Publications by authors named "Richard Conran"

39 Publications

Educational Case: Basal Cell Carcinoma.

Acad Pathol 2021 Jan-Dec;8:2374289521998030. Epub 2021 Mar 8.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040..
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http://dx.doi.org/10.1177/2374289521998030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944528PMC
March 2021

Educational Case: Hydatidiform Molar Pregnancy.

Acad Pathol 2021 Jan-Dec;8:2374289520987256. Epub 2021 Jan 28.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040..
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http://dx.doi.org/10.1177/2374289520987256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863141PMC
January 2021

Factors Influencing US Allopathic Medical Students to Choose Pathology as a Specialty.

Acad Pathol 2020 Jan-Dec;7:2374289520951924. Epub 2020 Sep 14.

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

The SARS-CoV-2 pandemic has highlighted the crucial role of pathologists in the health care system at a time of significant decline in the number of US medical students matching to pathology residency positions. To understand this decline, a national survey of fourth-year US allopathic medical students was conducted to assess experiences, knowledge, and attitudes of pathology and factors that impact specialty choice. Participating in a separate pathology course did not increase the probability of choosing pathology. Experiences significantly associated with choosing pathology included clinical or research opportunities in pathology during the last 2 years of medical school, autopsy observation/participation, and participation in pathology interest groups. Many respondents felt they were not sufficiently exposed to pathology to consider it as a specialty. Those who considered pathology but did not choose it were less likely to report understanding the activities of pathologists and being recruited by pathology faculty and more likely to express a preference for more direct patient contact as compared to those entering pathology. In general, respondents agreed that pathology has a good work-life balance and a satisfying degree of intellectual challenge. On the other hand, respondents generally agreed that information on social media and perception of the pathology job market do not seem to be positive and few agreed that pathology is a highly regarded specialty. We identify steps to address these issues and increase the number of US medical students choosing pathology as a specialty crucial to the future of medicine and public health.
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http://dx.doi.org/10.1177/2374289520951924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557358PMC
September 2020

Educational Case: Acute Appendicitis.

Acad Pathol 2020 Jan-Dec;7:2374289520926640. Epub 2020 Jun 1.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040..
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http://dx.doi.org/10.1177/2374289520926640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265080PMC
June 2020

Entry of Graduates of US Pathology Residency Programs Into the Workforce: Cohort Data Between 2008 and 2016 Remain Positive and Stable.

Acad Pathol 2020 Jan-Dec;7:2374289520901833. Epub 2020 Feb 6.

The Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.

The pathologist workforce in the United States is a topic of interest to the health-care community as a whole and to institutions responsible for the training of new pathologists in particular. Although a pathologist shortage has been projected, there has been a pervasive belief by medical students and their advisors that there are "no jobs in pathology." In 2013 and again in 2017, the Program Directors Section of the Association of Pathology Chairs conducted surveys asking pathology residency directors to report the employment status of each of their residents graduating in the previous 5 years. The 2013 Program Directors Section survey indicated that 92% of those graduating in 2010 had obtained employment within 3 years, and 94% of residents graduating in 2008 obtained employment within 5 years. The 2017 survey indicated that 96% of those graduating in 2014 had obtained employment in 3 years, and 97% of residents graduating in 2012 obtained positions within 5 years. These findings are consistent with residents doing 1 or 2 years of fellowship before obtaining employment. Stratification of the data by regions of the country or by the size of the residency programs does not show large differences. The data also indicate a high percentage of employment for graduates of pathology residency programs and a stable job market over the years covered by the surveys.
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http://dx.doi.org/10.1177/2374289520901833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005983PMC
February 2020

Gender Parity in Gainful Employment and Other Gender Trends in the Job Market for Recent Pathology Graduates.

Arch Pathol Lab Med 2020 04 9;144(4):435-442. Epub 2019 Dec 9.

From the Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond (Dr Shyu); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania (Dr George); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Childs); the Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk (Dr Conran); the Department of Pathology, University of Central Florida College of Medicine, Orlando (Dr Dixon); the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Dr McCloskey); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Prieto); ProPath Associates, Dallas, Texas (Dr Roberts); the Department of Pathology, Augusta University-Medical College of Georgia, Augusta (Dr Rojiani); the Department of Pathology, Children's Medical Center of Dallas, Dallas, Texas (Dr Timmons Jr); and the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Hoffman).

