CARDIOVASCULAR PATHOLOGY TRAINING IN NORTH AMERICA L

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CARDIOVASCULAR PATHOLOGY TRAINING IN
NORTH AMERICA

• L. Maximilian Buja, M.D.

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Survey of Membership

• 17 Responses
• 15 U.S.A.
• 2 Canada
• 9 Programs Identified

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Type of Training Program

• Separate CV Pathology Fellowship - 5
• Diagnostic Component - 5
• Research Component - 5 (encouraged)
• Duration - 1-2 years
• CV Training/Elective as part of AP Residency - 4

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Separate CV Pathology Fellowships

• No. Trainees No. Trainees
• Institution Last 5 Years Currently
• Massachusetts General Hospital 1 0
• Brigham and Womens Hospital 3 0
• Mayo Clinic 2 0
• Office of Chief Medical Examiner - 2
• of the City of New York (combined
  forensic CV path/neuropath)
• Texas Heart Institute/UTHSC-H 0 0

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CV Training/Elective asPart of AP Residency

• No. Trainees No. Trainees
• Institution Last 5 Years Currently
• Washington University ? ?
• Mt. Sinai, New York ? ?
• University of Toronto/
• Toronto General Hospital 2 0
• University of Minnesota 5 1
• University of Ottawa/
• Ottawa Hospital ? ?

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Components of Training

• Review in-house and referral CV cases
• Sign-out with attending faculty all CV surgical
  material
• Act as CV pathology consultant to autopsy service
• Act as CV pathology consultant to clinicians
• Attend and participate in clinical cardiovascular
  and pathology rounds and conferences
• Develop and present review papers on selected
  topics and case material with publication as
  desired outcome
• Perform research project with publication as
  desired outcome

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Components of Training

• Autopsy cases congenital heart disease,
  acquired heart disease, including cases with and
  without previous interventional procedures
• Endomyocardial biopsies general diagnostic
  and transplant cases
• Native and prosthetic heart valves
• Aortic, arterial and other vascular specimens
• Explanted hearts
• Explanted devices
• Other

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Components of Training

• Standard gross and light microscopic approaches
• Electron microscopy
• Immunocytochemistry
• Molecular diagnostic techniques

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Components of Training

• Pathology of congenital heart disease
• Pathology of acquired cardiovascular disease
• Pathology of medical and surgical interventions
  in cardiovascular disease
• Pathology of molecular cardiology and gene
  therapy
• Pathology of regenerative cardiology and stem
  cell biology

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Accreditation and Certification

• Prior to 2002
• Pathology RRC/ACGME
• AP/CP-4, AP-3, CP-3
• American Board of Pathology
• AP/CP-4, AP-3, CP-3 plus an additional
  credentialing year requirement
• Since 2002
• Pathology RRC/ACGME
• AP/CP-4, AP-3, CP-3
• American Board of Pathology
• AP/CP-4, AP-3, CP-3

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Accreditation ofTraining Programs

• Pathology Residency Review Committee of the
  Accreditation Council for Graduate Medical
  Education
• APCP-4 4-year program in anatomic
  pathology and clinical pathology
• AP-3 3-year program in anatomic
  pathology
• CP-3 3-year program in clinical
  pathology
• PCP-1 1-year program in cytopathology

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Accreditation ofTraining Programs

• Pathology Residency Review Committee of the
  Accreditation Council for Graduate Medical
  Education
• BB-1 1-year program in blood banking
• DP-1 1-year program in dermatopathology
• FP-1 1-year program in forensic pathology
• HMP-1 1-year program in hematology

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Accreditation ofTraining Programs

• Pathology Residency Review Committee of the
  Accreditation Council for Graduate Medical
  Education
• MM-1 1-year program in medical
  microbiology
• NP-2 2-year program in neuropathology
• PP-1 1-year program in pediatric pathology
• PCH-1 1-year program in chemical pathology
• SP 1-year program in selective pathology

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Accreditation ofTraining Programs

• APCP-4 programs must include 18 months of formal
  education in anatomic pathology and 18 months of
  formal education in clinical pathology. The
  remaining 12 months of training may be a
  continuation of structural anatomic pathology or
  clinical pathology education, or may be devoted
  to a specialized facet of pathology.

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Accreditation of Training Programs

• AP-3 and CP-3 programs must include 24 months of
  anatomic pathology or clinical pathology
  education. The remaining 12 months of training
  may be a continuation of structured anatomic
  pathology and/or clinical pathology education, or
  may be devoted to a specialized facet of
  pathology.

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Certification of Trainees

• The American Board of Pathology
• Primary certification
• Anatomic and Clinical Pathology, Anatomic
  Pathology, Clinical Pathology
• Subspecialty certification
• Blood Banking/Transfusion Medicine, Chemical
  Pathology, Cytopathology, Dermatopathology,
  Forensic Pathology, Hematology, Medical
  Microbiology, Molecular Genetic Pathology,
  Neuropathology, Pediatric Pathology
• Combined Primary and Subspecialty Certification

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Certification of Trainees

• Combined AP/CP Certification
• Four (4) full years of full-time, approved
  training in an accredited APCP-4 program that
  includes at least 18 months of structured
  training in anatomic pathology and 18 months of
  structural training in clinical pathology, and
  either an additional 12 months of full-time,
  continued training in anatomic pathology and/or
  clinical pathology, or 12 months of full-time,
  approved training in other areas of pathology as
  part of the defined four-year accredited AP/CP
  training program.

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Certification of Trainees

• AP Certification
• Three (3) full years of full-time, approved
  training in anatomic pathology in an accredited
  APCP-4 or AP-3 program that includes at least 24
  months of structured training in anatomic
  pathology, and either an additional 12 months of
  full-time, continued training in anatomic
  pathology, or 12 months of full-time, approved
  training in other areas of pathology as part of
  the defined accredited training program.

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Observations

• Reported numbers of CV Pathology Training
  Programs and reported number of trainees in the
  USA and Canada are very small.
• Better data are needed for numbers of CV
  Pathology Training Programs and trainees.

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Observations

• Perceived impediments to individuals choosing CV
  Pathology as a career
• ACGME does not accredit training programs in CV
  Pathology
• ABP does not grant subspecialty certification in
  CV Pathology
• CV Pathology is a purely academic discipline
  without a corresponding private practice
  opportunity.

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Observations

• The new flexibility in Pathology RRC/ACGME and
  American Board of Pathology requirements can be
  explored for possible recruitment and training
  opportunities for CV Pathology within the general
  pathology training programs.

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