Journal of Veterinary Medical Education, Vol 34, Issue 4, 478-484
DOI: 10.3138/jvme.34.4.478
Copyright © 2007 by Association of American Veterinary Medical Colleges
Pathology - Global Challenges in Education |
Residency Training Programs in Veterinary Clinical Pathology: A Comparison of Experiences at Two Institutions
Rose E. Raskin
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ABSTRACT
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Two institutions with different residency training formats in clinical pathology are compared with respect to application procedures, learning and teaching opportunities, learning resources, research training, publication requirements, and assessment methods of the program and trainees. The University of Florida and Purdue University programs are both based on an emphasis in morphologic recognition and interpretation of disease processes as well as training in basic science and applied research principles. The progress of trainees through each program is carefully monitored to meet individual needs as well as to meet the training requirements to allow candidates to sit for the certifying examination in clinical pathology. Periodic mock board exams are a critical tool to assess trainee progress and learning. The differences in format focus on coursework and publication requirements as well as on program assessment tools. While one program provides training in the form of 75% clinical diagnostic service, the other uses a mixture of 50% coursework and 50% clinical diagnostic training. Despite the contrast between a pure residency training program and one combining residency training with an MS degree, both institutions provide a solid program structure, ample learning resources, and adequate faculty mentorship to produce a high pass rate of board-certified specialists, the major focus for both programs. Numbers of post-training employment positions for both institutions are similar for those selecting faculty positions at veterinary schools. During the period studied, however, the combined residency and MS graduate program at Purdue University produced more graduates employed in pharmaceutical and biotechnology companies, while the residency program at the University of Florida produced more graduates employed by diagnostic laboratories.
Key Words: pathology • resident education • veterinary graduate education
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INTRODUCTION
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Residency programs in clinical pathology are intended primarily to provide veterinary graduates with daily participation and responsibility in the recognition and interpretation of morphologic lesions, assessment of specimen collection, and analysis of biologic data from veterinary patients submitted to diagnostic facilities. This supervised training for three to four years fulfills in part the eligibility requirements for the certification examination of the American College of Veterinary Pathologists (ACVP).1 The training may require a nearly full-time commitment to a diagnostic laboratory service or a part-time clinical service experience coupled with formal coursework and research responsibilities. The University of Florida and Purdue University are two institutions offering such training models. Personal experience as the training coordinator at both institutions provided the author with insight into the development and structure of each of these programs. This article explores and contrasts the key features of the two programs.
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OVERVIEW OF THE PROGRAMS
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University of Florida
This residency program involves three years of clinical training with a 75% time commitment to diagnostic service laboratory responsibilities and the remainder for independent study (research and publication preparation).2, 3 Teaching assistance within the veterinary professional curriculum is expected. Three submitted publications and one research project are required. Formal coursework is not required, and graduate studies for a master's or doctoral degree are optional. A doctoral degree requires approximately four additional years for completion following the residency. Currently three residents are supported through income generated by the veterinary medical teaching hospital within the College of Veterinary Medicine. Stipends match those of residents in the other clinical specialties within the teaching hospital. The residency program is administered by the clinical pathology faculty, with administrative responsibilities handled by one of the faculty, the training coordinator. All residency programs within the college are reviewed, generally at three- to five-year intervals, by a college-appointed Residency Program Evaluation Committee composed of residency coordinators.
Purdue University
This non-thesis master's degree/residency program involves three years of clinical training with a 50% time commitment as a graduate assistant.4, 5 Teaching assistance within the veterinary professional curriculum is expected. One submitted publication and one investigative study are required. Formal coursework is required that encompasses core and elective classes, seminars, and diagnostic duty. Pathology training of residents is shared by both clinical and anatomic pathologists through coursework. A doctoral degree may be pursued following the residency for an additional three years. Currently two residents are supported through departmental funding and a third through supplemental income generated by the clinical pathology faculty and service laboratory. Stipends match those of residents in the anatomic pathology program supervised by the Animal Disease Diagnostic Laboratory at Purdue. The graduate/residency program is directed by the clinical pathology faculty, with administrative responsibilities handled by the training coordinator with departmental secretarial support.
