2016 GRIPE Meeting – San Diego

“What Any and Every Physician Should Know About Pathology and Laboratory Medicine”

Pre-Conference Workshop
Thursday, January 28, 2016

Pathology in Integrated Curricula – Strategies for Success and Survival (Presentation not available)
Sebastian Alston, MD

In medical schools throughout the country, discipline-based courses are being quickly replaced by integrated approaches. This trend has definitely included pathology. Although there are benefits associated with this trend and great opportunities for pathology education, there are also significant concerns. Such concerns include the identity of pathology, the amount of curricular time, and the availability of resources. This workshop will feature discussions of these aspects based on the experiences of participants and on available literature and other resources. Potential individual and collective strategies that can maximize the curricular rewards and minimize the concerns/risk will be recognized and developed during the workshop.

Plenary Session
Friday, January 29, 2016

Making Sense of Competencies, EPAs, and Mastery Learning
Carol A. Aschenbrener, MD

This session will focus on the relationships among competencies, EPAs, learning objectives and mastery learning and the implications of those relationships for the formation of physicians across the continuum of learning. Examples will focus on the potential linkages between the “Consensus Guidelines for Practical Competencies in Anatomic Pathology and Laboratory Medicine” for medical students and the Core EPAs for Entering Residency. There will be opportunity for dialogue about the role that academic pathology might play in integrating the competency framework toward creation of a true continuum of learning. The session will begin with a brief team learning experience based on a pre-reading (Englander RE, Cameron T, Ballard AJ, Dodge J, Bull J & Aschenbrener CA: Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med 88: #8, Aug 2013, 1088-1094).

Reference Handout

Concurrent Workshops
Friday, January 29, 2016

Incorporation of Core Entrustable Professional Activities for Entering Residency
Amy Lin, MD

The Association of American Medical Colleges (AAMC) recently published a set of 13 core entrustable professional activities (EPAs) for entering residency. These are work activities that an intern on day 1 should be able to perform without direct supervision. Ten medical schools were selected as part of a pilot project with a primary goal of demonstrating the feasibility of implementing the Core EPAs for Entering Residency framework in the path to graduation of MD candidates. In particular, for each EPA, the schools are trying to establish the required curriculum, assessments, faculty development, and path to entrustment. This workshop will address how pathology educators can incorporate the EPA framework into medical student pathology education and contribute to entrustment decisions. We will provide an overview of EPAs, their relationship to competencies and milestones, and the concept of entrustment. Although pathology education may have a role in multiple EPAs, the discussion will focus primarily on EPA3: Recommend and interpret common diagnostic and screening tests. Participants will identify opportunities and barriers within their own context for students to learn about and be assessed on EPA3. Participants will apply the concept of backward design to brainstorm developmental milestones and assessments that allow students to demonstrate their achievement of learning outcomes, and educational experiences to provide the requisite knowledge, skills, and competencies to achieve entrustment. Objectives: By the end of the workshop, participants will be able to:
1. Explain the relationship between entrustable professional activities, milestones, and competencies
2. Discuss the concept of entrustment
3. Develop an initial approach for incorporating EPA3 into the medical student curriculum
4. Develop an initial approach for assessment of EPA3 and making entrustment decisions

Teaching Medical Students About the Importance of Proper Death Certification
Elizabeth Douglas, MD

The death certificate is an extremely rich and valuable data source for the public health sector, however, the quality and utility of this data hinges on the quality of the input. Proper instruction in death certification beginning in medical school is an important first step in ensuring the quality of the data, but death certification is an often neglected topic in medical education. This workshop will focus on death certification for non-medical examiner/coroner certifiers, with an emphasis on cause of death versus mechanism of death and appropriate guidelines for contacting the medical examiner/ coroner’s office. The workshop will consist of a didactic instruction followed by small group work focused on practicing proper death certification.

