Betsy D. Bennett

Senior pathology resident in-service examination scores correlate with outcomes of the American Board of Pathology certifying examinations.

The Resident In-Service Examination (RISE) addresses 1 area of the Accreditation Council for Graduate Medical Education Outcome Project; RISE results demonstrate progressive attainment of pathology knowledge during training. We compared RISE scores with primary pathology board certification success for residents graduating in 2008 and 2009. Overall RISE and nearly all sectional scores in anatomic and clinical pathology were significantly higher for residents passing all certifying examinations at the first attempt vs residents who failed any examination. The risk of failing increased with each lower quartile of overall RISE score, such that 34% (2009) and 54% (2008) of residents in the lowest quartile failed at least 1 certifying examination. Two thirds of graduating residents with lowest quartile scores had a similar quartile ranking in the previous RISE, identifying them as at risk. Residents passing the American Board of Pathology certifying examinations have a higher level of medical knowledge in general and specific pathology disciplines as assessed by senior RISE scores.

Neoplasms of the Mononuclear Phagocyte System

Malignant neoplasms of the mononuclear phagocyte system (MPS) (Van Furth et al ., 1972) include acute and chronic monocytic leukemias, and various malignant histiocytoses. There is considerable confusion in the classification of these neoplasms, particularly in regard to the malignant histiocytoses and their separation from histiocytoses of varying aggressiveness (e.g., histiocytosis X). Furthermore, the diagnosis of histiocytic neoplasms has often been based on histopathologic criteria of varying precision, and only recently have such diagnoses been confirmed by cytochemical and ultrastructural examinations. Finally, our knowledge of MPS subpopulations is rudimentary and immunologic or functional techniques for recognizing normal or neoplastic MPS subpopulations are not generally available. It is not surprising, therefore, that the clinical and pathological features of only a few MPS neoplasms are well-defined (Groopman and Golde, 1981). In this chapter, malignant neoplasms are separated from those proliferations such as histiocytosis X in which malignant features have not been clearly established. In this regard/we have not accepted fatal illnesses associated with widespread dissemination as definitive evidence for malignancy.