College of American Pathologists
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  Directing a lab: sink, swim—or look to CAP course


CAP Today




September 2011
Feature Story

Laura Hegwer

It may not be theater, but a new program for laboratory medical directors has opened to positive reviews.

“Wonderful opportunity to discover that I am not alone in my struggles as a laboratory director,” says Elise Occhipinti, MD, of New Orleans. Joseph Willis, MD, of Cleveland, describes it as “informative, collegial, helpful.” From Usha Jain, MD, of Baltimore: “This was an excellent course. It gave me resources and connections with other lab medical directors. It made me feel more confident.”And Marisa Marques, MD, of Birmingham, says “all new pathologists should attend this course before they become lab medical directors.”

The program they participated in and are talking about is the Laboratory Medical Director Advanced Practical Pathology Program, or LMD AP3 for short. It’s a first-of-its kind program from the CAP created to give pathologists the knowledge they need to be strong leaders and run laboratories efficiently. CAP Learning education manager Sue Plath, one of the program’s many developers, says the CAP “wanted to create a program that would fill in potential gaps where it thought pathologists might be at risk.”

“Although pathologists get wonderful medical training,” Plath says, “they don’t necessarily learn the business critical skills that are required to be successful laboratory medical directors.”

The program consists of seven online CME courses, each with its own self-assessment module, and a day and a half workshop led by a team of expert faculty. The participant must complete the online courses before attending the workshop. On day two of the workshop, participants complete a cognitive assessment containing 50 multiple-choice questions that can be retaken twice. Later, back at their jobs, participants complete a practical assessment.

“You can’t get this blended learning approach through academia,” Plath says. “You can get an MBA, but you won’t get the pathologist’s viewpoint and how you apply these topics in the real world.”

Thomas L. Williams, MD, was one of three expert faculty at the first workshop in June and a member of the program’s working group. “Most medical director problems are not really scientific problems,” says Dr. Williams, medical director of The Pathology Center at Methodist Hospital, Omaha. “Their problems are more about communication, people skills, organizational skills, and team problem-solving. This program spends a lot of time addressing these issues.”

Deborah A. Perry, MD, also a member of the faculty at the June workshop, says one of the program’s strengths is that most of the didactic learning is completed online. “That allowed the work-shop to be more interactive, case-based, and practical. People seemed to enjoy it,” says Dr. Perry, medical director of pathology, Children’s Hospital and Medical Center, Omaha.

Elizabeth R. Pollak, MD, attended the workshop and agrees—but she wasn’t without her reservations. “I was actually resistant to this process when I first arrived. I just wanted to be lectured to. But of course it’s always much more valuable when you go through the process and think it out, write it down, discuss it with someone next to you, and then hear what people across the room have to say.”

Dr. Pollak, who has been medical director of the laboratory at Uintah Basin Medical Center, Roosevelt, Utah, for 15 months, says the most valuable part of the workshop was being with other laboratory medical directors, hearing how they solve problems, and learning how “universal” the problems are, regardless of lab size. “My lab is small, but someone was there from one of the big laboratories and his problems are very similar to mine,” she says.

In the workshop, pathologists are taught how to organize teams and use leadership skills to keep the laboratory running smoothly. They practice team leadership techniques and learn the proper way to delegate tasks in a delegation simulation. They work together to create scenarios that demonstrate the four phases of team development—an exercise that gives them an opportunity to practice building their own teams while they discuss fictional cases involving teams.

“This was the most efficient way for me to learn risk management, compliance, team leadership, etc., in an organized and friendly environment,” says Barbara A. O’Malley, MD, medical director of clinical laboratories at Harper University Hospital, Detroit, and system medical director of blood banks at Detroit Medical Center. “I also feel like I have resources in the CAP.”

Like Dr. O’Malley, Dr. Occhipinti attended the June workshop, and she liked its small size—no more than 30 people can attend. “Everyone spoke very freely about issues that were going on in their lab. It was really good to shoot ideas off each other.” She liked the camaraderie of the participants: “I feel like I could call up any of the pathologists from the course with a question.”

