Fewer seniors from United States allopathic medical schools are filling pathology residency positions in the Main Residency Match, 2008-2017

Science, Medicine, and Cytology: an educational program of the Diversity, Equity, and Inclusion Committee of the American Society of Cytopathology

INTRODUCTION

As our field of pathology continues to grow, our trainee numbers are on the decline. To combat this trend, the ASC Diversity, Equity, and Inclusion Committee established the Science, Medicine, and Cytology SumMer Certificate program to improve exposure to pathology/cytopathology with a focus on diversity, equity, and inclusion. Herein, we report our findings of the first 2 years of the program.

MATERIALS AND METHODS

An online course was developed targeting students who are underrepresented in medicine at the high school and college level. It consisted of several didactic sessions, presenting the common procedures involving cytopathologists and cytologists. Interviews with cytopathologists were also included. Participants were surveyed for demographic information and provided course evaluations.

RESULTS

In the first year of the program (2021), 34 participants completed the program, which increased to 103 in 2022. In both years there was a diversity in participant demographic backgrounds; however, only a minority of participants self-identified as being underrepresented in medicine. A vast majority (>85%) of participants in both years were high school or college students. In 2021, 100% of participants stated that the program format was effective and 94% thought the content was appropriate for their level of education; in 2022 the results were similar. In 2021, 66% considered health care as a potential career; this value increased in 2022 to 83%. In 2021 and 2022, 31% and 38%, respectively, considered cytology as a career.

CONCLUSIONS

Evaluations were excellent, generating interest in cytopathology. Barriers in reaching underrepresented minorities exist and additional work is needed. Expansion to a wider audience may increase outreach.

Leadership perspectives on osteopathic medical school applicants to pathology residency training

The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.

Artificial Intelligence-Triaged 3-Dimensional Pathology to Improve Detection of Esophageal Neoplasia While Reducing Pathologist Workloads

Early detection of esophageal neoplasia via evaluation of endoscopic surveillance biopsies is the key to maximizing survival for patients with Barrett's esophagus, but it is hampered by the sampling limitations of conventional slide-based histopathology. Comprehensive evaluation of whole biopsies with 3-dimensional (3D) pathology may improve early detection of malignancies, but large 3D pathology data sets are tedious for pathologists to analyze. Here, we present a deep learning-based method to automatically identify the most critical 2-dimensional (2D) image sections within 3D pathology data sets for pathologists to review. Our method first generates a 3D heatmap of neoplastic risk for each biopsy, then classifies all 2D image sections within the 3D data set in order of neoplastic risk. In a clinical validation study, we diagnose esophageal biopsies with artificial intelligence-triaged 3D pathology (3 images per biopsy) vs standard slide-based histopathology (16 images per biopsy) and show that our method improves detection sensitivity while reducing pathologist workloads.

Automating Ground Truth Annotations for Gland Segmentation Through Immunohistochemistry

Microscopic evaluation of glands in the colon is of utmost importance in the diagnosis of inflammatory bowel disease and cancer. When properly trained, deep learning pipelines can provide a systematic, reproducible, and quantitative assessment of disease-related changes in glandular tissue architecture. The training and testing of deep learning models require large amounts of manual annotations, which are difficult, time-consuming, and expensive to obtain. Here, we propose a method for automated generation of ground truth in digital hematoxylin and eosin (H&E)-stained slides using immunohistochemistry (IHC) labels. The image processing pipeline generates annotations of glands in H&E histopathology images from colon biopsy specimens by transfer of gland masks from KRT8/18, CDX2, or EPCAM IHC. The IHC gland outlines are transferred to coregistered H&E images for training of deep learning models. We compared the performance of the deep learning models to that of manual annotations using an internal held-out set of biopsy specimens as well as 2 public data sets. Our results show that EPCAM IHC provides gland outlines that closely match manual gland annotations (Dice = 0.89) and are resilient to damage by inflammation. In addition, we propose a simple data sampling technique that allows models trained on data from several sources to be adapted to a new data source using just a few newly annotated samples. The best performing models achieved average Dice scores of 0.902 and 0.89 on Gland Segmentation and Colorectal Adenocarcinoma Gland colon cancer public data sets, respectively, when trained with only 10% of annotated cases from either public cohort. Altogether, the performances of our models indicate that automated annotations using cell type-specific IHC markers can safely replace manual annotations. Automated IHC labels from single-institution cohorts can be combined with small numbers of hand-annotated cases from multi-institutional cohorts to train models that generalize well to diverse data sources.