Context.—: Gender-based barriers to equal salary, career advancement, and leadership still exist in medicine. Herein we provide the first report of data comparing the experiences of men and women seeking their first nonfellowship position in pathology.

Objective.—: To identify gender trends regarding pathologists taking their first job after training and the relationship to various demographic factors, job search satisfaction, and outcome.

Design.—: Aggregate data from the College of American Pathologists Graduate Medical Education Committee Job Market surveys (2015-2018) were analyzed across multiple domains including residency focus, number and subspecialty of fellowships completed, and extent to which expectations were met in regard to work duties, geographic preference, benefits, and salary. These data were examined in the context of assessing gender-based differences.

Results.—: Comparable results were identified in all measured outcomes according to gender. There were no differences between gender and medical school type, relocation, residency training focus, number of fellowships completed, overall satisfaction with position accepted, salary, or extent to which the position met expectations. Similarly, there were also no discrepancies between gender and the geographic region in which positions were accepted, practice setting, practice subspecialty, partnership track, length of job search, or difficulty finding a position.

Conclusions.—: Analysis from 4 years of job market survey data shows equivalent results between men and women looking for their first nonfellowship position in pathology. There were no significant differences with regard to difficulty finding a position, overall satisfaction with the position accepted, salary, benefits, or access to partnership track.
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http://dx.doi.org/10.5858/arpa.2019-0354-CPDOI Listing
April 2020

Will I Need to Move to Get My First Job?: Geographic Relocation and Other Trends in the Pathology Job Market.

Arch Pathol Lab Med 2020 04 9;144(4):427-434. Epub 2019 Oct 9.

From the Department of Pathology, Penn State Health Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr George); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Dr McCloskey); Pathology and Anatomy, Eastern Virginia Medical School, Norfolk (Dr Conran); North Florida Division, HCA, Physician Services Group, Gainesville (Dr Dixon); ProPath Associates, Dallas, Texas (Dr Roberts); the Department of Pathology, Augusta University-Medical College of Georgia, Augusta (Dr Rojiani); the Department of Pathology, Virginia Commonwealth University, Richmond (Dr Shyu); the Department of Pathology, Children's Medical Center of Dallas, Dallas, Texas (Dr Timmons Jr); and the Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Hoffman).

Context.—: There is an ongoing perception that the pathology job market is poor, which may be discouraging medical students from pursuing the specialty. Academic pathologists believe that jobs are available but relocation may be necessary.

Objective.—: To identify trends regarding the geographic relocation of pathologists taking their first job after training.

Design.—: The College of American Pathologists (CAP) Graduate Medical Education Committee has sent an annual job search survey from 2012-2016 to CAP junior members and fellows in practice for 3 years or less and seeking their first job. Data were analyzed across demographics and geographic domains consisting of the following: stayed at same institution/city, relocated within the same region, or relocated to a different region. Standard statistical methods were used.

Results.—: Of 501 respondents, 421 reported completing combined anatomic pathology (AP)/clinical pathology (CP) training, while 80 reported AP- or CP-only training. Of the 421 AP/CP respondents, 109 (26%) stayed at the same institution or city, while of the 80 AP- or CP-only respondents, 36 (45%) stayed at the same institution or city. One hundred ninety-nine respondents completed surgical pathology fellowships with 124 (62%) general/oncologic surgical pathology and 75 (38%) subspecialty surgical pathology trainees. Job seekers who completed general surgical pathology/surgical oncologic pathology fellowship accounted for 34 of 52 (65%) of those remaining at the same institution or city, while those with subspecialty training accounted for 40 of 77 (52%) of those relocating to a different region. Relocation did not demonstrate any significant trends in regard to other demographics studied.

Conclusions.—: The pathology job market appears stable with no precedent for geographic hardship.
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http://dx.doi.org/10.5858/arpa.2019-0150-CPDOI Listing
April 2020

Educational Case: Barrett Esophagus.

