Students cutting up liver
UHN pathologists’ assistant Emmanuelle Chung, (R), guides students Katie Ford, (L), and Yoanna Mustelier in examining liver resections during the gastrointestinal academic half-day hosted by the Pathologists’ Assistant Boot Camp team at the Michener Institute of Education at UHN. (Photo: UHN)

Gross. Outside of a pathology lab, that usually means icky or disgusting.

But in the pathology world, that means broad examination of tissues, organs and body cavities.

Grossing is a critical part of diagnostics.

Pathologists' assistants (PAs) spend most of their time in what's called a gross room where they dissect organs, examine body parts removed from surgery, and describe and measure tissue. PAs play a critical role in preparing slides so that pathologists can make the best possible diagnoses to share with physicians.

For those studying to become PAs, the transition from learning in the classroom to hands-on clinical training can be extremely difficult.

In October 2020, Dr. Klaudia Nowak, a pathologist in the Laboratory Medicine Program at UHN, was tasked to help bridge the gap between didactic lectures and clinical practicums for PA students at the University of Toronto (U of T).

The result? An innovative two-week PA Boot Camp – the first of its kind in Canada.

"The main goal was to create the foundations for PA students in the gross room, but also to give them critical skills that will allow them to think beyond the gross room and how their grossing would impact patient management," says Dr. Nowak.

Group shot at window
The first students from the University of Toronto to participate in the Pathologists’ Assistant Boot Camp at UHN, (L to R), Yoanna Mustelier, Christiana Legaspi, Adrian Ng, Katie Ford, Peyton Schroeder and Senior Medical Laboratory Technologist Suganthini Ilaalagan, who is wearing the white coat. (Photo: UHN)

After earning a bachelor's degree, PAs are required to complete a master's program in pathology assisting. This is a relatively new concept in Canada. In 2020, U of T launched a two-year master's graduate program to educate PAs.

That's when Dr. Nowak and a team of PAs from UHN and other hospitals across Toronto stepped in to develop the boot camp.

"It was an incredibly busy seven months," says Dr. Nowak. "We essentially had to build a course from scratch: come up with a syllabus, develop the curriculum and all of the different lectures, create the schedule, and coordinate the lecturers."

Five students are accepted into the program each year. Dr. Nowak was the only pathologist who presented in the classroom. The nearly 30 other lecturers in 2022 were mostly senior PAs, allowing them to deepen their expertise by teaching others.

The boot camp is comprised of morning classroom sessions and afternoon hands-on grossing modules. During the grossing modules, students learn a wide range of physical aspects of the role, such as how to organize their space, insert and dispose of blades, and gross small specimens and biopsies.

The program also provides students with digital interactive materials developed with Articulate 360 – a powerful online learning tool.

"It was great for engagement," says Dr. Nowak. "Students would play around with various types of games online to help them learn where to dispose of certain items in the gross room or how to gross certain specimens like a breast for example."

Headshot of Dr. Klaudia Nowak
Dr. Klaudia Nowak, staff pathologist in Gastrointestinal/Pancreas and Autopsy Pathology at UHN, led development of Canada’s first Pathologists’ Assistant Boot Camp. (Photo: UHN)

The boot camp, with its mix of in-person classroom, hands-on gross room, and interactive, self-directed digital components is setting a new standard for educating the next generation of PAs.

Dr. Nowak led the effort to roll out this approach to learning, but she wasn't alone. In addition to the PAs who helped build the curriculum, the team had the support of technical and learning experts for creating the digital components.

The teamwork paid off. The boot camp's efficacy was gauged by comparing the outcomes of a pre- and post-boot camp quiz results. Prior to the boot camp, the average score was 50.7 per cent and after the boot camp, the average score was 86 per cent.

Students also provided feedback through the use of QR codes at the end of each lecture – overall they felt the boot camp created a safe and professional learning environment conducive to their learning.

The team will present their PA Boot Camp findings at the United States and Canadian Academy of Pathology (USCAP) Annual Meeting in March – the largest gathering of pathologists in the world.

"Hopefully other programs across Canada and beyond can use this as a template for their boot camps," says Dr. Nowak. "It's a great opportunity to acknowledge PAs and support students in what can be an intimidating transition to hands-on learning."

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