Downloaded from jcp.bmj.com on October 18, 2014 - Published by group.bmj.com
Editorial
The training of future tissue pathologists in a changing world J A James,1,2 M Salto-Tellez1,2 WHAT ARE THE CHALLENGES FOR THE MODERN PATHOLOGIST? To answer this pivotal question we need to have an understanding of where the future of medicine is as a whole. It is very likely that the future of modern medicine will be dictated by (a) general technological advancement and (b) advancements in molecular medicine. Indeed, translational research has transformed modern clinical practice, ensuring the rapid transfer of molecular biology findings into the clinical setting. This transformation however brings with it a need for change in the way histopathologists practice tissue diagnostics. The diagnostic paradigm for the surgical and cellular pathologist is changing and there is now a growing need for histopathologists to adopt molecular diagnostics and incorporate molecular pathology as a mandatory component into the training of all future histopathologists.1 The demands of a personalised healthcare system are phenomenal, leading to an increased need for histopathology trainees to have experience of specialised therapeutic immunohistochemistry, low and high throughput molecular analyses, pathology bioinformatics, biobanking as well as quantitative digital pathology. Modern histopathologists must also be able to deal with the broader aspects of research and interact with industry so that new products and tests are rapidly developed and brought into the pathology practice. While we cannot expect every pathologist to be an expert in each of these areas, it is reasonable to think that all these areas should be part of core, basic competencies in histopathology training. Furthermore, in an area in which subspecialisation is necessary, it would not be unreasonable to expect that, in the future, we should have histopathologists subspecialised in each of the areas stated above, as well as the 1
Department of Tissue Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland; 2Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, Northern Ireland Correspondence to Dr Jacqueline James and Prof Manuel Salto-Tellez, Northern Ireland Molecular Pathology Laboratory, CCRCB, 97 Lisburn Road, Belfast BT9 7BL, UK; [email protected], [email protected]
James JA, et al. J Clin Pathol July 2014 Vol 67 No 7
traditional organ-based or system-based subspecialisation we currently have. This is a new paradigm for histopathologists to grasp. All the activities stated above are primarily aimed at bringing molecular diagnostics into our routine practice: the projections in both academia and industry indicate that the use of advanced diagnostics for therapy selection will rise exponentially and it is imperative that histopathology is ready for the battery of tests that will soon become available for their use. It is critical that we rethink how histopathologists are traditionally trained, preparing them to become skilled not only in morphological interpretation but that they understand the molecular characterisation of diseases and are able to prepare comprehensive morpho-molecular diagnostic reports.
HOW DO WE CREATE THIS NEW TYPE OF TRAINING? Despite an increased demand for molecular knowledge, there is still a significant need for all types of pathologists; therefore, modular training with flexibility should be central to any reform of the current tissue pathology training programme. The fact is we need all kinds of tissue pathologists. We need those histopathologists who can provide a general morphological opinion on a wide range of diseases across multiple organ systems, and yet we need others who can give a general morphological opinion but who also have an area of superspeciality expertise. Additionally, we need histopathologists who understand subspeciality areas from a morphological and molecular point of view and pure tissue molecular diagnosticians who have molecular expertise and increased familiarity with high throughput technologies. There will also be a need for a new breed of pathologists who are familiar with molecular diagnostic testing but who understand bioinformatics and can integrate genomic information and turn detailed molecular high throughput data into a meaningful diagnostic opinion. There will be an increased need for the training of molecular digital pathologists, people who can extract information from image analysis to better understand the molecular biology of disease, as well as apply algorithms that
will transform some of the traditional pathology activities from a subjective into an objective exercise. Pathologists will be needed who have more than a rudimentary knowledge of biobanking to ensure quality assured collections of biosamples are systematically developed to best practice guidelines in order to increase our understanding of diseases and to facilitate the development of new diagnostics with the support of pharma and the commercial sector. All in all, a modern histopathology training programme is needed which has a significant degree of flexibility. There needs to be the potential for unusual training routes but yet ones that will ensure that those who complete them are still employable. For example, trainees need to be able to ‘step out’ of training to undertake higher degrees and to learn new diverse skills such as bioimaging or bioinformatics and yet ‘step back’ as and when to complete their more traditional pathology components, if required. Training should be more flexible lending itself to innovation and creativity with opportunities for new development and not remain rigid as is the case for the current, fixed programmes. Only with this versatility in training we will be able to attend to the complexity of modern medicine, and ensure that our specialty remains at the heart of the therapeutic decision-making and the interface between science and diagnostics. Contributors MS-T conceptualised the editorial and approved the final draft. JJ wrote the first draft. Competing interests None. Funding The Northern Ireland – Molecular Pathology Laboratory receives generous support from Cancer Research UK, the Experimental Cancer Medicine Centre network, the Friends of the Cancer Centre, the HSC Research and Development and the the Sean Crummey Memorial Fund. Provenance and peer review Not commissioned; internally peer reviewed.
To cite James JA, Salto-Tellez M. J Clin Pathol 2014;67:549. Received 31 March 2014 Accepted 31 March 2014 Published Online First 17 April 2014 J Clin Pathol 2014;67:549. doi:10.1136/jclinpath-2014-202332
REFERENCE 1
Flynn C, James J, Maxwell P, et al. Integrating molecular diagnostics into histopathology training: the Belfast model. J Clin Pathol 2014;67:632–6.
