Surgical Pathology Fellow, Fox Chase Cancer Center, Omar Habeeb, MD She is the founding chair of a multi-institutional consortium, the Cyto-Heme Interinstitutional Collaborative, which brings together hematopathologists, cytopathologists, and oncologists to optimize the benefits of small volume biopsy to lymphoma patients. Proposed Hematopathology Fellowship Entrustable Professional Activities. Overview. A housing allowance of $7,200 (paid monthly at $600) per year is also provided. Entrustable professional activities (EPAs) were formally conceptualized in 2005 by Olle ten Cate, who defined EPAs as units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence.1 The distinction between an EPA, whereby the work unit is described, and competency, whereby ones ability is described, is critical: Evaluating a trainees overall abilities is subjective and prone to comparative-based judgments, whereas evaluating whether a task was performed adequately or not is a more objective decision that can be made in the context of a discrete, granular interaction at a specific point in time. Your IP: Research electronic data capture (REDCap)a metadata-driven methodology and workflow process for providing translational research informatics support, The REDCap consortium: building an international community of software platform partners. The connections between EPAs and the ACGME Milestones may be of particular interest to educators in hematopathology fellowship programs. Fellows will have the opportunity to participate in tumor boards, to attend grand round lecture series and regional pathology society meetings, and to submit abstracts to a national pathology or hematology society conference. The Department of Pathology and Cell Biology offers a one-year ACGME-accredited fellowship in Hematopathology, designed to provide eligibility for the American Board of Pathology subspecialty examination in hematopathology. In an attempt to elicit potential EPAs, we asked our respondents to identify professional tasks and responsibilities they give their fellows feedback on during fellowship, and of these, which they would consider EPAs. Application of these entrustable professional activities in program design, fellow evaluation, and decisions regarding level of supervision is discussed with consideration of benefits and barriers to implementation. 2. Residency: Stanford University School of Medicine, Lisa McGinnis, MD government site. A model formative assessment for EPA 1 (guide selection of diagnostic tests and triage and allocate specimens for ancillary studies) is presented as Table 12. Consult on management of heparin, direct thrombin inhibitors, anti-Xa inhibitors, Medical Knowledge 1, 2, and 6: Interpretation of hematology and coagulation testing, clinical reasoning in hematopathology and hematology, Systems Based Practice 3 and 5: Physician role in health care system, utilization, Provide guidance on appropriate testing based on the clinical question and specimen and test characteristics, Troubleshoot discrepant/unusual/unreportable results and provide recommendations to laboratory staff and/or ordering provider, Develop laboratory protocols/procedures for commonly occurring test issues, Appropriate indications, technical requirements and techniques for routine and special hematology testing, special testing, flow cytometry immunophenotyping, cytogenetics, fluorescence in situ hybridization, immunohistochemistry, single and panel molecular testing, coagulation studies, Troubleshoot and provide guidance on effects of interfering substances (eg, elevated bilirubin, hyperlipidemia, cryoglobulins, anticoagulation medication) on automated hematology and coagulation testing, Evaluate automated hematology analyzer flagging criteria, manual differential/pathologist review criteria, Detect and resolve platelet clumping (pseudo-thrombocytopenia), Patient Care 1 and 4: Interdisciplinary consultation, specimen handling and triaging, Medical Knowledge 4 and 5: Selection of molecular and cytogenetics testing and interpretation of reports, clinical reasoning in hematopathology and hematology, Systems-Based Practice 3 and 5: Physician role in health care system, utilization, Interdisciplinary communication and presentation skills, Able to state and support degree of confidence of diagnosis, and specify additional studies that could clarify the diagnosis, Pathologic features that inform staging, prognostication, or prediction of treatment response, Ongoing clinical trials at institution that may require additional ancillary studies or reporting of specific features, Actively participate in multidisciplinary tumor boards, Present at morbidity and mortality conferences, Systems-Based Practice 2: Systems navigation for patient-centered care, Identify and evaluate potential