Towards a Competency-based Curriculum for Cytopathology: Results of a ASC CPDC Survey

Paul N. Staats MD, Israh Akhtar MD, Kamal Khurana MD, and Sara Monaco MD

In preparation for the annual Strategies in Cytopathology Education Session held November 17, 2019 at the American Society of Cytopathology (ASC) Annual Scientific Meeting in Salt Lake City, Utah, the ASC Cytopathology Program Directors Committee (CPDC) distributed a survey in early 2019 to assess cytopathology fellowship program’s use of competency-based curriculum and resources used in their curriculum. This information spearheaded the effort to convene a list of speakers to address some of these ideas and resources when planning the Strategies in Cytopathology Education program at the 2019 ASC Annual Scientific Meeting.

The survey was conducted using Survey Monkey software. A link to the survey and multiple reminders were distributed via the ASC Program Directors’ Listserv. Thirty-six responses were received (Figure 1), which represents approximately 39% of the cytopathology fellowship programs. The respondents were fellowship program directors (18; 62%), Clinical Competency Committee chairs (7;24%) or members (11; 37%), Program evaluation committee chairs (10; 35%) or members (6;21%), fellowship program faculty (13; 45%), and cytotechnologists involved in fellow education (5; 17%).

One question asked was, “Is your curriculum structured to offer a progressive learning format (basic to advanced) for your trainees?” Most (13/15, 87%) respondents said yes; but did not specify the basis for assessing the fellow for progression, but one respondent said progression was based on time in the program, one said it was based on a certain number of FNAs, and one said it was based on competency assessment. Two respondents indicated they did not have a progressive learning format.

Another question put forth was if programs have formatted (or plan to format) their curriculum based on ACGME competencies. Most (10/14, 71%) said yes, and two said they planned to in the future. We also asked what gaps respondents’ identified in the structure of their training program (Figure 2). The most common answer (12/19, 63%) was lab management, followed by ultrasound-guided FNA (7/19, 37%), wellness (5/19, 26%) and FNA performance (4/19, 21%). Open questions were asked about different approaches utilized to address these gaps, and what external new resources would be beneficial. Selected responses are shown in boxes 1-5. Of note, there were many comments about a lack of external resources, comprising 7 of the 16 responses (44%).

Overall, the survey responses revealed a distinct challenge for cytopathology fellowship program directors. Most program directors identify one or more gaps in their training programs. Particular needs exist in lab management, ultrasound-guided and palpation-guided FNA, and wellness. However, program directors identify few outside resources to assist them in filling these gaps. The results indicate that there are significant needs, and hopefully professional organizations, like the ASC, that can help to address some of these needs in upcoming educational offerings. Additionally, of the resources reported by program directors, none were identified by more than a small handful of program directors, suggesting that there could be improvements in the dissemination of valuable resources utilized by fellowship programs. This review of survey results illustrates some educational gaps that the ASC CPDC committee will try to address in upcoming communicator articles and educational sessions at the ASC meeting.

Acknowledgment: The authors wish to thank each participant for their thoughtful responses to this relatively time-consuming survey.

Figure 1: Respondents’ role in cytopathology fellowship program. Abbreviations: CCC, clinical competency committee; PEC, program evaluation committee.

Figure 2: Perceived gaps in cytopathology fellowship training.