The Value of Pathology Interest Groups

(upbeat music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, the Bow Tie Bandit of Blood, a transfusion medicine pathologist at Mayo Clinic. As we've experienced snow and colder weather here in Minnesota, we thought it would be fun to continue to travel south and connect with some of our colleagues at the other Mayo Clinic campuses over these winter months.

And today we're rounding with Dr. Yasmeen Butt, and Brittney Thiele. Dr. Butt is an assistant professor of laboratory medicine and pathology. And Brittney is a medical student, both of them at Mayo Clinic in Arizona. And what we're gonna be talking about today is talking about they've started a pathology interest group. And what we wanna do is kind of explore that, 'cause I think that'll be really interesting for our audience. So thank you for joining us today, Dr. Butt, and Brittney.

- Thank you. - Thank you for having us. - Awesome, so let's get started, 'cause this is an important thing, I think, to give our listeners. We're really talking about this pipeline of attracting very talented students into pathology and laboratory medicine. From your points of view, why do you think it's important to start a pathology interest group? - Yeah, I can start that from a student's perspective. So I'm applying a PCP this cycle to be a pathology resident.

And for me I felt very fortunate coming into medical school because I already had some background seeing what a pathology career would look like, what pathologists do, et cetera. But coming into medical school, there's a huge emphasis on clinical experiences that involve direct patient care a lot of times as it should, 'cause students have to learn how to cultivate skills, to do a history, a physical exam, et cetera. So they get exposure to a lot of specialties in medicine.

But one that is unfortunately not front and center tends to be pathology. And that's somewhat unfortunate because as some of the pathologists here have said, pathology is one of the best kept secrets in medicine. But it shouldn't be a secret 'cause it's such a great career option for students. So starting an interest group is important for students to be able see what pathologists do.

We have pathologists who teach courses at the medical school, who help students with their histology or pathology for example, but that doesn't tell students what the day-to-day ins and outs of a job in pathology looks like. And so to be able to have a group where students can see what an anatomic pathologist does at the scope, or what somebody who is a laboratory manager or transfusion medicine, something like that.

They can actually see what that looks like and hear about it, and hopefully then put it on their list of things that maybe they'd be interested in going into. So that is something that's important for an interest group and bringing that careers in pathology option to the table for students in the school. And I think whether students choose to go into pathology or something else, it's useful for them because pathology touches every aspect of patient care.

And so down the road, even if they're in internal medicine or something, they'll know where their biopsy is going, they'll know who to call if they have a question about blood bank or something with the lab. So there are a lot of advantages to having a pathology interest group and exposing students to pathology. And then I think finally myth busting is kind of big deal.

There's a lot of misconceptions around pathologists and being kind of reclusive in the basement or something, and being able to see pathologists and interact with them and hear what their day-to-day looks like and their interactions with clinicians and that sort of thing has been really good for students.

And a lot of students have come up to me and said, "Oh, wow, I didn't realize pathologists actually, some of them see patients or that they actually interact with clinicians throughout the day or that sort of thing." And so to be able to kind of myth bust is helpful too. - It's awesome. Dr. Butt, kind from your perspective, it's a faculty mentor. I imagine you kind of bring some of the similar perspectives that Brittney brings, but also some additional ones. - Absolutely.

I think that was so well put, Brittney. I almost have nothing else to add to it. But I think from a faculty perspective and just from our specialty in general, there is a lack of understanding in the medical school community, and honestly sometimes in our colleagues and practicing physicians of what pathologists do. And just like you said about myth busting, the idea that, "Oh, well, all your patients are dead. You only do autopsies, right?" And that could not be farther from the truth.

That said, autopsies are a great source of education and I am an auto fan myself. I always have to add that caveat in there. However, the majority of things that I do day-to-day, the patients are alive and we're trying to help to keep them that way and help guide treatment. So certainly having that pathology interest group is really valuable.

