Assessing cytopathology milestones with checklists and online learning

Abstract

Millennials and future generations expect innovative educational methodologies to supplement and potentially replace traditional books and lectures. Cytopathology is poised to be a leader in medical education should we choose to embrace this new world of competency-based assessment and continuous feedback. Similar to the Pathology Milestones for pathology residents, the Cytopathology Milestones offer a framework of expectations for cytopathology fellows as they progress through their training. Although there are myriad resources to assist with attaining Milestones, perhaps the biggest challenge is how to effectively integrate them into the cytopathology curriculum in a way that prepares residents and fellows to be successful pathologists. In this commentary, focusing on the use of checklists and online learning, I review a few resources and make some suggestions to help with assessing some of the Milestones. On-site Evaluation and Fine-Needle Aspiration (FNA) ChecklistsAs a specialty, we are familiar with checklists during laboratory inspections and cancer synoptic reporting. Why shouldn't we tackle pathology education with the same systematic rigor and ensure that trainees are competent in specific skills and tasks before they graduate? Checklists for procedural skills help the trainee to recognize, learn, practice, and demonstrate specific steps, and having standardized expectations makes it easier for faculty to observe and correct behavior. A checklist has been used to assess FNA performance in surgery residents, and a short instructional video was associated with improved scores.1 Practicing on artificial models adjacent to a cadaver's thyroid or breast, medical students demonstrated improvements in technical skills related to ultrasound-guided FNA, as assessed with checklists.2,3 Similar checklists can easily be used for instructing pathology residents and cytopathology fellows in smear preparation and FNA techniques. This type of approach, evaluating the performance of discrete tasks, will likely propagate as we move toward adopting entrustable professional activities.At our institution, we employ checklists that can be used during rapid on-site evaluations or pathologist-performed FNA to evaluate a resident's performance. These checklists have recently been made available electronically (Fig. 1) so that faculty can self-initiate an evaluation for a resident at the time of a procedure. This is not a replacement for immediate verbal feedback; rather, the evaluation should align with what is discussed during and after the procedure. Specific, direct, and timely feedback based on such a checklist is more helpful than general comments on an anonymous evaluation provided weeks or months later.

Communicating communication to pathology residents and fellows

“…In an effort to specifically address developing the skill, some institutions have developed formal communication training (role playing, lectures, simulated clinician‐pathologist interactions) as part of their pathology curriculum . Other programs recommend a communication checklist to ensure that trainees have the ability to do such things as properly introduce themselves and convey necessary information over the phone . Not to dismiss such strategies, because they certainly have their place, but I think we are missing the point.…”