Residency training in anatomic pathology: looking forward in the 21st century

Residency training in anatomic pathology in the United States elicits a wide range of fundamental questions and conflicting opinions. This paper reflects the author's opinion concerning 4 questions that are often integral to these discussions and impact the outlook on training in the current century. (1) What are the goals of residency training in anatomic pathology? (2) In the face of exponential growth of information in anatomic pathology, how are residents to be trained? (3) What changes are likely to occur in the practice and training of anatomic pathology? (4) Is combined training in anatomic and clinical pathology a viable program for the 21st century?     

Digital breast pathology: validation and training for primary digital practice

Digital pathology is a technology which is transforming the way in which breast histopathology specimens are assessed, reported and reviewed. Large scale clinical laboratory deployments of whole slide imaging systems are occurring in diagnostic pathology departments across the world, requiring laboratory and diagnostic staff to navigate new skills and workflows. Transferring from conventional light microscopy assessment of breast specimens to the use of whole slide images (WSI) can be a challenging experience. This article describes an approach to training and validation for breast consultant histopathologists, which has been used and adapted at a number of sites. Examples of types of case that are suitable for training, and some of the potential “pitfalls” of digital reporting for the novice are described, and practical advice regarding clinical digital breast workflow is shared.     

新时期放射科住院医师规范化培训模式初探

住院医师规范化培训是毕业后继续医学教育的重要组成部分,是每一位临床医师成长的必由之路。本文针对放射科住院医师规范化培训的现状和存在的问题,从规章制度制定、轮转计划安排、培训过程落实、考核体系建立、培训质量监督等方面进行了初步实践和探索,希望对新时期的放射科住院医师规范化培训提供一些启示和借鉴。     

Training in post-mortem pathology

A degree of post-mortem training is currently a requirement for every histopathology trainee within the United Kingdom. The expectation is that all trainees should be able to eviscerate and perform basic systematic organ examinations in a variety of straightforward cases to identify common causes of death. Those who are interested in pursuing further training may opt into the Royal College of Pathologists Higher Post-mortem training module. Becoming adept at post-mortem practice is challenging without access to an adequate number of a range of cases, high quality trainers, and a well-structured and supportive learning environment. The number of post-mortem-practising histopathologists is dwindling and the appetite amongst trainees to pursue a career which involves post-mortems is low. In this article, we will explore the need for quality post-mortem training as well as the structure and assessment processes currently in place for histopathology trainees. We will discuss the barriers to post-mortem training, and recent developments to both post-mortem training and techniques.     

Low-contact and high-interconnectivity pathology (LC&HI Path): post-COVID19-pandemic practice of pathology

The COVID-19 pandemic situation may be viewed as an opportunity to accelerate some of the ongoing transformations in modern pathology. This refers primarily to the digitalisation of the practice of tissue and cellular pathology diagnostics. However, it is also an opportunity to analyse the modus operandi of a discipline that has been practised in a similar manner for more than 100 years. The challenge is to define the next generation of interconnectivity tools that would be necessary to achieve a new operational model that, while ensuring low face-to-face interaction between the main players of the diagnostic pipeline, allows maximum interconnectivity to serve our patients and the immediate teaching and research needs associated with clinical tissue/cellular samples. This viewpoint aims to describe what this new paradigm, a low-contact and high-interconnectivity pathology (LC&HC Path) operation, may require in the near future.     

Knowledge of the anatomical polyp location might bias the pathological classification of histologically equivocal colorectal serrated polyps - a consensus study performed by pathology trainees

Colorectal serrated polyps (CSPs) comprise hyperplastic polyps (HPs), traditional (TSAs) and sessile (SSAs) serrated adenomas, as well as inflammatory cloacogenic polyps (ICPs). These lesions have typical anatomical locations and share a histomorphological overlap. In this study, we assessed the so far neglected issue as to what extent the histological classification of these lesions performed by pathology trainees is biased by the pathologists’ knowledge of the polyp location in dependency on the duration of their training. To reach this aim, 49 CSPs were classified by three pathology trainees blinded to clinical data. In a second round of examination, the same raters were provided with the polyp location. A third round was conducted after a consensus conference. Intra- and inter-rater analyses were performed using Kappa (K) statistics and Spearman correlations. Our data suggest that the histological classification of CSPs performed by pathology trainees might be influenced in a clinically significant fashion by knowledge of the anatomical polyp location depending on the duration of their pathology training.     