Acad Pathol 2019 Jan-Dec;6:2374289519848089. Epub 2019 May 30.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040.
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http://dx.doi.org/10.1177/2374289519848089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543786PMC
May 2019

Educational Case: Pediatric Osteosarcoma.

Acad Pathol 2019 Jan-Dec;6:2374289519833902. Epub 2019 Mar 5.

Eastern Virginia Medical School, Norfolk, VA, USA.

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http://dx.doi.org/10.1177/2374289519833902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402068PMC
March 2019

Educational Case: Wilms Tumor (Nephroblastoma).

Acad Pathol 2019 Jan-Dec;6:2374289518821381. Epub 2019 Jan 15.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040.
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http://dx.doi.org/10.1177/2374289518821381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343435PMC
January 2019

Educational Case: Membranous Nephropathy.

Acad Pathol 2018 Jan-Dec;5:2374289518813673. Epub 2018 Dec 16.

Eastern Virginia Medical School, Norfolk, VA, USA.

http://journals.sagepub.com/doi/10.1177/2374289517715040.
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http://dx.doi.org/10.1177/2374289518813673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295683PMC
December 2018

Due Process in Medical Education: Legal Considerations.

Acad Pathol 2018 Jan-Dec;5:2374289518807460. Epub 2018 Nov 14.

Department of Pathology, Houston Methodist Hospital, Houston, TX, USA.

Throughout the medical education continuum, some students encounter difficulty in meeting academic or professional standards that leads to remediation or dismissal. Termination of a student without due process may lead to litigation by deprivation of a student's property or liberty interest. This article outlines the concept of procedural and substantive due process as applied to litigated student dismissal cases in undergraduate and graduate medical education. Determination of the amount of due process owed is based on whether the dismissal is academic or nonacademic. The decision to dismiss a student where the entire student record has been reviewed, due process provided, and the institution complied with its own policies is usually upheld by the courts in litigation.
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http://dx.doi.org/10.1177/2374289518807460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238200PMC
November 2018

Educational Case: Pheochromocytoma.

Acad Pathol 2018 Jan-Dec;5:2374289518780500. Epub 2018 Aug 23.

Eastern Virginia Medical School, Norfolk, VA, USA.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.
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http://dx.doi.org/10.1177/2374289518780500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108014PMC
August 2018

Development of Professionalism in Graduate Medical Education: A Case-Based Educational Approach From the College of American Pathologists' Graduate Medical Education Committee.

Acad Pathol 2018 Jan-Dec;5:2374289518773493. Epub 2018 Jun 26.

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

Professionalism and physician well-being are important topics in academic medicine. Lapses in professional judgment may lead to disciplinary action and put patient's health at risk. Within medical education, students and trainees are exposed to professionalism in the institution's formal curriculum and hidden curriculum. Development of professionalism starts early in medical school. Trainees entering graduate medical education already have developed professional behavior. As a learned behavior, development of professional behavior is modifiable. In addition to role modeling by faculty, other modalities are needed. Use of case vignettes based on real-life issues encountered in trainee and faculty behavior can serve as a basis for continued development of professionalism in trainees. Based on the experience of program directors and pathology educators, case vignettes were developed in the domains of service, research, and education and subdivided into the areas of duty, integrity, and respect. General and specific questions pertaining to each case were generated to reinforce model behavior and overcome professionalism issues encountered in the hidden curriculum. To address physician burnout, cases were generated to provide trainees with the skills to deal with burnout and promote well-being.
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http://dx.doi.org/10.1177/2374289518773493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039899PMC
June 2018

The Recent Pathology Residency Graduate Job Search Experience: A Synthesis of 5 Years of College of American Pathologists Job Market Surveys.

Arch Pathol Lab Med 2018 Apr 6;142(4):490-495. Epub 2017 Dec 6.

