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PubMed2005

Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we?

OBJECTIVE: The objectives of our study were to define CT and MRI features that distinguish pathologic fractures from stress fractures and to compare the performance of CT and MRI with radiography. MATERIALS AND METHODS: Two reviewers retrospectively reviewed 45 MR images, 37 CT scans, and 43 radiographs in 59 patients (30 biopsy-proven pathologic fractures and 29 stress fractures followed to resolution). The features observed on MRI were abnormal bone marrow (well-defined, ill-defined); intracortical, periosteal, or muscle T1 or T2 signal; endosteal scalloping; and a soft-tissue mass. The features seen on CT were marrow abnormality and character (well-defined, ill-defined, permeative, moth-eaten), endosteal scalloping, periosteal reaction (benign, aggressive), and a soft-tissue mass. Reviewers rated their confidence for diagnosing a pathologic fracture on a 1-3 scale (< 50%, 50-95%, > 95% sure, respectively) with each technique. Performance of each technique was defined by reviewer accuracy and area under the receiver operating characteristic curve (Az); the frequency with which the MRI and CT features were associated with pathologic and stress fractures was calculated. RESULTS: For both reviewers, accuracy for differentiating pathologic from stress fractures was highest on MRI (accuracy/Az: reviewer 1, 98%/0.97; reviewer 2, 93%/0.99); CT (reviewer 1, 88%/0.83; reviewer 2, 82%/0.90) was less accurate than radiography (reviewer 1, 94%/0.98; reviewer 2, 88%/0.96). On MRI, pathologic fractures compared with stress fractures exhibited well-defined T1 marrow signal (83% vs 7%, respectively; p < 0.001), endosteal scalloping (58% vs 0%, p < 0.001), muscle signal (83% vs 48%, p = 0.026), and a soft-tissue mass (67% vs 0%, p < 0.001). On CT, pathologic fractures compared with stress fractures exhibited marrow abnormality (84% vs 17%, respectively; p = 0.001), endosteal scalloping (44% vs 0%, p = 0.006), and aggressive periosteal reaction (36% vs 0%, p = 0.04). CONCLUSION: MRI is useful for distinguishing pathologic from stress fractures, especially after inconclusive radiographic findings. Specifically, pathologic fractures exhibit well-defined T1 marrow alterations, endosteal scalloping, and adjacent soft-tissue abnormalities.

Adolescent↗
PubMed2005

Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. METHOD: Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria. RESULTS: The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05). CONCLUSION: Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.

Adolescent↗
PubMed2000

Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology.

BACKGROUND: Spurious increases in serum troponins, especially troponin T, have been reported in patients with and without acute myocardial syndromes. METHODS: We studied 78 autopsied patients without clinical myocardial infarction (MI) and correlated histologic cardiac findings with antemortem serum creatine kinase (CK), its MB isoenzyme (CK-MB), cardiac troponin I (cTnI), and cardiac troponin T (cTnT). RESULTS: There was no significant myocardial pathology in 15 patients. Cardiac pathologies were in five groups: scarring from previous MI or patchy ventricular fibrosis (n = 9), recent MI (n = 27), healing MI (n = 7), degenerative myocyte changes consistent with congestive heart failure (CHF; n = 12), and other cardiac pathologies (n = 8). The median concentrations in the five groups were not significantly different for either CK or CK-MB. Compared with the no-pathology group, only the MI group was significantly different for cTnI, and the MI and other pathology groups were significantly different for cTnT. For patients with MI, 22%, 19%, 48%, and 65% had increased CK, CK-MB, cTnI, and cTnT, respectively; for CHF and other cardiac pathologies combined, the percentages were 28%, 17%, 22%, and 50%. For patients with increased cTnI, 72% and 28% had MI and other myocardial pathologies, respectively; patients with increased cTnT had 64% and 36%, respectively. Patients without myocardial pathology had no increases in CK-MB, cTnI, or cTnT. CONCLUSIONS: All patients with increased serum CK-MB, cTnI, and cTnT had significant cardiac histologic changes. The second-generation cTnT assay appears to be a more sensitive indicator of MI and other myocardial pathologies than the cTnI assay used in this study.

