The College Trainees' Advisory Committee is dedicated to representing the interests of trainees entering their careers as pathologists. This article discusses 5 key challenges facing pathology trainees and highlights the features of excellent training as examples of our vision for the future of pathology training.
Introduction
The Royal College of Pathologists has a particularly wide scope of specialties under its umbrella. While these specialties broadly encompass laboratory medicine, the daily experiences of the doctors and clinical scientists within them are markedly variable. This is further compounded by the exponential expansion of knowledge within each specialty over the past few decades, leading to diverging developments in training and curricula – this diverse cohort is precisely what gives the College strength. Unsurprisingly, within this diversity, there is extensive common ground between specialties in terms of shared goals and challenges that we can all work towards together.
Improving training for all trainees
The Trainees' Advisory Committee (TAC), run by and for trainees and clinical scientist trainees, aims to achieve these shared goals and give time to specialty-specific issues as well. This requires a diverse range of perspectives, with Chair and College oversight.
It will be no surprise to doctors and clinical scientists reading this that recently, for the majority of us, pathology is in a more challenging position. Consistent underfunding – coupled with an overwhelming volume of work – has made day-to-day work and training more difficult. Trainers are being asked to do more, with less time allocated for this. Trainees are being asked to develop more nuanced and complex competencies in an environment that can make facilitating this development challenging.
I hope that sharing of the experiences of TAC members, coupled with my own commentary, may be useful in stimulating further discussions at all levels on the ways in which we can work together to improve training for all. Where do we go from here, then?
Challenge 1: Tackling the prohibitive costs of training
UK resident doctor salaries have not kept up with inflation. The recent work from the BMA around pay restoration, combined with the lengthy strikes in England and the passion seen at local and national meetings regarding pay, has cemented this issue as one of trainees' most important national concerns over the past few years. The associated costs of medicine, such as travel, conferences and courses, continue to be raised at every level by doctors as an unacceptable level of expense.
Trainees are clear regarding their vision for costs of training: core costs necessary for training should be covered by training; pay should be commensurate with work completed; and trainees should not be financially disadvantaged because of their training. For example, members of the TAC fed back that:
...trainees in neuropathology are impacted by the costs of training, including costs associated with courses and examinations. Post-mortem experience depends on where trainees are located, which involves significant travel and financial cost to meet curriculum requirements.
...the Histopathology Part 2 course costs continue to be very expensive and, in some areas, study budgets for the whole of training are used almost exclusively to cover 1 course.
DR RYAN CLARK
Histopathology
Understandably, this is difficult to solve. In the past, it has been all too common either for trainees to shoulder the burden of cost, or for consultants to provide extensive amounts of free work and time. Neither of these are the best solution to this challenge, particularly with rising rates of burnout. Some national-level pay initiatives can, and have, driven forward improvement in this domain. However, it is important to also consider how we in pathology can continue to improve this issue for trainees.
Collaboration and consideration of shared costs is one way in which these issues can be addressed. For example, in Scotland, within histopathology, the regions collaborate frequently on teaching and training. There is an ST1 introductory course, an ST1/2 weekly teaching course, a cervical cytology teaching course run in Glasgow and a neuropathology teaching course run in Edinburgh that all Scottish histopathology trainees can attend. There is then a conference once per year, rotating around Scotland, where trainees can learn from experts all across Scotland and present in person.
Similarly, within microbiology training, initiatives are developing that may also reduce the burden of cost for trainees.
London infection trainees are examining ways to overcome barriers to attending regional training days (including possible financial support). Additionally, they are in conversation with Training Programme Directors (TPDs) to examine ways to gain support from NHS England regarding the cost of training.
A multi-region approach, with appropriate buy-in and remuneration, is an excellent way to reduce costs associated with course attendance. Trainees informally report that they enjoy these courses and find it useful to meet and work with trainees in other areas. However, initiatives like these have multiple pitfalls that need to be fully considered. Local and national consideration of remuneration needs to continue, so that those running and contributing to these courses are not doing so at a personal loss or by staying late to complete other work. Otherwise, there is a definite and important risk of burnout for educators. Furthermore, there is a risk of imbalanced funding between areas such that there is no shared burden of cost.
While these are only some examples, they show the principle of how we may tackle the burden of cost of training and, provide an excellent training experience without breaking the bank for trainees.
Challenge 2: Providing equity of access to training opportunities
Our second training challenge focuses on access to high-quality, timely and detailed training opportunities. This is an area in which there is already great success; training in the pathology specialties continues to be highly rated within the related GMC training surveys. However, with the evolving landscape of consultant and clinical scientist practice within the UK, some important issues continue to arise.
I used the LEPT system ARCP outcome form for the first time yesterday – it was excellent and will save us so much work in the summer!
Summer School has completely changed my view on pathology, which is now one of my top career choices. I enjoyed meeting doctors representing different pathology specialties, but the highlight of the event for me was the pathology quiz - a fun opportunity to network with trainees and students from across the UK.
As we await publication of the Government’s 10-year plan it is vital to recognise the importance of pathology services for the delivery of healthcare and for the Government's ambition to fix and strengthen the NHS. The three shifts to prevention, digitisation and the community will all rely on pathology services to be equipped with the relevant workforce infrastructure, estate and IT.
The College has played a vital role, particularly in the training of MEs and MEOs and the publication of guidance for ME services. I’m sure there will be further challenges ahead but the College is well equipped to meet them.
Remember you are recently trained, bang up-to-date and bring fresh ideas – making you extremely valuable to the team.
We must advise, inform and develop appropriate strategies that are in the best interests of our specialties and members and, above all, essential for patient care.
Taking part in a guideline review was an invaluable learning opportunity. As well as gaining a deeper understanding of the topic and the process, I got the opportunity to influence the guidelines by producing a series of illustrations to make them more accessible to trainees. I also got to work with colleagues from a range of locations and backgrounds. I would really recommend getting involved.
The APPG for Diagnostics was set up to highlight the benefits and promote the greater use of diagnostic testing, and to further promote the diagnostics profession.
- Everything you do as a doctor should be for the benefit of patients.
- Feeling anxious is natural, but you have done the training & passed your exams. You are ready. Believe in yourself.
- Treat everyone you work with whatever their role with respect.
Everyone has something to offer the College, their colleagues and the profession ... I would urge each and every one of you to consider applying to one of these exciting roles.
The College is the members, and it’s only if we members engage that we can achieve things. The more of us that get involved, the stronger we will be. I’d encourage every member who has a view on how we should work or what the future of pathology should be to get involved.
The examples provided by Chris here hit home for me - I experienced and witnessed bullying far too many times during my undergraduate and postgraduate study. Humiliation and belittling behaviour were cited as the most frequent forms of bullying and harassment in both the 2017 and 2018 GMC Trainee surveys and have become ingrained in the culture of training.
The responsibility for tackling bullying shouldn’t just fall on those victimised – we all need to take a stand. ‘Bystanders’ often have the power to diffuse an unpleasant situation that they are witnessing or support the person going through it. As Chris has said, we can and do lose great doctors and scientists to these often preventable incidents: I’d encourage anyone working in pathology to keep their eyes and ears open and to always speak up when witnessing someone being treated with unkindness or disrespect.
COVID-19 vaccines prevented 14.4 million deaths in 185 countries in the first year since their introduction.
This College relies on so many of our trainees, members and fellows working across training and exams, professional guidelines, workforce, governing bodies and committees - hundreds volunteering for the College to make it what it is.
Without them we would not be able to achieve our mission to uphold the highest professional standards across pathology services. This National Volunteers’ Week I would like to take the opportunity to thank them all for their contribution and dedication to the work of the College.
There is a need for ongoing collaboration between relevant professional organisations to ensure updated and explicitly clear guidelines promoting recommendations for fetal RhD screening...
Quality interactions build trust between researchers, clinicians and patients; the failure to seek and value input and feedback can leave interactions being tokenistic.
- Never be afraid to ask or say you don’t know.
- Say no to extra roles for a bit until you decide which you want to do.
- E-portfolios never go away! Set a bit of time in your diary every month to keep on top of it.
- Outlook is your friend - use it well.
Only 55 of the 80 full-time equivalents PPP posts in the UK are filled...
The UK's commitment as a leader in global health is at risk with this cut and the College urges the government to set out how it will continue to galvanise international action on the issue, as described in its strategy to combat AMR, to ensure the gains the programme has made are not lost.
Robust surveillance, prompt diagnosis and good antimicrobial stewardship are essential...
Volunteering gives me variety in my work and reminds me why I enjoy my career as a medical microbiologist. The College has so many free resources on their website that can help you with planning great activities. Other members should get involved to inspire people to pursue pathology as a career. Most of all, it’s really fun!
‘I've been working as a doctor for 10 years, and I've been doing haematology for the last five. I think I really ended up in it by chance. I wanted something that was a bit of a break from constant clinical work and patients. I had done a number of haematology jobs and everyone was always really friendly. I felt like it would be a nice group of people to be a part of, and the patients are great too.
Moving forward, I'm excited to not have to do exams anymore. I just want to keep learning really; it’s one of those specialties where things are always changing. Technology is changing quickly within haematology. It's nice to have some of the really old skills still in use, but also to keep developing and using digital technology and microscopes in a slightly different way.’
- Dr Tania Dexter, new Fellow specialising in haematology.
‘I started medicine when I was 34. I graduated in 2001 and worked in anaesthetics, but unfortunately became unwell with breast cancer so I changed specialty. That's why I've ended up doing pathology, though it was something I was always interested in. As I’m a bit older, the challenge was to get through the exams, but I got there in the end!
My hopes for my time at the College are to continue learning and engaging with everything that's going on. I’d like support with my continuing education, getting advice whilst learning the job as a new consultant and so forth. I’d also like to volunteer to help with supervision training and things like that.’
- Dr Maria Brereton, new Fellow.
I like the new LEPT format for recording workplace learning. It may need more words but it asks us to reflect on what we have done and what we think about next. It helps move towards the learning being the point, not completing the form.
‘I have been practicing pathology since 2014. I was inspired to join the Royal College by members who attending a meeting about the College in my home country, Egypt. I started my training there whilst practicing within UK guidelines. I took my first exam in 2018 and my second in 2022, so it only took four years which felt like a big success. So now I’m here and it’s fun- the dream is fun! It’s worth it and I'd like to encourage anyone to do it.
To become a member of a huge thing like the Royal College of Pathologists is a nice feeling; the feeling of being a part of a family. It's one of the biggest things I have achieved in my life so far.
I started working in the UK three months ago and have been applying what I have studied. It’s a little bit tiring as it’s different to what I’m used to, but it’s a huge step in my career.
In terms of my hopes for my time at the College, I’m planning to publish papers, and to volunteer as an examiner.’
- Dr Nesrin Tolba, new Fellow.
Completely changed my view of pathology. Such an insight.
College members were extremely concerned about workload and workforce issues.
As I had only completed first year and had no prior knowledge of pathology, it was fascinating to attend lectures by professionals across all areas of pathology. In particular, I enjoyed the forensic pathology session. Being able to play detective with some of the extensive number of specimens from the museum was both intriguing and a good challenge. I also got the opportunity to meet people from all different types of backgrounds and, through the quiz night and buffet, had some great conversations! I would highly recommend the summer school, no matter what stage of medical school you're at or which medical school you attend.
Hundreds of GP practices have engaged with ME services and are benefitting from advice about coroner referrals and causes of death, and valuing the support provided to both certifying doctors and bereaved families.
The Transfusion 2024 and BTRU data programmes may be able to achieve some quick wins.
In the words of management guru Roy Lilley, “How do we fix the NHS? Ask frontline staff.”
Hospitals are boring places, they can get you down. People need to talk and sadly we are often too busy.
Unless the multiplicity of issues causing the current workforce are resolved, the crisis in paediatric and perinatal pathology service provision will deepen...
