Minority Training Program In Cancer Control: Fill & Download for Free

These days clinical trials are a global endeavor spanning 204 countries, according to Home - ClinicalTrials.gov (1), something that should make accusations of racial bias harder to substantiate. However, the crux of the matter is who participates in clinical trials within a given country.Briefly,Diversity mandates do little when mechanisms to enforce them are left unstated. In such a vacuum, individual biases and structural barriers drive the process.The US has a bleak history of unethical medical experimentation on minorities that has left them with a persistent and deep mistrust of the medical establishment.Meantime, being largely white, US clinical trial organizers don't reflect the ethnic diversity of the population at large. Such a decision-making silo inadvertently de-prioritizes clinical trial recruitment of minorities.Diversity mandates do little when mechanisms to enforce them are left unstatedAfter clinical trials became the norm for new drug approvals post- WWII, white males remained over-represented in them for several decades. In response, the US National Institutes of Health Revitalization Act of 1993 mandated women and minorities be represented in NIH-funded research. Enforcing a mandate is easier said than done especially when mechanisms to do so are left unstated. Not surprising then that biases and structural barriers take hold and drive the process in such a vacuum.As recently as 2015, though blacks and Latinos make up ~30% of the US populations, a study found they accounted for just ~6% of participants in federally funded clinical trials (2).Another US study found <2% of cancer clinical trials focused on the health needs of racial/ethnic minorities (3).Even though African Americans are >30% more likely to have asthma and even >3X more likely to die from it, a study found <5% of federally funded lung disease studies in the US focused on them between 1993 and 2013 (4).Even Precision medicine - Wikipedia, the notion that medical treatment could be tailored to an individual's variations in genes, environment and lifestyle, leaves minorities far behind. As of 2011, ~96% of participants in >1000 Genome-wide association study - Wikipedia (GWAS) were of European descent (5).Since some minorities tend to be poorer and to live in places far from large reputed medical centers that conduct clinical trials, practical constraints such as time and money needed to travel to a study site may hamper their participation.Diversity mandates on federally funded trials don't apply to the pharmaceutical industry which is today the biggest funder of clinical trials. For such trials, only something like a diversity mandate enforceable by the FDA during its review process of product approval could make a dent (6).The US has a bleak history of unethical medical experimentation on minorities that has left them with a persistent and deep mistrust of the medical establishmentIn the US, the Tuskegee syphilis experiment - Wikipedia looms large in collective consciousness as a constant reminder of the lengths to which racial animus could infect a clinical study design in that the study doctors knowingly and wantonly withheld treatment from syphilis-infected poor, uneducated, rural black men not for a year or two but for a whopping 40 years. Any wonder then that studies (7, 8) continue to find the African American community mistrust of the medical establishment?Given such a bleak history, where African Americans are concerned, racial bias in US clinical trial enrollment is best viewed as a two-way street with low black (and other minority) participation explainable two ways,one, implicit bias of trial researchers may play a considerable role in restricting minority enrollment. Some recent studies found a profound degree of implicit bias in medical doctors on matters of race. It stands to reason to assume such bias might well bleed into clinical trial enrollment processes as well.A 2016 study found substantial numbers of white medical students continue to hold false beliefs about biological differences between black and white people, (see below from 9),'blacks have thicker skin than do white people or that black people’s blood coagulates more quickly than white people’s blood.’Another 2016 study found (see below from 10, emphasis mine),'...significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56–0.67, p value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariate.’Indeed, such implicit bias has been used to explain the far lower rates of prescription opioid abuse among African Americans and Hispanics in the early years of the ongoing opioid crisis (11, 12).two, blacks, especially black males, have for long actively avoided participating in clinical trials due to their understandable deep-rooted mistrust of the medical establishment (7, 8). Some other minorities also avoid them due to lingering mistrust engendered by a past history of trust abuse.Apparently so hard-wired is this mistrust that as recently as 2014, a severe TB outbreak in the small rural Alabama town of Marion went unchecked because those affected chose not to go to a doctor (13).Bad acts and actors in US biomedical research didn't magically end with Tuskegee. In 1989, Arizona State University researchers collaborated with the Havasupai Tribe on a type II diabetes project. In 2003, Carletta Tiousi, a trial participant, found out that blood samples taken during this trial had been used without her and other participants' consent for testing schizophrenia, migration and inbreeding (14). A lawsuit led to an out of court settlement and the tribe members received funds for a school and clinic, and return of their samples.Being largely white, clinical trial organizers don't reflect the ethnic diversity of the population at large. Such a decision-making silo inadvertently de-prioritizes recruitment of minoritiesMinority participation in US clinical trials could be increased through concerted effort on fairly simple, practical steps (15, 16, 17, 18, 19),Situate clinical trials where minorities tend to live.Provide low income participants travel assistance back and forth to trial sites.Focus on recruitment efforts in places such as churches and barbershops where minorities tend to congregate.Employ minority recruitment staff to serve as outreach partners to engage with potential minority participants in their own languages.Advertise clinical trials within ethnic communities using culturally appropriate informational material clarifying purpose of the trial, and how data will be collected and used.Nothing new about any of these suggestions. They've floated around for years and yet little changes. Bias in clinical trial recruitment, as in any aspect of human life, need not always occur deliberately. They can and often are the result of blinkered thinking that easily takes root in silos. When a particular majority has the power, the decisions it makes reflect that.Minority researchers would be more likely to focus on issues of health disparities in minority populations and yet even after controlling for other variables such as education, training and experience, one study found that they were ~half as likely to get NIH grants (20).Racially homogenous make-up of clinical trial participants reflect the racially homogenous make-up of clinical trial decision makers. Seats at the table; changes in clinical trial participants will occur lockstep with changes in clinical trial organizers, when trials are conducted not by largely white doctors but by a healthy mix of white, black, Hispanic and other minority doctors who better represent their distribution in the US population at large.Bibliography1. Studies on Map - ClinicalTrials.gov2. Oh, Sam S., et al. "Diversity in clinical and biomedical research: a promise yet to be fulfilled." PLoS medicine 12.12 (2015): e1001918. http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1001918&type=printable3. Chen, Moon S., et al. "Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual." Cancer 120.S7 (2014): 1091-1096. Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual - Chen - 2014 - Cancer - Wiley Online Library4. Burchard, Esteban G., et al. "Moving toward true inclusion of racial/ethnic minorities in federally funded studies. A key step for achieving respiratory health equality in the United States." American journal of respiratory and critical care medicine 191.5 (2015): 514-521. https://www.atsjournals.org/doi/abs/10.1164/rccm.201410-1944PP#readcube-epdf5. Bustamante, Carlos D., M. Francisco, and Esteban G. Burchard. "Genomics for the world." Nature 475.7355 (2011): 163. https://www.igb.illinois.edu/sites/default/files/Genomics%20for%20the%20World.pdf6. Wilder, Julius M. "Scientific and Ethical Considerations for Increasing Minority Participation in Clinical Trials." (2018). https://cdn.intechopen.com/pdfs/56507.pdf7. Alsan, Marcella, and Marianne Wanamaker. "Tuskegee and the Health of Black Men." The Quarterly Journal of Economics 133.1 (2017): 407-455. https://economics.stanford.edu/sites/default/files/tuskegee_22may2016-1.pdf8. Wong, Kristin X. "The Pivotal Role that Race Plays in Medical Research: The Tuskegee Syphilis Study." (2018). https://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=1158&context=younghistorians9. Hoffman, Kelly M., et al. "Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites." Proceedings of the National Academy of Sciences 113.16 (2016): 4296-4301. http://www.pnas.org/content/pnas/early/2016/03/30/1516047113.full.pdf10. Singhal, Astha, Yu-Yu Tien, and Renee Y. Hsia. "Racial-ethnic disparities in opioid prescriptions at emergency department visits for conditions commonly associated with prescription drug abuse." PLoS One 11.8 (2016): e0159224. http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0159224&type=printable11. Meghani, Salimah H., Eeeseung Byun, and Rollin M. Gallagher. "Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States." Pain Medicine 13.2 (2012): 150-174. https://academic.oup.com/painmedicine/article/13/2/150/193596212. Finding Good Pain Treatment Is Hard. If You’re Not White, It’s Even Harder.13. In Rural Alabama, a Longtime Mistrust of Medicine Fuels a Tuberculosis Outbreak14. Havasupai Tribe and the lawsuit settlement aftermath15. Galsky, Matthew D., et al. "GEographic accessibility to clinical trials for advanced cancer in the United States." JAMA internal medicine 175.2 (2015): 293-295. Accessibility to US Clinical Trials for Cancer16. Tanner, Andrea, et al. "Communicating effectively about clinical trials with African American communities: A comparison of African American and White information sources and needs." Health promotion practice 17.2 (2016): 199-208. https://www.researchgate.net/profile/Yue_Zheng20/publication/288830931_Communicating_Effectively_About_Clinical_Trials_With_African_American_Communities_A_Comparison_of_African_American_and_White_Information_Sources_and_Needs/links/56f1b0ef08aee9c94cfd71c9/Communicating-Effectively-About-Clinical-Trials-With-African-American-Communities-A-Comparison-of-African-American-and-White-Information-Sources-and-Needs.pdf17. Wallington, Sherrie F., et al. "Enrolling minority and underserved populations in cancer clinical research." American journal of preventive medicine 50.1 (2016): 111-117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691547/pdf/nihms715368.pdf18. Konkel, Lindsey. "Racial and ethnic disparities in research studies: the challenge of creating more diverse cohorts." Environmental health perspectives 123.12 (2015): A297. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670264/pdf/ehp.123-A297.pdf19. Graham, Louis F., et al. "Outreach Strategies to Recruit Low-Income African American Men to Participate in Health Promotion Programs and Research: Lessons From the Men of Color Health Awareness (MOCHA) Project." American journal of men's health (2018): 1557988318768602. http://journals.sagepub.com/doi/pdf/10.1177/155798831876860220. Ginther, Donna K., et al. "Race, ethnicity, and NIH research awards." Science 333.6045 (2011): 1015-1019. Race, Ethnicity, and NIH Research AwardsThanks for the R2A, Christopher VanLang.

A2A: Medical Schools have links to Institutional and External Research Opportunities for Medical Students. Several links below:Johns Hopkins University Research Programs and OpportunitiesMedical Student Research DaySummer Internship Program for UndergraduatesSearch for Mentors and Summer Research OpportunitiesInstructions for Mentors and Preceptors- procedure for signing up as a mentor or posting a student research opportunity.Fellowship InformationFunding InformationSummer Research Funding OpportunitiesDean's Office Summer Research FundingA Summer Research Opportunity (SRO) experience is open to all JHU SoM M.D. students in the summer following completion of the first year of medical school. Details are provided by the Office of Student Affairs after the winter holiday break.CHLA/USC Summer Oncology Fellowship ProgramThis program is intended to provide the highest quality experience for first-year medical school students pursuing interests in oncology research. Students actively participate in clinical or laboratory research studies during their fellowship, and some have authored or co-authored peer reviewed publications as well as presented their work at major national and international scientific meetings. Many have gone on to academic medical careers.For more information, please visit:CHLA/USC Summer Oncology Fellowship ProgramCancer in the Under-Privileged, Indigent or Disadvantaged (CUPID) Summer FellowshipCancer in the Under-Privileged, Indigent, or Disadvantaged (CUPID) is a laboratory-based summer fellowship program at the Johns Hopkins University School of Medicine that is designed for medical students who have an interest in bringing the benefits of modern cancer research to underserved populations in the US.For more information, please visit:Cancer in the Under-Privileged, Indigent, or Disadvantaged (CUPID) Summer FellowshipInfectious Disease Society of America (IDSA) Medical Scholars ProgramAn important part of IDSA’s mission is to promote the subspecialty of infectious diseases by attracting the best and brightest medical students to the field. To further this goal, the IDSA Education and Research Foundation offers scholarships to medical students in U.S. and Canadian medical schools with mentorship by an IDSA member or fellow. It is the responsibility of IDSA members and fellows to identify and solicit interested students.For more information, please visit:Infectious Disease Society of America (IDSA) Medical Scholars ProgramKwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH)K-RITH offers a range of internship opportunities:Short-Term InternshipsOur short-term internship programme runs from June-August each year. Students need to identify their own funding as although K-RITH covers laboratory expenses, we do not offer financial support to cover relocation costs or a daily stipend. Please only apply if financial support has been obtained. To apply please submit your CV and a covering letter with a 200 word motivation on why you should be selected for the programme. The deadline for applications is 31 January each year.To apply please submit your CV and a covering letter with a 200 word motivation on why you should be selected for the programme and which laboratory you are interested in working in to [email protected] Internship OpportunitiesHHMI Medical Research Fellows ProgramMedical, dental, and veterinary students are in a unique position to advance biomedical research and translate findings from the lab into the treatment of disease. The HHMI Medical Fellows Program gives these students a chance to focus on a research project full-time and determine how they can incorporate research into their professional careers. For more information see: Year-Long Medical Research Fellows Program at Janelia or K-RITH.Who is Eligible to apply? Students must be in good standing at a medical, dental, or veterinary school located in the United States. U.S. citizenship is not required. Students cannot be enrolled in a combined medical, dental, or veterinary/PhD program (e.g., MD/PhD) or PhD, or ScD program, or have a PhD or ScD in a laboratory-based biological science.For more information, please visit:K-RITH Internship OpportunitiesMedical Student Training in Aging ResearchAdministered by AFAR and the National Institute on Aging (NIA), the MSTAR program encourages medical students--particularly budding researchers--to consider a career in academic geriatrics by awarding short-term scholarships. Strengthening the original Hartford/AFAR Medical Student Geriatric Scholars Program, MSTAR celebrates its 21st year in 2015.For more information, please visit:Medical Student Training in Aging ResearchMedical Student Research Program in DiabetesThe Medical Student Research Program in Diabetes is sponsored by the National Institutes of Health through the NIDDK and allows medical students to conduct research under the direction of an established scientist in the areas of diabetes, hormone action, physiology, islet cell biology or obesity at an institution with one of the NIDDK-funded Research Centers during the summer between the first and second year or second and third year of medical school. The Program helps students gain an improved understanding of career opportunities in biomedical research and a comprehensive understanding of diabetes, its clinical manifestations and its unsolved problems. Prior research experience is not required.In addition to working on his/her own research project, each student attends a series of web-cast seminars addressing various clinical and research aspects of diabetes mellitus and its complications. At the conclusion of the summer, each student presents a brief summary of his/her work at a scientific symposium for all Program participants (location varies from year to year).For more information, please visit:Medical Student Research Program in DiabetesMemorial Sloan-Kettering Cancer Center Medical Student Summer Fellowship ProgramThe Medical Student Summer Fellowship Program is an eight-week research program at Memorial Sloan Kettering offered to medical students who are interested in a career as a physician-scientist in the field of oncology and/or related biomedical sciences.Eligibility & Selection CriteriaFirst- or second-year medical students in good academic standing at LCME- or COCA-accredited US medical schools are eligible to apply for our fellowship program.For more information, please visit:Memorial Sloan-Kettering Cancer Center Medical Student Summer Fellowship ProgramNational Multiple Sclerosis Society Gateway Area ChapterThe Medical Student Fellowship in MS program offers the opportunity to expose medical students to the field of multiple sclerosis. Proposed rotations may include learning about multi-disciplinary care, clinical trials, research, and advocacy/support at a MS Affiliated Center for