Pathology Core Curriculum
UK Pathology Core Curriculum for AP/CP Residents
Innovative, Two-Year Core Curriculum
The UK Pathology Core Curriculum (PCC) is an innovative two-year curriculum that intentionally incorporates six principles of adult learning to teach anatomic and clinical pathology. AP and CP topics are interleaved and organized by organ system to strengthen integration across disciplines. The curriculum extends beyond traditional didactic lectures by incorporating retrieval practice (RP) in five distinct formats, promoting active learning, improving knowledge retention, and providing measurable opportunities to assess learning over time. Active learning amplifies knowledge retention, and with this novel, intensive curriculum, we VIGOROUSLY engage in it and quantitatively gauge it.
Faculty, Trainees, and Staff
All pathology residents participate in the Pathology Core Curriculum (PCC). Because the curriculum follows a two-year cycle, each resident completes the entire curriculum twice during residency, reinforcing knowledge through repeated exposure and content consolidation.
Each teaching block, organized by organ or organ system, is led by anatomic pathology (AP) and clinical pathology (CP) faculty with expertise in the subject area. Instruction includes lectures, interactive learning sessions, unknown slide conferences, and CP case conferences.
To support the educational design of the PCC, an additional faculty member with expertise in the curriculum collaborates with content experts to develop retrieval practice activities. Five retrieval practice formats are used throughout the curriculum (see below).
The curriculum is supported administratively by the Residency Program Coordinator and a who assists with scheduling and day-to-day operations.
Rationale
Our educational philosophy is informed by principles from cognitive psychology and medical education. Learning is generally understood to involve three interconnected processes: encoding (the initial acquisition of information), consolidation (the organization and stabilization of information into long-term memory), and retrieval (the ability to recall and apply knowledge in clinical practice).
Cognitive psychology studies show that “periodic retrieval of learning helps strengthen connections to the memory and the cues for recalling it, while also weakening routes to competing memories.”1 “Periodic retrieval of learning” = retrieval practice. These evidence-based principles are intentionally incorporated throughout our curriculum. By combining repeated exposure to key concepts, retrieval practice, graduated clinical responsibility, and continuous feedback, we help residents strengthen their knowledge of anatomic and clinical pathology, prepare for board certification, and develop the clinical reasoning skills needed for independent practice. Just as importantly, this approach fosters the habits of lifelong learning that are essential in the continually evolving field of pathology.
Six Strategies of Adult Learning
With the Pathology Core Curriculum, we employ the six main strategies of adult learning:
1. Spaced Practice: spreading subject materials and study activities over time
- At UK, residents experience the core curriculum twice over four years
2. Retrieval Practice: proven more effective than massed learning (cramming) and reading/re-reading
- At UK, residents augment assigned reading with content expert lectures and active learning sessions, and learning continues throughout the four years
3. Elaboration: delving further into the subject material to connect across subject areas
- At UK, the residents engage in elaborative interrogation of the materials as the core curriculum proceeds making connections across topics; for example, learning about sarcoma genetics as fusion driven or aneuploidy driven raises opportunities to explore the general tumor promoting effects of aging
4. Interleaving: switching between topics or types of problems while studying
- At UK, residents learn basic surgical pathology features of tumors but also learn corresponding microbiology, clinical chemistry or molecular aspects of the same tumors in the same block. For example: we combine diagnostic histopathology of colon cancer subtypes with an interactive learning session on microsatellite instability (MSI)-high and -low tumors.
5. Concrete Examples: illustrating abstract concepts with specific examples
- At UK, we regularly discuss pathologic entities in the setting of a case presentation
- At UK, the faculty on the anatomic pathology rotations actively query the residents when signing out daily, active clinical cases. In these sign-outs, faculty re-engage the resident in learning the block subject matter in a real-time clinical context.
6. Dual Coding: combining words with visuals to provide two pathways to retrieve information later
- At UK, the residents are referred to relevant chapters in surgical pathology textbooks for each organ or organ system block. They dual code the content they have read about visually through rapid-fire review sessions, unknown slide conference, retrieval practice quizzes, and team-based learning sessions.
