International recommendations for training future toxicologic pathologists participating in regulatory-type,nonclinical toxicity studies

The International Federation of Societies of Toxicologic Pathologists (IFSTP) proposes a common global framework for training future toxicologic pathologists who will support regulatory-type – nonclinical toxicology studies. Trainees optimally should undertake a scientific curriculum of at least 5 years at an accredited institution leading to a clinical degree (veterinary medicine or medicine). Trainees should then obtain 4 or more years of intensive pathology practice during a residency and/or on-the-job "apprenticeship," at least 2 years of which must be focused on regulatory-type toxicologic pathology topics. Possession of a recognized pathology qualification (i.e., certification) is highly recommended. A nonclinical pathway (e.g., a graduate degree in medical biology or pathology) may be possible if medically trained pathologists are scarce, but this option is not optimal. Regular, lifelong continuing education (peer review of nonclinical studies, professional meetings, reading, short courses) will be necessary to maintain and enhance one's understanding of current toxicologic pathology knowledge, skills, and tools. This framework should provide a rigorous yet flexible way to reliably train future toxicologic pathologists to generate, interpret, integrate, and communicate data in regulatory-type, nonclinical toxicology studies.     

The boundaries of cellular pathology: how pathologists see their clinical role

There has been much recent public attention on the effects of the practices of cellular pathology on patients and their relatives. It is important to establish clearly pathologists' views about their professional relationships to clinicians and patients. A national postal questionnaire survey was performed to investigate how cellular pathologists perceive their role in clinical practice and whether there are important differences between different groups of pathologists. Responses were received from 773 pathologists, of whom 167 were trainees. On the basis of responses to 25 attitude statements, it appears that the profession shares a core belief that pathologists are clinicians rather than scientists and sees diagnosis as its main clinical responsibility. However, the role that each pathologist feels clear about differs significantly between pathologists, with a stronger consensus over function, responsibility, and professional image than on the clinical practice of pathology, job satisfaction, and the impact of technological change. Academic activities are a minority interest, although academic pathologists express better job satisfaction and more radical views of professional practice. Young trainees are more likely to work in teaching hospitals, to be female, to have trained outside the UK, and to have had experience in other specialties. They have, however, a more restricted view of the clinical role of pathology than accredited pathologists. Most cellular pathologists see themselves as clinicians with a special role in diagnosis, but how this is interpreted and the extent to which pathologists involve themselves in clinical decision-making is inconsistent. This professional dilemma should be addressed by research to obtain more systematic knowledge of the clinical impact of cellular pathology and especially the ill-defined links between diagnosis and clinical decision-making.     

Toward a cardiovascular pathology training: Report on the forum held in Vancouver, March 6, 2004, Society for Cardiovascular Pathology

Cardiovascular pathology is a subspecialty of anatomic pathology that requires both clinical education and expertise in contemporary physiopathology. The Society for Cardiovascular Pathology sponsored a special workshop within the frame of the USCAP Annual Meeting, held in Vancouver, March 6-12, 2004, to address the present and future role of cardiovascular pathology in research, clinical care, and education. Clearly, the recruitment and training of young pathologists are crucial to this aim. The forum tried to answer a series of questions. First, is there room for cardiovascular pathologists and clinicopathologic correlations in the era of extraordinary advances of in vivo human body imaging? What is the evolving role of the autopsy? How can the cardiovascular pathologist simultaneously be an autopsy prosector, a surgical pathologist, a molecular pathologist, and an experimental pathologist? Is there a specific domain content for training in cardiovascular pathology and does it meet the constellation of market needs and demands? What are the experiences in Europe, North America and elsewhere? What is the influence of cardiovascular pathology in departments of pathology? Is the subdiscipline still a Cinderella in the anatomic theatre or a Princess with a double helix coat of arms? The Society for Cardiovascular Pathology is strongly committed to optimizing the academic and professional profile of the future generation of cardiovascular pathologists. This article reports the outcome of the forum and directions that may lead to a vibrant future for well-trained cardiovascular pathologists.     

Symposium on Training Programs in Pathology (VII European Congress of Pathology, Valencia, 1979). An introduction to the symposium: participants, aims--the Spanish programme; proposed general conclusions

The need for learning pathology as a physical substratum of disease is unquestioned. Thus at the undergraduate level opinions vary only on the best time for teaching pathology, the length and the depth of teaching, the degree of integration with clinical disciplines, the use of audiovisual aids, the direct involvement of the students with routine material, the nature of evaluation tests, and so on. Postgraduate pathology should ideally reach all physicians, at least in the field in which they specialize. As for future pathologists, they need to understand the three way role expected from them in medicine: 1. A proper knowledge of morphopathology in close relation with etiology, pathogenesis, and clinical consequences; 2. A scientific attitude of permanent learning through experience and study, and 3. Availability of their experience for the progress of medicine through teaching, writing, and quality control at their hospitals. To reach these goals, pathology should be taught in well functioning, active, and adequatly staffed hospital departments, through long, progressive, controlled and flexible residency programs under some kind of advice and supervision of national and even international Agencies. These advisory bodies should attempt to permanently evaluate the real needs and desirable location of pathologists in the future, and propose any needed changes concerning their background, education, and professional role.     

