Future Pathologist Champions: Ensuring the Future of the Specialty

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Lisa Tomcko:

Welcome to the latest edition of the College of American Pathologists CAPcast. I'm Lisa Tomcko, content strategist with the CAP.

Beginning in the early 2000s, the number of US medical school seniors matching into a pathology residency experienced a steady decline. Rates went from 2.5% in 2003 to nearly 1% in the late 2010s. In 2020, in response to the declining rates of medical students going into pathology residency, the CAP created an ad hoc committee. The committee was charged with developing a strategy for the organization to address the critical issue of preventing a pathologist shortage, which would negatively impact patient care. The ad hoc committee has since transitioned to the Future Pathologist Initiative Project Team. This summer 2024, that project team will sunset with its work to be divided amongst other CAP committees to continue the mission of inspiring medical students and ensuring the future of the specialty. 

In this episode, I'm joined by Dr. Kalisha Hill, project team chair and a governor on the CAP Board of Governors. With her is Dr. Kamran Mirza, future pathologist champion facilitator. They'll discuss what the project team has accomplished since its inception and the impact it's had on medical students choosing to pursue pathology. So to start us off, Dr. Hill and Dr. Mirza, would you like to introduce yourselves?

Dr. Kalisha Hill:

Thank you, Lisa. I'm Dr. Hill. I am an independent practice owner in Illinois, a long-time member and committee council participant with the College of American Pathologists since residency. So I have seen firsthand the opportunity we have to attract people into this wonderful specialty. Dr. Mirza?

Dr. Kamran Mirza:

Thank you, Dr. Hill. My name is Dr. Kamran Mirza. I am a professor of pathology at Michigan Medicine, ardent supporter of the Future Pathologist Champion Project. And it's such a great honor to work with you, Dr. Hill, on this as we talk about the future of pathology. I'd love to start by asking you why this project team was created and what are the issues impacting the funnel of future pathologists?

Dr. Kalisha Hill:

Absolutely. Since the time I was on the Residents Forum as the vice chair, conversations were occurring about why there were not more people applying to our specialty, most of us would commiserate on how one or two of us matched into pathology and we were seen as the rare breed. There are so few specialties where you can literally curate your day, where you get to interact with patients as well as have alone time. And every single day there is a challenge. No day is identical and the best part, once you're actually out in practice, you can select a career and a practice that matches what you love. And that autonomy in and of itself is what kept me in this specialty and keeps me thriving over 20 years later and enjoying every single day in practice. 

So we all knew this. We know that this is a wonderful specialty to be in. Unfortunately no one else did. And so there were a myriad of reasons that there were so many issues impacting the funnel of pathologists. And the number one is exposure. Showing people a box of slides, giving them a microscope, giving them a lecture, does not teach them what we do every day. It's very important that our medical students and even younger have the opportunity to be with a pathologist, see what we do, see how we interact with our physician colleagues as the doctor's doctor, see how we have opportunities to provide patients with procedures, consultations, and really show what we actually do on a day-to-day basis. So that is an opportunity that was before us, and it wasn't until this project team was birthed that we actually started seeing actionable results.

Dr. Kamran Mirza:

I love that. I'm right there with you when we discuss medical students and how they view pathologists and how we aren't immediately thought of as clinicians. In fact, many pathologists often call other physicians the clinicians, and I think that there's, over the last couple of decades, we as pathologists have really had to start looking at the future of our careers and the future of who is going to be part of pathology. And I fully agree with you that this is an incredible forum that the CAP has put together looking at the future of pathology. 

And so you mentioned medical students. I guess my next question to you would be what types of programs were developed for medical students, and if you were to describe who could be eligible to participate in these programs?

