Frequently Asked Questions
If you can’t find your question here, simply ask a question - Our expert panel of pathologists involved with the CAP’s Campaign to Transform the Specialty of Pathology is here to help! Simply click on any question below to read the full answer.
December - Certificate Program on Ultrasound Guided FNA
I recently learned from an e-mail that the American
Society of Cytopathology (ASC) is putting together an informal group
of pathologists who perform ultrasound-guided fine-needle aspiration
(UG-FNA). The purpose is to ask the CAP to study the feasibility of
starting courses on UG-FNA for pathologists, instituting a certification
program (perhaps like the American Society of Breast Surgeons?), and
writing a certification exam. If the proposal gets that far, how would
I join the CAP committee that studies this proposal? This may be the
next great change that transforms cytopathology. I am a member of
both the CAP and ASC. I perform over 1000 UG-FNA of nonpalpable masses
per year and recently published an article on cytopathologist-performed
UG-FNA and core-needle biopsies in a cytology journal. I also attended
an advanced ultrasound course this past week to become a certified
ultrasound instructor for the American College of Surgeons.
David Lieu, MD, MBA
Fine Needle Aspiration Medical Group
You are entirely correct in observing that ultrasound-guided fine-needle aspiration is a topic of great interest within the CAP community. In fact, we are in the initial states of developing education to support a certificate program in this area that is scheduled to launch in the third quarter of 2009.
The CAP education department is working with several content experts for the UGFNA certificate program; at this point, we are not planning to add additional content experts to the team. Although our content experts have not yet identified all of the requirements for the UGFNA certificate program, we expect that the primary focus will be on the thyroid.
As the various certificate content teams moved forward, some may want to seek pilot feedback. It is too soon to know whether our UGFNA team will be looking for feedback experts; that decision will be made down the road a bit.
If you would like to become more involved with the College, either as a pilot feedback expert or in any other role, please access the committee appointments information on cap.org.
The College has many committees and opportunities for our members to volunteer their expertise. Sometimes there are more candidates than available committee positions; in that event, not all candidates can be placed on a committee right away. However, the College keeps the names of those not appointed on file for immediate reference should midyear openings occur, and all applications remain on file for 3 years.
Your interest in the certificate programs is most welcome, thank you for writing. Your letter reflects kind of initiative, energy, and attitude that will drive the success of our transformation.
Is forensic pathology part of this?
The forensic pathologist will have several leadership roles in the transformation. First, your colleagues will turn to you as a mentor and role model. Forensic pathology requires interpersonal skills and agility in functioning outside the medical comfort zone. Daily interaction with persons in the legal and criminal justice systems keeps the forensic pathologist flexible, fosters perspective-taking, and yields important insights into how non-medical professionals think and interact. The forensic pathologist is called upon to exercise a level of versatility rarely seen in any field of medicine. He or she has chosen to live “outside the box,” and that is what the transformation is all about.
Despite all the talk about new tools and techniques, transformation is, at its heart, about personal growth. As physicians who put themselves in uncomfortable situations that they cannot change, forensic pathologists take on tasks that many people would go some lengths to avoid. Transformation is very much about learning to function well outside your comfort zone and forensic pathologists are natural leaders in this regard.
Finally, transformational pathology conjures an ability to embrace new technologies. Forensic pathologists have already experienced the benefits of an outstanding new tool: the virtual autopsy. This innovation has enabled the staff at Dover Air Force Base to provide a complete and timely postmortem report to the family of every American soldier and contractor killed in Afghanistan or Iraq. CAP leaders who visited the Dover Air Force Base in October of 2007 found that the military is employing the virtual autopsy in an extremely touching and dignified environment. An important gesture of respect for our soldiers, the virtual autopsy procedure at Dover was made possible, in part, by innovative thinkers at the General Electric Company, who converted an older model CT scanner for this purpose.
Virtual autopsy is a complementary technology, meaning that it makes use of a current tool, the CT scanner, for a new purpose. Complementary technology, which signals sensitivity to limited resources, is expected to be a hallmark of transformational pathology. As our specialty evolves, pathologists will not only study new technologies and teach others to use them, but will explore and evaluate new ways to adapt current tools for new purposes. (To learn more about virtual autopsy, visit www.virtopsy.com, where cutting-edge work in this field is taking place.)
In sum, the forensic pathologist has several extremely important roles in the transformation. As role models and innovators, they will be among those who will bring the transformation home.
October - What Is The Difference Between Transformation And CME
“Transformation” sounds so dramatic. We do need to learn to use new technologies, but isn’t that the purpose of continuing medical education?
CME is a vital part of what we’re setting out to do, but transformation is not an overstatement. The difference between CME and transformation is the difference between staying current and reinvention. This is more than a matter of degree; it’s a substantial change in how we see ourselves and how others see us. CME increases the knowledge base; transformation changes behavior. CME is about maintaining competence; transformational pathology is lifelong learning on steroids.
October - Learning Goals Differ According To Stage In Career
I enjoy reading about new diagnostics and emerging technologies but our staff is already stressed to the max. I’m inclined to send our younger colleagues to the CAP Institute courses while I cover for them here; at 10 years to retirement, I think that’s how I can best contribute to our practice.
New technologies are not only for new pathologists! CAP Institute coursework will enhance your ability to relate to your clinical colleagues and bring your practice-based knowledge to the conversation. For many pathologists, leadership on the clinical team will be a new experience. For most, it will be a very good experience. Seasoned pathologists who understand the new tools are needed to guide younger colleagues in their use and put new knowledge in context for other specialists on the clinical team. If you are an experienced pathologist, that job has your name on it.
October - CAP Center And CAP Institute - Significant Resources
The College is investing significant resources in the CAP Institute and the CAP Center for Quality. I wonder if this is a prudent investment.
The Institute and the Center are strategies to protect quality and patient safety in an era of great volatility and promise. Transformation is more than education; it’s evolution. Just as the CAP Institute is about more than CME, transformational pathology is about more than new tools. The CAP Institute and the CAP Center will house and nourish essential developmental changes in our specialty. Pathologists are a population at risk; if we do not evolve we will not survive. The CAP Institute and CAP Center are frivolous investments only if you think that investing in our survival is less than prudent.
October - New Technology - It's a Necessity, Not a Luxury
I get the impression that if pathologists don't take charge of new technologies, others will. I’m not sure that would be a bad thing. We’re working double-duty already. Why is this our job?
Those who say that “this is not our job” are right. We do not have a job; we have a mission.
New technologies are emerging rapidly from a host of sources; there is a void to be filled in monitoring quality and protecting patient safety. All of medicine is in transformation. As we move from a curative to a preventive model, everyone is looking to find a footing. Transformational pathology requires a monumental shift in our collective thinking. To ensure that scientific progress continues to occur with all deliberate speed but also without risk to patient safety, physicians must regroup and specialists must work more closely with one another. Pathologists, who work with all specialists and see all the evidence, are uniquely positioned to understand why and drive that message home to our clinical partners.
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