And I think especially from a medical school perspective, it's really useful to have a place for students to go like a touch point if they wanna find out more about pathology. And that is compounded by the fact that there isn't a required pathology rotation. Most medical students only interact with pathologists as teachers in their early years in their first and second year.

And so that can lead to a perception that, oh, we're teaching more of the basic science information in anything, and maybe histology. but as you said, Brittney, they don't have an idea of what it is that we actually do on a day-to-day basis and how we impact patient care on almost every level in almost every single specialty.

And so I think having a touch point for those students to go to, regardless of whether they wanna go into pathology or if they're just interested to learn more about it as a specialty, I think it's so valuable. For me, my thoughts about a pathology interest group are twofold. One, you wanna be able to spark the interest in the couple of students in every class that are potentially gonna go into pathology. And then two, serve as a source of information for those that aren't.

I think the more you know about pathology, it will only enhance your medical career going forward, because whether or not you are aware of our existence, we're impacting your medical decisions every day. - It's well put. Both of you, one of the things in preparing for this podcast, I was reading, I think, just the other day, I saw CAP put out a commentary about, part of the challenge is demonstrating for medical students. What is that actual work of a pathologist look like?

Which I know Brittney, you very well articulated. And so I'm kinda curious if you could kind of explain for our listeners who maybe they don't have a pathology interest group, and they're looking to maybe start one up. Or maybe people have an established interest group, but they're kind of looking at retooling, critically examining on what can they kinda work forward on the next year.

So what are some important elements that you think are important for a successful interest group in your experience? - So that's a great question. And as you mentioned CAP, I'm also involved in the CAP Pathologist Pipeline Initiative.

And because it's something that is really important to looking into the future of our specialty is recruiting the next generation of people into our specialty. And I think there are a couple of successful elements you can integrate into any pathology interest group regardless of size. One of the simplest and easiest things you can do is create a round table, a workshop-type event for first years.

Try to gather folks from AP, from CP, from different areas, to give students the ability to ask questions about what it is to be a pathologist. And so those are very simple events to set it up. Even in the Zoom age, you can set them up on Zoom or ideally if you can have them in person, and just to have interested students in first year come. Oftentimes I think these medical students don't realize or think about pathology as a viable career until maybe they do an elective in their fourth year.

I've known actually more than in one person who did an elective and fourth year after they matched another specialty and decided they wanted to change and go into pathology. So it does happen. And so creating that workshop event or just kind of like a round table with pathologists, I think geared mainly towards first years, but certainly second years and third years as well, to give them an idea and different perspectives of the different types of career you can have in pathology.

Because that is something I think is quite valuable about the specialty is you can have such a wide variety of careers, and you can be an anatomic pathologist and look at biopsies all day. You can be in blood bank and be managing a forensic patient and dealing with reactions in totally different worlds, but under the same umbrella. So I think that's the number one thing that would be very simple to do and allows you to contact with students who may be interested.

And after that, there is so many different ideas of activities. And CAP has a lot of ideas that they've put up on their website, which are definitely worth looking at. If you have a small group or you're thinking about starting a group, they can range from, if you have a strong cytology area, you could do FNA clinics. That's something that we actually are in the process of planning for our group now that some of our COVID restrictions have lifted.

And that's a really hands-on procedure and does highlight one of the ways that pathologists do actually have direct patient contact. Doing, finding needle aspiration biopsies on patients in a clinic setting. So you can set up something like that, would be very nice. We also had a nice event with donating blood that Brittney spearheaded, which was really nice.

So we had competition between all the different medical school classes on who could donate the most blood and that was run by the pathology interest group. So that was really nice. So basically exposure also, you can set up lab tours. You can say, hey, if you're interested in coming to see what the lab is like, see the histology lab, see the clinical chemistry lab, the microbiology lab, invite them to plate rounds. Those are always fun.

