Forensic Pathology Education in Pathology Residency: A Survey of Current Practices, a Novel Curriculum, and Recommendations for the Future

How (Cautious) Social Media Use May Improve Education and Pipeline Efforts of a Growing Postpandemic Forensic Pathologist Workforce Shortage

ABSTRACT

Many subspecialties of pathology have initiated novel methods and strategies to connect with medical students and residents, stimulate interest, and offer mentorship. Emerging concern about the future of forensic pathology has been highlighted in contemporary literature as recruitment of new fellows has stagnated and workforce shortage concerns have blossomed. Amidst these challenges, the potential role of social networking platforms like social media (SoMe) in enhancing autopsy pathology/forensics education has garnered attention, yet literature focusing specifically on its application in autopsy and forensic pathology remains limited. This review aims to provide a comprehensive narrative overview of the current literature on the established uses of SoMe in forensic pathology. It seeks to build upon existing recommendations, introducing a contemporary compilation of online resources designed to facilitate virtual engagement among pathologists, learners, patients, and families. The review supports the idea that strategic, ethical, and conscientious use of SoMe has a place in addressing the growing workforce shortages and closing educational gaps in forensic pathology by enhancing exposure to the field and dispelling antiquated stereotypes.

Graduate Medical Education in Pathology: A Scoping Review

CONTEXT.—

Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized.

OBJECTIVE.—

To chart the concepts, research methods, and publication patterns of studies on GME in pathology.

DATA SOURCES.—

This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases.

CONCLUSIONS.—

Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.

Problems in Postmortem Pathology Training

OBJECTIVE

In Turkey, autopsy performers, namely forensic medicine practitioners, are neither pathologists nor have properly received pathology training during residency in contrast to the Anglo-Saxon model of forensic medicine practices, since the current curriculum of forensic medicine residency lacks adequate training in post-mortem histopathology. Likewise, pathologists lack a specific post-mortem pathology clerkship. In this study, we intended to determine whether forensic physicians in Turkey find themselves competent in post-mortem histopathology or were adequately trained during their residencies.

MATERIAL AND METHOD

Turkish forensic medicine practitioners were administered an online questionnaire whereby self-evaluations of their histopathology knowledge and their views on histopathology training during forensic medicine residency were assessed. The 151 physicians who completed the questionnaire made up the study group.

RESULTS

It was found out that the majority of Turkish forensic medicine practitioners (85.4%) did not find the histopathology training during their residency adequate. Similarly, 85.4% of the participants indicated their incompetence in histopathological examination of post-mortem tissue of any kind, and showed their willingness for further training in pathology. 66.9% strongly agreed that post-mortem histopathology requires training that is distinct from surgical pathology. In case of providing post-mortem histopathology training within the scope of forensic medicine residency, topics such as microscopic morphology of post-mortem changes, histological changes related to injuries, and estimation of wound age are expected to be beneficial to 88.7% 83.4%, and 83.4% of the participants respectively.

CONCLUSION

The current curriculum should be revised in a way that the surgical pathology clerkship meets forensic physicians' needs, so that they can then refer more difficult, non-routine histopathological consultations to pathologists who are also well-trained in postmortem histopathology. Consideration should also be given to establishing a subspecialty training - a master's or doctoral degree programs in forensic pathology.

The Relationship Between Medical School-Based Pathology Departments and Affiliated Forensic Pathology Training Sites

Medical school–based pathology departments were surveyed in order to evaluate their relationship with sites providing forensic pathology training. Of 59 departments surveyed, 49 (83%) responded. Most (88%) respondents indicated that training occurs at an affiliated medical examiner/coroner office, and 78% indicated that the facility is 10 miles or less from the academic health center. The majority (61%) of respondents require 4 weeks of forensic pathology training for their residents while the others require none (3); 6, 8, or 12 weeks (2 each); and 16 weeks (3, with two having integrated forensic and medical autopsies). The majority (81%) send one resident at a time to the forensic pathology training site, and almost always (92%) the experience is dedicated to forensic pathology without mixing with other training. Two-thirds of respondents send between 1 and 5 residents per year for training. Prior autopsy experience is required by 79% of departments. Medical student rotations in forensic pathology are available to 86% of reporting departments. Almost 3 quarters of respondents indicated that a forensic pathology fellowship is available through the training site with 83% being funded by the training site. About half of departments indicated that they provide some financial support to the site. Of reporting departments, 71% indicated that they give faculty appointments to forensic pathologists at the training site, with 3 quarters being voluntary appointments. Affiliated forensic pathology training sites are a valuable asset although 6 respondents report offering such training either totally or partially within the pathology department itself.

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.