Autopsy↗
PubMed2002

Pathologic fracture in osteosarcoma : prognostic importance and treatment implications.

BACKGROUND: The presence of a pathologic fracture in an osteosarcoma has been considered a poor prognostic factor and an indication for immediate amputation. The purpose of the present study was to determine, in the current era of neoadjuvant chemotherapy, whether a pathologic fracture in an osteosarcoma has prognostic importance and whether limb salvage can be safely performed in such patients without compromising clinical outcome. METHODS: In a cooperative effort of the Musculoskeletal Tumor Society, members from eight institutions provided retrospective data on fifty-two patients with osteosarcoma who had a pathologic fracture and on fifty-five patients with osteosarcoma who had not had a pathologic fracture and had been followed for at least two years or until disease recurrence, metastasis, or death. The two groups were matched for patient age and tumor location. Outcomes examined were survival and local recurrence. A subgroup analysis was performed to assess differences in outcome within the group with the pathologic fracture. RESULTS: The five-year estimated survival rates were 55% for the group with a pathologic fracture and 77% for the group without a fracture (p = 0.02). The rate of survival without a local recurrence at five years was 75% for the group with a fracture and 96% for the group without a fracture (p = 0.007). In the group with a fracture, seven (23%) of the thirty patients managed with limb salvage and four (18%) of the twenty-two managed with an amputation had a local recurrence (p = 0.75). Eleven (37%) of the thirty patients with a fracture who were managed with limb salvage and ten (45%) of the twenty-two patients with a fracture who were managed with an amputation died of the disease (p = 0.50). Five patients underwent open reduction and internal fixation followed by limb-salvage surgery. Two of them had a local recurrence and died at an average of eight months postoperatively. The remaining three patients were alive at an average of 6.1 years postoperatively. Local disease control and the survival of these patients were not significantly different from those for the thirty-three patients who were treated with nonoperative immobilization of the fracture followed by limb-salvage surgery. CONCLUSIONS: Patients with osteosarcoma who present with a pathologic fracture or sustain one during preoperative chemotherapy have an increased risk of local recurrence and a decreased rate of survival compared with patients who have not sustained a pathologic fracture. The performance of a limb-salvage procedure in carefully selected patients with a pathologic fracture does not significantly increase the risk of local recurrence or death. Factors predictive of improved outcome, such as the response to chemotherapy and union of the fracture, should be taken into account when limb salvage is being considered.

Adolescent↗
PubMed2004

[Multicenter prospective study on relationship of TCM syndrome type and renal pathology in 286 patients with IgA nephropathy].

OBJECTIVE: To study the distribution pattern of TCM Syndrome type and its relationship with renal pathology in patients with IgA nephropathy. METHODS: Apopting multicenter coordinated method, patients' TCM Syndrome type was differentiated according to their clinical manifestations, data concerning laboratory examination and renal pathology were collected to establish a database for analyzing the relationship between TCM Syndrome type and renal pathology in 286 patients. RESULTS: Patients of Pi-Fei Qi-deficiency type (type 1) and both Qi-Yin deficiency type (type 2) showed rather milder pathological changes, by Lee classification, most of them belonged to grade I-III (72.3%, 70.2%); patients of Gan-Shen Yin deficiency type (type 3) had severe pathological change and majority of them belonged to grade III-IV (84.6%); and the most severe pathological change was shown in patients of Pi-Shen Yang-deficiency type (type 4), and the Lee's grade IV-V was dominant (88.0%) in them. Syndrome type of patients was significantly correlated with their Lee's grade (r = 0.26, P < 0.01). Percentage of glomerular sclerosis in patients of type 4 was higher than that in patients of the other three types. Semi-quantitative scoring upon pathological changes showed that the total, glomerular, tubulo-interstitial and vascular scores were significantly higher in patients of type 4 than in those of the other three types; those scores were higher in patients of type 3 than in type 1; the total, glomerular and vascular scores were higher in patients of type 3 than in type 2; and scores in patients of type 1 and type 2 showed insignificant difference. CONCLUSION: Multicentric prospective study proves that the TCM Syndrome typeof patients with IgA nephropathy is significantly correlated with the grade and severity of their renal pathological changes, thus, the TCM Syndrome typing shows definite referential importance to conclude the severity of renal pathological change in patients with IgA nephropathy.

