Vol 64 No 2 2024
Page 1
Education in Pathology- A Never Ending Mission
IAP Education Committee Report 2021-2024
Educational programs in all medical specialties, pathology included, have been undergoing modifications dictated by newly acquired knowledge, rapidly evolving technology, and a changing role of the pathologist in medicine. Over the past three years, IAP Education Committee has been carrying on with the primary mission and mandate of IAP in advocating and promoting education in pathology by sponsoring symposia at IAP, USCAP and ECP congresses where presentations and interactive discussions highlighted new knowledge, technological discoveries, and new approaches in education and practice as they apply to pathology.
Digital Pathology & Information Technology in Pathology Education
Digital Pathology has been one of the major technological advances of recent times and this has been topped by Artificial Intelligence which brought pathology practice, teaching and research into new untapped frontiers. Moreover, the COVID pandemic has dramatically accelerated the demand on the utilization of digital pathology and this reflected itself to a great extent in pathology education. In this spirit, the Education Committee sponsored a symposium at USCAP 2021 on “Pathology Education in Time of COVID & Post-COVID” where the speakers, Dr. James K. Stoller, Dr. Walter H. Henricks, Dr. Michael Osborn, and Dr. Gordon G.A. Hutchins- addressed “Megatrends in Education, COVID & Beyond”, “Administrative Aspects of Delivering Education in the COVID/Post-COVID Era”, “Practical Aspects of Delivering Undergraduate and Postgraduate Pathology Teaming in the COVID and Post- COVID Eras”, and “Digital Pathology in the COVID and Post-COVID Eras - from Adversity to Innovation”, respectively.
Realizing the tremendous impact of the COVID pandemic on education and new approaches in teaching, the topic of the proper utilization of digital pathology and informatics was revisited at IAP 2022 in a symposium on “Adapting anatomical pathology training and assessment in the post-COVID era”. Dr. Anita Borges reflected on the changing paradigms in teaching methodologies and summarized the lessons learned from the pandemic times. Prof. Peter Schirmacher tackled the question as why & how academies & schools can promote the development and further education of trainees. Dr. Gary Procop addressed this topic from the perspective of certification of pathology training and he shared his experience at the American Board of Pathology and projected on a bold and bright future for this aspect of education. Dr. Amanda Charlton demonstrated nicely that virtual promiscuous pair programming: An efficient, effective and engaging method to teach histopathology using digital slides. Prof. John Nicholls carried this further by elaborating on an original thought of how Daniel Kahneman’s theory of judgment and decision making can reduce errors in pathology diagnosis.
This key topic of digital pathology and informatics was further built on in another symposium at USCAP 2022 where the emphasis was on “Professional Development & Innovations in Pathology Education to Medical Students and Pathology Trainees”. This was a forum where the speakers shared their experiences with pathology educational platforms and the application of information technology in pathology practice and quality management. Dr. Anil Parwani shared his rich experience in education in a slideless laboratory. Dr. Rifat Mannan & Dr. Emilio Madriga demonstrated their educational platform, pathCast, which highlighted the amazing transformation that is taking place in pathology education and the wealth of information and teaching material that is readily available to trainees at no cost. Prof. Dr. med. Hans H. Kreipe discussed how IT-based models can be utilized for quality assurance in pathology. This session extended its scope by having Dr. Eduardo Alcaraz Mateos demonstrate how to make pathology an interesting specialty to medical students through the amazing technology of simulation and virtual reality. This alternative approach is useful to make the pathology specialty attractive to medical students now that the direct interaction with them has dropped with the changing paradigms within the medical educational curricula.