safety/quality issues in the hematopathology service/hematology laboratory and propose changes as needed, Maintain appropriate and up-to-date hematology laboratory testing menus, flow cytometry panels, immunohistochemical stains, and fluorescence in situ hybridization and molecular tests if appropriate (in-house and reference testing), Apply root cause analysis and performance improvement tools (Lean, Six Sigma, Plan Do Study Act cycle) to the hematopathology service/hematology laboratory, Be aware of applicable hematology, anatomic pathology, and flow cytometry laboratory accreditation requirements, Stay up to date with new clinically relevant hematology tests and ancillary diagnostic tests, Monitor send out test request patterns to prioritize new hematology test or molecular tests for in house validation, Identify a recurring slide quality issue, communicate the issue to the appropriate section supervisor, and provide feedback on whether changes to workflow are satisfactory, Evaluate, choose, and validate a new hematology laboratory or hematopathology service test, instrument, or assay, such as an immunohistochemistry assay or flow cytometry panel, Participate in proficiency testing and sign off on protocol changes in the hematology lab, such as coagulation test, flow cytometry, or immunohistochemistry, Systems Based Practice 1, 2, 3, and 4: Patient safety and quality improvement, systems navigation for patient-centered care, physician role in health care system, accreditation, compliance, and quality, Interpersonal and Communication Skills 1, 2, and 3: Patient and family-centered communication, interprofessional/team communication, communication within health care systems, Provide informed consent, administer local anesthetic, identify correct needle placement, sterile technique, identify bone spicules, document procedure, Collect and triage material for flow immunophenotyping, cytogenetic studies, and other studies in appropriate media as clinically indicated, Components of informed consent, collection requirements for ancillary testing, anatomy/landmarks of the posterior superior iliac crest, appropriate postprocedural care, Diagnostic bone marrow biopsy and aspirate in a patient with unexplained cytopenias, with material sent for cytogenetics and flow immunophenotyping, Patient Care 3 and 4: Bone marrow aspiration and biopsy, specimen handling and triaging, Medical Knowledge 6 (levels 1-3): Clinical reasoning in hematopathology and hematology, Interpersonal and Communication Skills 1, 2, and 3: Patient- and family-centered communication, interprofessional and team communication, communication within health care systems, entrustable professional activities, hematopathology, fellowship, graduate medical education, entrustment, milestones, assessment, Entrustability of professional activities and competency-based training, A primer on entrustable professional activities. NOTE: PDF documents require the free Performance & security by Cloudflare. Additional Information If you do not pass the urine drug screening which includes testing for tobacco compounds, you CANNOT be appointed at MD Anderson. the contents by NLM or the National Institutes of Health. It is our hope that rather than being an additional burden, EPA-based assessment forms will become a chosen tool to provide concrete fellow feedback and inform entrustment and clinical competency committee decision-making. Learn more about the Hematopathology Fellowship program at Loyola Medicine. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. This website is using a security service to protect itself from online attacks. Recognizes when tissue or sample is limited, b. The HEWG also coordinated with concurrent updating of the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Hematopathology Fellowship to version 2.0. Dita Gratzinger, Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA. Hematopathology Entrustable Professional Activity 1: Guide Selection of Diagnostic Tests and Triage and Allocate Specimens for Ancillary Studies. Dr. Gratzinger received her B.A. Email: jeanoak@stanford.edu, Rachael Buenafe-Jacinto Entrustable professional activities are not a panacea to the challenges of modern medical education. Dr. Jason Kurzer, MD is a hematology specialist in Stanford, CA. 4. https://orcid.org/0000-0001-5581-8561, Dita Gratzinger We would like to acknowledge Laura Edgar, EdD, CAE Vice President, Milestones Development, Accreditation Council for Graduate Medical Education (ACGME) and Sydney McLean, MHA, ACGME Milestones Project Manager, for their assistance and willingness to let us use the ACGME Hematopathology Fellowship Milestones version 2.0 as a reference while it was still a work in progress. This complexity is in competition with the need for timely hematopathology care with stewardship of patient, laboratory, and societal resources. 