MANAGEMENT

Resident Rotation Summary

Rotation Philosophy and General Purpose Statement:

Most pathologists will be called on to manage important clinical resources. The increasing complexity and competitiveness of the healthcare environment demands effective management by all those responsible for deploying resources. There is a broad consensus that training in management skills should be a part of the training of pathologists. Similarly because of demands for increasingly effective communication of pathology’s primary product, information, pathologists must possess communication skills and be familiar with modern means for collecting, storing, and disseminating clinical information in support of patient care and education of professional colleagues.

Principles of management and informatics are challenging to convey to residents and fellows who are dealing with the urgency and workload related to patient care. In addition, because of a lack of prior exposure, many residents find it difficult to put the principles covered into a structured whole that can be remembered and applied. Therefore, in the rotation emphasis is placed on including the residents in outreach activities with faculty members who serve as laboratory directors in small community hospitals via WVUH’s outreach service, University Medical Laboratories (UML).

Teaching Faculty Members

West Virginia University

Patricia Canfield, M.D.

Linda L. Cook, M.D.

Barbara S. Ducatman, M.D.

Jeffrey A. Stead, M.D.

EDUCATIONAL GOALS AND OBJECTIVES:

The goals and objectives of the management rotation are to prepare and enable residents to:

• Demonstrate a commitment to developing management skills and reviewing and improving these to improve practice patterns. 
• Explain management techniques and theories and the ability to utilize the literature.
• Communicate effectively in verbal and written form with their clinical colleagues, administrative, technical, and clerical personnel.
• Discuss the policies and regulations affecting health care (i.e., CAP accreditation, HIPAA, compliance to Medicare and billing regulations, etc.) 

REQUIRED COMPETENCIES:

PATIENT CARE

Residents work with faculty pathologists at WVU engaged in outreach activities to travel to small community hospitals in rural WV (St. Joseph’s Hospital, Minnie Hamilton Health Care Center, Preston Memorial Hospital, Grafton City Hospital). At these locations they engage in laboratory management activities with the respective laboratory managers and interact with the local attending staff in patient care matters

• Discussion of history with clinical housestaff and/or attendings.
• Review of laboratory reports of previous pathologic specimens.
• Review of the online medical record when applicable.

Residents are able to be actively involved with clinical pathology consultations and are able to handle clinical questions with increasing degrees of independence including:

•  Researching and reviewing medical information.
• Preparation and interpretation of clinical consults.
• Timely and effective communication with clinicians.

Residents demonstrate competence in the performance of procedures considered essential for community hospital pathology practices, including:

• Interpretation of peripheral blood smears and body fluids,
• Review of microbiology and virology cultures.
• Review of blood banking results and transfusions.
• Review of abnormal lab results.
• Review of quality assurance and control data.

Residents make informed decisions regarding further diagnostic workup of patients in a community hospital setting:

• Consider referral to WVU or other reference labs for specialized testing, etc. based on patients’ clinical history, up-to-date scientific evidence gleaned from textbooks, journal articles, internet-based searches, and clinical judgment. 
• Expected to be able to handle difficult problems by the time they reach the management rotation.

Residents use available information technology (hospital and laboratory information systems, internet-based literature searches)

• To support workup and diagnosis of pathology consults.
• To help educate clinicians by providing relevant literature references.

Residents work with health care providers, in the generation of accurate and clinically useful pathology reports and effective communication of results to clinicians.

Evaluation:

• Rotation evaluation

Presentations to medical technologist and clinical staff at community hospitals.. 

• 360o Global evaluation

MEDICAL KNOWLEDGE

Residents demonstrate an investigative and analytical thinking approach to management activities situations, including:

• Provide continuing education to medical technologists and medical staff at small, rural hospitals.
• Present interesting laboratory cases to clinicians and suggest appropriate additional testing if applicable.
• Participate in at least one project, such as choosing new laboratory instrumentation, engaging in quality assurance activities, or implementing a new technique either at WVU or one of the outreach hospitals.

Residents discuss and apply the basic and clinically supportive sciences which are appropriate to the management skills in a monthly, interactive management conference including:

• Explain the sociology and psychology necessary for optimal management skills.
• Discuss the management scenarios to deal with management issues.
• Explain basic personnel, billing, and other compliance requirements.

Evaluation:

• Rotation evaluation

Management score for the in-service examination compared to national means

PRACTICE-BASED LEARNING

Residents show the ability to analyze practice experience and perform practice-based improvement activities using a systematic methodology, including:

• Evaluating quality assurance data for errors and trends.
• Participate in monthly Pathology Quality Assurance Committee meetings, learning how to identify and report on a variety of QA monitors (case turnaround time, mislabeled/unlabeled specimens, clotted specimens, etc.).

 Residents show ability to locate, appraise, and assimilate evidence from scientific studies related to patients’ health care problems, including:

•  Perform literature search and review to find relevant scientific references to aid solving quality control and quality assurance problems.
• Obtain and incorporate information about their patient population (via COPATH computer searches and medical records chart review) for clinicopathologic study of selected diseases and problems.

Residents are able to discuss study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. 