- Jeffrey Meyers, University of Michigan, presented "Patient and Family Centered Care – An Important Next Step for Pathology"
- Melanie Boise, Mayo Clinic presented "Same Objective, Different Scope: Pathologist-Patient Dialogue in Thoracic Transplantation"
- Lija Joseph, Lowell General Hospital, (not in photo) presented "“Engaging your patient, in their journey to wellness: role of the pathologist”
Artificial Intelligence in Pathology Education
To build on these symposia on digital pathology, it was imperative to follow with one on the “Role of Artificial Intelligence (AI) in Teaching Pathology”; this was held at ECP 2022. Dr. Marcial Garcia shared his insightful views on what should be learnt about digital pathology and AI during pathology residency. Dr. Eric Walk demonstrated useful examples of Al applications in training and practice in diagnostic pathology. Dr. Anil Parwani highlighted the status of digital and computational pathology for clinical applications and teaching in prostate cancer. He reviewed what has been achieved thus far and the challenges of the future. Dr. Jordi Temprana-Salvador indicated that AI can be applied to cytopathology and demonstrated examples of. Dr. Bethany Williams emphasized the importance of incorporating digital pathology training and education in curricula. The discussions that followed the presentations highlighted the important role for pathology professional organizations in developing a curriculum for AI in educational and training programs and to build on platforms such as Pathology Informatics Essentials for Residents (https://www.apcprods.org/). Such objective should prepare the residents well for future practice, licensing and validation of systems as AI being increasingly applied to diagnostic pathology.
Molecular Biology and Pathology
Another major advance in biology and medicine has been molecular medicine which provided the pathologist with a powerful tool in diagnosis and placed him in a key role in the treatment of cancer patients, determining the prognosis of disease, and personalized medicine. Therefore, it is imperative to prepare well the trainees in pathology and to address the challenge for programs where human and technological resources in molecular pathology are limited or unavailable. For this purpose, the symposium at ECP 2021 was on “Molecular Pathology training – present and future challenges”. The speakers covered: what should a board-certified pathologist know about molecular pathology, the challenges in molecular pathology and their impact on training, what is needed to formulate a curriculum in molecular pathology, the training and qualifications for non-pathologist in offering a service, and challenges that are peculiar to developing countries in introducing molecular pathology to their clinical services and incorporating it in the training programs.
In the same venue and realizing that many practicing pathologists have limited access to molecular resources and specific immunohistochemical markers which in today’s practice constitute major tools and parameters in the diagnosis and classification of tumors, the Education Committee is holding a symposium at IAP 2024 on “Demystifying WHO Blue books in support of pathologists with limited resources”. Recognizing tumor subtypes can pose a challenge to pathologists in poor-resourced countries, who may have limited training and experience, it is hoped that the presentations on some of most common tumor types (breast, hematolymphoid, gynecologic and neuropathology), can offer a useful and pragmatic approach in such situations. And with the hope that capacity building will take place in the future to allow the performance of such tests at their work places, based on practical prioritization.
Role of the Pathologist in Clinical Trials and Direct Clinical Care
Involvement of pathologists in the design of clinical trials quite often comes as an afterthought. To heighten the critical role of the pathologist in investigative work as a full and active member of the research team and the fact this approach should be part of postgraduate training, a symposium was held at ECP 2023 on the “Role of pathologists in clinical trials: Practical aspects, education and future perspectives”. Dr. Iris Nagtegaal offered a general view on the role of pathologists in clinical trials. Dr. Tim Kendall covered key aspects and guidelines for the cellular and molecular content of clinical trial by demonstrating a program that he leads for this purpose. Prof. Reinhard Büttner expanded on the guidelines by emphasizing the importance of tissue biomarker evaluation in clinical trials design. Dr. Yukako Yagi demonstrated how digital pathology can be well and usefully utilized in clinical trials. The oncologist perspective on the role of pathologist was appropriately reflected upon by Antonio Llombart-Cussac. The training and accreditation standards for clinical standards were reviewed by Dr. Manuel Salto-Tellez and incorporating such knowledge in educational programs was well outlined by Dr. Abhik Mukherjee.
