16
Am J Clin Pathol 2011;136:671-678 671 671 DOI: 10.1309/AJCPWABWFBU9EYXR 671 © American Society for Clinical Pathology Abstract Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/ PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty. What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora- tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice? A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec- tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com- munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found, 1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com- munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi- ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice. 3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol- ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod- ing and billing, contract negotiations, the role of the laboratory Upon completion of this activity you will be able to: • describe the value of laboratory management training for pathology residents. • describe the opportunities and challenges that are faced by residency program directors in providing management training. • describe key elements of the proposed management curriculum. The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module. The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme. Key Words: Residency training; Laboratory management; Consensus curriculum DOI: 10.1309/AJCPWABWFBU9EYXR A Consensus Curriculum for Laboratory Management Training for Pathology Residents Ronald L. Weiss, MD, 1 Barbara J. McKenna, MD, 2 Melissa Lord-Toof, 3 Nancie Noie Thompson, 4 and the Work Group Members * AJCP / Special Article CME/SAM Reprinted from AMERICAN JOURNAL OF CLINICAL PATHOLOGY Vol. 136, No. 5, November 2011. Copyright © 2011 by American Society of Clinical Pathologists, Inc. Printed in U.S.A.

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Page 1: AJCP A Consensus Curriculum for Laboratory Management ... · PDF fileA Consensus Curriculum for Laboratory Management Training for Pathology Residents ... A Consensus Curriculum for

Am J Clin Pathol 2011;136:671-678 671671 DOI: 10.1309/AJCPWABWFBU9EYXR 671

© American Society for Clinical Pathology

AJCP / Special Article

CME/SA

M

A Consensus Curriculum for Laboratory Management Training for Pathology Residents

Ronald L. Weiss, MD,1 Barbara J. McKenna, MD,2 Melissa Lord-Toof,3 Nancie Noie Thompson,4 and the Work Group Members*

Key Words: Residency training; Laboratory management; Consensus curriculum

DOI: 10.1309/AJCPWABWFBU9EYXR

A b s t r a c t

Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty.

What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora-tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice?

A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec-tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com-munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found,1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com-munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi-ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice.3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol-ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod-ing and billing, contract negotiations, the role of the laboratory

Upon completion of this activity you will be able to:• describe the value of laboratory management training for pathology

residents.• describe the opportunities and challenges that are faced by residency

program directors in providing management training.• describe key elements of the proposed management curriculum.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme.

Am J Clin Pathol 2011;136:671-678 671671 DOI: 10.1309/AJCPWABWFBU9EYXR 671

© American Society for Clinical Pathology

AJCP / Special Article

CME/SA

M

A Consensus Curriculum for Laboratory Management Training for Pathology Residents

Ronald L. Weiss, MD,1 Barbara J. McKenna, MD,2 Melissa Lord-Toof,3 Nancie Noie Thompson,4 and the Work Group Members*

Key Words: Residency training; Laboratory management; Consensus curriculum

DOI: 10.1309/AJCPWABWFBU9EYXR

A b s t r a c t

Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty.

What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora-tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice?

A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec-tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com-munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found,1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com-munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi-ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice.3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol-ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod-ing and billing, contract negotiations, the role of the laboratory

Upon completion of this activity you will be able to:• describe the value of laboratory management training for pathology

residents.• describe the opportunities and challenges that are faced by residency

program directors in providing management training.• describe key elements of the proposed management curriculum.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme.

Am J Clin Pathol 2011;136:671-678 671671 DOI: 10.1309/AJCPWABWFBU9EYXR 671

© American Society for Clinical Pathology

AJCP / Special ArticleCM

E/SAM

A Consensus Curriculum for Laboratory Management Training for Pathology Residents

Ronald L. Weiss, MD,1 Barbara J. McKenna, MD,2 Melissa Lord-Toof,3 Nancie Noie Thompson,4 and the Work Group Members*

Key Words: Residency training; Laboratory management; Consensus curriculum

DOI: 10.1309/AJCPWABWFBU9EYXR

A b s t r a c t

Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty.

What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora-tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice?

A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec-tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com-munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found,1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com-munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi-ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice.3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol-ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod-ing and billing, contract negotiations, the role of the laboratory

Upon completion of this activity you will be able to:• describe the value of laboratory management training for pathology

residents.• describe the opportunities and challenges that are faced by residency

program directors in providing management training.• describe key elements of the proposed management curriculum.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme.

Am J Clin Pathol 2011;136:671-678 671671 DOI: 10.1309/AJCPWABWFBU9EYXR 671

© American Society for Clinical Pathology

AJCP / Special Article

CME/SA

M

A Consensus Curriculum for Laboratory Management Training for Pathology Residents

Ronald L. Weiss, MD,1 Barbara J. McKenna, MD,2 Melissa Lord-Toof,3 Nancie Noie Thompson,4 and the Work Group Members*

Key Words: Residency training; Laboratory management; Consensus curriculum

DOI: 10.1309/AJCPWABWFBU9EYXR

A b s t r a c t

Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty.

What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora-tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice?

A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec-tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com-munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found,1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com-munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi-ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice.3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol-ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod-ing and billing, contract negotiations, the role of the laboratory

Upon completion of this activity you will be able to:• describe the value of laboratory management training for pathology

residents.• describe the opportunities and challenges that are faced by residency

program directors in providing management training.• describe key elements of the proposed management curriculum.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme.

Am J Clin Pathol 2011;136:671-678 671671 DOI: 10.1309/AJCPWABWFBU9EYXR 671

© American Society for Clinical Pathology

AJCP / Special Article

CME/SA

M

A Consensus Curriculum for Laboratory Management Training for Pathology Residents

Ronald L. Weiss, MD,1 Barbara J. McKenna, MD,2 Melissa Lord-Toof,3 Nancie Noie Thompson,4 and the Work Group Members*

Key Words: Residency training; Laboratory management; Consensus curriculum

DOI: 10.1309/AJCPWABWFBU9EYXR

A b s t r a c t

Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a “wiki” design tool for use by program directors, residents, and faculty.

What is a pathologist, fresh out of training in anatomic pathology (AP), clinical pathology (CP), or both (AP/CP), expected to know about laboratory and pathology practice management when he or she joins a community-based practice, an academic medical center department, or a research labora-tory? Does the setting really matter that much? And how well do we prepare residents for this aspect of their future practice?

