What Does Competency Mean and Does it Really Matter?

Instead of having to deal with the sub-zero cold weather in Chicago (where my car doors froze earlier in the week and I had to tug on them for over half an hour to get into the backseat of my car to turn on the heat), I was fortunate last weekend to be in the sunny and warm wine countryof Temecula (near San Diego). I was there for a CAP Council on Education meeting where I served as their junior (resident) member. Due to confidentiality agreements, I can’t divulge specific details, but it did get me to thinking about what “true competency” means and what we need to do to obtain and maintain it after we graduate.

Residency is a transition for many (especially if you didn’t take time off to work before continuing your higher education) between two different mentalities: that of school versus employment. Ideally, there shouldn’t be a large difference between how we approach school and our job but that’s not always how it goes. In medical school, if we didn’t continually study, it was just our grade that would suffer and we could study harder for the next test to average out to a decent grade. But with residency, which is now my job, when I don’t apply myself to learn everyday (and I can’t say that I’ve perfected this yet but I keep trying), it’s really my patients, and possibly future patients, who suffer the consequences.

Pathology is the “end game.” We are the regulator of most diagnostics (both on the CP and AP sides) that other physicians use to make treatment and prognostic decisions.And so, we need to train now and develop a trainee culture that nurtures life-long learning (and truly mean more than just lip-service). We need to allow residents to participate in true “practice-based” learning (not just passive learning) and to feel the punitive consequences if we ignore our responsibilities or are incompetent. I believe in second, and even third, chances. I believe that our residency programs should remediate residents who are not where they should be in a non-threatening manner. But I do also believe that there is a minimum bar that we all need to meet within a specified time frame.

I believe that we need to be good representatives of our respective programs as graduates, and more importantly, “competent” pathologists who do not hurt our patients due to lack of important knowledge that we should possess – and of course, it’d be nice not to have to worry about malpractice issues as well. Developing this mentality starts during residency – where we should study a little everyday in order to perform as much as we can– and where we can take feedback from our attendings and work to improve our areas of deficiency while we have them around to guide us.

Some pathologists on forums that I’ve visited decry maintenance of certification (MOC) and the continuing medical education (CME) and/or self-assessment modules (SAM) as money-making measures for the organizations who put together CME/SAM material. This weekend, I learned what these and many other acronyms mean. I can see their point since it often costs money to obtain CME/SAM; also, physicians do not want to think of having to take tests once they graduate med school. However, I do think that in a rapidly changing field such as pathology, not being up-to-date may have detrimental effects on patient care, so CME/SAM are necessary. We can’t always expect that everyone in our profession will be motivated to be up-to-date without some sort of “carrot stick.” It’s sad but true. So my main point, fellow residents, is that we should develop good habits now that encourage life-long learning and an attitude that shows that we put our patients first…and we’ll probably find that without even realizing it, we have worked toward gaining competency in our profession. So what do you think about the need for CME/SAM and MOC every 10 years? There’s no “grandfathering in” for any of us, so we will have to deal with this. But do you think that this is the way to go to help our maintain competency once we’ve achieved it?

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Engage Yourself to Transform Our Profession

It’s never too early to be an engaged pathologist-in-training. This means that we must understand our past and have a strong vision of the future we hope to shape. We must evaluate the forces that have influenced the role and perception of our profession within society, what we did or didn’t do in the past that has led us to our current status, and not only what things we would like to change but also to what do we want to change them.

Since I have an advocacy and organizing background, I may look at our profession a little differently than other residents. First, we are a small profession. The majority of medical students do not choose to become pathologists. But I believe that may be due to at least in part, to a lack of commitment to nurture our pipeline. There is no national medical student organization for those who are interested in learning more about pathology as a profession, and often the little exposure that medical students do get is not an accurate representation of what they would do during residency and ultimately, in the working world.

It’s never too early to be an engaged pathologist-in-training. This means that we must understand our past and have a strong vision of the future we hope to shape.

Secondly, we are still more discohesive (and I’m not talking about a lymphoma here) than we should be as a profession. This may partly be due to the diverse nature of our profession where AP and CP are all considered pathology. In many Asian or European countries, pathology residents must choose one track or the other; they, more times than not, do not have the option for combined AP/CP. So does this confuse or hurt us to educate our future pathologists in this manner where allegiances are often diluted? I say no, not directly. But since we do have so many subspecialties, and consequently, subspecialty organizations, many residents and pathologists who are limited in terms of time and energy have to choose and prioritize which organization to devote their efforts. Even though we have ASCP and CAP as more all-encompassing organizations, we could still have stronger solidarity and more frequent interactions between these groups.

Thirdly, from my n=1 (level 3 evidence which isn’t always worth much), most residents and attendings I see have very little interest or experience in political advocacy even though this may be the greatest avenue we have for palpable change. I have seen some committed to curricular reform. I have also seen some who promote the profession by serving on hospital and program committees as well as leadership in state and national societies. But what I don’t see much of are those who keep track of what is going on in DC and within society that affects our profession and who attempt to do something to change what they perceive as negative. We need to change our culture and encourage and train our residents to get involved early in such activities.

And last, but not least, we need to own our value as physicians. We must not allow anyone to treat as us less than a physician from another specialty. And practice makes perfect–we as residents should start early by serving on organizational committees, etc. I will be doing my part this weekend serving on the CAP Council on Education (COE). I’ll let you know how that goes.

As an aside, creating an organization to educate medical students about pathology is a pet project of mine. If you’re interested in helping to start such an organization where we can also serve as mentors to pathology residents-to-be, please feel free to email me at bchung73@uic.edu.

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.