The autopsy as a performance measure and teaching tool

A survey of pathology training programs about current operations and attitudes revealed that the autopsy is underused in medical student and pathology resident teaching, is inadequately reported, often does not have a dedicated faculty, is not championed by pathologists or clinicians, is not valued as a performance measure, and is barely used as a resource for medical research. The autopsy can be reestablished as a teaching tool and performance measure, but this will require that the autopsy be recognized as a credible and valuable medical procedure. The autopsy must then be funded; and new sources of both volume and funding, such as incorporating autopsies into payment schedules, into clinical trials, and in pay-for-performance initiatives, must be solicited. Once there is reimbursement for autopsies, pathologists, clinicians, and health care administrators will embrace the autopsy as a new source of revenue and as a valid measure of physician, hospital, and health system performance. Pathologists and the pathology specialty societies must take the lead in the reestablishment of the autopsy and must, at the same time, encourage innovations such as centralization, greater use of Pathology Assistants, and application of molecular techniques. New tools for using the autopsy in medical student teaching should be embraced, and the role of the autopsy in pathology residency programs must be reevaluated.     

Pathologists and laboratory medicine: personal experiences]

The author started his career as an anatomical pathologist and now works as an anatomical and clinical pathologist. Most Japanese anatomical pathologists are not well trained for laboratory medicine, but they are required to have a knowledge of laboratory medicine and are expected to become managers of laboratories in general hospitals. The reconstruction of the laboratory is necessary to include an anatomical pathology division and a new post-graduate education system should be established in which both anatomical and clinical pathologists should be cross-taught mutual fields.     

Pathology in the continuing education of other disciplines

Since pathology is one of the main pillars upon which the ultimate handling of the patient by the clinician should be based, it should also be an integral part of the teaching of the clinical disciplines. This is true both for the training of the resident as a specialist, as well as for the continuing education of the specialists themselves. In both, pathology should play an important role. It is essential that the clinician has sufficient knowledge of the different aspects of a disease in order to choose the most appropriate therapy. To this aim, discussions of the findings and implication of biopsies, surgical specimens, and autopsies can be employed. This can be done with the individual clinician, with several members of a department, or with members of different disciplines, at so-called clinical-pathological conferences. In addition, contributions by pathologists at postgraduate courses especially intended for clinicians and/or general practitioners are also requested. The way this matter is handled in the Netherlands will be presented as stimulus for further discussion.     

Some characteristics of the community practice of pathology in the United States. National Manpower Survey of 1987

An evaluation of 629 pathologists engaged in community hospital and private laboratory practice and representing 601 pathology practices of varying size shows surprising uniformity in the distribution of professional effort. On average, pathologists in community practice distribute their effort as follows: surgical pathology, 34.6%; autopsy pathology, 6.7%; cytology, 8.8%; clinical pathology, 18.0%; teaching, 6.0%; research and development, 2.3%; laboratory administration, 17.5%; hospital administration, 2.9%; and other, 3.2%. The average community pathologist is male, 52 years of age, and a graduate of an American medical school (60%). When surveyed in 1986, community pathologists worked an average of 50 hours per week and retired at an average age of 62 years.     

Resident physician opinions on autopsy importance and procurement

The national decline in hospital autopsy cases negatively impacts physician education and medical quality control to an unknown degree. The current non-medicolegal autopsy rate is less than 5% of hospital deaths. This study compares internal medicine and pathology resident physician perceptions of the autopsy, including the importance, procurement, technique, and the pathologist-internist interaction. An 84-item survey based on autopsy literature was designed, piloted, and distributed to 214 residents at a single 800+ bed tertiary care academic teaching hospital (Massachusetts General Hospital, Boston) to accomplish this goal. Completed surveys were obtained from 72% of medicine (n = 118) and 84% of pathology (n = 42) residents. Residents strongly agree on the importance of autopsies for education, answering clinical questions, public health, and research. Autopsy rates are deemed inadequate. Internists are comfortable requesting autopsies, but report insufficient guidance and difficulty with answering technical questions. Although not requested on all hospital deaths, internists are more likely to initiate an autopsy request than a decedent's family, and worry significantly less about institutional costs and malpractice litigation than pathologists believe. Internists expressed interest in having an instructional brochure to give families, observing an autopsy, and having increased communication and support with autopsies from pathology residents. The main reasons why autopsy consent is not requested (it is unpleasant, cause of death is known, family is upset or seems unwilling) and why families refuse (patient has suffered enough, body may be handled disrespectfully, religious/moral objections, lack information) were similar for both resident groups. Despite their decline, autopsies still remain important to medicine as indicated by internal medicine and pathology residents at a large academic center. Improving autopsy education, enhancing availability of resources, and strengthening the pathologist-internist collaboration may serve to heighten awareness and ultimately procurement.     