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APPLICATION PROCESS
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Position announcements are submitted to the Journal of the American Veterinary Medical Association as well as to pathology-related Internet sites and discussion lists.2, 4 Applications are accepted until December 1 of the year preceding the start of the programs. As no matching program exists for pathology residencies, candidates need additional time to await the decisions from the various institutions considering them. The applicant pool is similar for both Florida and Purdue, with approximately eight candidates per year for the one open position at each school. As in other specialty residency programs, candidates are selected on the basis of academic excellence, a strong interest in clinical pathology and interaction with clinical pathologists, other scholarly activities, previous clinical experience, and excellent communication and interpersonal skills.6
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PROGRAM FORMAT
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Each institution provides three years of supervised training in clinical pathology, as required for the standard route of training by the ACVP.1 Generally, three board-certified clinical pathologists have been available at each institution to provide supervision for the average of two to three trainees in the residency program (see Table 1). While the program at the University of Florida began in 1978 as a pure residency, Purdue's program began predominantly as a PhD graduate program in 1971 and had evolved to a combined residency/graduate format by 1992. Preference is given to staggering the number of trainees over the three years to allow the more senior trainee to help mentor those more junior. Compared with other US and Canadian clinical pathology training programs surveyed in 1998 and 2002, the Florida program exceeded the median number (2.0) of residency trainees in both years, but the Purdue program exceeded the median number (1.0) of graduate trainees only in 1998.7 In the same survey, the median faculty:trainee ratio was 2.0 for all programs; this ratio agreed with the Purdue program's in 2002, but at most other times the ratio was closer to 1.0 for both Florida's and Purdue's programs.7
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LEARNING OPPORTUNITIES
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Readings and Coursework
Written objectives and program requirements are available to the trainees at the beginning of their program, and they are provided with lists of recommended texts and journals.1, 3, 5 Neither program is geared to spoon-feed trainees the material they need to learn to pass the certification exam. Trainees must assume significant responsibility for reading the literature covering the four major exam divisions (hematology, clinical chemistry, cytology/surgical pathology, and general pathology). Both institutions have library resources that include major pathology and clinical medicine reference texts as well as journals to review the current literature. Journal clubs are organized by the trainees, with encouragement and optional participation by faculty. Coursework helps the trainees to organize topics and provides an incentive to study the material in a timely manner. For trainees enrolled in the graduate school at the University of Florida, courses taken may involve statistics, mechanisms of disease, immunology, molecular biology, and protein chemistry.2 The core courses at Purdue University include multiple aspects of general pathology, neoplastic histopathology, ultrastructural pathology, immunopathology, statistics or medical epidemiology, biochemistry, and a histopathology seminar, while elective courses may involve cancer biology, molecular biology, and toxicology.5
Diagnostic Duty
The programs at both Florida and Purdue promote direct supervision of residents by faculty, particularly for the first two years. Residents are scheduled for diagnostic duty together with faculty but have the main responsibility for the initial diagnosis and for interaction with clinicians. Reports are initially generated by residents, after which the supervisor reviews the content, style, and final diagnosis one on one. Over the three years of the program, residents gain added liberty in writing reports, along with increased responsibility for diagnoses. Whereas the Florida program permits only boarded residents to take primary responsibility, Purdue allows third-year residents primary responsibility on a case-by-case basis, as determined by faculty relative to the trainee's demonstrated diagnostic skills. Faculty may still assist when requested by the trainee. This tapered supervision permits trainees to begin the process of independence with increased confidence sooner, and often before they leave the program.
Supplemental Learning Experiences
Outside rotations can provide an exceptional learning experience for both the trainee and the training program through exposure to viewpoints, techniques, and skills outside the current program (see Table 2). Both Florida's and Purdue's programs support opportunities for coursework and outside rotations, as long as these do not have a negative impact on the training program or service schedule. The number and types of permitted rotations frequently reflect the interests of the trainee, the professional relationships of program faculty, and schedule availability. To ensure adequate experience in histopathology, University of Florida residents are routinely scheduled for a two-week rotation in the surgical biopsy service, along with the anatomic pathology residents, each spring for the three years of the program. Coordination and cooperation with the anatomic pathology faculty, who are members of another department, has been excellent, although the quality and quantity of feedback may vary among individuals. In contrast, anatomic pathology at Purdue University is supervised by the faculty of the Animal Disease Diagnostic Laboratory. While anatomic pathologists have faculty appointments to the same department as clinical pathologists, supervision of the histopathologic skills of the trainees is limited to the histopathology seminar offered each fall and spring and to other histopathology-related coursework. Sufficient surgical pathology skills may be learned in this manner, or the training may be supplemented through outside rotations at diagnostic laboratories or other institutions, as elected by the resident. It is therefore beneficial to have a minimum of two residents at a time to permit this educational experience away from the primary training program.