Adolescent↗
PubMedDate not supplied

[Pathology of the internal organs and central nervous system in acquired immunodeficiency syndrome (with special reference to opportunistic infections)].

Extracerebral and cerebral pathology in AIDS (with particular emphasis on the opportunistic infections). The Authors present the extracerebral pathology of 27 cases of AIDS observed at the Department of Pathology of Milan and the cerebral pathology of 80 cases of AIDS collected by three Institutes (Department of Pathology of Milan, Department of Pathology of Rimini and Department of Neuropathology of Münster) with particular emphasis on the pathology of the opportunistic infections. In the adults' group, the most frequent infections are the protozoan ones (T. gondii) followed with equal incidence by the viral and fungal diseases. In the pediatric group the viral diseases are the most frequently seen. Almost all of the adults show multiple infections in the same organ or in different organs. Diffuse lesions with heavy pathologic fields were observed also without tissue reaction. As to cerebral pathology AIDS' patients with opportunistic infections show focal symptoms, whereas the so called "subacute microglial encephalitis" generally appears as a demential syndrome. In cases with progressive multifocal leukoencephalopathy JC virus was always found and in one case also SV 40 - and BK virus. The diffuse demyelinization in some cases of HIV-Encephalopathy is aspecific. In HIV-positive newborns with cerebral signs, the lesions are characterized by oedema, spongiosis and microcalcifications of the basal ganglia; these are aspecific lesions which can be found in toxic and infectious encephalopathies.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Childhood psychoses and organic pathology: results of a study of 144 cases].

The records of 144 patients of Child Psychiatry Units of Alsace (France), with childhood psychosis (CP) or pervasive developmental disorders (PDD) have been systematically screened for previous or associated pathological events. Half of the children studied have been or are still affected by severe somatic disorders, but none of the diagnostic subcategories (referring to DSM III or CFTMEA) appeared significantly more frequently affected. In our population, the severity of organic disorders was positively correlated with: the age of the mother: more severe cases were reported when the mother was younger than 20 or older than 40 at the moment of childbirth; pathological events during pregnancy; early mother-child separation during the first year of life. The most frequent associated disorders however (neonatal pathology 45% of the cases, epilepsy 17% of the cases, neurological or neurosensorial pathology 15% of the cases) were associated neither with a specific diagnostic nor with a clinical and social specific pattern. The only statistically significant correlation was found between neurological pathology and a relatively low level of cognitive and social functioning. All these results were confirmed by multivariate statistical analysis. A main component analysis integrating all quantified data concerning organic pathology was performed: it emphasizes the independence of the different pathological events reported. The factorial analysis including the clinical, diagnostical and somatic event-related data failed to show any statistical profile associating functional features of the children with any particular previous or existing somatic disorders. Our results suggest that a history of organic pathological events is frequent not only in autistic disorders but in any kind of PDD or early CP - associated with moderate to severe mental retardation, in most cases of our study. However, this does not demonstrate that this type of pathological events constitute the direct and unique cause of PDD and CP: the concept of the aetiology of these severe diseases must take account of other factors - such as relational disruption -, also frequently seen in these children.

Adolescent↗
PubMed1997

Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update.