The normal language of blood moves us so easily to anger, violence, fear, punishment, retribution and fundamental primal feelings. And then we walk through the door and say: “Hello, I’m the blood doctor, here to take some blood as you may have something wrong with your blood.”
My hope for the blogs I write is that at least one person reads them and this helps them in some way to have an easier time.
After passing my FRCPath exam, I was grateful to the supportive examination centre team at Newcastle for making my experience bearable despite the pressure. I volunteered as an examiner to pay that experience forward.
I strongly encourage fellow pathologists to engage in this valuable experience, as it not only supports the advancement of our profession but also offers personal and professional growth.
The College has also published several important documents to support ME services...
Now that I’m a member of the College, I’m excited to continue to learn and develop new skills alongside advancements in technology and digital pathology.
– Dr Tania Dexter, new College fellow specialising in haematology.
The Portal is a fabulous pathology community resource and a huge tribute to all of those involved. The sharing of expertise by all our expert contributors and the unparalleled access for learners make this a unique and incredibly valuable facility.
During the biochemistry workshop, we were given case studies to make diagnoses in order to gain a better understanding of this sub-speciality. In addition to increasing my awareness of the role of biochemists, it also made me appreciate how different fields of pathology work together as part of a multi-disciplinary team. A discussion that made an impact on me was one on the impact of technology on the future of pathology particularly relating to precision medicine. It is exciting to imagine a future where diagnosis and treatment are personalised therefore potentially more effective. Overall, the pathology summer school was an incredible experience that I would recommend to medical students interested in the field.
The College has also published several important documents to support ME services...
I have also been broadly interested in research for a long time and felt that doing a project while still at university would help me get involved in future research projects after I graduate.
“This Annual Report is a celebration of pathology and pathologists. It highlights our collective mission in providing the best pathology service we can.”
Bereaved families have welcomed the opportunity to talk to an independent medical examiner about their loved one’s final illness and death.
While exams are seldom a pleasant experience, I want to do what I can to make exams as fair and transparent an experience as possible for candidates.
I have been in training for nearly 10 years, having taken a circuitous route including 2 periods of parental leave and now time out for my PhD. As a result, trainees who commenced training after me have already become consultants. Juggling research, while maintaining my clinical competencies and negotiating life with 2 young children has been challenging. Sometimes, it feels as though I’m not doing particularly well at any of these things!
The RCPath summer school was a kaleidoscopic new experience for me, having not really been exposed to much pathology in my early medical student career. In my eyes, the Gordon Museum stole the show; it was incredible seeing what a polycystic kidney or adenomatous polyposis looks like in the flesh, and holding the specimens yourself was quite something. I ended up going on the tour twice!
Volunteering with the College provides opportunities to work with a wide variety of people across the profession, as well as with non-pathologist College staff, all providing a different perspective. Although there may be divergent views, we all share the same commitment to improving pathology.
Feedback from families has been overwhelmingly positive, with almost everyone welcoming the opportunity to talk to someone about their loved one’s final illness and death.
By identifying those at the greatest risk, more personalised blood management strategies can be developed, tested and employed to improve patient outcomes and reduce healthcare costs.
My secondment was a great personal achievement for me in my career as a scientist and a quality manager of our laboratory. I was posted to the UK National External Quality Assessment (UK NEQAS) laboratory for haematology and transfusion, and the Katherine Dormandy Haemophilia and Thrombosis Centre, where I learned a lot of theoretical and practical applications of quality management systems (QMS). I have made contacts and connections where I can always enquire about anything concerning QMS.
It is important to say that my secondment has really added value to Kaduna NBS in such a way that I can always render quality diagnostic services and training with the knowledge and skills I acquired.
One of our most outstanding achievements is the increased visibility of my clinical scientist colleagues to patient-facing clinicians ... This relationship is vital to achieving better patient testing and outcomes.
As a fellow of the College, I deeply value the sense of community and professional belonging that the College adopts. One of the most enjoyable aspects of being a member is the opportunity to engage with a diverse network of professionals who are equally passionate about advancing the field of pathology.
Feedback from families has been overwhelmingly positive, with almost everyone welcoming the opportunity to talk to someone about their loved one’s final illness and death.
I attended a Microbiology session which was led by a local specialist in infectious diseases. She used examples from her own career to illustrate how pathologists help very sick patients when standard therapies have failed. Returning to these cases keeps me motivated in my own studies.
Working closely with College staff, volunteer members and other stakeholders has highlighted the great skill, commitment and dedication that everyone puts in to help the College deliver work that is vital for healthcare, patients and our membership. So, a huge thank you to everyone for your much valued contributions that are so essential.
By identifying those at the greatest risk, more personalised blood management strategies can be developed, tested and employed to improve patient outcomes and reduce healthcare costs.
It was clear that everyone participating in the event is passionate about pathology, and that made me feel very excited. Not only was I able to learn more about pathology as a career, I was also able to learn about some of the research being conducted now, which was very exciting and interesting to hear. Thank you very much for a great event.
I aspire to specialise in infectious diseases and microbiology, and I found this elective extremely encouraging in working towards this aspiration.
Studies of practice continue to indicate that up to 20% of blood is used outside evidence-based recommendations.
Lab Tests Online-UK is in a unique position to empower patients with supporting a patient-centred approach to delivery of care.
National Pathology Week ran from 19 to 25 June and was once again a huge success.
London infection trainees are examining ways to overcome barriers to attending regional training days (including possible financial support). Additionally, they are in conversation with Training Programme Directors (TPDs) to examine ways to gain support from NHS England regarding the cost of training.
Hundreds of GP practices have engaged with ME services and are benefitting from advice about coroner referrals and causes of death, and valuing the support provided to both certifying doctors and bereaved families.
The UK is not alone in diagnostic and AMS workforce challenges. Reports from the United States and Canada have cited similar challenges...
Most of all, I find it rewarding to be part of this important moment in a trainee’s career, and I try to approach the role with kindness and encouragement to help reduce their anxiety. It’s a privilege to contribute in this way.
June is a 30-year-old lady with Down’s syndrome and hypothyroidism, who is cared for by her brother, Darren. Concerns had been raised over June’s welfare due to her significant recent weight loss at her annual health checks with her general practitioner. Despite multiple attempts over a few years, blood sampling had never been successful, causing increasing distress due to anxiety. Her levothyroxine medication dose could therefore not be monitored appropriately. The introduction of the touch-activated phlebotomy device has transformed the situation and her thyroid function tests are now regularly carried out and thyroxine dose adjusted as appropriate.
Darren commented: “They tried to do the blood test with a needle but as soon as they go to the ‘pump’ on her arm, she knew what was going to happen and she would refuse. My little sister has been scared for over 8 years and that is how long we have been waiting for a blood test. Since we have had this [new method], she has done maybe 4 or 5 of these and sits there good as gold. I would say it is absolutely brilliant!”
I sat the FRCPath Part 2 examination more than once, so I’m aware of what a big step it is in the journey of becoming a histopathologist, and the challenges trainees face while taking the exam.
Concerns facing College members include workload and workforce challenges... alongside training and CPD issues
...the Histopathology Part 2 course costs continue to be very expensive and, in some areas, study budgets for the whole of training are used almost exclusively to cover 1 course.
DR RYAN CLARK
Histopathology
This insight into life as a forensic pathologist and the histopathology training path is very valuable to my career and I am grateful that I had this opportunity.
The College has an important role in engaging and educating the people who make national policies and laws.
The positive way in which the College and its membership had pulled together in response to the COVID-19 pandemic was a subject of well-deserved pride.
I got involved in the BTRU because I wanted to learn more about what goes on behind the scenes in terms of how the research is done, how patient data is processed, and give my opinions based on the experiences I have had so it can be done better for others.
This opportunity allowed me to observe and actively engage with leading experts in the field as well as gaining invaluable insight and practical knowledge. It is a privilege to be recognised by such prestigious organisations.
Having been qualified for less than a year, I know that new consultants are a unique cohort with specific needs relevant to their stage of practice. As the future of the consultant workforce, it is important to support this group with professional, clinical and educational aspects of daily practice that are tailored to their requirements.
Becoming a member of the New Consultants Committee is a great opportunity to help create a supportive and inclusive environment for consultants at the beginning of their careers, setting strong foundations for their future.
– Dr Claire Deakin, Consultant Histopathologist and New Consultants Committee Chair
SHOT data continues to demonstrate deficiencies in processes, culminating in a further national patient safety alert in 2022 that mandated further improvements.
Readily available molecular techniques now support the non-invasive testing of the fetal RHD status from a maternal blood sample...
PPI members are new in the research field; they need time to understand but not to be treated as ignorant. Each member has their ethnic diversities, which may have some influence on how they look at things.
For those trainees engaged in research, the provision of research time comes at the cost of clinical training time, which can place added pressure on trainees.
Studies of practice continue to indicate that up to 20% of blood is used outside evidence-based recommendations.
Becoming a fellow makes me feel more confident in myself. It also gives the users of the service I provide more confidence in our work.
– Dr Victoria Busby, new fellow specialising in genetics and molecular genetics.
It is encouraging to see high levels of haemovigilance reporting in the UK.
There is a lack of data integration across hospitals to enable visibility across the whole blood supply chain.
We are absolutely delighted that the Pathology Portal has won this prestigious award.
This is a wonderful recognition of all those who have supported the Portal, helping it go from strength to strength since its launch in August 2022.
In particular, the award is testament to the Royal College of Pathologists and NHS England Technology Enhanced Learning Project team, and the 100+ editors and contributors who develop content and provide thousands of resources.
If you want to change something you need to help make that change happen. Be realistic; it is a lot of work and takes some time management skills. Speak to people within the College to get a feel of what is involved for the role you are interested in. It is always good to have a new perspective on issues and new members are welcomed; I was.
I am delighted and honoured to be elected as President of the Royal College of Pathologists. Pathology is more important than ever, and as President, I will work to ensure that the work of the College continues to be vital and relevant to members and most importantly to patients. As President, I will strive to ensure I represent all members across all 17 specialties throughout all stages throughout their career. I will make the case for the vital importance of pathology services in healthcare at every available opportunity.
I am so grateful to have had this opportunity, as it helped me to explore the multifactorial determinants of infection and access to healthcare in a much more holistic way than I would ever have understood from staying in the UK.
"You maybe wouldn't believe how often I have thought about this incident, odd how it keeps appearing."
Advancements in technology have enabled us to do things we could not do 10 years ago. We can now easily measure analytes that were previously thought to be very difficult to measure at point of care. Devices that previously filled a room have now been miniaturised to hand size.
“Completing my Medical Examiner Officer training has given me confidence in my job role and a better understanding of the death certification process. This has enabled me to support families through the start of their bereavement journey.
I can honestly say I love my job, as each day I feel I have been able to help someone through one of the most difficult experiences we go through as humans.”
"Your decisions become those to avoid regret and your practice has to continually improve to avoid mistakes."
The Pathology Portal is a fantastic new educational resource for trainees, practising pathologists, scientists and those in pathology-linked roles. Free to use, the new and unique Pathology Portal includes a range of online and interactive educational resources.
The NHS has pledged 'Delivering a net zero' initiative with the aim that directly controlled emissions reach net zero by 2040.
I felt inspired and was particularly impressed that very senior doctors would take the opportunity to talk to us about pathology training.
The story of how Professor Sebastian Lucas impacted the Gwaze trial sent shivers down my spine - and it made me appreciate the true beauty of Pathology.
My elective has solidified my plans to embark on a career as an academic physician.
This annual report reflects some, but by no means all, of the amazing work that has gone on during the year. It highlights the vast range of achievements and brings you summaries of the areas of activity and some of the COVID-19 related work that has gone on.
The Royal College of Pathologists has been instrumental in implementing the medical examiner system, training over 2,500 medical examiners and medical examiner officers. Joining the College as an medical examiner/medical examiner officer member offers an opportunity to continue developing in the role, with access to further educational events and an online community hub, where news and support can be shared.
