"Cardiovascular Pathology Training in North America"
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"Cardiovascular Pathology Training in North America" "Cardiovascular Pathology Training in North America" Presentation Transcript

  • CARDIOVASCULAR PATHOLOGY TRAINING IN NORTH AMERICA L. Maximilian Buja, M.D .
  • Survey of Membership
    • 17 Responses
      • 15 U.S.A.
      • 2 Canada
    • 9 Programs Identified
  • Type of Training Program
    • Separate CV Pathology Fellowship - 5
      • Diagnostic Component - 5
      • Research Component - 5 (encouraged)
      • Duration - 1-2 years
    • CV Training/Elective as part of AP Residency - 4
  • Separate CV Pathology Fellowships
    • No. Trainees No. Trainees
    • Institution Last 5 Years Currently
    • Massachusetts General Hospital 1 0
    • Brigham and Women’s Hospital 3 0
    • Mayo Clinic 2 0
    • Office of Chief Medical Examiner - 2
    • of the City of New York (combined forensic CV path/neuropath)
    • Texas Heart Institute/UTHSC-H 0 0
  • CV Training/Elective as Part of AP Residency
    • No. Trainees No. Trainees
    • Institution Last 5 Years Currently
    • Washington University ? ?
    • Mt. Sinai, New York ? ?
    • University of Toronto/
    • Toronto General Hospital 2 0
    • University of Minnesota 5 1
    • University of Ottawa/
    • Ottawa Hospital ? ?
  • Components of Training
    • Review in-house and referral CV cases
    • Sign-out with attending faculty all CV surgical material
    • Act as CV pathology consultant to autopsy service
    • Act as CV pathology consultant to clinicians
    • Attend and participate in clinical cardiovascular and pathology rounds and conferences
    • Develop and present review papers on selected topics and case material with publication as desired outcome
    • Perform research project with publication as desired outcome
  • Components of Training
    • Autopsy cases – congenital heart disease, acquired heart disease, including cases with and without previous interventional procedures
    • Endomyocardial biopsies – general diagnostic and transplant cases
    • Native and prosthetic heart valves
    • Aortic, arterial and other vascular specimens
    • Explanted hearts
    • Explanted devices
    • Other
  • Components of Training
    • Standard gross and light microscopic approaches
    • Electron microscopy
    • Immunocytochemistry
    • Molecular diagnostic techniques
  • Components of Training
    • Pathology of congenital heart disease
    • Pathology of acquired cardiovascular disease
    • Pathology of medical and surgical interventions in cardiovascular disease
    • Pathology of molecular cardiology and gene therapy
    • Pathology of regenerative cardiology and stem cell biology
  • Accreditation and Certification
    • Prior to 2002
      • Pathology RRC/ACGME
        • AP/CP-4, AP-3, CP-3
      • American Board of Pathology
        • AP/CP-4, AP-3, CP-3: plus an additional credentialing year requirement
    • Since 2002
      • Pathology RRC/ACGME
        • AP/CP-4, AP-3, CP-3
      • American Board of Pathology
        • AP/CP-4, AP-3, CP-3
  • Accreditation of Training Programs
    • Pathology Residency Review Committee of the Accreditation Council for Graduate Medical Education
      • APCP-4 4-year program in anatomic pathology and clinical pathology
      • AP-3 3-year program in anatomic pathology
      • CP-3 3-year program in clinical pathology
      • PCP-1 1-year program in cytopathology
  • Accreditation of Training Programs
    • Pathology Residency Review Committee of the Accreditation Council for Graduate Medical Education
      • BB-1 1-year program in blood banking
      • DP-1 1-year program in dermatopathology
      • FP-1 1-year program in forensic pathology
      • HMP-1 1-year program in hematology
  • Accreditation of Training Programs
    • Pathology Residency Review Committee of the Accreditation Council for Graduate Medical Education
      • MM-1 1-year program in medical microbiology
      • NP-2 2-year program in neuropathology
      • PP-1 1-year program in pediatric pathology
      • PCH-1 1-year program in chemical pathology
      • SP 1-year program in selective pathology
  • Accreditation of Training Programs
    • APCP-4 programs must include 18 months of formal education in anatomic pathology and 18 months of formal education in clinical pathology. The remaining 12 months of training may be a continuation of structural anatomic pathology or clinical pathology education, or may be devoted to a specialized facet of pathology.
  • Accreditation of Training Programs
    • AP-3 and CP-3 programs must include 24 months of anatomic pathology or clinical pathology education. The remaining 12 months of training may be a continuation of structured anatomic pathology and/or clinical pathology education, or may be devoted to a specialized facet of pathology.
  • Certification of Trainees
    • The American Board of Pathology
    • Primary certification
      • Anatomic and Clinical Pathology, Anatomic Pathology, Clinical Pathology
    • Subspecialty certification
      • Blood Banking/Transfusion Medicine, Chemical Pathology, Cytopathology, Dermatopathology, Forensic Pathology, Hematology, Medical Microbiology, Molecular Genetic Pathology, Neuropathology, Pediatric Pathology
    • Combined Primary and Subspecialty Certification
  • Certification of Trainees
    • Combined AP/CP Certification
      • Four (4) full years of full-time, approved training in an accredited APCP-4 program that includes at least 18 months of structured training in anatomic pathology and 18 months of structural training in clinical pathology, and either an additional 12 months of full-time, continued training in anatomic pathology and/or clinical pathology, or 12 months of full-time, approved training in other areas of pathology as part of the defined four-year accredited AP/CP training program.
  • Certification of Trainees
    • AP Certification
      • Three (3) full years of full-time, approved training in anatomic pathology in an accredited APCP-4 or AP-3 program that includes at least 24 months of structured training in anatomic pathology, and either an additional 12 months of full-time, continued training in anatomic pathology, or 12 months of full-time, approved training in other areas of pathology as part of the defined accredited training program.
  • Observations
    • Reported numbers of CV Pathology Training Programs and reported number of trainees in the USA and Canada are very small.
    • Better data are needed for numbers of CV Pathology Training Programs and trainees.
  • Observations
    • Perceived impediments to individuals choosing CV Pathology as a career:
      • ACGME does not accredit training programs in CV Pathology;
      • ABP does not grant subspecialty certification in CV Pathology;
      • CV Pathology is a purely academic discipline without a corresponding private practice opportunity.
  • Observations
    • The new flexibility in Pathology RRC/ACGME and American Board of Pathology requirements can be explored for possible recruitment and training opportunities for CV Pathology within the general pathology training programs.
  •