From the Department of Pathology, Stanford University School of Medicine, Stanford, California (Dr Gratzinger); Learning, College of American Pathologists, Northfield, Illinois (Dr Johnson); The Joint Pathology Center, Silver Spring, Maryland (Dr Brissette); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Cohen and Powell); the Department of Pathology, Augusta University-Medical College of Georgia, Augusta (Dr Rojiani); the Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk (Dr Conran); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, University of Colorado-Anschutz Medical Campus, Aurora (Dr Post); the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Drs McCloskey and Talbert); ProPath Associates, Dallas, Texas (Dr Roberts); and the Division of Laboratory Medicine, Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, Pennsylvania (Dr Domen).

Context: - Pathology residents and fellows tailor their training and job search strategies to an actively evolving specialty in the setting of scientific and technical advances and simultaneous changes in health care economics.

Objective: - To assess the experience and outcome of the job search process of pathologists searching for their first non-fellowship position.

Design: - The College of American Pathologists (CAP) Graduate Medical Education Committee has during the past 5 years sent an annual job search survey each June to CAP junior members and fellows in practice 3 years or less who have actively searched for a non-fellowship position.

Results: - Job market indicators including job interviews, job offers, positions accepted, and job satisfaction have remained stable during the 5 years of the survey. Most survey respondents who had applied for at least 1 position had accepted a position at the time of the survey, and most applicants who had accepted a position were satisfied or very satisfied. However, most attested that finding a non-fellowship position was difficult. Despite a perceived push toward subspecialization in surgical pathology, the reported number of fellowships completed was stable. Respondent demographics were not associated with job search success with 1 significant exception: international medical school graduate respondents reported greater perceived difficulty in finding a position, and indeed, fewer reported having accepted a position.

Conclusions: - Pathology residents and fellows seeking their first position have faced a relatively stable job market during the last 5 years, with most accepting positions with which they were satisfied.
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http://dx.doi.org/10.5858/arpa.2017-0207-CPDOI Listing
April 2018

Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 2. The 2nd Decade: From the Radiologic Pathology Archives.

Radiographics 2017 Sep-Oct;37(5):1538-1558

From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.).

Malignant renal tumors account for 7% of childhood cancers, and Wilms tumors are by far the most common-but not in older children and adolescents. Among individuals in the latter half of their 2nd decade of life, renal cell carcinoma (RCC) is more common than Wilms tumor. The histopathologic spectrum of RCCs in children differs from that in adults. The most common subtype of RCC in children and adolescents is Xp11.2 translocation RCC, which is distinguished by hyperattenuation at nonenhanced computed tomography, a defined capsule, and associated retroperitoneal lymphadenopathy. Papillary RCC is the second most common histologic subtype. It enhances less intensely compared with the adjacent renal parenchyma and has a propensity for calcification. Clear cell RCC is seen in patients with von Hippel-Lindau disease and is distinguished by its relatively hypervascular nature. Medullary carcinoma affects adolescents with the sickle cell trait and is characterized by an infiltrative growth pattern and extensive metastasis at presentation. Angiomyolipoma is seen in children with tuberous sclerosis complex and is often multifocal and hypervascular, with macroscopic fat. Metanephric tumors are central, circumscribed, and typically calcified. Lymphoma usually manifests as multifocal masses, but it may involve a solitary mass or infiltrative pattern. Extensive adenopathy and involvement of the gastrointestinal tract or other organs also may be seen. Primitive neuroectodermal tumor is an aggressive neoplasm that is typically quite large at diagnosis. Knowledge of the clinical, biologic, and histopathologic features of renal tumors in older children and adolescents and their effects on the imaging appearance can help the radiologist offer a useful preoperative differential diagnosis.
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http://dx.doi.org/10.1148/rg.2017160189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621729PMC
December 2017

Autosomal Recessive Polycystic Kidney Disease.

Acad Pathol 2017 Jan-Dec;4:2374289517718560. Epub 2017 Jul 24.

Eastern Virginia Medical School, Norfolk, VA, USA.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.
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http://dx.doi.org/10.1177/2374289517718560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5528912PMC
July 2017

Pathology Competencies for Medical Education and Educational Cases.

Acad Pathol 2017 Jan-Dec;4:2374289517715040. Epub 2017 Jul 24.

Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.