Multidisciplinary team meetings are crucial but need a radical overhaul. Given the workforce shortages the profession is facing, with 80% of cellular pathologists believing current staffing levels are inadequate to meet growing clinical demand and ensure long-term sustainability of their services, reform is essential to make services more efficient and ensure their focus optimises patient care.
Getting involved with the College keeps your clinical work fresh by giving you a different perspective on that particular activity.
When you become a member of the Royal College of Pathologists (RCPath), you join a community of healthcare professionals dedicated to advancing the pathology profession. Our mission is to work with our members to uphold the highest professional standards across pathology services.
The remits of the medical microbiologist and medical virologist had started to expand quite rapidly due to increased demand for infection expertise at MDTs and expansion of national mandates for control and management of infections...
Bereaved families have welcomed the opportunity to talk to an independent medical examiner about their loved one’s final illness and death.
Haemovigilance entails surveillance of all steps covering the transfusion chain...
‘I work in genetics and molecular genetics, and I've been working towards my fellowship for about eight years. I did my PhD viva first, followed by a project with the 100,000 Genomes Project, analysing metabolic cases that were yet to be diagnosed.
Becoming a Fellow makes me feel more confident in myself. It also gives the users of the service more confidence in our work. My hopes for the future are to keep learning and developing, possibly by going to some of the members’ classes and clinics.’
– Dr Victoria Busby, new Fellow in Genetics.
I’m really excited to become a part of the pathology community at the College, and have the opportunity to volunteer as an examiner.
– Dr Nesrin Tolba, new College fellow.
Here at the College, we are all really proud of the new LEPT system, which has been designed to better support trainees through their training in the 2021 RCPath curricula. It will help trainees reflect their learning and growth across the whole spectrum of CiPs through the years in order to truly demonstrate their progress.
This summer, I had the pleasure of attending the Royal College of Pathologists Summer School in London. To say I have fallen in love with the specialty would be an understatement, I have never become so interested in something so quickly as I have pathology after this experience.
Over 2 days, I took part in multiple academic workshops, in different specialties within the branch of pathology. To see the stark differences between these specialties but also how they integrate into patient care equally well was so eye-opening.
Among these fantastically organised, hands-on workshops, we received talks from leading experts in their respective fields, showcasing what pathology truly has to offer us (after all, pathology is required in ~95% of patient cases!).
I particularly enjoyed the evening of socialising at the Royal College where I could speak with specialists and students in a more informal setting and really appreciate what the specialties can bring to the world of medicine. So many aren’t aware of the lasting impact it can have on patients and other healthcare professionals.
Over the next 2 years, I will be pursuing an SSC and elective in a pathology-based specialty because of this experience! I am so grateful for this experience and anyone remotely thinking of applying, you have absolutely nothing to lose and everything to gain! I wish everyone could experience what I did this summer!
Thank you, Royal College of Pathologists, for showing us what an enjoyable career in medicine could look like.
It is important to prioritise time in the laboratories to observe and understand how tests are done. Increasing access to transfusion courses, time observing biomedical scientists and participating in laboratory meetings is vital.
Diagnostic haematology has been centralised in most areas, with Specialist Integrated Haematological Malignancy Diagnostic Service in tertiary centres providing regional diagnostics. Therefore, if placed in a district general hospital, it can be challenging to maintain your specialist diagnostic and bone marrow morphology skills. Some deaneries have helped overcome this by having lab weeks to provide the opportunity for all trainees to gain experience in diagnostic haematology, which is an exciting and constantly evolving field.
As with all specialties, our workload continues to grow with increasing patient numbers, which is not always reflected in our rotas. There have been plans for redistribution of trainees, which have created uncertainty. With many trainees balancing a busy work and home life, it is easy to be under increased pressure and risk burnout. In some trusts, increased psychological support has been introduced as well as Balint groups to help avoid this.
My objective is to amplify the voices of patients in the work of the NBTC. This will necessitate identifying and responding to patients' perceptions about the provision of transfusion services, making sure that those experiences influence the thinking of the committee members.
The intention of haemovigilance is to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood components.
Another challenge is how to maintain relationships with clinical colleagues at all sites so that any AMS programme has their support. This is a particular challenge when the NHS workforce, in general, is exhausted and depleted on the back of the pandemic. How do we engage our colleagues in the fight against AMR?
The key to the success of these guidelines has been the true collaboration of lab scientists and clinicians...
The Pathology Summer School was an amazing opportunity to reflect on my medical journey and what the future could bring. Like many other attendees, I was motivated to attend out of curiosity. Pathology was only just on my radar. I came out with a deeper understanding of a fascinating and broad specialty with powerful impacts on patient care – but also an understanding of what it means to be a doctor.
Hearing from consultants with decades of experience, openly sharing their journeys and reflections, was something I hadn’t realised I’d been missing in the high-pressure, low-time medical school environment. Sharing with my peers from across the country, united by an interest in the science behind medicine, was a further highlight.
It was a reminder as to why I’d decided to commit to medicine in the first place. I have had my eyes opened to so many exciting possibilities in medicine, and plan to gain more experience in pathology. Whatever the future brings, I feel enriched by my experience on the summer school, and I would heartily recommend it!
The Transfusion 2024 and BTRU data programmes may be able to achieve some quick wins.
The feedback from patients is that they are very keen on CDCs that can deliver diagnostic services that are easy to reach and close to their homes.
My secondment to the UK was a transformative experience that significantly enhanced my professional growth. The opportunity to work alongside renowned experts and immerse myself in a world-class healthcare system broadened my perspectives and deepened my understanding of laboratory medicine.
Since returning to my home country, I've been able to apply the knowledge and skills I acquired to improve our local healthcare practices. At the Synnovis Hub, Daniel Monterio and the entire team taught me about daily meetings, where they discuss the previous day's activities. I saw how helpful it was, so I adopted it for us, where it is working perfectly. It has helped us to improve turnaround times, improved the accuracy and reproducibility of reports in terms of running our controls twice every day, and has also enhanced our patients' satisfaction.
I sincerely thank the College and the ARISE team for this great opportunity to expand my knowledge.
The Pathology Summer School was a fantastic event which really stimulated me to think about pathology in its broadest sense, while helping me to consider future career options. It was also a brilliant opportunity to meet like-minded future colleagues and doctors already involved in pathology. Thanks to all involved!
Only 55 of the 80 full-time equivalents PPP posts in the UK are filled...
None of our achievements, nor any of the work of the College, would be possible without the effort and support of College staff, lay people and the huge number of members who work tirelessly to facilitate all we do. I would like to personally thank everyone involved in the College … for all your help and support.
The College has a long-standing tradition of engaging internationally on global health issues and promoting improvements in pathology.
‘I am a woman of Ghanaian heritage who grew up in Liverpool. I studied undergraduate medicine in the East Midlands and am now training at the North West School of Pathology as a histopathologist.
In future, I would love to be involved in several initiatives that the College currently engages in. I believe that the College is forward-thinking in terms of its public engagement efforts, getting the public interested in the science behind health and the human body. It would be great to be more involved in that.
I also appreciate the College’s collaborative approach to advancing histopathology practices globally. I would enjoy the opportunity to be involved in efforts to advance diagnostic services and practices globally, working with and learning from the experience of colleagues in other countries.’
- Dr Vanessa Djabatey, new Fellow specialising in histopathology.
I realised that my concerns regarding the lack of patient contact were actually concerns that I wouldn’t have a direct impact on patient care. However, this isn’t the case. The histopathologist’s diagnosis has important implications for the patient’s prognosis and management, and therefore their quality of life.
‘I’m a specialist training in pathology, having started in 2017. I took some time out during training to do a master’s in medical education, and I was a teaching Fellow, so it's been a slightly longer process than it otherwise could have been. Becoming a new Fellow is the big achievement that you're really anxious about from day one. It's a rite of passage and can feel impossible at the start so it feels kind of surreal to have done it.
I'm really looking forward to being a Fellow of the Royal College and taking part in everything that the College has available. I’d like to get involved in the education aspect, having done a master’s. I’m particularly interested in new technologies, such as the Pathology Portal and how that’s going to progress.
I’m also interested in digital pathology and making learning more equitable across the country and internationally. Furthermore, in equalising opportunities for all trainees regardless of specialty, or background or where they are.
Throughout my professional career, I hope that the College will provide us with easy to access, up-to-date and efficient updates with regards to advances in the profession, in workflow, in supporting departments and members who are encountering problems (such as workforce issues). I’d like them to bring together experiences across the profession so that we can learn from each other, as it will be a challenging time. There are fewer and fewer pathologists, but more and more work. Best practices and professional guidelines are really important, so I’d like the College to focus on making them equitable and accessible.’
– New Fellow, Anonymous
[Paediatric and perinatal histopathology] is essential for the diagnosis of variety of conditions...
During my ST4 year as a histopathology resident, I co-authored the latest version of the College’s Tissue pathways for cardiovascular pathology. This was an excellent opportunity to learn about the processes involved in clinical guideline development, familiarise myself with the most up-to-date, relevant literature in this field and refine my writing skills for this type of clinical document.
I very much enjoyed working with and learning from other pathologists who share a similar interest in cardiovascular pathology as part of this wider national working group, which also helped to expand my professional network and leadership skills. The public consultation and the implementation webinar activities that followed were also useful to understand the impact of guideline recommendations on service organisation and clinical practice based on feedback and discussions with colleagues from across the country and beyond.
I benefited so much from the experience and I am now co-authoring international guidelines on cardiac explant, in part due to the networks created via the College guidelines I helped to write. I would absolutely recommend getting involved in guideline development – as trainees, we can contribute from a unique perspective to standardising and improving pathology practice for the future.
Working closely with College staff, volunteer members and other stakeholders has highlighted the great skill, commitment and dedication that everyone puts in to help the College deliver work that is vital for healthcare, patients and our membership. So, a huge thank you to everyone for your much valued contributions that are so essential.
SHOT recognises the key role patients play in promoting transfusion safety and has promoted the engagement of patients, their families and carers as safety partners.
..advancement of molecular diagnostic technology has allowed the development of a test that detects the presence of fetal DNA gene in maternal blood and determines the presence or absence of an RhD gene in the fetus.
I want to extend a personal thanks to everyone who took the time to share their thoughts in the Member Survey 2024. At the heart of this survey – and everything we do – is our commitment to our members. We want you to know that we’re listening and taking your feedback seriously. We are dedicated to developing our services to better support, represent and celebrate our members and the profession.
An additional challenge faced by trainees is knowing how and what to prepare for as a consultant. Infection trainees are expected to have sufficient laboratory knowledge to advise and support laboratory staff, while simultaneously building their knowledge base and experience to provide advice to patients in clinics and on hospital wards.
However, progressive centralisation of laboratories has made gaining laboratory experience challenging. Trainees may be required to seek placements in hospitals that have an onsite laboratory. One of the ways to do this is to discuss learning requirements with educational supervisors and training programme directors.
The College is a well-trusted institute; the name implies quality to the highest standard. The more members and fellows who are involved in its activities, the better the College will function.
As the Southeast Asia Advisor, I see my role as a conduit between the fellows of the region and the College. Each region also has several country advisors. Our job is to collect feedback from members about the FRCPath examinations, as well as training and research opportunities in the region.
When we truly understand people we know what to do for them ... Spend 15 minutes with someone, 15 minutes to be curious, to talk, to listen, to understand, to grok them. It will be time well spent.
The new LEPT system is extremely user-friendly and slick in its format. My clinical supervisors as well as competency assessors also found the process easy to navigate and manage. The content was highly relevant to the chemical pathology curriculum, and also enabled easy association with the GMC’s general professional capabilities framework. Furthermore, the administrative team at RCPath were always on hand to answer any queries regarding the new LEPT system in a timely manner.
The NHS workforce, in general, is exhausted and depleted on the back of the pandemic. How, then, do we engage our colleagues in the fight against AMR?