Comprehensive Care based in a medical school or private practice setting. Students are expected to identify a mentor from an approved list to discuss interests and opportunities.For more information, please visit: National Multiple Sclerosis Society Gateway Area Chapter or Suzanne Carron, [email protected] or by phone 1-800-344-4867, select option #2Roswell Park Summer Oncology Research ProgramOur summer fellowship program offers rising second-year medical students the chance to conduct mentored, NIH-funded research in a faculty lab at UB or Roswell Park Cancer Institute. Test your interest in research or get a head start on your long-term plans.You will design and carry out independent research in infectious diseases, microbiology and/or immunology under the guidance of our world-renowned faculty. Your mentor will work with you to develop a project abstract before the fellowship begins and help you see your goals to completion.The fellowship application will ask you to list three mentors with whom you wish to work, and we will make every effort to match you with a mentor based on your interests.For more information, please visit: Roswell Park Summer Oncology Research ProgramVanderbilt Student Research Training ProgramThe Vanderbilt Student Research Training Program (SRTP) is sponsored by the National Institutes of Health and allows medical students to conduct research under the direction of an established scientist in the areas of diabetes, obesity, kidney disease, or digestive disease at Vanderbilt during the summer between the first and second year or second and third year of medical school.SRTP offers three areas of emphasis: Diabetes and Obesity, Kidney Disease, and Digestive Disease.For more information, please visit: Vanderbilt Student Research Training ProgramOffice of Medical Student ResearchUniversity of North CarolinaResources for StudentsResources for MentorsHome › Resources for Students › Research Opportunities › Short-Term Research OpportunitiesRESOURCES FOR STUDENTSResearch ProgramsResearch OpportunitiesOne-Year Research Training OpportunitiesShort-Term Research OpportunitiesSupplemental Funding Grants and Award OpportunitiesResource LibraryShort-Term Research OpportunitiesThis page is a resource for discovering research training opportunities available outside of the Carolina Medical Student Research Program. Some programs offer students grants to conduct their research at the institution of their choice, including here at UNC. Other programs offer stipends for students to come specifically to their training facilities to conduct research. The listings below give a brief program description in alphabetical order by Agency. When you find a program that interests you, please go to that program's website to learn more about their application deadlines and procedures.The Office of Medical Student Research is always looking for opportunities that suit each student's interests and availability. Please email the Office of Medical Student Researchwith any additional research training opportunities that should be listed on this page.Agency: M. D. Anderson Cancer CenterTitle: M.D. Anderson Cancer Center Summer Research ExperienceProgram Description: The M.D. Anderson Cancer Center at University of Texas is accepting summer research applications beginning November 30, 2015 through midnight on January 18, 2016. Please visit this website for more information: www.mdanderson.org/summerOur 10-week research program is specifically designed for medical students who are interested in hands-on basic biomedical, translational, or clinical research and have completed their first year of medical school. Students are paired with one of our distinguished research or clinical faculty and are assigned individual projects that reflect the ongoing research efforts of the institution’s clinical and laboratories. In addition to hands-on investigative research, the program also includes interview workshops and lectures fom experts in the field of oncology. Students create valuable connections and indelible tools that can be used to assess their individual career goals relating to research and patient care in oncology. Participants receive a stipend of $5,000 for the complete 10-week period. The stipend is not a salary but is provided to subsidize all research-related expenses, housing, meals and travel.Our program is looking for students that demonstrate a commitment to scientific exploration and share the spirit of academic excellence. Students must be in good academic standing and exhibit an interest and aptitude for scientific investigation.Agency: Memorial Sloan-Kettering Cancer CenterTitle: MSKCC Medical Student Summer Fellowship ProgramProgram Description: The Memorial Sloan-Kettering Cancer Center Medical Student Summer Fellowship Program is accepting applications beginning the week of December 14, 2014. For more information please visit the program website: www.mskcc.org/summerfellowships.This eight-week research program is offered to medical students who have a career interest as a physician-scientist in the field of oncology and/or related biomedical sciences. Supported by the National Cancer Institute (NCI), MSKCC Office of Diversity Programs in Clinical Care, Research, and Training, and MSKCC Brain Tumor Center , the summer fellowship program offers students who have completed their first or second year of medical school the opportunity to conduct basic laboratory or clinical research mentored by MSKCC faculty. Students in the program will:Gain clinical or laboratory research experience mentored by MSKCC facultyInteract with MSKCC physicians, PhD investigators, post-doctoral fellows and graduate studentsAttend a weekly education lecture series presented by world-renowned MSKCC facultyAttend additional institutional lectures, departmental conferences and lab meetingsPresent their summer research to fellowship peers and MSKCC faculty during the final week of the programReceive a $5500 stipendThe 2015 Summer Fellowship Program online application and project list will be available on December 17, 2014, at 12:00 noon EST. All applications and supplemental materials must be received by January 14, 2015, at 12:00 noon EST. All applicants will be notified of a decision via e-mail between February 27 and March 15, 2015.Agency: The Hispanic-Serving Health Professions Schools (HSHPS)Title: Hispanic-Serving Health Professions SchoolsProgram Description: The Hispanic-Serving Health Professions Schools (HSHPS) is now recruiting for all of our summer 2009 government-based internships and fellowships. Applications are now being accepted for the following programs: HSHPS/CDC Student Internship and Fellowship Program, HSHPS/NIOSH Student Internship and Fellowship Program, and the HSHPS/NCHS Student Internship Program. The application deadline for the government-based programs is February 20, 2015 (received by). Application deadlines for our Border Health and Disease Specific programs will be announced soon. To access the application, which also includes applicant requirements, visit www.hshps.org. For more information, please contact Arlenin Dushkuat at 202-293-2701 (ext 103) or email [email protected]: Alpha Omega AlphaTitle: Carolyn L. Kuckein Student Research FellowshipsProgram Description: Summer Fellowships support one student from each school that has an active Alpha Omega Alpha chapter. The student is supported for clinical investigation, basic laboratory research, epidemiology, or social science/ health services research.Project Location: UNCDuration/ Stipend: summer / $4,000Website: http://www.alphaomegaalpha.orgAgency: American Academy of Allergy, Asthma & ImmunologyTitle: Summer Fellowship Medical Student GrantProgram Description: Summer fellowship grants provide stipends to medical students who wish to pursue research projects over the summer. Eligibility is limited to full-time medical students residing in the U.S. or Canada who have successfully completed one year of medical school.Project Location: UNC or outside accredited institutionDuration/Stipend: summer / $2,000Website: http://www.aaaai.orgAgency: American Academy of Child and Adolescent PsychiatryTitle: Jeanne Spurlock Minority Medical Student Clinical Fellowship in Child & Adolescent PsychiatryProgram Description: The clinical training experience must provide for significant contact between the student and the mentor. The plan should include program-planning discussions, instruction in treatment planning and implementation, regular meetings with the mentor and other treatment providers, and assigned readings. Clinical assignments may include responsibility for part of the observation or evaluation, conducting interviews or tests, use of rating scales, and psychological or cognitive testing of patients. The training plan also should include discussion of ethical issues in treatment.Project Location: UNC or outside accredited institutionDuration/Stipend: 12 weeks/ $3,000Website: http://www.aacap.org/cs/awardsAgency: American College of NeuropsychopharmacologyTitle: Pharmacia & Upjohn, Inc. Minority Summer Fellow ProgramProgram Description: This grant is made to promote and enhance the interest of minority graduate students and residents in careers in psychoparmacology and the neurosciences.Project Location: This project will be completed in the laboratory of the Immediate Past President of the American College of Neuropsychopharmacology, or another research lab as designated by the Immediate Past President.Duration/Stipend: 6-8 