In 2019, an emerging therapy showing promising results in breast cancers with low levels of HER2 began to emerge, indicating significant changes would need to be made in the testing, reporting and tracking of a patient’s HER2 status. As part of a larger educational initiative designed to advance knowledge, competence and performance in pathologists and interprofessional cancer care teams in diagnosing and managing HER2-low breast cancer, the American Society for Clinical Pathology (ASCP) collaborated with Q Synthesis to develop a collaborative learning exchange called Pathology Trailblazers.
Pathology Trailblazers leveraged virtual peer-to-peer discussions that enabled cohorts to address potential challenges with HER2-low implementation in their institutions. Through its innovative design, learners were guided and empowered to develop, implement and evaluate action learning projects to improve HER2 testing and prepare their institutions for changes needed as HER2-low therapies emerged.
Through innovative case studies and virtual peer-to-peer discussions facilitated by Q Synthesis, participants discussed practical ways to prepare their laboratories for impending changes, strengthened their leadership skills, and implemented and disseminated best practices in HER2 testing. ASCP published summaries of the learners’ action learning projects on its website to inspire others to make changes in their institutions.
Forty-one pathologists from 36 different institutions across the United States (24 states and D.C.) participated in the Pathology Trailblazers collaborative learning exchange. Over the course of several months, learners participated in two virtual small-group meetings in which they reviewed case studies and participated in discussions to learn from each other and hone their leadership skills as they developed leadership growth projects designed to implement best practices in HER2 testing in their institutions.
While the leadership growth activities undertaken by the participants varied, the resulting projects led to self-reported improvements in three broad areas: awareness about HER2-low, scoring practices for IHC, and reporting practices and communication about patient care. To increase awareness of the implications of HER2-low, several of the Trailblazers participants adopted education-focused projects, such as planning and delivering formal presentations for their staff and colleagues and teaching pathology trainees (e.g., residents and fellows) about the evolving landscape of HER2 classification in breast cancer. Other participants incorporated updates about HER2-low to their colleagues during regular staff meetings. The aims of these knowledge exchanges were to both increase awareness of HER2-low and explore how it would potentially impact testing protocols, as well as the interpretation of test results for various types of tumors at the participants’ institutions.
Also related to the interpretation of test results, several projects focused on improving practices in IHC scoring. For example, one of the projects entailed an internal concordance study of lower level of HER2 expression via IHC and a similar project audited how slides were being scored via IHC. The results of these projects helped refine how the pathologists interpreted the results of IHC testing.
Other projects focused on the communication and reporting of the test results. For example, one of the projects improved the way the IHC score was documented in the summary of HER2 results, conveying the information more clearly to make it more conducive to informing subsequent decisions about patient care. Also related to the coordination of patient care, another project entailed forming a multidisciplinary breast care coalition at the institution to identify and implement ways to improve planning.
The Pathology Trailblazers collaborative learning exchange demonstrated how learners can be equipped and empowered to create, implement and evaluate action learning projects for quality improvement in their institution. Learners received peer-to-peer support, enabling them to carry out the changes they intended to make to improve HER2 testing and prepare for anticipated changes due to emerging HER2-low therapies in their institutions. This type of design helps address obstacles where learners declare an intent to change following an educational activity but are not equipped to implement the changes effectively.
Changes made by the learners also highlight improvements made in patient care, as the learners evaluated the interventions they had designed and implemented. Thus, the results show how the education achieved the program goals to: (1) equip pathologists with the knowledge and skills needed to conduct appropriate HER2 testing in accordance with clinical practice guidelines for patients with breast cancer; (2) ensure pathologists are well-versed on the science behind emerging treatments for patients with HER2-low breast cancer; and (3) support the identification, dissemination and implementation of best practices in HER2 testing, documentation and communication among pathologists, oncologists and other key members of the cancer care team to improve quality of care for patients with breast cancer, in light of emerging HER2-low treatments.
Finally, several aspects of the design of the program also support replicability and scalability, as the educational strategies and methods can be transferred to a variety of contexts. For instance, ASCP has posted project summaries from the action learning projects online for public viewing, which may inspire others to replicate similar efforts in their workplace or practice setting. Pathology Trailblazers was also designed to help the learners increase their procedural knowledge and strengthen their leadership skills in helping their laboratory or cancer center proactively prepare for the anticipated changes needed as new HER2-low treatments emerge. The embedded leadership curriculum targeted the learners’ adaptive capabilities for addressing future updates and potential challenges. Thus, they can be better prepared to facilitate future related changes as new evidence, developments and advances occur for improving patient outcomes. To address this ongoing need, ASCP has received funding to replicate and scale this design in other projects where practice change among pathologists and multidisciplinary teams is critical, such as in the diagnosis and treatment of breast cancer.
To learn more about the educational design for the full project, please click here.
This initiative was funded by independent educational grants from AstraZeneca Pharmaceuticals and Daiichi Sankyo, Inc.
About the Authors
Melissa Kelly, PhD, is senior manager in evaluation, measurement and assessment for the American Society for Clinical Pathology, where she oversees the evaluation of educational programs and related initiatives. In addition to expertise in evaluation, she also has experience working as an instructional designer and teaching courses in assessment and program evaluation.
Joseph Kim, MD, MPH, MBA, FACEHP, CPHQ, is president of Q Synthesis LLC, an independent healthcare education and quality improvement company that advances interprofessional collaborative practice by applying principles of systems thinking, implementation science and health services research. Some of his recent projects have focused on improving team-based processes around cancer biomarker testing, identifying and managing treatment-related adverse events, aligning treatment plans with clinical guidelines and coordinating care in complex patient populations. Dr. Kim serves on the board of directors for the Alliance for Continuing Education in the Health Professions (ACEhp). He is also a past president of the National Association of Medical Education Companies (NAMEC). Dr. Kim holds a BS in engineering from Massachusetts Institute of Technology, an MD from University of Arkansas for Medical Sciences, an MPH from the University of Massachusetts Amherst and an MBA from St. Joseph’s University.
Kellie Beumer is the director of learning innovations for the American Society for Clinical Pathology, where she oversees the instructional design and delivery of ASCP's live and online education and grant writing efforts. With nearly 20 years of experience, she is passionate about helping associations develop innovative medical education solutions aligned with best practices in adult education and learner needs. Her background is in molecular biology and instructional design, and she is currently working on her MBA.