"cardiovascular pathology training in north america"

CARDIOVASCULAR CARDIOVASCULAR PATHOLOGY TRAINING PATHOLOGY TRAINING

IN NORTH AMERICA IN NORTH AMERICA

L. Maximilian Buja, M.DL. Maximilian Buja, M.D..

Survey of MembershipSurvey of Membership

17 Responses17 Responses- 15 U.S.A.15 U.S.A.- 2 Canada2 Canada

9 Programs Identified9 Programs Identified

Type of Training ProgramType of Training Program

Separate CV Pathology Fellowship - 5Separate CV Pathology Fellowship - 5- Diagnostic ComponentDiagnostic Component - 5- 5- Research ComponentResearch Component - 5 (encouraged)- 5 (encouraged)- DurationDuration - 1-2 years- 1-2 years

CV Training/Elective as part of AP CV Training/Elective as part of AP Residency - 4Residency - 4

Separate CV Pathology Separate CV Pathology FellowshipsFellowships

No. Trainees No. No. Trainees No. TraineesTrainees

InstitutionInstitution Last 5 YearsLast 5 Years CurrentlyCurrently

Massachusetts General HospitalMassachusetts General Hospital 11 00

Brigham and Women’s HospitalBrigham and Women’s Hospital 33 00

Mayo ClinicMayo Clinic 22 00

Office of Chief Medical ExaminerOffice of Chief Medical Examiner -- 22 of the City of New York of the City of New York (combined forensic CV path/neuropath)(combined forensic CV path/neuropath)

Texas Heart Institute/UTHSC-HTexas Heart Institute/UTHSC-H 00 00

CV Training/Elective asCV Training/Elective asPart of AP ResidencyPart of AP Residency

No. Trainees No. No. Trainees No. TraineesTrainees

InstitutionInstitution Last 5 YearsLast 5 Years CurrentlyCurrently

Washington UniversityWashington University ?? ??

Mt. Sinai, New YorkMt. Sinai, New York ?? ??

University of Toronto/University of Toronto/ Toronto General HospitalToronto General Hospital 22 00

University of MinnesotaUniversity of Minnesota 55 11

University of Ottawa/University of Ottawa/ Ottawa HospitalOttawa Hospital ?? ??

Components of TrainingComponents of Training Review in-house and referral CV casesReview in-house and referral CV cases Sign-out with attending faculty all CV surgical Sign-out with attending faculty all CV surgical

materialmaterial Act as CV pathology consultant to autopsy Act as CV pathology consultant to autopsy

serviceservice Act as CV pathology consultant to cliniciansAct as CV pathology consultant to clinicians Attend and participate in clinical cardiovascular Attend and participate in clinical cardiovascular

and pathology rounds and conferencesand pathology rounds and conferences Develop and present review papers on selected Develop and present review papers on selected

topics and case material with publication as topics and case material with publication as desired outcomedesired outcome

Perform research project with publication as Perform research project with publication as desired outcomedesired outcome

Components of TrainingComponents of Training

Autopsy cases – Autopsy cases – congenital heart disease, acquired congenital heart disease, acquired heart disease, including cases with and without previous heart disease, including cases with and without previous interventional proceduresinterventional procedures

Endomyocardial biopsiesEndomyocardial biopsies – general diagnostic – general diagnostic and transplant casesand transplant cases

Native and prosthetic heart valvesNative and prosthetic heart valves Aortic, arterial and other vascular specimensAortic, arterial and other vascular specimens Explanted heartsExplanted hearts Explanted devicesExplanted devices OtherOther


Standard gross and light microscopic Standard gross and light microscopic approachesapproaches

Electron microscopyElectron microscopy

ImmunocytochemistryImmunocytochemistry

Molecular diagnostic techniquesMolecular diagnostic techniques


Pathology of congenital heart diseasePathology of congenital heart disease

Pathology of acquired cardiovascular Pathology of acquired cardiovascular diseasedisease

Pathology of medical and surgical Pathology of medical and surgical interventions in cardiovascular diseaseinterventions in cardiovascular disease

Pathology of molecular cardiology and Pathology of molecular cardiology and gene therapygene therapy

Pathology of regenerative cardiology and Pathology of regenerative cardiology and stem cell biologystem cell biology