Besides surgical pathology, exposure to commercial diagnostic or biotechnology laboratories can provide large and varied case loads as well as experience with laboratory management, including quality-assurance, methodology, and instrumentation issues. This experience was cited as a program weakness in four clinical pathology training programs (20%) in a 1998 survey involving self-identified weaknesses from 20 training programs in the United States and Canada.7
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TEACHING OPPORTUNITIES
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Residents must become familiar with the material taught within the veterinary curriculum, so attendance and assistance with these courses is an excellent way to bring trainees up to a minimal level of understanding within the first year of the program. Laboratory sessions teach microscopic examination of hematologic and cytologic specimens to veterinary students in the first three years of the curriculum. Both Florida and Purdue teach a core and an elective class in clinical pathology to veterinary students in the fourth year of the curriculum that involve small-group learning.3, 5 Groups of three to six students provide the ideal environment for residents to review their general knowledge of clinical pathology, as well as expanding into the current literature, as they answer probing questions from students. Large classroom teaching is typically reserved for faculty, but delivering one or two lectures per year allows senior residents the opportunity to gain a perspective about academia. Preparation for these lectures as well as seminars given to peers or departmental groups provides excellent training, as topics are often thoroughly researched and organized for presentation. Use of residents to teach veterinary students may be seen by some as a form of cheap labor, but it is a necessary exercise for residents to gain confidence and further develop their communication skills with their constituents. It is a critical aspect of any training program, regardless of whether the resident continues with a career in academia, in a pharmaceutical or biotechnology company, or in a diagnostic service laboratory. Frequently this experience leads trainees to a newly discovered enjoyment of teaching.
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PATHOLOGY LEARNING RESOURCES
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Case Load and Equipment
The most obvious and important source of learning is the service case load encountered by the resident. Not only the number of specimens but also the variety of species and tissues provided is important. Both Florida and Purdue have a strong interest in bone-marrow pathology, so materials from this tissue are abundant. University of Florida residents often obtain the aspirate and core biopsy material, but only the cytology is read by the clinical pathology service. Purdue trainees do not personally obtain the biopsy material but write the diagnostic reports from concurrent cytologic and histologic bone-marrow samples taken from cases at the veterinary teaching hospital. Materials from exotic and wildlife species are especially abundant at the University of Florida. Annual case-load numbers are similar for both institutions, with current hematology submissions at 6,400–7,100; chemistry panels at 6,400–6,600; urine analyses at 1,500–2,200; and cytology cases at 2,400–3,800.3 Presentation of the case material at service rounds and hospital seminars strengthens residents’ ability to recognize, describe, and interpret hematologic, cytologic, and biochemical data. Case material used for teaching is later archived for the use of future trainees. Laboratory instrumentation problems are discussed during staff meetings to emphasize laboratory-management concerns in the training program, as supported by a recent report.8 This report lists expected competencies in clinical chemistry as determined by peer experts and suggests ways in which training programs can incorporate these competencies into their programs. Chemistry cases involving in-house and external laboratory-management problems are also archived for future use. Equipment available at each institution typically includes a trainee individual microscope, a multi-head teaching microscope, microscope video projection systems, and conventional film and/or digital image capture units attached to a microscope.
Archived Collections
It is essential to have a collection of archived materials relating to less frequently encountered lesions to supplement the common conditions seen on the diagnostic service. In addition to slide sets used to teach veterinary students, each institution has a unique collection of resources that support resident training.