weeks in the summer/ up to $15,000 for lab supplies, room and board, and travelWebsite: http://www.acnp.orAgency: American College of RheumatologyTitle: Abbott Medical Student Clinical PreceptorshipProgram Description: This program is designed to introduce students who are between first and second year of medical school to the specialty of Rheumatology by supporting a full-time clinical experience.Project Location: UNC or outside accredited institutionDuration/Stipend: 4 or 8 weeks/ $1,500 per 4 week block plus $1,000 in travel funds to attend the ACR Annual Scientific MeetingWebsite: http://www.rheumatology.orgAgency: The American Federation for Aging ResearchThe MSTAR Program provides medical students, early in their training, with an enriching experience in aging-related research and geriatrics, under the mentorship of top experts in the field. Students participate in an eight- to twelve-week structured research, clinical, and didactic program in geriatrics, appropriate to their level of training and interests. Students may train at a National Training Center supported by the National Institute on Aging or, for a limited number of medical schools, at their own institution.For more information and to view the application, please visit the AFAR website at http://www.afar.org/medstu.html.American Federation for Aging Research (AFAR)55 West 39th Street, 16th FloorNew York, NY 10018tel: (212) 703-9977fax: (212) 997-0330e-mail: [email protected]: American Foundation for Urologic DiseaseTitle: Summer Medical Student FellowshipProgram Description: This is an introductory research fellowship to attract medical students to work in urologic research laboratories during the summer. An accredited medical research institution/department must sponsor the candidate by guaranteeing adequate support, including responsibility for the adequacy of the environment for research and development.Project Location: UNC or outside accredited institutionDuration/Stipend: summerWebsite: http://www.healthline.com/channel/urinary-incontinence.htmlAgency: American Gastroenterological Association / Foundation for Digestive Health & NutritionTitle: AGA Student Research Fellowship AwardProgram Description: This program offers support for students to spend time performing research in the areas of digestive diseases or nutrition. Up to 20 students are funded each year and 7 of these slots are saved for underrepresented minorities.Project Location: UNC or outside accredited institutionDuration/Stipend: minimum of 10 weeks/ $2,000 - $3,000Website: http://www.fdhn.orgAgency: American Heart AssociationTitle: Student Scholarships in Cerebrovascular DiseaseProgram Description: This program is offered to stimulate interest, knowledge and investigative work related to cardiovascular disease, stroke and basic sciences early during pre-doctoral training.Project Location: UNC or outside accredited institutionDuration/Stipend: minimum 2 months/ $2,000 plus $750 in travel fees to attend the International Stroke ConferenceWebsite: http://www.americanheart.orgAgency: American Parkinson Disease AssociationTitle: Medical Student Summer FellowshipProgram Description: Summer Fellowships of $4000 will be awarded to medical students to perform active supervised laboratory clinical research on Parkinsons Disease, its nature, manifestation, etiology and treatment.Project Location: UNC or outside accredited institutionDuration/Stipend: summer/ $4,000Website: http://www.apdaparkinson.orgAgency: American Pediatric Society, Society for Pediatric ResearchTitle: Student Research ProgramProgram Description: This program is offered to encourage gifted medical students to consider careers in research related to pediatrics. This program is specifically designed for students seeking a research opportunity at an institution other than at their own medical school.Project Location: Any institution other than your own medical school that is listed in their directory of participating programs. They have nearly 300 laboratories and research experiences available for students to choose from.Duration/Stipend: 8-10 weeks/ up to $4,270Website: http://www.aps-spr.orgAgency: Betty Ford CenterTitle: Summer Institute for Medical StudentsProgram Description: This unique program is open to all medical students. Student recipients may be selected to participate in either the inpatient or family treatment program for 5 days at the Betty Ford Center.Project Location: Rancho Mirage, CaliforniaDuration/Stipend: 5 days (year-round) / no stipendWebsite: http://www.bettyfordcenter.org and choose "training"Agency: Carolinas Heathcare System - Charlotte, NCTitle: Summer Research Scholar ProgramProgram Description: Medical students who are awarded this internship will work closely with mentors and their team performing original research in a clinical or laboratory setting.Project Location: Carolinas Medical Center, Charlotte, NCDuration/Stipend: 10 weeks, full time/$5000Center Website: http://www.carolinashealthcare.org/summer-research-scholarsContact: Celest C. Colcord 704-446-5556Agency: Center for Disease ControlTitle: O.C. Hubert Student Fellowship in International HealthProgram Description: This program provides an opportunity for third and fourth year medical students to gain public health experience in an international setting. Fellows spend four to six weeks in a developing country working on a priority health problem in conjunction with CDC staff.Project Location: Students can choose from ongoing projects in Kenya, Republic of Congo, Thailand and PeruDuration/Stipend: 4-6 weeks / $3,000Website: http://www.cdcfoundation.orgAgency: Children's Hospital LATitle: USC Summer Oncology Fellowship ProgramProgram Description: Work at the Children's Center for Cancer and Blood Diseases at the Children's Hospital in Los Angeles. Participating students will be expected to attend a lecture series on aspects of pediatric oncology at CHLA designed specifically for them.Project Location: Los Angeles, CaliforniaDuration/Stipend: 6-10 weeks/ $225 per weekWebsite: http://www.chla-sof.nant.org/Agency: Cystic Fibrosis FoundationTitle: Student TraineeshipProgram Description: Student traineeships are offered to introduce students to research related to Cystic Fibrosis (CF). Applicants must be students in or about to enter a doctoral program. Each applicant must work with a faculty sponsor on a research project related to CF.Project Location: UNC or outside accredited institutionDuration/Stipend: 10 weeks/ $1,500Website: http://www.cff.orgAgency: Endocrine SocietyTitle: Summer Research FellowshipsProgram Description: Medical students are given a stipend to participate in research projects under the guidance of an Endocrine Society mentor.Project Location: UNC or outside accredited institutionDuration/Stipend: 10-12 weeks/ $4,000Website: http://www.endo-society.orgAgency: Epilepsy FoundationTitle: Health Sciences Student FellowshipProgram Description: Three-month projects are funded in order to encourage career interests in epilepsy research.Project Location: UNC or outside accredited institutionDuration/Stipend: 3 months/ $3,000Website: http://www.epilepsyfoundation.orgAgency: Grass FoundationTitle: Grass Fellowships in NeuroscienceProgram Description: This program provides a first opportunity for neuroscientists during late stages of predoctoral training or during postdoctoral years to conduct independent research for scientific discovery on their own at the Marine Biological Laboratory each summer.Project Location: Woods Hole, MassachusettsDuration/Stipend: 14 weeksWebsite: http://www.grassfoundation.orgAgency: Himalayan Health ExchangeTitle: Student ProgramProgram Description: This program's mission is to provide medical and dental care to the underserved people living in remote regions of the Indian and Nepal Himalayas and to uplift two orphanages located in the North Indian state of Himachal Pradesh.Project Location: Indian and Nepal HimalayasDuration/Stipend: 2-3 weeks/ contact program directly for more informationProgram Contact: [email protected]: http://www.himalayanhealth.comAgency: Institute for Research, Education and Training in AddictionsTitle: Scaife Foundation Advanced Medical Student ClerkshipProgram Description: This program offers students hands-on training in Addiction Services.Project Location: Pittsburgh, PA at the Institute for Research Education and Training in AddictionsDuration/Stipend: 3 weeks, summer/ $650 plus meals and boardingWebsite: http://www.ireta.orgAgency: International Alliance in Service and Education ProgramsTitle: International Experiential Learning ProgramProgram Description: This program's focus is on health and education in the area of primary care, public health community-based research projects, mental and chronic disease management, nutrition, tropical and infectious diseases, and topics and services that are relevant and identified by the local community.Project Location: South Africa & MexicoDuration/Stipend: 4-8 weeks/ contact program directly for more information.Website: http://www.iaseco.orgAgency: Lupus Foundation of AmericaTitle: Gina Finzi Memorial Student Summer FellowshipProgram Description: To foster an interest in systemic lupus erythematosus in the areas of basic, clinical or psychosocial research under the supervision of an established investigator.Project Location: UNC or outside accredited institutionDuration/Stipend: summer/ $2,000Website: http://www.lupus.orgAgency: National Institute of HealthTitle: Summer Research Fellowship