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

2. 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.

3. 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

4. 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)

5. 7 of 15 schools
separate course
Little pathology integration into the clinical years

6. 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

7. 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

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

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

10. 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

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

12. Q2: Is the curriculum split between the disciplines or fully integrated?
Answered: 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

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

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. 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%

29. 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

30. 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

31. 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

32. Questions?