Academic Pathology最新文献

According to the National Resident Matching Program in 2022, 631 pathology positions were offered. In total, 248 senior applicants from United States (US) allopathic schools filled 36.6% of these positions. To bolster medical student understanding of pathology, a medical school pathology interest group organized a multi-day activity to introduce rising second-year medical students to pathology as a career. Five students completed both pre- and post-activity surveys assessing their knowledge of the specialty. All five students had a BA/BS degree as their highest level of education. Only one student indicated that he or she had previously shadowed a pathologist as a medical laboratory scientist for a duration of four years. Two students indicated that they were interested in internal medicine, one indicated radiology, one forensic pathology or radiology, and one was undecided. During the activity, students biopsied tissue from cadavers in the gross anatomy lab. Thereafter, students participated in the standard tissue processing by shadowing a histotechnologist. Under the guidance of a pathologist, students microscopically examined slides and discussed the clinical findings. Post-activity survey results indicated that participation increased their knowledge of pathology as a career with a median increase of 0.8 points (range: 0.2 to 1.6) on a 5-point Likert scale. Students also indicated that their participation increased their knowledge of pathology skills and techniques—median increase of 1.2 (range: 0.8 to 1.8). This activity can be implemented by medical educators to expose medical students to pathology as a career with the benefit of increasing student knowledge in the specialty.

Currently, there are few osteopathic physician trainees who choose to pursue pathology residencies when compared to allopathic students and international medical graduates. Although the amount of residency positions filled by osteopathic students has increased in recent years, the percentage of osteopathic students choosing pathology has not changed much from 2011 to 2022 (about 0.16% increase), and, in 2022, pathology had the third lowest percentage of filled post-graduate year 1 residency positions by osteopathic applicants when compared to fifteen other major medical specialties. Potential explanations for this disparity may include relatively few total numbers of osteopathic applicants when compared to allopathic and international medical graduate trainees, as well as potential institutional educational limitations (i.e., pathology exposure differences among academic-based versus community-based hospital settings). This review suggests ways pathologists and educational institutions may help improve pathology exposure to osteopathic physician trainees, such as pathology interest groups, post-sophomore fellowships, rotating pathology electives, and through social media (e.g., Twitter). Utilizing these (and other) pathways may help improve osteopathic physician recruitment to pathology during subsequent applicant-residency match cycles.

Eosinophilic cystitis (EC) is an uncommon diagnosis, mimicking urothelial carcinoma. Multiple etiologies including iatrogenic, infectious, and neoplastic have been suggested, effecting both adults and pediatric population. A retrospective clinicopathologic review of patients with EC in our institution between 2003 and 2021 was conducted. Age, gender, presenting symptoms, cystoscopic findings, and history of urinary bladder instrumentation were recorded. Histologically, urothelial and stromal changes were noted, and mucosal eosinophilic infiltration was graded as mild (scattered eosinophils in the lamina propria), moderate (visible small clusters of eosinophils without brisk reactive changes), or severe (dense eosinophilic infiltrate with ulcer formation and/or muscularis propria infiltration). Twenty-seven patients (male to female ratio = 18/9, median age 58 [12–85 years]), of whom two were in the pediatric age group were identified. Leading presenting symptoms were hematuria (9/27, 33%), neurogenic bladder (8/27, 30%), and lower urinary tract symptoms (5/27, 18%). Four of 27 (15%) patients had history of urothelial carcinoma of urinary bladder. Cystoscopy commonly revealed erythematous mucosa (21/27, 78%) and/or urinary bladder mass (6/27, 22%). Seventeen of 27 (63%) of patients had history of long-term/frequent catheterization. Mild, moderate, and severe eosinophilic infiltrates were seen in 4/27 (15%), 9/27 (33%), and 14/27 (52%) of cases. Proliferative cystitis (19/27, 70%) and granulation tissue (15/27, 56%) were additional common findings. All cases of long-term/frequent instrumentation cases had moderate or severe eosinophilic infiltrate. EC should be in the differential diagnosis; particularly in patients with long term/frequent catheterization.

Medical student interest and pursuit of a career in pathology have been steadily declining since 2015. We conducted three separate surveys of medical students to better understand these trends. In our first survey, we focused on assessing U.S. allopathic medical students understanding and perceptions of pathology. We later surveyed U.S. osteopathic medical students as a companion to the allopathic medical student survey, in which many similarities were discovered with some key differences. In our final survey, we specifically looked at curriculum differences between the U.S. allopathic medical schools that graduate the most students who enter pathology training programs (Group 1) versus those schools that graduate the fewest future pathologists (Group 2) to determine if the curriculum had an impact on medical student matriculation into pathology. Together, through these surveys, we were able to identify several remarkable recurring trends, presenting areas of targetable action. Here, we summarize themes from the three studies as well as a review of pertinent literature to offer best practices for exposing and engaging medical students to pathology and possibly recruiting students to consider pathology as a career.