ProgramProgram Description: This program is designed to provide training in research procedures and principles of independent investigation.Program Location: Bethesda, MDDuration/Stipend: 8-12 weeks/ $2,200Website: http://www.training.nih.gov/student/srfp/index.aspAgency: National Institute of Neurological Disorders and StrokeTitle: Summer Program in the Neurological SciencesProgram Description: Unique opportunity to get hands-on experience working with leading scientists in the Institute's Division of Intramural Research.Program Location: Bethesda, MDDuration/Stipend: 10-12 weeks/ $2,000 per monthWebsite: http://www.ninds.nih.govAgency: National Institute of Mental HealthTitle: Summer Training on Aging Research Topics - Mental HealthProgram Description: This program gives selected students an opportunity to gain research experience and work closely with established mentors/investigators in the field of aging and mental health research.Program Location: UNC or outside accredited institutionDuration/Stipend: 10 weeks/ $6,250Website: http://startmh.ucsd.eduAgency: New England Institute of Jewish StudiesTitle: Jewish Medical Ethics & Israel Experience ProgramProgram Description: This program is offered to Jewish medical students and consists of a 4 week course on Jewish medical ethics combined with seminars on Jewish thought and tours of Israel.Project Location: Shaare Zedek Medical Center, Jerusalem, IsraelDuration/Stipend: 4 weeks/ $2,400Website: http://www.neijs.orgAgency: New York Academy of MedicineTitle: David E. Rogers Fellowship ProgramProgram Description: National fellowship for medical and dental students in support of a project initiated during the summer between first and second years of school. Projects should serve the needs of underserved or disadvantaged patients or populations.Project Location: Special consideration is given to projects conducted in New York CityDuration/Stipend: 8 weeks/ $3,462Website: http://www.nyam.orgAgency: Oak Ridge Insitute for Science & EducationTitle: Student Research Participation at the National Center for Toxicology ResearchProgram Description: This program is for opportunities to participate in research on biological effects of potentially toxic chemicals and solutions to toxicology problems that have a major impact on human health and the environment.Project Location: Jefferson, ArkansasDuration/Stipend: 2-12 months/ $500 per week plus $75 per week housing allowanceWebsite: http://www.orau.orgAgency: Oregon Health & Science UniversityTitle: Summer Research at the Oregon Hearing CenterProgram Description: The Department of Otolaryngology/ Head & Neck Surgery, and the Oregon Hearing Center, is offering summer research fellowships to medical students. Students will work with a faculty member on a ENT-related project already in progress.Project Location: Portland, OregonDuration/Stipend: 2-3 months/ $1,371 per monthWebsite: http://www.ohsu.eduAgency: Parkinson's Disease FoundationTitle: Fellowship Training ProgramProgram Description: This fellowship supports medical students to study Parkinson's Disease and related disorders under the supervision of an established investigator.Project Location: UNC or outside accredited institutionDuration/Stipend: 10 weeksWebsite: http://www.pdf.orgAgency: Roswell Park Cancer InstituteTitle: Summer Oncology Research ProgramProgram Description: This program is designed for medical and dental students to engage in clinical and/or basic science research in oncology.Project Location: Buffalo, New YorkDuration/Stipend: 8 weeks/ $2,240Website: http://www.roswellpark.orgAgency: Sjogren's Syndrome FoundationTitle: Summer Student Fellowship ProgramProgram Description: This award is intended for dental and medical students interested in conducting Sjogren's related research under the guidance of a mentor.Project Location: UNC or outside accredited institutionDuration/Stipend: summer/$2,000Website: http://www.sjogrens.comAgency: Society for Academic Emergency MedicineTitle: Medical Student Research GrantProgram Description: This grant is co-sponsored by the Emergency Medical Foundation. The purpose is to encourage research in emergency medicine. The funded medical student must have a qualified research mentor and a specific research project proposal.Project Location: UNC or outside accredited institutionDuration/Stipend: 3 months/ $2,400Website: http://www.saem.orgAgency: Society for Gynecologic InvestigationTitle: Medical Student Stipends for Research in GynecologyProgram Description: The Society for Gynecologic Investigation is committed to expanding interest in research in reproductive biology. To this end, five (5) awards of $2,000 each will be made for research related to reproductive biology to be carried out by medical students.Project Location: UNC or outside accredited institutionDuration/Stipend: summer/ $2,000Website: http://www.sgionline.orgAgency: Special OlympicsTitle: Health Professions Student Grant ProgramProgram Description: The purpose is to promote short-term projects with a focus on the Special Olympics Healthy Athletes programs and Special Olympics athletes, as well as the health and well-being of all persons with intellectual disabilities. Projects may include: data collection and analysis on issues impacting persons with intellectual disabilities; measurement of attitudes, opinions and behaviors of health professionals, coaches, family/caregivers and athletes; follow-up assessments of existing programs; or health promotion projects. Projects that involve collaborations with Special Olympics Programs or other CDC grant recipients (e.g., state and local health departments) are encouraged.Project Location: UNC or outside accredited institutionDuration/Stipend: 8 weeks - 12 months/ $3,500Website: http://www.specialolympics.orgAgency: St. Jude Children's Research HospitalTitle: Pediatric Oncology Education ProgramProgram Description: The Pediatric Oncology Education Program offers a unique opportunity for students preparing for careers in the biomedical sciences, medicine, dentistry, pharmacy, allied health, and veterinary medicine to gain biomedical and oncology research experience. The program provides short-term training experiences in either laboratory research or clinical research. Trainees will attend a core lecture series as well as weekly conferences.Project Location: Memphis, TennesseeDuration/Stipend: 9-12 weeks/ $8.00/hrWebsite: http://www.stjude.orgAgency: Strong Children's Research CenterTitle: Summer Training ProgramProgram Description: The Strong Children's Research Center supports basic and clinical research directed to the cause, prevention, and treatment of the diseases of infants, children, and adolescents, as well as studies of developmental biology, child and adolescent development, the delivery of health services, and interventions designed to improve the outcomes of clinical pediatric practice. Student trainees will participate in research and clinical seminars, and will associate with each other as well as trainees enrolled in similar programs in the Medical Center.Project Location: Rochester, New YorkDuration/Stipend: 10 weeks/ $3,000Website: http://www.urmc.rochester.edu/scrc/sumprogs.htmAgency: University of ArizonaTitle: Summer Course on International HealthProgram Description: University of Arizona School of Medicine offers a multidisciplinary, case-based, problem-solving course that prepares medical students and primary care residents for health care experiences in developing countries.Project Location: Tuscon, ArizonaDuration/Stipend: 2 weeks in JulyWebsite: http://www.globalhealth.arizona.eduAgency: University of Nebraska Medical CenterTitle: Belize Wilderness & Tropical Medicine RotationProgram Description: These unique rotation experiences combines didactic teaching and guided independent study with actual field training in wilderness and tropical medicine; wilderness, cave, and river rescue; and related disciplines.Project Location: Belize, Central AmericaDuration/Stipend: contact program director for more informationProgram Contact: Dr. Keith Brown, [email protected]: http://www.unmc.edu/isp/studyabroad/belizeintroandoverview.htmAgency: University of Texas MD Anderson Cancer CenterTitle: Summer Research Program for Medical StudentsProgram Description: The purpose of this program is to provide participants with first hand biomedical research experience in the basic and clinical sciences. This program is a 9-week course running from the end of May through the beginning of July.Project Location: Houston, TexasDuration/Stipend: 9 weeks/ $2,500Website: http://www.mdanderson.orgAgency: University of Utah: School of Alcoholism & Other Drug DependenciesTitle: Medical Student Scholarship for TrainingProgram Description: Scholarship assistance is available to attend the 54th Annual Session of theUniversity of Utah School on Alcoholism and Other Drug Dependencies, Physicians Section.Project Location: Salt Lake City, UtahDuration/Stipend: Full tuition, up to six nights dormitory housing, and up to $350 travel allowance.Website: http://www.uuhsc.med.utah/uas/Agency: Vanderbilt Diabetes CenterTitle: Medical Student Summer Research Training Program in Diabetes, Endocrinology, and MetabolismProgram Description: This program is funded by the National Institute for Diabetes, Digestive & Kidney Diseases. It allows for medical students to conduct independent research under the direction of an established scientist during the summer.Project Location: Vanderbilt University, Nashville, TennesseeDuration/Stipend: 12 weeks/ $4,700Website: http://www.mc.vanderbilt.eduContact UsOffice of Medical Student Research130 Mason Farm Rd CB# 7080 Chapel Hill NC 27599 Phone 919-966-3997 Fax 919-843-2508 [email protected]

