Establishing molecular pathology curriculum for pathology trainees and continued medical education: a collaborative work from the Molecular Pathology Study Group of the Korean Society of Pathologists

Lessons from US experiences

In US, the need for adequate MP education started around late 1990s [9], owing to the advances in the application of molecular biology technology. In the year 1999, the Training and Education Committee of Association for Molecular Pathology (AMP) provides an outline of important elements of resident MP education [7]. The general goals provided by the AMP include basic knowledge in human genetics, basics of molecular biology, and specific skills relevant to microbiology, molecular oncology, genetics, histocompatibility, and identity determination [7]. In addition, the AMP also provided the list of sentinel papers highlighting the important concepts of infectious disease, molecular oncology, inherited disorders, histocompatibility, and identity determination [7].

Along with the advances in NGS technologies and increase in the importance of genomic medicine in the clinical practice, the need for the refinement of educational topics was increased over time. Therefore, the Stanford group pioneered to establish a genomic pathology curriculum–so-called The Stanford Open Curriculum–to help pathology residents build a foundation for the understanding of genomic medicine and the implications for clinical practice [10]. The 10 lectures encompassed the overview of the fundamental principles of molecular biology, clinical genomics, and personalized medicine, and the curriculum also provided 7 additional topics as the elective course of advanced genomic medicine [11].

However, the real-world data suggested that there existed a significant discrepancy between the literal description of curriculum and the subjective perception among the trainees. In a survey of 42 pathology residency programs, only 31% reported that genomic medicine training was included in their program [12]. The serious educational gap prompted the pathologists and medical education specialists in US to organize Training Residents in Genomics (TRIG) Working Group. The TRIG Working Group conducted a nationwide survey for the in-serviced pathology residents in 2013 [13]. 42% and 7% of residents reported that they had no training of genomic medicine and MP during their residency, respectively [13]. When asked whether they were able to discuss MP or genomic medicine test results with a provider, only 13% and 28% of the responders scored that their ability as “very good/excellent” [13].

On observing the obvious educational gap, the Training and Educational Committee of AMP appointed the Molecular Curriculum Task Force; the TF developed an organized curriculum in MP for residents [14]. The major subjects of curriculum included basic MP goals/laboratory management, basic concepts in molecular biology and genetics, technology, inherited disorders, oncology, infectious diseases, pharmacogenetics, histocompatibility and identity, genomics, and information management [14]. Besides, TRIG Working Group provided online genomic pathology modules to improve genomics knowledge and the ability to utilize online genomics tools (https://www.pathologylearning.org/trig). The first version was introduced in the year 2016, and the most recent updates were added in the year 2020 [15,16]. To date, the TRIG has expanded their work toward the education of the undergraduate medical students [17].

Learning objectives and online repository

For adaptation of US experiences into real-world education in South Korea, 13 major topics of MP education was selected by the TF, and detailed description of objectives and goals were generated under each topic, comprising a total of 75 structured items as shown in Table 1. The structured objectives included basic items such as ‘1-2. Definition of genome, exome, proteome, transcriptome, and metabolome’, and further encompassed timely topics such as ‘2-10. Able to explain the definitions of companion diagnostics and complementary diagnostics.’

Table 1.

Structured goals and objectives of molecular pathology training

To provide high-quality resources for trainees, TF members were assigned with each major topic and reviewed the relevant online resources and assessed the quality of contents. After the thorough review of contents, the most adequate learning sources were selected and gathered to form the online repository of MP learning objectives. The online repository became available for all the members of KSP via the official webpage (https://www.pathology.or.kr/html/?pmode=boardlist&MMC_pid=306&cate=study) (Fig. 1).

Fig. 1.

Snapshot showing the online repository of structured molecular pathology goals and learning objectives. The repository of learning objectives became available online for all the members of Korean Society of Pathologists. Each element is linked with high-quality learning resources as shown in the bottom right panel.

3-Day online structured educational session and survey

Based on the structural objectives, the Molecular Pathology Study Group of the KSP planned and held 3-day online structured educational session in February 2022 (Table 2). A total of 201 pathologists participated in the educational session.

Table 2.

The course overview of 3-day molecular pathology educational session

To immediately assess the effectiveness of refined educational session, the TF selected 22 key learning objectives out of total 75 elements and asked the session audience to grade their understanding of each topic before and after the lecture, respectively. The survey was performed at day 1 and day 2 with response rates as follows: day 1 pre-lecture, 93/201 (46.3%); day 1 post-lecture 83/201 (41.3%); day 2 pre-lecture 50/201 (24.9%); day 2 post-lecture 34/201 (16.9%).

Among 22 learning objectives (Fig. 2), the audience reported higher scores regarding their prior understanding on the basic concepts of MP including ‘1-1. Composition and structure of DNA and RNA’ (mean score 72.8), ‘2-1. Oncogene and tumor suppressor gene’ (mean score 73.0), and ‘6-1. Principle and indication of PCR’ (mean score 73.5). In contrast, self-reported understanding prior to the session was lowest in the topics related to NGS: ‘5-6. Quality metrics of NGS library and sequencing data’ (mean score 51.8); ‘5-7. Database for variant interpretation’ (mean score 54.1); ‘5-3. Whole genome, whole exome, target gene, and transcriptome sequencing’ (mean score 58.2).

Fig. 2.

Comparison of subjective understandings on the selected topics between before and after the 3-day structured course. The participants of 3-day structured course were asked to grade their subjective understanding before and after the lecture, and the results for selected topics are depicted.

The scores of self-reported understandings increased after educational session by 9.9 points on average (range, 6.6 to 17.0) (Fig. 2). Of interest, the most effectively improved items were those with lowest pre-lecture scores as follows: ‘5-6. Quality metrics of NGS library and sequencing data’ (score increased from 51.8 to 68.8); ‘5-7. Database for variant interpretation’ (score increased from 54.1 to 68.0); ‘5-3. Whole genome, whole exome, target gene, and transcriptome sequencing’ (score increased from 58.2 to 71.2).

Additionally qualitative responses regarding the adequacy of refined educational curriculum were collected, where favorable comments dominated. The audience provided responses regarding the further suggestions regarding the topic for future educational sessions, and some of the examples are as follows: real-world clinical NGS cases, NGS raw data analysis using R software, wet-lab techniques of NGS, and cutting-edge novel technologies including proteomics and proteogenomics.