Separate AP and CP Training?

[KeratinPearls]

---

Members do not see this ad.

I heard of program directors talking about separating AP from CP training. I think one reason being the overwhelming amount of material. In my opinion, it seems as if most programs don't train residents well in CP unless you are at a large academic center. I also agree that the information is overwhelming. C'mon AP you have to master ALL the subspecialties (knowledge base and diagnostic skills) as well as CP (micro, BB/TM, Cytogenetics, chemistry, immuno, hemepath)...

Seems like byt the time you finish training, you are a jack of all trades, master of none....I mean if anything MASTER AP because that's where you can make serious errors. Most pathologists really forget CP as they go along in their career and really just know what they do on a daily basis like signing out electrophoreses, etc. As I watch fellow residents study for boards, they are just memorizing thousands and thousands of factoids (CP) and I wonder how much these ppl will remember years out in practice. I'm not even sure most of the stuff tested in CP boards is practical?

What do you guys and gals think about this?

 

[lifehouse51]

Do you mean not having combined AP/CP programs and instead having separate 3-years AP and 3-years CP programs for people to pick both or either?
Residency training is in a way similar to med school (or even Undergrad): You will learn a lot of info that you don't need for your job on a daily basis, and probably will forget a lot of the details within a few years. However, being exposed to the material will make it easier for you to look up info that you forgot later on; and I think one's general understanding of a subject gets better with the exposure, even when you forgot the details.
Plus the U.S. Medical Education system is long as it is, extending the length of residency training is not gonna help. Medical school curriculum is quite condensed already, and I think that will be a sizable number of people who oppose turning it into 5, 6 year curriculum or more.

 

[icpshootyz]

I just don't think enough people would ever sign up for a CP-only residency for it to be possible to separate the two. I despise CP, but I know I might not want to stay strictly academic so I'm sucking it up and doing it. We've offered a CP-only spot at my program for years and this coming year is the first time it's been filled. So, if they separate AP and CP, basically no one would ever do CP and there would be no one trained to cover the labs. Personally I think CP should be more of a PhD field - they're the ones that like all the super-sciency details of the CP world. But, I'm sure there's all sorts of economic and legal issues involved with making CP a PhD-run job.

 

[KCShaw]

If you're for relinquishing another segment of the physician-pathologist's domain, then this might be a good consideration. As it is, non-medical "pathologists" (PhD's, technicians, other basic scientists, etc.) have extensively infiltrated the realm of CP and are quite poised for a coup. Were it not for the need to maintain laboratory oversight by a physician, it's quite possible this would have already occurred.

The reality is, I think, that most clinicians have surprisingly little idea what is involved in obtaining valid laboratory results, what a given test means or -doesn't- mean, and what may or may not have interfered with it. While getting and keeping the machines up and running might appear well suited to technicians and PhD's, helping a clinician interpret really is not. It's already difficult for some pathologists to be taken seriously by some clinicians -- I simply don't think it's in the best interests of medicine for physician-pathologists to just walk away from the clinical laboratory.

In the good old days CP was apparently a big moneymaker, which made it something aggressively protected. Not so easy anymore.

I'm not saying the current training scheme is necessarily the best possible option. But I don't think completely separating AP & CP as a "standard" is a better alternative (though it is currently possible and some programs offer it -- most don't, I suspect in part to keep cheap labor around for both AP & CP labs for a fairly standard 4 years).

 

[Parts Unknown]

Personally I think CP should be more of a PhD field - they're the ones that like all the super-sciency details of the CP world. But, I'm sure there's all sorts of economic and legal issues involved with making CP a PhD-run job.

CP still involves a lot of clinical knowledge, and if we hand it over to PhDs then we are essentially reliquishing a huge part of our turf for no good reason. If all this newfangled molecular testing that has been promised forever actually emerges, I'm betting most (if not all) of it will be under the purview of CP. Should it turn into a cash cow like imaging did back in the 90's we will forever regret not laying claim to it.

There is a lot to dislike about CP, but if you want to be part of a group the provides comprehensive laboratory services to a hospital, you're better off embracing it as a necessary part of the job. CP board certification is actually necessary for my credentialing, so I'm glad I have it.

 

[2121115]

Clinical pathology training should by no means go away. However, calling CP an independent residency is beyond absurd IMO. AP and CP should be merged into one specialty, "Diagnostic Pathology", and the training integrated. In some ways it already is and CP is a separate residency in name only but we need to make it official and allow those with forward thinking, global perspective trim the fat from CP and AP both to make an improved specialty.

 

[path19]

Clinical pathology training should by no means go away. However, calling CP an independent residency is beyond absurd IMO. AP and CP should be merged into one specialty, "Diagnostic Pathology", and the training integrated. In some ways it already is and CP is a separate residency in name only but we need to make it official and allow those with forward thinking, global perspective trim the fat from CP and AP both to make an improved specialty.

Excellent suggestion.

 

[pathstudent]

What the hell are you talking about. You do a mooTha of ap only and months of cp only. Some programs like ucsf have you do year blocks and some like Stanford have you do two year blocks. But you never do both at the same time. They already are separate. Which program directors are you talking about.

I heard of program directors talking about separating AP from CP training. I think one reason being the overwhelming amount of material. In my opinion, it seems as if most programs don't train residents well in CP unless you are at a large academic center. I also agree that the information is overwhelming. C'mon AP you have to master ALL the subspecialties (knowledge base and diagnostic skills) as well as CP (micro, BB/TM, Cytogenetics, chemistry, immuno, hemepath)...