It is well known that there are geographic differences in the quality of pathology education and many programs suffer because of limited accessibility to educational resources and training opportunities. To explore what measures and means can assist in bridging such gaps, a symposium on “Global capacity building of pathology education through international collaborations” was held at USCAP 2023. Dr. Henry Tazelaar described the Mayo Clinic Experience which offers institutionally sponsored and self-sponsored educational programs that can offer outstanding training opportunities for trainees worldwide. Dr. Reza Alaghehbandan reported on his unique work experience of on-site education and training in extremely under-resourced Asian countries with an amazing and impressive outcome. Dr. Kamran M. Mirza highlighted the utility of digital platforms and social media in undergraduate & postgraduate pathology education. He demonstrated several educational platforms that can be useful to those with limited resources. Dr. Issam Francis & Dr. Ghazi Zaatari emphasized the importance of formative assessment in strengthening postgraduate education and shared their experience with a program offered for free to trainees worldwide through IAP Arab Division. In this context, it is important to bring awareness to the Ambassadorship program that is sponsored by IAP Education Committee. The main objective of this program is to bridge educational gaps and building capacity in underserved communities.
Traditionally the pathologist has been perceived as a professional behind the scene in the medical care of patients but in recent times, this norm is changing and there is advocacy to see the pathologist moving upfront and dealing face to face with the patient in select situations. At USCAP 2024, a symposium on “The Pathologist and the Patient” was held. Dr. Jeffrey Myers shared the pathologist’s interesting and constructive experience in “Patient and Family Centered Care”. Dr. Lija Joseph, a pioneer on this theme, reflected elegantly on the active role of the pathologist in engaging the patient in their journey to wellness. Dr. Melanie Bois shared her pathologist-patient dialogue experience with heart transplant patients and how she shares with them information about their ex-planted heart specimens with rewarding outcome with patients.
Pathologists Changing the World
Not surprisingly, there are many pathologists who have extended their daily work beyond mainstream pathology practice and academic work to include unique work that culminated in global impact on important public health topics, democratizing pathology knowledge beyond conventional means of education, enhancing quality of patient care and diagnosis of disease by utilizing innovative ways in situations of limited resources. To highlight the work of a sample of these pathologists from around the world, two symposia on the theme of “Pathologists changing the world” were scheduled this year. The first was held at ECP 2024 in Florence where Dr. Kamran Mirza (USA) shared the experience with his several social media platforms that are focused on education in pathology with global outreach and the opportunity for training at no cost to pathologists in underserved countries. Dr. Karen Villar Zarra (Spain) described her experience in fine needle aspiration by turning it to an easy and useful tool as point-of-care testing using ultrasound technology. Dr. Andrezej Marszalek (Poland) reported on his crusade to establish a pathology quality assurance program in Poland and the lessons to be learned from this personal experience. I reported on my experience as Chair of the WHO Study Group on Tobacco Product Regulation and the effort it has been undertaking in the global effort on combating the tobacco use epidemic. The second session is scheduled for IAP2024 in Cancun where in addition to Kamran and myself, Dr. Reza Alaghehbandan (USA) and Dr. Catarina Eloy (Lebanon) will be sharing their unique experiences as pathologists and beyond.
Greening the Laboratory
The work of the Committee is incomplete without including a discussion on the very important and contemporary topic of environment and how to extend this to the work place by “Greening the Labs”. At USCAP 2022, Dr. Ilyssa Gordon highlighted and emphasized what pathology residents need to know about the sustainable healthcare delivery movement and its significance during their training as well as during their future careers.
IAP Education Committee strives to fulfill the mission of IAP in global education in pathology by addressing contemporary medical and pathology topics, new technological discoveries, and exploring new horizons to strengthen and diversify educational programs and to offer opportunities to narrow the gaps between developed and underserved communities. It is deeply thankful for the partners in its programs, particularly US-Canadian Academy of Pathology (USCAP) and European Society of Pathology (ESP), and for the large score of professionals who volunteered to share their experience and knowledge during this period.
Ghazi Zaatari
American University of Beirut
June 7, 2024