OBJECTIVE: To combine the clinical data from 3 academic institutions that serve as centers of excellence for the surgical treatment of clinically localized prostate cancer and develop a multi-institutional model combining serum prostate-specific antigen (PSA) level, clinical stage, and Gleason score to predict pathological stage for men with clinically localized prostate cancer. DESIGN: In this update, we have combined clinical and pathological data for a group of 4133 men treated by several surgeons from 3 major academic urologic centers within the United States. Multinomial log-linear regression was performed for the simultaneous prediction of organ-confined disease, isolated capsular penetration, seminal vesicle involvement, or pelvic lymph node involvement. Bootstrap estimates of the predicted probabilities were used to develop nomograms to predict pathological stage. Additional bootstrap analyses were then obtained to validate the performance of the nomograms. PATIENTS AND SETTINGS: A total of 4133 men who had undergone radical retropubic prostatectomy for clinically localized prostate cancer at The Johns Hopkins Hospital (n=3116), Baylor College of Medicine (n=782), and the University of Michigan School of Medicine (n=235) were enrolled into this study. None of the patients had received preoperative hormonal or radiation therapy. OUTCOME MEASURES: Simultaneous prediction of organ-confined disease, isolated capsular penetration, seminal vesicle involvement, or pelvic lymph node involvement using updated nomograms. RESULTS: Prostate-specific antigen level, TNM clinical stage, and Gleason score contributed significantly to the prediction of pathological stage (P<.001). Bootstrap estimates of the median and 95% confidence interval of the predicted probabilities are presented in the nomograms. For most cells in the nomograms, there is a greater than 25% probability of qualifying for more than one of the pathological stages. In the validation analyses, 72.4% of the time the nomograms correctly predicted the probability of a pathological stage to within 10% (organ-confined disease, 67.3%; isolated capsular penetration, 59.6%; seminal vesicle involvement, 79.6%; pelvic lymph node involvement, 82.9%). CONCLUSIONS: The data represent a multi-institutional modeling and validation of the clinical utility of combining PSA level measurement, clinical stage, and Gleason score to predict pathological stage for a group of men with localized prostate cancer. Clinicians can use these nomograms when counseling individual patients regarding the probability of their tumor being a specific pathological stage; this will enable patients and physicians to make more informed treatment decisions based on the probability of a pathological stage, as well as risk tolerance and the values they place on various potential outcomes.

Decision Support Techniques↗
PubMed2003

Surgical pathology for the oncology patient in the age of standardization: of margins, micrometastasis, and molecular markers.

From initial diagnosis through definitive treatment, pathologic evaluation plays a central role in the care of patients with cancer. All patient management is dependent on the correct tissue diagnosis. For surgically resected malignancies, the pathologic stage is widely recognized as the most accurate predictor of survival, and it typically determines the appropriateness of adjuvant treatment as well. Numerous additional pathologic factors have been shown by multivariate analyses to have prognostic significance that is independent of stage, and these may help to further substratify tumors, individualize treatment, and more accurately predict outcome. On a larger scale, pathologic data are essential for epidemiologic and clinical research and is the common language of cancer worldwide. Despite its overriding importance, however, current pathologic analysis is fraught with variations in methodology, interpretation of findings, terminology, reporting norms, and statistical approaches that compromise its utility, both to the individual patient and to the progress of cancer medicine and research. In the last 5 years, increasing attention has been focused on the negative impact of variation in pathology practices on patient care and medical progress at all levels including institutional, regional, national, and international. This problem is within the immediate ability of the pathology profession to correct, and the author's prediction for oncologic pathology over the next 5 years is that standardization based on best practices will become, itself, the standard.

Biomarkers↗
PubMed1987

[Pathological anatomy--past, present and future].