So those are opportunities where you can engage medical students in the practice of pathology. - I'm glad you mentioned that resource that we can put in the show notes. - Yes, I think it's an excellent resource. The CAP has put a lot of time and effort into coming up with ideas and helpful things that people can do. And everyone is gonna have a different capacity to do some of these activities, but I think there's something for every group, for every size, that they can do on that website.

- Wonderful. So Brittney, I'm kinda curious. Dr. Butt kinda talked about all these wonderful ideas to integrate and is very involved really at the national level in kind of this pipeline of brilliant folks tracking into the field. From your perspective, what you've seen with the medical students that have been involved with the group, is there one or two activities that really kind of stands out as has been perceived as really the most valuable and best experiences so far?

- Yes, so really the experiences that are linked to courses

that they are currently in tend to be the most successful. So it tends to recruit people who may otherwise not come to those events, and then discover, "Oh, that's quite interesting." So one of the events that was very successful was the first year's anatomy course. We had the general chief medical examiner from the Medical Examiner's Office here at our county, come and speak about forensic pathology.

And a lot of students were really interested in that, and thought it was very fascinating hearing kind of the public health side of forensic pathology, as well as what they do with autopsy. That was really interesting to them. And I've gotten students since then who've been really interested in wanting to observe an autopsy or wanting to spend some time over at the ME's Office. So that was very successful, and it correlated well with what they were learning in their course.

And then kind of what Dr. Butt mentioned about the round table, that's also been a very successful event for us because students can really get a glimpse into what the various specialties and pathology are. And especially during their pathology course where that's kind of more on the forefront of their mind, there are more apps to come and explore what that might look like. So those two, I think, have been some of our more successful events and have really garnered student interest.

- One of the things that just popped in my head right now, we put some emphasis on understanding, what is that work that a pathologist is doing? And I'm curious for some of us as we get into practice longer. We sort of forget that beginner's mindset. And I'm kinda curious, has there been any challenge with some faculty being able to explain or demonstrate their work? Or is there any way that has been important

to kind of coach faculty or direct faculty during a session so that they can really truly show what is the work that they're doing? - Well, that's a really good question. And I'll have Dr. Butt elaborate on that a bit more. But what I will say is that here at Mayo, Arizona, I feel like a lot of the pathologists are educators at heart. I feel like they really have been involved in our courses and they really want to teach and have been enthusiastic about that.

So from my perspective, as a student, I haven't seen any situation where I thought, "Oh, maybe that didn't go so well." Like really they came in ready and eager to talk to students and able to articulate what they do in a way that students can understand. So I feel like from my perspective I haven't. But Dr. Butt you've interfaced with them more than I have. - Well, I'm glad to hear that we've had a positive impact. And you come across just good educators. So that's what we all strive for.

That really is an interesting question. I would say I have not run into that personally. And I think part of that is just by selection bias. So certainly the people that show interest in coming to these round tables, and the people that are involved in teaching medical students. It's essentially a volunteer basis. In our department, I mean, certainly that the teaching needs to happen, but there are enough people that want to teach that are involved.

So we're not dragging anybody, kicking and screaming to teach our courses. So I think we've had generally positive age experiences with that from the faculty side. But I could see perhaps if there was a program where everyone had to teach and maybe not everyone would prefer to teach, certainly there might be useful resources. Maybe CAP has useful resources saying how to explain your job to medical student.

But I think a self selection bias is important there to have people actually interested and invested in education and reaching out to medical students, being the people that interact with medical students most. And I'll say that medical school curriculum, this is a little bit of a tangent, but it touches a little bit on what we were talking about before with involvement on the course level, because I do agree.

I think as much as you can link your events and your inner actions with the courses that the students are taking, because let's face it, medical schools are consuming. You're spending hours and hours a day studying. You don't have a lot of time for extra things. I think is those activities that link to the courses are gonna have the most success.

And so certainly, medical school curriculum is changing and it's changing across the country, both at Mayo Clinic and everywhere else to a more integrated type of curriculum, where you're trying to bring everything together. So rather than having discreet ways of learning, okay, we're gonna learn, we're gonna learn the histology of this in histology. And then you're gonna learn the physiology of this when you do the cardiac block and everything more separated.

