Pathology as a medical specialty

Pathologists are physicians who diagnose and characterize disease in living patients by examining biopsies or bodily fluid. Pathologists may also conduct autopsies to investigate causes of death. Pathology is a core discipline of medical school and many pathologists are also instructors. As managers of medical laboratories, pathologists play an important role in the development of laboratory information systems. Although the medical practice of pathology grew out of the tradition of investigative pathology, most modern pathologists do not perform original research.

Pathology is a unique medical specialty in that pathologists typically do not see patients directly, but rather serve as consultants to other physicians (often referred to as "clinicians" within the pathology community). To be licensed, candidates must complete medical training, an approved residency program and be certified by an appropriate body. In the US, certification is by the American Board of Pathology or the American Osteopathic Board of Pathology. The organization of subspecialties within pathology varies between nations, but usually includes anatomical pathology and clinical pathology.

Training

Pathology in the United States

In the United States, pathologists are physicians that have completed a four-year undergraduate program, four years of medical school training, and three to four years of postgraduate training in the form of a pathology residency. Training may be within two primary specialties, as recognized by the American Board of Pathology: anatomical Pathology and clinical Pathology, each of which requires separate board certification. The American Osteopathic Board of Pathology also recognizes two primary specialties: Anatomic Pathology and Laboratory Medicine. Many pathologists pursue a broad based training and become certified in both fields. These skills are complementary in many hospital based private practice settings, since the day to day work of many clinical laboratories only intermittently requires the attention of a physician. Thus, pathologists are able to spend much of their time evaluating anatomical pathology cases, while remaining available to cover any special issues which might arise in the clinical laboratories. Pathologists may pursue specialised fellowship training within one or more subspecialties of either anatomical or clinical pathology. Some of these subspecialties permit additional board certification, while others do not.^[1]

Pathology in the United Kingdom

In the United Kingdom, pathologists are medical doctors registered with — and nowadays licensed by — the UK General Medical Council. The training to become a pathologist is under the oversight of the Royal College of Pathologists. After four to six years of undergraduate medical study, trainees proceed to a two year foundation programme. Full-time training in Histopathology presently lasts between five to five and a half years. The first year involves structured training and is assessed by an objective structured practical exam (OSPE), which must be passed to progress to year two. This is followed by further specialist training in surgical pathology, cytopathology, and autopsy pathology. There are two examinations run by the Royal College of Pathologists, termed Part 1 and Part 2. The Part 2 examination is designed to test competence to work as an independent practitioner in pathology and is typically taken after four or five years of specialist training. All postgraduate medical training and education in the UK is overseen by the General Medical Council (GMC). It is possible to take a specialist part 2 examination in forensic pathology, pediatric pathology, or neuropathology. It is also possible to take a Royal College of Pathologists diploma in forensic pathology, dermatopathology, or cytopathology, recognising additional specialist training and expertise.

Pathology in France

In France, Pathology is separate in two distinct specialties, Anatomical pathology and Clinical pathology. Residencies both lasts four years. Residency in anatomical pathology is open to physicians only, while clinical pathology is open to both physicians and pharmacists. Anatomical pathology in France is integrated in the internal medicine specialty track. At the end of the second year of clinical pathology residency, residents can choose between general Clinical pathology and a specialization in one of the disciplines, but they can not practise Anatomical pathology. And conversely, Anatomical pathology residents can not practise Clinical pathology ^{[2] [3]}.

Other subspecialties

The following outline is an attempt at synthesising information on profession pathology as it exists in the United Kingdom ^[4][5] and the United States.^[6]

1) Clinical Pathology:
1.1) Biochemistry and Immunology:
1.1.1) Clinical Biochemistry
1.1.2) Analytical Toxicology
1.1.3) Histocompatibility and Immunogenetics
1.1.4) Immunology
1.1.5) Tissue Banking
1.2) Haematology and Transfusion:
1.2.1) Blood Transfusion
1.2.2) Haematology
1.2.3) Haemostasis and Thrombosis
1.3) Microbiology and Infection:
1.3.1) Microbiology and Virology

2) Cellular Pathology:
2.1) Anatomical Pathology
2.2) Cytopathology and Cervical Cytology
2.3) Histopathology

3) Molecular Pathology:
3.1) Embryology:
3.1.1) Embryology and Andrology
3.2) Genetics:
3.2.1) Cytogenetics
3.2.2) Molecular Genetics

See also

• Anatomical pathology
• Clinical pathology
• Pathology
• United States and Canadian Academy of Pathology

References