Review of Pathology Specialist Development Pathways (2010)
Description
This project examined options to achieve maximum efficiency and effectiveness of the policy and procedures for preparing new specialist pathologists workforce entrants. This was in response to the current and long-standing workforce shortage of pathologists in Australia where strategies to promote the uptake of pathology as a career can be considered in three broad areas of need:
to enhance the visibility of pathologists as key members of health care teams and providers of vital input that influences a very high proportion of clinical decisions
to investigate and address possible barriers to undertaking pathology training, and to actively promote pathology as a career to medical students and junior doctors
for more flexible training options available in an extended range of settings which are supported and evaluated to ensure the required standards are maintained.
Grant Recipient
Royal College of Pathologists of Australasia (RCPA)
Aims
to examine options for achieving maximum efficiency and effectiveness of the policy and procedures for preparing new specialist pathology workforce entrants
to develop strategies to promote the uptake of pathology as a career
to develop a strategic approach to the supply of specialists for identified areas of sub-discipline shortages (e.g. paediatric, neuropathology and general pathology)
to give consideration to future planning for the provision of quality pathology services in difficult-to-service locations, including regional centres.
Objectives
stage 1 involved the preparation of a review of national and international pathways for pathology specialist training where information on a range of strategies was collated and presented for consideration
stage 2 required the examination of strategies indentified in Stage 1 in terms of best practice, their relevance and opportunities for their possible adoption in the Australian pathology context
stage 3 involved a review of the current RCPA options, policy, procedures and training/development support capacity of its Fellows, with a view to maximising and streamlining opportunities for entry to the pathologist workforce at an adequately trained standard
to review assessment processes for overseas qualified pathologists who need further training and assessment prior to being able to work in Australia unsupervised
to review strategies for the development of educational resources, particularly those that are deliverable online, to support the learning requirements set out in the curricula
to review current strategies used to attract young doctors into a career in pathology, and identify further measures the RCPA could undertake to promote pathology as a career
Stage 4 required the finalisation of recommendations for the pathology profession and the development of strategies to improve the training of pathologists
to provide recommendations regarding how to assess UK Fellows to enable them to obtain RCPA Fellowship without examinations.
These aims and objectives were achieved by this project although reviewing strategies to develop educational resources required further substantial resources. Outcomes
Curriculum Review
The review for stage 1 was prepared by the Curriculum Development Officer and presented to the Board of Censors of the RCPA on 10 July 2009. The report highlighted the following characteristics of best practice curricula including:
basing the assessment program on a blueprint which maps outcomes against the methods by which they will be assessed to ensure constructive alignment between outcomes and assessment
a range of valid, reliable, feasible workplace-based assessment methods for formative assessment
suitable learning experiences for developing the desired competencies
emphasising the importance of trainees receiving regular, supportive diagnostic feedback from a variety of sources before final judgements are made about their performance
a range of valid, reliable methods for making summative judgements of competence across the range of education outcomes
not assuming that proficiency develops after a particular duration of training.
Disciplinary panels revised their curricula in relation to best practice including developing clear outcome statements. They then developed blueprints for assessment based upon the revised curricula to consider reducing the overall load of formal summative assessment, replacing some existing assessment with more reliable forms of assessment, and a broader range of in-training and formative assessment enhancing opportunities for feedback and early remediation of problems.
The Basic Pathological Sciences (BPS) curriculum was extensively revised with more explicit definition of learning outcomes. Essay questions have been replaced with multiple-choice questions (MCQs) mapped to the learning outcomes in the examination.
Extensive stakeholder consultation and iterative revisions have contributed to the development of the new microbiology curriculum accompanied by a portfolio incorporating documentation of learning activities and outcomes and a suite of workplace-based assessment tools which were trialed in 2011.
Restructured curricula have been drafted for anatomical pathology, chemical pathology and immunology, with other disciplines under development.
The Curriculum Development Officer has been working with the Chief Examiner in anatomical pathology and others to develop a curriculum for a Diploma in Paediatric Pathology.
