ACGME Program Requirements for Graduate Medical Education in Anatomic Pathology and Clinical Pathology ACGME-approved major revision: September 28, 2014; effective: July 1, 2015 Revised Common Program Requirements effective: July 1, 2015 Revised Common Program Requirements effective: July 1, 2016
ACGME Program Requirements for Graduate Medical Education in Anatomic Pathology and Clinical Pathology Common Program Requirements are in BOLD Introduction Int.A. Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. It is physically, emotionally, and intellectually demanding, and requires longitudinally-concentrated effort on the part of the resident. The specialty education of physicians to practice independently is experiential, and necessarily occurs within the context of the health care delivery system. Developing the skills, knowledge, and attitudes leading to proficiency in all the domains of clinical competency requires the resident physician to assume personal responsibility for the care of individual patients. For the resident, the essential learning activity is interaction with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions. As residents gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with greater independence. This concept--graded and progressive responsibility--is one of the core tenets of American graduate medical education. Supervision in the setting of graduate medical education has the goals of assuring the provision of safe and effective care to the individual patient; assuring each resident s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine; and establishing a foundation for continued professional growth. Int.B. Int.C. Int.C.1. Int.C.2. Int.C.3. Pathology is a discipline that includes the opportunity to acquire techniques and methods of anatomic and clinical pathology, and experience with the consultative role of the pathologist in patient-care decision making. (Core) * Education in anatomic and/or clinical pathology must be provided in one of these formats: Anatomic and Clinical Pathology (APCP-4): 48 months of education in anatomic pathology and clinical pathology. (Core) Anatomic Pathology (AP-3): 36 months of education in anatomic pathology. (Core) Clinical Pathology (CP-3): 36 months of education in clinical pathology. (Core) I. Institutions I.A. Sponsoring Institution One sponsoring institution must assume ultimate responsibility for the Pathology 1
program, as described in the Institutional Requirements, and this responsibility extends to resident assignments at all participating sites. (Core) The sponsoring institution and the program must ensure that the program director has sufficient protected time and financial support for his or her educational and administrative responsibilities to the program. (Core) I.A.1. I.A.2. I.B. I.B.1. A sponsoring institution providing graduate medical education in anatomic pathology and/or clinical pathology should also sponsor ACGMEaccredited residency programs in at least three of the following specialties: diagnostic radiology, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. (Core) The sponsoring institution and program must provide administrative and financial support for the program director, and for an associate program director, if applicable. (Core) Participating Sites There must be a program letter of agreement (PLA) between the program and each participating site providing a required assignment. The PLA must be renewed at least every five years. (Core) The PLA should: I.B.1.a) I.B.1.b) I.B.1.c) I.B.1.d) I.B.2. I.B.3. identify the faculty who will assume both educational and supervisory responsibilities for residents; (Detail) specify their responsibilities for teaching, supervision, and formal evaluation of residents, as specified later in this document; (Detail) specify the duration and content of the educational experience; and, (Detail) state the policies and procedures that will govern resident education during the assignment. (Detail) The program director must submit any additions or deletions of participating sites routinely providing an educational experience, required for all residents, of one month full time equivalent (FTE) or more through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS). (Core) Resident assignments away from the primary clinical site should not prevent residents regular participation in rounds or conferences at the primary clinical site, or in equivalent conferences at participating sites. (Detail) II. Program Personnel and Resources Pathology 2
II.A. II.A.1. II.A.1.a) II.A.2. II.A.3. II.A.3.a) II.A.3.b) II.A.3.b).(1) II.A.3.b).(2) II.A.3.c) II.A.3.d) II.A.4. Program Director There must be a single program director with authority and accountability for the operation of the program. The sponsoring institution s GMEC must approve a change in program director. (Core) The program director must submit this change to the ACGME via the ADS. (Core) The program director should continue in his or her position for a length of time adequate to maintain continuity of leadership and program stability. (Detail) Qualifications of the program director must include: requisite specialty expertise and documented educational and administrative experience acceptable to the Review Committee; (Core) current certification in the specialty by the American Board of Pathology, or specialty qualifications that are acceptable to the Review Committee; (Core) The program director must have current certification in anatomic and/or clinical pathology. (Core) If the program director is not certified in both anatomic and clinical pathology, there should be an associate program director with certification in the complementary specialty area. (Detail) current medical licensure and appropriate medical staff appointment; and, (Core) at least five years of participation as an active faculty member in an ACGME-accredited pathology residency program or a pathology residency located in Canada and accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). (Core) The program director must administer and maintain an educational environment conducive to educating the residents in each of the ACGME competency areas. (Core) The program director must: II.A.4.a) II.A.4.b) oversee and ensure the quality of didactic and clinical education in all sites that participate in the program; (Core) approve a local director at each participating site who is accountable for resident education; (Core) Pathology 3