Current medical school curricula predominantly facilitate early integration of basic science principles into clinical practice to strengthen diagnostic skills and the ability to make treatment decisions. In addition, they promote life-long learning and understanding of the principles of medical practice. The Pathology Competencies for Medical Education (PCME) were developed in response to a call to action by pathology course directors nationwide to teach medical students pathology principles necessary for the practice of medicine. The PCME are divided into three competencies: 1) Disease Mechanisms and Processes, 2) Organ System Pathology, and 3) Diagnostic Medicine and Therapeutic Pathology. Each of these competencies is broad and contains multiple learning goals with more specific learning objectives. The original competencies were designed to be a living document, meaning that they will be revised and updated periodically, and have undergone their first revision with this publication. The development of teaching cases, which have a classic case-based design, for the learning objectives is the next step in providing educational content that is peer-reviewed and readily accessible for pathology course directors, medical educators, and medical students. Application of the PCME and cases promotes a minimum standard of exposure of the undifferentiated medical student to pathophysiologic principles. The publication of the PCME and the educational cases will create a current educational resource and repository published through .
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http://dx.doi.org/10.1177/2374289517715040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5528910PMC
July 2017

Entrustable Professional Activities for Pathology: Recommendations From the College of American Pathologists Graduate Medical Education Committee.

Acad Pathol 2017 Jan-Dec;4:2374289517714283. Epub 2017 Jun 27.

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.

Competency-based medical education has evolved over the past decades to include the Accreditation Council for Graduate Medical Education Accreditation System of resident evaluation based on the Milestones project. Entrustable professional activities represent another means to determine learner proficiency and evaluate educational outcomes in the workplace and training environment. The objective of this project was to develop entrustable professional activities for pathology graduate medical education encompassing primary anatomic and clinical pathology residency training. The Graduate Medical Education Committee of the College of American Pathologists met over the course of 2 years to identify and define entrustable professional activities for pathology graduate medical education. Nineteen entrustable professional activities were developed, including 7 for anatomic pathology, 4 for clinical pathology, and 8 that apply to both disciplines with 5 of these concerning laboratory management. The content defined for each entrustable professional activity includes the entrustable professional activity title, a description of the knowledge and skills required for competent performance, mapping to relevant Accreditation Council for Graduate Medical Education Milestone subcompetencies, and general assessment methods. Many critical activities that define the practice of pathology fit well within the entrustable professional activity model. The entrustable professional activities outlined by the Graduate Medical Education Committee are meant to provide an initial framework for the development of entrustable professional activity-related assessment and curricular tools for pathology residency training.
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http://dx.doi.org/10.1177/2374289517714283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496684PMC
June 2017

Pathology Course Director Perspectives of a Recent LCME Experience: Preparation in an Integrated Curriculum With the Revised Standards.

Acad Pathol 2017 Jan-Dec;4:2374289516687070. Epub 2017 Jan 27.

Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Preparation for a Liaison Committee of Medical Education (LCME) accreditation site visit is a daunting task for any medical school, particularly for medical schools that have adopted integrated curricula. The LCME accreditation is the standard that all US and Canadian allopathic medical schools must meet in order for the school to award the degree of medical doctor. The Uniformed Services University of the Health Sciences (USU) recently underwent a full-scale LCME accreditation visit that was conducted under the newly revised LCME standards and elements. The site visit occurred just 5 years after our school began implementing a totally revised, organ system-based curriculum. Preparing for a critical, high-stakes site visit shortly after transitioning to a totally revised, integrated module-based preclerkship curriculum presented an array of new challenges that required a major modification to the type of preparation, communication, and collaboration that traditionally occurs between course directors and departmental chairs. These included the need to ensure accurate, timely communication of curricular details to different levels of the academic administration, particularly as it related to the execution of self-directed learning (SDL). Preparation for our site visit, did, however, provide a novel opportunity to highlight the unique educational experiences associated with the study of pathology, as pathology traverses both clinical and basic sciences. Sharing these experiences may be useful to other programs that are either undergoing or who are preparing to undergo an accreditation visit and may also aid in a broader communication of the highlights or initiatives of educational activities.
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http://dx.doi.org/10.1177/2374289516687070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497909PMC
January 2017

Perceptions of Unprofessional Attitudes and Behaviors: Implications for Faculty Role Modeling and Teaching Professionalism During Pathology Residency.

