Pathology as a medical specialty
Encyclopedia
Pathologists are physician
s who diagnose and characterize disease in living patients by examining biopsies
or bodily fluid
. Pathologists may also conduct autopsies
to investigate causes of death. Pathology is a core discipline of medical school
and many pathologists are also instructors. As managers of medical laboratories, pathologists play an important role in the development of laboratory information systems
. Although the medical practice of pathology grew out of the tradition of investigative pathology
, most modern pathologists do not perform original research.
Pathology is a unique medical specialty in that pathologists typically do not see patient
s directly, but rather serve as consultants to other physicians (often referred to as "clinicians" within the pathology community). To be licensed, candidates must complete medical training, an approved residency program and be certified by an appropriate body. In the US, certification is by the American Board of Pathology or the American Osteopathic Board of Pathology. The organization of subspecialties within pathology varies between nations, but usually includes anatomical pathology
and clinical pathology
.
and clinical Pathology
, each of which requires separate board certification. The American Osteopathic Board of Pathology also recognizes two primary specialties: Anatomic Pathology and Laboratory Medicine. Many pathologists pursue a broad based training and become certified in both fields. These skills are complementary in many hospital based private practice settings, since the day to day work of many clinical laboratories only intermittently requires the attention of a physician. Thus, pathologists are able to spend much of their time evaluating anatomical pathology cases, while remaining available to cover any special issues which might arise in the clinical laboratories. Pathologists may pursue specialised fellowship training within one or more subspecialties of either anatomical or clinical pathology. Some of these subspecialties permit additional board certification, while others do not.
. The training to become a pathologist is under the oversight of the Royal College of Pathologists
. After four to six years of undergraduate medical study, trainees proceed to a two year foundation programme. Full-time training in Histopathology presently lasts between five to five and a half years. The first year involves structured training and is assessed by an objective structured practical exam (OSPE), which must be passed to progress to year two. This is followed by further specialist training in surgical pathology, cytopathology, and autopsy pathology. There are two examinations run by the Royal College of Pathologists
, termed Part 1 and Part 2. The Part 2 examination is designed to test competence to work as an independent practitioner in pathology and is typically taken after four or five years of specialist training. All postgraduate medical training and education in the UK is overseen by the General Medical Council (GMC). It is possible to take a specialist part 2 examination in forensic pathology
, paediatric pathology, or neuropathology
. It is also possible to take a Royal College of Pathologists
diploma in forensic pathology
, dermatopathology, or cytopathology, recognising additional specialist training and expertise.
and Clinical pathology
. Residencies both lasts four years. Residency in anatomical pathology
is open to physicians only, while clinical pathology
is open to both physician
s and pharmacist
s. Anatomical pathology in France is integrated in the internal medicine
specialty cursus. At the end of the second year of clinical pathology residency, residents can choose between general Clinical pathology
and a specialization in one of the disciplines, but they can not exercise Anatomical pathology
. And conversely, Anatomical pathology
residents can not exercise Clinical pathology
.
1) Clinical Pathology:
1.1) Biochemistry and Immunology:
1.1.1) Clinical Biochemistry
1.1.2) Analytical Toxicology
1.1.3) Histocompatibility and Immunogenetics
1.1.4) Immunology
1.1.5) Tissue Banking
1.2) Haematology and Transfusion:
1.2.1) Blood Transfusion
1.2.2) Haematology
1.2.3) Haemostasis and Thrombosis
1.3) Microbiology and Infection:
1.3.1) Microbiology and Virology
2) Cellular Pathology:
2.1) Anatomical Pathology
2.2) Cytopathology and Cervical Cytology
2.3) Histopathology
3) Molecular Pathology:
3.1) Embryology:
3.1.1) Embryology and Andrology
3.2) Genetics:
3.2.1) Cytogenetics
3.2.2) Molecular Genetics
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s who diagnose and characterize disease in living patients by examining biopsies
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
or bodily fluid
Bodily fluid
Body fluid or bodily fluids are liquids originating from inside the bodies of living people. They include fluids that are excreted or secreted from the body as well as body water that normally is not.Body fluids include:-Body fluids and health:...
. Pathologists may also conduct autopsies
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...
to investigate causes of death. Pathology is a core discipline of medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
and many pathologists are also instructors. As managers of medical laboratories, pathologists play an important role in the development of laboratory information systems
Information systems
Information Systems is an academic/professional discipline bridging the business field and the well-defined computer science field that is evolving toward a new scientific area of study...