We're going into more combined ways of educating students. And so I think then the burden or whatever words you wanna use falls back on pathology faculty to become as involved as possible as they can with these more integrated curriculum courses. Because if we're not there to talk about our portion of these things, then we're gonna get lost in the background. And it's not that we're not doing the work, but no one realizes that we do it.

Time and time again, when I talk to people outside of medicine and they're like, "What do you do?" And I'm like, "Oh, I diagnose cancer." And they're like, "Oh, yeah. So-and-so got a diagnosis of cancer from their oncologist." I'm like, "Actually that came from a pathologist." So we're very easily lost in the background if we're not advocating for our specialty and educating about what we do.

So I think from a faculty perspective, as much as you can step up and become integrated, be at the table, get involved in those courses, I think the better off you'll do. But from a pathology interest group, something that we're doing here, so we have gross labs incorporated into our MS1 pathology course, of course, of course, of course. But for some of the other courses we don't always. So our cardiac block does, but pulmonary doesn't.

And so, of course I would like to have things integrated into the courses themselves but that's not always possible because we have more and more limited time to go over these classes and to get into lecture to give this material. So time is always limited. So a potential pathology interest group activity that you can do is a gross lab session.

Collect a bunch of interesting specimens, and when the students are going through, say, for example, their pulmonary block, have 15 cases of lung cancer, sarcoidosis, interstitial lung disease, whatever cool cases you can get together and just have an event and have them come. And you can say, "Hey, you learned about this in class. Here's what the actual cancer looks like grossly. Like not just from a PowerPoint picture.

Why don't you hold it?" So I think linking those activities as much as you can to the actual courses provides a really valuable, and literally in some cases a hands-on experience. - And I should say, you can see Dr. Butt's enthusiasm with all of this. And so when starting an interest group at any location it's so important to have someone like Dr. Butt, who is very excited about medical student education and really furthering pathology.

And so for me, it was great and I think any student who might be interested in starting a pathology interest group, look for a faculty member who is excited and really interested in get getting that whole department involved in helping to really start these things. Because I think Dr. Butt has been absolutely instrumental in making a lot of these things happen and really helping to bring pathologists on board to join and be part of these events.

So that's critically important for students who wanna start an interest group. - So as we're recording this in February of 2022, COVID and the pandemic is still a present reality for us. And I'm kinda curious about, has the pandemic had an impact on how you approached the pathology interest group? - Yes (laughs). So we started the group in March of 2020.

So as you can imagine that was right when everything kind of shut down and that made it somewhat challenging to really start engaging students right off the bat. So we did a lot of, we did two Zoom events right off the top that were good. And it's difficult I think sometimes when students are get trying to understand what a new group is, to then join with Zoom and all of that.

So it took a little bit of doing, but I think especially now as restrictions have kind of lessened a bit and we were able to do some in-person events with more social distancing, students have been a lot more engaged and it's easier to interface with them and have them ask questions and interact with them even after the event's over.

So that has been good, but it certainly was a little bit challenging to get it off the ground at first, because we really had to think creatively on what can we present to students over Zoom? And I think everyone in the world was thinking, how can we present things over Zoom? So we were just kind of caught in that as well. - Yeah, I totally agree. Brittney has been an amazing advocate. She came to me with the idea of starting a pathology interest group. So kudos there for making this happen.

But we could do minimal things because of COVID. And I think, like you said, we're all stuck in that same sort of doldrums of, well, we can only do, we can do over Zoom. So I think having those round tables was really valuable. At least we were able to connect with students who showed some interest in pathology through that. But I am so grateful that restrictions have started to lift and we're actually able to do more things in person. But I think best teaching happens in person.

