Anatomical Pathology: Transition to Practice
EPA #1- Managing the daily workload of an anatomical pathologist including surgical pathology, intraoperative consultations, cytopathology and autopsy
Key Features:
- This EPA focuses on managing the workload of an anatomical pathologist: preparing cases for sign out, performing autopsy and intraoperative consultation, teaching junior residents and medical students, preparing, presenting and leading multidisciplinary activities.
- This includes working effectively with clinicians, laboratory staff, interprofessional staff, and administrators, and communication with patients.
- At this stage, the resident will prepare pathology reports that are ready for verification by staff, with no or minimal modification.
- This EPA includes attaining a certain concordance with peer review, complying with institutional turnaround time (TAT), consulting with colleagues appropriately, and adhering to institutional performance indicators.
- The observation of this EPA is based on a day’s work.
Assessment Plan:
Direct and indirect observation of a day’s work by pathologist, with input from other health care professionals and junior trainees
Use form 1
Collect 10 observations of achievement
- At least different 5 observers
Relevant Milestones:
- ME 1.5 Set priorities, triage and manage the workload within accepted turnaround times
- ME 1.5 Carry out professional duties in the face of multiple, competing demands
- ME 1.6 Demonstrate insight into their own limits of expertise
- COM 4.1 Prepare clear, concise, comprehensive and timely written reports for surgical pathology, cytopathology, and autopsy consultations
- COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhance patient management
- S 3.4 Integrate best evidence and clinical expertise into decision-making
- P 1.1 Exhibit appropriate professional behaviours
- P 4.3 Provide mentorship to residents and colleagues
Evaluation type:
Direct or indirect observation
Clinical Scenario:
Existing frameworks:
· Almost all PGY5 rotations (need mix of surgical pathology, cytopathology and autopsy)
Suggested changes/additions to program to consider:
· Consider TTP autopsy rotation
· Need to have slides routed directly to TTP trainee
· Need to ensure TTP trainee is scheduled on frozen sections
Specific rotations: None
EPA #2- Supervising, teaching and assessing junior learners
Key Features:
- This EPA focuses on the informal teaching that occurs as part of usual laboratory activities, and includes teaching, providing support and feedback, and ensuring quality laboratory practices and reports.
- This EPA may be observed in daily laboratory activities such as grossing, performing an autopsy, intra-operative consultation or case sign-out.
Assessment Plan:
Direct and/or indirect observation by supervisor, with input from junior learners Use Form 1.
Collect 4 observations of achievement
Relevant Milestones
- S 2.2 Ensure a safe learning environment for all members of the team
- S 2.3 Supervise learners to ensure they work within their limits, seeking guidance and supervision when needed
- S 2.4 Provide teaching and/or other informal learning activities
- S 2.5 Provide feedback to enhance learning and performance
- P 1.1 Intervene when behaviours toward learners undermine a respectful environment
- P 3.3 Participate in the assessment of junior learners
Evaluation type:
Direct or indirect observation
· Consider sending survey/feedback form to junior learners to capture informal, clinical day-to-day teaching, with summation and comments by supervising pathologist
· Supervising pathologist should attend various academic day sessions to observe TTP trainee (ex. During Black Box rounds)
Clinical Scenario:
Existing frameworks:
· PALM Grand Rounds
· Gross room supervision
· Informal double-headed microscope teaching
· All academic day activities
Suggested changes/additions to program to consider:
· Consider TTP autopsy rotation where TTP trainee can supervise TTD/foundations trainee
· Consider buddying TTP trainee with TTD/foundations trainee on frozen sections
Specific rotations: None
EPA #3- Participating in laboratory management activities, in the role of junior staff
Key Features:
- This EPA focuses on the role of the anatomical pathologist as a participant in and leader of quality management in the laboratory.
- This EPA builds on the knowledge and skills of Core to add increased responsibility for quality management activities at the individual and system level
- This includes managing critical incidents, such as breaches in laboratory safety or mislabeling of specimens, and leading quality management activities such as:
- Chairing quality assurance rounds, such as cytology-histology correlation, case consensus rounds, or other pathology quality related rounds
- Leading a process improvement initiative
- Leading the validation of a new test or methodology
- Participating as a member of a hospital committee responsible for the oversight of multiple quality assurance activities
- Participating in laboratory accreditation activities
- The observation of this EPA is divided into two parts: leading quality management activities; and managing a critical incident.
- The critical incident may be real or simulated.
