Valerie Neff Newitt
May 2024—The number of “champions” who have joined the CAP’s Future Pathologist Champion program grew from 71 in 2022 to 135 in 2023 and now stands at 222, and the goal is to reach 250 by the end of this year.
The aim of the program, previously known as Pathology Pipeline Champions, is to address the shortage of pathologists and medical students’ declining interest in the specialty. It’s open to all faculty members, practicing pathologists, and pathology residents.
The results of last year’s survey of the champions found that starting, strengthening, or promoting mentoring, shadowing, and pathology interest group opportunities were the top three student interventions the champions got behind.
“It was the shortage of pathologists and an inability to fill pathology residency spots that moved the [champions] initiative forward,” says Barbara Ritschel, MD, a member of the CAP Graduate Medical Education Committee and one of the program’s creators, with Charles Timmons, MD, PhD, and Cindy McCloskey, MD. She’s encouraged by the “doubling of the champions in one year,” she says.
“Without pathology there’s no laboratory, no laboratory testing, no anatomic pathology, no frozen sections, no diagnosis for a biopsy anywhere in the body. Everything stops,” says Dr. Ritschel, vice chair of pathology education and professor of pathology and emerging infectious diseases, Uniformed Services University, Bethesda, Md.
Last year, the 135 champions were invited to participate in the survey, and 46 responded. Of the 46, 24 were new to the program within the prior 15 months, and 22 had been in the program for a longer period. The program was launched in 2021.
In addition to mentoring, shadowing, and interest group opportunities, the champions reported starting, strengthening, or promoting other ways to expose medical students to pathology: social media outreach, autopsy observation or participation, pathology electives or selectives, career specialty talks, post-sophomore or summer fellowships, the then-CAP student forum, and other organizations’ opportunities for young scholars.
Mentoring was the No. 1 intervention, with 69 percent of the champions doing so or enhancing or promoting it. “Mentoring took a big jump. It went up from the prior year,” Dr. Ritschel says, referring to the data from the first survey of champions in 2022, which found that pathology electives and selectives were the No. 1 intervention and mentoring was No. 2. Nineteen percent of those who reported mentoring as an intervention in the latest survey rated it extremely successful, 44 percent as very successful, and 33 percent as moderately successful. One respondent described it as slightly successful.
“It provides that one-to-one dialogue where students can ask, ‘What does it mean to be a pathologist? What would this mean for me as a career possibility?’” Dr. Ritschel says. Mentors can explain that “the job market is very favorable for new graduates coming in and is open to negotiations on the hours for the work-life balance they want. We have jobs open in every state in the U.S. It’s important for students to know that.”
Nineteen percent of the survey champion respondents were involved in efforts to get medical students engaged in autopsy observation or participation, and they reported high rates of success. “Autopsies are always interesting, and students feel like they’re involved and engaged and actively participating,” Dr. Ritschel says, even when they’re observing and taking notes for residents and autopsy staff.
Before becoming program champions, the mean number of hours respondents spent per month, on average, on activities related to improving medical student exposure to pathology was 3.10. After becoming a champion, it was 4.41. “That 1.3 hours is similar to the increase we had on our 2022 survey,” Dr. Ritschel says. “It’s encouraging to see about the same rate of increase.”
The barriers to doing more? “Time is by far the biggest challenge for everybody,” Dr. Ritschel reports. “Time is repeated over and over again” in respondents’ answers.
“Our specialty is short on pathologists, so the active working pathologist is wearing multiple different hats,” she says, limiting time for medical students. “Some pathologists say it’s the increasing clinical workload, with fewer pathologists to share it.”
Having more champions is one solution to the limited time people can devote, she says, as is ensuring that the champions know about the resources the CAP makes available to them, among them slide sets, a toolkit on how to create a pathology interest group, and tip sheets on activities they can engage in. “Having multiple helpful tools makes it easy for champions so they don’t need to brainstorm ideas for creative activities to engage students,” Dr. Ritschel says.