Beginning with a brief overview of its history the future developments of pathologic anatomy are anticipated. While the major tasks of the institutes of pathology in hospitals lie in clinical pathology, the emphasis of the university institutes is on teaching and communicating the basis of general pathology and pathological anatomy. Progress requires a more intensive development of experimental and theoretical research as well as new morphologic techniques, taking advantage of recent scientific and technical advances. Clinical pathology should not be among the primary goals of university institutes. One of their major tasks must be the elaboration of cognitive theoretical concepts to further develop the understanding and classification of diseases and neoplasias, and their complex etiologies. The relationship with other medical disciplines is discussed. Pathological anatomy at universities should reflect the spirit of Virchow's pathology as is obvious from its history and traditions.

History, 18th Century↗
PubMed1994

Quality assurance of pathology in clinical trials. The National Surgical Adjuvant Breast and Bowel Project experience.

Large cooperative clinical trials such as those conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) require measures for assurance of quality and consistency of their pathologic findings. The NSABP experience indicates that these issues may in large part be resolved by a central or headquarters review of pathologic materials submitted by institutional pathologists. This cooperation is implicit with participation in NSABP protocols, and its importance is emphasized at annual NSABP meetings. Assessments of gross characteristics of tumors and total number of lymph nodes and number with metastases used in analyses are performed by institutional pathologists and may be confirmed if necessary from routine surgical pathology reports or special D-1 forms submitted to the central pathology headquarters. The microscopic assessments by headquarters pathologists are performed without knowledge of clinical events and require preliminary training. The requirement of preliminary training emphasizes use of established criteria for the many qualitative and quantitative evaluations required. In some studies there may be as many as 35 quantitative evaluations. Agreement of findings of at least 90% with other experienced members of the pathology center or on subsequent individual re-review is required before an individual's assessments are accepted for analyses. Studies performed with limited pathologic material require assurance that members of the test cohort exhibit similar pathologic and clinical characteristics with those excluded from participation. Those performed without microscopic sections require confirmation that the material used contains adequate viable tumor tissue. This algorithm has resulted in a consistent demonstration of pathologic characteristics that affect diagnosis, prognosis, and treatment of patients with breast cancer.

Breast Neoplasms↗
PubMed2006

Career choices for pathology: national surveys of graduates of 1974-2002 from UK medical schools.

In the past 10 years there has been increasing concern about recruitment of junior doctors into pathology, particularly histopathology, in the UK. In this study, we report on career choices for pathology, derived from postal questionnaire surveys of all qualifiers from all UK medical schools in nine qualification years since 1974. 74% (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. The percentage of doctors choosing pathology 1 year after qualification has fallen sharply in recent years: between 1974 and 1983 it was 4.5% (95% confidence interval 4.1-4.9%) and between 1993 and 2002 it was 2.3% (CI 2.0-2.5%). 57% of doctors who chose pathology 1 year after qualification were still working in pathology at year 10. Hours and conditions of work, the doctor's personal assessment of their aptitudes, and their experience of the subject as a student influenced long-term career choices for pathology. Recruitment of UK graduates into the pathology specialties must increase to meet demand in the new and expanding subspecialties. This depends on developing innovative ways of raising the profile of pathology to medical students and junior hospital doctors.

Adult↗
PubMed2000

Pathology in the new medical curriculum: what has replaced the subject courses?

In line with the UK General Medical Council recommendations, the traditional, taught curriculum at Liverpool was replaced from 1996 by a new one using problem-based learning (PBL) as its principal method of information transfer. There is integration of clinical and preclinical studies, coupled with a reduction in the factual knowledge content and the disappearance of identifiable separate subject courses. Learning is now student-centred. This requires a new approach to the acquisition of pathology knowledge. 1. Pathology is included in all relevant PBL case scenarios by pathology representation on module planning and review committees. 2. Special study modules (SSMs) allow students to observe the practice of pathology including surgical and autopsy work, carry out a detailed study and write a dissertation. Career selectives are provided for individual students in the final year. 3. Clinicopathological (CPC) teaching meetings are held, with the discussion of case examples, clinicians and students contributing. 4. Assessments include the input of appropriate pathology content, integrated with other subjects. 5. A pathology teaching website is provided, containing images, notes, self-assessment questions, handouts, timetables and information. Although the 1996 intake have not yet completed their studies, the results of in-course assessments have been encouraging. The response to the pathology SSMs has been very positive, and the level of presentations and dissertations reached is of a high standard. With the disappearance of a separate subject course in pathology, the subject is being learned by other routes, and the students will complete their undergraduate course with a sound basis for proceeding with their further studies.