There exists a wide variation in the competence of the postgraduate residents trained in pathology in different institutions across India. This results in strong disparities in the clinical diagnostic skills, teaching skills, research capabilities and the managerial skills of the graduates. The end users of this training, namely the community, clinicians and health care institutions would benefit from a more uniform and better trained pathologist. The article reviews the reasons for the variation in the quality of the training programs. The main deficiencies include, lack of well-defined criteria for recruitment of residents, training facilities, faculty resources, curriculum with well-defined learning objectives and competencies, hands-on experiences in diagnostic and research activities, diagnostic specimens and medical autopsies, exposure to molecular pathology, pathology informatics, electron microscopy, research experiences, communication skills, professional behavior and bioethics, business practices in pathology and quality assurance. There is also a lack of defined career tracks in various disciplines in laboratory medicine, standard protocols for evaluation and regional and national oversight of the programs. The steps for rectification should include defining the competencies and learning objectives, development of the curriculum including teaching methods, facilities and evaluation strategies, communication skills, professional behavior skills, teaching skills, legal aspects of practicing pathology and the various career pathways to sub-specialtiesin pathology. The training should include defined exposure to molecular pathology, electron microscopy, quality control and assurance, laboratory accreditation, business aspects of pathology practice, review of literature, evidence-based medicine, medical autopsy and medical informatics. Efforts should be made to share human and laboratory resources between regional cooperation. The oversight and accreditation policies should be evolved and well-documented. Web-based platforms need to be developed for easy interaction among residents, faculty and administrators on a national level.IntroductionThere is a wide variation in the way different institutions select students for postgraduate training. The matriculating candidate may have various reasons for joining the field of pathology and the desire and aptitude may play only a minor role in the decision. The institutions are varied in terms of faculty, laboratory support, infrastructure facilities, evaluation standards, quality control of the laboratories and the program and the institutional support. The products coming out of these programs are thus trained in a variety of fashions and may have varied capabilities to deliver the expectations from a competent pathologist. Some of these factors may be out of the control of individual faculty or the heads of departments in pathology. We have a choice in "letting things slide" as they are currently or take a bold step in planning for a better graduate for the future. "The best way to predict the futures is to invent it". The article explores the various options available and provides some guidelines for those who want to pursue this path. The authors have made the observations and recommendations on the basis of the insights they have gained through their work and interactions related to this program in several countries across continents, including India, over the last 36 years.Deficiencies in the Current SystemAdmissionsThe admission policy on the quality and the number of residents in a given department is often quite outside the purview of the head of the department or faculty. There may be students who opt for pathology as a last resort because they could not get into any other clinical program. Such students may not be motivated to actively learn and enjoy the practice of pathology.The number of postgraduates enrolled in a program may be determined by monetary considerations by the Institution and may not correlate with the training resources within the department including faculty, laboratories, number of specimen/samples, physical space and interactions with the clinical departments.Training FacilitiesThe department may lack the quality and quantity of laboratory infrastructure, research programs, research laboratories, teaching space, adequate number and variety of pathology samples processed in the laboratory, and medical autopsies.Faculty ResourcesThe faculty teaching in the program may not have adequate training in the educational technology, content training in the discipline, communication skills, overall vision, clinical perspectives or evaluation strategies. Some faculty may be in the position not out of choice but because they had no other choice. Some faculty may not be able to provide adequate time and attention to the training of residents because of their private practice or other affiliations.Learning Objectives and CompetencesVery few departments if any have written learning objectives or outcome objectives for their postgraduate program. It is generally assumed that the student must learn "everything" about pathology including all the sub-specialties within the defined time span of 2-3 years. Others assume that the textbooks of pathology and monographs of sub-specialties liked by the head of department constitute the objectives. This assumption sends mixed signals to the trainee on what competences he is expected to gain.CurriculumThe department may not have a defined curriculum of the postgraduates. The sessions specifically directed at them like lectures, biopsy sessions, slide seminars, clinicopathological conference (CPCs), etc., may vary greatly at different institutions. In some departments the curriculum may be restricted to what the local faculty knows or feel is important. Some programs over emphasize on the technical components of the laboratories like tissue processing, section cutting and staining which should be the domain of medical technologists. What are the minimum exposures needed for surgical pathology, clinical pathology, hematology, immunopathology, cytopathology, etc.?Residency Training Versus Postgraduate TrainingSome institutions provide for residency training with employment cum training programs. This includes hands-on training in processes like grossing of specimens, signing out slides, performing processes like frozen section, fine needle aspiration cytology, bone marrow biopsies, electron microscopy, participating in biopsy rounds and CPC. Other institutions run a postgraduate teaching program which includes lectures, review of collection of slides with very little hands on activities by the students in the day-to-day diagnostic and interactive activities of the department. This leads to accumulation of theoretical knowledge with little practical competences.Lack of Medical AutopsiesMost institutions do not have this facility. The autopsies are one of the best resources in the training of a pathologist.Molecular Pathology, Electron MicroscopyMost of the institutions do not have these facilities. Most of the current faculty are not trained in it and feel uncomfortable to learn it and hence cannot teach these aspects.Communication Skills and ProfessionalismThere is not currently any effort to teach and evaluate these in the training program although these are valued as necessary attributes of any good doctor.Opportunities for Research and PublicationThese vary tremendously between institutions. There is also a tendency to use an inadequate database just to write a thesis or publish where these activities are mandated.Business PracticesA large majority of the trained pathologists enter in the private practice in their own laboratories or commercial laboratories. There is no training on the special business management skills beyond the knowledge of pathology that is needed for such practice.Teaching Methods and TechniquesVery few institutions involve the postgraduate students actively and constructively in the teaching of medical students. Often it is treated as a chore and some of it may be passed on to the postgraduates in the concepts of education.Electronic and Online Learning ToolsVery little of these opportunities are actually utilized in many programs.Evaluation MethodsMany institutions use subjective methods in reality even if they go through the process of including slides and specimens in the process. Undue control may be exercised by the heads of departments in the outcomes without any input from all the faculty members. Undue importance may be given to the extra-curricular activities of the residents throughout the training program. The external examiners may not be able to maintain objectivity expected of them in evaluating the examinees.Extramural Oversight of Training and EvaluationThis supervision is either non-existent or gets only lip service on paper. History tends to repeat itself in the form of the entire program and the outcomes being almost exclusively in the hands of the local heads. There is very little effort to change and evolve.Defined Career Tracks in Branches of Laboratory MedicineVery few trainees may eventually practice surgical pathology. Do they need so much training in that segment? How much training is provided in clinical