A combination of anecdotes and survey results during the past 10 to 15 years has defined a gap between training in management principles and skills development and the expec-tation that employers have for pathologists in their first couple of years in practice. To paraphrase 1 senior pathologist in a large private practice setting, “More often than not, we are now recruiting young pathologists with competency in anatomic pathology but lacking in those good interpersonal and com-munication skills necessary to be productive members of the group.” In 2 descriptions that spanned approximately 10 years of practice, Horowitz found,1,2 as a result of 3 separate surveys of community-based pathologists, that interpersonal and com-munication skills were “essential” and that “management and coding/billing” skills were “useful” to successful practice. These so-called nonpathology skills remained, in his experi-ence, the major deficiency for newly trained pathologists. Other authors have added further confirmation of the gap between new pathologist skills and the expectations of their colleagues and employers in subsequent practice.3-6 In their white paper, “Resident Preparation for Practice,” authors from the College of American Pathologists (CAP) and the Association of Pathol-ogy Chairs (APC) emphasize the importance of necessary skills in strategic planning, budgeting, operations management, cod-ing and billing, contract negotiations, the role of the laboratory

Upon completion of this activity you will be able to:• describe the value of laboratory management training for pathology

residents.• describe the opportunities and challenges that are faced by residency

program directors in providing management training.• describe key elements of the proposed management curriculum.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 817. Exam is located at www.ascp.org/ajcpcme.

Reprinted from AMERICAN JOURNAL OF CLINICAL PATHOLOGYVol. 136, No. 5, November 2011. Copyright © 2011by American Society of Clinical Pathologists, Inc. Printed in U.S.A.

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672 Am J Clin Pathol 2011;136:671-678672 DOI: 10.1309/AJCPWABWFBU9EYXR

© American Society for Clinical Pathology

Weiss et al / Laboratory Management Curriculum

medical director, and the interaction of pathologists with a vari-ety of other constituents in their institutions and communities.6

Beginning in 1987, with the formulation of the Park City Report of the APC on the core components—including man-agement and informatics—of pathology residency training programs, there have been a series of meetings and reports that have focused on the adequacy of residency training. The Colo-rado Springs Conference I, in 1989, focused on the “Future Content and Structure of Residency Training in Pathology”; it was followed in 1993 by the Colorado Springs Conference IV “Clinical Pathology Residency: Curriculum Reform.”7,8

As a result of intersociety conferences on pathology training, representatives from the APC, ASCP, CAP, and the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) formed the “Conjoint Task Force on Clinical Pathol-ogy.” From the Task Force’s breakout group on management and informatics, a number of conclusions and recommenda-tions were reached.. Most important, the Task Force recom-mended that to meet the objective that a “clinical pathologist should use management and informatics to direct and control the operational effectiveness of the clinical laboratory,” pathol-ogy residents should receive training in broad competencies in management and informatics. Furthermore, the group strongly recommended that this training be introduced early in the programs and should be reinforced continuously with graded responsibility. In 1995, the Conjoint Task Force summarized these recommendations in the Graylyn Conference Report, “Recommendations for Reform of Clinical Pathology Train-ing.”9 Subsequently, the Association of Directors of Anatomic and Surgical Pathology and the ACLPS each published “cur-riculum content and evaluation” proposals for resident com-petency in anatomic and clinical pathology, respectively.10,11 Both included specific knowledge and skill sets in laboratory management. Several training programs have also published descriptions of their curricula in laboratory management.12-17

Early in 2009, we were invited to conduct a workshop on resident laboratory management training for the program direc-tors group at the APC/Program Directors Section (PRODS) Annual Meeting in Seattle, WA, on July 15, 2009. In prepara-tion for that workshop, a survey was developed for distribution to the PRODS listserv. This report describes that survey, sum-marizes the discussion and action items agreed to during the workshop, and describes a year-long curriculum design process and the development and deployment of this laboratory man-agement curriculum resource to a “wiki” site.

The Process

To prepare for the workshop, we decided to survey the PRODS to assess whether and how laboratory management training was occurring in residency training programs. To

ensure that the issues of most importance were addressed by the survey, a presurvey questionnaire was sent to members of the listserv. By using those responses, combined with our experience, the laboratory management survey was then designed and distributed, also via the listserv using the Internet-based survey tool Zoomerang.

Of the program directors surveyed, 54 responded; 40 were in academic medical centers and 14 were in community hospital–based training programs.

The survey questions addressed program practices, con-straints, and resource needs. The responses showed that the time devoted to management and leadership varied consider-ably, from once a month to a dedicated course. Teaching tools used by program directors included mock laboratory inspec-tions (51%) and elective rotations (15%). Major obstacles included faculty time and interest, resident time and interest, not enough faculty experts, and the lack of evaluation tools. Expressed needs included textbooks, Web resources, and institutional and departmental support and commitment.

The session at the 2009 APC/PRODS Annual Meeting had grown from a workshop into a 3-hour plenary session, which attracted a standing-room-only crowd. The presenta-tions generated intense discussion and many questions, such as, “How do you assess communications skills?” and “How do we teach residents to play well with others?”

Emerging from the hour-long question-and-answer format were several themes and several suggested tools, solutions, and actions. Also as a result of this discussion the Work Group on Laboratory Management was constituted to forward these findings into the development of a draft consensus curriculum for full vetting by the PRODS and for presentation at the 2010 APC Annual Meeting.

Through a series of conference calls, the proposed curriculum was formulated to serve as a resource guide rather than a mandate for all programs. In addition, this curriculum was converted into a prototype wiki format intended to become the vehicle for a dynamic resource for program directors, residents and fellows, and any others in the pathology community interested in contributing to the further development of this resource tool. From October 2009 through June 2010, a series of conference calls was held. The group collected sample curricula, which were then posted at a Google Group site. By using the results of the survey and the discussion of these results during the work-shop, a draft curriculum was designed by the APF-ASCP-PRODS Work Group and presented to the PRODS listserv and to the APC/PRODS Annual Meeting attendees for feed-back and discussion before and during the July 14-16, 2010, annual meeting. The curriculum was finalized based on the feedback from these sources. A prototype wiki was built by Dane Falkner, Surgeworks, Salt Lake City, UT (http://www.surgeworks.com). This prototype was moved to the ASCP

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Am J Clin Pathol 2011;136:671-678 673673 DOI: 10.1309/AJCPWABWFBU9EYXR 673

© American Society for Clinical Pathology

AJCP / Special Article

for final design, development, and deployment. The Web site is a cobranded initiative of the American Pathology Foundation (APF), ASCP, and PRODS and can be accessed at www.lab-management.info.