II.A.4.c) II.A.4.d) II.A.4.e) II.A.4.f) II.A.4.g) II.A.4.g).(1) II.A.4.h) II.A.4.i) II.A.4.j) approve the selection of program faculty as appropriate; (Core) evaluate program faculty; (Core) approve the continued participation of program faculty based on evaluation; (Core) monitor resident supervision at all participating sites; (Core) prepare and submit all information required and requested by the ACGME. (Core) This includes but is not limited to the program application forms and annual program updates to the ADS, and ensure that the information submitted is accurate and complete. (Core) ensure compliance with grievance and due process procedures as set forth in the Institutional Requirements and implemented by the sponsoring institution; (Detail) provide verification of residency education for all residents, including those who leave the program prior to completion; (Detail) implement policies and procedures consistent with the institutional and program requirements for resident duty hours and the working environment, including moonlighting, (Core) and, to that end, must: II.A.4.j).(1) II.A.4.j).(2) II.A.4.j).(3) II.A.4.j).(4) II.A.4.k) distribute these policies and procedures to the residents and faculty; (Detail) monitor resident duty hours, according to sponsoring institutional policies, with a frequency sufficient to ensure compliance with ACGME requirements; (Core) adjust schedules as necessary to mitigate excessive service demands and/or fatigue; and, (Detail) if applicable, monitor the demands of at-home call and adjust schedules as necessary to mitigate excessive service demands and/or fatigue. (Detail) monitor the need for and ensure the provision of back up support systems when patient care responsibilities are unusually difficult or prolonged; (Detail) Pathology 4
II.A.4.l) II.A.4.m) II.A.4.n) II.A.4.n).(1) II.A.4.n).(2) II.A.4.n).(3) II.A.4.n).(4) II.A.4.n).(5) II.A.4.n).(6) II.A.4.n).(7) II.A.4.n).(8) II.A.4.o) II.A.4.o).(1) II.A.4.o).(2) II.A.4.p) II.A.4.q) comply with the sponsoring institution s written policies and procedures, including those specified in the Institutional Requirements, for selection, evaluation and promotion of residents, disciplinary action, and supervision of residents; (Detail) be familiar with and comply with ACGME and Review Committee policies and procedures as outlined in the ACGME Manual of Policies and Procedures; (Detail) obtain review and approval of the sponsoring institution s GMEC/DIO before submitting information or requests to the ACGME, including: (Core) all applications for ACGME accreditation of new programs; (Detail) changes in resident complement; (Detail) major changes in program structure or length of training; (Detail) progress reports requested by the Review Committee; (Detail) requests for increases or any change to resident duty hours; (Detail) voluntary withdrawals of ACGME-accredited programs; (Detail) requests for appeal of an adverse action; and, (Detail) appeal presentations to a Board of Appeal or the ACGME. (Detail) btain DIO review and co-signature on all program application forms, as well as any correspondence or document submitted to the ACGME that addresses: (Detail) program citations, and/or, (Detail) request for changes in the program that would have significant impact, including financial, on the program or institution. (Detail) prepare and implement a supervision policy that specifies resident and faculty member lines of responsibility; and, (Detail) devote a minimum of 20 hours per week, averaged over four weeks, to the program, to include clinical work and research Pathology 5
project work with residents, teaching, and residency-related administration. (Detail) II.A.4.q).(1) II.A.4.q).(1).(a) II.A.5. II.B. II.B.1. Faculty Programs with more than 20 residents should have an associate program director to assist the program director with program administration and management. (Detail) An associate program director should have at least two years of experience as an active faculty member in an ACGME-accredited pathology residency program or a pathology residency located in Canada and accredited by the RCPSC. (Detail) The program director should ensure that residents who plan to sit for the certifying examinations in anatomic pathology, clinical pathology, or in both anatomic pathology and clinical pathology complete all requirements specified by the American Board of Pathology. (Detail) At each participating site, there must be a sufficient number of faculty with documented qualifications to instruct and supervise all residents at that location. (Core) The faculty must: II.B.1.a) II.B.1.b) II.B.2. II.B.3. II.B.4. II.B.5. II.B.5.a) devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities; and to demonstrate a strong interest in the education of residents; and, (Core) administer and maintain an educational environment conducive to educating residents in each of the ACGME competency areas. (Core) The physician faculty must have current certification in the specialty by the American Board of Pathology, or possess qualifications judged acceptable to the Review Committee. (Core) The physician faculty must possess current medical licensure and appropriate medical staff appointment. (Core) The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments. (Core) The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. (Core) The faculty must regularly participate in organized clinical discussions, rounds, journal clubs, and conferences. (Detail) Pathology 6
