Cullen Lilley is Pathology Resident (PGY3), Chief Resident (ombuds), University of California Los Angeles, David Geffen School of Medicine, UCLA Health Department of Pathology and Laboratory Medicine, California, USA
Kamran Mirza is Professor of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
From your perspective, what are the biggest needs or gaps in pathology education today?
Kamran Mirza: Pathology education is evolving. Historically, it relied on physical microscopes and in-person rotations, but that model is changing. With the digitization of pathology, learners – both in the US and globally – no longer need to be tied to those physical limitations.
In resource-limited settings, access to diverse cases and experienced faculty has often been a challenge. Digitization helps bridge that gap, offering broader and more equitable access to pathology training than ever before.
The remaining challenges lie in ensuring educational equity – addressing disparities between high- and low-resource environments – and in developing effective asynchronous learning tools to support learners everywhere.
Cullen Lilley: I completely agree. As Kamran mentioned, there’s a tremendous variation in experiences – not just globally, but even across different institutions within the US. Medical education has also changed dramatically over the past two decades, and today’s learners are different.
Medical students entering pathology residency are accustomed to asynchronous, self-paced learning models. Yet, much of pathology education still relies on traditional, experience-based learning and lengthy didactic sessions. That’s something that will likely need to evolve over time. It will be interesting to see how pathology training adapts in the coming years.
How did PathElective come about?
CL: When I was a medical student working with Kamran, one of my mentors, I was looking for ways to get involved in the pathology department. He mentioned that when medical students come for a rotation, many don’t really know what pathologists do or how the department functions. They often lack background knowledge – how slides are prepared, what we look for under the microscope, and what happens before and after sign-out. None of that is typically taught in medical school.
Kamran wondered whether we could create an online experience with short, focused didactics that students could watch before sign-out. The idea was to give them context, so they’d gain more from their one-on-one time with attending pathologists. It would make the experience richer and help even those not pursuing pathology understand our role in patient care.
That’s how it started – an effort to help medical students get more out of their pathology rotations. Then the pandemic hit, and everything shut down. During a Zoom call, Kamran asked, “Do you think we can make this work virtually?” We decided to try. We pulled together more than 50 faculty members, and I built the website from scratch – despite having zero web design experience.
It took time, but we piloted the program with Loyola students, refined it over a few months, and officially launched it in the summer of 2020. The response was incredible. It spread quickly within the pathology community, and seeing participants from all over the world was surreal. What started as a small idea became a global learning platform. I thought it might fade after COVID, but it hasn’t – it continues to grow and remains a valuable educational resource for pathology trainees everywhere.
KM: The timing really was a perfect storm – in the best possible way. We were able to enhance pathology education at a moment when most in-person learning had come to a halt. The pandemic accelerated the need for accessible online resources, and we were fortunate to already be thinking along those lines.
Both of us have long been interested in pathology education and social media, and as Cullen mentioned, we had tremendous support from generous educators who partnered with us. Together, we created a free, modular learning platform that reached far beyond what we initially imagined. It’s been incredible to see how this project has benefited not only those with access to pathology resources, but also learners in places where such opportunities are limited. It’s been a truly rewarding experience.
How does PathElective work in practice?
CL: As someone who used this resource throughout medical school and now in residency, I can say firsthand how valuable it’s been.
When I began my clinical rotations, I started completing a few modules before sign-out sessions. Suddenly, things clicked – I recognized terminology, understood key concepts, and could actually contribute to discussions instead of just observing. It transformed what might have been a passive experience into an interactive and meaningful one.
Later, as a junior resident, I used the modules to prepare before each rotation. They helped me understand common diagnoses, pitfalls, and even grossing tips from faculty. That preparation made me feel confident stepping into service and providing quality patient care, even early in training.
Now, as a senior resident, I still use the platform – but I also direct medical students and junior residents to it. It’s rewarding to see them have the same “aha” moments I did. I’ve really used this resource at every stage of my training, and that’s what makes it so special – it grows with you and supports learning from medical school through residency and beyond.
KM: We were so excited to see that growth. Originally, the platform was designed as a virtual elective for medical students, but as Cullen mentioned, junior residents often benefit from it even more. It functions beautifully as a supplement to in-person training, but in settings where on-site experiences aren’t possible, it can also serve as the only form of pathology education available.
