Abstract #9

Presenter

Hao Li is a resident in Pathology at Schulich School of Medicine and Dentistry, Western University. He is currently in PGY5 year of Diagnostic and Molecular Pathology (formerly Anatomical Pathology), and will be pursuing an additional 2 years of training in Neuropathology at Western University afterwards.

Authors

 Hao Li¹, Sarah J. Aziz¹, Lindsay Ninivirta¹, Louise Mui¹, David K. Driman¹, Christopher J. Watling², Emily A. Goebel¹

 ¹Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

²Centre for Education Research & Innovation, Western University, London, ON, Canada

CanMEDS:
Medical Expert (the integrating role), Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

Assessment challenges and headaches in the implementation of Competence By Design (CBD): The experience in a Diagnostic and Molecular Pathology residency program

Background/Objectives: The recent implementation of Competence by Design (CBD) in Neuropathology residency creates changes in both education philosophy and practical administration. This study analyzes perceptions of specific assessment criteria in CBD at one Diagnostic and Molecular Pathology (formerly Anatomical Pathology) residency program, and the lessons learned.

Methodology:  We focused on assessment interpretation of Transition to Discipline (TTD) Entrustable Professional Activities (EPAs), which overlap with those in Neuropathology – basic specimen handling, basic microscopy, and summarizing clinical information for clinicopathologic correlation. Eight pathology faculty were interviewed. They were first shown the EPA titles only (“gestalt” impression), then the full descriptions, and expressed their perceived expectations of the EPAs during each phase. Interviews were recorded, transcribed, and subjected to thematic analysis.

 Results:  The gestalt impression of specimen handling and microscopy EPAs varied widely in the expected level of performance at a “basic” stage. While the descriptions clarified expectations, participants disagreed on whether they were valid and complete, due to contrasts with their own training experience, daily work, and subspecialty niche. It was also felt that all EPA descriptions contained internal inconsistencies that were challenging to interpret. Consequently, faculty described varying approaches to resident assessment despite identical criteria.

 Conclusions:  Our findings demonstrate significant subjectivity in the interpretation of CBD EPAs, even with detailed assessment criteria. This is due to both inadequate clarity of descriptions as well as faculty attitudes and biases. Therefore, further refinement of EPA descriptions may be necessary, along with education of faculty on the underlying purpose of each assessment item.