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.     

A Survey of Pediatricians in Private Practices Who Participated in Community-Based Clerkships: An Intellectual, Inspirational and Professional Growth Experience

Purpose

To examine how pediatricians in private practices are affected by the process of training medical students in their clinics as part of a community-based clerkship program.

Materials and Methods

In 2007, a questionnaire was sent to 35 pediatricians who had provided private clinical settings for clerkship training for the previous 3 years. The questionnaire covered a number of points, including the pediatricians'' motivation to join and/or reasons to quit the program; if there were changes seen in their stress levels while supervising students; changes in their treatment procedures or attitudes because of the students'' presence; responses of patients and/or their guardians in regard to have medical students treating them, and whether the doctors were inspired to grow professionally by participating in the program.

Results

Of the 35 pediatricians, 31 (88.5%) responded. Eighteen respondents (58%) selected ''responsibility to cooperate with medical school'' as a reason to participate. Fifteen physicians (48.3%) answered that the clerkship program had a positive impact on their treatment procedures and their attitude towards patients.

Conclusion

Based on the pediatricians'' responses, the community-based clerkship program may instill intellectual inspiration and promote professional growth among the pediatricians in private practices, resulting in potentially better treatment for patients.     

病理报告延迟相关因素分析

目的 分析病理报告延迟的相关因素,为病理科服务质量改进提供参考途径.方法 从浙江省东阳市人民医院1999-2006年8年的病理报告中,以月为单位整群随机抽取24个月共21 038份病理报告,按活检标本、手术标本和冷冻切片标本分别统计报告的及时性,分析延迟报告发生的原因.结果 及时报告19 579份,及时报告率93.06%,延迟报告1459份,延迟报告率6.94%,其中活检报告延迟率6.02%(665/11 052),手术标本报告延迟率7.26%(643/8858),冷冻报告延迟率13.39%(151/1128).延迟报告的原因,以技术原因为主,占1158份(79.37%),其中免疫组织化学或特殊染色、科内讨论或院外会诊、访视患者或与临床沟通比例较高.责任原因占301份(20.63%),其中申请单缺项和缺既往病理资料最多见.发生环节中,以科内因素为主占1048份(71.83%),其中技术原因1017份(97.04%).科外因素411份,其中以责任原因为主,占270份(65.69%,X2=709.59,P<0.05).结论 影响病理报告及时性的因素有技术性和责任性两大类,科内以技术性为主,科外以责任性为主,应当分别运用流程改造、技术进步和加强责任心等措施加以改进.     

Asiatic Center of Pathology as a basis of progress of Asiatic pathology in the future.

Nowadays in the Asian continent the necessary conditions seem ripe for the creation of an Asiatic Center for Pathology which could function as a 'brain' center and, at the same time, be an office of the Asian continent's pathologists. The process of organizing the Asiatic Center for Pathology is proposed in the form of brief outlines and considerations for scrutiny and analysis to be followed by a thorough discussion. The creation of such an Asiatic Center for Pathology, which would have no counterpart in the world's pathoanatomical practice, will undoubtedly be a powerful breakthrough in Asiatic pathology.     

