Casting a Training Lifeline

Where did you receive your pathology education? Did you have access to state-of-the-art computers, simulated training, interactive quizzes, or the latest in multi-headed microscopes? Or did you work from textbooks, diagrams, or the basic information available on the Internet? Not every pathologists’ medical training looks the same, and it’s certainly true that not every student of pathology can access the same resources and assistance. It’s those differences that we feel should be addressed – and that’s what pathCast, a free pathology lecture series streamed live and available on demand, hopes to accomplish.

Starting a multicast

In May 2016, we were about to start our fourth and final year as pathology residents at Mount Sinai in New York City. We were interested in enhancing the didactic sessions at our program with expert lecturers across different subspecialties, so we reached out to several pathologists both at our own institution and elsewhere – and they immediately expressed a strong willingness to participate! A challenge arose when many of the interested lecturers were not local to the New York area, because our program did not have an established policy for financing guest speakers. Unwilling to pass up the chance to learn from the many generous experts who had offered to share their time, we explored ways of circumventing the issue – including the possibility of “hosting” our guests as part of a webinar. We knew the necessary equipment was already available to us in the department, and the webinar format was already familiar to many of our speakers. And so we shared the approach with our residency program director, Mark Friedman, and he happily gave the nod. We quickly got started by organizing dates and times to host our remote guest speakers.

For our first webinar, we used WebEx, a tool our co-residents thoroughly enjoyed. Inspired by this initial success, we wondered if we could host another webinar – but this time, transmit a live, web-based broadcast to amplify the reach of the lecture beyond our conference room. Our first attempt involved trying out Twitter’s Periscope, which was mostly successful, but limited by the fact that we relied on a smartphone for input – meaning that we had to use a small camera, a low-quality microphone, and no other tools. To transmit a speaker’s actual presentation (either via computer slide show or whole slide images) and capture their voice with good sound quality, we created a YouTube channel to transmit and archive the lectures. And, of course, now that we had the speakers, the tools, and the channel, we needed the finishing touch: a name. We chose “pathCast” – a portmanteau of “pathology” and “broadcast.”

A brief history of multicasting

“Multicasting” is the process of sending data across a computer network to several users at the same time. We’ve tried a few different platforms and online social networks, sometimes transmitting to as many as three at once: Facebook, Periscope, and YouTube. Most of the time, though, we only transmit to Facebook and YouTube, because that’s where the bulk of our users reside.

Most of our lectures are planned exclusively for pathCast, but we have streamed sessions directly from conferences as well – two from the Lenox Hill Hospital Cytopathology Meeting in New York in 2017, and one from Johns Hopkins’ 2017 continuing medical education event, “Current Topics in Gastrointestinal and Liver Pathology.”

PathCast is our attempt at a truly open-access education platform in pathology; anyone from anywhere in the world with any kind of computer equipment can access the lectures – live or archived (on Facebook, YouTube, iTunes, or via our website, pathologycast.com) as they prefer, without requiring a prior invitation or registration. And, if they choose to participate live, viewers can interact with the speakers during the session via chat windows. All in all, it’s a setup designed to offer truly accessible pathology training and education to any interested person.

How it’s made

Step 1: Invite a speaker

We personally contact our speaker(s) and invite them to give a pathCast lecture. Of course, we let them know in advance that we plan to broadcast the lecture live! 

Step 2: Ensure that broadcasting equipment is set up

The basic arrangements include a computer with a reliable, high-speed Internet connection and a high-quality microphone at the speaker’s location. Depending on whether the lecturer is presenting a computer slide show, glass slides, or whole slide images, they will need to make sure that their software is up-to-date and their microscope-to-camera connection is properly set up.

Step 3: Go live!

We receive the guest speaker’s computer screen and microphone input using video-conferencing software, which we then feed to locally installed open-source streaming and recording software. Once the audio and visual inputs are properly configured, a master stream key is generated that we then distribute to our Facebook and YouTube channels via a web-based multi-streaming service.

We also generate a promotional banner with a photograph of the guest lecturer, their name and affiliation, the title and date of the lecture, and information on how to access the pathCast. In the run-up to the event, we share the banner multiple times on our social networking websites to promote it.

Finally, when the live transmission takes place, we can learn from and enjoy it alongside (at least virtually) our colleagues from across the globe.

An unexpected impact

In the course of reviewing our Facebook analytics, we noticed that one of the cities that generated some of the greatest viewership was Korai, India. Though one of us is from India, we had never heard of this place – so, curious, we looked it up. It turns out that Korai (or Korei) is the name of a very small village in Odisha, one of India’s eastern states. We were thrilled to find this. To us, Korai is an inspiration – and a vindication. It proves our belief that pathCast can (and will) indeed reach remote corners of the world. We are convinced that there are many other Korais across the world that our pathCast videos reach, and that’s what encourages us to continue our efforts to promote pathology education and reach out to the farthest corners of the globe.

Recently, we had the opportunity to host a multilingual pathCast series focused on the Milan System for Reporting Salivary Gland Cytopathology, whose Atlas was recently released. Before the release, co-editors William Faquin (live from the Massachusetts General Hospital in Boston, USA) and Esther Diana Rossi (Catholic University of Sacred Heart in Rome, Italy) kicked off the series in English and Italian, respectively. That was soon followed by versions in French, Japanese, Mandarin, and Portuguese! We’re proud to have provided the Milan System with an avenue to disseminate their classification system to a broad, international audience even before the official release of the Atlas.

One of our personal favorite pathCast seminars was our very first, which took place on May 11, 2016. Neil Theise, a renowned liver pathologist, was the speaker. Back then, he was also one of our faculty members (now a Professor of Pathology at New York University). He was very excited when we introduced him to the concept of pathCast. In fact, he rode his bike all the way from the Lower East Side to the West Side of Manhattan and was there at 7:30 in the morning, long before we were. He even brought doughnuts for breakfast!

Getting involved

Medical education, pathology or otherwise, should be accessible to everyone across the world, irrespective of geographic, language, or financial barriers. As medical professionals, we subscribe to the idea that accurate and correct patient care is paramount, but that is only possible when physicians – even in the remotest corners of the world – are aware of recent advances and best practice guidelines. By leveraging the Internet and social networking platforms, we can increase the accessibility of medical education. We hope our efforts will contribute to closing the knowledge gap and helping our colleagues better treat their patients – everywhere. To that end, we all have a responsibility to educate and pass on our understanding of pathology.

Our fundamental raison d’être is the idea that pathCast could become a pathology knowledge-sharing platform with perspectives from different parts of the world. Its overall goal is to bridge the knowledge gap between resource-rich and resource-poor regions. As such, we enthusiastically invite all pathologists to join us and help spread advances in pathology to every corner of the world. Anyone interested in delivering a pathCast is very welcome to contact us via our website or by direct message on Twitter (@pathologycast, @EMadrigalDO, or @mannanrifat03) or Facebook (@pathCast).

Let’s work together to spread pathology education sans frontières!