University of Florida2-
The following resources are available to residents:
- The Integrative Glass Slide Teaching File, a computer-catalogued set of more than 2,300 glass slides with cytology and histopathology correlations, along with more than 1,600 slide transparencies
- American Society for Veterinary Clinical Pathology (ASVCP) case-review materials from 1989 to the present containing glass slides with chemistry data and slide transparency cases
- The International Slide Bank of Veterinary Pathology (7th ed.) laserdisc, a worldwide collection of hematologic and cytologic materials to which University of Florida faculty have contributed
- The University of Florida Health Science Center laserdisc, containing more than 500 images of hematologic and cytologic material submitted by the clinical pathology faculty
Purdue University4-
The following resources are available to residents:
- Integrative Cases, a computer-catalogued set of more than 400 cases involving hematology or cytology, with corresponding histopathology grouped by organ system, as well as selected clinical chemistry cases
- A computer-catalogued collection of ASVCP case-review materials from 1982 to the present, containing more than 500 cases involving glass slides, chemistry data, slide transparencies, and digital images
- A collection of 75 clinical chemistry cases with written interpretations from Purdue University Veterinary Teaching Hospital (PUVTH)
- A collection of 150 surgical pathology glass slides with written descriptions from PUVTH
- Searchable databases of current daily cytologic cases and prior surgical pathology cases (more than 25,000 combined)
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RESEARCH PROJECTS AND TRAINING
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Residency and graduate program requirements at the University of Florida and Purdue University include completion of an investigative project. Residents are expected to give an oral presentation of their project results at a university seminar or national meeting. The research project at Florida represents a significant component of the residency program, in which the trainee often works in a basic science research laboratory, with a formal presentation expected at the completion of the program. An in-house grant competition assists in funding this project. The experience provides exposure to scientific design of a project, grant writing, research methodologies, and statistical analysis. The non-thesis MS degree program at Purdue is heavily focused on coursework and class projects. Investigative projects outside the classroom are encouraged, in the form of collaborative efforts with faculty researchers in basic and applied science. Clinic cases may be thoroughly investigated to complete the project requirement at Purdue. These investigations often result in a seminar presentation at the university or in an oral or poster presentation at a national meeting.
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PUBLICATION REQUIREMENTS
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The training programs at both Purdue University and the University of Florida require publication of at least one first-author refereed journal article. While only one publication is required for the three-year program at Purdue, Florida requires one publication for each year of the program, meaning that three must be submitted to receive the residency certificate. Publications may include any investigative study of laboratory methods or diagnostic testing; case reports; case studies; or an introduction of preliminary data for doctoral studies. Compliance is generally excellent, as the requirements are emphasized early and frequently during the program.
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PROGRAM EVALUATION
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The clinical pathology residency program at the University of Florida is overseen by a college-wide committee. Residents provide formal annual critiques of the program to the evaluation committee and the clinical pathology training coordinator. The evaluation committee reviews all residency programs in the college every three years, and a detailed report is given to the coordinator and college administrators for consideration. The residency program evaluation protocol used in this review is shown in Table 3. The training coordinator is expected to indicate the need for an advanced degree in the discipline based on position descriptions received from prospective employers. Positions in industry usually require a graduate degree, while diagnostic laboratories often only require board certification. Comments from previous trainees, statistics about program applicants, data on trainee outcomes, and program changes and accomplishments are evaluated during this review. This extensive program report is submitted by the training coordinator and details each current and past resident's accomplishments, including board certification status. Residents involved in the program since the prior report are contacted by the college committee for information about their current job status and asked for their appraisal of the strengths and weaknesses of the program; results are treated confidentially. Deficiencies in a program can influence future college support of the residency program.
Program evaluation at Purdue University is handled through the departmental graduate committee and department chair. Coursework selection for the MS degree program is guided by departmental faculty, with specific requirements selected by the clinical pathology faculty and the trainee's graduate committee. Feedback about the program is generally obtained through exit interviews and informal discussions throughout the training program.