II.B.5.b) II.B.5.b).(1) II.B.5.b).(2) II.B.5.b).(3) II.B.5.b).(4) II.B.5.c) II.C. Other Program Personnel Some members of the faculty should also demonstrate scholarship by one or more of the following: peer-reviewed funding; (Detail) publication of original research or review articles in peer-reviewed journals, or chapters in textbooks; (Detail) publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, (Detail) participation in national committees or educational organizations. (Detail) Faculty should encourage and support residents in scholarly activities. (Core) The institution and the program must jointly ensure the availability of all necessary professional, technical, and clerical personnel for the effective administration of the program. (Core) II.C.1. II.C.2. II.D. Resources There must be clerical, administrative, and qualified laboratory technical personnel to support the clinical, teaching, educational, and research activities of the program. (Core) Programs must have a designated program coordinator who is provided sufficient time to fulfill the responsibilities essential to meeting the educational goals and administrative requirements of the program. (Core) The institution and the program must jointly ensure the availability of adequate resources for resident education, as defined in the specialty program requirements. (Core) II.D.1. II.D.2. II.D.3. II.D.3.a) The program must provide each resident with a designated work area and a computer with Internet access. (Core) The program must provide microscopes for rotations on which microscopic evaluations account for a major portion of the clinical experience. (Core) The program must have a sufficient volume and variety of material available to ensure that residents have broad exposure to both common conditions and unusual entities. (Core) This material should be sufficient for anatomic pathology and/or Pathology 7
clinical pathology, as matches the program s specialty concentration. (Detail) II.D.4. II.D.5. II.E. The number and variety of tests performed in the program s laboratories should be sufficient to give residents experience in those tests typically available in a general hospital. (Core) The program must provide access to updated teaching materials (e.g., interesting case files, archived conference materials) or study sets (e.g., glass slides, virtual study sets) encompassing the core curriculum areas of anatomic and/or clinical pathology residency education, as matches the program s specialty concentration. (Core) Medical Information Access Residents must have ready access to specialty-specific and other appropriate reference material in print or electronic format. Electronic medical literature databases with search capabilities should be available. (Detail) III. III.A. Resident Appointments Eligibility Criteria The program director must comply with the criteria for resident eligibility as specified in the Institutional Requirements. (Core) III.A.1. III.A.1.a) III.A.1.b) Eligibility Requirements Residency Programs All prerequisite post-graduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGME-accredited residency programs, or in Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada. Residency programs must receive verification of each applicant s level of competency in the required clinical field using ACGME or CanMEDS Milestones assessments from the prior training program. (Core) A physician who has completed a residency program that was not accredited by ACGME, RCPSC, or CFPC may enter an ACGME-accredited residency program in the same specialty at the PGY-1 level and, at the discretion of the program director at the ACGME-accredited program may be advanced to the PGY-2 level based on ACGME Milestones assessments at the ACGME-accredited program. This provision applies only to entry into residency in those specialties for which an initial clinical year is not required for entry. (Core) Pathology 8
III.A.1.c) III.A.1.d) III.A.2. A Review Committee may grant the exception to the eligibility requirements specified in Section III.A.2.b) for residency programs that require completion of a prerequisite residency program prior to admission. (Core) Review Committees will grant no other exceptions to these eligibility requirements for residency education. (Core) Eligibility Requirements Fellowship Programs All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in an RCPSC-accredited or CFPC- accredited residency program located in Canada. (Core) III.A.2.a) III.A.2.b) Fellowship programs must receive verification of each entering fellow s level of competency in the required field using ACGME or CanMEDS Milestones assessments from the core residency program. (Core) Fellow Eligibility Exception A Review Committee may grant the following exception to the fellowship eligibility requirements: An ACGME-accredited fellowship program may accept an exceptionally qualified applicant**, who does not satisfy the eligibility requirements listed in Sections III.A.2. and III.A.2.a), but who does meet all of the following additional qualifications and conditions: (Core) III.A.2.b).(1) III.A.2.b).(2) III.A.2.b).(3) III.A.2.b).(4) III.A.2.b).(5) Assessment by the program director and fellowship selection committee of the applicant s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and (Core) Review and approval of the applicant s exceptional qualifications by the GMEC or a subcommittee of the GMEC; and (Core) Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3, and; (Core) For an international graduate, verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification; and, (Core) Applicants accepted by this exception must complete fellowship Milestones evaluation (for the purposes of Pathology 9
