/4,
• 3/6, 2/6, 5/6, 4/7, 3/4, 2/4, 5/5, 7/7, 2/5,
  3/5, 3/4, 3/4

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Review of Applications - Cytopathology
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Review of Applications - Cytopathology

• of Cytologies
• 440
• 1600
• 600
• 460
• 750
• 600

• of Surgicals
• 7,200
• 15,300
• 14,000
• 17,200
• 9100
• 14,000

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Review of Applications

• Program Requirement for Anatomic Pathology
• While the quality of an educational program is
  not based upon volume of teaching material alone,
  programs should have sufficient volume and
  variety of material available for educational
  purposes to ensure that all residents . . .
  examine at least 1,500 cytologic specimens during
  the program

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Exam Exit Surveys

• Did your pathology training adequately prepare
  you for this examination?
• First time takers
• Anatomic Pathology
• Yes 330
• No 57
• Clinical Pathology
• Yes 171
• No - 163

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Exam Exit Surveys

• Did your pathology training adequately prepare
  you for this examination?
• All Examinees
• Anatomic Pathology
• Yes 421
• No 113
• Clinical Pathology
• Yes 225
• No - 226

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Exam Exit Surveys

• I was not prepared for the exam. Although the
  program was a poor program to make me ready for
  this test.
• Preparation for practical was inadequate.
  Background training for practical was adequate
  but needs strengthening.

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Exam Exit Surveys

• I believe my pathology program trained me very
  well for real life situations of clinical
  pathology but I have to say that the exam is far
  from what you need to know to practice pathology
  effectively.

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Exam Exit Surveys

• My program is a good AP/CP program. The CP test
  is unfair and irrelevant and is more stressing
  than positively evaluating for qualification of
  certificate.

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Exam Exit Surveys

• We are pathologists, not lab techs. The
  difficulty level and focus of the questions is
  absurd and has almost no relevance to pathology
  in the modern era.

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Exam Exit Surveys

• What was the practical exam about? Was that a
  pathology test? No correlation there with
  residency!

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Exit Exam Surveys AP

• I never saw cases by myself until I was out in
  private practice. The first prostatectomy
  specimen I handled was in my first year of
  private practice.
• My program stressed work (i.e. grossing and
  autopsies) and put less emphasis on teaching
  basic path. The only time you could get
  additional info was to (1) go to Osler, (2) get
  one of the few pathologists that would go through
  stuff with you, or (3) try to get it from Robbins.

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Exit Exam Surveys AP

• My program makes PAs not pathologists.
• We are deficient in exfoliative cytology
  (non-gyn) experience also dont get much primary
  lymph node or spleen and no electron microscopy
  outside of renal work-ups
• Our program has only one month of cytology.

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Exit Exam Surveys AP

• We dont train for blind pattern recognition nor
  for demographic information (most common tumors
  of specific groups, etc) which makes the exam
  more difficult than I think it actually is.
• Most programs want you to gross if you learn
  anything it is because you trained yourself.

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Exit Exam Surveys AP

• Not a lot of basic path taught in my training and
  not very good prep for cytology whatsoever.
• Very few staff are good/skilled in teaching,
  especially with the pressure to decrease
  turn-around-time, etc.
• Generally good but key areas left out such as lab
  administration and molecular path

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Exit Exam Surveys CP

• I came from a residency where AP was stressed and
  CP minimally emphasized.
• This is the worst part of our training. The
  department knows and has not done anything about
  it.
• Spending a few weeks in a lab ( micro, blood bank
  etc) and reading from standard texts does not
  prepare one for material covered in this exam.

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Exit Exam Surveys CP

• My training program was an AP/CP program but too
  heavy on AP without enough CP. Many of the CP
  instructors had no real interest in resident
  education. We were also short staffed
  (residents) which meant we had to cover more AP
  months.
• Only do AP. CP Covering Pathologist

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Exit Exam Surveys CP

• Lacks management and statistics
• Microbiology and chemistry were highly deficient
  in the training program.
• CP in my program is quite poor. Basically go
  read. It didnt prepare me well.
• No training in lab management. Little emphasis
  on lab testing in chemistry. Molecular
  diagnostics training weak

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Exit Exam Surveys CP

• How many of us are going to be practicing in an
  environment where we need to interpret daily
  multiple difficult Southern blot,
  electrophoresis, and obscure tests? Almost never
  is the answer and when we do we go read about it.
  Your ability to determine what is relevant and
  practical has somehow been obscured. Get back to
  reality folks! You are wasting money and our
  precious time.

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Exit Exam Surveys CP

• Our program only focuses on product approval
  (tests or blood products). We do not learn about
  the instrumentation, chemical reactions, etc. We
  never interpret molecular studies, in fact
  molecular is probably non-existent.
• Management and FDA/CAP/AABB etc is not covered in
  residency. A guideline book made available to
  all residents would be nice.
• Most of what we do on clinical rotations is scut
  paperwork.

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Training Program Standardization

• Participate in review of pathology training
  programs and support directors and trainees of
  these programs
• Program Director Report

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Program Director Report

• Reports for 157 AP/CP programs in US for
  2000-2004
• Number of programs with failure rates gt50
• AP and CP 18
• AP only 10
• CP only 8

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Exit Exam Surveys

• If I pass you can change my answer to yes.