3624 Market Street Phone: (301) 480-8465 The Hematopathology Section collaborates with the Clinical Services of the NCI, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases in both clinical management and research. 1515 Holcombe Blvd., Unit 0072 Co-Director, Hematopathology Fellowship Program 1Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA, 2Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 3Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA, 4Department of Pathology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA, 5Department of Pathology and Cell Biology, Columbia University, New York, NY, USA, 6Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA, 7Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA, 8Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA, 9Stanford University School of Medicine, Stanford, CA, USA, Supplemental Material, sj-pdf-1-apc-10.1177_2374289521990823 for Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal by Kristie White, Julianne Qualtieri, Elizabeth L. Courville, Rose C. Beck, Bachir Alobeid, David R. Czuchlewski, Julie Teruya-Feldstein, Lorinda A. Soma, Sonam Prakash and Dita Gratzinger in Academic Pathology, Supplemental Material, sj-pdf-2-apc-10.1177_2374289521990823 for Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal by Kristie White, Julianne Qualtieri, Elizabeth L. Courville, Rose C. Beck, Bachir Alobeid, David R. Czuchlewski, Julie Teruya-Feldstein, Lorinda A. Soma, Sonam Prakash and Dita Gratzinger in Academic Pathology, Supplemental Material, sj-pdf-3-apc-10.1177_2374289521990823 for Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal by Kristie White, Julianne Qualtieri, Elizabeth L. Courville, Rose C. Beck, Bachir Alobeid, David R. Czuchlewski, Julie Teruya-Feldstein, Lorinda A. Soma, Sonam Prakash and Dita Gratzinger in Academic Pathology, Supplemental Material, sj-pdf-4-apc-10.1177_2374289521990823 for Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal by Kristie White, Julianne Qualtieri, Elizabeth L. Courville, Rose C. Beck, Bachir Alobeid, David R. Czuchlewski, Julie Teruya-Feldstein, Lorinda A. Soma, Sonam Prakash and Dita Gratzinger in Academic Pathology. Associate Program Director, Pathology Residency Training (AP). Before A modified mini-Delphi approach68 was used. Triage cerebrospinal fluid or fine needle aspiration/core biopsy material to appropriate diagnostic assays, including morphology (cytologic or cell blocks), flow cytometry immunophenotyping, cytogenetic and molecular analysis. UAMS was ranked seventh in the nation on the Forbes Magazine's Best Employers for Diversity list in 2020. The survey was deemed to be exempt by the Stanford University School of Medicine Institutional Review Board. Email:jeanoak@stanford.edu, Krista Tanquary Exposure to all aspects of hematology, in addition to tissue-based diagnostic hematopathology, is provided by structured activities and rotations in different sections of clinicalpathology including routine and special hematology, coagulation, flow cytometry, molecular genetics, and cancer cytogenetics. An official website of the United States government. In addition, the fellow will gain exposure to molecular biology as it pertains to hematologic diseases. Fellows already competent at the resident level for analogous EPAs might be eligible for earlier entrustment based on faculty observations at the fellowship level. Accreditation Council for Graduate Medical Education Milestones provide a guidance document for hematopathology training, but fellows and their educators are in need of a simple framework that allows assessment and feedback of growth toward independent hematopathology practice. Fourth-year residents also may apply and use part of the fellowship to satisfy ABP requirements. Should a trainees schedule be modified, either in duration or content, to ensure they achieve independent practice of EPAs before matriculation? 99, Entrustable professional activities in health care education: a scoping review, Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study. Opens in a new window. Programs, departments, and specialties that have adopted EPAs have followed diverse strategies, and implementation among hematopathology fellowship programs will likely also differ according to specific program needs and assessment philosophies. ACGME indicates Accreditation Council for Graduate Medical Education; EPA, entrustable professional activity; HEWG, Hematopathology EPA Working Group. We would like to thank the Society for Hematopathology Educational and Executive committees for their expert input, particularly Dr Genevieve Crane and Dr Alexandra Kovach for their specific input. Fellows are encouraged to participate in faculty-led