It is a privilege to witness firsthand the dedication, talent and enthusiasm of future specialists. This role gives me the chance to give back to the institution that played a formative role in shaping the pathologist I am today.
...trainees in neuropathology are impacted by the costs of training, including costs associated with courses and examinations. Post-mortem experience depends on where trainees are located, which involves significant travel and financial cost to meet curriculum requirements.
[Paediatric and perinatal histopathology] is essential for the diagnosis of variety of conditions...
I think a key challenge is achieving greater acceptance and appreciation of the clinical scientist role and harnessing its full potential. One solution could be to enable clinical scientists to prescribe via the Patient Group Directive mechanism. This offers huge potential for expansion of their current clinical roles and the opportunity to work in greater partnership with medical colleagues.
There is a lack of data integration across hospitals to enable visibility across the whole blood supply chain.
Oral and maxillofacial pathology is a small specialty; because of this, we sometimes face a lack of understanding. On entering the specialty, one issue sometimes faced is the geographical limitation that comes with few available training places. Issues are also experienced with recruitment, as there is a lack of dental core training posts available, meaning few people get to gain experience of our specialty.
I feel more confident chairing meetings and speaking in public. I am learning more about governance and how the different bodies interact with each other.
I thought the workshops were well organised and the staff were very friendly. After attending the event, I am now strongly considering a career in pathology.
I think it can be difficult for trainees to take up training opportunities, such as attending transfusion meetings or observing biomedical scientists in the laboratory, in the context of urgent and demanding clinical commitments on the wards and in clinics. However, we need to prioritise and ring-fence transfusion training now to prevent future knowledge gaps in this important facet of haematology training.
The Transfusion Specialty Advisory Committee is working with other stakeholder organisations and trainees towards solutions to improve transfusion training. We will be looking to introduce more transfusion posts, resources to signpost transfusion training opportunities in hospital rotations and educational materials with a particular focus on hospital transfusion laboratory cases and management.
The College has played a vital role, particularly in the training of MEs and MEOs and the publication of guidance for ME services. I’m sure there will be further challenges ahead but the College is well equipped to meet them.
‘I'm now a consultant histopathologist in Oxford. I completed my Fellowship about a year ago, but couldn't come to the award ceremony because I had a very young daughter who was unfortunately too young for the College crèche.
It was really nice to come today and experience a Fellowship ceremony – my belated graduation. I also won the Silver Research Medal in cellular pathology for some work that I did during my PhD, which was finished in 2020. Though it's a few years ago now, it was nice to get some recognition for all that hard work.
About 18 months ago I went to the New Consultant's Day, which I found very useful. I think it's a really good initiative, because the step up from trainee to consultant felt quite large at the time. We received advice from people who had done that transition recently. They let us know about the sort of things that we might not even be aware about: management, business cases, financial planning, and what you’ll be expected to do. So that was really helpful.
Going forward, I think any similar ideas or events that the College can do to support consultants is really important because it's quite an intense period of your career. Adapting to that change with support is really valuable.
The College regulates our activities and as long as they keep doing what they're doing, that's what we need them to do. In the future, if time and energy permits, I could get involved with College initiatives. It's definitely something I would consider doing when I’m less tied up with clinical responsibilities.
I think the College just needs to keep letting its fellows know what opportunities there are to volunteer, as people will definitely want to take those up in due course.’
- Philip Macklin, Silver Research Medal prize winner.
The stakes are high to ensure smooth running for candidates to perform at their best, given their sacrifices and pressures. This drives me to continue despite the demands from our diagnostic service. Finding time to examine is a challenge, but the work is rewarding and motivating.
It is a privilege to lead the new specialty of medical examiners. Once again, I am delighted to have the Royal College of Pathologists' support in promoting good practice. The Good Practice Series will ensure consistency and high standards are maintained and each instalment has the benefit of subject matter expert input. I hope the resource will be of value outside the medical examiner office as well.
Becoming a fellow of the College is vitally important for pathology. As pathologists, we save lives every day. We diagnose every day. We make an impact every day. Your career is defined not by what you do for yourself, but what you do for others. For your colleagues, your patients, your profession. Thank you for becoming a member of the College.
So much talent, so much potential, so many opportunities. All of this is vitally dependent on their College continuing to be relevant, potent and driven by their involvement – their careers and professional wellbeing depends on it.
To anyone interested [in volunteering], I would say to go for it! It not only broadens your knowledge of the expansive world of pathology, but you may also gain a valuable support group. Volunteering for QAPC and NQAAP positions allows us to play an integral part of shaping our growing services.
I would like to congratulate and thank everyone involved in our work − members and staff alike − for their considerable efforts during this difficult time.
Do not attempt to write about too many things. One or two points well-made will usually be better.
No test is routine, no results can come quick enough. Keep people informed, be there, be available and know what you are going to do with the results when they come.
Unless the multiplicity of issues causing the current workforce are resolved, the crisis in paediatric and perinatal pathology service provision will deepen...
The main challenge for pathology across the UK is providing adequate services against a backdrop of inadequate numbers of staff and limited funding...
Being disabled within histopathology is consistently challenging. There are so many issues that I experience that have either been considered rarely or never before. It can be exhausting to constantly highlight and challenge these issues. However, there are so many areas of good practice that should be highlighted too!
Dr Ryan Clark
Histopathology
Day two offered captivating talks on neuropathology and microbiology, then ended with a tour of the world-famous Gordon’s Museum of Pathology. I was filled with both awe and dread as I walked through its galleries of specimens dating from the 19th and 20th century. It was a gripping portrayal of life, death and disease, and I’d like to go as far as describing it as a pilgrimage for medical students.
Pathology services underpin healthcare from cradle to grave and will be central to delivering the 3 shifts in the plan. Pathologists and scientists play a vital role across all stages of patient care, including disease prevention and screening, diagnosis, treatment and monitoring.
Bringing vital diagnostic services closer to people's neighbourhoods has the potential to reduce delays and enable quicker clinical decision making. This will provide greater convenience and better health outcomes.
The College welcomes the publication of this plan at a time when NHS services face significant pressure, with many patients still experiencing delays in diagnosis and access to treatment.
Being entrusted with upholding the standards of our profession, ensuring consistency and integrity, and supporting the next generation of consultants is both humbling and fulfilling.
Examining candidates has been one of the most fulfilling and meaningful volunteer roles I have undertaken within the College.
Being a microbiologist involves being a detective; you take the clues given by the clinician speaking to you, or by examining the patient yourself and formulate a diagnosis and management plan. Quite often you are lucky and obtain the “evidence” for your diagnosis by way of laboratory results.
The haematology break out session was very interactive and taking a 'bone marrow' biopsy from an apple was definitely an interesting experience! The quiz and buffet rounded of the end of a very well organised and informative event.
For new trainees, who tend to have significant clinical experience, laboratory medicine can feel unfamiliar. The limited training and support available at the start of ST3 can be daunting. To address this, my colleagues and I have developed a series of introductory lectures designed to help new ST3s hit the ground running, providing them with a solid foundation in the specialty.
I have found the Pathology Portal incredibly beneficial to my learning and only wish it had been available to me when I was preparing for my exams. There is an abundance of excellent quality, well-annotated images and scanned slides, and helpful Q&As which highlight differentials and potential pitfalls. The pearls of wisdom are overflowing.
I think it's brilliant to have this integration of different pathology subspecialties and this collaboration of experts from varying fields, with the common goal of teaching the next wave of pathologists. I recommend it to every trainee I meet, and consultants as well.
Many trainees report subspecialty-specific barriers to training, most commonly in renal and hepato-pancreato-biliary pathology. A key cause of this may be that these 2 areas suffer from understaffing at consultant level in most areas in the UK. Devoting time to training juniors is challenging and so many trainees receive suboptimal exposure. This leads to a lack of interest, contributing to the consultant staffing issue.
Ensuring that laboratories participate in EQA schemes, and monitoring their performance, is integral to both patient safety and patient experience. This is something I am very passionate about. Patients should be reassured that, whichever pathology laboratory they are referred to, they will receive the highest standard of testing possible and be given accurate results.
The shift of diagnostic testing closer to the community and the patient is a direction indicated by the 10-year health plan and which empowers patients to become more involved in their own healthcare. Such testing needs however to be appropriate (clinically indicated and useful) and using tests/devices that are regulated and of sufficient quality.
Direct to consumer testing, chosen and carried out by patients and pushed by the private/commercial sector remains largely unclear when such issues around quality, regulation and appropriteness are considered. There are significant risks to patients when poor quality tests are carried out inappropriately, with both false reassurance and unncessary knock-on consequences for the NHS to repeat tests or take additional action.
Vitamin D tests, in particular are very much overused across the UK, with hundreds of millions of pounds spent every year within the NHS on both testing and prescriptions for vitamin D supplements. Encouraging patients to do more testing at home can only add to this unnecessary burden, especially if the quality of such tests cannot be relied upon.'
I became involved in the BTRU research programme because l felt that I wanted to use my lived experience as an NHS patient to help shape and steer health research for the benefit of all. Being of Black African ethnicity, I endeavour to provide representation from a diverse perspective and promote inclusivity in pursuit of helping to reduce health inequalities. I would like all clinical staff and researchers to know and appreciate the positive and valuable benefits that patient and public interaction can bring. Progress best occurs when a voice is not just heard but is listened to and engaged. PPIE seeks to provide that important communication forum.
Inevitably, the COVID-19 pandemic slowed the uptake of the test in some hospital antenatal services, but there is now a steady increase in adoption in units across England within their antenatal screening programmes.
Your role [as a clinical scientist] is every bit as critical to that patient as the clinician choosing the tests and delivering the news with the outcome of those results.
We stated our intent for continued involvement in any further discussions, to further support our members in providing an excellent service to patients.
Lab Tests Online-UK is in a unique position to empower patients with supporting a patient-centred approach to delivery of care.
For new trainees, who tend to have significant clinical experience, laboratory medicine can feel unfamiliar. The limited training and support available at the start of ST3 can be daunting. To address this, my colleagues and I have developed a series of introductory lectures designed to help new ST3s hit the ground running, providing them with a solid foundation in the specialty.
Trainee-led initiatives
Frequently, entry and exit from training – where there is a graded adjustment of responsibility – are key transition points where these issues tend to arise. No matter the medical specialty, this progression is difficult for trainees, and there is extensive literature on how we can better tackle these transition points. Some examples of trainee-led and trainee-focused initiatives for this include collaborative introductory lectures for all trainees to help with the transition into laboratory medicine and training days for specific regions. The Pathology Portal has been used in some specialties to facilitate this, too. It is an area that is perhaps fruitful for national, College-supported initiatives to improve these transition point experiences further.
Post-mortem examinations are consistently one of the most raised issues within all histopathology specialties. In an environment where there are fewer and fewer post-mortem examinations, with increasing use of CT scanning and centralisation of services in areas, this will continue to be an issue that requires innovative solutions.
While there are local/regional agreements and plans in place, these are not without issues, particularly financial ones. This is something that has been, and continues to be, raised and considered at TAC meetings and will continue to be a priority for TAC representatives for histopathology-associated specialties. See the articles in this issue from Dr Erin Whyte and Dr Esther Youd for more reflections on autopsy training.
Challenge 3: Exposure to specialties and tackling recruitment issues
There are 2 components to this third challenge: recruitment into specialties (with exposure at undergraduate and foundation level as a determinant of interest) and exposure to areas within a specialty that may be traditionally underrepresented. Several TAC members discuss this issue below.
I used the LEPT system ARCP outcome form for the first time yesterday – it was excellent and will save us so much work in the summer!
Summer School has completely changed my view on pathology, which is now one of my top career choices. I enjoyed meeting doctors representing different pathology specialties, but the highlight of the event for me was the pathology quiz - a fun opportunity to network with trainees and students from across the UK.
As we await publication of the Government’s 10-year plan it is vital to recognise the importance of pathology services for the delivery of healthcare and for the Government's ambition to fix and strengthen the NHS. The three shifts to prevention, digitisation and the community will all rely on pathology services to be equipped with the relevant workforce infrastructure, estate and IT.
