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Pathology - Global Challenges in Education |
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ABSTRACT |
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Traditionally, much post-graduate training in toxicological pathology is done "on the job" in the United Kingdom, but completion of a residency and/or PhD program is recognized as a good foundation for a career in industry and for successful completion of professional pathology examinations. New models of residency training in veterinary pathology must be considered in the United Kingdom to enable a more tailored approach to training toward specific career goals. A modular approach to residency training would allow core skills to be maintained, while additional training would target specific training requirements in toxicological pathology. Exposure to laboratory-animal pathology, toxicology, research methodology, and management skills would all be of benefit as an introduction to a career in toxicological pathology.
However, long-term funding for UK residencies remains a problem that must be resolved if future recruitment needs in veterinary pathology are to be met.
Key Words: toxicological pathology • careers • training • residency • industry
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CAREERS IN TOXICOLOGICAL PATHOLOGY IN THE UNITED KINGDOM |
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The industry is composed of a small number of major pharmaceutical corporations and a growing number of small biotechnology companies. These companies provide most of the research and development for new pharmaceuticals, but much of the safety testing required by the regulatory authorities is subcontracted to contract research organizations (CROs). Pathologists are employed within the industry in many roles, working in management, in research and development,2, 3 and as project representatives as well as toxicological pathologists.4 The lack of a comprehensive list of veterinary pathologists or a required qualification in the United Kingdom means that there are no accurate figures for the number of pathologists in any sector; however, an estimate based on personal contacts of the authors suggests that approximately 80 anatomic pathologists work in industry, compared to 20 in university veterinary pathology departments, in the United Kingdom.
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RECRUITMENT ISSUES IN TOXICOLOGICAL PATHOLOGY |
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Potential recruitment is affected by several factors, one of which is the lack of awareness of career options among veterinary graduates.10 Students studying for veterinary degrees currently tend to see specialist clinical practice or academic research11 as the main alternatives to general practice.
Another possible factor in the United Kingdom is public perceptions about the uses of animals in research and the media visibility of the animal rights movement.12 These issues have a direct negative impact on some companies, which are heavily targeted and find recruitment difficult. There is also a perceived lack of trustworthiness on the part of the profit-making sector and scientists working in industry.12, 13 Little research has been done into veterinary students’ opinions on the use of animals in biomedical research. In the United Kingdom there is the suggestion of a tendency for students to oppose the use of animals, even though the research may benefit animals.10 There is also a lack of awareness that there is a regulatory requirement to use animals to test veterinary medicines as well as human pharmaceuticals.10 A study of veterinary students in Sweden provides conflicting information, showing that, while respondents largely thought the use of animals was morally justified (94%), approximately 40% had participated in some form of action against animal use or considered themselves animal-rights activists.14 There is also public misunderstanding about the role of pathologists in general. A recent survey by the Royal College of Pathologists (RCPath) highlights the fact that the general public's view is often of pathologists performing forensic post mortems15 and is colored by media portrayals of pathologists. The media controversy surrounding several high-profile events involving medical pathology departments in the United Kingdom (Alder Hey and Bristol) is also thought to be a possible cause of the 50% drop, between 1974–1983 and 1993–2002, in the number of British medical graduates choosing pathology as a career.16 There is currently no published research to determine whether these negative influences affect the decisions of veterinary graduates to enter research, veterinary pathology, or toxicological pathology.
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UNDERGRADUATE CURRICULUM AND TOXICOLOGIC PATHOLOGY |
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There is a realization that current undergraduate curricula are already very intense,18 so the idea that specific training can be provided for all future career options is unrealistic. However, it is not unrealistic to expect that veterinary undergraduates should be exposed to other career options and be expected to acquire generic skills (see Table 1) that can be used outside veterinary practice.
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Role Models
Positive undergraduate experiences of pathology and positive role models are also thought to contribute to career choices in medicine,20 and there is no reason to suppose that this should be different for veterinary pathology. Currently the most likely means of student exposure to toxicological pathologists as role models is through a careers "road show" staffed by BSTP members that periodically visits UK veterinary schools to highlight careers in toxicological pathology. Role modeling can also be provided by exposure to scientists actively involved in research within the veterinary faculty.