Shortage of pathologists in Italy: survey of students and residents

Objective

In Italy, shortage of pathologists is a problem that affects the quality of the National Health System (NHS). The cause of the shortage of pathologists in Italy must be sought in the lack of interests in the pathologist career by Medical Course Students (MCS) and in drop out of Post-Graduate Medical Schools (PGMS). We investigated reasons of both through two surveys.

Methods

We developed and proposed on Facebook two surveys, one to MCSs attending last years of study and one to Pathology School Residents (PSRs). Survey for MCSs consisted of 10 questions centered on their perception about pathologist activity; survey for PSRs consisted of 8 questions and investigated the most and least appreciated aspects of Italian PGMS.

Results

We obtained 500 responses from the MCSs and 51 responses from the PSRs. Our results show that lack of interest of MCS may be due to their incomplete knowledge of the pathologist's activities. On the other hand, PSR answers show that some teaching aspects should be improved.

Conclusions

Our surveys showed that lack of interest of MCS in the pathology career depends on poor knowledge about the real clinical significance of pathology and PSRs believe that Italian PGMS do not meet their interest. One solution could be a renewal of teaching both in the pathology courses for MCS and in PGMS.

Pathology education project (PEP): A pilot program to spark student understanding in pathology as a career

According to the National Resident Matching Program in 2022, 631 pathology positions were offered. In total, 248 senior applicants from United States (US) allopathic schools filled 36.6% of these positions. To bolster medical student understanding of pathology, a medical school pathology interest group organized a multi-day activity to introduce rising second-year medical students to pathology as a career. Five students completed both pre- and post-activity surveys assessing their knowledge of the specialty. All five students had a BA/BS degree as their highest level of education. Only one student indicated that he or she had previously shadowed a pathologist as a medical laboratory scientist for a duration of four years. Two students indicated that they were interested in internal medicine, one indicated radiology, one forensic pathology or radiology, and one was undecided. During the activity, students biopsied tissue from cadavers in the gross anatomy lab. Thereafter, students participated in the standard tissue processing by shadowing a histotechnologist. Under the guidance of a pathologist, students microscopically examined slides and discussed the clinical findings. Post-activity survey results indicated that participation increased their knowledge of pathology as a career with a median increase of 0.8 points (range: 0.2 to 1.6) on a 5-point Likert scale. Students also indicated that their participation increased their knowledge of pathology skills and techniques-median increase of 1.2 (range: 0.8 to 1.8). This activity can be implemented by medical educators to expose medical students to pathology as a career with the benefit of increasing student knowledge in the specialty.

Seniors from United States allopathic medical schools matching into pathology residency, 2018-2022

BACKGROUND

From 2008 to 2017, 28.8 % fewer United States allopathic medical students (MD seniors) applied to pathology residency in the Main Residency Match (MRM) and 27.5 % fewer matched. This study is a 5-year follow-up.

METHODS

MRM data from 2018 to 2022 were reviewed to determine the numbers of MD seniors that applied and matched to pathology residency and other major medical specialties.

RESULTS

From 2018 to 2022, the number of MD seniors applying to pathology increased 4.6 % from 237 to 248, while MD seniors matching to pathology increased 5.0 % from 220 to 231. For the 4 years from 2018 to 2021, there was a slight decline in MD seniors filling pathology positions, followed by a substantial 16.7 % spike in 2022. For the entire 5-year interval, because the number of filled pathology residency positions increased by 9.0 %, the percentage of filled positions taken by MD seniors declined from 38.7 % to 37.3 %. Of the 15 major medical specialties evaluated, pathology now has the 14th lowest percentage of filled positions taken by MD seniors.