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ASSESSMENT OF TRAINEES' PROGRESS
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Mock Board Exam
Each program currently includes a formal yearly mock board exam for each trainee in the program. This exam began and continues locally at the University of Florida with a one-day mini version of the clinical pathology certification exam given in June prior to the end of the resident year. It should be noted that all residents, regardless of their year in the program, are evaluated by the mock board exam. Florida was the only institution to identify the mock board exam as a strength of its program in the 1998 survey.7 General pathology multiple-choice questions are compiled jointly by pathology faculty from two departments. These questions are also used for the mock board exam in the anatomic pathology residency program. Multiple-choice questions for the sections on hematology, clinical chemistry, and cytology/surgical pathology (CSP) are written by the clinical pathology faculty. In years when trainees from other institutions take the Florida mock exam, contributions from their faculty are requested and included in the exam. Five projected images are included for each of the hematology and CSP sections, as well as three glass slides for each of these sections. One clinical biochemistry case for interpretation is provided. Residents take the mock exam under test conditions similar to those of the actual exam. Glass slides may be shared, and the timing of the sections is strictly enforced. Answers are graded by the training coordinator and discussed with the resident to indicate deficiencies. Training plans are individualized as a result of the mock board exam. While the actual board exam requires a passing grade of 60% for each of the four major sections, 16 years’ experience with the Florida mock exam indicates that trainees often receive a grade in the 30s in their first year, in the 40s in their second year, and in the 50s at the end of their third year, three months prior to the actual board exam. Residents comment that the mock exam is occasionally more difficult than the real exam but that it is similar in content, depth, and complexity. The mock board exam results cannot predict whether or not a candidate will pass the real exam, but they can suggest his or her degree of readiness, since deficiencies revealed in the summer months are then targeted for improvement prior to taking the exam. This annual exam helps the trainee and the training coordinator to recognize gradual improvements in the training process as well as revealing deficiencies. Most trainees achieve the most dramatic improvements during their second year.
The mock board exam process at Purdue University is currently a collaborative exercise with eight other training programs, mostly in the Midwest, to produce a combined mini-exam for a larger group of trainees that is taken in July. All nine training programs participate in formulating questions and cases as well as gathering visual images and glass slides. To ensure minimal duplication and an appropriately broad exam, topics are identified in advance and assigned to each participating school. Over the past three years, this exam was organized and held alternately at Michigan State University and the University of Guelph. Trainees grade their papers using an answer sheet, and results are shared with the respective schools’ program coordinators. Those trainees unable to travel take the written portions of the exam at their home institutions. All residents, even those just beginning the first year, are required to take the mock exam, so as to introduce the format of the exam early in their training.
Both Florida and Purdue also challenge their trainees with periodic unknown specimens in an informal manner, through weekly service rounds or mini slide quizzes.
Written Evaluation Reports
In addition to tests of the trainee's knowledge, annual (Purdue) and semi-annual (Florida) assessments of overall performance are submitted to department/college committees. These help provide feedback to the trainee that compares their performance to that of other past or current participants in the program.
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OUTCOMES ASSESSMENT
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The University of Florida and Purdue University have produced a similar number of individuals who complete their training programs, approximately one boarded individual every two years per institution (see Table 4). The number of individuals who eventually pass of the ACVP board exam is equally high for both institutions (81% for Florida, 87% for Purdue). In a report that compiled the results of two surveys taken in 1998 and 2002 by 20 and 25 clinical pathology training programs respectively, the eventual pass rate of all 108 trainees was 72.2%;7 the same report documented a first-time pass rate at program completion of 51.9%.7 Data on first-time passes for the University of Florida and Purdue University are incomplete but are similar to the survey report, with 55% and 57%, respectively, for known trainees at both institutions (see Table 4). The lack of difference in first-time pass rate between these two institutions with different training formats mirrors the findings of the survey report, which found no significant difference in board certification status at program completion between trainees in residency programs (53.6% certified) and those in graduate programs (50.0% certified).7