Awareness of the Use of Animals in Research
Specific exposure of students to courses in laboratory animal medicine can result in an increased understanding of the need for the use of animals in research.14 As previously reported,10 and based on an informal survey of three UK veterinary schools,21–23 there is still a wide variation in the amount of exposure UK veterinary undergraduates have to laboratory-animal species. All schools offer at least one formal lecture on laboratory animals and the role of the Home Office and the Named Veterinary Surgeon under the Animals (Scientific Procedures) Act 1986. Other formal teaching (lectures and practicals, with a range of seven to 27 hours’ total teaching time) and clinical rotations are still dominated by the care and treatment of pet rodents and rabbits. However, with the increasing use of electives and extramural placements (e.g., the industry-sponsored LAVA scheme, which supports short placements at establishments licensed under the Animals (Scientific Procedures) Act 1986),24 more undergraduates have the potential for direct exposure to the use of experimental animals. It may be that in future a complete change in emphasis in the veterinary curricular structure, with increased exposure to research techniques throughout the course—as is planned at the new veterinary school in Nottingham—would be beneficial in increasing recruits into academia and industry,25 but this hypothesis remains to be tested.
Retention of Traditional Skills
Much of the traditional content of veterinary curricula, including the teaching of anatomy, histology, physiology, and pathology, provides a foundation for a career in pathology. However, there are fears that the move toward integrated clinical teaching or problem-based learning will erode these basic sciences, further reduce veterinary students’ exposure to these disciplines, and make it harder to recruit into non-clinical areas such as research and pathology.20 The effect of curriculum change is not yet clear, as the apparent decline in recruitment of medical pathologists predates the introduction of integrated curricula in the United Kingdom,16 but limited evidence from North America suggests that these fears may be unjustified.26 There is a consensus that certain key areas of pathology should be retained in the medical curriculum, including a basic understanding of pathological processes, the underlying pathophysiology of common diseases, and the principles and uses of laboratory medicine.20, 27 Again, this would also seem reasonable for veterinary pathology.
There is little understanding of what skills pathologists have, or need to develop, other than an above-average color acuity,28, 29 but it has been suggested that one fundamental skill required in developing microscopic pathology expertise is that of visual "search and detection"—a strategy that may not be fostered by studying static images online.30 Therefore, while there are advantages in using virtual slides and/or "dynamic interfaces" in histopathology teaching (allowing students to compare normal and abnormal features of tissues, enabling out-of-hours access, and improving efficiency of conceptual learning31), retention of traditional skills in microscopy is essential.
Transferable Skills
The teaching of transferable skills is an area that is being addressed and is recognized as important in the list of Day One competences required by the Royal College of Veterinary Surgeons (RCVS)32 (Table 2). There is evidence of positive initiatives in veterinary education, for example, the introduction of communication skills using role-playing and simulated clients33 and the development of computer-based skills used to access curriculum material via virtual learning environments.
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THE ROLE OF INTERCALATED DEGREES |
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POST-GRADUATE TRAINING |
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Pathologists in all spheres of industry are required to integrate complex study data, including in-life information, clinical pathology, and histopathology. They must evaluate these data in light of the prevailing scientific literature,4 and their findings must be communicated to all relevant parties via coherent scientific reports. As a result, there are some expectations of a residency training program (see Table 3) that will be applicable to all veterinary pathologists (core skills) and some skills that are more specific to the needs of the pharmaceutical industry.8
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Proficiency in Diagnostic Pathology- In most veterinary pathology residency programs the trainee forms the backbone of service provision under the supervision of experienced pathologists. This structure is largely dictated by the training requirements of the major examination bodies,39–41 but it is also the most efficient and safest way for trainees to learn. Necropsy and surgical biopsy responsibilities, as part of service provision, develop essential skills such as routine tissue dissection, appropriate tissue selection, sampling, fixation, slide-preparation techniques, and gross lesion interpretation. Toxicological pathologists are less likely to perform necropsies in their routine work, but they will still be expected to provide guidance to technical staff, and familiarity with tissue preparation techniques aids understanding of the effects of tissue artifact and orientation.37, 42 A thorough grounding in microscopic lesion recognition and interpretation is necessary to a career in the pharmaceutical industry, since classification of host tissue response is an essential starting point for understanding etiology and pathogenesis.43 Applying further investigative techniques (e.g., electron microscopy, immunohistochemistry, molecular biology) while working with diagnostically challenging cases builds an understanding of the uses of newer technologies as well as an analytical approach to understanding disease mechanisms.37