强化初始培训在医学生向急诊住院医生转换中的作用

目的 初始培训是住院医师开始临床工作前的培训.探讨不同的初始培训方式对医学生向临床医生角色转换的作用.方法 15名上岗前的住院医师随机分成2组,强化培训8人,进行系统的基本知识和技能的培训,常规培训组7人,沿用传统的方法,在培训前后分别进行理论考核,1及3个月后针对自我能力评价和主治医师评价进行问卷调查打分.结果 初始培训后的考核成绩分别为78.25±5.90和59.71 4±3.90(P<0.05),强化培训组对于急诊知识和技能的掌握情况更好.3个月后强化培训组在临床工作中的自信心评价结果为91.20±8.76,显著高于常规训练组的75.46±6.56(P<0.05).结论 针对毕业的医学生进行强化初始培训能更好地帮助他们完成由学生向医生的转变,尽快树立信心,提高临床工作能力,改善患者的满意度和降低医疗风险.     

Virtual microscopy and digital pathology in training and education

Traditionally, education and training in pathology has been delivered using textbooks, glass slides and conventional microscopy. Over the last two decades, the number of web-based pathology resources has expanded dramatically with centralized pathological resources being delivered to many students simultaneously. Recently, whole slide imaging technology allows glass slides to be scanned and viewed on a computer screen via dedicated software. This technology is referred to as virtual microscopy and has created enormous opportunities in pathological training and education. Students are able to learn key histopathological skills, e.g. to identify areas of diagnostic relevance from an entire slide, via a web-based computer environment. Students no longer need to be in the same room as the slides. New human-computer interfaces are also being developed using more natural touch technology to enhance the manipulation of digitized slides. Several major initiatives are also underway introducing online competency and diagnostic decision analysis using virtual microscopy and have important future roles in accreditation and recertification. Finally, researchers are investigating how pathological decision-making is achieved using virtual microscopy and modern eye-tracking devices. Virtual microscopy and digital pathology will continue to improve how pathology training and education is delivered.     

Learning in the working place: the educational potential of a multihead microscope in pathology postgraduate training

Training future pathologists is an important mission of many hospital anatomic pathology departments. Apprenticeship—a process in which learning and teaching tightly intertwine with daily work, is one of the main educational methods in use in postgraduate medical training. However, patient care, including pathological diagnosis, often comes first, diagnostic priorities prevailing over educational ones. Recognition of the unique educational opportunities is a prerequisite for enhancing the postgraduate learning experience. The aim of this paper is to draw attention of senior pathologists with a role as supervisor in postgraduate training on the potential educational value of a multihead microscope, a common setting in pathology departments. After reporting on an informal observation of senior and junior pathologists’ meetings around the multihead microscope in our department, we review the literature on current theories of learning to provide support to the high potential educational value of these meetings for postgraduate training in pathology. We also draw from the literature on learner-centered teaching some recommendations to better support learning in this particular context. Finally, we propose clues for further studies and effective instruction during meetings around a multihead microscope.     

Molecular pathology of gastric cancer: research and practice

Recent advances in the understanding of molecular stomach carcinogenesis are reviewed. As to molecular events in individual mucin phenotypes of gastric cancer, the CDX2-Reg IV-SOX9 pathway is associated with the intestinal mucin phenotype, while OLFM4 and CLDN18 are novel markers for the gastric phenotype. microRNAs play an important role in epigenetic deregulation in gastric cancer. Many microRNAs are up-regulated and down-regulated, and some of these are associated with histological differentiation and cancer progression. Reduced miR-200 may participate in the genesis of diffuse type gastric cancer by reducing E-cadherin expression. Genetic polymorphism is a crucial endogenous cause and a fundamental factor of cancer risk. PSCA polymorphism alters the susceptibility to diffuse type gastric cancer through modulation of cell proliferation activity. Cancer stem cells possess the capacity for self-renewal and cause the heterogeneous lineages of cancer cells. Cancer stem cells also show resistance to anti-tumor chemotherapy. Only a minor population of gastric cancer cells reveals the properties of cancer stem cells, and CD44 is one of the markers for gastric cancer stem cells. The origin of gastric cancer stem cells remains to be elucidated.     