establishment of baseline performance by the Clinical Competency Committee), conducted by the receiving fellowship program within six weeks of matriculation. This evaluation may be waived for an applicant who has completed an ACGME International-accredited residency based on the applicant s Milestones evaluation conducted at the conclusion of the residency program. (Core) III.A.2.b).(5).(a) If the trainee does not meet the expected level of Milestones competency following entry into the fellowship program, the trainee must undergo a period of remediation, overseen by the Clinical Competency Committee and monitored by the GMEC or a subcommittee of the GMEC. This period of remediation must not count toward time in fellowship training. (Core) ** An exceptionally qualified applicant has (1) completed a non-acgme-accredited residency program in the core specialty, and (2) demonstrated clinical excellence, in comparison to peers, throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following: (a) participation in additional clinical or research training in the specialty or subspecialty; (b) demonstrated scholarship in the specialty or subspecialty; (c) demonstrated leadership during or after residency training; (d) completion of an ACGME-Internationalaccredited residency program. III.B. Number of Residents The program s educational resources must be adequate to support the number of residents appointed to the program. (Core) III.B.1. III.B.2. III.C. III.C.1. III.C.2. The program director may not appoint more residents than approved by the Review Committee, unless otherwise stated in the specialty-specific requirements. (Core) For APCP-4, on average, there should be at least two residents enrolled in each year of a program. (Detail) Resident Transfers Before accepting a resident who is transferring from another program, the program director must obtain written or electronic verification of previous educational experiences and a summative competency-based performance evaluation of the transferring resident. (Detail) A program director must provide timely verification of residency Pathology 10
education and summative performance evaluations for residents who may leave the program prior to completion. (Detail) III.D. Appointment of Fellows and Other Learners The presence of other learners (including, but not limited to, residents from other specialties, subspecialty fellows, PhD students, and nurse practitioners) in the program must not interfere with the appointed residents education. (Core) III.D.1. IV. IV.A. IV.A.1. IV.A.2. IV.A.3. Educational Program The program director must report the presence of other learners to the DIO and GMEC in accordance with sponsoring institution guidelines. (Detail) The curriculum must contain the following educational components: Overall educational goals for the program, which the program must make available to residents and faculty; (Core) Competency-based goals and objectives for each assignment at each educational level, which the program must distribute to residents and faculty at least annually, in either written or electronic form; (Core) Regularly scheduled didactic sessions; (Core) IV.A.3.a) IV.A.3.a).(1) IV.A.3.a).(2) IV.A.3.a).(2).(a) IV.A.3.a).(2).(b) Residents experience must be augmented by course materials and study sets (e.g., glass slides or virtual sets), including unusual cases, as well as by didactic/interactive sessions, such as seminars, departmental conferences, multidisciplinary conferences, lectures, and journal clubs. (Core) The program director must ensure that there are regularlyscheduled seminars and conferences devoted to the basic and applied medical sciences, as well as clinical correlation conferences. (Core) The program director must ensure that there are departmental conferences, in which both faculty members and residents participate, for detailed discussion of difficult and unusual cases. (Core) The program director and faculty members should monitor and evaluate the residents effectiveness as teachers. (Detail) The program director should ensure that clinical correlation conferences (e.g., a pediatric mortality conference) are held with clinical services such as Pathology 11
diagnostic radiology, internal medicine, obstetrics and gynecology, pediatrics, and surgery, and their subspecialties. (Detail) IV.A.4. IV.A.5. Delineation of resident responsibilities for patient care, progressive responsibility for patient management, and supervision of residents over the continuum of the program. (Core) ACGME Competencies The program must integrate the following ACGME competencies into the curriculum: (Core) IV.A.5.a) IV.A.5.a).(1) Patient Care and Procedural Skills Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents: (Outcome) Anatomic and Clinical Pathology (APCP-4) must demonstrate competence in: IV.A.5.a).(1).(a) IV.A.5.a).(1).(b) IV.A.5.a).(1).(c) IV.A.5.a).(1).(d) IV.A.5.a).(1).(e) IV.A.5.a).(1).(f) the performance and diagnostic interpretation of autopsies; (Outcome) all aspects of an autopsy, as appropriate to the case; (Outcome) examining and diagnosing surgical pathology specimens; (Outcome) performing and diagnosing intra-operative consultations; (Outcome) examining and diagnosing gynecologic, nongynecologic, and fine needle aspiration cytology specimens; and, (Outcome) interpreting common laboratory tests, including peripheral smears, body fluids, bone marrow aspirates and biopsies, microbiology and chemistry tests, and transfusion medicine tests. (Outcome) Anatomic Pathology (AP-3) must demonstrate competence in: IV.A.5.a).(1).(g) the performance and diagnostic interpretation of autopsies; (Outcome) Pathology 12
