News flash! Practicing pathology can get very busy! Whether you are in academics or private practice, each presents its own time-swallowing challenges. For the academic pathologists out there, along with all the other responsibilities you have, do you find a long list of evaluations to fill out for all the residents that came through? During my residency at Indiana University I remember waiting for months before I would get an evaluation back from faculty. There were several reasons for that but one that stood out was the evaluation form took so long to fill out. A committee made up of residents was formed to restructure the evaluation system and one of the first things they worked on was condensing and summarizing the categories. This made it easier for the faculty to fill out the form and it also gave the resident a more focused evaluation.
The ACGME Pathology Milestones Project has a total of 25 categories. One argument in favor of this many categories is that the milestones should be comprehensive and cover every aspect of residency. In contrast, if the evaluation system is too long, the message that it’s supposed to send the resident gets diluted. Here are the titles of all the categories (summarized for clarity):
- Timely reports
- Formulate diagnosis
- Gross examination and dissection
- Frozen section: Grossing, cutting, reading, reporting
- Other procedures: FNA, bone marrow aspirate, apheresis
- Autopsy: gross, analysis, reporting
- Life long learning and evidence based medicine
- Patient Safety
- Lab Management (regulatory and compliance)
- Lab Management (personnel and finance)
- Lab Management (risk management and safety)
- Lab Management (test utilization)
- Lab Management (technology)
- Scholarly activity
- Licenses and examinations
- Professionalism (honesty, integrity, ethical Behavior)
- Professionalism (responsibility, follow through)
- Professionalism (gives and receives feedback)
- Professionalism (responsive to patients needs)
- Professionalism (personal responsibilities to maintain emotional, physical, mental health)
- Inter department interaction
Seeing the categories as a list helps show where there may be some redundancies.
First: Consultation and Formulate Diagnosis are essentially the same category which is, can you make the right diagnosis. I don’t think it really matters whether you are working on a famous faculty’s consult service or whether its the general pathology service, if you can make the right diagnosis and fill out the report correctly, that’s what counts.
Second: Why are there 5 separate categories on laboratory management? I was never formally taught specifics on laboratory management until PGY-4. That means for all the years leading up to my fourth year I was given a 1/10 or X/10 (X being my PGY year) depending on how the faculty interpreted the question. This gets into a whole other issue about interpreting the milestones which I will get to in another post. How about condensing laboratory management into 1 category and then added a few subcategories with either yes or no questions or out of 5 scale questions.
Third: Wait, what?! There are also 5 separate categories for professionalism too? This one really gets to me. I got a 1/10 in professionalism my first year in residency because everyone thought since I was a PGY-1 that’s what I was supposed to get. In my mind I was thinking, why in the world do you even rank me to this program if you thought I had almost no professionalism?! Again, this is a problem with interpreting the questions. Shouldn’t the evaluation be build in a more intuitive way so it doesn’t take a PhD in behavioral science to figure it out?
When it comes to patient care, there are no white lies
I’ll only say one more thing about professionalism as it currently reads in the milestones. Why are residents being graded on honesty/integrity/ethical behavior on a scale from 1 through 10? Either you’re honest or you’re not. When it comes to patient care, there are no “white lies.” This category could be as simple as yes or no. If no, then a detailed comment to the resident about what gave the perception that they were not honest and an accompanied suggestion as to how they might have acted differently to improve patient care.
I drafted a up with a condense version of categories that help simplify the evaluation but still maintain all the different aspects that need to be address while training.
Condensed Categories Comparison Chart