Seems like byt the time you finish training, you are a jack of all trades, master of none....I mean if anything MASTER AP because that's where you can make serious errors. Most pathologists really forget CP as they go along in their career and really just know what they do on a daily basis like signing out electrophoreses, etc. As I watch fellow residents study for boards, they are just memorizing thousands and thousands of factoids (CP) and I wonder how much these ppl will remember years out in practice. I'm not even sure most of the stuff tested in CP boards is practical?

What do you guys and gals think about this?

 

[green mantis]

As I watch fellow residents study for boards, they are just memorizing thousands and thousands of factoids (CP) and I wonder how much these ppl will remember years out in practice. I'm not even sure most of the stuff tested in CP boards is practical?

If you really think about, how much of the stuff that gets tested on the AP boards is truly practical? I think part of the reason most of us don't think there's as much is because most of it is force-fed to us during residency. There were tumors that I was tested on that I've only read about while studying & like will never see in practice unless it's in a study set.


----- Antony

PS: In case anyone is wondering, AP & CP are separate residencies in Korea.

 

[Perry Mason]

Same story in the UK.

IMO, it makes sense from the academic point of view, i.e. one can dedicate more time to their specific area of interest. I don't see it working in the US though. Even if, hypothetically, such a divide is enforced, it will take decades for all the combined AP/CP trained pathologists to retire. In the meantime who would want to employ a purely CP trained graduate when you can have both?

 

[KCShaw]

..snip..
<snip>Even if, hypothetically, such a divide is enforced, it will take decades for all the combined AP/CP trained pathologists to retire. In the meantime who would want to employ a purely CP trained graduate when you can have both?

Interesting point, and probably accurate for "common" (though becoming less common) smaller labs. Even if you get one AP-only then go get a PhD, or an experienced tech to handle day-to-day admin, you're out more than you would be paying a single AP/CP. Greed (or rather, our encouraged economic philosophy) makes change a real pain sometimes.
</snip>

 

[2121115]

Interesting point, and probably accurate for "common" (though becoming less common) smaller labs. Even if you get one AP-only then go get a PhD, or an experienced tech to handle day-to-day admin, you're out more than you would be paying a single AP/CP. Greed (or rather, our encouraged economic philosophy) makes change a real pain sometimes.
</snip>

Why would it be 'greedy' for a pathologist to manage a laboratory? That may be overstating it more than a little bit.

 

[KCShaw]

I don't think it would. It could be considered greedy, however, to have anything "less" than a strongly CP trained pathologist run a lab for the sole reason that the practice doesn't want to pay more for more formal medical clin-path education. Whether that's an AP/CP with an AP focus, PhD, or tech. I used the term "greed" to intentionally overstate that last line -- so much for subtle humor and poking fun at the capitalist regime which, in general, we benefit from so much. And I used it to agree that I doubt there would be enough CP-only jobs for a sudden influx of CP-only patholgists. Similarly, but with less humor, I used the term "less" not intending to minimize the contributions of non-MD PhD's and other laboratory professionals but to highlight their general lack of specific clinical/patient-oriented formal education, which I feel is important in any clinical pathology laboratory.

 

[Kezaar]

Interesting thread, actually in a lot of European countries AP and CP are separated. I don't know if it's a good decision, but medicine becomes more and more specialized. I think it's hard enough to master only microbiology for example.

 

[Gene_]

...medicine becomes more and more specialized. I think it's hard enough to master only microbiology for example.

This is THE point. It is not possible to be good at everything.

What is better for patients?

 

[KCShaw]

Ideally, one clinician who knows everything and can handle anything including procedures/surgeries, and pathologic analysis/interpretation. One person who knows about everything a patient is being treated for, and understands how they (and their treatments) might interact. (And who is ethical enough not to self-refer for personal gain; the financial & ethical issues are a whole other problem.) But, these days that's no longer even remotely practical given the immense volume of available medical knowledge and techniques.

Yet...I'm really -not- a fan of extensive early medical ultraspecialization to the detriment of developing solid foundations. The average physician (or clinical resident) shouldn't be spending half of their time requesting consults or reading others' consultation reports. The average pathologist should have enough understanding to not HAVE to send most brain biopsies out, should be able to correlate autopsy & clinical findings, know what to do with most given tissue or fluid specimens, or be able to understand the meaning (or lack of meaning) of a series of CP lab results. It's also another of the many reasons I'm not a particular fan of PhD's (ultraspecialists of a slightly different sort) running labs. The lack of a good foundation means constantly assuming someone else is giving you all the information you need, and that someone else is handling everything you aren't; it turns generalists into managers, and gives specialists the sense of lack of general responsibility for the patient (&/or lab) as a whole.

Yes, absolutely there is benefit to ultraspecialization. No doubt about it. There's a lot of things I'll probably never know, or know well, and someone needs to. But what is odd to an ultraspecialist shouldn't turn out to be common for a generalist. And a generalist should be able to function without spraying a constant fountain of consult requests. Medical school used to pretty much suffice for the strong foundation, with branching into specialties after that, subspecialties after that, and sometimes ultraspecialties after that. I just hope we're not losing, or risking the loss of, some early and middle ground while searching for the next branch as quickly as possible.

Let the rare be rare, and seek out the rare few to help understand &/or deal with it. Beware the top-heavy nature of an explosion of ultraspecialists without maintaining the broad foundations.