Champion meetings are held online several times yearly, during which champions learn from each other, she says. “They hear from fellow champions what they did, what was successful, and what didn’t work.”
“Time is critical, and having tools readily at hand can be very helpful, even essential,” she adds.
Seventy-six percent of respondents reported being satisfied with the support the CAP provides. Eighty-nine percent say they intend to remain in the program, up about 10 percent from what respondents said in the 2022 survey.
As part of their pathology champion efforts, 26 percent of respondents said they engaged not only physicians in other specialties but also the medical school curriculum committee, and 12 percent said they engaged dedicated career advisors such as student affairs deans.
Of those who connected with physicians in other specialties, in the 2023 survey “it was a big shift to surgeons,” Dr. Ritschel says, compared with the internists and gastroenterologists cited most in 2022. “It’s a partnership so it’s nice to see that shift.” Her hope is that it’s a sign the champions are becoming more comfortable in their champion role “and working with one specialty after the other to help engage them.” The latest survey results showed it was predominantly surgeons who provided access to their students in clerkships, an opportunity offered to rotating students “to spend a day or two with us,” one respondent said. Another respondent wrote of a family medicine attending who discusses the work of the pathologist when training students and makes the connection for the students who show an interest in pathology.
As for connecting with the school’s curriculum committee, one respondent wrote, “I’m on the committee and fighting to keep pathology presence in the curriculum.” Another said, “We’ve been able to keep separate pathology and microbiology courses, rather than have them split into organ-specific modules.” A third said they received approval for a “new pathology-driven multispecialty rotation.”
Of the connection with career advisors, one wrote that he or she got the opportunity to cohost a pathology specialty panel during the medical school’s career night.
Twenty-nine percent said they were able to increase exposure to pathology in a core clerkship, and 71 percent said they were not able to do so. “That’s where we need to learn from one another about those little get-your-toe-in-the-door moments of opportunity,” Dr. Ritschel says, adding, “We need to learn from the strategies of the 29 percent group that was able to increase pathology exposure.”
Asked how medical students responded to their efforts to increase the exposure to pathology, 80 percent said very positively or positively, and 19.5 percent said the response was neither positive nor negative. What do they think most contributed to the positive response? It was a chorus of replies about their own “enthusiasm,” Dr. Ritschel says. That word and other similar words came up repeatedly:
- “My enthusiasm and receptiveness to their needs.”
- “My passion and excitement about pathology.”
- “Our pathologists are a happy group, and medical students appreciate that happiness.”
- “Pathology is awesome, and I give a pretty good presentation.”
- “Our enthusiasm.”
Says Dr. Ritschel, “This is all about bringing that passion for our specialty to the students, and they are drawn to that.”
What drew pathologists to the champion program? For 56.5 percent of the respondents, it was the email from the CAP, for 15 percent it was by word of mouth, and for nine percent it was a mention at a professional conference. Nineteen percent of respondents said they recruited new champions from among their practice partners and fellow pathology residents.
“As our champion core group expands,” Dr. Ritschel says, “word of mouth will become very influential.”
Twenty of the respondents answered the question about their “greatest accomplishment” as a champion. A few of their answers:
- “One of the two medical students who shadowed me is now doing research in pathology.”
- “Working with medical students who didn’t know pathology existed and seeing them come to appreciate everything we do in clinical and anatomic labs.”
- “Assisting a fairly large number of people with their applications to pathology residency, and at the most recent CAP meeting, seeing many of them, located internationally, in person for the first time. I also take a lot of pride in having been invited to speak by a pathology interest group in Poland.”
Pathologists are by nature champions, Dr. Ritschel says. “Pathologists are natural teachers and clinicians. Every interaction we have as pathologists with medical students, whether we’re champions or not, is an opportunity for us to show what pathologists do and to underscore that pathologists are clinicians essential to the care team, and experts in diagnosis.” Pathologists are sometimes labeled as basic scientists, she says. “But we are clinicians. Sometimes that’s hard for students to understand.”
Valerie Neff Newitt is a writer in Audubon, Pa.