CONCLUSIONS

The number of MD seniors applying and matching to pathology residency increased over the past 5-years, in contrast to the timespan of 2008 to 2017. However, the percentage of pathology residency positions taken by MD seniors continued to decline and remains low compared to other major medical specialties. MRM data should be continually monitored to study trends in MD seniors filling pathology residency positions in the context of new recruitment efforts and the pandemic.

Pathology Rotations Embedded Within Surgery Clerkships Can Shift Student Perspectives About Pathology

PURPOSE

Medical school curricula have focused more on early clinical exposure with compressed didactic curricula, raising questions on how pathology can be effectively integrated into clinically relevant medical education. This study highlights how a required 1-week pathology rotation embedded within a surgery clerkship can impact students' knowledge base and perspectives of pathology.

METHODS

One hundred ninety-two medical students rotated through a newly designed mandatory 1-week pathology rotation during surgery clerkship. Post-rotation feedback and survey data from students were collected to evaluate their perspectives of pathology. Pathology residents and faculty were surveyed about changes on workflow imposed by the new rotation.

RESULTS

Eighty percent of student respondents agreed the rotation improved understanding of pathology workflow and its integration into the larger picture of healthcare delivery. 62% and 66% reported the rotation had a positive impact on their perspectives of pathology and pathologists, respectively. However, a significant number pathology resident respondents noted that integration of students into clinical activities either slightly (42%) or significantly (5%) decreased their own learning. Both pathology faculty and residents also noted medical student presence either slightly (19% and 37%, respectively) or significantly (63% and 58%, respectively) decreased workflow efficiency.

CONCLUSIONS

Integration of pathology rotations into surgical clerkships is a viable strategy to remedy decreased pathology contact and education due to curricular restructuring that condenses preclinical time while offering medical students a more integrated and practical perspective of pathology as a field. It is essential for pathology departments to prioritize and actively participate in both preclinical and clinical curricular development.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01569-y.

Factors influencing US osteopathic medical students to choose pathology as a specialty

The decline in the number of US allopathic (Medical Doctor or M.D.) medical students matching to pathology residency has been a topic of much discussion at national pathology professional society meetings and in recent publications. A recent survey of fourth-year allopathic medicals students was conducted to better understand the rationale behind students’ interest or lack thereof in pathology as a specialty. This study utilizes a similar survey tool gauging osteopathic (Doctor of Osteopathy or D.O.) student knowledge and interest in pathology, and offers insight into a possible growth market for the specialty. Similar to allopathic students, osteopathic students noted that clinical or research opportunities in pathology during medical school, autopsy observation/participation, and participation in pathology interest groups correlated with a greater likelihood of selecting pathology as a specialty. However, some key differences in osteopathic medical school curricular elements including microscope use, gross pathology specimen demonstrations, case-based learning by pathologists, exposure to pathology during other rotations, awareness of a pathology interest group, as well as an overall understanding of the everyday work of a pathologist were noted. Experiential exposure to pathology, and direct mentorship from pathologists may present an opportunity for pathology professional organizations, and pathology residency programs to partner with osteopathic medical schools to increase interest in the field, and aid in pipeline development.

Osteopathic students and graduates matching into pathology residency, 2011-2020

Context

In the past decade, two changes have affected the pathology residency match. First, the American Osteopathic Association (AOA) Match, which did not offer pathology residency, became accredited under a single graduate medical education (GME) system with the Main Residency Match (MRM), which offers pathology residency. Second, substantially fewer United States senior-year allopathic medical students (US MD seniors) matched into pathology residency.

Objective

To determine whether there were major changes in the number and percentage of osteopathic students and physicians (DOs) matching into pathology residency programs over the past decade.