Curriculum↗
PubMed1991

Pathology trainee manpower: APC program directors' questionnaire, 1989 results.

The shortage of pathologists is being created by a combination of three factors: inadequate trainee recruitment, high trainee attrition, and accelerating practitioner attrition. The current report provides comprehensive data on the first two factors. The third factor is, by every estimate, likely to become worse over the decade beginning in 1988. Demographics show that greater numbers of pathologists will be reaching retirement age every year. The trainee attrition problem appears to be very serious, and we currently do not have data on why residents leave pathology training, when they leave, or where they go (ie, to what other specialties, etc). Future APC program directors' questionnaires must address these issues. Yet, we must also solve a serious problem in recruitment. Currently, about 35% to 38% of all first-year pathology residents decide to enter pathology only after entering residency programs in other specialties with the intent to remain in that specialty. Therefore, we need to recognize both the problem of inadequate recruitment and the problem of high attrition in order to address the serious manpower shortage facing pathology. When shortages occur in specialties, practitioners tend to cease performing the most time-intensive tasks (eg, autopsy). However, shortages of the magnitude predicted for pathology suggest that many more tasks traditionally performed by pathologists may very well be in jeopardy. In such a setting, other specialties (especially subspecialties) are likely to fill the void. This is likely to be catalyzed by the emergence of the new resource-based relative-value scale. Subspecialties in medicine and surgery will be looking for additional ways to retain income when they cannot expect as much for their services as before. This scenario is especially worrisome given the necessity for the practice of pathology to expand into the domain of molecular biology. Unless problems causing the shortage in pathology manpower are addressed, not only are our traditional practices threatened, we are also likely to have inadequate manpower to take advantage of those areas crucial for the future of pathology.

Career Choice↗
PubMed2004

Research issues in forensic pathology: a survey of academic institutions employing forensic pathologists.

In an effort to characterize research efforts in forensic pathology, a questionnaire was sent to a representative of each of the 14 academic medical centers that employ full-time faculty forensic pathologists. Responses were received from all 14 (100%) of the institutions queried, representing a total of 39 forensic pathology faculty positions; 21 positions were tenure track and 18 positions were clinical or other tracks. Of the 39 positions, 25 positions (64%) at 10 institutions required some degree of research or scholarly output. Of the 25 forensic pathologists with a research imperative, only 3 (12%) were principal investigators or co-investigators on funded forensic pathology-based projects. The major limitation cited by respondents on the performance of forensic pathology research was the lack of protected time from service responsibilities. Fellowship training in forensic pathology was available at 6 of the 14 respondent institutions. Of these institutions, 4 (67%) had a research requirement for trainees, and 4 (67%) provided research training. In conclusion, very few US medical schools currently employ full-time faculty forensic pathologists. Of these, only a small number of institutions prioritize research by these faculty members. Scant federal funds are available to support research in forensic pathology. Few forensic pathology fellowship programs provide research training. To achieve a robust research agenda in forensic pathology that is sufficient to support the needs of the criminal justice and public health systems will require a paradigm shift in the medicolegal death investigative system and investment by federal agencies.

Academic Medical Centers↗
PubMed2004

Changes in pathology instruction and student performance on the United States Medical Licensing Examination Step 1, 1995-2000: a nationwide 6-year longitudinal study.

