Pathology

Pathology is often misunderstood by the general public and medical profession, who consider it to be only ‘forensic pathology’, as depicted (incorrectly) on the television. It actually comprises a variety of specialties, each with a variable degree of laboratory and clinical exposure, which form the foundations of medical and surgical diagnoses alike. Imagine being forced to make a definite diagnosis in the absence of pathology investigations: no chemical blood test results, no haematology results, no medical microbiology results or sensitivities, no histopathology or cytopathology reports on biopsies or cancer resections, and no immunology to diagnose allergies or the cause of renal and connective tissue diseases.

‘But I’d miss the patient contact.’ Specialties such as metabolic medicine and haematology can involve running clinics and advising on ward rounds; the clinical decision-making capability of a histopathologist is evident in the development of the multidisciplinary team meeting; the staging and grading of cancers has an immensely important role in the prognosis and treatment planning for many malignant tumours. These examples show that the pathologist is central to patient management and not a reclusive figure hidden away in a laboratory in the depths of the hospital.

Training pathway

Trainees wishing to train in haematology, immunology, chemical pathology (metabolic medicine) and joint training in medical microbiology or virology and infectious diseases are required to undertake two years of core medical training (CMT) after completion of foundation training and before entry to specialist training in pathology. MRCP is also required. For chemical pathology, histopathology, medical microbiology and virology, CMT or any other further training is optional but entry to specialist training is also possible directly after completion of foundation training. For all pathology specialties, MRCPath by examination is a prerequisite for the award of the certificate of completion of training (CCT). Specialist pathology training varies in length between a minimum of four to six years (plus the two year CMT requirement for some). 

Training posts and competition

With workforce planning indicating a large number of consultant vacancies across the country, now is an ideal time to enter this fascinating and challenging profession.

Specialties and subspecialties

The specialties of pathology (subspecialties in brackets) are: chemical pathology (metabolic medicine), haematology (transfusion medicine, paediatric haematology), histopathology (cytopathology, forensic pathology, neuropathology and paediatric pathology), immunology, medical microbiology and virology (mycology).

Best and worst

‘I can’t bear the thought of staring down a microscope all day’ and ‘I don’t want to work with corpses all the time!’ These are some of the phrases heard regularly in response to the question: ‘Have you ever considered a career in pathology?’ You never hear ‘I don’t want to work sociable hours and have a life!’ or ‘I hate the thought of a well-guided training scheme with full and complete consultant supervision, working in a friendly environment free from bleeps.’ Such opinions are not helped by the GMC-recommended changes to medical school curricula, which have resulted in a general loss of formal pathology teaching in undergraduate education.

Key information resources

• Royal College of Pathologists

Express an interest with your local pathology department. The chances are they will be more than happy to show you around and discuss issues with you. 

Ben Swift MB ChB MD MRCPath (forensic) is an independent consultant Home Office registered forensic pathologist and former chairman of the trainees’ advisory committee at the Royal College of Pathologists.