Dr. Kalisha Hill:

Eligibility is easy. If you are in medical school, you are eligible to apply for a residency in pathology. I would say the starting point in the 21st century are all of the pathology interest groups that are budding in so many programs across the country. This is really an opportunity for medical students to work directly with the residents and faculty at their program and develop connectivity between what a pathologist does and what a student is learning. And they don't always correlate in an obvious way when you're learning about a fungus in a microbiology class, it may not correlate to the patient who has a UTI and as a pathologist looking at urine, we see this every day, but a medical student may not have the opportunity to look at a fresh urine to see that, oh, we're actually looking for fungus and identifying a patient with chronic kidney disease. And actually last week I tweeted a photo of a Candida that surviving antibiotics that had been thrown at this poor Candida for years with this 80-year-old with chronic kidney disease and it was the lone Candida that basically mutated into the shape of a shark and it was quite remarkable. But these are the things that we see that you're not going to get that in a classroom in a textbook. You need that connectivity on how you as a pathologist are impacting patients.

Dr. Kamran Mirza:

I love that you brought in social media. I think that the CAP and this group has done incredible things on social media platforms and I think that that also serves as another mechanism, as another touch point for medical students to understand the role of the pathologist and of the laboratory. And so as we're thinking about the program and what projects have been created, can you explain a little bit about the champion program and some things about its impact, any notable successes or impactful moments that stand out?

Dr. Kalisha Hill:

I will say the champion program is a very nice combination of academic pathologist, community pathologist, medical students, residents. It really expands the entire scope of those we are trying to attract into our specialty as well as retain into our specialty. I often hear about other specialties where physicians either stop practicing because they're not happy with what they're doing. On the contrary, we've heard of, and I know personally several physicians who have changed specialties to pathology because they find out what we do. Sometimes you would almost say too late, but it's never too late. Even an ob-GYN doctor can decide pathology is awesome and I know someone who has done that, so it's always good for our champions to include people who can really have an impact. As I shared, the desire to move our exposure to pathology with our medical students really started in the residence forum. 

And so it took a couple of decades for us to finally get to the point where we had this project team and the four main initiatives that we had, we have already succeeded, and that was our promotional marketing campaign, the enhanced educational materials supporting our future pathologists champions in the medical schools, as well as establishing the CAP Distinguished Medical Student Award. And that award has gained popularity to the point where we are expanding the number of awards we're giving every year. And I will say the student interest groups really did start taking legs with the Champion program. There was a lot of conversation between those who had very robust interest groups and they started sharing what they were doing to attract other medical students into pathology. And the word has spread and it really has made a difference. So very grateful for the champions and work that they're doing and not just for medical students, but also reaching to high school students and elementary students. Several of our champions do programs where they have high schoolers come to their practice and it really is an opportunity for them to reach the youngest to even get them into medical school in the first place and then have them go in thinking, oh my gosh, I know what pathology is and this is actually what I want to do.

Dr. Kamran Mirza:

The CAP has done incredible things and as the facilitator for this program, I'm really proud of the work the champions have been doing. Other types of medical student programming, including the free medical student membership, free registration to the CAP annual meeting and all the other forums that the residents put together. This has been key in attracting more medical students and what we've been seeing is a lot of interactivity with medical students at different areas within the CAP programming, whether this be in the national meeting or it be webinars, et cetera. Webinars that we put forward include things such as Pathology 101, expanding what a career in pathology looks like, talking about things such as post sophomore fellowships and what they can do for medical students and exploring things in anatomic and clinical pathology.

Lisa Tomcko:

We’re going to take a quick break from today's episode to talk about an exciting new program from the CAP, now open for registration. When it comes to successfully starting a new job, preparation is key. Introducing the Job Prep Bootcamp from the CAP, a fast-paced, interactive virtual review designed just for pathologists like you. Refresh your skills in signing out less familiar cases, access the library of resources to ensure thorough and accurate case workups, learn to recognize and avoid common pitfalls, get guidance from experts, and tap into a supportive network exclusive to the Job Prep Bootcamp alumni community. You can find the link in the episode description to get more details and register. And now back to the episode.

Dr. Kamran Mirza:

So all of this taken together has really put the Champions program in a position to be able to leverage the best and brightest medical students and to explain to them what an amazing career this is. But now we would like to introduce people who actually have benefited from this initiative and are our champions. I'd like to introduce Dr. Murat Gokden, a future pathologist champion, and Dr. Cox, recipient of a Distinguished Medical Student Award.