Knowledge of Disease Pathophysiology- The MRCPath, ECVP, and ACVP examinations incorporate a general pathology section that demands an in-depth knowledge of disease mechanisms, from basic cell injury to the fundamentals of neoplasia.39–41 General pathology is also a "linchpin" in toxicological pathology, since it encompasses the response of cells and tissues to a broad spectrum of injurious agents or processes.8 Knowledge of disease mechanisms goes hand in hand with a familiarity with the current literature. Trainees must learn how to access relevant literature and have the discipline to review it on a regular and frequent basis. An inherent curiosity about disease processes is a quality sought after by both the pharmaceutical industry and academia, and it has direct relevance to the need to attract the best, most highly motivated graduates to a career in experimental pathology.44, 45
Communication Skills- Effective oral and written communication skills are recognized as Day One core competences by the RCVS, and a residency program should aim to build on this. Report writing requires a range of generic skills applicable to both diagnostic and industrial settings, including the ability to summarize information accurately, present scientific data in a way that can be understood by non-specialists, and structure reasoned explanations for findings.37 Inevitably there will be wide variation in the individual level of innate communication skill that residents possess, as well as in their training needs in this area. Previous studies have identified inadequate verbal and written communication skills as a major deficiency of training programmes,8 although these skill sets are difficult to define. As in most areas of veterinary medicine, it may be necessary to look at the approaches being taken in the human medical field to assess communication competence46 and the effectiveness of communication skills training.47
In addition, many toxicological pathologists work within global companies, and there is a need to ensure that communication training also includes an understanding of diversity and cultural differences that may affect their ability to interact successfully with colleagues and clients.
Specific Training Skills
The responsibilities of a toxicological pathologist are wide, including support for drug discovery and development, xenobiotic safety assessment, unraveling mechanisms of toxicity, extrapolation from animal to human through animal models, presentation of data to regulatory bodies,7 and higher administrative roles.44 Over the last decade, the toxicological pathology industry has raised concerns that traditional training programs are failing to address many of these areas adequately.8 Specific deficiencies identified include the following:
The potential negative impact of these deficiencies on industry is reflected in the toxicological pathologist's slow career growth and delayed attainment of maximum productivity.8, 38
Such inadequacies are further compounded by the overall dearth of training positions, shortage of high-quality applicants, and scarcity of funding.7, 48 Furthermore, academic mentors generally have very little experience of industry and insufficient time in which to address specific issues. It is therefore likely that on-the-job training will always be required to some degree.8 This philosophy is echoed by the US-based based ACVP/STP Coalition for Veterinary Pathology Fellows,49 which was formed to solicit funding from primarily industrial sources for subsequent administration to pre-existing residency training programs. The criteria carrying the most weight in deciding whether or not a training program will be successful in securing funds are the program's examination success history, the number of residents trained in the previous 10 years, and the current employment status of prior residents. Although the criteria are still subject to some adjustment, areas such as specific toxicological training, interaction with other training environments, qualifications of faculty, and diagnostic service case load, while still considered important, carry less weight in deciding the likelihood of funding.50
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MODULAR RESIDENCIES: A PRACTICAL APPROACH TO SPECIALIZATION IN POST-GRADUATE PATHOLOGY TRAINING |
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 TOPABSTRACTCAREERS IN TOXICOLOGICAL...RECRUITMENT ISSUES IN...UNDERGRADUATE CURRICULUM AND...THE ROLE OF INTERCALATED...POST-GRADUATE TRAINING MODULAR RESIDENCIES: A PRACTICAL... CONCLUSIONSREFERENCES |
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Cultivating a detailed knowledge of laboratory-animal pathology in trainees is unrealistic, but major concepts such as the use of industrial terminology, the pathology of rodent and non-rodent species commonly used in toxicology studies, and applications of animal models could be introduced, which would address some of the specific knowledge deficiencies in this area. The use of animal models of human diseases is common to comparative, experimental, and toxicological pathology, so this is an important area that training programs should include. In this context, residents should ideally be made aware of specific nomenclature for rodent strains, genes, and mutations and of the technologies involved in generating genetically modified animals to help reduce confusion and prevent experiments on inappropriate strains, a recent industry concern.52 Identifying similarities and differences between species in terms of how they respond to infection, their relative risk of specific neoplasms, and their vulnerability to drug-related toxicity are also fundamental to comparative pathology. The importance of background lesions, classical induced lesions, and common causes of mortality in the most frequently used species in toxicology would also provide essential background information for toxicological pathology. There would be significant benefits from the formation of strong training links between academia and industry to provide training in these areas.
