Anatomical Pathologist Registrar - Dr Natasha Prosser
Natasha Prosser
(Source:
Researchgate)
The following information has been taken
directly from
On the Wards.org: A day in the life of an Anatomical Pathology Registrar
What is anatomical pathology?
Pathology is a medical specialty that determines the cause and nature of
diseases by examining and testing human biological samples such as tissue,
fluid and blood. Anatomical Pathology is a subspecialty area of Pathology
focusing on human tissue and cells. A Pathologist is a medical doctor who
has completed at least 11 years of training, including two years as an
undifferentiated hospital doctor post-medical school plus five years of
training and successful completion of exams.
Pathology is often considered as a bit of a black box, however, so much work
and attention to detail goes on behind the scenes from when a specimen is ‘sent
to pathology’ to the generation of the final report. As a medical
student, my exposure to Pathology was a didactic two-hour weekly lecture at
Uni, supplemented with a rare bottle tutorial in the dusty Anatomy museum.
The only contact we had as junior doctors was writing request forms and
calling the lab for urgent results. Occasionally at multidisciplinary
meetings, Pathologists would appear, flashing their mysterious pink and
purple works of art before revealing the diagnosis like a magician.
Pathology certainly wasn’t sold as a career choice at any time.
Choosing a career in anatomical pathology
As a junior doctor working in a busy tertiary hospital, I was enjoying my
life on the wards and practicing clinical medicine. During my intern and
resident years, I considered a number of disciplines including Obstetrics
and Gynaecology, Emergency Medicine and General Practice, but still wasn’t
completely sure which direction to go. I thumbed my way through the medical
career guidebook multiple times and dog eared a number of pages, but kept
coming back to Pathology.
I can’t say I was completely naive to it as a specialty. I had obtained my
undergraduate degree in Medical Science majoring in, among other things,
histology [the study of tissues and their structures].
I had also completed an Honours year in molecular techniques in a major
teaching hospital laboratory plus time working briefly as a scientist. I
eventually applied for and was accepted into Anatomical Pathology training,
commencing at Royal Prince Alfred in 2018. Having a few extra years of
clinical experience has been incredibly beneficial in my training, as it has
given me a broader appreciation for the impact of a diagnosis on the patient
in a bio-psycho-social sense plus an understanding of medicine over a broad
range of disciplines.
Typical week
As an Anatomical Pathology registrar, part of our service work is the
macroscopic examination and dissection of the specimen, or being ‘on cut’.
On other days we may be on the fresh/frozen phone dealing with incoming
queries or frozen sections generated as part of an inter-operative
consultation.
A frozen section may be required to answer specific questions such as margin
status or diagnosis while the patient is still on the operating table.
Tissue is snap frozen, processed rapidly and assessed within a short amount
of time, and the result is then used to guide the next stage of the
operation. This may mean that the surgery is continued to completion or
abandoned, or further tissue obtained for diagnostic material.
On cut
On our cut days in the laboratory, we deal with an incredibly diverse array
of tissue, ranging from a tiny 1mm gut biopsy to whole limb amputations.
Pretty much anything you can cut out, we can cut up. A standard day on cut
would see me assessing a couple of hemicolectomies, a uterus, lung
resection, prostate, 20 or so skin excisions, and any number of placentas.
More difficult specimens would include total laryngectomies, Whipple’s, and
complex pelvic exenterations. Dealing with these specimens requires
extensive knowledge of anatomy and pathology, as well as an understanding of
prognostic features in order to ensure that sampled tissue is taken to
demonstrate this.
After cutting up the specimen, the sampled tissue passes through a series of
time and labour intensive steps requiring input from technicians and
scientists. Tissue is processed, then embedded in wax before generating
stained slides. Once the slides are produced, the clinical work commences.
As a registrar, we are in training to learn how to report cases. This
involves looking at thousands of slides, developing an eye for patterns, and
interpreting cytological clues [cell clues]. We
work closely with our Consultants, and all of the cases we look at are
reviewed before generating the final validated report.
A lot of time is spent going through cases on a one-to-one basis with our
supervisors or in regular teaching sessions. Sometimes a case can be
diagnosed on routine stained slides, however, others may be more
undifferentiated and require investigations of the antigenic properties with
immunohistochemical stains or molecular profiling. Cases can be very
difficult and require review by multiple consultants, both in house and
externally, and then discussion at a multidisciplinary meeting with input
from Radiologists, Surgeons, and Oncologists.
Why it appeals to me
The lifestyle is incredibly attractive. There are no ward rounds, a very
civilised 8am start for the most part, and generally home on time at the end
of your shift. There is rarely the need for overtime, and night shifts are a
thing of the past. I work with a wonderfully supportive team of medical
colleagues, laboratory technicians and scientists and this makes for a great
work environment.
Training is fairly flexible and allows you to incorporate areas of interest
into your work life. Research is actively encouraged, and my Consultants
generate and foster opportunities by highlighting interesting cases.
Additionally, there is a generous study leave allocation that enables you to
attend and present at local, national, and international conferences. An
area of special interest for me is in teaching and education and I am able
to initiate and develop courses and information sessions for medical
students, junior doctors, and registrars.
Pathology is intellectually stimulating and calls on a comprehensive
understanding of anatomy, physiology and biochemistry. It attracts people
with scientific minds who are lateral thinkers and are curious about how and
why things happen on a cellular and molecular basis. The medical landscape
is shifting at a rapid rate due, in part, to new molecular discoveries that
change the way we think about diseases and diagnostic classifications. It is
exciting to be at the forefront of discoveries leading to improving
prognostication, treatment modalities, and better patient care.
The most satisfying thing about pathology is you get to make a difference in
patients’ lives every single day. Even though I would rarely see a patient
face-to-face, pathology contributes vital information that directs clinical
care and provides much-needed answers for patients and their families.
NanoMslide
- An Australian Invention: How will you promote it?
Secondary
Australian
Curriculum General Capability:
Critical and creative thinking
Australian
Curriculum General Capability: ICT Capability
Cooperative
Learning Activity
1. In groups of four students read the following article from
The Conversation 7 October 2021
2. Using the
Cornell Note-taking Method analyse the article individually with the
exception of:
3. Share your questions about this article and any
further information that you would like to discuss.
4. As scientist don't always know how to promote their
findings or inventions, you as a group, are going to create an infographic.
Look at the different ways to create an infographic
here
and decide as a group which one you will use to be the most effective to
promote this invention to the world and Australia.
5.
Start
Brainstorming and producing ideas. Work out how these ideas will fit
into your infographic.
6. Create and promote your infographic
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