She’s been the laboratory medical director at Ochsner Medical Center in New Orleans for one year and says the director role can be a “nebulous” one. “The workshop gave me exactly what I was supposed to do, how I’m supposed to do it, and where I can find the resources to help me do the right thing.”

Of the seven online courses, Dr. Occhipinti found she learned the most from the one on “Regulatory and Accreditation Essentials,” which took her through a day in the life of “Dr. Newbie.” “A lot of the scenarios described in that course were similar to things that have happened to me in the real world.” The other online courses cover communication, leadership and team leadership, risk management and compliance, quality management, and medical knowledge management.

Laboratory utilization is another area the program addresses. The coursework is aimed at helping pathologists recognize the implications of patterns, trends, and variations in test ordering and results. As part of the workshop, pathologists participate in a test-costing exercise and learn communication strategies to help them work with other members of the health care team.

On the topics of quality management and lab improvement, they talk about real-life compliance issues and review regulatory and compliance plans. In one exercise, they review a lab scenario to identify regulatory and compliance pitfalls. As a group, they discuss which areas are at risk for an inspection deficiency, and then delve into accreditation requirements. From there, they create plans for deficiency improvement and discuss when it’s appropriate to delegate responsibilities. Afterward, the group works in pairs to write down ideas for delegation, based on a sample laboratory scenario.

“Very little that we do as laboratory medical directors is cookie-cutter,” says Michael L. Talbert, MD, who was the third faculty member at the June workshop and is chief of Pathology and Laboratory Services at the OU Medical Center, Oklahoma City, and chair of the Department of Pathology at the University of Oklahoma College of Medicine. “So much of what we do is situational. In the workshop, there are many chances to practice application and gain experience in a unique forum.”

“It gives pathologists a certain sense of validation that they can do this and are making good decisions,” Dr. Talbert says.

Once they’ve completed the online work and attended the workshop, participants complete the two assessments to earn their certificate: the online cognitive assessment and the practical assessment. The latter consists of six open-ended questions intended to simulate real-world situations pathologists encounter. The questions focus on communicating information to others about lab errors, consulting with stake-holders, creating a technology assessment, and managing change. Enrollees are expected to complete the full program—online courses, workshop, and two assessments—within a year to 18 months.

The full program price is $3,000. Those who want CME/CE credits only can take the online courses and attend the workshop for $2,000. The CAP recommends but doesn’t require that enrollees have at least three years of experience as a laboratory director or head of section.

Twenty-four of the 26 June work-shop attendees evaluated the program, and all rated the overall value of the workshop as excellent or good. All said they would recommend the full program to a colleague. What might they do more of or better or differently in their jobs as a result of their participation? “I will return to my quality management plan and revise it substantially,” wrote one. Others wrote: “Verify that there is thorough documentation of delegated duties and backup plans for appropriate situations” and “I think I will have more confidence leading the lab and interacting with the hospital administration to advocate for the lab.”

How might the program be improved? “More time on site might help,” one said. “Be more concise and less redundant in materials,” said another. “We need more scenarios on talking and negotiating with higher administration,” one participant suggested. A few reported that the online courses took more time than they expected. The feed-back will be used to strengthen the program, Plath says.

While Broadway it isn’t, the new LMD AP3 program did not disappoint. “Wealth of information, powerful information. Clear, concise, and useful,” one pathologist wrote. “Worth it!” said another. So the LMD AP3 show will go on. Faculty member Dr. Williams, in reflecting after the June debut, described it as “something experiential, above and beyond traditional learning, from which the participant emerges changed in a tangible way.”

Laura Hegwer is a writer in Lake Bluff, Ill.
This new program was created under the guidance and stewardship of a CAP working group led by James S. Hernandez, MD, chair; Richard C. Friedberg, MD, PhD; Paul Bachner, MD; Ronald L. Weiss, MD; Thomas L. Williams, MD; and Teresa P. Darcy, MD. In addition, many other pathologists and CAP Learning staff supported the program’s development.
For more information about LMD AP3, visit the CAP Transformation Web site at Send your questions to

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