IV.A.5.a).(1).(h) IV.A.5.a).(1).(i) IV.A.5.a).(1).(j) IV.A.5.a).(1).(k) IV.A.5.a).(1).(l) all aspects of an autopsy, as appropriate to the case; (Outcome) examining and diagnosing surgical pathology specimens; (Outcome) performing and diagnosing intra-operative consultations; (Outcome) examining and diagnosing gynecologic, nongynecologic, and fine needle aspiration cytology specimens; and, (Outcome) interpreting common laboratory tests, including peripheral smears and bone marrow aspirates and biopsies. (Outcome) Clinical Pathology (CP-3) IV.A.5.a).(1).(m) must demonstrate competence in interpreting common laboratory tests, including peripheral smears, body fluids, bone marrow aspirates and biopsies, microbiology and chemistry tests, and transfusion medicine tests. (Outcome) Anatomic and Clinical Pathology (APCP-4), Anatomic Pathology (AP-3), Clinical Pathology (CP-3) must demonstrate competence: IV.A.5.a).(1).(n) IV.A.5.a).(1).(o) IV.A.5.a).(1).(p) IV.A.5.a).(1).(q) IV.A.5.a).(1).(r) IV.A.5.a).(2) in interpreting immunohistochemical stains; (Outcome) and the ability to provide appropriate and effective pathology services consultation; (Outcome) in interpreting laboratory data as part of patientcare decision-making; (Outcome) in addressing laboratory quality, safety, and management issues, with appropriate support; and, (Outcome) in providing medical advice on the diagnosis and management of diseases, and laboratory test selection and interpretation. (Detail) Residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. (Outcome) Pathology 13
IV.A.5.b) Medical Knowledge Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. Residents: (Outcome) must demonstrate knowledge of: IV.A.5.b).(1) IV.A.5.b).(2) pathogenesis, diagnostic techniques, and prognostic factors for disease processes commonly analyzed and diagnosed by laboratory and pathologic methods, as matches the program s specialty concentration; and, (Outcome) the principles of laboratory management. (Outcome) Anatomic and Clinical Pathology (APCP-4) IV.A.5.b).(3) the performance of fine needle aspiration, apheresis, and bone marrow procedures, including indications, complications, safety considerations, and specimen preparation. (Outcome) Anatomic Pathology (AP-3) IV.A.5.b).(4) the performance of fine needle aspiration and bone marrow procedures, including indications, complications, safety considerations, and specimen preparation. (Outcome) Clinical Pathology (CP-3) IV.A.5.b).(5) IV.A.5.c) the performance of apheresis and bone marrow procedures, including indications, complications, safety considerations, and specimen preparation. (Outcome) Practice-based Learning and Improvement Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (Outcome) Residents are expected to develop skills and habits to be able to meet the following goals: IV.A.5.c).(1) IV.A.5.c).(2) identify strengths, deficiencies, and limits in one s knowledge and expertise; (Outcome) set learning and improvement goals; (Outcome) Pathology 14
IV.A.5.c).(3) IV.A.5.c).(4) IV.A.5.c).(5) IV.A.5.c).(6) IV.A.5.c).(7) IV.A.5.c).(8) IV.A.5.c).(9) IV.A.5.c).(10) IV.A.5.d) identify and perform appropriate learning activities; (Outcome) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (Outcome) incorporate formative evaluation feedback into daily practice; (Outcome) locate, appraise, and assimilate evidence from scientific studies related to their patients health problems; (Outcome) use information technology to optimize learning; (Outcome) participate in the education of patients, families, students, residents and other health professionals; (Outcome) participate in quality improvement projects; and, (Outcome) evaluate personal practice using an individualized learning plan and portfolio. (Outcome) Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (Outcome) Residents are expected to: IV.A.5.d).(1) IV.A.5.d).(2) IV.A.5.d).(3) IV.A.5.d).(4) IV.A.5.d).(5) communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (Outcome) communicate effectively with physicians, other health professionals, and health related agencies; (Outcome) work effectively as a member or leader of a health care team or other professional group; (Outcome) act in a consultative role to other physicians and health professionals; (Outcome) maintain comprehensive, timely, and legible medical records, if applicable; (Outcome) Pathology 15
IV.A.5.d).(6) IV.A.5.d).(7) IV.A.5.e) demonstrate competence in effective verbal and written communication; and, (Outcome) demonstrate competence in generating comprehensive pathology and consultation reports. (Outcome) Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (Outcome) Residents are expected to demonstrate: IV.A.5.e).(1) IV.A.5.e).(2) IV.A.5.e).(3) IV.A.5.e).(4) IV.A.5.e).(5) IV.A.5.f) compassion, integrity, and respect for others; (Outcome) responsiveness to patient needs that supersedes selfinterest; (Outcome) respect for patient privacy and autonomy; (Outcome) accountability to patients, society and the profession; and, (Outcome) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. (Outcome) Systems-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. (Outcome) Residents are expected to: IV.A.5.f).(1) IV.A.5.f).(2) IV.A.5.f).(3) IV.A.5.f).(4) work effectively in various health care delivery settings and systems relevant to their clinical specialty; (Outcome) coordinate patient care within the health care system relevant to their clinical specialty; (Outcome) incorporate considerations of cost awareness and risk-benefit analysis in patient and/or populationbased care as appropriate; (Outcome) advocate for quality patient care and optimal patient Pathology 16
care systems; (Outcome) IV.A.5.f).(5) IV.A.5.f).(6) IV.A.6. IV.A.6.a) IV.A.6.a).(1) work in interprofessional teams to enhance patient safety and improve patient care quality; and, (Outcome) participate in identifying system errors and implementing potential systems solutions. (Outcome) Curriculum Organization and Resident Experiences The APCP-4 program must include a minimum of 18 months of core anatomic pathology and 18 months of core clinical pathology education. (Core) The remaining 12 months should be a continuation of structured anatomic pathology or clinical pathology education, or should be devoted to a specialized facet of pathology, which may include up to six months of research, as determined by the program director, Clinical Competency Committee, and/or a Pathology Education Committee, in conjunction with the resident. (Detail) IV.A.6.b) The AP-3 and CP-3 programs must include a minimum of 24 months of core anatomic pathology (AP-3) or core clinical pathology (CP-3) education. (Core) IV.A.6.b).