‘In histopathology 90% of my time is spent being trained and I receive daily feedback when looking at cases with a consultant. There is very little service provision.’
The training programme
Training in histopathology is divided into four stages across five-and-a-half years. Trainees are within one deanery for the entirety of their training although there are plenty of opportunities to work in different deaneries for research, sub specialist training and additional experience. Histopathology training is unique amongst speciality training in that there is very little service provision. Every day is dedicated to training and there is lots of formal and informal teaching. This is especially true in ST1 where trainees attend three weeks of residential training spread across the year.
Look at the GMC National Training results for histopathology
A day in the life of an ST2 trainee:
I start the day by meeting my supervising consultant in cut up to discuss the cases that need dissecting and sampling. I’m doing a four week gynae pathology rotation currently so most cases are hysterectomies with or without ovaries and fallopian tubes for benign and malignant conditions. We prioritise the specimens so MDT cases get processed first and then (after I’ve explained my approach to each one) I’m left to describe, photograph, dissect and take blocks of the cases. The blocks each represent an important aspect of the case such as depth of tumour invasion or involvement of surgical margins so its important to get this stage right. My consultant comes back to supervise me on a challenging case. The level of supervision is excellent and consultants are always happy to offer help and advice.
After cut up I pick up slides that have been processed by the lab. Some of these are cases I cut up over the last 2-3 days. I look at these in the trainee’s room. There’s ten of us in the room each with our own microscope and desk, and each at different stages of training. It’s a very social environment and great for learning as everybody has different experience and knowledge that they can share. There’s a lot to learn in a short space of time in histopathology. Most trainees have at least one book open on their desk at any one time and there is a lot of reading to do. Today is no exception for me as I try to decide how to classify and grade a challenging ovarian tumour. I have to go through these cases with the consultant in the early afternoon and I also have some work from earlier in the week that required immunohistochemistry. This needs checking with a different consultant before it can be signed out in the final report. You have to have great organisational skills to keep on top of lots of work for lots of consultants at varying stages of completeness!
By early afternoon I’ve got everything finished and sit down at a double header microscope with my consultant. We go through the cases together and he points out certain features and asks me questions about what I saw and how I came to my conclusions. This near instant feedback on my performance is great for learning but you have to pick up new knowledge and skills quickly. Later in the afternoon all the trainees get together around the multi-header microscope for a consultant led teaching session. These sessions are great for seeing interesting/ unusual or exam cases. They can be daunting to begin with but the questions from the consultant are usually not confrontational and it is so useful to have this level of tuition every week in addition to the day-to-day supervision.
Best things about histopathology training: Trainee focussed and well supervised, really varied workload, constantly learning and (hopefully) improving
Worst things about histopathology training: You will never know everything! There is a lot of reading to do which I don’t mind but some might, the exams are hard.
Essential skills for a histopathology trainee: Be a quick learner, have great attention to detail, be organised, have good written and oral communication skills