Assessment Plan:
Part A: Leadership in quality management activities Direct and indirect observation by supervisor
Use form 1. Form collects information on:
- Activity: [free text]
Collect 1 observation of achievement
Part B: Management of critical incident(s)
Direct observation and/or incident review by supervisor
Use form 1. Form collects information on:
- Type of critical incident: [free text]
- Nature of critical incident: real; simulation Collect 1 observation of achievement
Relevant Milestones:
Part A: Leadership in quality management activities
- ME 2.1 Identify and explore clinical issues to be addressed in the pre-analytical, analytical and post-analytical handling of a case
- L 1.1 Apply the science of quality improvement to contribute to improving systems of patient care
- L 1.2 Contribute to a culture that promotes patient safety
- L 1.4 Use health informatics to improve the quality of patient care and optimize patient safety
- L 1.1 Participate in quality control, quality assurance and quality improvement initiatives
- L 3.1 Demonstrate knowledge of the principles of laboratory management, including resource allocation and collaboration with technical managers, and hospital and laboratory administration
- P 2.2 Demonstrate a commitment to patient safety and quality improvement initiatives within their own practice envirnment
Part B: Management of critical incident(s)
- ME 5.1 Recognize and respond to a breach in quality or safety of laboratory practices
- ME 5.1 Take appropriate actions to address a breach in quality or safety
- COM 3.2 Document actions taken to address a breach in quality or safety
Part A: Quality management
Evaluation type:
Direct or indirect observation
Clinical Scenario:
Existing frameworks:
· QA/QC rotation activities (frozen-permanent section concordance, cyto-histo correlation, ?review of patient safety incidents)
· Attend QA/QC committee meetings
Suggested changes/additions to program to consider:
· Could move QA/QC rotation to PGY5
Specific rotations:
· QA/QC
· Cytology
Part B: Critical Incident
Evaluation type: Direct observation or incident review, real or simulated
Clinical Scenario:
Existing frameworks:
· Critical incidents as they arise in daily practice
· QA/QC rotation
Suggested changes/additions to program to consider:
· Add oral exam or simulation if not seen by end of training
Specific rotations:
· QA/QC
· Any
EPA #4- Developing and implementing a personal learning plan geared to setting of future practice
Key Features:
- This EPA may include a variety of scenarios. Examples include: a plan to act on the performance gaps identified in another EPA; a plan to prepare for fellowship training; a plan to prepare for practice in a specific setting (i.e. community) and/or a setting requiring distinct skills.
- Achievement of this EPA includes providing a) the rationale for a learning plan, b) self-reflection, c) personal needs assessment, d) time management and e) identification of the methods to achieve the personal learning plan such as literature review, clinical training, conference attendance and/or rounds attendance
Assessment Plan:
Supervisor review of resident’s submission of a personal learning plan Use Form 1
Collect one observation of achievement
Relevant Milestones:
- S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
- L 4.2 Examine personal interests and career goals
- S 1.1 Define learning needs related to personal practice and/or career goals
- S 3.1 Generate focused questions that address practice uncertainty and knowledge gaps
- S 1.1 Create a learning plan that is feasible, includes clear deliverables and a plan for monitoring ongoing achievement
- S 1.1 Identify resources required to implement a personal learning plan
Evaluation type: Evaluation of the personal learning plan by the same coach/advisor in quarterly intervals. Specific goals and an action plan should be developed followed by evidence showing progress in these areas. Short journal entries would be a preferred method for documenting areas that require self-reflection. The journal entries would not have to be shared, but they are useful for discussing the topics with the coach during the quarterly review.
Clinical scenario: Continuous activity that applies to all rotations.
Specific rotation: Continuous activity that applies to all rotations.
Comments: This EPA will require residents have a specific transition to practice advisor.
EPA #5- Liaising with clinical services regarding the diagnostic, prognostic and predictive implications of molecular pathology test results
Key Features:
-This focus of this EPA is the role of the anatomical pathologist as a consultant regarding investigation of clinical questions using molecular pathology
- This includes gathering the needed clinical information about the case, discussing the implications of the molecular test results and, as relevant, making recommendations for further testing and/or patient management
- This EPA includes direct communication with clinician(s) as well as integration of molecular pathology test results into the pathology report
- This EPA does not include the interpretation of complex raw data (e.g. next- generation sequencing)
- This EPA may be observed in a case discussion with clinicians, or at tumour boards or other multidisciplinary rounds.
