Student fellowship’s pluses seen in the field and out

Valerie Neff Newitt

April 2020—At Oregon Health and Science University, one of the oldest post-sophomore fellowship programs in pathology is recruiting steadily and channeling a quarter to a half of its student fellows into pathology residencies.

Dating back to the 1920s, the OHSU Pathology Student Fellowship, as it is now known, starts recruiting at the end of the first year of medical school, says Nicole Andeen, MD, assistant professor of pathology and co-director of the program. “Medical students join after the preclinical curriculum or after a year in clinical rotations.” With former student fellows spreading the word, “recruitment happens naturally,” she says.

The program admits three students per year, a number pegged to the training, close supervision, and mentoring required of surgical pathology faculty at OHSU Hospital and Portland Veterans Affairs Medical Center and autopsy pathology staff at OHSU. In 2019, 15 people interviewed for the three fellowship slots. Selection is based primarily on demonstrated interest, motivation, and skills.

Once the participants begin the pathology year, it’s all hands on deck. “Residents, fellows, pathology assistants, histotechnologists, lab and departmental staff, and faculty are all involved in training student fellows,” Dr. Andeen says. She and her co-director, Olivia Snir, MD, oversee and check in with them. “In terms of day-to-day routine, they are integral to the department and work with everyone.”

After a period of training and orientation, student fellows are given graduated responsibility equivalent to that of first-year residents in anatomic pathology. “They manage their own surgical pathology and autopsy cases essentially as first-year residents, but with a case cap. They learn to gross, write reports, and sign out one-on-one with faculty,” Dr. Andeen says. “It’s hands on; they learn by doing. They grow and understand their importance in the patient care team.”

Student fellows receive a stipend for living expenses, as well as health care coverage and vacation and sick time. At year’s end, the students can pick up where they left off in their medical training.

Typically about a third of the participants in the fellowship program each year decide to pursue residency in pathology. For those who choose a different specialty, “the time spent in pathology is informative for their chosen field and health care in general,” Dr. Andeen says. Whatever the career path, “graduates of the student fellowship have a deeper understanding of the biologic and anatomic basis of disease and how a pathology lab functions.” They have a deeper understanding, too, of medical diagnostics, “which they bring to their chosen specialties. They can serve as stewards of our profession,” Dr. Andeen says.

“They interface with many components of the medical system. They get a sense of how operating rooms and tumor boards function, and how to present information and communicate with a variety of professionals. They think about cellular drivers of tumorigenesis and investigate why people die. They develop a better understanding of the pathophysiology of disease and a stronger foundation of anatomy. They participate in research projects. They begin to appreciate new aspects of uncertainty, objectivity, and equipoise. Ultimately they come away understanding that pathology encompasses all of this.”

Students who do not select pathology as their specialty tend to be enthusiastic about the Pathology Student Fellowship, creating interest in other students, Dr. Andeen says. “There’s an indirect effect from students having completed the program and talking about it with their peers. Plenty of students from our institution who have not done the fellowship choose pathology after learning about the field from peers, faculty mentors, or the pathology elective.”