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Graduate Medical/Pathology Education
Suggested Articles and Resources
Laboratory Medicine and Pathology Education During the COVID-19 Pandemic-Lessons Learned.
Patel R, Hoppman NL, Gosse CM, et al. Laboratory Medicine and Pathology Education During the COVID-19 Pandemic—Lessons Learned. Academic Pathology. 2021;8:23742895211020490. doi:10.1177/23742895211020487
Summary: The COVID-19 pandemic necessitated rapid and significant organizational shifts in departments of laboratory medicine and pathology, including development of new diagnostic testing capabilities while delivering graduate medical and allied health staff education in a safe and effective manner. This article details effects of the COVID-19 pandemic and solutions implemented at the large academic Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota. In the early stages of the pandemic, nonessential healthcare workers were mandated to work from home; this included many pathology residents and fellows (with the exceptions of the frozen section, autopsy, and transfusion medicine services). Educational solutions included moving regular lectures/didactic sessions to a Zoom format, and recapitulating the sign-out experience remotely with trainees viewing cases with faculty via secure sharing of microscope camera feeds over Zoom. Although these digital solutions allowed for continued education during physical distancing, disadvantages included loss of nonverbal communication and contextual cues during remote meetings and difficulty engaging with educational content in the home environment for some learners. While the department has returned to mostly in-person operations, many didactic sessions, meetings, and training program interviews will continue in either a hybrid or virtual format, and this experience has shown that virtual sign-out can be used for medical education in pathology when faculty and learners cannot be present together.
Future of Education or Present Reality?
Lyapichev KA, Loghavi S, El Hussein S, et al. Future of Education or Present Reality? Archives of Pathology & Laboratory Medicine. 2021;145(11):1350-1354. doi:10.5858/arpa.2021-0195-SA
Summary: The COVID-19 pandemic necessitated a number of restrictions such as social distancing and work from home orders which significantly impacted the delivery of hematopathology education to pathology trainees. This article details the resulting changes to the hematopathology curriculum at the University of Texas MD Anderson Cancer Center hematopathology fellowship training program in Houston, Texas, and the center’s experience with virtual pathology education. At the start of the pandemic, the MD Anderson program faced the challenge of moving a number of daily and weekly group meetings to a socially distanced environment, including didactics, unknowns conferences, and subspecialty lectures. The program utilized Cisco WebEx for hosting online videoconferences, and scanned glass slides for unknowns sessions and uploaded them to the Pathpresenter website to allow access from anywhere; these resources are collectively known as the VirtualHemepathMDA platform. With the success of this virtual education among MD Anderson pathology trainees, the access to the VirtualHemepathMDA platform was expanded, attracting nearly 10,000 unique visitors worldwide, and igniting discussions on social media platforms which gained over 3 million impressions. The authors note that their experience with the VirtualHemepathMDA platform highlights widespread substantial interest in virtual hematopathology education, and the department will continue to offer online education for interested learners worldwide.
Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning
Hassell LA, Afzal A. Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning. American Journal of Clinical Pathology. 2021;156(2):176-184. doi:10.1093/ajcp/aqab034
Summary: This article is a review of the disruption in pathology graduate medical education models caused by the advent of digital pathology and related technologies, as well as a discussion of the opportunities this provides to promote and equitize pathology education both at home and abroad. The emergence of digital pathology and the learning model changes necessitated by the COVID-19 pandemic have led to increased virtual options for learning via virtual clerkships, remote conferences and lectures, and other digital teaching platforms. The authors note that this presents an opportunity to make high-quality pathology education (and diagnostic capabilities) more accessible to a worldwide audience, which could address gaps in pathology training programs and in healthcare delivery, particularly in the developing world where subspecialty pathology expertise is less concentrated. Other benefits of virtual training include increased variety of curriculum options and modalities, exposure to topics not covered by all training programs (such as informatics and esoteric laboratory testing topics), and access to subspecialty expertise. Disadvantages include technological breakdowns and lack of infrastructure, difficulties in evaluating competency, and the inability to transfer certain skills to a virtual environment, such as benchwork in microbiology and transfusion medicine. Through the adoption and intentional direction of these new technologies, our field has an opportunity to enhance and standardize conventional pathology graduate medical education, and address the inequity of healthcare delivery on an international stage.
Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer
Jasani B, Bänfer G, Fish R, et al. Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer. Diagn Pathol. 2020;15(1):37. doi:10.1186/s13000-020-00953-9
Summary: Pathologists’ interpretation and scoring of tumor programmed cell death ligand-1 (PD-L1) expression is paramount in the age of precision medicine and with the advent of anti-PD-L1 immunotherapy for the treatment of non-small cell lung cancer. To reduce inter-pathologist as well as temporal variability, particularly at key cut-offs relevant to clinical decision-making, the authors of this study created an online PD-L1 e-trainer tool utilizing digital images from scanned slides. Seven online training sessions with 69 pathologists were completed, with overall percentage agreement ranging from 85% (≥50% of staining in tumor cells cut-off) to 95% (≥1% tumor cells staining cut-off), with moderately good interobserver reliability (>0.5 kappa for all clinically relevant cut-off values). This study demonstrates that an online training tool utilizing digital pathology offers an effective means of training pathologists in PD-L1 scoring.
