Implementing the Promotion in Place Model of Competency-Based Time-Variable Graduate Medical Education in Pathology

Background Promotion in Place (PIP) is a competency-based time-variable graduate medical education innovation model developed at Mass General Brigham and not previously tested for feasibility, acceptability, or outcomes. Objective To assess early PIP outcomes in the Massachusetts General Hospital (MGH) pathology residency program. Methods Approved by the American Board of Pathology, PIP was launched in 2021. The Clinical Competency Committee developed and implemented explicit graduation criteria. Trainees meeting criteria who chose early graduation became credentialed, board-eligible junior attendings at MGH in a period of "sheltered independence" and were assessed using the Focused Professional Practice Evaluation. PIP sheltered independence (PIP-SI) participation rates, time, and activities were followed. We also assessed board pass rates, Milestones, and patient safety reports for all residents. We measured additional participant time and resources. Results Over 4 years, 24 of 30 (80%) residents qualified for PIP-SI, 17 of 24 (71%) accepted, and 7 of 24 (29%) declined. Eleven of 17 (65%) had a period of sheltered independence as junior attendings (median 9 weeks [range 5-24 weeks]) in various anatomic and clinical pathology roles. Of 6 eligible residents not participating, 4 took a leave of absence, and 2 experienced licensing or visa delays. All residents passed their board examinations on the initial attempt and none had concerns identified through patient safety reports. Time and resource requirements were acceptable to stakeholders. Conclusions Most residents met criteria for PIP-SI and accepted, demonstrating high acceptability. PIP-SI was feasible with implementation into standard workflows over 4 years. PIP-SI attendings had no adverse outcomes identified.