Professional attitudes toward the autopsy. A survey of clinicians and pathologists

One hundred six clinicians and 20 pathologists at a pediatric hospital and an adult general hospital in Halifax, Nova Scotia, were surveyed by way of a mailed questionnaire on their attitudes toward the autopsy. Approximately two-thirds of both groups rated the overall usefulness of the autopsy as high, but most limited its benefits to ascertaining the cause of death and as a tool for medical education. The autopsy was rated more highly by pathologists; those who worked in the pediatric hospital; medical rather than surgical specialists; and medical staff rather than housestaff. Personal attitudes toward authorization of an autopsy on a member of the respondent's family or on his or her own body did not differ from declared professional attitudes. It is unclear whether clinicians' and pathologists' negative attitudes toward the autopsy are related to lack of knowledge, lack of hospital and community support of the autopsy, or barriers to the practice of autopsy pathology.     

Telemedicine and telepathology at the Armed Forces Institute of Pathology: history and current mission.

The Armed Forces Institute of Pathology uses telepathology and telemedicine programs to support its mission of providing pathology consultation, education, and research. The telepathology service is based on a static imaging or "store-and-forward" approach using both proprietary equipment and open systems through the Internet. Initiated in 1993, the service provides rapid expert consultation to pathologists globally. Diagnoses are provided by pathologists in 22 specialized departments. Educational programs are delivered through the World Wide Web. Category I continuing medical education credits can be obtained through Internet-based courses. Research activities are focused on forensic applications and the creation of image databases.     

Expectations and essentials for the community practice of pathology

In 3 surveys during the past 10 years, community hospital pathologists were asked what they want, need, or look for when employing a pathologist and, more specifically, what skills and knowledge a newly minted pathologist should have to be successful in the community practice of pathology. The most recent survey, done in spring of 2005, cited surgical pathology diagnosis, frozen section diagnosis, gross dissection, cytology, and fine-needle aspiration as essentials in anatomic pathology. For clinical pathology, knowledge of clinical medicine and test strategies that use the laboratory for clinical problem solving was paramount. New expectations in the latest survey were knowledge of molecular pathology and experience in quality assurance procedures. New pathologists generally meet the expectations of the community hospital workplace; however, there were some deficiencies: they were not proficient in gross pathology or autopsy pathology, they were slow, and many lack the clinical knowledge and experience to be effective consultants. The principal attribute that determines success in the practice of pathology, however, is skill in communication and interpersonal relations, and this remains the major deficiency of the fledgling pathologist.     

检验医师培养的实践探讨

采取临床科室轮转学习、临床教学查房、临床会诊和病例讨论、检验项目和质量控制宣传教育、定期学术汇报、规范考核制度以及加强科研创新能力培养等多种形式进行检验医师规范化培训,积极探索检验医师临床工作模式,并对我国检验医师培养面临的问题进行剖析与思考。     

The status and outlook of the training of pathologists in the RSFSR

Pathology service in the RSFSR suffers, at present, from the lack of pathologists: only 2393 (57.3%) of 4174 positions are occupied. Particularly difficult is the situation in Eastern Siberia and Moscow where only 47.7 and 48.6% positions, respectively, are covered. Lack of professional pathologists is aggravated by an artificial decrease of positions number as compared to real need, by the increase of proportion of persons retired or those having a preretirement age (30%), by a high percentage (over 30% of positions) of persons experiencing pathology as a second profession (65% of them do not have a sufficient knowledge and practice in pathology), by a low level of medical education in general and nonsufficient promotion of pathologists (only 39.3% pathologists have attestation categories). To solve the crisis the RSFSR Ministry of Health started in 1988/89 4-year training of pathologists at the pathology chairs of the RSFSR Medical Institutes: subinternship (1 year), internship (1 year), clinical internship (2 years). The realization of this program will result in turning out of 724 pathologists by 1994. The progress in pathologists training will require the improvement of technical basis of pathology chairs and departments and solution of certain organizational problems.     