. Although the medical practice of pathology grew out of the tradition of investigative pathology
General pathology
General pathology, also called investigative pathology, experimental pathology or theoretical pathology, is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury...
, most modern pathologists do not perform original research.
Pathology is a unique medical specialty in that pathologists typically do not see patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s directly, but rather serve as consultants to other physicians (often referred to as "clinicians" within the pathology community). To be licensed, candidates must complete medical training, an approved residency program and be certified by an appropriate body. In the US, certification is by the American Board of Pathology or the American Osteopathic Board of Pathology. The organization of subspecialties within pathology varies between nations, but usually includes anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
and clinical pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
.
Pathology in the United States
In the United States, pathologists are physicians that have completed a four-year undergraduate program, four years of medical school training, and three to four years of postgraduate training in the form of a pathology residency. Training may be within two primary specialties, as recognized by the American Board of Pathology: anatomical PathologyAnatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
and clinical Pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
, each of which requires separate board certification. The American Osteopathic Board of Pathology also recognizes two primary specialties: Anatomic Pathology and Laboratory Medicine. Many pathologists pursue a broad based training and become certified in both fields. These skills are complementary in many hospital based private practice settings, since the day to day work of many clinical laboratories only intermittently requires the attention of a physician. Thus, pathologists are able to spend much of their time evaluating anatomical pathology cases, while remaining available to cover any special issues which might arise in the clinical laboratories. Pathologists may pursue specialised fellowship training within one or more subspecialties of either anatomical or clinical pathology. Some of these subspecialties permit additional board certification, while others do not.
Pathology in the United Kingdom
In the United Kingdom, pathologists are medical doctors registered with — and nowadays licensed by — the UK General Medical CouncilGeneral Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
. The training to become a pathologist is under the oversight of the Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...
. After four to six years of undergraduate medical study, trainees proceed to a two year foundation programme. Full-time training in Histopathology presently lasts between five to five and a half years. The first year involves structured training and is assessed by an objective structured practical exam (OSPE), which must be passed to progress to year two. This is followed by further specialist training in surgical pathology, cytopathology, and autopsy pathology. There are two examinations run by the Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...
, termed Part 1 and Part 2. The Part 2 examination is designed to test competence to work as an independent practitioner in pathology and is typically taken after four or five years of specialist training. All postgraduate medical training and education in the UK is overseen by the General Medical Council (GMC). It is possible to take a specialist part 2 examination in forensic pathology
Forensic pathology
Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a corpse. The autopsy is performed by the pathologist at the request of a coroner or medical examiner usually during the investigation of criminal law cases and civil law cases in some...
, paediatric pathology, or neuropathology
Neuropathology
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery...
. It is also possible to take a Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...
diploma in forensic pathology
Forensic pathology
Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a corpse. The autopsy is performed by the pathologist at the request of a coroner or medical examiner usually during the investigation of criminal law cases and civil law cases in some...
, dermatopathology, or cytopathology, recognising additional specialist training and expertise.
Pathology in France
In France, Pathology is separate in two distinct specialties, Anatomical pathologyAnatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
and Clinical pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
. Residencies both lasts four years. Residency in anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
is open to physicians only, while clinical pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
is open to both physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s and pharmacist
Pharmacist
Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use...
s. Anatomical pathology in France is integrated in the internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
specialty cursus. At the end of the second year of clinical pathology residency, residents can choose between general Clinical pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
and a specialization in one of the disciplines, but they can not exercise Anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
. And conversely, Anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
residents can not exercise Clinical pathology
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
.
Other subspecialties
The following outline is an attempt at synthesising information on profession pathology as it exists in the United Kingdom and the United States.1) Clinical Pathology:
1.1) Biochemistry and Immunology:
1.1.1) Clinical Biochemistry
1.1.2) Analytical Toxicology
1.1.3) Histocompatibility and Immunogenetics
1.1.4) Immunology
1.1.5) Tissue Banking
1.2) Haematology and Transfusion:
1.2.1) Blood Transfusion
1.2.2) Haematology
1.2.3) Haemostasis and Thrombosis
1.3) Microbiology and Infection:
1.3.1) Microbiology and Virology
2) Cellular Pathology:
2.1) Anatomical Pathology
2.2) Cytopathology and Cervical Cytology
2.3) Histopathology
3) Molecular Pathology:
3.1) Embryology:
3.1.1) Embryology and Andrology
3.2) Genetics:
3.2.1) Cytogenetics
3.2.2) Molecular Genetics