Methods

Pathology match outcomes for DOs from 2011 to 2020 were obtained by reviewing AOA Match data from the National Matching Services and MRM data from the National Resident Matching Program (NRMP). The number of DOs that filled pathology positions in the MRM was divided by the total number of pathology positions filled in the MRM to calculate the percentage of pathology positions taken by DOs.

Results

Over the past decade, there was a 109% increase in the total number of DOs matching into pathology residency (34 in 2011 vs. 71 in 2020). During this time, there was a 23.3% increase in the total number of pathology positions filled in the MRM (476 in 2011 vs. 587 in 2020). Thus, the percentage of pathology residency positions filled by DOs increased from 7.1% in 2011 to 12.1% in 2020. The substantial increase of DOs in pathology occurred simultaneously with a 94.2% increase in the total number of DOs filling AOA/MRM "postgraduate year 1" (PGY-1) positions (3201 in 2011 vs. 6215 in 2020). Thus, the percentage of DOs choosing pathology residency has remained steady (1.06% in 2011 and 1.14% in 2020). In 2020, pathology had the third lowest percentage of filled PGY-1 residency positions taken by DOs, out of 15 major medical specialties.

Conclusion

The proportion of DOs choosing pathology residency was stable from 2011 to 2020 despite the move to a single GME accreditation system and the stark decline in US MD seniors choosing pathology. In 2020, a slightly higher percentage of DOs (1.14%) chose pathology residency than US MD seniors (1.13%). Overall, DOs more often choose other medical specialties, including primary care. Additional studies are needed to determine why fewer US MD seniors, but not fewer DOs, are choosing pathology residency.

The medical student's guide to pathology residency, fellowships, and careers

Recent studies have shown that relatively few MD, DO, and underrepresented in medicine (URM) students and physicians are matching into pathology residency in the United States (US). In the 2021 Main Residency Match, just 33.6% of filled pathology residency positions were taken by senior year students at US allopathic medical schools. This has been attributed to the fact that pathology is not a required rotation in most US medical schools, pathology is often taught in an integrated curriculum in the US where is does not stand out as a distinct field, and because the COVID-19 pandemic led to a suspension of in-person pathology rotations and electives. Ultimately, many US medical students fail to consider pathology as a career pathway. The objective of this article is to provide medical students with basic information, in the form of frequently asked questions (FAQs), about pathology training and career opportunities. This was accomplished by forming a team of MD and DO pathology attendings, pathology trainees, and a medical student from multiple institutions to create a pathology guide for medical students. This guide includes information about post-sophomore fellowships, 5 major pathology residency tracks, more than 20 fellowship pathways, and allopathic and osteopathic board examinations. This guide also contains photographs and descriptions of major pathology sub-specialties, including the daily and on-call duties and responsibilities of pathology residents. The exciting future of pathology is also discussed. This guide supports the agenda of the College of American Pathologists' (CAP) Pathologist Pipeline Initiative to improve student recruitment into pathology.

Strategies to Enhance Diversity, Equity, and Inclusion in Pathology Training Programs: A Comprehensive Review of the Literature

CONTEXT.—

Like many medical specialties, pathology faces the ongoing challenge of effectively enriching diversity, equity, and inclusion within training programs and the field as a whole. This issue is furthered by a decline in US medical student interest in the field of pathology, possibly attributable to increasingly limited pathology exposure during medical school and medical student perceptions about careers in pathology.

OBJECTIVE.—

To review the literature to identify the challenges to diversity, equity, and inclusion in pathology, with an emphasis on the pathology trainee pipeline. To evaluate the medical education literature from other medical specialties for diversity and inclusion-focused studies and initiatives, and determine the outcomes and/or approaches relevant for pathology training programs.

DATA SOURCES.—

A literature review was completed by a search of the PubMed database, as well as a similar general Google search. Additional resources, including the Web sites of the Association of American Medical Colleges, the Electronic Residency Application Service, and the National Resident Matching Program, were used.