549
Downloaded from jcp.bmj.com on October 18, 2014 - Published by group.bmj.com
The training of future tissue pathologists in a changing world J A James and M Salto-Tellez J Clin Pathol 2014 67: 549 originally published online April 17, 2014
doi: 10.1136/jclinpath-2014-202332
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Editorial
The training of future tissue pathologists in a changing world J A James,1,2 M Salto-Tellez1,2 WHAT ARE THE CHALLENGES FOR THE MODERN PATHOLOGIST? To answer this pivotal question we need to have an understanding of where the future of medicine is as a whole. It is very likely that the future of modern medicine will be dictated by (a) general technological advancement and (b) advancements in molecular medicine. Indeed, translational research has transformed modern clinical practice, ensuring the rapid transfer of molecular biology findings into the clinical setting. This transformation however brings with it a need for change in the way histopathologists practice tissue diagnostics. The diagnostic paradigm for the surgical and cellular pathologist is changing and there is now a growing need for histopathologists to adopt molecular diagnostics and incorporate molecular pathology as a mandatory component into the training of all future histopathologists.1 The demands of a personalised healthcare system are phenomenal, leading to an increased need for histopathology trainees to have experience of specialised therapeutic immunohistochemistry, low and high throughput molecular analyses, pathology bioinformatics, biobanking as well as quantitative digital pathology. Modern histopathologists must also be able to deal with the broader aspects of research and interact with industry so that new products and tests are rapidly developed and brought into the pathology practice. While we cannot expect every pathologist to be an expert in each of these areas, it is reasonable to think that all these areas should be part of core, basic competencies in histopathology training. Furthermore, in an area in which subspecialisation is necessary, it would not be unreasonable to expect that, in the future, we should have histopathologists subspecialised in each of the areas stated above, as well as the 1
Department of Tissue Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland; 2Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, Northern Ireland Correspondence to Dr Jacqueline James and Prof Manuel Salto-Tellez, Northern Ireland Molecular Pathology Laboratory, CCRCB, 97 Lisburn Road, Belfast BT9 7BL, UK; [email protected], [email protected]
James JA, et al. J Clin Pathol July 2014 Vol 67 No 7
traditional organ-based or system-based subspecialisation we currently have. This is a new paradigm for histopathologists to grasp. All the activities stated above are primarily aimed at bringing molecular diagnostics into our routine practice: the projections in both academia and industry indicate that the use of advanced diagnostics for therapy selection will rise exponentially and it is imperative that histopathology is ready for the battery of tests that will soon become available for their use. It is critical that we rethink how histopathologists are traditionally trained, preparing them to become skilled not only in morphological interpretation but that they understand the molecular characterisation of diseases and are able to prepare comprehensive morpho-molecular diagnostic reports.
HOW DO WE CREATE THIS NEW TYPE OF TRAINING? Despite an increased demand for molecular knowledge, there is still a significant need for all types of pathologists; therefore, modular training with flexibility should be central to any reform of the current tissue pathology training programme. The fact is we need all kinds of tissue pathologists. We need those histopathologists who can provide a general morphological opinion on a wide range of diseases across multiple organ systems, and yet we need others who can give a general morphological opinion but who also have an area of superspeciality expertise. Additionally, we need histopathologists who understand subspeciality areas from a morphological and molecular point of view and pure tissue molecular diagnosticians who have molecular expertise and increased familiarity with high throughput technologies. There will also be a need for a new breed of pathologists who are familiar with molecular diagnostic testing but who understand bioinformatics and can integrate genomic information and turn detailed molecular high throughput data into a meaningful diagnostic opinion. There will be an increased need for the training of molecular digital pathologists, people who can extract information from image analysis to better understand the molecular biology of disease, as well as apply algorithms that
will transform some of the traditional pathology activities from a subjective into an objective exercise. Pathologists will be needed who have more than a rudimentary knowledge of biobanking to ensure quality assured collections of biosamples are systematically developed to best practice guidelines in order to increase our understanding of diseases and to facilitate the development of new diagnostics with the support of pharma and the commercial sector. All in all, a modern histopathology training programme is needed which has a significant degree of flexibility. There needs to be the potential for unusual training routes but yet ones that will ensure that those who complete them are still employable. For example, trainees need to be able to ‘step out’ of training to undertake higher degrees and to learn new diverse skills such as bioimaging or bioinformatics and yet ‘step back’ as and when to complete their more traditional pathology components, if required. Training should be more flexible lending itself to innovation and creativity with opportunities for new development and not remain rigid as is the case for the current, fixed programmes. Only with this versatility in training we will be able to attend to the complexity of modern medicine, and ensure that our specialty remains at the heart of the therapeutic decision-making and the interface between science and diagnostics. Contributors MS-T conceptualised the editorial and approved the final draft. JJ wrote the first draft. Competing interests None. Funding The Northern Ireland – Molecular Pathology Laboratory receives generous support from Cancer Research UK, the Experimental Cancer Medicine Centre network, the Friends of the Cancer Centre, the HSC Research and Development and the the Sean Crummey Memorial Fund. Provenance and peer review Not commissioned; internally peer reviewed.
To cite James JA, Salto-Tellez M. J Clin Pathol 2014;67:549. Received 31 March 2014 Accepted 31 March 2014 Published Online First 17 April 2014 J Clin Pathol 2014;67:549. doi:10.1136/jclinpath-2014-202332
REFERENCE 1
Flynn C, James J, Maxwell P, et al. Integrating molecular diagnostics into histopathology training: the Belfast model. J Clin Pathol 2014;67:632–6.
549
Downloaded from jcp.bmj.com on October 18, 2014 - Published by group.bmj.com
The training of future tissue pathologists in a changing world J A James and M Salto-Tellez J Clin Pathol 2014 67: 549 originally published online April 17, 2014
doi: 10.1136/jclinpath-2014-202332
Updated information and services can be found at: http://jcp.bmj.com/content/67/7/549.full.html
These include:
Email alerting service
Topic Collections
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Histopathology (103 articles) Molecular biology (25 articles)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to: http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to: http://group.bmj.com/subscribe/