The College has played a vital role, particularly in the training of MEs and MEOs and the publication of guidance for ME services. I’m sure there will be further challenges ahead but the College is well equipped to meet them.
Remember you are recently trained, bang up-to-date and bring fresh ideas – making you extremely valuable to the team.
We must advise, inform and develop appropriate strategies that are in the best interests of our specialties and members and, above all, essential for patient care.
Taking part in a guideline review was an invaluable learning opportunity. As well as gaining a deeper understanding of the topic and the process, I got the opportunity to influence the guidelines by producing a series of illustrations to make them more accessible to trainees. I also got to work with colleagues from a range of locations and backgrounds. I would really recommend getting involved.
The APPG for Diagnostics was set up to highlight the benefits and promote the greater use of diagnostic testing, and to further promote the diagnostics profession.
- Everything you do as a doctor should be for the benefit of patients.
- Feeling anxious is natural, but you have done the training & passed your exams. You are ready. Believe in yourself.
- Treat everyone you work with whatever their role with respect.
Everyone has something to offer the College, their colleagues and the profession ... I would urge each and every one of you to consider applying to one of these exciting roles.
The College is the members, and it’s only if we members engage that we can achieve things. The more of us that get involved, the stronger we will be. I’d encourage every member who has a view on how we should work or what the future of pathology should be to get involved.
The examples provided by Chris here hit home for me - I experienced and witnessed bullying far too many times during my undergraduate and postgraduate study. Humiliation and belittling behaviour were cited as the most frequent forms of bullying and harassment in both the 2017 and 2018 GMC Trainee surveys and have become ingrained in the culture of training.
The responsibility for tackling bullying shouldn’t just fall on those victimised – we all need to take a stand. ‘Bystanders’ often have the power to diffuse an unpleasant situation that they are witnessing or support the person going through it. As Chris has said, we can and do lose great doctors and scientists to these often preventable incidents: I’d encourage anyone working in pathology to keep their eyes and ears open and to always speak up when witnessing someone being treated with unkindness or disrespect.
COVID-19 vaccines prevented 14.4 million deaths in 185 countries in the first year since their introduction.
This College relies on so many of our trainees, members and fellows working across training and exams, professional guidelines, workforce, governing bodies and committees - hundreds volunteering for the College to make it what it is.
Without them we would not be able to achieve our mission to uphold the highest professional standards across pathology services. This National Volunteers’ Week I would like to take the opportunity to thank them all for their contribution and dedication to the work of the College.
There is a need for ongoing collaboration between relevant professional organisations to ensure updated and explicitly clear guidelines promoting recommendations for fetal RhD screening...
Quality interactions build trust between researchers, clinicians and patients; the failure to seek and value input and feedback can leave interactions being tokenistic.
- Never be afraid to ask or say you don’t know.
- Say no to extra roles for a bit until you decide which you want to do.
- E-portfolios never go away! Set a bit of time in your diary every month to keep on top of it.
- Outlook is your friend - use it well.
Only 55 of the 80 full-time equivalents PPP posts in the UK are filled...
The UK's commitment as a leader in global health is at risk with this cut and the College urges the government to set out how it will continue to galvanise international action on the issue, as described in its strategy to combat AMR, to ensure the gains the programme has made are not lost.
Robust surveillance, prompt diagnosis and good antimicrobial stewardship are essential...
Volunteering gives me variety in my work and reminds me why I enjoy my career as a medical microbiologist. The College has so many free resources on their website that can help you with planning great activities. Other members should get involved to inspire people to pursue pathology as a career. Most of all, it’s really fun!
‘I've been working as a doctor for 10 years, and I've been doing haematology for the last five. I think I really ended up in it by chance. I wanted something that was a bit of a break from constant clinical work and patients. I had done a number of haematology jobs and everyone was always really friendly. I felt like it would be a nice group of people to be a part of, and the patients are great too.
Moving forward, I'm excited to not have to do exams anymore. I just want to keep learning really; it’s one of those specialties where things are always changing. Technology is changing quickly within haematology. It's nice to have some of the really old skills still in use, but also to keep developing and using digital technology and microscopes in a slightly different way.’
- Dr Tania Dexter, new Fellow specialising in haematology.
‘I started medicine when I was 34. I graduated in 2001 and worked in anaesthetics, but unfortunately became unwell with breast cancer so I changed specialty. That's why I've ended up doing pathology, though it was something I was always interested in. As I’m a bit older, the challenge was to get through the exams, but I got there in the end!
My hopes for my time at the College are to continue learning and engaging with everything that's going on. I’d like support with my continuing education, getting advice whilst learning the job as a new consultant and so forth. I’d also like to volunteer to help with supervision training and things like that.’
- Dr Maria Brereton, new Fellow.
I like the new LEPT format for recording workplace learning. It may need more words but it asks us to reflect on what we have done and what we think about next. It helps move towards the learning being the point, not completing the form.
‘I have been practicing pathology since 2014. I was inspired to join the Royal College by members who attending a meeting about the College in my home country, Egypt. I started my training there whilst practicing within UK guidelines. I took my first exam in 2018 and my second in 2022, so it only took four years which felt like a big success. So now I’m here and it’s fun- the dream is fun! It’s worth it and I'd like to encourage anyone to do it.
To become a member of a huge thing like the Royal College of Pathologists is a nice feeling; the feeling of being a part of a family. It's one of the biggest things I have achieved in my life so far.
I started working in the UK three months ago and have been applying what I have studied. It’s a little bit tiring as it’s different to what I’m used to, but it’s a huge step in my career.
In terms of my hopes for my time at the College, I’m planning to publish papers, and to volunteer as an examiner.’
- Dr Nesrin Tolba, new Fellow.
Completely changed my view of pathology. Such an insight.
College members were extremely concerned about workload and workforce issues.
As I had only completed first year and had no prior knowledge of pathology, it was fascinating to attend lectures by professionals across all areas of pathology. In particular, I enjoyed the forensic pathology session. Being able to play detective with some of the extensive number of specimens from the museum was both intriguing and a good challenge. I also got the opportunity to meet people from all different types of backgrounds and, through the quiz night and buffet, had some great conversations! I would highly recommend the summer school, no matter what stage of medical school you're at or which medical school you attend.
Hundreds of GP practices have engaged with ME services and are benefitting from advice about coroner referrals and causes of death, and valuing the support provided to both certifying doctors and bereaved families.
The Transfusion 2024 and BTRU data programmes may be able to achieve some quick wins.
In the words of management guru Roy Lilley, “How do we fix the NHS? Ask frontline staff.”
Hospitals are boring places, they can get you down. People need to talk and sadly we are often too busy.
Unless the multiplicity of issues causing the current workforce are resolved, the crisis in paediatric and perinatal pathology service provision will deepen...
The normal language of blood moves us so easily to anger, violence, fear, punishment, retribution and fundamental primal feelings. And then we walk through the door and say: “Hello, I’m the blood doctor, here to take some blood as you may have something wrong with your blood.”
My hope for the blogs I write is that at least one person reads them and this helps them in some way to have an easier time.
After passing my FRCPath exam, I was grateful to the supportive examination centre team at Newcastle for making my experience bearable despite the pressure. I volunteered as an examiner to pay that experience forward.
I strongly encourage fellow pathologists to engage in this valuable experience, as it not only supports the advancement of our profession but also offers personal and professional growth.
The College has also published several important documents to support ME services...
Now that I’m a member of the College, I’m excited to continue to learn and develop new skills alongside advancements in technology and digital pathology.
– Dr Tania Dexter, new College fellow specialising in haematology.
The Portal is a fabulous pathology community resource and a huge tribute to all of those involved. The sharing of expertise by all our expert contributors and the unparalleled access for learners make this a unique and incredibly valuable facility.
During the biochemistry workshop, we were given case studies to make diagnoses in order to gain a better understanding of this sub-speciality. In addition to increasing my awareness of the role of biochemists, it also made me appreciate how different fields of pathology work together as part of a multi-disciplinary team. A discussion that made an impact on me was one on the impact of technology on the future of pathology particularly relating to precision medicine. It is exciting to imagine a future where diagnosis and treatment are personalised therefore potentially more effective. Overall, the pathology summer school was an incredible experience that I would recommend to medical students interested in the field.
The College has also published several important documents to support ME services...
I have also been broadly interested in research for a long time and felt that doing a project while still at university would help me get involved in future research projects after I graduate.
“This Annual Report is a celebration of pathology and pathologists. It highlights our collective mission in providing the best pathology service we can.”
Bereaved families have welcomed the opportunity to talk to an independent medical examiner about their loved one’s final illness and death.
While exams are seldom a pleasant experience, I want to do what I can to make exams as fair and transparent an experience as possible for candidates.
I have been in training for nearly 10 years, having taken a circuitous route including 2 periods of parental leave and now time out for my PhD. As a result, trainees who commenced training after me have already become consultants. Juggling research, while maintaining my clinical competencies and negotiating life with 2 young children has been challenging. Sometimes, it feels as though I’m not doing particularly well at any of these things!
The RCPath summer school was a kaleidoscopic new experience for me, having not really been exposed to much pathology in my early medical student career. In my eyes, the Gordon Museum stole the show; it was incredible seeing what a polycystic kidney or adenomatous polyposis looks like in the flesh, and holding the specimens yourself was quite something. I ended up going on the tour twice!
Volunteering with the College provides opportunities to work with a wide variety of people across the profession, as well as with non-pathologist College staff, all providing a different perspective. Although there may be divergent views, we all share the same commitment to improving pathology.
Feedback from families has been overwhelmingly positive, with almost everyone welcoming the opportunity to talk to someone about their loved one’s final illness and death.
By identifying those at the greatest risk, more personalised blood management strategies can be developed, tested and employed to improve patient outcomes and reduce healthcare costs.
My secondment was a great personal achievement for me in my career as a scientist and a quality manager of our laboratory. I was posted to the UK National External Quality Assessment (UK NEQAS) laboratory for haematology and transfusion, and the Katherine Dormandy Haemophilia and Thrombosis Centre, where I learned a lot of theoretical and practical applications of quality management systems (QMS). I have made contacts and connections where I can always enquire about anything concerning QMS.
It is important to say that my secondment has really added value to Kaduna NBS in such a way that I can always render quality diagnostic services and training with the knowledge and skills I acquired.
One of our most outstanding achievements is the increased visibility of my clinical scientist colleagues to patient-facing clinicians ... This relationship is vital to achieving better patient testing and outcomes.
As a fellow of the College, I deeply value the sense of community and professional belonging that the College adopts. One of the most enjoyable aspects of being a member is the opportunity to engage with a diverse network of professionals who are equally passionate about advancing the field of pathology.
Feedback from families has been overwhelmingly positive, with almost everyone welcoming the opportunity to talk to someone about their loved one’s final illness and death.
I attended a Microbiology session which was led by a local specialist in infectious diseases. She used examples from her own career to illustrate how pathologists help very sick patients when standard therapies have failed. Returning to these cases keeps me motivated in my own studies.
Working closely with College staff, volunteer members and other stakeholders has highlighted the great skill, commitment and dedication that everyone puts in to help the College deliver work that is vital for healthcare, patients and our membership. So, a huge thank you to everyone for your much valued contributions that are so essential.
By identifying those at the greatest risk, more personalised blood management strategies can be developed, tested and employed to improve patient outcomes and reduce healthcare costs.
It was clear that everyone participating in the event is passionate about pathology, and that made me feel very excited. Not only was I able to learn more about pathology as a career, I was also able to learn about some of the research being conducted now, which was very exciting and interesting to hear. Thank you very much for a great event.
I aspire to specialise in infectious diseases and microbiology, and I found this elective extremely encouraging in working towards this aspiration.
Studies of practice continue to indicate that up to 20% of blood is used outside evidence-based recommendations.