Five Formats of Active Learning (Retrieval Practices)
At UK, we employ five formats of retrieval practice in the PCC: 1) retrieval practice in the form of ExamSoftTM quizzes; 2) team-based learning in the form of Jeopardy-like sessions; 3) real time identification of pathology by rapid fire review using projected photomicrographs; 4) texting of quiz questions (with or without images); 5) and the traditional unknown slide conference.
Over the two-year curriculum, residents undergo several dozen RPs in the form of ExamSoftTM quizzes. The quizzes also include bi-annual cumulative quizzes. We publicly recognize top performers with certificates and gift cards. ExamSoftTM retrieval practices accommodate not only multiple-choice type questions but also short answer, essay, true-false, matching and identification of key histologic features in photomicrographs. To further enhance learning, a faculty member thoroughly reviews the answers to the ExamSoft RP with the residents. We schedule the review at an interval of one to four days following the retrieval practice, because evidence shows that spacing between the RP session and formal review of answers enhances retention.
Evidence Based Data Tracking
We capitalize on data aggregation strengths of the ExamSoftTM software to track individual resident performance through time and by subject matter, among assessing other metrics. We correlate RP performance with performance in anatomic pathology rotations, the RISE exams, and AP/CP Boards. We anticipate providing targeted additional training in areas identified as weak by RP performance.
Schedule
We began the Pathology Core Curriculum (PCC) with a gastrointestinal tract (GIT) block covering seven organ systems over approximately 10 weeks. (See the schedule below.) Since then, the curriculum has expanded into a comprehensive two-year cycle that integrates anatomic pathology, clinical pathology, and evidence-based learning strategies.
All reading assignments, learning sessions, and retrieval practice activities are scheduled through Microsoft Outlook, providing faculty and trainees with a shared curriculum calendar. This coordinated schedule allows faculty across disciplines to reinforce topics being covered in the PCC while residents are rotating through both anatomic and clinical pathology services.
For example, during the neuropathology block, a resident rotating on microbiology may discuss the infectious causes of encephalitis and the diagnostic workup of a current patient with microbiology faculty. These complementary learning experiences reinforce core concepts by connecting the formal curriculum with real-world clinical practice.
We refer to this integrated educational model as 360-degree learning. It extends beyond the formal curriculum to include multidisciplinary teaching, clinical application, and residents learning froam and teaching faculty, peers, and other physicians.
For an example, view a PCC schedule at the link below:
Scholarly Activity
We periodically analyze the PCC program effectiveness in an evidence-based manner. Subsequently, we plan to present our results to the graduate medical education community via peer-reviewed publications. See below for our initial peer reviewed publication.2
References
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Make It Stick: The Science of Successful Learning. Peter C. Brown, Henry L. Roediger III, Mark A McDaniel. Belknap/Harvard Press: Cambridge MA, 2014.
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Neltner J, Bocklage T. Levering Adult Learning Principles into a Residency Core Curriculum. Cancer Cytopathology 2021 Jul;129(7):501-505. doi: 10.1002/cncy.22418. Epub 2021 Mar 19.
Education Committee Members
The education committee meets once a week to discuss ways to implement adult learning principles into their teaching and mentoring.
- Janna Neltner, MD
- Nathan Shelman, MD
- Aaron Shmookler, MD
- Robert D Maynard, PhD
- Sahar Nozad, MD
- Justin Rueckert, MD
- Derek Allison, MD
- Eleanor Powell, PhD
- Elizabeth Pogue, MD
Adult Learning Principles
Interview with Dr. Thèrése Bocklage, Director of Anatomic Pathology in the Department of Pathology and Lab Medicine:
What does the term "Adult Learning" mean and how does it apply to the UK Pathology Residency Program?
Adult learning is a concept explored for decades and describes the differences between children and adult learning and how concepts are absorbed. At UK, we incorporate adult learning principles to maximize adult learning through our two year pathology core curriculum. Specially, we follow the Six Strategies of Adult Learning.
How do you motivate and engage an adult learner?
To begin, our residents already arrive motivated. Then we promote active learning, including an emphasis on individual cases, and residents master the material. Through our passion for pathology, we hope our enthusiasm is contagious.
Since applying these learning principles to this residency program, what changes have you seen?
We have seen improvement in general through performance in external measures of knowledge such as the RISE exam and in personal knowledge as measured in periodic retrieval practices and clinical responsibilities.
