Improving Quality of Care through Tailored Medical Education in a Pathology Residency Program

Abstract: Improvements in quality and safety in healthcare and reducing medical errors are imperative. Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. Postgraduate residency training programs are designed for residents to acquire competence through workplace-based clinical care provision and academic learning. Academic teaching helps consolidate basic and applied knowledge for quality patient care. Residency programs in Pathology, one of which is “Diagnostic and Clinical Pathology” aimed at general competence in clinical and laboratory medicine is heavily influenced by the changing landscape of practice and emerging technologies. Within the Diagnostic and Clinical Pathology residency program specifically, the best pedagogical approach to delivering academic (classroom-based) teaching to promote quality care, reduce medical errors, prepare for digital literacy and promote resource stewardship remains unclear. This study measured residents' perceptions of course satisfaction, ability to meet learning objectives and future clinical application across courses offered in three different pedagogical approaches (an introductory "Boot Camp" course utilizing traditional didactic lectures, interactive case-based sessions, and asynchronous learning based on pre-developed Modules). Specific topics related to quality care- among other topics – included, utilization, role as a laboratory professional, medical error, quality and safety, and self-efficacy of practicing required behaviors. Clinical scenarios, such as acetaminophen poisoning, provided a scaffolding for learning these aspects. Kirkpatrick level 1 “Reaction” was evaluated across satisfaction, engagement, perceived relevance and usefulness, emotional response and immediate feedback through a survey (10 questions for satisfaction, 7 for achievement of learning objectives, 1 for usefulness for clinical application and open-ended comments). Descriptive statistics were used for reporting quantitative data and key quotes/themes were extracted from the narrative comments. For all three teaching methods, most residents agreed that sessions were satisfactory (>80%), had met learning objectives (>75%), and were comfortable applying material for clinical applications (80%) The interactive case-based sessions scored highest, averaging 91%, 86% and 100% respectively in these three categories. Didactic teaching sessions and pre-developed modules had a wider range of disagreement amongst the residents, specifically related to time, opportunities for discussion and achievement of learning objectives. Open-ended responses highlighted case-based teaching as “bridging the gap between theoretical knowledge and clinical application” and articulated the need for more case-based teaching. While all three methods were well-received and met expectations, our study suggests that a difference may exist between pedagogical approaches to improve quality care. The boot camp provided foundational knowledge; the interactive cases consolidated learning, and the modules highlighted clinical relevance and applicability. Recognizing that most medical errors result from system and process issues and the centrality of high quality medical education to safe care, utilizing different modalities for academic teaching (across the system and emphasizing current and emerging topics) to complement workplace-based learning for deep and practical knowledge is essential for teaching Pathology residents. Future studies with a larger sample size and additional measures of engagement are needed to assess if an interactive case-based approach is a superior educational strategy.

Keywords: Quality Care, Medical error, Case based learning, Pedagogy, active learning, Asynchronous learning, Diagnostic and Clinical Pathology

DOI: 10.54941/ahfe1005690

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