Lab Tests Online-UK is in a unique position to empower patients with supporting a patient-centred approach to delivery of care.
National Pathology Week ran from 19 to 25 June and was once again a huge success.
London infection trainees are examining ways to overcome barriers to attending regional training days (including possible financial support). Additionally, they are in conversation with Training Programme Directors (TPDs) to examine ways to gain support from NHS England regarding the cost of training.
Hundreds of GP practices have engaged with ME services and are benefitting from advice about coroner referrals and causes of death, and valuing the support provided to both certifying doctors and bereaved families.
The UK is not alone in diagnostic and AMS workforce challenges. Reports from the United States and Canada have cited similar challenges...
Most of all, I find it rewarding to be part of this important moment in a trainee’s career, and I try to approach the role with kindness and encouragement to help reduce their anxiety. It’s a privilege to contribute in this way.
June is a 30-year-old lady with Down’s syndrome and hypothyroidism, who is cared for by her brother, Darren. Concerns had been raised over June’s welfare due to her significant recent weight loss at her annual health checks with her general practitioner. Despite multiple attempts over a few years, blood sampling had never been successful, causing increasing distress due to anxiety. Her levothyroxine medication dose could therefore not be monitored appropriately. The introduction of the touch-activated phlebotomy device has transformed the situation and her thyroid function tests are now regularly carried out and thyroxine dose adjusted as appropriate.
Darren commented: “They tried to do the blood test with a needle but as soon as they go to the ‘pump’ on her arm, she knew what was going to happen and she would refuse. My little sister has been scared for over 8 years and that is how long we have been waiting for a blood test. Since we have had this [new method], she has done maybe 4 or 5 of these and sits there good as gold. I would say it is absolutely brilliant!”
I sat the FRCPath Part 2 examination more than once, so I’m aware of what a big step it is in the journey of becoming a histopathologist, and the challenges trainees face while taking the exam.
Concerns facing College members include workload and workforce challenges... alongside training and CPD issues
...the Histopathology Part 2 course costs continue to be very expensive and, in some areas, study budgets for the whole of training are used almost exclusively to cover 1 course.
DR RYAN CLARK
Histopathology
This insight into life as a forensic pathologist and the histopathology training path is very valuable to my career and I am grateful that I had this opportunity.
The College has an important role in engaging and educating the people who make national policies and laws.
The positive way in which the College and its membership had pulled together in response to the COVID-19 pandemic was a subject of well-deserved pride.
I got involved in the BTRU because I wanted to learn more about what goes on behind the scenes in terms of how the research is done, how patient data is processed, and give my opinions based on the experiences I have had so it can be done better for others.
This opportunity allowed me to observe and actively engage with leading experts in the field as well as gaining invaluable insight and practical knowledge. It is a privilege to be recognised by such prestigious organisations.
Having been qualified for less than a year, I know that new consultants are a unique cohort with specific needs relevant to their stage of practice. As the future of the consultant workforce, it is important to support this group with professional, clinical and educational aspects of daily practice that are tailored to their requirements.
Becoming a member of the New Consultants Committee is a great opportunity to help create a supportive and inclusive environment for consultants at the beginning of their careers, setting strong foundations for their future.
– Dr Claire Deakin, Consultant Histopathologist and New Consultants Committee Chair
SHOT data continues to demonstrate deficiencies in processes, culminating in a further national patient safety alert in 2022 that mandated further improvements.
Readily available molecular techniques now support the non-invasive testing of the fetal RHD status from a maternal blood sample...
PPI members are new in the research field; they need time to understand but not to be treated as ignorant. Each member has their ethnic diversities, which may have some influence on how they look at things.
For those trainees engaged in research, the provision of research time comes at the cost of clinical training time, which can place added pressure on trainees.
Studies of practice continue to indicate that up to 20% of blood is used outside evidence-based recommendations.
Becoming a fellow makes me feel more confident in myself. It also gives the users of the service I provide more confidence in our work.
– Dr Victoria Busby, new fellow specialising in genetics and molecular genetics.
It is encouraging to see high levels of haemovigilance reporting in the UK.
There is a lack of data integration across hospitals to enable visibility across the whole blood supply chain.
We are absolutely delighted that the Pathology Portal has won this prestigious award.
This is a wonderful recognition of all those who have supported the Portal, helping it go from strength to strength since its launch in August 2022.
In particular, the award is testament to the Royal College of Pathologists and NHS England Technology Enhanced Learning Project team, and the 100+ editors and contributors who develop content and provide thousands of resources.
If you want to change something you need to help make that change happen. Be realistic; it is a lot of work and takes some time management skills. Speak to people within the College to get a feel of what is involved for the role you are interested in. It is always good to have a new perspective on issues and new members are welcomed; I was.
I am delighted and honoured to be elected as President of the Royal College of Pathologists. Pathology is more important than ever, and as President, I will work to ensure that the work of the College continues to be vital and relevant to members and most importantly to patients. As President, I will strive to ensure I represent all members across all 17 specialties throughout all stages throughout their career. I will make the case for the vital importance of pathology services in healthcare at every available opportunity.
I am so grateful to have had this opportunity, as it helped me to explore the multifactorial determinants of infection and access to healthcare in a much more holistic way than I would ever have understood from staying in the UK.
"You maybe wouldn't believe how often I have thought about this incident, odd how it keeps appearing."
Advancements in technology have enabled us to do things we could not do 10 years ago. We can now easily measure analytes that were previously thought to be very difficult to measure at point of care. Devices that previously filled a room have now been miniaturised to hand size.
“Completing my Medical Examiner Officer training has given me confidence in my job role and a better understanding of the death certification process. This has enabled me to support families through the start of their bereavement journey.
I can honestly say I love my job, as each day I feel I have been able to help someone through one of the most difficult experiences we go through as humans.”
"Your decisions become those to avoid regret and your practice has to continually improve to avoid mistakes."
The Pathology Portal is a fantastic new educational resource for trainees, practising pathologists, scientists and those in pathology-linked roles. Free to use, the new and unique Pathology Portal includes a range of online and interactive educational resources.
The NHS has pledged 'Delivering a net zero' initiative with the aim that directly controlled emissions reach net zero by 2040.
I felt inspired and was particularly impressed that very senior doctors would take the opportunity to talk to us about pathology training.
The story of how Professor Sebastian Lucas impacted the Gwaze trial sent shivers down my spine - and it made me appreciate the true beauty of Pathology.
My elective has solidified my plans to embark on a career as an academic physician.
This annual report reflects some, but by no means all, of the amazing work that has gone on during the year. It highlights the vast range of achievements and brings you summaries of the areas of activity and some of the COVID-19 related work that has gone on.
The Royal College of Pathologists has been instrumental in implementing the medical examiner system, training over 2,500 medical examiners and medical examiner officers. Joining the College as an medical examiner/medical examiner officer member offers an opportunity to continue developing in the role, with access to further educational events and an online community hub, where news and support can be shared.
Multidisciplinary team meetings are crucial but need a radical overhaul. Given the workforce shortages the profession is facing, with 80% of cellular pathologists believing current staffing levels are inadequate to meet growing clinical demand and ensure long-term sustainability of their services, reform is essential to make services more efficient and ensure their focus optimises patient care.
Getting involved with the College keeps your clinical work fresh by giving you a different perspective on that particular activity.
When you become a member of the Royal College of Pathologists (RCPath), you join a community of healthcare professionals dedicated to advancing the pathology profession. Our mission is to work with our members to uphold the highest professional standards across pathology services.
The remits of the medical microbiologist and medical virologist had started to expand quite rapidly due to increased demand for infection expertise at MDTs and expansion of national mandates for control and management of infections...
Bereaved families have welcomed the opportunity to talk to an independent medical examiner about their loved one’s final illness and death.
Haemovigilance entails surveillance of all steps covering the transfusion chain...
‘I work in genetics and molecular genetics, and I've been working towards my fellowship for about eight years. I did my PhD viva first, followed by a project with the 100,000 Genomes Project, analysing metabolic cases that were yet to be diagnosed.
Becoming a Fellow makes me feel more confident in myself. It also gives the users of the service more confidence in our work. My hopes for the future are to keep learning and developing, possibly by going to some of the members’ classes and clinics.’
– Dr Victoria Busby, new Fellow in Genetics.
I’m really excited to become a part of the pathology community at the College, and have the opportunity to volunteer as an examiner.
– Dr Nesrin Tolba, new College fellow.
Here at the College, we are all really proud of the new LEPT system, which has been designed to better support trainees through their training in the 2021 RCPath curricula. It will help trainees reflect their learning and growth across the whole spectrum of CiPs through the years in order to truly demonstrate their progress.
This summer, I had the pleasure of attending the Royal College of Pathologists Summer School in London. To say I have fallen in love with the specialty would be an understatement, I have never become so interested in something so quickly as I have pathology after this experience.
Over 2 days, I took part in multiple academic workshops, in different specialties within the branch of pathology. To see the stark differences between these specialties but also how they integrate into patient care equally well was so eye-opening.
Among these fantastically organised, hands-on workshops, we received talks from leading experts in their respective fields, showcasing what pathology truly has to offer us (after all, pathology is required in ~95% of patient cases!).
I particularly enjoyed the evening of socialising at the Royal College where I could speak with specialists and students in a more informal setting and really appreciate what the specialties can bring to the world of medicine. So many aren’t aware of the lasting impact it can have on patients and other healthcare professionals.
Over the next 2 years, I will be pursuing an SSC and elective in a pathology-based specialty because of this experience! I am so grateful for this experience and anyone remotely thinking of applying, you have absolutely nothing to lose and everything to gain! I wish everyone could experience what I did this summer!
Thank you, Royal College of Pathologists, for showing us what an enjoyable career in medicine could look like.
It is important to prioritise time in the laboratories to observe and understand how tests are done. Increasing access to transfusion courses, time observing biomedical scientists and participating in laboratory meetings is vital.
Diagnostic haematology has been centralised in most areas, with Specialist Integrated Haematological Malignancy Diagnostic Service in tertiary centres providing regional diagnostics. Therefore, if placed in a district general hospital, it can be challenging to maintain your specialist diagnostic and bone marrow morphology skills. Some deaneries have helped overcome this by having lab weeks to provide the opportunity for all trainees to gain experience in diagnostic haematology, which is an exciting and constantly evolving field.
As with all specialties, our workload continues to grow with increasing patient numbers, which is not always reflected in our rotas. There have been plans for redistribution of trainees, which have created uncertainty. With many trainees balancing a busy work and home life, it is easy to be under increased pressure and risk burnout. In some trusts, increased psychological support has been introduced as well as Balint groups to help avoid this.
My objective is to amplify the voices of patients in the work of the NBTC. This will necessitate identifying and responding to patients' perceptions about the provision of transfusion services, making sure that those experiences influence the thinking of the committee members.
The intention of haemovigilance is to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood components.
Another challenge is how to maintain relationships with clinical colleagues at all sites so that any AMS programme has their support. This is a particular challenge when the NHS workforce, in general, is exhausted and depleted on the back of the pandemic. How do we engage our colleagues in the fight against AMR?
The key to the success of these guidelines has been the true collaboration of lab scientists and clinicians...
The Pathology Summer School was an amazing opportunity to reflect on my medical journey and what the future could bring. Like many other attendees, I was motivated to attend out of curiosity. Pathology was only just on my radar. I came out with a deeper understanding of a fascinating and broad specialty with powerful impacts on patient care – but also an understanding of what it means to be a doctor.
Hearing from consultants with decades of experience, openly sharing their journeys and reflections, was something I hadn’t realised I’d been missing in the high-pressure, low-time medical school environment. Sharing with my peers from across the country, united by an interest in the science behind medicine, was a further highlight.
It was a reminder as to why I’d decided to commit to medicine in the first place. I have had my eyes opened to so many exciting possibilities in medicine, and plan to gain more experience in pathology. Whatever the future brings, I feel enriched by my experience on the summer school, and I would heartily recommend it!