CONCLUSIONS.—

Many strategies exist to increase diversity and encourage an inclusive and equitable training environment, and many of these strategies may be applied to the field of pathology. Interventions such as increasing exposure to the field, using a holistic application review process, and addressing implicit biases have been shown to promote diversity, equity, and inclusion in many medical specialties. In addition, increasing access to elective and pipeline programs may help to bolster medical student interest in careers in pathology.

Increasing Medical Student Exposure to Pathology by Creating an Integrated Rotation During Surgery Clerkship

Following a nationwide trend, the University of Michigan Medical School has restructured its curriculum to facilitate integration of basic science curricula and early inclusion of clinical experiences, resulting in a truncation of a 19-month didactic-based preclinical curriculum to 13 months. Because preclinical didactic and lab sessions formed the bulk of pathology contact hours, the curriculum overhaul significantly reduced student exposure to pathologists. This reduction in exposure may decrease student understanding of how pathology integrates into the larger picture of healthcare delivery and could also decrease the pipeline of students interested in pursuing pathology as a career choice. To ameliorate these concerns, a mandatory 1-week rotation through the Pathology Department was integrated into the surgery clerkship. This brief report outlines the process of creating a new, unique pathology rotation for surgery clerkship students that includes observation in autopsy and surgical pathology sign-out, small group sessions focused on foundational concepts in microbiology, chemistry, and transfusion medicine, and access to online case-based modules. Available qualitative student feedback indicates that students appreciate how this rotation granted them a “behind the scenes” look at pathology but also noted that the fast pace of clinical sign-out sessions and length of small group sessions were suboptimal for student learning. This feedback and future survey data will serve as a platform on which curricular improvements can be made to enhance the learning environment for both learners and educators.

Designing and Implementing a Virtual Anatomic Pathology Elective During the COVID-19 Pandemic

The COVID-19 pandemic transformed conventional undergraduate medical education, converting previously in-person clerkships into virtual experiences. In order to allow students to gain exposure to the field of pathology, make connections with pathologists, and provide opportunities for letters of recommendation, the authors quickly developed a Virtual Anatomic Pathology Elective at the University of Minnesota. We succeeded in developing the foundation of a Virtual Anatomic Pathology Elective that allows for the rotation to be accessible not only to our medical students but also to international medical graduates and medical students from different programs. In 1 month, we were able to create a 4-week elective that was available before the start of the 2021 residency application season. We provided students with the closest possible experience to an in-person Anatomic Pathology Elective by developing an introductory week of lectures and assignments that provided structure for the rotation, introduced the field of anatomic pathology, and demonstrated the role of pathologists in health care. Furthermore, students attended virtual resident lectures and grand rounds, participated in virtual sign-out sessions, and presented an interesting case to the faculty at the end of their rotation. The goal was ultimately to customize the curriculum to students' interests by making the rotation applicable to those applying to pathology as well as to other specialties (eg, general surgery, internal medicine, dermatology). Overall, we were able to design and implement a novel Virtual Anatomic Pathology Elective which we know can be effectively reproduced by other medical schools.

Engaging Pathology Residents in Clinical Chemistry: The Essential Ingredient Is a Committed Teacher

BACKGROUND

Pathology residents are thought to show a lack of interest in clinical chemistry, therefore potentially graduating from training programs unprepared to function as laboratory directors and clinical consultants.

METHODS

A structured program of tutorials based primarily on Henry's textbook, supplemented by recent review articles; a question bank of about 600 questions to emphasize key concepts; requirement for performing and presenting quality improvement projects; participation in on-site CAP inspections; review of reference laboratory test requests; and involving residents in scholarly activity have resulted in sustained, transferable, and significant improvements in engagement, knowledge, competence, and examination scores.

RESULTS

The primary parameter for measuring change in resident competence and engagement were improvements in resident in-service examination (RISE) scores, publications in peer-reviewed journals, and receipt of awards. The revised program produced significant improvement in RISE scores in clinical chemistry, over and above the improvements in the general residency program. The residents were authors on 12 publications in peer-reviewed PubMed listed journals in the 5-year period since revision in the clinical chemistry curriculum compared to no publications in clinical chemistry in the 5-year period before the new curriculum. Over the past 2 years, 6 of the 11 publications by graduating residents were in clinical chemistry, and 6 of 7 awards for research were garnered by residents engaged in clinical chemistry investigations. All of the residents passed their clinical pathology boards on first attempt since the change compared to 2 failures in the prior 5-year period.