Accreditation and Accreditation and CertificationCertification

Prior to 2002Prior to 2002- Pathology RRC/ACGMEPathology RRC/ACGME

• AP/CP-4, AP-3, CP-3AP/CP-4, AP-3, CP-3

- American Board of PathologyAmerican Board of Pathology• AP/CP-4, AP-3, CP-3: plus an additional AP/CP-4, AP-3, CP-3: plus an additional

credentialing year requirementcredentialing year requirement

Since 2002Since 2002- Pathology RRC/ACGMEPathology RRC/ACGME

• AP/CP-4, AP-3, CP-3AP/CP-4, AP-3, CP-3

- American Board of PathologyAmerican Board of Pathology• AP/CP-4, AP-3, CP-3AP/CP-4, AP-3, CP-3

Accreditation ofAccreditation ofTraining ProgramsTraining Programs

Pathology Residency Review Committee of the Pathology Residency Review Committee of the Accreditation Council for Graduate Medical Accreditation Council for Graduate Medical EducationEducation- APCP-4APCP-4 4-year program in anatomic 4-year program in anatomic

pathology and clinical pathology and clinical pathologypathology

- AP-3AP-3 3-year program in anatomic 3-year program in anatomic pathologypathology

- CP-3CP-3 3-year program in clinical 3-year program in clinical pathologypathology

- PCP-1PCP-1 1-year program in cytopathology1-year program in cytopathology


Pathology Residency Review Committee Pathology Residency Review Committee of the Accreditation Council for Graduate of the Accreditation Council for Graduate Medical EducationMedical Education- BB-1BB-1 1-year program in blood banking1-year program in blood banking- DP-1DP-1 1-year program in 1-year program in

dermatopathologydermatopathology- FP-1FP-1 1-year program in forensic 1-year program in forensic

pathologypathology- HMP-1HMP-1 1-year program in hematology1-year program in hematology


Pathology Residency Review Committee Pathology Residency Review Committee of the Accreditation Council for Graduate of the Accreditation Council for Graduate Medical EducationMedical Education- MM-1MM-1 1-year program in medical 1-year program in medical

microbiologymicrobiology- NP-2NP-2 2-year program in neuropathology2-year program in neuropathology- PP-1PP-1 1-year program in pediatric pathology1-year program in pediatric pathology- PCH-1PCH-1 1-year program in chemical pathology1-year program in chemical pathology- SPSP 1-year program in selective pathology1-year program in selective pathology


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

Accreditation of Accreditation of Training ProgramsTraining Programs

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

Certification of TraineesCertification of Trainees

The American Board of PathologyThe American Board of Pathology

Primary certification Primary certification - Anatomic and Clinical Pathology, Anatomic Pathology, Anatomic and Clinical Pathology, Anatomic Pathology,

Clinical PathologyClinical Pathology

Subspecialty certification Subspecialty certification - Blood Banking/Transfusion Medicine, Chemical Blood Banking/Transfusion Medicine, Chemical

Pathology, Cytopathology, Dermatopathology, Pathology, Cytopathology, Dermatopathology, Forensic Pathology, Hematology, Medical Microbiology, Forensic Pathology, Hematology, Medical Microbiology, Molecular Genetic Pathology, Neuropathology, Molecular Genetic Pathology, Neuropathology, Pediatric PathologyPediatric Pathology

Combined Primary and Subspecialty CertificationCombined Primary and Subspecialty Certification

Certification of TraineesCertification of Trainees Combined AP/CP Certification Combined AP/CP Certification

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

Certification of TraineesCertification of Trainees

AP CertificationAP Certification- Three (3) full years of full-time, approved Three (3) full years of full-time, approved

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

ObservationsObservations

Reported numbers of CV Pathology Reported numbers of CV Pathology Training Programs and reported number Training Programs and reported number of trainees in the USA and Canada are of trainees in the USA and Canada are very small.very small.

Better data are needed for numbers of Better data are needed for numbers of CV Pathology Training Programs and CV Pathology Training Programs and trainees.trainees.


Perceived impediments to individuals Perceived impediments to individuals choosing CV Pathology as a career:choosing CV Pathology as a career:- ACGME does not accredit training programs ACGME does not accredit training programs

in CV Pathology;in CV Pathology;- ABP does not grant subspecialty certification ABP does not grant subspecialty certification

in CV Pathology;in CV Pathology;- CV Pathology is a purely academic discipline CV Pathology is a purely academic discipline

without a corresponding private practice without a corresponding private practice opportunity.opportunity.


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

"cardiovascular pathology training in north america"

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