Integration of Genomic Medicine in Pathology Resident Training

Abstract

Objectives: To assess current pathology resident training in genomic and molecular pathology.

Methods: The Training Residents in Genomics (TRIG) Working Group has developed survey questions for the pathology Resident In-Service Examination (RISE) since 2012. Responses to these questions, as well as knowledge questions, were analyzed.

Results: A total of 2,529 residents took the 2019 RISE. Since 2013, there has been an increase in postgraduate year 4 (PGY4) respondents indicating training in genomic medicine (58% to approximately 80%) but still less than almost 100% each year for molecular pathology. In 2019, PGY4 residents indicated less perceived knowledge and ability related to both genomic and traditional molecular pathology topics compared with control areas. Knowledge question results supported this subjective self-appraisal.

Conclusions: The RISE is a powerful tool for assessing the current state and also trends related to resident training in genomic pathology. The results show progress but also the need for improvement in not only genomic pathology but traditional molecular pathology training as well.

Keywords: Genomics; Medical education; Next-generation sequencing; Pathology; Residency training.

Figure 1

Postgraduate year 4 residents’ reported training in molecular pathology (MP) and genomic medicine (GM) since 2013. Examinees were asked, “Please indicate how much training you have completed during your residency in (molecular pathology/genomic medicine).” The y-axis shows the percent reporting any training in the different areas. Answer options included none, ≤1 week, >1 week and ≤4 weeks, >4 weeks and ≤6 months, and >6 months.

Figure 2

Residents’ (2019 Resident In-Service Examination) reporting training in gastrointestinal pathology (GI), molecular pathology (MP), and genomic medicine (GM). Examinees were asked, “Please indicate how much training you have completed during your residency in (gastrointestinal pathology/molecular pathology/genomic medicine).” The y-axis shows the percent reporting any training in the different areas by postgraduate year (PGY). Answer options included none, ≤1 week, >1 week and ≤4 weeks, >4 weeks and ≤6 months, and >6 months.

Figure 3

Postgraduate year 4 residents’ (2019 Resident In-Service Examination) reported knowledge in Sanger sequencing/polymerase chain reaction (PCR), next-generation sequencing (NGS), and immunohistochemistry testing. Examinees were asked to “rate your training during residency” for the different testing modalities.

Figure 4

Postgraduate year 4 residents’ (2019 Resident In-Service Examination) reported comfort with pathology tasks. Examinees were asked, “Please rate how comfortable you are in your ability to do the following: knowledgably discussing the results of a next-generation sequencing (NGS)–based tumor genetic testing report with a clinician; knowledgably discussing results of a PCR or Sanger sequencing-based tumor genetic testing report with a clinician; determining the clinical significance of a genetic variant; selecting the best tissue block for tumor genetic testing; knowledgably discussing the results of a colon polyp biopsy report with a clinician.” PCR, polymerase chain reaction.

Figure 5

Postgraduate year 4 residents’ (2019 Resident In-Service Examination) reported use of online genomics resources. Examinees were asked, “Have you heard of or used any of the following websites?” including PharmGKB, PolyPhen, cBioPortal, ClinGen, ClinVar, ClinicalTrials.gov, COSMIC, OMIM, and PubMed.

Figure 6

Postgraduate year (PGY) 1 and 4 residents’ (2019 Resident In-Service Examination) performance on knowledge questions. The average percent correct for the 15 hematopathology (HP), 17 molecular pathology (MP), and six genomic medicine (GM) knowledge questions. Error bars represent the standard deviation.