Results

Following is a brief survey of responses to each of the questions.

Question 1

Over the course of the residency, how much time does your training program dedicate to lectures for residents on practice and laboratory management topics?

The responses ❚Table 1❚ were bimodal in frequency, with the largest number of programs (32%) devoted to the least number of contact hours (1-10 hours), and the next most fre-quent number of programs (28%) devoted to the most number of contact hours (≥40 hours). Of the programs, 52% devoted 20 or fewer hours and 48% devoted more than 20 hours.

Question 2

How much time do residents in your program spend on practice and laboratory management responsibilities (junior laboratory directorship)?

For 31% of the programs, residents were able to spend at least 1 month in this form of graduated responsibility ❚Table 2❚. Of the programs, 17% do not offer this opportunity and 11% offer it only as an elective.

Question 3

How often are your residents exposed to laboratory management topics through your training program?

The majority (57%) of the programs provide at most weekly exposure to management topics, with 30% of pro-grams doing so at least monthly (Table 1). In 13%, exposure is only through a dedicated management course.

Question 4

At what point in your program are practice or laboratory management topics taught?

Nearly one third of programs expose residents to man-agement topics as soon as their residency starts ❚Table 3❚. A small minority (6%) do so only near the end of their training. Management is integrated into the rotations of 42% of the programs, with the inference from the results that this occurs primarily during CP rotations and not during AP rotations.

Question 5

What general laboratory management topics does your program cover?

The top 4 responses were quality assurance (51%), labo-ratory inspections (51%), regulatory affairs and accreditation (48%), and test validation (43%) ❚Table 4❚. The topics round-ing out the top 10 responses included risk management, a variety of financial topics, and leadership and management.

❚Table 1❚Time Dedicated to Lectures on Laboratory Management and Frequency of Exposure to Management Topics During Training

Time and Frequency of Management Training % of Programs

Contact hours >40 28 31-40 9 21-30 11 11-20 20 1-10 32 None 0Frequency Monthly 30 Once every 2 wk 9 Once per wk 18 Infrequently 13 Through a dedicated course 13 Other 17

❚Table 2❚Time Spent by Residents in a “Junior Laboratory Directorship” Role

Time % of Programs

>2 mo 51-2 mo 26<1 mo 19Elective time only 11None 17Other 22

❚Table 3❚When Laboratory Management Is Taught During the Residency

% of Programs

As soon as resident begins program 29Toward the end of the program 6Integrated with other subjects 42In clinical pathology rotations 15In anatomic pathology rotations 0As an elective rotation 2Within other areas or time frames 6

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674 Am J Clin Pathol 2011;136:671-678674 DOI: 10.1309/AJCPWABWFBU9EYXR

© American Society for Clinical Pathology

Weiss et al / Laboratory Management Curriculum

Question 6

What tools are a part of your program’s laboratory management curriculum?

Real or mock CAP inspections (51%) and lecture series (48%) were the 2 most frequent responses ❚Table 5❚. A defined management project was used by 34% of the pro-grams. Textbooks or manuals, question-and-answer sessions,

specific rotations with individual evaluations, use of the CAP “Current Procedural Terminology Tutorial,” advanced management electives and rotations at affiliated hospitals or laboratories, and formal case studies rounded out the top 10 responses.

Question 7

Rate the tools that are part of your program’s laboratory management curriculum.

Real or mock laboratory inspections were ranked “highly effective” or “moderately effective” by 96% of the programs ❚Table 6❚. This tool was followed by lectures/didactics for 93% of programs. More than 60% of programs similarly rated the use of textbooks or manuals, defined projects, rota-tions with individual evaluations, and question-and-answer sessions as effective. Formal case studies, formal examina-tions, resources outside the program, and the use of a research laboratory setting were less frequently rated as highly or moderately effective.

Question 8

What are the titles and specialties of the faculty members who teach practice or laboratory management education topics in your training program?

The most frequent response ❚Table 7❚ was the laboratory medical director/clinical laboratory director (44%), followed by the administrative laboratory director (41%) and the resi-dency program director (33%). Other positions were reported with lesser frequency, including the anatomic pathology director (18%), the department chair (18%), and a variety of hospital staff, other university faculty, outside medical staff, and other regulatory staff.

❚Table 4❚Ten Most Common Laboratory Management Topics Covered

Topic % of Programs

Quality assurance 51Laboratory inspections 51Regulatory affairs and accreditation 48Test validation 43Billing and compliance 40Risk management 37Test cost assessment 37Capital equipment purchasing 37Financial management and accounting 34Leadership and management 32

❚Table 5❚Ten Most Commonly Used Teaching Tools

Tool % of Programs

Real or mock laboratory inspection 51Lecture series 48Defined project 34Textbook or manuals 30Question-and-answer sessions 27Rotations with an individual faculty member or other 25College of American Pathologists CPT Tutorial 21Advanced laboratory management elective 15Rotations at an affiliated hospital or laboratory 15Formal case studies 13

CPT, current procedural terminology.

❚Table 6❚Most Effective Teaching Tools

% Rated as “High” or Tool “Moderately” Effective

Real or mock laboratory inspections 96Didactic lectures 93Textbook and/or manual 65Defined projects 63Rotation with an individual faculty member 63 or otherQuestion-and-answer sessions 62College of American Pathologists 42 CPT TutorialFormal case studies 24Resources outside of the program 20Formal examination 20Research laboratory 11

CPT, current procedural terminology.

❚Table 7❚Responsibility for Teaching Laboratory Management

Title of Person and/or Specialty % of Programs

Laboratory medical director/clinical laboratory 44 directorAdministrative laboratory director 41Program director 33Blood transfusion services 30Core laboratories 23Administrative staff outside the department 21Anatomic laboratory director 18Department chair 18Anatomic pathology 18Director of laboratory outreach 17Hospital medical director 9Faculty from other colleges 9

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Question 9

What are the major obstacles your program faces in teaching practice and laboratory management to residents?

Although 1 respondent indicated “no major obstacles,” the most common responses ❚Table 8❚ could be described as lack of time, lack of interest, and lack of sufficient resources for residents and responsible faculty.

