Resident preparation for practice a white paper from the College of American Pathologists and Association of Pathology Chairs

Michael L. Talbert, Edward R. Ashwood, Noel A. Brownlee, Jimmy R. Clark, Richard E. Horowitz, Ronald B. Lepoff, Ann Neumann, Christopher N. Otis, Suzanne Zein Eldin Powell, Thomas M. Sodeman

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Pathology's future depends on training pathologists who are as facile with new technologies as they are with the microscope. Trainees must absorb, assimilate, and be ready to apply an unprecedented breadth of scientific and technologic knowledge and concepts and apply these skills as part of the patient treatment team. During the past decade, several pathology surveys have identified gaps in resident preparation for practice. The identified gaps typically involve a minority of trainees and may be more evident in certain practice settings, such as highvolume general practice. However, as pathology practice continues to evolve, these gaps are becoming more evident and problematic. Action is needed now because the process of training a new pathologist spans 4 to 6 years (anatomic pathology [AP], clinical pathology [CP], or more commonly AP/CP, plus 1 or 2 fellowships) or 10 years if medical school education is included. Currently, gaps exist for some residents in the preresidency mastery of basic histology, anatomy and pathology, the ability to make relevant clinical decisions, life-long learning habits, interpersonal and communication skills, professionalism, ability to recognize limitations, readiness to practice independently, gross pathology skills, ability to handle high-volume surgical pathology, ability to provide competent CP consultation, and preparation in laboratory medical direction and management. Most trainees elect a fellowship, suggesting that current residency training is not adequate to prepare them for immediate practice. In its current form, the American Board of Pathology (ABP) examination is not designed as a comprehensive measure of competence and may contribute to the gaps by misdirecting the focus of residency training. Academic and private practice pathologists must be cooperatively engaged in building the bridge that connects our current path to our future road. As the largest professional organization of pathologists and the organization of chairs of academic departments overseeing training programs, the College of American Pathologists (CAP) and Association of Pathology Chairs (APC) must take a lead in addressing these issues. The CAP Board of Governors and APC Council (oral and written communication to Michael L. Talbert, MD [CAP Graduate Medical Education chair] from J. Charles Jennette, MD [APC president] on behalf of the APC Council, April 2009) recommend the following actions: 1. Share this joint position with internal and external groups, propose solutions, and obtain support for proposed solutions. Within the next 6 months, begin a series of forums to build consensus around the need to enhance resident preparation for practice, involving, for example, CAP Residents Forum, CAP councils, APC/Program Directors Section of APC, Accreditation Council for Graduate Medical Education (ACGME)/Residency Review Committee of the ACGME, ABP, and other cooperating societies. 2. Fund projects to develop and implement a comprehensive set of residency learning objectives based on the 6 general competencies of the ACGME that address the future of the specialty and further define the knowledge, skills, and attitudes needed to perform successfully in practice. 3. Develop strategies and mechanisms for providing sufficient graduated responsibility across all aspects of residency training that simulates the practice experience. 4. Develop tools to teach and assess the skills necessary for practice (eg, pathology practice-specific simulations, such as computer-assisted simulations). 5. Strengthen medical school pathology instruction (eg, anatomy, microanatomy, pathophysiology) so that medical school graduates are prepared to begin pathology residency training and other clinical specialists have sufficient understanding of pathologic processes to appropriately use pathology and laboratory services for the provision of patient care.

Original languageEnglish (US)
Pages (from-to)1139-1147
Number of pages9
JournalArchives of Pathology and Laboratory Medicine
Issue number7
StatePublished - Jul 2009

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology


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