A multi-institutional collaborative longitudinal study was conducted to assess the effect of curricular change (overall curricular format and detailed pathology instruction) and school policy regarding the Step 1 requirement on the United States Medical Licensure Examination (USMLE) Step 1 Total and Step 1 Pathology scores over a period of 6 years (1995 to 2000). Detailed descriptions of instruction (overall curricular format and the format and number of hours of instruction in various areas of pathology) and the school policy of USMLE Step 1 requirement for classes entering in 1993 to 1998 were matched with Step 1 Total scores and Step 1 Pathology scores for 48,166 students from 73 schools who took the corresponding June 1995 to 2000 examination. Hierarchical linear modeling was used for analysis while controlling for students' MCAT-bpv (Medical College Admission Test, composite of biological and physical sciences and verbal reasoning) scores and undergraduate grade point average (GPA). Results indicated that the GPA and MCAT-bpv scores of students significantly impacted their Step 1 Total score and Step 1 Pathology score for each year. The mean MCAT-bpv scores of entering classes showed a steady increase from 1993 to 1998. About this same time, Step 1 Total scores were on the rise (especially for classes entering 1994 to 1996, after which they stabilized). During the same time period (1993 to 1998), there was a substantial move toward integrated instruction of Pathology. The mean Step 1 scores of schools with integrated instruction were slightly higher than those of schools with nonintegrated instruction, but the difference was not significant. Analyses of variance were run to examine the effect of change of curriculum on Step 1 Total and Step 1 Pathology scores. Our analysis does not appear to show a cause-and-effect relationship between changes in curriculum toward integrated instruction and the increasing Step 1 scores during the study period. The MCAT-bpv scores showed an upward pattern during the study period, and given that they are strong predictors of Step 1 scores, it appears that the rising MCAT-bpv scores are a major contributory factor to the upward trend in the scores during the study period. The only clearly significant result at the school level is that a requirement to pass Step 1 before moving on to clinical rotations is positively related to Step 1 Total and Step 1 Pathology scores.

Analysis of Variance↗
PubMed2006

Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal.

Ten years have passed since the Graylyn Conference Report on Laboratory Medicine Clinical Pathology training was issued. Over that period, the Accreditation Council for Graduate Medical Education substantially revised the requirements for training programs; the American Board of Pathology amended both the requirements and the periods needed for certification; and the discipline itself, along with the broader discipline of pathology, evolved significantly. Recently, a curriculum proposal in anatomical pathology was published as a potential template to be used by training programs to help meet these new and evolving needs. Toward the same end, the Academy of Clinical Laboratory Physicians and Scientists has now developed a template for a curriculum in clinical pathology (laboratory medicine), taking into account newly designated and revised areas of residency core competency, the alterations in training requirements promulgated by the Accreditation Council for Graduate Medical Education and American Board of Pathology, and the rapidly developing nature of the discipline itself. The proposed clinical pathology curriculum defines goals and objectives for training, provides guidelines for instructional methods, and gives examples of how outcomes can be assessed. This curriculum is presented as a potentially helpful outline for use by pathology residency training programs.

Clinical Competence↗
PubMed2006

Expectations and essentials for the community practice of pathology.

In 3 surveys during the past 10 years, community hospital pathologists were asked what they want, need, or look for when employing a pathologist and, more specifically, what skills and knowledge a newly minted pathologist should have to be successful in the community practice of pathology. The most recent survey, done in spring of 2005, cited surgical pathology diagnosis, frozen section diagnosis, gross dissection, cytology, and fine-needle aspiration as essentials in anatomic pathology. For clinical pathology, knowledge of clinical medicine and test strategies that use the laboratory for clinical problem solving was paramount. New expectations in the latest survey were knowledge of molecular pathology and experience in quality assurance procedures. New pathologists generally meet the expectations of the community hospital workplace; however, there were some deficiencies: they were not proficient in gross pathology or autopsy pathology, they were slow, and many lack the clinical knowledge and experience to be effective consultants. The principal attribute that determines success in the practice of pathology, however, is skill in communication and interpersonal relations, and this remains the major deficiency of the fledgling pathologist.

Clinical Competence↗