Question 10

In what areas do you want your program to improve teaching practice and laboratory management to residents?

Respondents were asked to supply free-form answers ❚Table 9❚. The responses emphasized the need for increased focus on practical experiences and activities that are more likely to engage the interest of the residents, such as “appren-ticeships” (junior directorship) and graded responsibilities, exercises integrated into rotations, and more meaningful interactions with laboratory supervisors and managers. From the faculty perspective, there was a clear interest in having a better defined curriculum in management, readings and other supplemental teaching materials, more focused teaching methods, and more interactions with others in management, including outside the pathology department. There were no surprises in the topic areas the respondents focused on: finan-cial management, personnel, regulatory and accreditation issues, and leadership.

Question 11

What tools and resources would help your training program to implement these improvements/changes?

This question was also posed in a way to solicit free-form answers. The responses could be lumped ❚Table 10❚ into needs for better teaching tools and resources (support and commitment) and a consensus curriculum.

Question 12

Describe any unique methods your program utilizes which have been particularly effective in teaching laboratory management and/or engaging residents in the learning process for these topics.

The free-form responses fell into several common themes. They were as follows: participation in CAP inspections and/or inspector training, 6 responses; participation in quality assurance/quality improvement meetings and/or projects, 4 responses; providing a special “management” lecture series, 4 responses; doing a management project, such as a major equipment justification for purchase, 3 responses; spend-ing a 1-month rotation with the laboratory medical director

or the administrative director, 2 responses; or serving as a junior medical director or in a management apprenticeship, 2 responses. The remaining responses included rotations to out-side community hospital settings, incorporating management topics into every case review, and use of the CAP Virtual Management College online tool, plus several admissions that nothing was particularly unique or effective.

Question 13

How does your program measure and evaluate resident success in learning and applying laboratory management topics?

❚Table 9❚Desired Improvements to Existing Training in Management

For resident learners Establish or expand on junior laboratory directorships More day-to-day, practical, hands-on management experience on all rotations More interaction with laboratory supervisors/managers related to management issues Graded responsibility in laboratory management Development of resident interest in these topicsFor teachers/faculty A more comprehensive, coherent, and better defined curriculum Supplemental materials, reading lists, and a set of proven effective lectures Better teaching methods, more informed and focused teachers, and more active learning opportunities Enlistment of others in the effort, eg, hospital and outside administratorsTopics to be taught/learned Financial management, accounting, budgeting, and billing Personnel management Regulatory issues Leadership Laboratory accreditation

❚Table 10❚Tools and Resources That Would Be Most Helpful to Implement Improvements to Management Training

Tools and Resources % of Programs

Textbooks, Web resources, evaluation tools 43Better institutional and/or departmental support 30 for teaching managementNational consensus on curriculum 7

❚Table 8❚Major Obstacles to Teaching Laboratory Management

Obstacle % of Programs

Lack of faculty time 56Lack of resident interest 54Lack of evaluation tools 50Lack of resident time 46Not enough faculty to cover the subjects 41Lack of faculty interest 39Lack of resources 33Other 7

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The most common measure of effectiveness ❚Table 11❚ was performance on the ASCP RISE (Resident In-Service Examination) examination (85%), followed by an evaluation of the ability to perform assigned management-related respon-sibilities during a rotation (51%), completion of a project (35%), the use of a follow-up postgraduate survey (23%), fol-low-up survey of employers (5%), and the use of a dedicated course with a final examination (4%). Of the respondents, 8 indicated that they had no formal evaluation process or tool.

Question 14

Choose the setting(s) which best describes your training program.

Not unexpectedly, the most common training environ-ment is in academic centers (40), followed by community hospital–based training programs (14). One respondent also indicated it had an affiliated independent commercial labora-tory. Another respondent also described itself as a university in a large multisite private hospital system.

Question 15

How many accredited residency positions does your program have?

The range in residency program size was from 8 to 38 residents. The mean size was 18, the median was 16, and the mode was 12 residents.

Question 16

How many residents does your program typically have in each of the following tracks?

For respondents whose program has an AP track only, 39% indicated that they had 1 to 5 residents in this track, with 8% indicating 6 or more. Similarly, for programs with a CP track only, 26% indicated 1 to 5 residents in this track, with 8% indicating 6 or more. One could infer from the responses that about 54% and 67% of programs do not have an AP-only or a CP-only track, respectively. Within the AP/

CP track, 35% had 16 to 20 residents, followed by 31% with 11 to 15, and 19% with more than 20 residents.

Question 17

What questions would you like us to ask or ideas would you like us to present during the APC/PRODS workshop “Moving Toward Solutions: Lab Management Training for Residents”?

Several common themes emerged from this free-form question. The most common request was for help with cur-riculum development and standardization (9 responses), followed closely by creating interest in/appreciation of man-agement activities (for trainees and faculty) (8 responses), devise meaningful experiential activities in management (5 responses), teaching methods and tools (4 responses), and the creation of assessment tools for measuring effectiveness (3 responses).

Results From the Workshop Discussion and Work Group Efforts

A PRODS workshop discussion was held at the APC meeting on July 15, 2009. Feedback received as a result of the report of this Working Group to the APC/PRODS, July 14-15, 2010, was incorporated into refinement of the curriculum. Hyperlinks in the curriculum are intended to provide access to more detailed content for the curriculum’s subject matter. The wiki was transferred to the ASCP for maintenance, user input designs, and deployment as an accessible Web site endorsed by APF, ASCP, and PRODS (www.lab-management.info).

Discussion

The initial PRODS survey and workshop discussion pro-duced several important, recurring themes. The importance of how best to deliver content, and, in turn, effectively foster needed skills development was a dominant theme. Several participants debated the value of time spent in didactic pre-sentations as compared with meaningful practical exercises and experiences. Providing opportunities as “assistant medi-cal directors” or “junior laboratory directors” was offered by several as examples of complex, longitudinal experiences over a broad array of management issues. These experiences serve to reinforce didactic presentations on management top-ics. The challenge pointed out in implementing these experi-ences is the inconsistency between how programs define the responsibilities of these roles and in the mentorship given by the faculty and management staff to facilitate them. Very good communication among the resident, the faculty, and the

❚Table 11❚Evaluation Tools Most Commonly Used

Tool % of Programs

Performance on the ASCP Resident In-Service 85 Examination Evaluation of ability to perform assigned tasks 51 within a rotation Completion of a project 35Follow-up postgraduate survey 23Follow-up survey of employers 5Dedicated course with final examination 4

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Acknowledgment: We thank Stephen Black-Schaffer, MD, Department of Pathology, Massachusetts General Hospital, Boston, for assistance with the development and distribution of the survey questionnaires.

