Author: Sara E. Monaco MD, Chair of the ASC CPDC, & Members of the ASC CPDC

Affiliations: Cytopathology Fellowship Program Director, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA

The ASC Cytopathology Fellowship Program Director Committee (CPDC) is a committee of the ASC dedicated to assisting cytopathology fellowship program directors and improving the quality of cytopathology fellowship education.  The committee met at the 2019 ASC Annual Scientific Meeting in Salt Lake City, and helped to organize the 2019 ASC Strategies in Cytopathology Education Session, which was entitled “Toward a Competency Based Cytopathology Curriculum: What to Teach, How to Teach, and How to Assess”.  This session was heavily attended by program directors and core teaching faculty at various institutions, and included discussions about entrustable professional activities (EPA), interactive teaching initiatives, use of social media, and various educational materials available from different organizations (such as the ASC and American Society of Clinical Pathology (ASCP)), and handouts from the session are available online.  The session also featured a presentation by Dr. Ritu Nayar, a trustee of the American Board of Pathology (ABPath), and a member of several of the Accreditation Council for Graduate Medical Education (ACGME) committees, including the ACGME Pathology Residency Review Committee and ACGME Cytopathology Milestones 2.0 Committee.  Her presentation discussed some of the results of the ABPath cytopathology fellowship graduate surveys, in which diplomates from the past decade have provided feedback about how fellowship training could be improved.  This information is valuable as our subspecialty attempts to analyze how our training programs are preparing fellows for employment and the real-life practice of modern cytopathology.  This is similar to the analysis that was recently performed in the subspecialty of hematopathology, where surveys were distributed to recent hematopathology diplomates and program directors in order to understand how well training programs are preparing fellowship graduates for future jobs in hematopathology practices.[1]  This is important given that the field of pathology has changed in the past few years, with greater emphasis placed on molecular testing, informatics and other aspects, which may not be well-reflected in current training programs and board certification examinations.  Some of this could be attributed to the fact that the current ACGME program training requirements are not very specific, and leave a great deal up to individual programs to design and implement.  Furthermore, training programs and examinations likely lack the most up-to-date information that fellows will need for practice, since there may be a delay in developing educational programs to address new initiatives and testing that occur.  In an effort to carry out a similar analysis in cytopathology, ABPath released a survey to all cytopathology fellowship program directors, which will be active until April 20, 2020.  If you did not receive the link in your electronic mailbox, please see the link below for the survey:  https://survey.az1.qualtrics.com/jfe/form/SV_d4LYGRmlmjmthv7?Q_R=R_24wm8b6lAGIESI3&Q_R_DEL=1

This year has also been one of intense activity for the planning of upcoming changes for cytopathology fellowship programs.  In early 2020, the ACGME released a proposal for cytopathology program requirement changes, with an open comment period that ended on January 17, 2020.  Some of the proposed changes include providing more details regarding the expectations for educational resources available to fellows (e.g. work area, computer, updated teaching materials, and study sets), the minimum protected time for program directors (0.20 FTE for 1-3 fellows and 0.25 FTE for programs with 4-6 fellows) and minimum program coordinator support (0.2 FTE if 3 or fewer fellows or 0.3 FTE if 4-9 fellows) based on the size of the program, and the minimum requirement of at least two core faculty members for fellow education with at least one board certified by the ABPath.  The proposed changes also specify that fellows must demonstrate competence in communicating results to patients when performing FNA biopsies, and that fellow experiences must be created to demonstrate their preparation for independent sign-out. The new proposed cytopathology fellowship milestones (Milestones 2.0) were also released earlier this year for open comment.  A helpful addition that will be available is the supplemental guide that provides insight behind the intent of different Milestones and examples of ways fellows can demonstrate different levels within each milestone, in addition to assessment ideas, pertinent educational resources, references, and other useful information.  These new cytopathology milestones 2.0 are scheduled to be in effect for the 2020 or 2021 fellowship year, so stay tuned for more.

Given all the proposed changes that are soon to be finalized and implemented, the 2020 ASC Strategies in Cytopathology Fellowship Education session at the ASC Annual Scientific Meeting will address these changes in detail, and is scheduled to occur on Thursday, November 5th from 2:30-5:30pm in Orlando, Florida.  This will be a two-part educational session with presentations by representatives from the AGGME and ABPath about cytopathology fellowship program updates in the first half, and a more intimate, round table discussion in the second part with presentations by various cytopathology faculty and program directors about new initiatives, policies, or other changes that they have successfully implemented in their programs.  The hope is that these small group sessions will allow the sharing of ideas that can help everyone to improve their fellowship programs to meet the new expectations and stay current with the new ACGME requirements.

We understand that the past few weeks have been a challenging one for cytopathology fellows and training programs given the COVID-19/SARS-CoV-2 pandemic, given the impact on our practice of cytopathology and how we educate one another in a time of social distancing.[2] Our hope is that we will all emerge from this in a new and improved fashion, with a greater handle on electronic learning and ways to adapt our training programs in times like this.  An accompanying article in the Bulletin, entitled, “Cytopathology Training in the COVID-19 Pandemic: Top 10 Challenges & Opportunities” will address some of the recent issues programs are dealing with and provide some ideas on how fellowship programs can continue to educate fellows during this time. The ASC CPDC hopes that we can all meet in person at the ASC Annual Scientific Meeting in November 2020 to share our experiences and to learn from each other, as we have done in the past.

 

Reference:

  1. Swerdlow SH, Monaghan SA, Douglas AR, Johnson K, Johnson RL. Harmonization of Training, Training Requirements, Board Certification, and Practice of Hematopathology.  AJCP 2019; 152:625-637.
  2. Pambuccian S. The COVID-19 Pandemic: Implications for the cytology laboratory. Journal of the American Society of Cytopathology.