Females are under-represented as departmental chairs in academic medical centers and identifying ways to increase their numbers in this position would be useful. A previous study of women chairs of pathology showed that 35% of permanent chairs had previously been interim chairs, suggesting that the interim position was a common pathway for women to advance to a permanent chair position. We sought to determine whether it might also be true for males and if not, possible reasons for the difference. Between January 2016 and June 2022, the Association of Pathology Chairs identified 50 people who had served as interim pathology department chairs. Males served as interim chairs more often than females (66% vs 34%), but, within this time frame, female interim chairs were more likely to become permanent chairs than males (47% of females compared to 27% of males). To better understand the difference in the rate of advancement from interim to permanent chair, we surveyed the 50 individuals who had served as interim chairs to explore gender differences in backgrounds, reasons for serving as interim chairs and reasons for seeking or not seeking the permanent chair position. No significant gender differences were found except that male interim chairs were older (59.2 years) than female interim chairs (50.4 years). This study affirms that serving as an interim chair is a common pathway for females to become permanent chairs, while it is less so for males, although the reasons for this difference could not be determined.

Academic pathology departments across the United States vary greatly in terms of size, clinical workloads and research activity. It is therefore not surprising that their chairs may be an equally diverse group. However, to our knowledge, little is formally known about the “phenotype” (academic credentials, leadership background, and subspecialty focus) or career pathways of these individuals. Using a survey tool, this study sought to determine whether or not dominant phenotypes or trends. Several predominant findings emerged including: race (80% Whites), gender (68% males), dual degrees (41% MD/PhDs), years in practice (56% being in practice >15 years at time of first chair appointment), rank upon appointment (88% holding the rank of professor), and funded research (67% holding research funding). While Anatomic and Clinical Pathology (AP/CP) certified chairs represented 46% of the cohort, 30% were AP-only and another 10% were Anatomic Pathology and Neuropathology (AP/NP) certified. For subspecialty focus, neuropathology (13%) and molecular pathology (15%) were disproportionately represented compared to the general population of pathologists. Previous leadership roles on the path to chairmanship included vice chair (41%), division chief (39%), residency program director (29%), or fellowship director (27%). Many (41%) had not participated in any formal business or leadership training. This information may influence training or experience pursued by individuals aspiring to academic pathology leadership. It also highlights the challenges of suboptimal diversity in race and gender, as well as the professional backgrounds of academic pathology chairs and may suggest consideration of alternate pathways to leadership.

The senior author created a 2-week online laboratory medicine course for fourth-year medical students to meet an unmet need at our institution for a brief survey course of clinical pathology in an online format. The course includes online videos, reading assignments, study questions, and a rubric for written assignments that apply the key principles to topics that are customized based on the specialty interests of each student. Anonymous course evaluation surveys were completed by 42 of 60 students (70%), and 92% of respondents stated that they strongly agree with the quality metrics statements in the survey. The complete course materials are shared in this article in the spirit of open access and may be used for medical students, pathology residents, and other learners.

TP53 mutation status guides early therapeutic decisions in the treatment of clonal myeloid disorders and serves as a simple means of monitoring response to treatment. We aim here to develop a standardized protocol for evaluating TP53 mutation status in myeloid disorders using immunohistochemistry assisted by digital image analysis and further compare this approach to manual interpretation alone. To accomplish this, we obtained 118 bone marrow biopsies from patients with hematologic malignancy and molecular testing for mutations associated with acute myeloid leukemia was performed. Clot or core biopsy slides were stained for p53 and digitally scanned. Overall mutation burden was assessed digitally using two different metrics to determine positivity, compared to the results of manual review, and correlated with molecular results. Using this approach, we found that digital analysis of immunohistochemistry stained slides performed worse than manual categorization alone in predicting TP53 mutation status in our cohort (PPV 91%, NPV 100% vs. PPV 100%, NPV 98%). While digital analysis reduced inter- and intraobserver variability when assessing mutation burden, there was poor correlation between the quantity and intensity of p53 staining and molecular analysis (R² = 0.204). Therefore, digital image analysis of p53 immunohistochemistry accurately predicts TP53 mutation status as confirmed by molecular testing but does not offer a significant advantage over manual categorization alone. However, this approach offers a highly standardized methodology for monitoring disease status or response to treatment once a diagnosis has been made.