pathology which would be the bread and butter for most practicing pathologists? What are the community needs?Lack of exposure to special components like electron microscopy, molecular pathology, quality assurance, pathology informatics, business practices in pathology, communication skills, professional behavior, evidence based medicine.Why is the Urgent Need to Change?The frontiers of medical practice are ever expanding and the speed of evolution has grown geometrically in the past few decades. Pathologists are involved not only in making accurate diagnosis but also in providing, influencing the decision regarding the type and extent of therapy to be given and subsequently objective evaluation of the effect of the therapy. It is estimated that over 70% of all decisions in patient care and medical research involve the pathology laboratories and decisions of the pathologists. The pathology trainees no longer stay at the local institution or the local region. There is widespread movement across the states, the nation and the globe. The programs must develop a graduate who is comprehensive in skills and current and relevant to the present practice of medicine and be ready to adapt to the evolving practices of healthcare. The "mantra" is "think globally and act locally." India is emerging as a leader in health care and the preferred location for medical tourism. We cannot afford to continue to produce pathologists who are not ready for the current demands of health care. The postgraduate training programs in North America have evolved continually based on the development in the field. Japan has also documented similar progress. We also cannot afford to have graduates of different qualities coming out of different institutions. The market forces and the global economy will look upon unfavorably at the centers that cannot guarantee quality graduates. The mentors and leaders in pathology education need to actively analyze the situation and plan for the immediate future to stay relevant in the health care practices.Opportunities and Areas for ImprovementAdmissions/Enrollment to the ProgramThe faculty and the heads should define the competencies they desire from an incoming trainee. This should include knowledge but not be restricted to it. There should be a process to evaluate these competences like interest in the discipline, attitude, dedication, communication skills among the short listed candidates for final decisions on enrollment. The tests of knowledge should not be in pathology because that is what they are entering the program for. The tests should concentrate on the knowledge of a good intern or a good undifferentiated physician within the clinical context.All the departments may not have full control over the enrollment but developing a list of prerequisites as above and providing the same to those responsible for the enrollment could be the first step.Define the Core CompetencesThe Accreditation Council for Graduate Medical Education (ACGME) in the USA advocates six well-defined competences in medical education including patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal skills and communication and system-based practices. All of these are applicable in drawing up a curriculum for postgraduate training in pathology although traditionally there has been a greater emphasis on medical knowledge and patient care. These need to be incorporated in the curriculum.Defining Career Tracks in PathologyThe great emphasis currently is on surgical pathology. How many of the trainees eventually end up practicing that in their professional career? It would be a minority who are based in a hospital or big laboratories. The bulk of practice generally involves clinical pathology that needs to be emphasized so that the community at large is served better. There should be a general year of rotations through all branches and the subsequent years should be spent more on what the candidates desire to practice.Cognitive Component of the Curriculum(i). Providing a list of learning objectives in a sequential manner and evaluating their achievement in a step-wise process: There should be an opportunity for both the trainee and the faculty to determine the progress regularly. A review of this nature at the end of the first 3 months might give a good perspective to both. The objectives in these months should include a recapitulation of the applied aspects of anatomy, histology, elements of the blood, cell biology and some basic techniques of tissue preservation, processing and staining.An evaluation at this step can decide if the trainee has achieved these basics and can move on or needs to repeat these steps. If warranted, there could be decisions taken on remedial measures at this stage before moving onto the next stage of the program. Similar building blocks or stepping stones in the form of learning objectives can be constructed sequentially for each component of the pathology program and evaluations carried out before training at the next higher level. In this way there could be a sequential development and documentation of learning objectives for the entire program. This will make the direction and targets clear to both the student and the examiner.(ii). Hands on training: The trainee should be involved in supervised participation in all the diagnostic and interactive activities of the pathology laboratory such as grossing of specimens, frozen section, signing out of cases, performance and interpretation of special tests and procedures, discussions with clinicians and biopsy rounds, CPCs, consultations, etc.(iii). Interaction with patients: The trainee should have supervised interaction with patients like fine needle aspiration cytology, bone marrow biopsy, venepuncture for blood samples, etc. Communication skills need to be taught, practiced and evaluated.(iv). Ward rounds (clinical exposure): The training program should include opportunities to go for ward rounds with clinical teams to discuss the laboratory issues related to patient management (indications for tests, collection and transport of appropriate samples, interpretation of tests results, additional tests needed, etc.) This will also provide an insight to the trainees on what questions the clinicians expect answered in the pathology report.(v). Discussion on the quality of pathology reports: The faculty should provide examples of incomplete, inaccurate, inappropriate laboratory reports and hold discussions with the residents on the construction of good quality reports. Indian college of pathology (ICP) may be encouraged to come up with templates for completeness of surgical pathology reports on specific types of specimen including tumors.(vi). Sensitization to applications of molecular pathology and genomics: The current practice of medicine involves the routine use of several techniques. All the departments may not have the faculty or the laboratory resources to practice and demonstrate them to the trainees. An attempt could at least be made to discuss the basis for the techniques and the common diagnostic and therapeutic applications of the common ones. If there is a regional laboratory that performs these tests, the trainees should be encouraged to go and observe them.(vii).Research methodology and statistical analysis: These should be an integral part of any postgraduate training program. They should be taught and tested as modules. Their applications should be reviewed in regular journal club sessions where the trainees and faculty discuss the critique of pathology publications in peer-reviewed journals. Emphasis should also be placed on evidence-based medicine.(viii).Exposure to experimental medicine/pathology laboratories: Most departments do not have the facilities for animal experimentation or tissue cultures. An attempt should be made to arrange visitation by trainees to centers where these are available to get a concept on how they run.(ix).Clinical correlations: Many pathologists feel that writing a good report is the total activity of a pathologist. The trainees should be encouraged to think about the patient whom the pathology sample represents. They should learn to explain etiology, pathogenesis, the basis for the symptoms, signs and investigations for the patient. They should be able to aptly describe the gross, microscopic and molecular features of the disease process and predict the usual course and complications. They should be able to suggest the broad lines of management based on the pathology.This should be a part of the daily sign-outs, group discussions and other teaching sessions. The trainee should develop the competence to build a clinical story based on a pathology image and vice versa. This should be a part of teaching and testing. Training in clinical pathology is very important but not much emphasized currently.(x). Electronic portfolio (e-portfolio): The trainees should be encouraged to develop an e-portfolio of their learning activities. They should add to it and enhance it regularly. The e-portfolio could be one vital segment of the overall evaluation of the trainee.