When I started as a resident in The Mount Sinai Hospital oral and maxillofacial pathology residency program, I was pleasantly surprised by the substantial degree to which it was integrated with the anatomic pathology (AP) and clinical pathology (CP) residency programs. We participated in all of their didactics as well as our own, and it was clear how much the AP/CP program had to offer for resident education. The Mount Sinai Health System is one of the largest in the country, and because of the synergy with the diversity of the New York City patient population and the sub-specialization of the Department, we had exposure to incredibly uncommon disease entities. However, the didactic structure was fairly traditional, with relatively disorganized teaching assets and little active learning.

Starting in May 2017, I started working with the assistant residency program director, Garrett Desman, MD, to reform the curriculum and fully realize the potential of existing assets while using evidence-based concepts of adult education. To begin, we worked with the Icahn School of Medicine educational technology team to create a Blackboard learning management system organization, allowing for us to organize educational content. To make the content, we recruited resident volunteers to reach out to each sub-specialty in which the residents rotated, where they would work with attendings to create a list of rotation expectations, learning objectives, and upload existing assets. Once consistency with the existing educational system was achieved, we started the reform proper.

A primary objective of our reform was to encourage active learning. To this end, we wanted to replace the existing didactic structure of relatively unrelated traditional didactic lectures with a more thematically structured format:

• Monday morning: an AP topic (e.g., neoplastic breast lesions, salivary gland tumors) presented as a traditional lecture. Residents can prepare for this lecture by reviewing the topic ahead of time in books or by using PathPrimer (Elsevier). This lecture is recorded to an unlisted YouTube channel and embedded into Blackboard. Residents can review this lecture at any time, and in future years, the traditional didactic lectures will be replaced with other active learning modalities like problem-based learning, with updates to the videos being recorded separately as needed.
• Monday afternoon: slide unknowns that test residents on the topic presented in the morning, which are generally available as whole slide images well before this session. This allows for residents to understand the concepts taught in the morning through application. The attending will review the slides and answer resident questions during the session. Because these slides are scanned, residents can re-review these slides whenever they want through a slide server that I created, and because these are de-identified, when residents leave, they can take with them a slide library of thousands of educational teaching slides.
• Tuesday morning: CP traditional didactic lectures; in the first year of this reform, we largely focused on AP education. However, like AP traditional didactic lectures, these are also recorded and embedded into Blackboard, allowing us to further reform CP education in the future.
• Tuesday afternoon: resident-presented CP unknowns, which are designed to be boards-focused. These materials and recordings are also embedded into Blackboard for future study. Some weeks also feature a "fishbowl" lesson, in which residents answer attending-crafted, boards-style questions by groups. The format is similar to fishbowl conversations
• Wednesday mornings: various miscellaneous lectures, usually cytology or informatics.
• Wednesday afternoon: professional development conferences. The premise of these lectures is to teach the residents skills that, while not boards-relevant, are important for their knowledge as academics and as team members in patient care. Past topics include CV creation, how to use computers more efficiently, professionalism, and others.
• Thursday morning: team-based learning on the AP topic presented on Monday. Attendings write a brief (10-15 question) quiz in Blackboard to test the residents on the subject presented on Monday. The residents have to work as a team to maximize their score. This promotes a sense of teamwork and friendly competition. At the conclusion of the quiz, the attending discusses the answers. Of all the new educational modalities we have implemented, this has increased resident engagement the most.
• Thursday afternoon: slide unknowns that test residents on any topic in that week's sub-specialty. The rationale for this session was that we wanted residents to have a more comprehensive review session on a weekly basis. Like Monday afternoon's unknowns session, these slides are also uploaded into the slide server.
• Friday afternoon: resident-presented interesting cases. Six residents present rare and/or complex cases from their AP rotations in the previous month. These cases are de-identified and uploaded into the Mount Sinai Case Viewer, for which I was the sole developer, using the Ruby on Rails web framework. Residents and the public can use search functions to review images and data about these fascinating cases. These cases are well-integrated with social media, and since the residents can watermark the images they create with their names, when cases get shared (sometimes tens of thousands of times), it promotes the resident, the Department, and the Health System.

Because of these changes, resident satisfaction with the program increased dramatically (internal data). It is our desire that these changes be further developed, and these changes could possibly be implemented in other residency programs in the Health System.