* The APF, ASCP, and PRODS Work Group Members are as follows: Brian Datnow, MD, Department of Pathology, University of California, San Diego; Peter A. Dysert, MD, Department of Pathology, Baylor University Medical Center, Dallas, TX; Kedar V. Inamdar, MD, Department of Pathology, Henry Ford Hospital, Detroit, MI; Karen L. Kaul, MD, PhD, Department of Pathology, NorthShore University HealthSystem, Chicago, IL; Scott A. Kirkley, Department of Pathology, University of Rochester Medical Center, Rochester, NY; Jerald E. Mullersman, MD, PhD, Department of Pathology, East Tennessee State University, Johnson City; Susan D. Roseff, MD, Department of Pathology, Virginia Commonwealth University, Richmond; Constance A. Stanton, MD, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC; Christopher P. Stowell, MD, PhD, Department of Pathology, Massachusetts General Hospital, Boston; Enrique Terrazas, MD, Department of Laboratory Medicine, University of California, San Francisco; and, Dani S. Zander, MD, Department of Pathology, Penn State College of Medicine/Penn State M. S. Hershey Medical Center, Hershey, PA.

References

1. Horowitz RE. The successful community hospital pathologist: what it takes. Hum Pathol. 1998;29:211-214.

2. Horowitz RE. Expectations and essentials for the community practice of pathology. Hum Pathol. 2006;37:969-973.

3. Brugnara C, Fenton T, Winkelman JW. Management training for pathology residents, I: results of a national survey. Am J Clin Pathol. 1994;101:559-563.

4. Kass ME, Crawford JM, Bennett B, et al. Adequacy of pathology resident training for employment: a survey report from the Future of Pathology Task Group. Arch Pathol Lab Med. 2007;131:545-555.

5. Brimhall BB, Wright LD, McGregor KL, et al. Critical leadership and management skills for pathology practice. Arch Pathol Lab Med. 2007;131:1547-1554.

6. Talbert ML, Ashwood ER, Brownlee NA, et al. Resident preparation for practice: a white paper from the College of American Pathologists and Association of Pathology Chairs. Arch Pathol Lab Med. 2009;133:1139-1147.

7. Burke MD, Lundberg GD, Nuzzo J, et al. Special report: ASCP Colorado Springs Conference: the future content and structure of residency training in pathology. Am J Clin Pathol. 1990;93:706-711.

8. Burke MD, Nuzzo J, Prichard RW. ASCP Colorado Springs Conference IV: clinical pathology residency curriculum reform. Am J Clin Pathol. 1993;100(4 suppl 1):S7-S14.

9. Conjoint Task Force on Clinical Pathology Residency Training Writing Committee. Graylyn Conference Report: recommendations for reform of clinical pathology residency training. Am J Clin Pathol. 1995;103:127-129.

10. Association of Directors of Anatomic and Surgical Pathology. Curriculum content and evaluation of resident competency in anatomic pathology: a proposal. Am J Clin Pathol. 2003;120:652-660.

staff is necessary for these arrangements to work effectively. If constructed well and managed effectively, most if not all rotations in the residency can provide management learning opportunities. Finally, a one-size-fits-all approach will not work for every resident. It is critical to match knowledge and skills development to not only resident needs and interests but also program resources, including faculty expertise.

An important outcome of this more than year-long effort was the development and deployment through APC/PRODS, the APF, and the ASCP of a consensus curriculum guideline on laboratory management training. The incorpo-ration of this curriculum into a dynamic tool—the wiki—is intended to serve as an evolving tool and resource set for programs, faculty, and residents in practice and laboratory management training.

Why Today?The Work Group believed it important for residency

program directors to understand why the need for laboratory management training is even more important today than ever. That rationale is presented in a preamble to the curriculum. An excerpt from that document follows:

“If management, communication, and interpersonal skills have been important and lacking for the past few decades, despite efforts of residency program directors to enhance curricula with such training, why does this deserve additional attention now? Every organization that has looked at the future of pathology has reached similar conclusions. Today and in the future, even more than in the past, the profession needs practitioners who can exert their influence beyond the laboratory. The ASCP has conducted two task forces on the future of pathology. Among other things, these task forces have concluded that it is essential for pathologists to change the way in which we relate to patients, physicians, and the wider health care community, establishing ourselves as an indispensable source of information and guidance. In similar language, the CAP’s Transforming Pathologists ini-tiative stresses the importance of repositioning pathologists as the center of the health care team. Clearly, the future of the profession depends on just those skills that pathologists seem to be lacking, at least as they emerge from their gradu-ate medical education.”

From the 1Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City; 2Department of Pathology, University of Michigan, Ann Arbor; 3American Pathology Foundation, Laguna Beach, CA; and 4American Society for Clinical Pathology, Chicago, IL.

Presented in part at the 2010 Annual Meeting of the Association of Pathology Chairs; July 14-16, 2010; Seattle, WA.

Address reprint requests to Dr Weiss: Dept of Pathology, ARUP Laboratories, University of Utah, 500 Chipeta Way, Salt Lake City, UT 84108.

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15. Farnsworth RJ, Weiss RL. A mentor-based laboratory management elective for residents. Am J Clin Pathol. 1999;111:156-160.

16. Horowitz RE, Naritoku W, Wagar EA. Management training for pathology residents: a regional approach. Arch Pathol Lab Med. 2004;128:59-63.

17. Hemmer PR, Karon BS, Hernandez JS, et al. Leadership and management training for residents and fellows: a curriculum for future medical directors. Arch Pathol Lab Med. 2007;131:610-614.

11. Smith BR, Wells A, Alexander CB, et al. Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Am J Clin Pathol. 2006;125(suppl 1):S3-S37.

12. Weiss RL. A clinical laboratory management elective for pathology residents. Arch Pathol Lab Med. 1992;116:108-110.

13. Winkelman JW, Brugnara C. Management training for pathology residents, II: experience with a focused curriculum. Am J Clin Pathol. 1994;101:564-568.