Assessment Plan:
Direct observation and/or case review by staff pathologist
Use Form 1. Form collects information on:
- Organ system: [free text]
- Setting: multidisciplinary rounds; direct communication with clinician; family conference, other
- Test type(s): in situ hybridization; PCR-based testing; cytogenetics; next-generation sequencing
Collect at least 2 observations of achievement
- Various tests and system/sites as defined by competence committee
Relevant Milestones
- ME 2.2 Interpret the diagnostic, prognostic and treatment implications of molecular pathology test results
- COL 1.3 Convey information to clinical colleagues in a manner that enhances patient management
- ME 2.4 Recommend additional genetic/non-genetic testing if required
- L 2.1 Utilize genetic testing resources effectively to balance costs with potential utility of results
- ME 1.3 Apply knowledge of appropriate sample requirements and handling
- ME 4.1 Coordinate the use of multiple diagnostic investigations so as to ensure complementarity and efficiency
- COM 4.1 Incorporate the diagnostic, prognostic or predictive implications of molecular pathology tests into an integrated pathology report
- COM 4.1 Include the recommended reporting elements, when integrating molecular results into an anatomic pathologic report
Evaluation type: Direct observation by pathologist.
Clinical scenario: During sign out, tumour boards/multidisciplinary arounds, and phone calls with clinicians.
Specific rotation: Lung, MSK, breast,GI, lymphoma, gyne-onc, molecular pathology.
EPA #6- Representing Anatomical Pathology in multidisciplinary teams
Key Features:
-This EPA focuses on the role of the anatomical pathologist in contributing expertise to shared clinical decision making for individual patients, as well as to administrative aspects of practice that contribute to improving care delivery within the department, hospital and/or community
- This EPA includes contributions as the lead pathologist in
- Tumour boards or other multidisciplinary case conferences
- intradepartmental committees (e.g. workplace safety, quality assurance, university committee or hospital committee)
- This EPA includes advocating for the profession, which may require being an advocate for additional resources, workload management, quality assurance, or promoting the role of the pathologist in patient care.
- The resident is expected to be involved in these activities on a longitudinal basis during the Transition to Practice stage.
- The observation of this EPA is divided into two parts: tumour boards/multidisciplinary case conferences; other committee work
Assessment Plan:
Part A: Tumour boards / Multidisciplinary case conferences
Multiple observers provide feedback individually, which is then collated to one report
Use form 3. Form collects information on:
- Observer role: pathologist; clinician; resident; other
Collect feedback from at least 2 observers on two occasions
- At least one pathologist and one clinician for each observation
Part B: Other committee work
Direct observation by senior committee member (ideally committee chair) Use form 4
Collect 1 observation of achievement
Relevant Milestones:
Part A: Tumour boards / Multidisciplinary case conferences
- ME 1.4 Present and discuss pathology cases effectively at clinical rounds, in the role of a consultant in pathology
- COL 1.3 Convey information from the pathology assessment to clinicians in a manner that enhances patient management
- S 3.4 Integrate best evidence and clinical expertise into decision-making
- COL 1.3 Support clinical colleagues in the development and implementation of a management plan, as appropriate
- COL 2.2 Achieve consensus when there are differences in recommendations provided by other health care professionals
- ME 1.6 Convey diagnostic uncertainty and recommend additional studies when needed
- P 1.1 Exhibit appropriate professional behaviours
Part B: Other committee work
- P 2.1 Demonstrate a commitment to active participation in the activities of the profession
- ME 1.5 Carry out professional duties in the face of multiple, competing demands
- ME 1.6 Demonstrate insight into their own limits of expertise
- L 1.1 Apply the science of quality improvement to contribute to improving systems of patient care
- L 3.1 Demonstrate knowledge of the principles of laboratory management, including resource allocation and collaboration with technical managers, and hospital and laboratory administration
- L 3.1 Demonstrate leadership skills to enhance health care
- L 4.1 Set priorities and manage time to integrate practice and personal life
- S 3.4 Integrate best evidence and clinical expertise into decision-making
- COL 1.1 Receive and respond appropriately to input from others
- COL 1.3 Work effectively with physicians and other colleagues
- P 1.1 Exhibit appropriate professional behaviors
Evaluation type: Direct observation by pathologists and other members of the multi-disciplinary team.
Clinical scenario: Tumour boards/multi-disciplinary rounds, consensus rounds.
Specific rotation: Any rotation that has tumour boards/multi-disciplinary rounds, consensus rounds.
Comments: Easily achievable.