Novel adult learning-based curriculum for pathology residents: components and critique at five years

Active learning forms the foundation of adult education methodology as it promotes durable retention of knowledge in accessible long-term memory. The most successful active learning strategy uses periodic testing, a memory recall, application, and consolidation activity termed "retrieval practice." After reviewing adult learning science evidence, we created a two-year anatomic and clinical pathology residency core curriculum (Pathology Core Curriculum) in which we deployed six principles of adult learning, prioritizing retrieval practice as our key learning strategy. We hypothesized that the Pathology Core Curriculum would improve long-term knowledge retention which would correlate with progressively higher retrieval practice and resident in-service exam scores. Residents showed a significant upward trend in retrieval practice scores after initiation of the Pathology Core Curriculum. Retrieval practice scores most strongly positively correlated with surgical pathology resident in-service exam scores, as expected, given the preponderance of surgical pathology questions in the retrieval practices. For UK residents, the annual improvement in resident in-service exam scores post Pathology Core Curriculum significantly outpaced the pre-Pathology Core Curriculum resident in-service exam scores in eight of 10 disciplines and outpaced national gains/year in five of 10 disciplines. We also conducted an anonymized survey of residents and graduates to gauge satisfaction with and perceptions of the curriculum. Survey results indicated most residents agreed or strongly agreed the Pathology Core Curriculum promoted effective learning. Most graduates strongly agreed or agreed the Pathology Core Curriculum facilitated practice competency. In summary, the innovative and adaptable adult learning-based Pathology Core Curriculum is effective and well received by trainees. Long-term retention of accessible knowledge may endure for years through using spaced retrieval practices and other adult-learning principles in a pathology residency curriculum.