Leading by Example

How did you find your way into digital pathology?

I only chose medicine as a career at the last minute. My original choice was fine art preservation and restoration! Art is my great passion, so I was naturally drawn to histopathology – the assessment and interpretation of complex images, rendered in aesthetically pleasing shades of pink and purple! Making a diagnosis on a histology slide mirrors the way one assesses a work of art – identifying and responding to features and patterns and pulling this together with contextual information to reach a conclusion.

What I love about digital pathology is how accessible and engaging these diagnostic images become when they are viewed on a large, high-resolution screen, rather than through the keyhole view of your own light microscope. Branching out into a leadership and management role as a pathology trainee allowed me to gain a new perspective on how pathology services are planned and delivered, and how digital pathology could help address some of the issues we are facing at the moment – particularly mismatches in capacity and demand for histology case reporting.

Can you tell us a little about your world-first fellowship?

I am fortunate to live and work in Yorkshire, where Health Education England offers a fantastic leadership scheme for specialty registrars and allied health professionals from all medical specialties. Successful candidates can take a year out of their training to develop and deliver a quality improvement project and receive formal training in management and leadership skills. My supervisor created the world’s first leadership fellowship in digital pathology at Leeds, and I was charged with planning and delivering our pilot project for primary digital diagnosis in breast specimens.

This role has since been taken up by others here and elsewhere, so there is a growing community of junior doctors and allied professionals across the world who have experience in digital pathology deployment. We ourselves scaled up to 100 percent slide scanning deployment in September 2018, and I am currently overseeing the training and validation of our remaining pathologists who don’t yet diagnose digitally.

In the course of my leadership fellowship, I also developed the research interests I am now pursuing in my PhD fellowship: the patient safety aspects of digital pathology, and the training and validation of doctors for primary digital diagnosis. Much of my work seeks to answer very pragmatic questions about digital adoption: is it safe? Why should our laboratory go digital? How do I know when I am safe to diagnose digitally? How do I build a business case for digitization? It’s very exciting to focus on questions that could fundamentally change how we perform routine work.

What advice do you have for others who want to pursue a similar path?

Think carefully about what you really want out of your career, as well as the environments and situations in which you thrive. You are unlikely to find a “perfect” fit with what you want to do, so be prepared to be adaptable (I was once asked to select digital slide images to adorn the toilet cubicles of the new Royal College of Pathologists headquarters – most unexpected!). If necessary, create your own opportunities. Established leadership schemes for junior doctors are excellent, but thin on the ground; if you have the enthusiasm and the inclination, you can collaborate on or develop your own quality improvement projects.

When I was asked what I do for a living, I used to shy away from mentioning that I was a pathologist, thinking it would preface a look of disgust or a lengthy discussion about Silent Witness. In fact, as pathologists, we are privileged to work in a field that people find genuinely fascinating, and I am now more than happy to satisfy that curiosity.

How do you see the future of pathology?

I believe pathology is undergoing a complete rebrand. Digital pathology emphasizes the fact that we are, first and foremost, an imaging specialty. Bringing our work environments and practices into the 21st century will make pathology a more visible and appealing career option for medical undergraduates.

The other great advance we are going to see (as the use of digital images for primary diagnosis becomes more widespread) is the development and implementation of augmented intelligence applications to support our diagnostic work. Deputizing some of the more onerous tasks (counting, quantifying, searching) to background AI will leave pathologists more time to concentrate on refining diagnoses and contextualizing them with patient metadata. This hybrid approach to diagnosis is likely to improve the reproducibility of certain aspects of the diagnosis and improve some of the time pressures placed on pathologists.

As a woman who has worked less than full time in an attempt to balance the demands of family and career, I am particularly excited about the opportunities digital pathology offers for flexible and remote working. I see the technology as a great enabler and leveler, supporting the needs of parents, carers, and those with long term health issues to optimize the hours they can put into their training and careers.