Dr. Murat Gokden:

I am Dr. Murat Gokden. I am a neuropathologist and a professor of pathology and the director of neuropathology at the University of Arkansas for Medical Sciences in Little Rock, Arkansas and have been here for about 25 years. In addition to patient care, I am actively and deeply involved in clinical research and teaching.

Dr. Carli Cox:

Hi, I'm Carli Cox. I'm a first year pathology resident at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. I went to medical school here at UAMS and decided to continue my journey here with pathology residency.

Dr. Kalisha Hill:

Well, Dr. Cox, again, thank you so much for being here. I am very curious. How much did your medical school curriculum expose you to pathology and did it give you the fundamental knowledge you need for your pathology residency?

Dr. Carli Cox:

So at UAMS, the first and second years are didactic based, and the third and fourth years are clinical rotations. UAMS starts with our pathology exposure in the first and second year where many pathology faculty do the lectures and that gets everyone acquainted with them early on. That's how I got acquainted with Dr. Matthew Quick, reached out to him from a lecture that he did on gynecologic pathology and asked him if I could start shadowing in the pathology lab, and that was a fantastic opportunity to start early before there was any structured pathology education in clinical rotations to start meeting everybody and learning where all the parts of the lab are in third year. Then they have a two week elective that's available for anybody to take. I took that elective and was fortunately already acquainted with people. So just starting to build up on that knowledge as I progressed through medical school. 

And fourth year is where I think UAMS really shines with the amount of opportunities that we have for pathology education. So you can take up to five months of pathology rotations in your fourth year if you're interested in pathology or even if it's just something to accompany something else like surgery, doing surge path or HEM O to do heme path. So I did one month each of surgical pathology, dermatopathology heme clinical pathology, and the most unique thing at UAMS that I'm very proud of is that I was able to start a grossing elective on my campus with Dr. Quick and a co-resident of mine who also went to medical school here. We started very early with hands-on learning and seeing all that pathology has to offer. Something else that UAMS does is of course our interest group, which I think is very accessible for every institution and something that everybody should get involved in if they want to be champions of Future Pathologist initiative. Our interest group is called SCOPE or the Student Club of Pathology Education where I served as president of that organization and started bringing in medical students as early as their first year of medical school to get used to pathology and all that. It has to offer. UAMS also offers a summer elective program between the first and second year of medical school where students get to rotate for two whole months during that time and see everything that we have in pathology.

Dr. Kamran Mirza:

That's spectacular. I think with that grossing elective, Dr. Cox, you've instantly become a future pathologist champion as a nascent pathologist yourself. That's amazing. And I love the role of pathology, student interest groups, especially things like scope that you've talked about. One of the institutions I was part of also had a pathology interest group called SCOPE, except that stood for Students Curious in Outrageous Pathology Experiences. And so a scope had a great double meaning. That's wonderful.

Dr. Kalisha Hill:

That amazing. That is amazing. You said something in there that really struck me. You were exposed to a pathologist who was on faculty. You reached out and made that connectivity. So that really speaks to your desire to be exposed yourself, you making that choice but also speaks to the faculty who demonstrated what they do in a way that was attractive to you and that connectivity is very important and I totally agree with Dr. Mirza. The grossing opportunity is huge and I have always felt and continue to feel as someone who still grosses their own specimens, it is the most valuable thing that you can do outside of looking at the microscope, seeing your own specimens and correlating that with what you're seeing under the microscope makes a huge difference and it's a very valuable skill to have. So kudos to you for developing that program. 

So tell me, how likely do you think it is both currently in the future that more programs will mimic what you all are doing? 

Dr. Carli Cox:

I think it's very likely that institutions may be inspired by some of this and want to implement these changes in their own programs. We've definitely seen in our own program that these initiatives that we've done have increased the number of students that are interested in pathology, and not only that, but also increased the interest of students who aren't going into pathology but are going to be working alongside pathologists for the rest of their careers.

Dr. Kalisha Hill:

That is a very, very important point, and we often say that even if you don't choose pathology as your specialty, you will work with a pathologist because laboratory medicine impacts every single patient that comes into a hospital or outpatient facility.