CONCLUSIONS

The structured program described here is important as a template that could be adopted by any pathology training program. The question bank developed by this program is a valuable and transferable aid. However, success of such a program is dependent on the commitment of a knowledgeable, dedicated, and passionate teacher.

The Texas Society of Pathologists: molded by the legacy of pathology and focused on excellence in medicine for 100 years and beyond

In 1921, 16 Texas pathologists gathered in Dallas, Texas, to found the Texas Society of Pathologists (TSP). The TSP is now the oldest state pathology society in the USA with continuity traced back to its founding 100 years ago. This article aims to both commemorate the TSP centennial and to provide context for the remarkable success of the society. The article takes a look back and a look forward from 1921. The look back focuses on the development of the field of pathology and the maturation of medicine and pathology in the USA and Texas. The look forward encompasses developments in science, technology, American health care policy, and medicine that have impacted Texas pathologists and influenced proactive initiatives of the TSP. The review of the life and times of the TSP highlights the importance of leaders and leadership in shaping outcomes. Complexities and uncertainties of the contemporary health care scene point to the need for continued strong leadership. The successful past century and hopeful future of the TSP are inextricably linked to the guiding principle of the TSP, which is a focus on continual striving for excellence in medicine.

Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce

OBJECTIVES

This study assessed historical and current gender, racial, and ethnic diversity trends within US pathology graduate medical education (GME) and the pathologist workforce.

METHODS

Data from online, publicly available sources were assessed for significant differences in racial, ethnic, and sex distribution in pathology trainees, as well as pathologists in practice or on faculty, separately compared with the US population and then each other using binomial tests.

RESULTS

Since 1995, female pathology resident representation has been increasing at a rate of 0.45% per year (95% confidence interval [CI], 0.29-0.61; P < .01), with pathology now having significantly more females (49.8%) compared to the total GME pool (45.4%; P < .0001). In contrast, there was no significant trend in the rate of change per year in black or American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander (AI/AN/NH/PI) resident representation (P = .04 and .02). Since 1995, underrepresented minority (URM) faculty representation has increased by 0.03% per year (95% CI, 0.024-0.036; P < .01), with 7.6% URM faculty in 2018 (5.2% Hispanic, 2.2% black, 0.2% AI/AN/NH/PI).

CONCLUSIONS

This assessment of pathology trainee and physician workforce diversity highlights significant improvements in achieving trainee gender parity. However, there are persistent disparities in URM representation, with significant underrepresentation of URM pathologists compared with residents.

How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents

Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.

Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency

From 2010 to 2019, 40.5% fewer senior students from United States (US) allopathic medical schools pursued pathology in the Main Residency Match. To possibly explain this trend, we sought to identify major concerns about pathology which were made during this time. Because the Student Doctor Network (SDN) website is widely used by students at American medical schools during the residency application process, SDN has been shown to influence career decisions. So, the 50 all-time most-viewed SDN pathology threads (as of February 2018) were analyzed. The words “job” and “jobs” were used in the title of 11 of the 50 (22%) threads, which altogether received more than 400,000 views. However, the term “job(s)” was rarely used by 14 other major medical specialties. Seven of the 11 (63.6%) job-related threads were created from 2009 to 2011, corresponding with the start of the decline in medical students pursuing pathology residency. It was reasoned that job-market concerns within SDN threads may have discouraged students from pursuing pathology. To test this hypothesis, 5 pathology residents were asked to read all 11 threads and then complete a survey. Most thread reviewers agreed that commenters, which included medical students, were concerned about the pathology job-market and that medical students who viewed the threads would be less likely to pursue pathology residency. Because more than 85% of SDN users are from the US, the threads likely had a greater impact on American medical students compared to foreign students. In conclusion, job-market concerns over the past decade are so prominent in the SDN pathology forum that they likely contributed to fewer seniors from US allopathic medical schools pursuing pathology residency. As of 2019, there are 12 job-related threads among the 50 all-time most-viewed, including threads created in 2016 and 2017. To improve recruitment, the pathology community should carefully review and address concerns about employment opportunities. Due to conflicting reports, additional studies are needed to determine if a mismatch in workforce supply and demand warrants prompt and thoughtful intervention.