(1) IV.A.6.b).(1).(a) IV.A.6.c) Of the remaining 12 months, a minimum of six months should be structured education in one or more highly integrated areas of pathology (e.g., clinical informatics, laboratory management, hematopathology, molecular pathology, cytopathology, microbiology). (Detail) The remaining six months should be devoted to a specialized facet of pathology, which may include up to six months of research, as determined by the program director, Clinical Competency Committee, and/or a Pathology Education Committee, in conjunction with the resident. (Detail) All education must occur under the direction of the program director or a designated member of the faculty. (Core) Anatomic and Clinical Pathology (APCP-4) IV.A.6.d) Resident education in anatomic pathology must include instruction in aspiration techniques, autopsy and surgical pathology, clinical informatics, cytogenetics, cytopathology, dermatopathology, forensic pathology, histochemistry, immunopathology, lab management, medical renal pathology, molecular pathology, neuropathology, pediatric pathology, ultrastructural pathology, and other advanced diagnostic techniques as they become available. Pathology 17
(Core) IV.A.6.e) IV.A.6.f) IV.A.6.f).(1) IV.A.6.f).(2) IV.A.6.f).(3) IV.A.6.f).(4) IV.A.6.f).(5) IV.A.6.f).(6) IV.A.6.f).(7) IV.A.6.f).(8) IV.A.6.g) IV.A.6.h) IV.A.6.i) IV.A.6.i).(1) IV.A.6.i).(2) Resident education in clinical pathology must include instruction in aspiration techniques, blood banking/transfusion medicine, chemical pathology, clinical informatics, coagulation, cytogenetics, hematology, immunopathology, lab management, medical microscopy (including urinalysis), microbiology (including bacteriology, mycology, parasitology, and virology), molecular pathology, toxicology, and other advanced diagnostic techniques as they become available. (Core) Each resident must perform at least 50 autopsies. Autopsies may be shared, but no more than two residents may count a shared case toward this standard. To be counted as one of the required 50 cases, an autopsy must include: (Core) review of history and circumstances of death; (Core) external examination of the body; (Core) gross dissection, including organ evisceration; (Core) review of microscopic and laboratory findings appropriate to the case; (Core) preparation of written description of gross and microscopic findings; (Core) development of opinion on cause of death; (Core) clinicopathological correlation, as appropriate to the case; and, (Core) review of autopsy report with a faculty member. (Core) Residents must have exposure to forensic, pediatric, perinatal, and stillborn autopsies. (Core) Residents must document all autopsies performed in the ACGME Case Log System. (Core) Each resident must examine and assess at least 2000 surgical pathology specimens. (Core) This material must be from an adequate mix of cases to ensure exposure to both common and uncommon conditions. (Core) Residents must formulate a microscopic diagnosis for the majority of cases they examine grossly. (Core) Pathology 18
IV.A.6.i).(3) IV.A.6.j) IV.A.6.k) IV.A.6.l) IV.A.6.l).(1) IV.A.6.m) IV.A.6.n) IV.A.6.o) Residents must preview their cases, prior to sign-out, with an attending pathologist. (Core) Each resident must perform at least 200 intra-operative consultations. (Core) Each resident must examine at least 1,500 cytologic specimens, including a variety of both exfoliative and aspiration specimens. (Core) Residents must participate in the regular, formal, clinical, and teaching rounds corresponding to the laboratory services to which they are assigned. (Core) These educational experiences may be provided in separate, exclusive rotations, in rotations that combine more than one area, or by other means, but all rotations and other assignments must conform to the educational goals and objectives of the program. (Detail) Residents must participate in pathology conferences, rounds, teaching, and scholarly activity. (Core) Resident experience must include education in laboratory management, including coding and billing compliance, laboratory expense and revenue calculations and projections, laboratory inspections, method validation, principles of human resource management, proficiency testing, public health reporting, quality assurance, regulations, risk management, safety, and the use of hospital and laboratory information systems. (Core) Residents must participate in laboratory inspections or mock inspections, method validation, review of proficiency testing results, quality assurance activities, and the use of hospital and laboratory information systems. (Core) Anatomic Pathology (AP-3) IV.A.6.p) IV.A.6.q) Resident education in anatomic pathology must include instruction in aspiration techniques, autopsy and surgical pathology, clinical informatics, cytogenetics, cytopathology, dermatopathology, forensic pathology, histochemistry, immunopathology, lab management, medical renal pathology, molecular pathology, neuropathology, pediatric pathology, ultrastructural pathology, and other advanced diagnostic techniques as they become available. (Core) Each resident must perform at least 50 autopsies. Autopsies may be shared, but no more than two residents may count a shared case toward this standard. To be counted as one of the required 50 cases, an autopsy must include: (Core) Pathology 19