The Transfusion 2024 and BTRU data programmes may be able to achieve some quick wins.
The feedback from patients is that they are very keen on CDCs that can deliver diagnostic services that are easy to reach and close to their homes.
My secondment to the UK was a transformative experience that significantly enhanced my professional growth. The opportunity to work alongside renowned experts and immerse myself in a world-class healthcare system broadened my perspectives and deepened my understanding of laboratory medicine.
Since returning to my home country, I've been able to apply the knowledge and skills I acquired to improve our local healthcare practices. At the Synnovis Hub, Daniel Monterio and the entire team taught me about daily meetings, where they discuss the previous day's activities. I saw how helpful it was, so I adopted it for us, where it is working perfectly. It has helped us to improve turnaround times, improved the accuracy and reproducibility of reports in terms of running our controls twice every day, and has also enhanced our patients' satisfaction.
I sincerely thank the College and the ARISE team for this great opportunity to expand my knowledge.
The Pathology Summer School was a fantastic event which really stimulated me to think about pathology in its broadest sense, while helping me to consider future career options. It was also a brilliant opportunity to meet like-minded future colleagues and doctors already involved in pathology. Thanks to all involved!
Only 55 of the 80 full-time equivalents PPP posts in the UK are filled...
None of our achievements, nor any of the work of the College, would be possible without the effort and support of College staff, lay people and the huge number of members who work tirelessly to facilitate all we do. I would like to personally thank everyone involved in the College … for all your help and support.
The College has a long-standing tradition of engaging internationally on global health issues and promoting improvements in pathology.
‘I am a woman of Ghanaian heritage who grew up in Liverpool. I studied undergraduate medicine in the East Midlands and am now training at the North West School of Pathology as a histopathologist.
In future, I would love to be involved in several initiatives that the College currently engages in. I believe that the College is forward-thinking in terms of its public engagement efforts, getting the public interested in the science behind health and the human body. It would be great to be more involved in that.
I also appreciate the College’s collaborative approach to advancing histopathology practices globally. I would enjoy the opportunity to be involved in efforts to advance diagnostic services and practices globally, working with and learning from the experience of colleagues in other countries.’
- Dr Vanessa Djabatey, new Fellow specialising in histopathology.
I realised that my concerns regarding the lack of patient contact were actually concerns that I wouldn’t have a direct impact on patient care. However, this isn’t the case. The histopathologist’s diagnosis has important implications for the patient’s prognosis and management, and therefore their quality of life.
‘I’m a specialist training in pathology, having started in 2017. I took some time out during training to do a master’s in medical education, and I was a teaching Fellow, so it's been a slightly longer process than it otherwise could have been. Becoming a new Fellow is the big achievement that you're really anxious about from day one. It's a rite of passage and can feel impossible at the start so it feels kind of surreal to have done it.
I'm really looking forward to being a Fellow of the Royal College and taking part in everything that the College has available. I’d like to get involved in the education aspect, having done a master’s. I’m particularly interested in new technologies, such as the Pathology Portal and how that’s going to progress.
I’m also interested in digital pathology and making learning more equitable across the country and internationally. Furthermore, in equalising opportunities for all trainees regardless of specialty, or background or where they are.
Throughout my professional career, I hope that the College will provide us with easy to access, up-to-date and efficient updates with regards to advances in the profession, in workflow, in supporting departments and members who are encountering problems (such as workforce issues). I’d like them to bring together experiences across the profession so that we can learn from each other, as it will be a challenging time. There are fewer and fewer pathologists, but more and more work. Best practices and professional guidelines are really important, so I’d like the College to focus on making them equitable and accessible.’
– New Fellow, Anonymous
[Paediatric and perinatal histopathology] is essential for the diagnosis of variety of conditions...
During my ST4 year as a histopathology resident, I co-authored the latest version of the College’s Tissue pathways for cardiovascular pathology. This was an excellent opportunity to learn about the processes involved in clinical guideline development, familiarise myself with the most up-to-date, relevant literature in this field and refine my writing skills for this type of clinical document.
I very much enjoyed working with and learning from other pathologists who share a similar interest in cardiovascular pathology as part of this wider national working group, which also helped to expand my professional network and leadership skills. The public consultation and the implementation webinar activities that followed were also useful to understand the impact of guideline recommendations on service organisation and clinical practice based on feedback and discussions with colleagues from across the country and beyond.
I benefited so much from the experience and I am now co-authoring international guidelines on cardiac explant, in part due to the networks created via the College guidelines I helped to write. I would absolutely recommend getting involved in guideline development – as trainees, we can contribute from a unique perspective to standardising and improving pathology practice for the future.
Working closely with College staff, volunteer members and other stakeholders has highlighted the great skill, commitment and dedication that everyone puts in to help the College deliver work that is vital for healthcare, patients and our membership. So, a huge thank you to everyone for your much valued contributions that are so essential.
SHOT recognises the key role patients play in promoting transfusion safety and has promoted the engagement of patients, their families and carers as safety partners.
..advancement of molecular diagnostic technology has allowed the development of a test that detects the presence of fetal DNA gene in maternal blood and determines the presence or absence of an RhD gene in the fetus.
I want to extend a personal thanks to everyone who took the time to share their thoughts in the Member Survey 2024. At the heart of this survey – and everything we do – is our commitment to our members. We want you to know that we’re listening and taking your feedback seriously. We are dedicated to developing our services to better support, represent and celebrate our members and the profession.
An additional challenge faced by trainees is knowing how and what to prepare for as a consultant. Infection trainees are expected to have sufficient laboratory knowledge to advise and support laboratory staff, while simultaneously building their knowledge base and experience to provide advice to patients in clinics and on hospital wards.
However, progressive centralisation of laboratories has made gaining laboratory experience challenging. Trainees may be required to seek placements in hospitals that have an onsite laboratory. One of the ways to do this is to discuss learning requirements with educational supervisors and training programme directors.
The College is a well-trusted institute; the name implies quality to the highest standard. The more members and fellows who are involved in its activities, the better the College will function.
As the Southeast Asia Advisor, I see my role as a conduit between the fellows of the region and the College. Each region also has several country advisors. Our job is to collect feedback from members about the FRCPath examinations, as well as training and research opportunities in the region.
When we truly understand people we know what to do for them ... Spend 15 minutes with someone, 15 minutes to be curious, to talk, to listen, to understand, to grok them. It will be time well spent.
The new LEPT system is extremely user-friendly and slick in its format. My clinical supervisors as well as competency assessors also found the process easy to navigate and manage. The content was highly relevant to the chemical pathology curriculum, and also enabled easy association with the GMC’s general professional capabilities framework. Furthermore, the administrative team at RCPath were always on hand to answer any queries regarding the new LEPT system in a timely manner.
The NHS workforce, in general, is exhausted and depleted on the back of the pandemic. How, then, do we engage our colleagues in the fight against AMR?
It is a privilege to witness firsthand the dedication, talent and enthusiasm of future specialists. This role gives me the chance to give back to the institution that played a formative role in shaping the pathologist I am today.
...trainees in neuropathology are impacted by the costs of training, including costs associated with courses and examinations. Post-mortem experience depends on where trainees are located, which involves significant travel and financial cost to meet curriculum requirements.
[Paediatric and perinatal histopathology] is essential for the diagnosis of variety of conditions...
I think a key challenge is achieving greater acceptance and appreciation of the clinical scientist role and harnessing its full potential. One solution could be to enable clinical scientists to prescribe via the Patient Group Directive mechanism. This offers huge potential for expansion of their current clinical roles and the opportunity to work in greater partnership with medical colleagues.
There is a lack of data integration across hospitals to enable visibility across the whole blood supply chain.
Oral and maxillofacial pathology is a small specialty; because of this, we sometimes face a lack of understanding. On entering the specialty, one issue sometimes faced is the geographical limitation that comes with few available training places. Issues are also experienced with recruitment, as there is a lack of dental core training posts available, meaning few people get to gain experience of our specialty.
I feel more confident chairing meetings and speaking in public. I am learning more about governance and how the different bodies interact with each other.
I thought the workshops were well organised and the staff were very friendly. After attending the event, I am now strongly considering a career in pathology.
I think it can be difficult for trainees to take up training opportunities, such as attending transfusion meetings or observing biomedical scientists in the laboratory, in the context of urgent and demanding clinical commitments on the wards and in clinics. However, we need to prioritise and ring-fence transfusion training now to prevent future knowledge gaps in this important facet of haematology training.
The Transfusion Specialty Advisory Committee is working with other stakeholder organisations and trainees towards solutions to improve transfusion training. We will be looking to introduce more transfusion posts, resources to signpost transfusion training opportunities in hospital rotations and educational materials with a particular focus on hospital transfusion laboratory cases and management.
The College has played a vital role, particularly in the training of MEs and MEOs and the publication of guidance for ME services. I’m sure there will be further challenges ahead but the College is well equipped to meet them.
‘I'm now a consultant histopathologist in Oxford. I completed my Fellowship about a year ago, but couldn't come to the award ceremony because I had a very young daughter who was unfortunately too young for the College crèche.
It was really nice to come today and experience a Fellowship ceremony – my belated graduation. I also won the Silver Research Medal in cellular pathology for some work that I did during my PhD, which was finished in 2020. Though it's a few years ago now, it was nice to get some recognition for all that hard work.
About 18 months ago I went to the New Consultant's Day, which I found very useful. I think it's a really good initiative, because the step up from trainee to consultant felt quite large at the time. We received advice from people who had done that transition recently. They let us know about the sort of things that we might not even be aware about: management, business cases, financial planning, and what you’ll be expected to do. So that was really helpful.
Going forward, I think any similar ideas or events that the College can do to support consultants is really important because it's quite an intense period of your career. Adapting to that change with support is really valuable.
The College regulates our activities and as long as they keep doing what they're doing, that's what we need them to do. In the future, if time and energy permits, I could get involved with College initiatives. It's definitely something I would consider doing when I’m less tied up with clinical responsibilities.
I think the College just needs to keep letting its fellows know what opportunities there are to volunteer, as people will definitely want to take those up in due course.’
- Philip Macklin, Silver Research Medal prize winner.
The stakes are high to ensure smooth running for candidates to perform at their best, given their sacrifices and pressures. This drives me to continue despite the demands from our diagnostic service. Finding time to examine is a challenge, but the work is rewarding and motivating.
It is a privilege to lead the new specialty of medical examiners. Once again, I am delighted to have the Royal College of Pathologists' support in promoting good practice. The Good Practice Series will ensure consistency and high standards are maintained and each instalment has the benefit of subject matter expert input. I hope the resource will be of value outside the medical examiner office as well.
Becoming a fellow of the College is vitally important for pathology. As pathologists, we save lives every day. We diagnose every day. We make an impact every day. Your career is defined not by what you do for yourself, but what you do for others. For your colleagues, your patients, your profession. Thank you for becoming a member of the College.
So much talent, so much potential, so many opportunities. All of this is vitally dependent on their College continuing to be relevant, potent and driven by their involvement – their careers and professional wellbeing depends on it.
To anyone interested [in volunteering], I would say to go for it! It not only broadens your knowledge of the expansive world of pathology, but you may also gain a valuable support group. Volunteering for QAPC and NQAAP positions allows us to play an integral part of shaping our growing services.
I would like to congratulate and thank everyone involved in our work − members and staff alike − for their considerable efforts during this difficult time.
Do not attempt to write about too many things. One or two points well-made will usually be better.
No test is routine, no results can come quick enough. Keep people informed, be there, be available and know what you are going to do with the results when they come.
Unless the multiplicity of issues causing the current workforce are resolved, the crisis in paediatric and perinatal pathology service provision will deepen...
The main challenge for pathology across the UK is providing adequate services against a backdrop of inadequate numbers of staff and limited funding...
Being disabled within histopathology is consistently challenging. There are so many issues that I experience that have either been considered rarely or never before. It can be exhausting to constantly highlight and challenge these issues. However, there are so many areas of good practice that should be highlighted too!
