Integrated Pathology Curricula: Challenges and Opportunities Barbara Knollmann-Ritschel CAPT, MC, USN

The opinions expressed herein are those of the author, and are not necessarily representative of those of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DOD); or, the United States Army, Navy, or Air Force.

Objectives Review the data from the Discussion Group on Integrated curricula Discuss challenges with integrated curricula Highlight opportunities in integrated curricula Describe the EPAs and how they may relate to pathology and integrated curricula Next steps with Pathology Learning Competencies

Integrated Curricula: APC Discussion Group 2016 Leadership Opportunities in Pathology Education in the Era of Integrated Curricula: Creating Horizontal Pathology Threads and Implementing Entrustable Professional Activities (EPAs)

7 of 15 schools separate course Little pathology integration into the clinical years

National Drivers of Integration AAMC and HHMI Scientific Foundations for Future Physicians (SFFS) Report of 2009 Educate physicians to be inquisitive Build a strong scientific foundation for future clinical practice Equip students with knowledge skills and attitudes to integrate new scientific knowledge into medical practice Work in interdisciplinary teams

Integration of Curriculum SFFS charged with developing a concept of “science competencies” Holistic learner proficiency Not academic course based education Recommend specific competencies in the science to be foundational

Integrate Curricula: Discussion Group Co-leaders: Robert Folberg Rebecca Wilcox Jim Williams Barbara Knollmann-Ritschel Participants: Registered-31

Q1: Do you teach in an integrated or modular curriculum, or in a stand-alone pathology curriculum? Answered: 24 Skipped: 0 75% 25%

Pathology Curricula: Major Types? Stand alone Pathology Course: Traditional second year pathology Course Fully Integrated Curriculum: No separate pathology grade is given, e.g.: module grade Hybrid Curriculum: Partially integrated with some disciplines- separate grades

Q2: Is the curriculum split between the disciplines or fully integrated? Answered: 24 Skipped: 0 58.33% 41.67%

Q2: Is the curriculum split between the disciplines or fully integrated? Answered: 24 Skipped: 0 58.33% 41.67% 75% had integrated curriculum, but only 41.67% are fully integrated 25% had a single course, 58% had teaching split between disciplines so 33% of “integrated curriculums” have split discipline teaching

Integrated Pathology Curricula Full integration requires that disciplines coordinate teaching The responsibility of the Integration relies on the module directors, not course directors

Integrated Pathology Curricula Benefits: Minimize overlap in topics with one person(s) integrating Allow one instructor to teach multiple topics, such as pathology, immunology and histology in order to make the material more cohesive for students Allows disciples to co-teach clinical and basic sciences as teams

Integrated Pathology Curricula Benefits: Create horizontal threads throughout a single module or multiple modules Benefit of single instructors over a series is that they know what was previously presented and can reinforce without repeating more easily making a cohesive curriculum

Integrated Pathology Curricula: Challenges: Lectures are often taught by multiple instructors who may not be aware of what was previously taught- adding repetition Takes time for faculty to see what faculty of other disciplines are teaching Domino effect if one discipline changes their topics Module directors need to review ppts/attend lectures of all faculty teaching in a module for true integration

Q3: Do you feel your students recognize a cohesive pathology curriculum in your institution? Answered: 23 Skipped: 1 52.17% 47.83%

Is Pathology recognized as a cohesive course? Large variation in responses during discussion Some institutions surveyed their students Don’t just assume students don’t recognize pathology

Is Pathology recognized as a cohesive course? Does it Matter? Yes! It is hard for students to recognize pathology as a medical specialty if it is not recognized as a discipline in the curriculum This is our pool of potential residents Recognize pathology in pre-clerkship and clerkship

Strengthening Pathology to be recognized as a cohesive course Common thread: Make sure your faculty are engaging and vocal advocates for pathology We need to say that we are taking care of patients

Advocating for Pathology at the Institutional Level Institutional Committees Executive Curriculum Committee Student Promotions Committee Module Directors Interdisciplinary Committees Promote interdisciplinary teaching everywhere

Opportunities for Strengthening Pathology Curriculum Pathology Interest Group Out reach to students (they talk) Social Media Presentations on careers in pathology Future of Pathology Subspecialty talks related to curriculum Stress that we are the decision makers in medicine Student concerns for no future in pathology Example of Immunology- “don’t need pathology as just do CD markers and get patient diagnosis in heme Example BBB – transfusion medicine not taught by pathology

Pathology Exposure Clinical Skills Workshops on pap smears (gyn rotation), bone marrow biopsies (Hematology rotation), frozen sections (surgery rotation) Tumor Board exposure- prime recruitment time in clerkship years Pathologist often leads the discussions at tumor board

Clerkship/Post Clerkship Curriculum Laboratory Medicine Not uniformly taught Not a mandatory rotation Opportunities for rotations, workshops, mock tumor boards Round with pediatrics, medicine, … Be proactive to insert pathology curriculum

How can Chairs Support Education Advocate for pathology faculty on committees Seek dynamic pathology role models for teaching Engage residents in the education of medical students Teach everyone to say we are caring for patients

How can Chairs Support Faculty in Education Learn the language of education to move pathology topics forward Support partnering with other disciplines to teach- truly integrate teaching Provide faculty development in education Invite speakers on integration Volunteer to team teach

“Leadership does not require a title.” Dr. Folberg

EPA’s AAMC published Entrustable Professional Activities 1 of 24 participants on survey indicated that they are using the EPAs at their institution Should EPA’s be tied to the PLC: Yes 75% No-25%

EPAs Gather a history/perform PE Prioritize a Differential diagnosis Recommend/interpret common diagnostic tests Enter orders/prescriptions Document a clinical encounter in patient record Provide an oral presentation of patient encounter Form clinical questions and retrieve evidence on patient care Patient handover/transition Collaborate on inter-professional team Recognize patients needing urgent/ED care Obtain informed consent for procedures Perform general physician procedures Identify system failure/ culture of safely/improvement

EPAs Gather a history/perform PE Prioritize a Differential diagnosis Recommend/interpret common diagnostic tests Enter orders/prescriptions Document a clinical encounter in patient record Provide an oral presentation of patient encounter Form clinical questions and retrieve evidence to advance patient care Patient handover/transition Collaborate on inter-professional team Recognize patients needing urgent/ED care Obtain informed consent for procedures Perform general physician procedures Identify system failure/ culture of safety/improvement

Update on Pathology Learning Competencies Some progress in past 2 years ~25 cases submitted in the old format Partnered with Academic Pathology for publication of Educational Cases Academic Credit Revised format Reviewing/Revising the Pathology Learning Competencies

Questions?