IV.A.6.q).(1) IV.A.6.q).(2) IV.A.6.q).(3) IV.A.6.q).(4) IV.A.6.q).(5) IV.A.6.q).(6) IV.A.6.q).(7) IV.A.6.q).(8) IV.A.6.r) IV.A.6.s) IV.A.6.t) IV.A.6.t).(1) IV.A.6.t).(2) IV.A.6.t).(3) IV.A.6.u) IV.A.6.v) IV.A.6.w) IV.A.6.w).(1) review of history and circumstances of death; (Core) external examination of the body; (Core) gross dissection, including organ evisceration; (Core) review of microscopic and laboratory findings appropriate to the case; (Core) preparation of written description of gross and microscopic findings; (Core) development of opinion on cause of death; (Core) clinicopathological correlation, as appropriate to the case; and, (Core) review of autopsy report with a faculty member. (Core) Residents must have exposure to forensic, pediatric, perinatal, and stillborn autopsies. (Core) Residents must document all autopsies performed in the ACGME Case Log System. (Core) Each resident must examine and assess at least 2000 surgical pathology specimens. (Core) This material must be from an adequate mix of cases to ensure exposure to both common and uncommon conditions. (Core) Residents must formulate a microscopic diagnosis for the majority of cases they examine grossly. (Core) Residents must preview their cases prior to sign-out with an attending pathologist. (Core) Each resident must perform at least 200 intra-operative consultations. (Core) Each resident must examine at least 1,500 cytologic specimens, including a variety of both exfoliative and aspiration specimens. (Core) Residents must participate in the regular, formal, clinical, and teaching rounds corresponding to the laboratory services to which they are assigned. (Core) These educational experiences may be provided in Pathology 20
separate, exclusive rotations, in rotations that combine more than one area, or by other means, but all rotations and other assignments must conform to the educational goals and objectives of the program. (Detail) IV.A.6.x) IV.A.6.y) IV.A.6.z) Residents must participate in pathology conferences, rounds, teaching, and scholarly activity. (Core) Resident experience must include education in laboratory management, including coding and billing compliance, laboratory expense and revenue calculations and projections, laboratory inspections, method validation, principles of human resource management, proficiency testing, public health reporting, quality assurance, regulations, risk management, safety, and the use of hospital and laboratory information systems. (Core) Residents must participate in laboratory inspections or mock inspections, method validation, review of proficiency testing results, quality assurance activities, and the use of hospital and laboratory information systems. (Core) Clinical Pathology (CP-3) IV.A.6.aa) IV.A.6.bb) IV.A.6.bb).(1) IV.A.6.cc) IV.A.6.dd) Resident education in clinical pathology must include instruction in aspiration techniques, blood banking/transfusion medicine, chemical pathology, clinical informatics, coagulation, cytogenetics, hematology, immunopathology, lab management, medical microscopy (including urinalysis), microbiology (including bacteriology, mycology, parasitology, and virology), molecular pathology, toxicology, and other advanced diagnostic techniques as they become available. (Core) Residents must participate in the regular, formal, clinical, and teaching rounds corresponding to the laboratory services to which they are assigned. (Core) These educational experiences may be provided in separate, exclusive rotations, in rotations that combine more than one area, or by other means, but all rotations and other assignments must conform to the educational goals and objectives of the program. (Detail) Residents must participate in pathology conferences, rounds, teaching, and scholarly activity. (Core) Resident experience must include education in laboratory management, including coding and billing compliance, laboratory expense and revenue calculations and projections, laboratory inspections, method validation, principles of human resource management, proficiency testing, public health reporting, quality assurance, regulations, risk management, safety, and the use of Pathology 21
hospital and laboratory information systems. (Core) IV.A.6.ee) IV.B. IV.B.1. IV.B.2. IV.B.2.a) IV.B.2.b) IV.B.2.b).(1) IV.B.2.b).(2) IV.B.2.b).(3) IV.B.3. Residents must participate in laboratory inspections or mock inspections, method validation, review of proficiency testing results, quality assurance activities, and the use of hospital and laboratory information systems. (Core) Residents Scholarly Activities The curriculum must advance residents knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. (Core) Residents should participate in scholarly activity. (Core) The program should provide an environment that promotes research and scholarly activity by the residents. (Detail) Each resident should participate in at least one of the following: (Detail) research; (Detail) evidence-based presentations at journal club or meetings (local, regional, or national); or, (Detail) preparation/submission of articles for peer-reviewed publication. (Detail) The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. (Detail) V. Evaluation V.A. V.A.1. V.A.1.a) V.A.1.a).(1) Resident Evaluation The program director must appoint the Clinical Competency Committee. (Core) At a minimum the Clinical Competency Committee must be composed of three members of the program faculty. (Core) The program director may appoint additional members of the Clinical Competency Committee. V.A.1.a).(1).(a) These additional members must be physician faculty members from the same program or other programs, or other health professionals who have extensive contact and experience with the program s residents in patient care and Pathology 22
other health care settings. (Core) V.A.1.a).(1).(b) V.A.1.b) V.A.1.b).(1) V.A.1.b).(1).(a) V.A.1.b).(1).(b) V.A.1.b).(1).(c) V.A.2. V.A.2.a) V.A.2.b) V.A.2.b).(1) V.A.2.b).(2) V.A.2.b).(3) V.A.2.b).(4) V.A.2.b).(5) Chief residents who have completed core residency programs in their specialty and are eligible for specialty board certification may be members of the Clinical Competency Committee. (Core) There must be a written description of the responsibilities of the Clinical Competency Committee. (Core) Formative Evaluation The Clinical Competency Committee should: review all resident evaluations semi-annually; (Core) prepare and ensure the reporting of Milestones evaluations of each resident semi-annually to ACGME; and, (Core) advise the program director regarding resident progress, including promotion, remediation, and dismissal. (Detail) The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment, and document this evaluation at completion of the assignment. (Core) The program must: provide objective assessments of competence in patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice based on the specialty-specific Milestones; (Core) use multiple evaluators (e.g., faculty, peers, patients, self, and other professional staff); (Detail) document progressive resident performance improvement appropriate to educational level; (Core) provide each resident with documented semiannual evaluation of performance with feedback; and, (Core) ensure that assessment includes a resident learning portfolio. (Core) Pathology 23