(xi).Developing algorithms for various observations: The algorithms can be computerized. This is more helpful than jumping to diagnostic conclusions. This method should be taught, records maintained and evaluated formatively and summatively (Example-pigment in hepatocytes, fatty changes in hepatocytes, villus atrophy-Develop an algorithm and draw a chart to step-wise distinguish the diagnostic possibilities).Communication Skills and Professional BehaviorThese are vital functions of anyone involved in the health care provided by the specialists. A conscious effort must be made to develop objectives related to this and the list should be provided to the trainees. They should be evaluated on an ongoing basis throughout their program. This area might be difficult for some faculty to conceive. Some examples would be-coming to work on time, wearing the appropriate attire to work, compassionate attitude to patients, patient's relatives and colleagues, respect to peer and faculty, showing restraint when angry or provoked, handling professional disagreements without ill-feeling, actively listening to another's opinion, clear and concise speech at biopsy rounds, CPCs, responding accurately, briefly and politely to any queries, showing care for the laboratory area, instruments, slides, specimens, copies of reports, maintaining confidentiality, team-player spirit, leadership qualities, volunteering for community service, etc.Business PracticesA curriculum model needs to be developed for training the students on the issues involved in setting up a private laboratories and how to handle them. Legal aspects of the practices of pathology also need to be introduced.Involvement in the Teaching of MBBS StudentsThe trainees should be involved actively in the laboratories sessions to help the medical students learn clinical correlations. This will also teach the trainees the art and science of education and evaluation.Quality Control and Quality AssuranceThe trainees need to be aware of these issues in a laboratories so that they can set up or work properly in the diagnostic or research laboratories after their qualifications. The program could arrange for mock inspections of laboratories of cooperating departments/hospitals so that the residents can go through an A-Z check list for compliance.Exposure to Autopsy Pathology and CPCsMedical autopsies and the study of pathology material obtained is one of the best learning tools in pathology. It provides an opportunity to touch, feel and study diseased organs and correlate with histopathology and all the clinical and radiological features. Efforts must be made to include as a part of the program a few weeks of exposure to autopsy pathology at other institutions where it is available. It could also involve archived autopsy material with the specimens, slides and the clinical files.Online Electronic ResourcesEfforts should be made to include several electronic resources for the learning of pathology. Several sites such as pathology outlines, Path Xchange, Medscape, Med MD, United States and Canadian Academy of Pathology (USCAP), several hospital and medical school websites like the national cancer Institute, John Hopkins Hospital, Tulane University, etc., offer several modes of learning through images, virtual microscopy, clinicopathological exercises, lectures, textual information, quizzes, continuing medical education (CME) exercises. Most of these are free and a few may need institutional membership at nominal charges. The medical informatics or pathology informatics is an essential component of residency training in the US. The residents should be encouraged to develop an e-portfolio and keep adding to it and modifying it as they progress in their training. It can also be an invaluable tool for evaluation.Inter-institutional CooperationEach and every department does not have all the resources needed to fulfill all the requirements in terms of faculty resources, laboratories, teaching set-ups, pathology specimens, etc. It would be worthwhile to work on a regional basis where institutions can support with the training activity for most of the trainees of that region. The trainees could have rotational postings in those institutions to get trained and evaluated there for those aspects. This is already happening to some extent in some regions for the training in autopsy pathology. The cost could be shared between the institutions and the trainees. Some of the commercial and national medical and educational bodies could be tapped for such funding. The exchange process could be established on a national level too. The cost would be well-worth when compared to the benefits accrued to our national graduates. Some of the computer experts in pathology, faculty and postgraduates could be encouraged through the Indian Association of Pathologists and Microbiologists (IAPM) to set up a dedicated website to pathology postgraduate training. Telepathology is a great tool for teaching, learning and clinical service. There could be contributions online to this site by experts in the field through podcasts, slide seminars, quizzes, CPCs, autopsy data analysis, QA/QC measures, etc. There could be sections on the same site of different sub-specialties for pathology. It could provide opportunities for communications between faculty at various sites, trainees at various sites and a dialogue between faculty and trainees at various locations.International CollaborationInternational organizations like the College of American Pathology (CAP), USCAP, Indian Association of Pathologists from North America (AIPNA), International Academy of Pathology could be requested to assist in the electronic learning and testing through the website created. Their members and alumni pathologists from any college in India could provide teaching material for the site. The site could archive teaching material, slides and quizzes for future generations of trainees. The faculty could use the site for self-learning.National Oversight of the Training Program (National Committee for Postgraduate Training in Pathology)There needs to be a formal body charged with the oversight of the postgraduate training program in pathology across the country. It could set the curriculum, the standards of education and evaluation in addition to the quality control of the laboratories that are involved in this educational process. It could have a regional branch each for North, South, East and West or pass the charge to the state chapters of the IAPM and the ICP should move toward voluntarily establishing such a body and write the constitution and remit of this committee. The process will be long drawn and is likely to have some political and financial obstacles. Steps need to be taken right away so that the program gets started with out delay. Every meeting of the Annual Conference of IAPM Conference (APCON) should have at least one day dedicated to the meeting of this NCPTP along with faculty involved in the training programs and representatives from the postgraduate residents. The committee could deliberate electronically on a monthly basis and the news and developments transmitted through an electronic newsletter on the website dedicated for pathology postgraduate training.EvaluationsThe evaluations should be in multiple stages, at the end of first three months, first 6, 12, 18 and 24 months. A greater value should be attached to the in-course evaluation to reduce the tensions and subjectivity of an all or none final examination. The in- course assessment should monitor the communications skills and professional behavior in addition to cognitive skills. The faculty members should also be evaluated by the trainees regularly and should have regular meetings with the residents to discuss and resolve issues related to training.Looking at the FutureThe programs now offer a fixed duration of training, at the end of which, the trainee must pass an examination to qualify. This system does not take into consideration the individual learning abilities and the competence of the students. The conclusions are made on a set of slides and specimens and a grand viva under a trying experience for the examinee. Factors other than competence may play a major role in the outcome.We could think of a system where we define the skills and competences to be achieved by the trainees. They could be evaluated on a continual basis in course for the achievement of these competences. Some may achieve these quickly and others may take a little longer. Thus instead of defining the period of training one could define the competences and make the learning and evaluation individualized. This will lead to more competent pathologists for the community, but it needs a reorientation of the educational philosophy behind the pathology residency training program.ConclusionsThe authors have contributed to the postgraduate residency training programs in pathology in eight countries across Asia, Middle East, UK and North America in several institutions over 35 years. They have also attended and participated in several seminars that discussed the postgraduate training programs in the medical field and pathology in particular. They have visited several medical schools across India and interacted with pathology residents in various teaching sessions.This background offered a unique opportunity to take a global view at how the programs can be improved in India to train and graduate a pathologist who has competence acceptable anywhere in the world.The article documents the lacunae and categorizes various areas on which efforts need to be made locally, regionally and nationally with international cooperation to improve and enhance the program. There is a certain degree of urgency to this quest for our nation to remain competent in the international health care scene.Source: How can the postgraduate training program in pathology departments in India be improved? Bhusnurmath SR, Bhusnurmath BS