Basic Research Techniques
Exposure to basic research would confer a number of advantages on pathology trainees in terms of their suitability to industry and would increase awareness of the multidisciplinary approach to research.
As most pathology training programs take place within research-active universities, there ought to be plenty of scope for exposing trainees to a research project within pre-existing three-year residencies. However, as it is traditionally recognized that three years are required to produce a competent and confident diagnostic veterinary pathologist, there are limitations on actually achieving sufficient time away from the diagnostic service to complete a meaningful project. There are several potential approaches to this problem. The first is to offer combined five-year residency/PhD programs, although there is evidence from the United States53 that longer programs may be significantly less attractive to potential candidates because of existing levels of student debt, also a growing problem in the United Kingdom. This approach may be most suitable for trainees intending to work for pharmaceutical research and development companies. The second is to include a well-planned short project within the existing three-year program without linking this directly to achievement of a research post-graduate qualification. Finally, it must be recognized that not all residents will need to achieve the same goals. For example, for trainees intending to work in a CRO where extensive on-the-job training is the norm, recognition of normal tissues and basic pathological lesions and exposure to research methodology may be more appropriate than achieving full diagnostic competence and completing a research project.
As well as the requirement to understand basic research techniques, there is increasing demand in the medical sciences for knowledge in the field of informatics.54 Proficiency in this area is important to the pharmaceutical industry because it encompasses information management, data analysis, sourcing of scientific literature, digital image capture, and genomics/proteomics analysis systems.55 Currently interest in this area in the veterinary sphere is embryonic,56 but it may have to be considered for inclusion in future residency training.
Introduction to Toxicology
In the United Kingdom, academic mentors in most veterinary pathology departments are unlikely to have skills in specific areas, such as toxicology, xenobiotic metabolism, and pharmacokinetics. Any effort to provide training on the principles of toxicology will have to involve the integration of courses taught by experts in the field. The small number of anatomic pathology residents training in the United Kingdom at any one time (in 2006 there were approximately 12 anatomic pathology and five clinical pathology residents) makes it unrealistic and uneconomic to expect specific courses to be established. One possible way to increase exposure to these areas would be to consider accessing didactic teaching through pre-existing toxicology programs such as those provided by the BSTP or the British Toxicological Society (BTS).
Management and Leadership Training
It is interesting to note that the main UK-based pathology examination for veterinary pathologists, the MRCPath, includes questions related to laboratory management, budgeting, and safety issues despite which there has been no apparent move to incorporate instruction in these areas into residency programs. This deficiency is probably partly due to limitations in time and in the management experience of existing faculty, which is also true of medical pathology.51 Nevertheless, leadership and management training is expected within medical pathology curricula, and similar skills are needed by toxicological pathologists.51, 57 Medical pathology training programs have responded by providing tuition in personnel and financial management, quality assurance, marketing, and informatics in a didactic fashion throughout the five-year training period.54, 57, 58 Non-pathologist management specialists have been used to overcome the lack of experience in management-related issues among pathologists.51 A similar approach, or collaboration with medical school training programs, could be used to introduce these skills formally into veterinary pathology residency programs, but this would have cost implications.
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CONCLUSIONS |
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ACKNOWLEDGMENTS |
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The views expressed above are the authors’ own opinions and are not necessarily representative of those of any organizations they are associated with.
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Footnotes |
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Cheryl L. Scudamore, BVSc, PhD, MRCPath, MRCVS, is Director of Discovery and Regulatory Pathology at GSK R&D, Park Road, Ware, Herts SG12 0DP UK. E-mail: cheryl.l.scudamore{at}gsk.com.
Sionagh H. Smith, BVMS, PhD, Dipl. ACVP, MRCVS is Senior Lecturer in Veterinary Pathology at the Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, Midlothian EH45 9RG UK. E-mail: sionagh.smith{at}ed.ac.uk.
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REFERENCES |
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