1. Pathology Post-Sophomore Fellowship Survey American Board of Pathology Cooperating Societies Meeting May 5, 2015 Wesley Naritoku, M.D., Ph.D. Chair, Pipeline Subcommittee Advocacy Committee Thanks goes to Priscilla Markwood and Jen Norman for the SurveyMonkey

2. Introduction and Background Pathology workforce shortage anticipated Pipeline Subcommittee of APC Advocacy Committee formed, July 2014 One of many interests: advanced credit for the Post-Sophomore Fellowship (PSF) graduates PSF not a new concept – Whipple 1926 Many studies in the literature point to the fact that PSF graduates choose pathology more than non-PSF and more go into academics

3. Post-sophomore Fellowship Survey n = 48 programs total responded (33.8%) n = 20 programs with post-sophomore fellowships (PSF) (approaching 100% of PSF) 28 programs without PSF could answer the first 7 questions focused on experience with PSF graduates and were looped out of the survey 20 programs with PSF completed Q8 – Q26 to drill down on characteristics of the PSF programs

4. Q1. How many going into pathology? Average per medical school class: 2.8 (1.9%) Range of # of seniors go into Pathology: 1 – 10 Average size of graduating class: 145.2 Range of # of seniors graduating: 29 – 270

5. Questions 2 – 6 applies to all responders (PSF and non-PSF programs) Q2. How many of your PSF-trained residents pursued an academic career? 59.8% (n = 15)

6. Questions 2 – 6 applies to all responders (PSF and non-PSF programs) Q3. Of your PSF-trained residents, do you know if any have changed specialty during or after residency or left medicine altogether? Not Changed: 29 (60.4%) Changed: 4 (8.3%) Don’t know: 15 (31.25%)

7. Questions 2 – 6 applies to all responders (PSF and non-PSF programs) Q4. If PSF-trained graduates have changed specialty during or after residency or left medicine altogether? (n = 3) Left Pathology for another specialty: 2 Left Medicine altogether: 1

8. Questions 2 – 6 applies to all responders (PSF and non-PSF programs) Q5. Type of training PSF did during residency and after: AP/CP residency: vast majority AP only: distant second CP only: 1 AP/NP: 0 Did fellowship after residency: many

9. Questions 2 – 6 applies to all responders (PSF and non-PSF programs) Answered: 31 Skipped: 18

10. Q8. Does your medical school have a PSF program? Yes: 20 (50%)No: 16 (40%)

11. Q9. The PSF Director is:

12. Q10. How many years has your PSF been in existence? n = 20

13. Q11. How many students have completed the PSF at your institution? Average: 45.7 Range: 3 – 180 n = 20

14. Q12. Total # of PSF that went into Pathology? Average: 21.8 Range: 1 – 105 n = 19

15. Q13. Total # of PSF that went into Pathology, that stayed at same program? Average: 9.9 Range: 0 – 20 n = 17

16. Q14. Who is responsible for direct supervision of the PSF?

17. Q15. Is there a point in training where the PSF is on ‘Indirect Supervision’ n = 20

18. Q16. Do you have separate (dedicated) learning G&O’s for PSF? n = 20

19. Q17. Are the learning G&O’s competency-based and robust?

20. Q19. How do you evaluate the PSF? n = 20

21. Q20. Please list the number of weeks that a typical PSF has of the following subspecialty areas out of 52 weeks:

23. Q21. How do you evaluate the quality and efficacy of your PSF program? (check all that applies)

24. Q22. If the PSF performs autopsies, do they share with a resident or solo?

25. Q23. If the PSF performs autopsies, do they participate in all 7 components of the autopsy as defined by ACGME? No: 1 (5%)

26. Q24. If the PSF grosses Surgical Pathology, do they take ownership over the case as would a PGY1 (sign-outs, synoptic reporting, cancer staging, histochem, IHC, molecular)

27. Q25. Do you feel that students completing a PSF should receive advanced standing?

28. In Favor Of: They essentially function as first-year residents They are usually miles ahead of the average medical student going into pathology

29. Neutral, favoring ‘oppose’ I would have to change my PSF if they were to get advanced credit. We have made it less intense in the past years…Some PSF are a yr long and some are less. Great variability.

30. Opposed I don't unless we go back to five year programs

31. If you have a PSF, is it mainly: A passive observership 5.3% (1) Essentially it is like PGY1 year 63.2% (12) Somewhere in between ‘a’ and ‘b’ 26.3% (5) No answer from 5.3% (1) Comments: 2 n = 19

32. Programs ‘opposed’ n = 7 programs opposed or neutral 2 programs run their PSF somewhere between a passive observership and a PGY1 year 5 programs run their PSF essentially like a PGY1 year

33. Programs ‘In Favor’ 2 programs that describe their PSF as somewhere in between a passive observership and a PGY1 were in favor of awarding advanced credit.

34. Q26. Who do you feel should ‘accredit’ the PSF in Pathology? ACGME: 12 (60%) LCME: 2 (10%) Other 6 (30%)

35. A former PSF, now APD I spent a year rotating on all AP services including surgical pathology, cytopathology and autopsy pathology. I also did an elective in forensics and one in neuropathology…this year was of indescribably value to my career. I learned more this year than during my 1st year of residency including how to gross all major specimens and all the most common diagnostic encounters in pathology. When I applied for residency I received offers to interview at every single place I wanted to go. During interviews numerous attendings told me how highly they values attaining PSFs as incoming residents because they are more than well prepared. My medical school grades were not AOA level and my Step 1 score of moderate at best, but I matched at the #1 Pathology residency program in the nation…I STRONGLY feel this year should be given the credit it deserves, as from my experience, it is rigorous training at the same or higher level than residency training at most institutions.

36. Concluding comments from MacPherson (ref 7) “Although the Board’s decision is understandable in the context of requiring only 4 rather than 5 years of postgraduate training, ignoring the student fellowship experience completely is unreasonable in this era of competency-based residency training. I would propose that the Board continue to require program directors to register their student fellowship programs, submit accurate program descriptions, provide appropriate supervision of the program, preferably by the director of the residency program, and compile data concerning the outcome of graduates from these student fellowship programs. In return, I propose that the student fellows receive partial or limited credit for their experience (eg, credit for their autopsy experience), which would permit them to increase the flexibility (ie, electives) of their 4-year residency program. Naturally, any credit for these activities would be awarded at the discretion of the program director.”

37. Thank you for the opportunity to present Wesley Y. Naritoku, MD, PhD Immediate Past Chair, PRODS Chair, Pipeline Subcommittee