Mehr Chelsea R, Obstfeld Amrom E, Barrett Amanda C, Montone Kathleen T, Schwartz Lauren E
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Acad Pathol. 2017 Nov 26;4:2374289517736344. doi: 10.1177/2374289517736344. eCollection 2017 Jan-Dec.
Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.
病理学领域和住院医师教育的变革使得持续评估住院医师培训成为必要。对于构成解剖病理学培训项目核心的外科病理学轮转而言，渐进式变革尤为重要。过去，我们基于主观见解来组织这一轮转。当近期面临重新规划轮转的需求时，我们力求采用一个更基于证据的流程。我们的方法涉及两个主要数据来源。我们对每种病例类型提交的病例数量和切片数量进行量化，以估算工作量，并就所有器官系统大体标本检查所需时间对住院医师进行调查。一个由教员、住院医师和工作人员组成的多学科委员会对结果进行评估，并利用这些数据来模拟轮转的各种变化将如何影响住院医师的工作量、周转时间及其他变量。最后，我们确定了能够平均分配工作的轮转结构，并创建了一个基于点数的系统，该系统为不同经验的住院医师设定了大体标本检查时间上限。实施之后，我们回顾性比较了这些变化前后的周转时间和违反值班时长规定的情况，并就住院医师对这两种系统的体验进行了调查。我们通过检查大体标本检查时间并将其与指定的点数进行比较，来评估基于点数的系统的准确性。我们发现实施后轮转情况总体有所改善。鉴于基本上没有关于外科病理学轮转组织这一主题的文献，我们希望我们的经验能为其他机构改善病理学住院医师教育提供一个路线图。