14. Sims KL, Darcy TP. A leadership-management training curriculum for pathology residents. Am J Clin Pathol. 1997;108:990-995.

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Teaching Laboratory Management to Pathology Residents

What Skill Set Are We Trying to Impart?

Michael Laposata, MD, PhD

DOI: 10.1309/AJCPOKS9MGHW9UTJ

The article by Weiss and colleagues1 on a consensus curriculum for laboratory management training for pathol-ogy residents provides much useful information about a long-standing challenge. Their report states where we are as a field in laboratory medicine with regard to education on management issues. The data in the article now beg the answers to 2 questions: “What do we do with these answers?” and, more fundamentally, “What are we trying to achieve by teaching laboratory management to pathology residents?”

Having been in the field of laboratory medicine as a clinical laboratory director for the past 26 years at the University of Pennsylvania (Philadelphia), the Massachu-setts General Hospital/Harvard Medical School (Boston), and Vanderbilt University School of Medicine (Nashville, TN), I have made several attempts to develop for residents a management training program that is truly effective. A successful training experience would be one about which the residents are enthusiastic learners and from which they develop measurable management skills that are more than just common sense; and the program should stand the test of time by improving continuously year after year. In the time that I have been working in the field, I have developed with my colleagues a lecture series on management topics, a management rotation, brief projects related to clinical labo-ratory management, and even a lecture series in operations management taught by instructors from a local business col-lege. For all the projects for which I can claim some measure of success in my career, none of my attempts to teach man-agement to pathology residents has stood the test of time. I believe that the data collected by Weiss and colleagues1 help us understand this difficulty.

My personal lack of success as a pathology educator on management training notwithstanding, there are many reports from those actively engaged in pathology resident education that include laboratory management as an essen-tial component of training, referencing here only several of many, and a number of those describe in detail a manage-ment training experience.2-7

Consider the following highlights of the data in the article by Weiss et al,1 and keep in mind that in most of the following examples, a major problem is related to the lack of a widely accepted definition of what constitutes laboratory management.

In Table 11 on the time dedicated to lectures on labora-tory management and the frequency of exposure to manage-ment topics during training, 28% of the programs said more than 40 hours of lecture on these topics occurred during the course of the residency. Forty hours is an average of about 10 hours per year or less than 1 hour per month. No one would reasonably ask someone to be in charge of a multimillion dol-lar operation of any kind, with more than 100 employees, after less than 1 hour per month of formal training on how to do it effectively. It was reported in a survey of pathology residents from the Massachusetts General Hospital that 8 weeks of full time training in each individual area of laboratory medicine is required for the resident to have confidence in providing clinical consultation.8 Even with only 50 resident work hours per week on a clinical laboratory rotation, for 8 weeks, this amounts to 400 hours of experience to gain minimal compe-tence for clinical skills. Is only 10% of that required to gain sufficient competence in management to meaningfully discuss problems with colleagues? This highlight also reminds us that it is subjective to determine what constitutes topics in

Reprinted from AMERICAN JOURNAL OF CLINICAL PATHOLOGYVol. 137, No. 1, January 2012. Copyright © 2012by American Society of Clinical Pathologists, Inc. Printed in U.S.A.

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laboratory management. For example, is a lecture on the sen-sitivity and specificity of a laboratory assay for the diagnosis of a specific clinical condition included in laboratory manage-ment because it does not fall into a topic list of lectures for an individual clinical laboratory?

In Table 21 on the amount of time residents experienced a “junior laboratory directorship,” it is not clear what man-agement roles are fulfilled by a junior laboratory director. I would argue that solving anything except the most trivial management issues in a complex clinical laboratory requires a person with a significant skill set, one that few residents have at the time they are serving as junior laboratory directors. I believe it is easier for residents to make informed clinical rec-ommendations on questions related to anatomic and clinical pathology than it is for them to make informed management recommendations. It would be most interesting to know if the authors obtained any information from the responders to the survey about what management decisions fall to the junior laboratory director.

In Table 31 on when laboratory management is taught during the residency, 15% of the programs indicated that it is taught during clinical pathology rotations and 0% reported that it is taught in anatomic pathology rotations. First, this point highlights that diagnostic knowledge acquisition in anatomic pathology is the primary goal, to the point where management training is completely omitted. This finding also makes a clear point that laboratory management training is considered completely dispensable for pathologists who train only in anatomic pathology. Second, these data raise the ques-tion of when the management training occurs in the programs that failed to respond to this question (85% of programs sur-veyed), since our programs are largely anatomic and clinical pathology rotations.

In Table 41 on the 10 most common laboratory manage-ment topics covered, quality assurance is the most common answer. From my own experience, this often means allowing residents to attend quality assurance meetings without any need for their active participation. Other common topics in Table 4 were laboratory inspections and regulatory affairs and accreditation. This frequently involves inclusion of residents in some way in a laboratory inspection preparation or actual performance of an inspection. It is commonly a 1- or 2-time event during training. Another common topic in Table 4 was resident participation in test validation. After years of educating pathology residents, I have found that most new pathology resident graduates are unable to navigate a step-by-step validation of a new test, even in its simplest form. This raises the possibility that for all of these exposures, sufficient management skills for use in the actual workplace are not gained during training and that the exposures are provided primarily to give the residents an awareness of the issues.

In Table 71 on the titles and specialties of the people who teach laboratory management, it is revealing that a large per-centage of management teaching in many institutions is done by a pathologist. However, according to the data in Table 81 on major obstacles to teaching laboratory management, this teaching pathologist does not have the time or evaluation tools or the interest or willingness among his or her residents to accomplish this task. Residents frequently comment that if the questions are on the pathology board examination, they will be necessarily interested in it because they need to know the material, but they largely remain uninterested in manage-ment topics. One possible reason is that many who have taken the pathology board examination have claimed that correctly answering the management questions requires mostly com-mon sense and not specific facts about the management of a clinical laboratory.

So should this be a matter of concern to us as patholo-gists? Is it wise to expose residents during residency to man-agement issues without making them competent to actually perform them? If yes, that means we must recognize that we are educating residents to fulfill a supportive role in laboratory management and that a respectful partnership with a labora-tory administrator, often formally trained in finance, human resources, and other related topics, is essential.

What about our nonpathologist colleagues who have laboratories or procedural suites to manage?