The "Race" Toward Diversity, Inclusion, and Equity in Pathology: The Johns Hopkins Experience

With 3.8% black trainees in 2012, pathology had significantly fewer trainees from groups underrepresented in medicine compared to other specialties. To address this, faculty in the Johns Hopkins Department of Pathology established an outreach program and funded rotation for students underrepresented in medicine and from disadvantaged groups. The aims were to increase exposure to the field and improve diversity, inclusion, and equity in pathology. A 1-month rotation for students underrepresented in medicine was established in 2013. Rotation schedules tailored to each rotator's interests included resident conferences and individual faculty meetings. In 2016, a proactive outreach program was established. Faculty visited historically black medical schools and underrepresented in medicine student groups at other institutions, where they gave a "Careers in Pathology" presentation targeted to second- and third-year medical students. Faculty also attended underrepresented in medicine student conferences and participated in high school student programs to further expand the underrepresented in medicine pipeline into medicine and pathology. Since 2016, fourteen outreach presentations have been delivered. The number of rotators increased from 1 in 2013 to 18 in July 2019. Rotators self-identified as African, African American, Hispanic, and Native American. Most were second- to fourth-year medical students, and 1 was a pathology resident. Six rotators are currently pathology residents, and others are strongly considering applying to pathology. The outreach efforts account for the success of our rotation, which, in turn, has had a positive impact on interest in pathology. However, we recognize barriers to retention and intend to incorporate additional professional development activities to further address equity.

Medical education today: all that glitters is not gold

BACKGROUND

The medical education system based on principles advocated by Flexner and Osler has produced generations of scientifically grounded and clinically skilled physicians whose collective experiences and contributions have served medicine and patients well. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in medical education. In this article, a critique is presented of the new undergraduate medical education (UME) curricula in relationship to graduate medical education (GME) and clinical practice.

DISCUSSION

Medical education has changed and will continue to change in response to scientific advances and societal needs. However, enthusiasm for reform needs to be tempered by a more measured approach to avoid unintended consequences. Movement from novice to master in medicine cannot be rushed. An argument is made for a shoring up of biomedical science in revised curricula with the beneficiaries being nascent practitioners, developing physician-scientists --and the public.

CONCLUSION

Unless there is further modification, the new integrated curricula are at risk of produce graduates deficient in the characteristics that have set physicians apart from other healthcare professionals, namely high-level clinical expertise based on a deep grounding in biomedical science and understanding of the pathologic basis of disease. The challenges for education of the best possible physicians are great but the benefits to medicine and society are enormous.

The Importance of the Autopsy in Medicine: Perspectives of Pathology Colleagues

This article presents a perspective on the importance of the autopsy in medical practice and science based on experiences of the authors as physician-scientists involved in autopsy practice. Our perspectives are presented on the seminal contributions of the autopsy in the areas of cardiovascular disease, including congenital heart disease, atherosclerosis, coronary artery disease, and myocardial infarction, and infectious disease, including tuberculosis and viral infections. On the positive side of the future of the autopsy, we discuss the tremendous opportunities for important research to be done by application of advanced molecular biological techniques to formalin-fixed, paraffin-embedded tissue blocks obtained at autopsy. We also note with concern the countervailing forces impacting the influence of pathology in education and clinical practice at our academic medical centers, which also present impediments to increasing autopsy rates. Our challenge as academic pathologists, whose careers have been molded by involvement in the autopsy, is to counter these trends. The challenges are great but the benefits for medicine and society are enormous.