Plenary Session
Friday, January 29, 2016

Laboratory Medicine – An Often Neglected Component of Medical School Curricula
Frank Wians, Jr., PhD

It has been a little over 5 years since the 100th anniversary of the 1910 publication of the Flexner Report on Medical Education in the United States and Canada and a little less than 20 years since the 100th anniversary of the 1898 publication of a simplified method for the determination of uric acid in urine by America’s first clinical biochemist, Otto Folin. Over the past 5 years, it is estimated that 75% of allopathic medical schools have initiated curriculum reforms in the direction of replacing the traditional 2+2 (basic sciences+clinical sciences) model with an organ-system approach. In addition, didactic lectures to medical students massed in large auditoriums are being replaced by case study-based discussions in small study groups and with a focus on organ-specific diseases. Unfortunately, there is little evidence to suggest that this approach provides more emphasis on the role of laboratory medicine in diagnostic decision-making, despite the fact that it is often noted that laboratory services, especially laboratory test results, are used in 60-70% of clinical decisions related to patient admittance, discharge, and pharmacologic therapy. Moreover, the critical role of laboratory medicine in these decisions is performed by a service that makes up only about 5% of a hospital’s budget. Yet, as often touted by Dr. Michael Laposata, the medical specialty that nearly every practicing physician relies on every day, for which training in many medical schools is limited to no more than a few scattered lectures throughout the entire curriculum, is “laboratory medicine.” Using case studies written in a specific format that focuses on the laboratory medicine component of these cases yet integrates it with organ-specific clinical findings, we will discuss how this approach might be successful in improving medical student knowledge of laboratory medicine.

Friday, January 29, 2016

Map to Success: Navigating the Path to Scholarly Publication
Darshana Shah, PhD

Learning Objectives:
1. Participants will identify a broad range of ideas worth disseminating to a wider scholarly audience.
2. Participants will learn about the “Whys” and “Hows” of identifying target journals
3. Participants will understand the peer review process
4. Participants will learn about barriers and opportunities of a successful publication

Concurrent Workshops
Saturday, January 30, 2016

Active Learning in Histopathology: The Collaborative Microdissection Team Concept
James Fishback, MD

We have been teaching histopathology laboratories by virtual microscopy for over a decade. Our original andragogical model operated under the assumption that students would first study the virtual slides, consult the required commercial textbook and/or atlas, take representative photomicrographs to construct their own personal atlas, and then attend lab prepared to ask the faculty questions about structures and concepts that required clarification. We now freely admit that we were wrong! Over the years, the majority of students have found it too difficult to find classical features of both normal and pathological tissues, and required more guidance than was provided. We have responded by providing “talk on” videos for each slide, taking our own photomicrographs, then linking them to the precise area of interest in the virtual slide. Students can then zoom to that area, and explore the neighborhood, looking for similar structures. We then ask “Essential Questions,” which enables the facilitated discovery of key facts and concepts about each case. We have de-emphasized normal structures, and geared student lab presentations to the pathologic cases only. Students construct team work products for each case in a shared Microsoft OneNote notebook. They review disease classification, pathogenesis, diagnosis and treatment strategies. Student ratings of laboratories have markedly improved. We intend to continue fine-tuning our active learning, student-directed approach, as we begin our transition into a new, case-based curriculum.

Integration of Hematopathology and Medical Skills
Osvaldo Padilla, MD, Ellen Dudrey, MD, and Gordon Woods, MD

Pathology is a basic science discipline with potential for integration into different clinical sciences, including a medical skills course. Vertical integration of these two disciplines could result in better retention and understanding of both hematopathology and medical skills, as previously demonstrated with integration of basic sciences with other clinical disciplines. Hematopathology and medical skills are often treated as different disciplines with different allotted lecture times, learning objectives, and test questions. In our case, we have integrated these two disciplines through coordination between the lecturing pathologist and the medical skills coordinator. This coordination required accepting a common goal with integration of different learning objectives, presentation of medical skills materials within hematopathology lectures, involvement of pathologists within medical skills sessions, and integrated testing for knowledge of both disciplines.

Concurrent Workshops
Saturday, January 30, 2016

GRIPE Photo Review (Presentation not available)
Amy Lin, MD

GRIPE Question Bank Review (Presentation not available)
Kevin Carnevale, MD

Attendees will:
1. Identify key components of a well-written multiple choice question.
2. Recognize and correct problems with sample questions.

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