What is Histopathology?

Histopathology is one of 17 different pathology specialties. It is a diagnostic specialty that is at the heart of medicine and surgery; it is difficult to find a specialty that does not require the involvement of a histopathologist at some point!

Histopathology involves examining tissues and cells microscopically to determine the diagnosis for a patient. Different diseases have different histological features that help a pathologist determine what may be happening. This information is crucial to allow the treating clinicians to implement the necessary treatment. Formerly, a microscope was needed for this task, but we are now seeing a digital revolution whereby most departments are now digitising the slides and histopathologists are using computers with hi-tech imaging software to examine each case.

One of the myths of histopathology is that we spend all our time performing autopsies. This is not the case! Autopsies only account for a small percentage of the workload of a histopathologist….and some choose not to do any at all. However, they remain a very important aspect of the job; helping to determine the cause of unexpected deaths and also helping us to better understand the mechanisms of disease.

If you have enjoyed all the medical and surgical specialties throughout your training so far, then histopathology is definitely worth considering as a career option. Throughout your histopathology training, you will cover all the general specialties including respiratory, gastrointestinal, urological and soft tissue pathology. At the end of training, you can choose to specialise in one particular specialty, or you can choose several specialties. There is more flexibility in your career choices and less pressure to super-specialise.

Molecular Pathology

We are now very much in the age of molecular pathology. Rather than just looking at the microscopic features of a cell or tissue, we can now enter a cell, go inside the nucleus and examine the genetic material to identify the changes that have occurred that may have resulted in disease. It is not just a microscope that a pathologist has to help them with their job; they also have immunohistochemistry, fluorescence in situ hybridisation, and different forms of sequencing at their disposal.

Molecular pathology is now part of the curriculum for trainees and there are lots of opportunities to get plenty of experience. It is not going to replace histopathology; it is another tool to help you make an accurate diagnosis for your patients. Histopathology is a constantly changing profession which is what makes it so exciting to be a part of!

Research

Currently, academic pathology is struggling; there are very few trainees who are interested and engaged in research which is very worrying for the future. If you are interested in research, then histopathology is definitely a positive move for you!! There are an abundance of research opportunities, and the advent of molecular pathology has opened up even more!

You can choose to take an ‘out of programme experience’ where you can spend a short period of time doing some research to explore whether you want to take it further. You can also do an ‘out of programme – research’ which could allows you to do a Masters Degree or a PhD. Who knows, you could be the next person to make a major discovery that could make a huge impact on patient care and outcome!

Training and assessments

Histopathology training generally lasts 5.5 years (although this can be longer depending on whether you choose to take advantage of the many opportunities that are available along the way.) After completing the first 2 years of training, you get the opportunity to decide whether or not to continue with autopsy and gynae cytology training.

This is also the time where you can choose to continue with the general histopathology training, or apply to join the training programmes for paediatric, neuro, or forensic pathology. There are two major examinations; the FRCPath Part 1 which is a written examination, and the FRCPath Part 2 which is a two day practical examination to assess whether you are competent to progress into the final stages of training.

Final thoughts!

Histopathology is a fantastic specialty choice! If you like medical detective work, and want a job that provides variety then definitely explore this further! You may not see patients face-to-face as frequently, but you are central to the diagnostic process and can make a huge impact on the treatment and management of a patient. It is your skill and expertise that ensures that the correct diagnosis is made. Make sure you take the opportunity to attend career events and taster days to explore it further. If you have any questions or want any advice, don’t hesitate to get in touch.