research projects or to develop research projects of your own. 185.146.23.99 Medical School: University of California, Los Angeles This survey also provided an opportunity to solicit information regarding additional resources to help programs implement EPAs and self-rated ability to rapidly identify learner deficiencies, a crucial activity that may benefit from EPA evaluation. Over time, when multiple formative assessments are available, the PD, rotation director, clinical competency committee member, and so on, can then synthesize the submitted formative assessments and create a summative evaluation for the EPA, such as that presented in Table 13. She also heads the Stanford hematopathology fellowship program and is leading an initiative to empower independence during hematopathology training through entrustable professional activities. Candidates must be Board eligible or certified in either anatomic pathology or anatomic and clinical pathology; combined training is preferred. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. In order to facilitate these objectives, we have provided a mechanism to assess EPAs via formative and summative assessment forms. Dr. Joshua Menke completed his hematopathology fellowship at Stanford and cytopathology fellowship at University of California San Francisco (UCSF). You are now leaving the NIH Clinical Center website. This form offers faculty a checklist of observed behaviors with respect to key skills encompassed in the EPA; in this example, skills include ordering a necessary and sufficient ancillary workup for diagnosis and clinical management, guiding stewardship of limited tissue, and managing appropriate test utilization. The site is secure. 1. The third mini-Delphi round resulted in consensus on the final list of proposed EPAs for hematopathology fellowship. An EPA-informed approach to program structure may provide needed balance to the workload-based approach that tends to dominate large, busy academic services. Providing test utilization consultation, including intervention in inappropriate test ordering, and identifying potential areas of test overutilization. Candidates must be Board eligible or certified in either anatomic pathology or anatomic and clinical pathology; combined training is preferred. My current areas of research focus on these areas. Oscar is an academic hematopathologist who completed anatomic and clinical pathology residency and hematopathology fellowship at Stanford in 2020. 10. Hematopathology Entrustable Professional Activity 6: Interpret Hematology/Coagulation Tests and Provide Consultation. Assumption of competency creates patient safety risks for fellows, their training programs, and future places of employment. Discuss inappropriate flow cytometry immunophenotyping orders with ordering provider. ACGME Milestone Systems-Based Practice 5: Utilization, Level 1: Identifies general hematopathology work practices and workflow, Level 2: Explains rationale for utilization patterns in own practice setting, Level 3: Identifies opportunities to optimize utilization of pathology resources, Level 4: Initiates efforts to optimize utilization, Level 5: Completes a utilization review and implements change, 4. Hematopathology Entrustable Professional Activity 2: Identify and Communicate Critical Values and Clinically Urgent Results. His interests include immunology, the pathogenesis and diagnosis of lymphomas, and global health. Select a flow immunophenotyping panel and compose an interpretive report. Systems-Based Practice 3 and 5: Physician role in health care system, utilization. If you have any questions please visit theStanford Medicine Graduate Medical Education(GME) and/or theCalifornia Medical Board websitefor more information. I am interested in the use of modern molecular techniques as a diagnostic aid as well as in providing prognostic information. In the second year, the majority of time is available for research. We serve a broad patient base at Stanford Health and Stanford Childrens Health, and also see cases submitted in consultation by pathologists and/or oncologists from many parts of the United States and abroad. Residency: Stanford University School of Medicine, Ashley Volaric, MD Harmonization of training, training requirements, board certification, and practice of hematopathology, https://creativecommons.org/licenses/by-nc-nd/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, sj-pdf-1-apc-10.1177_2374289521990823.pdf, sj-pdf-2-apc-10.1177_2374289521990823.pdf, sj-pdf-3-apc-10.1177_2374289521990823.pdf, sj-pdf-4-apc-10.1177_2374289521990823.pdf, https://www.acgme.org/Specialties/Milestones/pfcatid/18/Pathology, https://www.acgme.org/Specialties/Program-Requirements-and-FAQs-and-Applications/pfcatid/18/Pathology.
Massol Ave, Los Gatos,
Articles H