If we consider what happened to radiology, our sister diagnostic discipline, in the early 1980s, the new imaging modalities redirected the radiologists’ activities to interpre-tation of the imaging studies. The management of patients and resources in radiology became almost exclusively the property of administrators, or technical or operational direc-tors as they are called in some institutions, many of whom have months to years of formal training in clinical operations. One major reason for the satisfaction of radiologists with this virtually complete focus on image interpretation, presumably, is that radiologists have been paid well for clinical interpreta-tions of the imaging studies, but barely compensated, if at all, for management activity related to radiology services.

The same is true for clinical services that have a large procedural component. It is usually an administrator and not a clinician who has the primary responsibility for developing an endoscopy suite for the gastroenterologists. The gastroenter-ologists are consulted, but the largest part of the effort is usu-ally made by a nonphysician. Radiology and gastroenterology are 2 fields, among most others, that have moved most or all of their physicians almost exclusively into clinical activities and away from management of operations.

Even more relevant to pathology trainees, there are labo-ratory management needs from anatomic pathologists, such as directorship of the histopathology laboratory. However, even though many of the same skills are required for management

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of clinical pathology and anatomic pathology laboratories, anatomic pathology training is, in most institutions, almost exclusively focused on gross and microscopic pathology rath-er than management. Recall that the data from the report by Weiss et al1 indicated that there was 0% of time in anatomic pathology rotations for management activities.

It is also necessary to consider the fact that training in clinical pathology in toto, not just for topics in laboratory management, is largely observational without any indispens-able clinical service activity for residents, unlike what occurs in anatomic pathology in most institutions. In clinical pathol-ogy, most residents watch a thrombin time being performed but are rarely taught how a thrombin time is used in the diag-nosis of dysfibrinogenemia. In a recent study reported in CAP Today by Hoffman,9 at Vanderbilt University School of Medi-cine, who was seeking to determine the actual consultative activity of residents in clinical pathology training programs, the majority of the training programs he contacted refused to discuss the actual consultative activity of their residents or said they had nothing to show him with regard to clinical activities of residents in clinical pathology rotations. If we are not yet teaching residents in clinical pathology how to make a diagnosis using laboratory test results, is it premature to develop introductory training in laboratory management when the core consultative skills are not yet in place?

So the major question that emerges with the publication of these important data is that with 40 hours during an entire residency on laboratory management training, could we pos-sibly entrust a graduating trainee to manage employees and a measurable percentage of the hospital’s budget? Certainly if a graduating pathology resident undertook further edu-cational experiences in hospital administration or business administration, that person would be highly qualified for such a role. Many commercial clinical laboratory leaders and pathologist directors of large outreach programs at aca-demic medical centers have invested in such additional train-ing. However, more than 99% of pathologists do not pursue training in administration. Are we trying to groom them for a role in which they are a knowledgeable partner to a formally

trained person in management, or are we actually expecting graduating residents with 40 hours of training in 4 years to manage a clinical operation where incorrect answers can directly lead to adverse patient outcomes? Establishing the goals for management training during pathology residency should come first—and it seems like there is much uncer-tainty among pathologists about what the goals should be.

From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN.

References 1. Weiss RL, McKenna BJ, Lord-Toof M, et al. A consensus

curriculum for laboratory management training for pathology residents. Am J Clin Pathol. 2011;136:671-678.

2. Burke MD, Lundberg GD, Nuzzo J, et al. Special report: ASCP Colorado Springs Conference: the future content and structure of residency training in pathology. Am J Clin Pathol. 1990;93:706-711.

3. Kass ME, Crawford JM, Bennett B, et al. Adequacy of pathology resident training for employment: a survey report from the Future of Pathology Task Group. Arch Pathol Lab Med. 2007;131:545-555.

4. Conjoint Task Force on Clinical Pathology Residency Training Writing Committee. Graylyn Conference Report: recommendations for reform of clinical pathology residency training. Am J Clin Pathol. 1995;103:127-129.

5. Smith BR, Wells A, Alexander CB, et al. Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Am J Clin Pathol. 2006;125(suppl 1):S3-S37.

6. Laposata M. What we are doing or should be doing in clinical pathology. Am J Clin Pathol. 1996;106:571-573.

7. Weiss RL. A clinical laboratory management elective for pathology residents. Arch Pathol Lab Med. 1992;116:108-110.

8. Kirby JE, Laposata M. The nature and extent of training activities in clinical pathology required for effective consultation on laboratory test selection and interpretation. Arch Pathol Lab Med. 1997;121:1163-1167.

9. Hoffman RD. In CP training, are we teaching consultation? CAP Today. August 2011.

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Correspondence

c o r r e s p o n d e n c e

676 Am J Clin Pathol 2012;137:676-678 © American Society for Clinical Pathology

Teaching Laboratory Management

DOI: 10.1309/AJCPLS8CTCWCNHIY

To the EditorWe read, with interest and appreciation, the recent

editorial “Teaching Laboratory Management to Pathology Residents: What Skill Set Are We Trying to Impart?” by Laposata1 and agree with the 2 important questions that he posed: “What do we do with these answers?” and “What are we trying to achieve by teaching laboratory management to pathology residents?”

Although there is no widely accepted definition of laboratory management, the consensus curriculum (see http://www.lab-management.info) developed through a collaboration among the Association of Pathology Chairs Program Directors Section (PRODS), the American Pathology Foundation (APF), and the American Society for Clinical Pathology (ASCP) is based on the following conceptual framework: “Laboratory Management is the integration and coordination of organizational resources (people, equipment, procedures, supplies) to provide quality laboratory services as efficiently (financially, operationally) and effectively (patient outcomes-oriented, safely) as possible. Success requires a vast array of skills founded on sound principles of management science” (emphasis added).”

In the preface to a recent textbook on laboratory administration for pathologists, the editors focus on “the specific role and responsibility of the pathologist in directing the laboratory.”2 Neither that textbook nor the consensus curriculum we have developed are intended to turn pathologists into accountants, financial officers, operational managers, human resource managers, lawyers, or purchasing managers. As Laposata1 correctly points out, effective pathologist leaders are successful because of their ability to be “a knowledgeable partner to a formally trained person in management” to reach the service goals of their health care institutions. We believe that this consensus curriculum can foster this kind of successful relationship. Four years of anatomic pathology/clinical pathology training should allow a trainee to become a competent general pathologist. The ability to handle complex subspecialty-oriented patient care usually requires additional fellowship training and experience. Similarly, a trainee with a general knowledge of laboratory management would not be expected to step into a leadership role in a

“multimillion dollar operation” without additional training and/or experience.