Dr. Kamran Mirza:

We were talking about that connectivity and that faculty champion piece with Dr. Cox and Dr. Gokden. I wanted to ask you, how did you get involved as a champion and start impacting medical students at your institution?

Dr. Murat Gokden:

I have always been interested in medical student teaching and I see it as an excellent way to connect with them and influence our future colleagues. As you just mentioned, even if they do not go into pathology, they will be working with us closely in the future. I'm heavily involved in mainly the teaching of our first year medical students and the teaching module I am involved in is at the end of their first year having about 10 hours of interaction provides a lot of opportunities to tell them about pathology. As some of you may remember, pathology used to be a whole year sophomore course, and we used to have a lot more opportunities to dive into various aspects of pathology as a specialty. We used to have a laboratory tour, various orientation sessions, introduction to pathology, introduction to pathology report, how to read one and what to look for on one microscope sections, et cetera. 

We could actually get a chance to talk about what pathology does in daily medical practice while the students get to know us in person. Gradually medical education shifted towards a focus primarily on USMLE scores and pass rates, all the political and financial reasons and implications of this aside, what it did was class after class of medical students, there was nobody left to remember what pathology was about. We turned into people, we as pathologists turned into people who showed up to flash some pictures on the screen and talk about some percentages. In fact, nowadays we can't even show up. We are instructed to do teaching virtually as much as possible. That is what the format is. So we cannot even prepare our own questions anymore. They have to come from NBME. So what this means is we cannot teach pathology. We have to stay within what is on the exam. 

Otherwise the students tend to skip our extra material because the message unintentionally given to them is that if it is not a high yield subject for exam purposes, it is not important. So therefore, alongside these changes, I had to shift my focus and my approach to a more small group or even if possible, whenever possible a one-on-one interaction, I will still go off script in my lectures and insert some information or a link about pathology in my slides or notes. I offer students to come by over the summer and whenever they get a chance to visit us in pathology, I figured being personable and available, showing interest and enthusiasm encourages them to at least think about it. Our department has some rotation or clerkship every summer, including the one that Dr. Cox and her colleague started. So these all give me opportunities to interact with the students. 

For instance, Dr. Cox may remember me seeing her in the hallway and showing her some brain tumor slides and telling her about how what we say will impact management during one of her rotations. I try to take full advantage of our institution's shadowing program and invite the maximum number of students to come shadow me. I do not hear from some of them at all again, but the other extremists, we end up doing some projects, working on papers and going to annual meetings to present their work. Some of them have even gone into neuropathology, which is quite unusual. Being involved in student affairs. Interest groups are also very useful, especially in terms of visibility and availability. We presented the outstanding medical student award and the one for this year in the class right before the start of a class, when all the students were available to Dr. Cox and the subsequent year so that they can hear about pathology and CAP through that interaction. 

Because this approach has been going very well, I'm currently working on establishing a student research and travel fund within the AAMP and model other things after what we have in CAP. It is also a community effort. It has to be the culture of the department instead of students thinking this or that pathologist is great. It is a lot better if they say, oh, the pathology department is great. So learning about this initiative by CAP was the icing on the cake for me. Being involved in this group and its activities is encouraging, empowering, stimulating, reassuring for me to improve and continue on this path.

Dr. Kalisha Hill:

That is amazing work. Dr. Gokden, you are an example of how you can make change as an individual. Well, Dr. Cox, given that wonderful summary that Dr. Gokden has given us, tell us in terms of your transitioning from a medical student to a resident. How has his just being there, his mentorship, his tutelage, him as a person, how has it influenced you, how you actually perform as a resident and how you see yourself one day in practice?

Dr. Carli Cox:

Dr. Gokden has been such a joy to get to know. As he mentioned, we met when I was a medical student rotating in pathology, and he just took notice in the interest that I had for the field and took time out of his day to give me cases of brain tumors to review and go over them with me later on in the day. I think that his interest in me when I was there and him embracing students interested in pathology is the most important thing that faculty can do in any institution. Formal courses may not be there for pathology, but involving students in sign out and giving them hands-on opportunities to learn is what sparks passion for the field. And him, along with many other faculty at UAMS who did the same thing are exactly how I knew what the field had to offer from early on in medical school. 