Arch Pathol Lab Med 2017 Oct 7;141(10):1394-1401. Epub 2017 Jul 7.

Context: - Changes occurring in medicine have raised issues about medical professionalism. Professionalism is included in the Core Competencies and Milestones for all pathology residents. Previous studies have looked at resident professionalism attitudes and behaviors in primary care but none have looked specifically at pathology.

Objective: - To examine behavior and attitudes toward professionalism within pathology and to determine how professionalism is taught in residency programs.

Design: - Surveys were sent to all College of American Pathologists junior members and all pathology residency program directors, and responses were compared.

Results: - Although no single behavior received the same professionalism rating among residents and program directors, both groups identified the same behaviors as being the most unprofessional: posting identifiable patient information or case images to social media, making a disparaging comment about a physician colleague or member of the support staff on social media or in a public hospital space, and missing work without reporting the time off. Faculty were observed displaying most of these behaviors as often or more often than residents by both groups. The most common means to teach professionalism in pathology residencies is providing feedback as situations arise and teaching by example. Age differences were found within each group and between groups for observed behaviors and attitudes.

Conclusions: - As teaching by example was identified as a common educational method, faculty must be aware of the role their behavior and attitudes have in shaping resident behavior and attitudes. These results suggest a need for additional resources to teach professionalism during pathology residency.
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http://dx.doi.org/10.5858/arpa.2016-0477-CPDOI Listing
October 2017

Professionalism in Pathology: A Case-Based Approach as a Potential Educational Tool.

Arch Pathol Lab Med 2017 Feb 20;141(2):215-219. Epub 2016 Oct 20.

Context: -Professionalism issues in residency training can be difficult to assess and manage. Generational or role-based differences may also exist between faculty and residents as to what constitutes unprofessional behavior and how to manage it.

Objective: -To examine and compare how faculty and residents would approach the same 5 case scenarios detailing various aspects of unprofessional behavior.

Design: -Five case scenarios highlighting various unprofessional behaviors were presented in a workshop at an annual meeting of pathology department chairs, residency program directors, and undergraduate pathology medical educators (ie, pathologists involved in medical student pathology education). The same cases were presented to a cohort of pathology residents currently in training. A standard set of responses were offered to the participants, polling results were collected electronically, and results were compared.

Results: -Faculty and residents were fairly consistent within their respective groups. In a subset of cases, faculty were more likely to favor working with the individual in the scenario, whereas resident respondents were more likely to favor either no response or a severe response. Generational or role-based differences were also potentially evident.

Conclusions: -Assessing expectations and differences around professionalism for both faculty and residents should be considered as part of any educational and management approach for professionalism. Although a level of generational differences appears to be evident in this study regarding the recognition and management of unprofessional behavior, there was also agreement in some cases. Further exploration into the discrepant responses between faculty and residents may prove useful in developing educational, assessment, and remediation resources.
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http://dx.doi.org/10.5858/arpa.2016-0217-CPDOI Listing
February 2017

Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 1. The 1st Decade: From the Radiologic Pathology Archives.

Radiographics 2016 Mar-Apr;36(2):499-522

From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.).

Wilms tumor is the second most common pediatric solid tumor and by far the most common renal tumor of infants and young children. As most tumors are large at presentation and are treated with nephrectomy, the role of imaging is primarily in preoperative planning and evaluation for metastatic disease. However, with treatment protocols increasingly involving use of preoperative (neoadjuvant) chemotherapy (the standard in Europe) and consideration of nephron-sparing surgery, the role of imaging is evolving to include providing initial disease staging information and a presumptive diagnosis to guide therapy. Differential diagnostic considerations include lesions that are clinically benign and others that require more intensive therapy than is used to treat Wilms tumor. In part 1 of this article, the unique histologic spectrum of renal neoplasms of infants and young children is reviewed with emphasis on radiologic-pathologic correlation. Part 2 will focus on renal tumors of older children and adolescents.
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http://dx.doi.org/10.1148/rg.2016150230DOI Listing
January 2017

Consensus Guidelines for Practical Competencies in Anatomic Pathology and Laboratory Medicine for the Undifferentiated Graduating Medical Student.