V.A.2.b).(5).(a) V.A.2.c) V.A.3. V.A.3.a) V.A.3.b) This portfolio should include, at a minimum, documentation of: case procedure log(s) if applicable to the program s specialty concentration; regional, national, or international conferences, courses, and meetings attended; presentations at intra- or extra-mural conferences; performance on yearly resident in-service examinations; annual resident self-assessment and learning plan; quality improvement projects; scholarly activity; and other materials pertinent to the educational experience of the resident, as determined by the program director. (Detail) The evaluations of resident performance must be accessible for review by the resident, in accordance with institutional policy. (Detail) Summative Evaluation The specialty-specific Milestones must be used as one of the tools to ensure residents are able to practice core professional activities without supervision upon completion of the program. (Core) The program director must provide a summative evaluation for each resident upon completion of the program. (Core) This evaluation must: V.A.3.b).(1) V.A.3.b).(2) V.A.3.b).(3) become part of the resident s permanent record maintained by the institution, and must be accessible for review by the resident in accordance with institutional policy; (Detail) document the resident s performance during the final period of education; and, (Detail) verify that the resident has demonstrated sufficient competence to enter practice without direct supervision. (Detail) V.B. V.B.1. V.B.2. Faculty Evaluation At least annually, the program must evaluate faculty performance as it relates to the educational program. (Core) These evaluations should include a review of the faculty s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities. (Detail) Pathology 24
V.B.3. V.C. V.C.1. V.C.1.a) V.C.1.a).(1) V.C.1.a).(2) V.C.1.a).(3) This evaluation must include at least annual written confidential evaluations by the residents. (Detail) Program Evaluation and Improvement The program director must appoint the Program Evaluation Committee (PEC). (Core) The Program Evaluation Committee: must be composed of at least two program faculty members and should include at least one resident; (Core) must have a written description of its responsibilities; and, (Core) should participate actively in: V.C.1.a).(3).(a) V.C.1.a).(3).(b) V.C.1.a).(3).(c) V.C.1.a).(3).(d) V.C.2. V.C.2.a) V.C.2.b) V.C.2.c) V.C.2.d) V.C.2.d).(1) planning, developing, implementing, and evaluating educational activities of the program; (Detail) reviewing and making recommendations for revision of competency-based curriculum goals and objectives; (Detail) addressing areas of non-compliance with ACGME standards; and, (Detail) reviewing the program annually using evaluations of faculty, residents, and others, as specified below. (Detail) The program, through the PEC, must document formal, systematic evaluation of the curriculum at least annually, and is responsible for rendering a written, annual program evaluation. (Core) The program must monitor and track each of the following areas: resident performance; (Core) faculty development; (Core) graduate performance, including performance of program graduates on the certification examination; (Core) At least 80 percent of the program s graduates from the preceding five years must have taken the American Board of Pathology (ABP) certifying examination. (Outcome) Pathology 25
V.C.2.d).(2) V.C.2.e) V.C.2.e).(1) V.C.2.e).(2) V.C.2.f) V.C.3. V.C.3.a) At least 70 percent of the program s graduates from the preceding five years who take the ABP certifying examination must become certified on the first attempt. (Outcome) program quality; and, (Core) Residents and faculty must have the opportunity to evaluate the program confidentially and in writing at least annually, and, (Detail) The program must use the results of residents and faculty members assessments of the program together with other program evaluation results to improve the program. (Detail) progress on the previous year s action plan(s). (Core) The PEC must prepare a written plan of action to document initiatives to improve performance in one or more of the areas listed in section V.C.2., as well as delineate how they will be measured and monitored. (Core) The action plan should be reviewed and approved by the teaching faculty and documented in meeting minutes. (Detail) VI. VI.A. VI.A.1. VI.A.2. VI.A.3. VI.A.4. Resident Duty Hours in the Learning and Working Environment Professionalism, Personal Responsibility, and Patient Safety Programs and sponsoring institutions must educate residents and faculty members concerning the professional responsibilities of physicians to appear for duty appropriately rested and fit to provide the services required by their patients. (Core) The program must be committed to and responsible for promoting patient safety and resident well-being in a supportive educational environment. (Core) The program director must ensure that residents are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. (Core) The learning objectives of the program must: VI.A.4.a) VI.A.4.b) be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events; and, (Core) not be compromised by excessive reliance on residents to Pathology 26