We also do not believe that 40 hours of training over 4 years will make us into competent administrators; that was just the average time allotted by the responding programs.3 What is important is that whatever time is assigned to training in laboratory management, the training is based on a thoughtfully developed curriculum that is delivered effectively with the object being to “give the residents an awareness of the issues.” Our goal should be to establish a foundation of general knowledge, vocabulary, and some practical experience on which a graduate, with appropriate mentorship, can continue to learn and grow into an effective laboratory leader. Most successful leaders have relied on effective mentors, including those who are laboratory professionals, and other physicians and health care professionals outside of the laboratory. As we pointed out in our analysis, many of our training programs lack sufficient faculty time and expertise to better provide such mentorship.

The pathologist of the future is one who can integrate medical knowledge with the resources of the anatomic and clinical pathology laboratories to deliver value-based patient care services that promote optimal patient outcome and safety. Pathologists are in the best position, if they choose to be, to not only guide the use and interpretation of ever more sophisticated laboratory tools but also to influence, as a member of an administrative team, the availability and quality of those tools. To Laposata’s1 point, effective “core consultative skills” should mean how to interpret and use laboratory tests. Our residents must first understand what the test results mean, as diagnosticians, but they then must be able to guide others in the most clinically and cost-effective use of those tests. They are being, in that latter role, effective “administrative” guardians of costly and limited resources (clinically effective utilization management). Our duty as mentors and educators of our residents is to see that they can function effectively in this dual role.

The laboratory management consensus curriculum found at http://www.lab-management.info is intended to be one resource guide in this effort, but not the only guide. In

Reprinted from AMERICAN JOURNAL OF CLINICAL PATHOLOGYVol. 137, No. 4, April 2012. Copyright © 2012 by American Society of Clinical Pathologists, Inc. Printed in U.S.A.

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Correspondence

Am J Clin Pathol 2012;137:676-678 677© American Society for Clinical Pathology

3. Weiss RL, McKenna BJ, Lord-Toof M, et al; and the Working Group Members. A consensus curriculum for laboratory man-agement training for pathology residents. Am J Clin Pathol. 2011;136:671-678.

References 1. Laposata M. Teaching laboratory management to pathology

residents: what skill set are we trying to impart? Am J Clin Pathol. 2012;137:16-18.

2. Wagar EA, Horowitz RE, Siegal GP, eds. Laboratory Administration for Pathologists. Northfield, IL: CAP Press; 2011.

its wiki format, it can become a backbone on which many in the pathology and laboratory medicine community can “hang” useful training tools and make resources available to all who seek greater understanding or who want to help others (residents in particular) become more aware of management issues to be faced in future practice.

Ronald L. Weiss, MD, MBA, FASCPPathologyUniversity of Utah School of MedicineSalt Lake CityOn behalf of the APF, ASCP, and PRODS Work Group Members

Association of JAK2 Mutation Status and Cytogenetic Abnormalities at Diagnosis in Myeloproliferative Neoplasms and Myelodysplastic/Myeloproliferative Neoplasms

DOI: 10.1309/AJCP74TSVUHHAJFX

To the EditorWe read with great interest the contribution by Dunlap

et al.1 They correlated cytogenetic abnormalities with disease stage and JAK2 status in a series of 179 cases of myeloproliferative neoplasms and myelodysplastic/myeloproliferative neoplasms (MPNs and MDS/MPNs).

It is well known that MPNs are clonal hematopoietic stem cell disorders characterized by proliferation of 1 or more myeloid lineages, and MDS/MPNs include clonal myeloid neoplasms that at the time of initial presentation have some clinical, laboratory, or morphologic characteristics that support the diagnosis of MDS, and others are more consistent with MPN.2 In these neoplasms, cytogenetic abnormalities are found in about 20% of cases at diagnosis, a little bit higher if fluorescence in situ hybridization is used, and this percentage increases considerably with progression of the disease.2-5 On the other hand, the discovery of JAK2V617F mutations facilitates the diagnosis of these neoplasms owing to it being found at high frequency (50%-95% MPNs and <10%-60% MDS/MPNs).2

Dunlap et al1 reported cytogenetic abnormalities in 51% of JAK2+ cases and 27% of JAK2– cases, with an overall frequency of 38%. This high rate of cytogenetic alterations can be explained because they have an important number of patients with more advanced disease referred to their institution for intensive treatment, including bone marrow transplantation. As expected, when correlating their results with the stage of the disease, the frequency of cytogenetic abnormalities continuously increased from a nonfibrotic stage to marrow fibrosis and to blastic transformation/excess blasts regardless the JAK2 mutation status.

In our opinion, if the study had been done in patients at diagnosis, the results would have been different. For this

reason, we reviewed the cases studied for JAK2 mutation in our institution in the last 10 years. A total of 190 cases of MPNs and MDS/MPNs were analyzed for the JAK2 mutation at diagnosis. Among them, cytogenetic data were available for 89 cases (66/135 JAK2+ and 23/55 JAK2–). The JAK2+ group showed a similar number of cytogenetic abnormalities as the JAK2– group (7/66 vs 2/23; P = .649; ❚Table 1❚ and ❚Table 2❚). As the frequency of cytogenetic alterations at diagnosis was low, no other correlation with clinical or

❚Table 1❚Association of JAK2 Mutation Status With Cytogenetic Abnormalities*

Cytogenetic Study

Abnormal Normal No Mitosis Total

JAK2V617 mutation 7 (78) 46 (77) 13 (65) 66 (74)JAK2 wild-type 2 (22) 14 (23) 7 (35) 23 (26)Total 9 60 20 89

* Data are given as number (percentage).

❚Table 2❚JAK2 and Cytogenetic Data From Patients With Abnormal Karyotypes

Case JAK2 Mutation Karyotype FromNo. Classification Status Altered Clone

6 PMF V617F+ 46,XX,der(7)t(1;7)(q10;p10)18 ET V617F+ 45,X,–Y22 ET V617F+ 46,XY,t(7;16)(q22;q13)54 ET V617F+ 48,XX,+8,+960 ET Wild-type 46,XX,del(7)(q22)69 ET V617F+ 46,XX,del(20)(q11)108 PMF Wild-type 47,XY,+8

ET, essential thrombocythemia; PMF, primary myelofibrosis.

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