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How do we train and retain the new generation of pathologists?

Thanks to the advent of molecular medicine and personalized treatment, the diagnosis and treatment of cancer have changed enormously in recent years. In medicine, healthcare providers must constantly stay ahead of the curve to give patients our best.

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Dr. Graham

Dr. Graham

When we’re on top of our game, we can help save lives. If we’re not up to speed with the latest ways to diagnose and understand a disease, the outcomes can be devastating. While this is important for all healthcare disciplines, pathologists can feel this particularly strongly.

All therapeutic interventions are built upon the foundation that a patient’s diagnosis accurately reflects the underlying pathology. Pathologists are essential in the diagnostic process as they are the experts trained to identify the subtle clues present in a patient’s workup to accurately diagnose the disease process. If we get it wrong, there is a real knock-on effect on the next stages of care. Unfortunately, pathologists are often overlooked given their limited interactions with those outside of the laboratory setting. However, they play a critical role in nearly every step of a patient’s care.

Let’s take a moment to illustrate how healthcare would be different without the department of pathology and laboratory medicine. To start, there would be no laboratory for testing (CBCs, electrolytes, LFTs, troponin etc). No microbiology lab would be available to detect infections and guide treatment. Surgical procedures would be limited and mortality rates increased, particularly in trauma patients, as there would be no blood bank to provide the necessary products. Cancer would be improperly managed as no specific diagnosis could be rendered, nor molecular tests available to guide therapy. In addition, tumor rates and recurrences might increase since no diagnostic screening test interpretation nor microscopic evaluation of the resected tumor to identify high risk features would be available. Basically, medicine would be complete guesswork as clinicians would resolve to treat patients solely on their intuition based on symptoms or imaging studies.

While this is extreme, we must face reality that the number of pathologists is on the decline. Around a third of pathologists in the UK are due to retire in the next five years.1 In the US, the number of active pathologists decreased by 18% in the ten years ending in 2017.2 In addition, I’ve heard concerns that fewer numbers of medical students or trainees are pursuing pathology as a career option. If the trend continues, we will be facing a severe shortage of pathologists in the future. In addition, pathologists are pressured to stay razor sharp to meet the rapidly increasing demand for pathology at a time when cancer rates are on the rise.

That is precisely why recruitment, education and training of pathologists and trainees is so important. Pathology as a discipline is always changing and developing. To meet patient demand, to ensure the success of our hospitals and healthcare facilities, and to keep the profession growing in a positive direction, increasing pathology’s exposure and providing quality education is essential. I’m a fanatic about this, I even manage the pathology study website, We need to train pathologists to meet current standards in cancer diagnostics but we also need to be ahead of the curve.

Education is a priority for many reasons. Firstly, we need to educate other people about the work we do to ensure there is joined-up thinking across the provision of healthcare. We must also keep moving when it comes to technology and scientific discovery. In today’s world where social media dominates and everything is just the click-of-a-button away, we must be malleable and embrace the opportunity to share our insight and love of histopathology. With the advent of artificial intelligence (AI), machine learning, and an ever-more complex understanding of cancer and how to treat it, there is a lot to stay on top of.

By speaking to pathologists from around the world at our launch event, it was evident to me that the fundamental challenges and opportunities pathologists encounter are shared everywhere, though resources and healthcare settings differ. The Future of Pathology initiative has really reinforced this for me, as I’ve found time and again in discussions with my panel members, Dr. Jerad Gardner from the US and Dr. Bethany Williams and Dr. Matthew Clarke from the UK. There is so much opportunity here and I can’t wait to bring the topic to life in the Future of Pathology report.

We hope our report will be read by hospital administrators and managers, by trainees, and by pathologists who want to act as advocates for their specialty. With the support of these key individuals, we believe we can educate, train and retain a pathology workforce who can make cancer diagnosis and the delivery of patient care the very best it can be, and fit for the big challenges of tomorrow.

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1. Royal College of Pathologists. Meeting Pathology Demand. Histopathology Workforce Census. London, UK: Royal College of Pathologists. 2018.

2. Metter DM, Colgan TJ, Leung ST. Trends in the US and Canadian Pathologist Workforces From 2007 to 2017. JAMA Netw Open. 2019;2(5):e194337.

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