Beyond medical students, it’s proven valuable for allied health professionals as well. The grossing modules are particularly useful for pathologist assistant programs, and the clinical pathology modules work well for medical laboratory science training.
Over time, the platform has evolved organically to meet the needs of different learners. It’s modular, easy to navigate, and intentionally simple – yet effective. And yes, the certificates at the end are always a hit! Ultimately, it serves as an accessible, flexible virtual elective that perfectly complements in-person pathology learning.
What were some of the biggest challenges you faced in building and maintaining PathElective, and how have you adapted the platform to address these challenges?
KM: I think the biggest challenge has probably been bandwidth. The team has essentially been just Cullen and me – and this was before the rise of AI-driven tools that could make website development much easier today. If we were building it now, we’d likely use one of those platforms. But at the time, none of that existed, and Cullen truly led the charge. I still remember our first conversation when I asked if he’d ever built a website before, and he said, “No, but we can figure it out.” That spirit of resourcefulness really kept the project moving.
During the early days of COVID, the educational landscape was very different. Clinical activity slowed, and many people had more time to contribute content. That period of relative calm gave us the bandwidth to grow the site. Since then, of course, things have become busier – Cullen is now a chief resident, and our core team remains small.
Our biggest ongoing challenge is managing time and commitments. This project has always been volunteer-driven and completely free, so we rely entirely on the generosity of contributors. Some content has taken longer to develop, and coordinating updates can be time-consuming.
Fortunately, being recognized as an official publication of the Association of Academic Pathology has given us organizational backing and potential access to staff support. That partnership helps sustain our momentum, but day-to-day operations still largely come down to our small, dedicated team – especially Cullen, who continues to be the driving force behind the site.
CL: From the beginning, our goal has always been to provide this resource completely free of charge. That was a top priority. Educational websites, quizzing platforms, and online learning systems can be expensive, so we set out to build something simple but high-quality and accessible to everyone.
Of course, with that minimalist approach came challenges. Things broke along the way, and we often had to troubleshoot issues as users reported them. Over time, as our personal bandwidth decreased, we began relying more on outside support – especially from the Association of Academic Pathology, which has been incredible throughout this process.
That partnership has made a huge difference. As Kamran highlighted, it’s allowed us to maintain and improve the platform, expand its capabilities, and focus on long-term development rather than constant quick fixes. For me, it’s also been a learning experience – figuring out how to manage and maintain something I had no prior technical experience with. But overall, it’s been rewarding to see how far it’s come.
What successes or milestones are you most proud of since PathElective launched?
CL: I think the most exciting moment was when we released the platform to the world. For a while, it had been password-protected and limited to Loyola students. Once we opened it up, the response was incredible – the analytics skyrocketed, and we saw users joining from all over the globe. That was a huge milestone for us.
Another moment that stands out was our first anniversary. By then, it was clear this project had staying power. Now, the platform is used as an adjunct to pathology rotations at multiple medical schools, and programs frequently reach out about incorporating it as a virtual elective – especially in places that don’t have one already.
It’s been amazing to see how far it’s come. The analytics continue to climb each year – over 1.8 million page views, more than 300,000 unique visitors, and over 20,000 registered users. Watching it grow and realizing that people continue to find real value in it has been incredibly rewarding.
KM: I completely agree with Cullen. It’s incredible to see that even today, hundreds of people visit the website daily from more than 150 countries. Aside from just a handful of places, nearly every country in the world is represented – and that’s really exciting to see.
Another major milestone for me was when we hit one million page views. I remember it clearly – it was around the time of the USCAP meeting, and Cullen was preparing to present the data to the pathology community. That moment really highlighted how far the project had come.
What’s also been rewarding is hearing from institutions that want to partner with us. We often get emails asking how they can use our content, and it’s always great to tell them, “It’s open-access – you can use it freely.” Many of these collaborations have led to joint projects and publications, which has been an amazing and unexpected outcome.
Have you received feedback from trainees or educators that stands out to you?