Dr Ryan Clark
Histopathology
Day two offered captivating talks on neuropathology and microbiology, then ended with a tour of the world-famous Gordon’s Museum of Pathology. I was filled with both awe and dread as I walked through its galleries of specimens dating from the 19th and 20th century. It was a gripping portrayal of life, death and disease, and I’d like to go as far as describing it as a pilgrimage for medical students.
Pathology services underpin healthcare from cradle to grave and will be central to delivering the 3 shifts in the plan. Pathologists and scientists play a vital role across all stages of patient care, including disease prevention and screening, diagnosis, treatment and monitoring.
Bringing vital diagnostic services closer to people's neighbourhoods has the potential to reduce delays and enable quicker clinical decision making. This will provide greater convenience and better health outcomes.
The College welcomes the publication of this plan at a time when NHS services face significant pressure, with many patients still experiencing delays in diagnosis and access to treatment.
Being entrusted with upholding the standards of our profession, ensuring consistency and integrity, and supporting the next generation of consultants is both humbling and fulfilling.
Examining candidates has been one of the most fulfilling and meaningful volunteer roles I have undertaken within the College.
Being a microbiologist involves being a detective; you take the clues given by the clinician speaking to you, or by examining the patient yourself and formulate a diagnosis and management plan. Quite often you are lucky and obtain the “evidence” for your diagnosis by way of laboratory results.
The haematology break out session was very interactive and taking a 'bone marrow' biopsy from an apple was definitely an interesting experience! The quiz and buffet rounded of the end of a very well organised and informative event.
For new trainees, who tend to have significant clinical experience, laboratory medicine can feel unfamiliar. The limited training and support available at the start of ST3 can be daunting. To address this, my colleagues and I have developed a series of introductory lectures designed to help new ST3s hit the ground running, providing them with a solid foundation in the specialty.
I have found the Pathology Portal incredibly beneficial to my learning and only wish it had been available to me when I was preparing for my exams. There is an abundance of excellent quality, well-annotated images and scanned slides, and helpful Q&As which highlight differentials and potential pitfalls. The pearls of wisdom are overflowing.
I think it's brilliant to have this integration of different pathology subspecialties and this collaboration of experts from varying fields, with the common goal of teaching the next wave of pathologists. I recommend it to every trainee I meet, and consultants as well.
Many trainees report subspecialty-specific barriers to training, most commonly in renal and hepato-pancreato-biliary pathology. A key cause of this may be that these 2 areas suffer from understaffing at consultant level in most areas in the UK. Devoting time to training juniors is challenging and so many trainees receive suboptimal exposure. This leads to a lack of interest, contributing to the consultant staffing issue.
Ensuring that laboratories participate in EQA schemes, and monitoring their performance, is integral to both patient safety and patient experience. This is something I am very passionate about. Patients should be reassured that, whichever pathology laboratory they are referred to, they will receive the highest standard of testing possible and be given accurate results.
The shift of diagnostic testing closer to the community and the patient is a direction indicated by the 10-year health plan and which empowers patients to become more involved in their own healthcare. Such testing needs however to be appropriate (clinically indicated and useful) and using tests/devices that are regulated and of sufficient quality.
Direct to consumer testing, chosen and carried out by patients and pushed by the private/commercial sector remains largely unclear when such issues around quality, regulation and appropriteness are considered. There are significant risks to patients when poor quality tests are carried out inappropriately, with both false reassurance and unncessary knock-on consequences for the NHS to repeat tests or take additional action.
Vitamin D tests, in particular are very much overused across the UK, with hundreds of millions of pounds spent every year within the NHS on both testing and prescriptions for vitamin D supplements. Encouraging patients to do more testing at home can only add to this unnecessary burden, especially if the quality of such tests cannot be relied upon.'
I became involved in the BTRU research programme because l felt that I wanted to use my lived experience as an NHS patient to help shape and steer health research for the benefit of all. Being of Black African ethnicity, I endeavour to provide representation from a diverse perspective and promote inclusivity in pursuit of helping to reduce health inequalities. I would like all clinical staff and researchers to know and appreciate the positive and valuable benefits that patient and public interaction can bring. Progress best occurs when a voice is not just heard but is listened to and engaged. PPIE seeks to provide that important communication forum.
Inevitably, the COVID-19 pandemic slowed the uptake of the test in some hospital antenatal services, but there is now a steady increase in adoption in units across England within their antenatal screening programmes.
Your role [as a clinical scientist] is every bit as critical to that patient as the clinician choosing the tests and delivering the news with the outcome of those results.
We stated our intent for continued involvement in any further discussions, to further support our members in providing an excellent service to patients.
Lab Tests Online-UK is in a unique position to empower patients with supporting a patient-centred approach to delivery of care.
Many trainees report subspecialty-specific barriers to training, most commonly in renal and hepato-pancreato-biliary pathology. A key cause of this may be that these 2 areas suffer from understaffing at consultant level in most areas in the UK. Devoting time to training juniors is challenging and so many trainees receive suboptimal exposure. This leads to a lack of interest, contributing to the consultant staffing issue.
I think a key challenge is achieving greater acceptance and appreciation of the clinical scientist role and harnessing its full potential. One solution could be to enable clinical scientists to prescribe via the Patient Group Directive mechanism. This offers huge potential for expansion of their current clinical roles and the opportunity to work in greater partnership with medical colleagues.
Oral and maxillofacial pathology is a small specialty; because of this, we sometimes face a lack of understanding. On entering the specialty, one issue sometimes faced is the geographical limitation that comes with few available training places. Issues are also experienced with recruitment, as there is a lack of dental core training posts available, meaning few people get to gain experience of our specialty.
Increasing awareness of smaller specialties
There are similar principles across the different specialties. Principally, there is a lack of recognition of laboratory medicine specialties at medical school/foundation level that in the past has translated into these specialties not being considered as career options. Recent years have seen a great improvement in the numbers of applicants to pathology specialty training, in almost all specialties, coinciding with several RCPath initiatives, including the RCPath Foundation Fellowship scheme, the RCPath medical electives small grant scheme, Pathology Summer School and the annual College Taster Event, undergraduate and foundation essay prizes and the introduction of Longitudinal Integrated Foundation Training in pathology in some regions. Currently, we are in a newly turbulent time within postgraduate recruitment, with exponential increases in training applications, so this picture may evolve further over the next few years. Regardless, particularly for the smaller specialties within pathology, there is still a role for increased awareness, focus and recruitment drives.
We love our specialties and we can showcase them well to students. This is where the College diversity and influence can be a true strength of our profession.
Challenge 4: Providing time for training
We are at a time where clinical commitments are expanding, training time is being reduced and specific time for consultants to train (e.g. SPA time) is being curtailed. We are at a crossroads, where the choices made at a national level, driven by our activism, will determine the route for training going forward. Excellent training requires time for learning and processing, and dedicated time for trainers to teach properly. TAC members highlight some of the current challenges and possible solutions in this regard.
I think it can be difficult for trainees to take up training opportunities, such as attending transfusion meetings or observing biomedical scientists in the laboratory, in the context of urgent and demanding clinical commitments on the wards and in clinics. However, we need to prioritise and ring-fence transfusion training now to prevent future knowledge gaps in this important facet of haematology training.
The Transfusion Specialty Advisory Committee is working with other stakeholder organisations and trainees towards solutions to improve transfusion training. We will be looking to introduce more transfusion posts, resources to signpost transfusion training opportunities in hospital rotations and educational materials with a particular focus on hospital transfusion laboratory cases and management.
It is important to prioritise time in the laboratories to observe and understand how tests are done. Increasing access to transfusion courses, time observing biomedical scientists and participating in laboratory meetings is vital.
Diagnostic haematology has been centralised in most areas, with Specialist Integrated Haematological Malignancy Diagnostic Service in tertiary centres providing regional diagnostics. Therefore, if placed in a district general hospital, it can be challenging to maintain your specialist diagnostic and bone marrow morphology skills. Some deaneries have helped overcome this by having lab weeks to provide the opportunity for all trainees to gain experience in diagnostic haematology, which is an exciting and constantly evolving field.
As with all specialties, our workload continues to grow with increasing patient numbers, which is not always reflected in our rotas. There have been plans for redistribution of trainees, which have created uncertainty. With many trainees balancing a busy work and home life, it is easy to be under increased pressure and risk burnout. In some trusts, increased psychological support has been introduced as well as Balint groups to help avoid this.
An additional challenge faced by trainees is knowing how and what to prepare for as a consultant. Infection trainees are expected to have sufficient laboratory knowledge to advise and support laboratory staff, while simultaneously building their knowledge base and experience to provide advice to patients in clinics and on hospital wards.
However, progressive centralisation of laboratories has made gaining laboratory experience challenging. Trainees may be required to seek placements in hospitals that have an onsite laboratory. One of the ways to do this is to discuss learning requirements with educational supervisors and training programme directors.
Interdependent issues
A further important point is appropriate psychological support for trainees (and realistically for consultant and clinical scientist staff as well). This is an area in which we can learn from other specialties, such as psychiatry training, how to effectively support our staff. Balint groups are one such example of effective group-structured psychological support. Originally designed as a method of discussing the psychological aspects of a case, they have been trialled in areas of pathology as a way of discussing the human factors associated with laboratory cases and the effect these have on the individual presenting cases.
Other specialties have had some success with methods such as mindfulness sessions, Therapets or rest/relaxation hubs. There is a fine balance between effective psychological support and conflating systemic issues with individual responsibility. However, the principle of including appropriate psychological support within training deserves further consideration.
Challenge 5: Ensuring equality, diversity and inclusion and additional job responsibilities are at the forefront of curricula
Finally, with an increasingly diverse workforce that is undertaking additional research, teaching and leadership roles, consideration of diversity within our training spaces is especially important. For example, TAC members have commented:
I have been in training for nearly 10 years, having taken a circuitous route including 2 periods of parental leave and now time out for my PhD. As a result, trainees who commenced training after me have already become consultants. Juggling research, while maintaining my clinical competencies and negotiating life with 2 young children has been challenging. Sometimes, it feels as though I’m not doing particularly well at any of these things!
For those trainees engaged in research, the provision of research time comes at the cost of clinical training time, which can place added pressure on trainees.
Being disabled within histopathology is consistently challenging. There are so many issues that I experience that have either been considered rarely or never before. It can be exhausting to constantly highlight and challenge these issues. However, there are so many areas of good practice that should be highlighted too!
Dr Ryan Clark
Histopathology
The College has been working on these issues for the past few years through their Equality, Diversity and Inclusion (EDI) Network and through the work of TAC members. For example, the EDI Network spearheaded work on removal of stereotypes from College examination questions and considerations of indirect discrimination in the College fees structure, directly tackling EDI issues affecting training and assessment. While this is only the beginning, it highlights how these issues can be tackled effectively at a national level with effective organisation within the College.
Conclusion
It can be difficult to strike the balance between the provision of clinical care, learning for postgraduate professional exams, meeting clinical curriculum competencies, undertaking research and maintaining morale during a cost-of-living crisis. However, there is hope. Many of us are in the same boat, navigating the same troublesome seas, and our colleagues are constantly throwing us lifelines in support.
If you are struggling with some of the problems highlighted in this article, speak to your colleagues or contact your TAC representative. Support and help are available. You are not alone.
To trainees, trainers and the wider readership, I hope it is clear that these challenges, while difficult, are not insurmountable. As I said at the beginning of this article, it is through our unified strength that we can tackle these challenges and lead pathology training to the bright and evolving vision of a better tomorrow. Sure enough, the next generation of trainees will have issues to solve too – and that is all right. Striving to improve does not mean that the current efforts are not recognised and appreciated. Therefore, to trainers, thank you for your hard work, and, to trainees, let us all work collaboratively to face these challenges head on! Your TAC will be here to support you.
Dr Sophie Roberts
Chair, Trainees' Advisory Committee
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