Curriculum mapping for each discipline with defined parameters for development of WPBA tools, with processes in place to facilitate early recognition and remediation of problems with training.
Examination Processes
Examination processes were modified in microbiology to provide more authentic and reliable forms of assessment. Essay questions were replaced with MCQs and short answer questions. Examiner training videos were produced and used for the 2010 structured oral examinations.
Supervisor’s reports are being modified in all disciplines to clarify outcomes and standards, to accommodate documentation of workplace-based assessment (WPBA) and to enable input from more than one supervisor.
A peer review pathway has been developed to facilitate the progress to Fellow of the Royal College of Pathologists of Australasia (FRCPA) for pathologists with qualifications and experience that are substantially comparable to the standards for RCPA-trained pathologists.
There will be continued efforts to reduce the overall burden as WPBA are established to improve the reliability of examinations, clearly articulating standards and improving the selection and training of examiners. This will be completed by the end of 2011 and will be followed by ongoing evaluation and review.
A process is in place for rigorous peer-assessment over the course of 12 months of supervised practice for UK Fellows in anatomical and chemical pathology. Other disciplines may also offer this assessment following more extensive review of an individual’s past training and examinations. Consideration is being given to applying similar processes to other countries.
Educational Resources
The Moodle learning management system as a platform for a trainee education portal has been installed to offer convenient access to learning resources in each discipline. The program Questionmark Perception has been purchased to integrate with Moodle which will facilitate the banking of assessment items and delivery of online formative assessments, as well as construction of interactive case studies and mock exams.
Online learning materials have been made available to support preparation for the BPS examination with an online mock examination available in early 2011. Existing resources for all disciplines is being revised for the new online environment. Further resources are being planned in accordance with needs analysis and priority.
Training
The study reviewed how the RCPA may be better able to provide training for pathologists in difficult to service locations, including regional areas, and to develop a strategic plan to address these issues and identify current obstacles and possible solutions for overcoming them. The online environment will help with these issues and the work is being further supported through an Australian Government grant under the Specialist Training Program. Similar strategies may be used to supplement education and training in identified areas of sub-discipline shortages.
The Review of International and National Approaches to Pathology Training, and the identification of areas that are considered best practice for pathology training for Australia, forms the basis of a plan for ongoing development of an outcomes-based curriculum.
Pathology as a Career Choice
Funding from this project has supported the engagement of the Director of Education with a number of strategies to address attracting young doctors into a career in pathology. These include:
forming a Medical School Taskforce to identify opportunities to work constructively with medical schools to promote and support quality teaching of pathology and engage students’ interest in pathology as a career
the RCPA actively supporting an advanced standing pathway for medical students at the University of New South Wales (UNSW)
the development of templates for pathology rotations for post-graduation year one (PGY1) and PGY2 doctors
the Board of Education currently reviewing criteria for offering scholarships and support to medical students who undertake pathology-related projects to provide greater incentives
RCPA participation in Career Days at universities, high-schools and other national career events
the production of brochures, vodcasts (on YouTube) and posters promoting pathology as a career.
Finding
Standard setting and item analysis procedures have improved the fairness and reliability of the examination in the BPS curriculum, and electronic marking allows much faster availability of results.
Recommendations
The appointment of an Education Designer to develop an online learning environment and facilitate the delivery of online educational resources.
Further staff support may be needed as WPBA are rolled out, and there will be a need to train supervisors and examiners and to assist with monitoring and evaluation of ongoing developments.
The development of educational resources to support the revised curriculum is underway but will require substantial ongoing funding and human resources to continue the work of construction, editing and uploading of resources for supervisors, examiners, workplace assessors and international medical graduates.
Development and implementation of strategies to review and quality control the educational resources is a major priority that will require ongoing expert input from pathologists.
Areas for Future Consideration
The Director, Education was preparing a strategic plan at the time of the report to identify future priorities for technologies to support ongoing educational needs.