I really strongly believe that. And that goes for pathology, and any other type of teaching. There's always gonna be a limitation to Zoom when you're far away, and you're not in person and you're giving your talk to a blank screen, and everyone has their cameras off and you don't know what's going on. Are they sleeping, what's happening? Are they just gonna listen to it later and speed me up? So that's fine, but in person is always the best.

So hopefully things will only improve from here on out. - I mean, that makes my medical educator heart go pitter-patter. The relationship is very important, right? Between learner and mentor, this whole idea of being a guide on the side, helping our learners construct what we know in our heads in their own heads, that that takes work, that takes guidance. And certainly that video off Zoom, that connection is problematic at best maybe (laughs). I'm curious then, we've kind of gone through it.

And one of the things that really resonates with me, I'm sure for our audience too, is that you're really highlighting for me this concept of it's not just pathology interest group, people that are interested in the career of pathology, but I think that you've made the point very well here that it's also for those who want to be able to use pathology in their career. In other words it's time well spent. It's value add regardless of what specialty somebody might choose.

And that's really impacted me with what you guys have said today. And I'm curious, as you go forward in the future of this interest group, what are your thoughts for, how are you planning to be iterative and try next year that you didn't try this year? What are ways that you're interested in moving this forward?

- I think that that's a really good point that you pulled out and I couldn't agree more. I think a pathology interest group is not just for people who wanna go into pathology. Certainly those will be the people that will be most invested in, go to every event and be involved in it. But it comes back to basic values. The needs of the patient come first.

And in my mind, the more our future physicians know about pathology and what pathology can do for them and aid them in the care of their patients in the future, the better physicians that they'll be. And so creating events, like the blood drive that Brittney put together. And like gross lab presentations, where you can see different specimens and really gain an understanding, a visceral understanding of what it is, these disease processes that you're learning about. Observing an autopsy.

You may be an ICU doctor in the future and you may remember, "Oh, yeah, I observed that autopsy. And they found out some fascinating information that we didn't even think about." And maybe that can be useful and that you might be more likely to send for an autopsy and learn something and advance your knowledge and your colleagues' knowledge and might turn out better for a patient in the future.

So I think there's so much value to be had by educating students on what their pathology colleagues can do for them in the future in whatever field that they choose to go into. And so I think creating events, I mean, honestly all the events, I think, would be valuable for anybody potentially regardless of what field they go into. But perhaps they can tailor it towards what their area of interest is.

If you're planning on going into neurosurgery or neurology, maybe spend a week shadowing the neuropathologist at your institute. You're gonna learn a lot, I guarantee you. So I think that provides a lot of value. I'm curious, anything else you wanted to add Brittney, on that idea as we have for the future? - Yeah, I mean, I think you said it very well. It's so important to have students be exposed to pathology and all that it is.

And like you said, even if they go into various clinical specialties, pathology touches just every aspect. So knowing who to call, knowing what pathologists do, and even wait times, "Oh, I took a biopsy. I'm not going to get it an hour later." You know the results. Knowing those things is very important.

And so, I think looking into the future as well for this group, it's just kind of keeping the momentum going and finding more ways to kind of curate the experiences to the curriculum and also to student interest. I know that certain classes now have people who are more interested in certain subspecialties than others.

So there are certain events then that you might think, oh, okay, maybe we'll do something more with this type of pathology subspecialty or this other one, depending on student interest as well. So really kind of feeling that out, it is kind of an adaptable thing. And remembering that it's gonna help students down the road, whether they go into pathology or not. Though fingers crossed, we'll get some more people going into pathology. 'Cause that's super important. - Yes (laughs).

- We've been rounding with Dr. Butt, and Brittney Thiele, on pathology interest groups that they started here at Mayo Clinic in Arizona. Thank you both for being here with us today for this Lab Medicine Rounds. - Thank you. - Thank you so much for having us.

- So to our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via mail. Please direct any suggestions to [email protected]. If you've enjoyed Lab Medicine Rounds podcast, please follow or subscribe. And until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations. (upbeat music)