Acad Pathol 2015 Oct-Dec;2(4):2374289515605336. Epub 2015 Oct 5.

Departments of Pathology and Medical Education, University of Illinois College of Medicine at Chicago, Chicago, IL, USA.

The practice of pathology is not generally addressed in the undergraduate medical school curriculum. It is desirable to develop practical pathology competencies in the fields of anatomic pathology and laboratory medicine for every graduating medical student to facilitate (1) instruction in effective utilization of these services for optimal patient care, (2) recognition of the role of pathologists and laboratory scientists as consultants, and (3) exposure to the field of pathology as a possible career choice. A national committee was formed, including experts in anatomic pathology and/or laboratory medicine and in medical education. Suggested practical pathology competencies were developed in 9 subspecialty domains based on literature review and committee deliberations. The competencies were distributed in the form of a survey in late 2012 through the first half of 2013 to the medical education community for feedback, which was subjected to quantitative and qualitative analysis. An approval rate of ≥80% constituted consensus for adoption of a competency, with additional inclusions/modifications considered following committee review of comments. The survey included 79 proposed competencies. There were 265 respondents, the majority being pathologists. Seventy-two percent (57 of 79) of the competencies were approved by ≥80% of respondents. Numerous comments (N = 503) provided a robust resource for qualitative analysis. Following committee review, 71 competencies (including 27 modified and 3 new competencies) were considered to be essential for undifferentiated graduating medical students. Guidelines for practical pathology competencies have been developed, with the hope that they will be implemented in undergraduate medical school curricula.
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http://dx.doi.org/10.1177/2374289515605336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479462PMC
October 2015

Employer Expectations for Newly Trained Pathologists: Report of a Survey From the Graduate Medical Education Committee of the College of American Pathologists.

Arch Pathol Lab Med 2017 Feb 2;141(2):193-202. Epub 2015 Oct 2.

Context: -Multiple sources have identified challenges that training programs face in preparing graduates for the "real world" practice of pathology, and many training programs have sought to decrease the gap between skills acquired during training and those required in practice. However, there exists the possibility that some of the difficulty experienced by newly trained pathologists and employers might arise from differences between employer expectations of new hires and what applicants expect from their first job.

Objective: -To define the constellation of skills and attributes employers prioritize when hiring newly trained pathologists.

Design: -A survey of fellows of the College of American Pathologists in practice for 5 or more years in the United States was administered and the results were analyzed.

Results: -A total of 630 pathologists who were responsible for hiring a new-in-practice pathologist completed the survey. Regardless of practice setting, certain skills and attributes were rated critically important in new hires, including ethics/integrity, work ethic, and professionalism. Seventy-one percent reported having some difficulty hiring entry-level pathologists and cited inadequate training/experience during residency, and applicants having unrealistic expectations regarding work load/hours as the most common reasons.

Conclusions: -Prospective employers not only expect well-developed diagnostic skills in their job applicants, but also require evidence of a strong work ethic and outstanding professionalism. Successful applicants must display willingness to assume responsibilities and flexibility regarding existing and new responsibilities. A secondary but important finding of this survey was that most jobs are garnered through word-of-mouth recommendations; therefore, it is crucial for pathologists-in-training to hone their networking skills.
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http://dx.doi.org/10.5858/arpa.2015-0138-CPDOI Listing
February 2017

Assessment and Management of Professionalism Issues in Pathology Residency Training: Results From Surveys and a Workshop by the Graduate Medical Education Committee of the College of American Pathologists.

Acad Pathol 2015 Jul-Sep;2(3):2374289515592887. Epub 2015 Jul 6.

Department of Pathology, Houston Methodist Hospital, Houston, TX, USA.

Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director's meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors' experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.
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http://dx.doi.org/10.1177/2374289515592887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479457PMC
July 2015

National standards in pathology education: developing competencies for integrated medical school curricula.

Arch Pathol Lab Med 2014 Mar;138(3):328-32

From the Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Drs Prystowsky and Sadofsky); and.