Graduate Medical/Pathology Education
Suggested Articles and Resources
Laboratory Medicine and Pathology Education During the COVID-19 Pandemic-Lessons Learned.
Patel R, Hoppman NL, Gosse CM, et al. Laboratory Medicine and Pathology Education During the COVID-19 Pandemic—Lessons Learned. Academic Pathology. 2021;8:23742895211020490. doi:10.1177/23742895211020487
Summary: The COVID-19 pandemic necessitated rapid and significant organizational shifts in departments of laboratory medicine and pathology, including development of new diagnostic testing capabilities while delivering graduate medical and allied health staff education in a safe and effective manner. This article details effects of the COVID-19 pandemic and solutions implemented at the large academic Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota. In the early stages of the pandemic, nonessential healthcare workers were mandated to work from home; this included many pathology residents and fellows (with the exceptions of the frozen section, autopsy, and transfusion medicine services). Educational solutions included moving regular lectures/didactic sessions to a Zoom format, and recapitulating the sign-out experience remotely with trainees viewing cases with faculty via secure sharing of microscope camera feeds over Zoom. Although these digital solutions allowed for continued education during physical distancing, disadvantages included loss of nonverbal communication and contextual cues during remote meetings and difficulty engaging with educational content in the home environment for some learners. While the department has returned to mostly in-person operations, many didactic sessions, meetings, and training program interviews will continue in either a hybrid or virtual format, and this experience has shown that virtual sign-out can be used for medical education in pathology when faculty and learners cannot be present together.
Future of Education or Present Reality?
Lyapichev KA, Loghavi S, El Hussein S, et al. Future of Education or Present Reality? Archives of Pathology & Laboratory Medicine. 2021;145(11):1350-1354. doi:10.5858/arpa.2021-0195-SA
Summary: The COVID-19 pandemic necessitated a number of restrictions such as social distancing and work from home orders which significantly impacted the delivery of hematopathology education to pathology trainees. This article details the resulting changes to the hematopathology curriculum at the University of Texas MD Anderson Cancer Center hematopathology fellowship training program in Houston, Texas, and the center’s experience with virtual pathology education. At the start of the pandemic, the MD Anderson program faced the challenge of moving a number of daily and weekly group meetings to a socially distanced environment, including didactics, unknowns conferences, and subspecialty lectures. The program utilized Cisco WebEx for hosting online videoconferences, and scanned glass slides for unknowns sessions and uploaded them to the Pathpresenter website to allow access from anywhere; these resources are collectively known as the VirtualHemepathMDA platform. With the success of this virtual education among MD Anderson pathology trainees, the access to the VirtualHemepathMDA platform was expanded, attracting nearly 10,000 unique visitors worldwide, and igniting discussions on social media platforms which gained over 3 million impressions. The authors note that their experience with the VirtualHemepathMDA platform highlights widespread substantial interest in virtual hematopathology education, and the department will continue to offer online education for interested learners worldwide.
Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning
Hassell LA, Afzal A. Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning. American Journal of Clinical Pathology. 2021;156(2):176-184. doi:10.1093/ajcp/aqab034
Summary: This article is a review of the disruption in pathology graduate medical education models caused by the advent of digital pathology and related technologies, as well as a discussion of the opportunities this provides to promote and equitize pathology education both at home and abroad. The emergence of digital pathology and the learning model changes necessitated by the COVID-19 pandemic have led to increased virtual options for learning via virtual clerkships, remote conferences and lectures, and other digital teaching platforms. The authors note that this presents an opportunity to make high-quality pathology education (and diagnostic capabilities) more accessible to a worldwide audience, which could address gaps in pathology training programs and in healthcare delivery, particularly in the developing world where subspecialty pathology expertise is less concentrated. Other benefits of virtual training include increased variety of curriculum options and modalities, exposure to topics not covered by all training programs (such as informatics and esoteric laboratory testing topics), and access to subspecialty expertise. Disadvantages include technological breakdowns and lack of infrastructure, difficulties in evaluating competency, and the inability to transfer certain skills to a virtual environment, such as benchwork in microbiology and transfusion medicine. Through the adoption and intentional direction of these new technologies, our field has an opportunity to enhance and standardize conventional pathology graduate medical education, and address the inequity of healthcare delivery on an international stage.
Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer
Jasani B, Bänfer G, Fish R, et al. Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer. Diagn Pathol. 2020;15(1):37. doi:10.1186/s13000-020-00953-9
Summary: Pathologists’ interpretation and scoring of tumor programmed cell death ligand-1 (PD-L1) expression is paramount in the age of precision medicine and with the advent of anti-PD-L1 immunotherapy for the treatment of non-small cell lung cancer. To reduce inter-pathologist as well as temporal variability, particularly at key cut-offs relevant to clinical decision-making, the authors of this study created an online PD-L1 e-trainer tool utilizing digital images from scanned slides. Seven online training sessions with 69 pathologists were completed, with overall percentage agreement ranging from 85% (≥50% of staining in tumor cells cut-off) to 95% (≥1% tumor cells staining cut-off), with moderately good interobserver reliability (>0.5 kappa for all clinically relevant cut-off values). This study demonstrates that an online training tool utilizing digital pathology offers an effective means of training pathologists in PD-L1 scoring.