Numbers of master's and doctoral degrees vary as expected for the type of program, with 38% at Florida and 100% at Purdue, compared with 63% for all programs surveyed.7 Academic positions are most favored for post-training employment in both programs, accounting for 44% of Florida trainees and 53% at Purdue, compared with 39% from all programs.7 Florida trainees were next likely to select commercial diagnostic laboratories (25%), while Purdue trainees preferred pharmaceutical or biotechnology companies (38%), compared with 28% employment in diagnostic laboratories and 13% in industry by 108 trainees in the survey report.7 The tendency for residency trainees to be employed by diagnostic laboratories and graduate-degree trainees to be employed in academia and industry was shown to be statistically significant in the same survey.7
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CONCLUSIONS
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The University of Florida and Purdue University programs both emphasize morphologic recognition and interpretation of disease processes as well as training in basic science and applied research principles. The progress of trainees is carefully monitored through semiannual and annual evaluations by faculty, annual mock board exams, and oral and written feedback about the program from trainees. The ratio of one ACVP-boarded faculty member per trainee is frequently used to support each program, which differs from a recent survey of clinical pathology programs in which the median faculty:trainee ratio was 2:1.7 These results show that a program's quality does not depend solely on the number of participating faculty members. Research training is obtained through a single major resident project or through one or more small clinical or laboratory data studies. Coursework supplements and complements learning, although it is optional for the residency program at Florida. Scholarly activities by trainees are encouraged through requirements for publication and seminars. Teaching and communication skills are developed through lectures and small-group discussions with veterinary students and other house officers. Despite the contrast between a pure residency training program and a combined residency and MS degree program, both institutions provide a solid program structure, ample learning resources, and an adequate number of qualified mentors to produce board-certified specialists, the major focus for both programs. A similar number of trainees at both institutions choose post-training employment in faculty positions at veterinary schools, but the combined residency/graduate-degree program at Purdue University favors employment in pharmaceutical and biotechnology companies. This preference for industrial positions over commercial diagnostic laboratory positions may have been influenced by the larger number of graduate degrees awarded as well as by the high density of such companies in the Midwest region of the United States compared with the southern states. The higher percentage of PhD degrees awarded at Purdue University compared with the University of Florida relates in part to the fact that the program was predominantly a doctoral degree program prior to 1992. However, since the change to the current combined residency/MS format, approximately half of the trainees continue their graduate training, receiving a PhD after taking their board certification examination.
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Footnotes
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AUTHOR INFORMATION
Rose E. Raskin, DVM, PhD, Dipl. ACVP, is Professor of Veterinary Clinical Pathology and Director of Continuing Education, Department of Comparative Pathobiology, Purdue University School of Veterinary Medicine, 725 Harrison St., West Lafayette, IN 47907 USA. E-mail: rraskin{at}purdue.edu. She was the training coordinator at the University of Florida from 1989 to 2003 and has held the same post at Purdue University since 2003.
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REFERENCES
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- Training and Preparation for the Certifying Examinations of the ACVP. Madison, WI: American College of Veterinary Pathologists, 2005 <http://acvp.org/exam/train.php> Accessed 08/13/07.
- Alleman R. Madison, WI: American Society for Veterinary Clinical Pathology [ASVCP], 2007 University of Florida Training Program <http://www.asvcp.org/trainingprograms/florida.html> Accessed 08/13/07.
- Wamsley H. Gainesville: University of Florida, 2006 UF Veterinary Clinical Pathology <http://physio.vetmed.ufl.edu/clinpath/resident.html> Accessed 08/13/07.
- Raskin RE. Madison, WI: ASVCP, 2006 Purdue University Training Program <http://www.asvcp.org/trainingprograms/purdue.html> Accessed 08/13/07.
- Purdue University Requirements for Graduate Programs in Clinical Pathology. West Lafayette, IN: Department of Veterinary Pathobiology, Purdue University, 2006 <http://vet.purdue.edu/cpb/clpthsec.html> Accessed 08/13/07.
- Davidson HJ. Residency selection perceptions held by diplomates of the American College of Veterinary Ophthalmologists and veterinary ophthalmology residency applicant data. J Vet Med Educ 31:289–294, 2004.[Abstract/Free Full Text]
- Christopher MM, Schultze AE, Bird KE. Postgraduate training programs in veterinary clinical pathology in the United States and Canada (1998 to 2002). Vet Clin Pathol 32:121–135, 2003.[Medline]
- Christopher MM, Stokol T, Sharkey L. Guidelines for resident training in veterinary clinical pathology, I: clinical chemistry. Vet Clin Pathol 32:202–208, 2003.[Medline]
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ABSTRACT
INTRODUCTION