Residents demonstrate competency to perform with information technology to manage information, access on-line medical information, and support their own education, including:

• Accessing of patient clinical information and previous pathology accessions via Medsite and Copath.
• Performance of computer searches of the medical literature.
• Perform digital imaging technology.
• Accessing websites pertaining to specific pathologic diagnoses and issues. 

Residents actively participate in the teaching of medical students and other health care professionals employed in the clinical pathology section, including:

• Teaching medical students as lecturers (senior residents only), leaders in small groups and laboratory sections.
• Teaching medical technologists and medical faculty. 

Evaluation:

• Rotation evaluation

Review of resident portfolio yearly to assess improvement and discuss self-education

INTERPERSONAL AND COMMUNICATION SKILLS

Residents demonstrate effective communication with other health care providers, patients, and patients’ families by:

• Presenting cases at conferences at outreach sites under direct faculty supervision.
• Interacting with clinicians, patients, and patients’ families during performance of clinical consults and by providing support to clinicians and families during on-call assignments.

Evaluation:

• Rotation evaluation
• 360o Global evaluation

PROFESSIONALISM

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest with prompt response to calls from any clinical lab, faculty and clinicians during their clinical pathology and on-call rotations and accountability for this.
• Exhibit a commitment to excellence and on-going professional development by utilizing the study materials within the department including the slide file, the image data base, and books and journals for their own professional advancement.
• Demonstrate a commitment to ethical principles pertaining to provision of pathology services, confidentiality of patient information, informed consent, and business practices
• Demonstrate appropriate behavior with the faculty, clinicians, their peers, and the administrative, technical and clerical staff of the hospital.

Evaluation:

• Rotation evaluation
• 360o Global evaluation

SYSTEMS BASED PRACTICE

Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide pathology services that are of optimal value.

• Residents are expected to discuss how management patterns affect health care decisions for patients and the health care system.
• Explain types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• Practice cost-effective health care and resource allocation that does not compromise quality of care, understanding the need for and cost of special studies, extended testing, and send-out testing. 
• As senior residents attend the CP QA committee meetings to understand how to partner with the administrative and technical staff to assess, coordinate, and improve health care and know how these activities can affect system performance
• Residents may also inspect sections of a laboratory during a CAP inspection.
• Conduct a mock CAP inspection of the WVUH laboratories using the most recent version of the “Laboratory General” checklist. Report all new questions to Dr. Stead and Dr. Canfield

Evaluation:

• 360o Global evaluation

Supervisory Guidelines for Patient Care and Specimen Handling

The resident discusses any outreach issues or ongoing lab issues with the supervising faculty member prior to discussion with clinicians or technologists. The faculty pathologist is responsible for the direction of the laboratories.

The on service teaching faculty members are physically present during standard operating hours; faculty members not physically present are rapidly available by phone or pager. At all times, a supervising faculty member is on-call for evening and weekend questions. No diagnosis is communicated to the clinicians before a faculty member has evaluated the case.

Daily Duties and Responsibilities – Management

The resident travels with Drs. Stead or Cook to four outreach hospitals for regular scheduled laboratory visits and medical staff meetings. During the WVU portion, the resident may be asked to help solve a UML or WVUH laboratory problem, initiate or develop a new test (including analysis of workload measurement and planning), assist in choosing new equipment (including cost/benefit analysis, self-inspect a laboratory section and participate in continuing education for technical staff. By the end of the rotation, the resident should appreciate that the role of management in a pathologist’s professional work life is important and deserving of continuous involvement and learning, become familiar with key management knowledge that can facilitate and guide learning activities, know the basic skill sets associated with personal leadership and group leadership, understand one’s own areas of strength and weakness in terms of leadership, develop a strategy for finding a job and understand the purpose of lab accreditation and become familiar with CAP criteria.

Opportunities to Function as Consultant to Other Physicians

Residents have the responsibility of discussing the problem cases and laboratory issues with WVU physicians and residents, UML clients and the medical and technical staff at various small, rural community hospitals throughout West Virginia.

Structured Formal Education in Management:

Once a month, residents and fellows meet for a Management Conference with Dr. Ducatman. She presents a case scenario of a management problem from focused on a management or informatics theme. The forum is an interactive discussion with questions and suggestions form the residents. The conference is supplemented with a handout of related materials.

On-call Duties:

Residents on-call for Clinical Pathology may be called upon to answer questions related to patient care or specimen issues from UML client physicians or hospitals. During this rotation the residents will on average have at least one out of every seven days free of hospital duties. Due to the at-home nature of call and the limited number of emergencies, the call duties are constructed in the following fashion. The residents are on at-home/pager call every other week. The on-call periods last from 7:00 a.m. on Monday morning through the following weekend, ending at 7:00 a.m. on the subsequent Monday. While on-call, residents are supervised by a West Virginia University Teaching Faculty Member, who is available at all times, either via their office phone, pager, or home phone. On-call activities are reviewed with the residents on an on-going basis as evening and weekend calls are received. A faculty member is always present when a final diagnosis is established and at any time before, as necessary.

During the on-call period, the resident is responsible for handling clinical requests that arise during off hours, emergent interpretative consultations, and specimen handling issues.

Charleston Area Medical Center

Same as WVUH except that there is no weekend on-call rotation.