KM: I can think of one moment that really stands out. It might seem small to others, but it meant a lot to us. Someone once reached out from a pathology residency program in Asia and mentioned that several residents in their workspace all had PathElective open on their screens at the same time. That was incredible to hear – something we never imagined happening when we started this project.
As Cullen mentioned, it’s also been amazing to see educators formally incorporate PathElective content into their curricula. There are even published papers describing how institutions have used it in training. We never designed it to replace in-person pathology education – it was always meant to complement it – but in schools without a pathology department or dedicated faculty, it has become a meaningful substitute for learners who might otherwise have no exposure at all.
And now, when people recognize us as “the PathElective team,” it’s both humbling and gratifying. Moments like that remind us how far this initiative has come and how much impact it continues to have.
CL: Some users have shared that it made a big difference during their pathology rotations or helped them stand out. Hearing that always feels incredibly rewarding after all the work we’ve put into it.
Just recently, someone told me their program director encouraged them to earn PathElective certificates, which was amazing to hear – especially since it came from a well-respected residency program. Moments like that show how widely the platform is being adopted and recognized across institutions.
What’s most exciting is seeing PathElective become a legitimate and trusted educational resource. It’s being used by learners everywhere, and we want everyone – from medical students to residents – to feel the same sense of value and credibility in using it. Those personal messages of appreciation and recognition really reaffirm why we created this in the first place.
How do you see online and digital learning tools shaping the future of pathology training?
KM: Digital learning isn’t going away; if anything, it will continue to expand. Learners today are increasingly digitally native, and online education is only going to scale further.
That said, digital learning shouldn’t replace in-person education. Face-to-face learning offers unique pedagogical value – developing judgment, communication, and hands-on skills that can’t be replicated online. Instead, digital platforms should complement and enrich traditional training.
What’s exciting about digital learning, especially at scale, is its ability to standardize core knowledge and provide equitable access for trainees around the world – as long as they have an internet connection. Translation tools can also make these resources more inclusive, freeing faculty to focus on higher-level teaching and mentorship.
The future, I believe, is hybrid. Digital models will deliver broad, scalable content, while in-person experiences will deepen understanding and strengthen clinical reasoning and patient-centered care.
CL: I think digital tools will help personalize education. Just as PathElective offers modular learning, digital platforms can provide targeted content in specific areas – whether that’s a topic you want to strengthen, explore in more depth, or simply don’t have access to locally. That flexibility is going to be a major part of education’s digital transformation.
Still, no digital tool can replace the experience of looking through a microscope, reviewing real cases, and learning one-on-one from mentors. Pathology residency is, at its core, an apprenticeship – one that relies on observation, discussion, and developing professional judgment. Even when aided by technology, the hands-on learning and mentorship that define pathology training will always remain essential.
And finally, what advice would you give to educators who want to innovate in medical education?
CL: The first step is to get in touch with us – we’d love to collaborate! One of the biggest challenges in pathology education is that many initiatives are developed in silos. Different institutions often create similar tools independently rather than working together to build shared resources.
Given the increasing workloads and limited staffing that pathologists face, collaboration is essential. By connecting through national and international organizations and engaging in multi-institutional educational initiatives, we can pool expertise, reduce duplication of effort, and create stronger, more impactful learning resources for everyone.
KM: I couldn’t agree more. Broad collaboration is key to driving innovation – it thrives when people from different backgrounds, regions, and perspectives come together. That diversity of thought is incredibly powerful. Just because PathElective exists doesn’t mean innovation in pathology education is complete; there’s still plenty of room to grow and create.
My advice is to start by identifying a real gap – understand what’s missing and build a solution around it. Sometimes innovation fills a clear need; other times, it simply makes existing systems better. Both are valuable approaches, as long as we keep the learner at the center of everything we do.
Just as personalized medicine tailors treatment to each patient, personalized education should tailor learning to each student. We need to teach in ways that help learners thrive, meeting them where they are. There’s a tremendous opportunity to make pathology education more innovative and engaging. After all, our field has always been at the forefront of scientific advancement – we’ve revolutionized diagnostics through new technologies and tests. Now it’s time for our educational strategies to evolve at the same pace.
And as Cullen mentioned, we’re always open to collaboration. Reach out to us – we’d love to partner and keep pushing pathology education forward together.
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