Career choices for pathology: national surveys of graduates of 1974-2002 from UK medical schools

In the past 10 years there has been increasing concern about recruitment of junior doctors into pathology, particularly histopathology, in the UK. In this study, we report on career choices for pathology, derived from postal questionnaire surveys of all qualifiers from all UK medical schools in nine qualification years since 1974. 74% (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. The percentage of doctors choosing pathology 1 year after qualification has fallen sharply in recent years: between 1974 and 1983 it was 4.5% (95% confidence interval 4.1-4.9%) and between 1993 and 2002 it was 2.3% (CI 2.0-2.5%). 57% of doctors who chose pathology 1 year after qualification were still working in pathology at year 10. Hours and conditions of work, the doctor's personal assessment of their aptitudes, and their experience of the subject as a student influenced long-term career choices for pathology. Recruitment of UK graduates into the pathology specialties must increase to meet demand in the new and expanding subspecialties. This depends on developing innovative ways of raising the profile of pathology to medical students and junior hospital doctors.     

The framework of pathology: good laboratory practice by quantitative and molecular methods

Combined confocal laser scan microscopy (CLSM) and Fourier analysis (FA) by non-pathologists of dermal collagen bundle orientation recently gave results superior to subjective evaluation by experts. According to Good Laboratory Practice (GLP) criteria, combined CLSM/FA has not yet been adequately tested to replace current collagen evaluation, but this will not take long. Non-pathologists (clinicians) will then have taken over a laboratory test historically belonging to pathology. A general trend in this direction may develop, because pathologists seem not always to care enough about clinical significance, reproducibility and prognostic value, and new demands for innovative methods. Quantitative image analysis (QIA) and molecular methods are reproducible, inexpensive, and easy to perform; they often have greater value than classical evaluations and their cost-benefit ratio is good. However, their acceptance is not as widespread as one would expect and theoretical reasons which have been advanced do not provide a satisfactory explanation. A formal implementation study was therefore performed, in which an attempt was made to modernize a classical pathology laboratory. An external customer satisfaction investigation showed that 96% of the clinicians were 'very satisfied' (the highest rating possible) with the completed innovations, contrasting with low satisfaction at the beginning. Lack of primary innovative leadership among pathologists was judged to be the dominant cause preventing implementation. Pathologists should focus on carefully reacting to new clinical needs, using GLP criteria. Reproducibility and predictive accuracy should be major themes in any pathology practice.     

Comparative efficacy evaluation of disinfectants routinely used in hospital practice: India

Aim:

The aim of this study was to evaluate and compare practically achieved disinfection efficacy of some locally available disinfectants on surfaces and infectious microbiological hospital waste.

Materials and Methods:

Seven disinfectants were tested at concentrations recommended by manufacturers on rough and smooth surfaces that were contaminated experimentally by locally circulating isolates of methicillin-resistant Staphylococcus aureus, multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter aerogenes, Pseudomonas aeruginosa strains, standard isolate of Salmonella typhi and Candida albicans. Reduction in microbial counts before and after surface disinfection was expressed as log reduction. A very heavy microbial waste load was simulated by immersing culture plates with heavy microbial growth in disinfectants. Daily, a sample of disinfectant was taken and subjected to in-use test.

Results:

The highest average log reduction of test microbes on the rough surface was given by DesNet (5.05) and Bacillocid special (5.02). A comparable average log reduction of test microbes on a smooth steel surface was noted (5.68, 5.67, 5.50) for Lysol, Bacillocid sp. and DesNet, respectively. In the discard jars, Bacillocid special worked satisfactorily for 4 days, DesNet for 3 days and Hi-giene Germitol for 1 day. The remainder of the disinfectants failed in the in-use test on Day 1. Phenolics, although widely used in our settings, may not be as good surface disinfectants as newer formulations like DesNet and Bacillocid special.

Conclusions:

Newer quaternary ammonium compounds and aldehyde formulations were found to be the best disinfectants for disinfection of heavy contamination.