FEATURE

A New Era of Pathology Residency Education

On the first floor of the Centennial Building, in an office reminiscent of a library’s subject heading reading room, Dr. Christopher Otis compares the hours of work it took to obtain a patient’s record and research volumes during his residency training to the exponentially greater amount of reference material that can now be accessed with the “click of a mouse button.”

Otis believes pathology is experiencing a new era of advances and contributions to the medical field. His contribution has been to create and compile a library of thousands of disease scenarios that are fully indexed and referenced.  Additionally, structured and formatted reporting is exposed in which Otis has created electronic forms that not only record values, but also provide definition and stratagems to common and multifaceted diseases.

The Great Abyss
The ability to instantaneously access a patient’s records, digital images and reference materials is agressively altering the role of the pathologist.  Generally, medical education doesn’t allow much time for understanding the subtleties of a disease; it’s designed to posit, “if this…then that.”

Otis forecasts that the “great abyss” between a disease and its prescribed treatment will be traversed by the pathologist.  Increasingly, pathologists will need to clarify the predictive value of tests to better assist physicians in prescribing a course of treatment. 

Pathology residents are keenly aware of these expanded responsibilities. In contrast, pathology residency programs have been reduced from five years to four since the 1980’s, primarily as a result of governmental fiscal restraints. Program directors across the country feel hard pressed to train residents in the four pillars of pathology: anatomic, clinical, molecular/cytogenetic and information technology, and a majority of pathology residents feel trepidation about having to “make-up” a year of training in fellowship. Otis and many cooperating pathology societies assert that residency programs should return to a full five years – it is essential that residents become adept in this increasingly time-challenged field.

Training Above the Curve
Otis believes the success of Baystate’s pathology residency program is due in part to the unwavering dedication of the department’s faculty.  Baystate’s former residents have stayed in communication with Otis through their fellowships and beyond.  Now at academic centers such as Memorial-Sloan Kettering, MD Anderson, and Brigham and Women’s, they have remarked that their Baystate training placed them “above the curve” in relation to their colleagues.  Fellowship directors across the country have concurred and inquired, “Do you have any more?”

The Next Big Leap
As great as the challenge is to train current pathology residents, Otis foresees an even greater challenge unfolding for the professional pathology societies - to devise and help institute time-limited certification and maintenance for pathologist licensure.  Akin to “a bolt of lightning” out of the blue, these potential certification changes present highly complex issues that he predicts will require not only the efforts of the pathology societies, but also the collaboration of industry, academic medical centers, education offices and medical staff.

Christoper Otis, MD is the Director for Surgical Pathology at Baystate Medical Center and serves as the President of the Association of Directors of Anatomic and Surgical Pathology.

Further Reading:
Otis CN. Residency Training in Anatomic Pathology: Looking Forward in the 21st Century. Hum Pathol. 2006;37:929-931.