Postgraduate instruction and certification in the system of the continuing education of pathologists

The experience in changing pathology service, postgraduate training and attestation in the system of continuous education of pathologists is presented. The authors analysed different ways of pathologist training: specialization in subinternship, internship and clinical internship, short-term courses, at places of work and outpatient problem seminars, etc. The four-year program of pathologist training is suggested.     

Intradepartmental consultations in surgical pathology: Review of a standardized process and factors influencing consultation rates and practices in an academic and community hospital setting

Intradepartmental consultations (ICs) are important for quality assurance (QA) and ensuring diagnostic accuracy in surgical pathology. Few studies have reviewed pathologist factors that influence IC rates. Our study reviews IC data and factors that influence both formal (written) and informal (verbal) consultation practices among pathologists in academic and community hospital settings. Formal IC records from the academic hospital were collected and academic and community pathologists were invited to complete a survey about their IC practices. All centers had a formalized process for documenting ICs; however, 92% of academic and 90% of community pathologists also requested informal IC. The top reasons for selecting a particular colleague for IC was perceived level of expertise; however, interpersonal relationships and office proximity had a greater impact on informal IC practice. Top reasons for requesting a formal IC were mandatory (subspecialty defined) consultation and uncertainty regarding pathological findings. Advice on wording was a common reason for informal IC. Written documentation of IC aids in QA and determination of IC metrics; however, informal, undocumented ICs still occur. Reasons for IC and choice of consulting pathologist are multifactorial, and identifying these can help target quality improvement initiatives.     

A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA

To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in a more rigorous academic environment adopting advances in medical informatics.     

The pathology student fellowship program at the University of Vermont: 1956-2005

Student fellowship programs in pathology offer a unique educational experience for selected medical students. In this report, the specialty preferences of former student fellows graduating from the University of Vermont were analyzed. Since 1956, 110 students have participated in this program, of whom 33 chose pathology as a career. These individuals represented 32.6% of all Vermont graduates who entered pathology between 1958 and 2005. In addition, former student fellows were more likely to become academic pathologists and to obtain subspecialty certification. Furthermore, based on comments received from former student fellows, the program had a positive impact on the medical education and career of pathologists and nonpathologists alike. It is concluded that student fellowship programs represent a powerful recruitment tool for pathology generally and for academic pathology in particular. The development of a database to track these programs and their graduates is essential to fully assess the educational impact of pathology student fellowship programs nationally.     

Biomedical engineering--education & industry: an Australian perspective

Biomedical Engineering education requires a multidisciplinary approach. To achieve satisfactory results from biomedical undergraduate courses, the development of longer programmes incorporating the life sciences and formal hospital or scientific and medical industry-based clinical experience programmes is needed. The B.Sc./B.E. five-year, combined-degree satisfies these requirements. Undergraduate programmes should be supported by parallel postgraduate programmes. A postgraduate engineering master's programme, by coursework and minor thesis, formulated in collaboration with professional groups and designed to be presented within a hospital or scientific medical industry environment, is required by industry. These education programmes need to be supported by a research (Ph.D and engineering master's with major thesis), hospital and industry infrastructure, which may take the form of a "Centre for Biomedical Engineering."     

The challenge of education and training in pathology--the Basle response

The aim of pregraduate teaching is to form young physicians who are masters in theart of observation and of biological reasoning, two faculties for which pathology is particularly suitable as a teaching instrument. In Basle we teach general pathology in the 3rd year in lecturesand in coordinated histology courses which are programmed. Thus, the student following his booklet with sketches, works up some slides, each step guided by questions which he has to answer in order to go on. In the 4th year the same schedule is followed for special pathology, which in the 6th year is applied at autopsy demonstrations. At these demonstrations a clinician first discusses the clinical history with the students thus preparing the questions which the pathologist has to answer by demonstrating his findings on color television. In other courses the students receive the clinical data and a week later a real clinico-pathological conference is held. Finally pathology is taught in small groups with fresh and formalin-fixed specimens. A great number of audiovisual courses are at the disposition of the students. We use them exclusively for repetition and not for initial teaching. The most important thing for a young pathologist is to learn how to work up biopsies including the knowledge where to find necessary help in the literature, an understandingof the clinical problems, and the precise final diagnois. In doing autopsies he must be able to understand and answer the clinical questions as well as to see the scientific problems. The programme spans 5 years including 1 in clinical work. During the 4 years in pathology the young pathologist, according to a schedule, rotates from one specialist to the other working up the biopsies under supervision. The attendance of several slide seminars organized by the society of pathology is compulsory. The young pathologist does about 300 autopsies and learns how to work up autopsies of junior colleagues. For self-education we prepared audiovisual courses with microscopic sets of slides. The main point in postgraduate education is the conviction of all permanent members of a department that teaching is one of our most important tasks, since with a thorough education of the next generation we are significantly helping to produce better pathologists.