Context: Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations.

Objective: To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine.

Design: We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally.

Conclusions: Development of a coherent set of learning objectives will assist medical students nationally to gain the basic competencies in pathology necessary for clinical practice. Having national standards for competencies preserves schools' independence in specific curriculum design while assuring all students meet the evolving needs of medical practice.
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http://dx.doi.org/10.5858/arpa.2013-0404-RADOI Listing
March 2014

From the radiologic pathology archives: pediatric polycystic kidney disease and other ciliopathies: radiologic-pathologic correlation.

Radiographics 2014 Jan-Feb;34(1):155-78

From the Department of Radiology and Radiological Sciences (E.M.C.) and Department of Pathology (R.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.W.S., I.R.R.Q.); and Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii (V.J.R.).

Genetic defects of cilia cause a wide range of diseases, collectively known as ciliopathies. Primary, or nonmotile, cilia function as sensory organelles involved in the regulation of cell growth, differentiation, and homeostasis. Cilia are present in nearly every cell in the body and mutations of genes encoding ciliary proteins affect multiple organs, including the kidneys, liver, pancreas, retina, central nervous system (CNS), and skeletal system. Genetic mutations causing ciliary dysfunction result in a large number of heterogeneous phenotypes that can manifest with a variety of overlapping abnormalities in multiple organ systems. Renal manifestations of ciliopathies are the most common abnormalities and include collecting duct dilatation and cyst formation in autosomal recessive polycystic kidney disease (ARPKD), cyst formation anywhere in the nephron in autosomal dominant polycystic kidney disease (ADPKD), and tubulointerstitial fibrosis in nephronophthisis, as well as in several CNS and skeletal malformation syndromes. Hepatic disease is another common manifestation of ciliopathies, ranging from duct dilatation and cyst formation in ARPKD and ADPKD to periportal fibrosis in ARPKD and several malformation syndromes. The unifying molecular pathogenesis of this emerging class of disorders explains the overlap of abnormalities in disparate organ systems and links diseases of widely varied clinical features. It is important for radiologists to be able to recognize the multisystem manifestations of these syndromes, as imaging plays an important role in diagnosis and follow-up of affected patients.
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http://dx.doi.org/10.1148/rg.341135179DOI Listing
January 2015

From the radiologic pathology archives: precocious puberty: radiologic-pathologic correlation.

Radiographics 2012 Nov-Dec;32(7):2071-99

Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.

Precocious puberty represents a unique diagnostic problem in which imaging plays an important role. Development of secondary sex characteristics may result from inappropriate activation of the hypothalamic-pituitary axis with release of gonadotropin, or from gonadotropin-independent secretion of sex steroids by the adrenal glands or gonads. A variety of lesions can manifest with precocious puberty, including various central nervous system (CNS) lesions, adrenal lesions, and sex cord-stromal tumors of the testis or ovary. CNS lesions causing precocious puberty are much more common in boys than in girls and are well evaluated with brain magnetic resonance imaging. Neoplastic (hypothalamic-chiasmatic astrocytoma, suprasellar germinoma) and nonneoplastic (hypothalamic hamartoma, hydrocephalus, trauma, empty sella, infection, congenital midline anomalies) conditions may affect the function of the hypothalamic-pituitary axis. The adrenal cortex may produce sex hormones. Some adrenal cortical neoplasms (ACNs) in patients under 5 years of age are related to a mutation of the tumor suppressor gene p53 and represent a disease that is distinct from ACNs in older children and adults. Adrenal cortical hyperplasia secondary to an enzymatic defect in steroid biosynthesis causes virilization and salt wasting, which usually manifest in the neonatal period; however, milder forms of the disease may manifest in childhood. Female precocious puberty may be caused by an autonomously functioning ovarian cyst or a juvenile granulosa cell tumor of the ovary. Male precocious puberty may be caused by a sex steroid-producing Leydig or Sertoli cell tumor of the testis. Ultrasonography is the primary modality for evaluating the sex organs and may also be used to evaluate for adrenal abnormalities.
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http://dx.doi.org/10.1148/rg.327125146DOI Listing
May 2013