And I think that everybody can take him as an example as to how they can be involved with medical students and get people into the field. So Dr. Gokden being there for me as a mentor has meant so much to me, and as I transitioned from a medical student to a resident, it was always so comforting and gave me a lot of confidence as a new resident to know that I had a faculty member on my side that was going to be there if I needed somebody. He's always there if you have any questions or if you just want to talk about an interesting case. And I think that that's exactly how I knew that UAMS was going to be the home for me. The thing about pathology that I love the most is that it's such a tight knit group and it's so important to me to have people around to talk about interesting cases, to get help, to learn to the best of your ability. And having Dr. Gokden there is part of that for me.

Dr. Kalisha Hill:

That is wonderful.

Dr. Kamran Mirza:

This is so inspiring. Hearing about the work that you've done with Dr. Gokden and kind of your journey to pathology, Dr. Cox. So now that you're on the other side and in a pathology residency, what have you been doing now to reach more medical students? No pressure. You've already done enough, but I'm sure knowing you, you're probably still involved in one way or the other.

Dr. Carli Cox:

So I still take an active role in SCOPE. It's always been a passion of mine to be involved in the interest group, and now that I'm on the residency side of things, I still enjoy helping them plan meetings and making the connection between students and faculty who may do talks with the medical students on different topics. I'm also heavily involved in teaching rotating medical students regardless of whether they're interested in pathology or something else. Like Dr. Hill said, you never know when the person who wants to be an OB GYN might go into gynecologic pathology or something of the like. So I try to relate what we're talking about as much as I can to their field of interest and see that connection between pathology and a field that they might think about practicing clinically. I also continue to take a role in the grossing elective. I'd like to see it continue year after year. I also am the social media coordinator for my program. One of the things that we do is something called a Workup Wednesday where we show pictures and have multiple choice questions just to let people participate on social media and see what pathology is.

Dr. Kamran Mirza:

That's spectacular. I mean, what a list of amazing things. You are an inspiration. Dr. Cox, thank you for all that you do.

Dr. Kalisha Hill:

That is wonderful. Dr. Mirza, as our fearless leader of the Future Pathologist Champions, what advice would you give to other pathologists who are interested in becoming champions at their institutions?

Dr. Kamran Mirza:

I think that many pathologists don't realize that they're already champions. And so I am here to say, as the facilitator of this group, join the Future Pathologist Champion Program for the CAP. You are Not alone. The Future Pathologist Champion Program basically is anyone who serves as a role model by encouraging and mentoring medical students in our specialty. Anyone who raises awareness of the essential importance of pathology and laboratory medicine, I can guarantee many of them, many of them are listening right now to this podcast, and so we encourage you to become a member. All you have to do is go to the cap.org and under member resources, you'll find resources for medical students and the Future Pathologist Champions program is right there. In the last year alone, our champion community has increased by 169%. We now have 215 active members and they're raising awareness about the importance of pathology. And so we can serve the CAP can serve as a resource that can supplement your work. And if you've been inspired like I have by this conversation, being a member of that larger community will only push you forward.

Dr. Kalisha Hill:

Thank you, Dr. Mirza. First of all, I just have to thank you, Dr. Gokden and Dr. Cox for taking the time to do this and share your experience. I will tell you that every time I go to any meeting with their pathologist, the enthusiasm for what we do every day is palpable. So we just need to continue to get the word out of how wonderful pathology is to practice every day, how fabulous our specialty really is.

Lisa Tomcko:

Well, this has been a great discussion. Thank you all for your contributions around the important topic of medical students choosing pathology. We now know that pathologists and pathology residents have a unique opportunity to shape the future of the specialty by showing medical students the work that pathologists do and showcasing pathology's variety of career paths, practice settings, and also subspecialties. For more information on how to get involved as a Future Pathologist Champion, use the link in the show notes. And for any medical students listening who are interested in learning more about pathology, you can actually join the CAP for free as a medical student member. That link to join is also included in the show notes. For more information about the CAP, visit cap.org and stay tuned for future episodes of CAPcast.

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