Board certification for pathologists in clinical informatics: Are you a lumper or a splitter?

This issue's article entitled “Clinical fellowship training in pathology informatics: A program description” is a first critical look at how pathology informatics fellowships will measure up to the task of preparing fellows for the clinical informatics subspecialty board examination.[1] Recently approved by the American Board of Medical Specialties, clinical informatics is unique among subspecialty board examinations because it is open to applicants who have primary certification in any medical specialty, including pathology.[2] The practice of pathology is quite different than other medical specialties, and this has led to opposing concerns about the contents of the exam. On the one hand, the board examination might either focus too much on non-pathology informatics issues such as electronic prescription writing, thereby reducing the likelihood that pathologists could pass the test. Conversely, the exam may lack sufficient depth for those areas of informatics which are critically important to pathologists, such as automation. The controversy has stimulated this commentary. The article compares a relatively new but very large pathology informatics fellowship program against the program requirements proposed by the Clinical Informatics Training Program Requirements team within the American Medical Informatics Association.[3] Many of the program requirements are similar to those found in other American College of Graduate Medical Education (ACGME)-certified programs. As with all such programs, the mechanisms by which such requirements are met have different flavors and nuances that may ultimately achieve the same goal. However, this paper brings to light specific uncertainties associated with an untested new subspecialty program. It points out that the program requirements may not be amenable to some of the peculiar flexibilities already built in to some existing pathology core training programs. At the authors’ institution, one such flexibility allows a trainee to do a fellowship before completing core pathology training. Pathology residents often do two or more fellowships, so the burden of a 2-year program requirement for pathologists who want to train in clinical informatics is discussed. Despite these differences, the author of this commentary was surprised by the number of similarities between the proposed program requirements and the existing requirements of the described pathology informatics fellowship. Therefore, the overall assessment of the similarities between pathology and non-pathology informatics may be more subjective than realized in the conclusions of the article. While pathology practice is unique in medicine, the informatics principles that pathology informaticists use to improve data acquisition, storage, management, and retrieval are the same as those used in non-pathology practices. This begs the question as to how training programs for pathologists in clinical informatics should be structured. If you are the proverbial “lumper,” then clinical informatics fellows of any primary specialty would train in the same program with the same administrative structure and overhead. “Splitters” would then argue for completely separate pathology informatics training programs that have little to no interaction with non-pathology informatics programs. The answer to this dilemma will be highly dependent on the institution and the distribution of potential informatics faculty within it. Institutions with an abundance of informatics faculty within one department will likely gravitate toward a specialty-specific training program. However, given the broad audience of the board examination and the fact that pathology informaticists are often called upon to help resolve data management issues between non-pathologists and the laboratory, a better model may be a hybrid of general and specialty-specific training. Much of this will certainly depend on the final structure and content of the board examination. The Association of Pathology Informatics is working with the American Board of Pathology and the American Board of Preventive Medicine to assist in the construction and execution of the board examination, anticipated at this moment to be first available in the fall of 2012. Criteria for the by-experience pathway for those of us who are already practicing informaticists are also being set. This involvement will assist in providing clear guidance to pathology departments on how to align the program requirements[3] and core content[4] with those of clinical informatics fellowships, regardless of whether they are completely or partially housed within a department of pathology.