Did you always want to be a pathologist?
When I first started medical school, I thought I might follow in my father’s footsteps and become a medical oncologist. But where I trained, in Australia, oncology was a very competitive field with not enough positions to go round, so I started to rethink my options.
Fine vascular surgery was one specialty that I enjoyed during my residents' training, which led me to consider ophthalmology. But life and love intervened, and I ended up moving to Germany, where my lack of knowledge of the language prevented me from applying for surgical roles. Instead, I opted for a PhD researching corneal transplant rejection, alongside German language studies.
One aspect of the research that I enjoyed was doing the histology on the samples – which started me thinking about pathology as a specialty. And, after my PhD, I didn’t train in ophthalmology, after all, but in pathology.
I trained in a referral center in Berlin for lymphomas, head and neck tumors, and ophthalmology. By the time my husband and I moved to the UK, twenty years ago, I had expertise in hemato-, skin, and ophthalmic pathology. That led me to my position as a clinical academic and leader of the Liverpool Ocular Oncology Research Group at Liverpool University.
Were you driven more by scientific curiosity or the desire to make an impact on the medical world?
For me the driver was scientific curiosity – I’m a bit of a nerd when it comes to biology. Even relaxation involves watching science shows, like David Attenborough's Planet Earth, or listening to podcasts, to increase my understanding of the world around me.
I was at medical school at the height of the HIV epidemic, and I would have loved to have taken time out for a research year to study the disease and its immunology. It didn’t work out, but it’s a good example of how my brain works.
What do you regard as your key achievements?
One is continuing to work as an academic pathologist and clinical researcher after having children.
The other thing that is very precious to me is my research group. It’s a big responsibility – I have to ensure that we keep securing enough funding to employ the post docs, fund the PhD studentships, buy equipment, and so on.
At first that was all I focused on. Then I had a fantastic personal assistant who insisted we needed a logo, a website, branded items to give away at conferences, and so on. That led to me regarding the group as being like a small business, and considering all the factors that would keep it successful and sustainable.
Of course, good management involves empowering the team to take responsibility for its success as well. I’m lucky that when I’m away from Liverpool, I can entrust the group to my experienced and loyal post docs, knowing that they will successfully run the show in my absence.
What recent advancements in precision medicine are you most excited about?
In skin melanoma, immunotherapy has really made an impact. Twenty years ago, a skin melanoma diagnosis would have had a devastating prognosis. But once the BRAF genetic mutation was identified as a therapeutic target, new drugs were developed that improved dramatically improved survival.
Then the tumor cells began to develop resistance mechanisms, which rendered the targeted therapies less effective. But now we have learned, firstly, how to harness the body's own immune system to attack the tumor cells and, secondly, how to sequence treatments for the best outcomes. Those advances have led to some amazing cure rates.
Pathology is vital to the precision medicine pathway. Treatment decisions are based on the depth of the melanoma, the extent of the inflammatory infiltrate, the presence or absence of particular biomarkers, and the genetic mutational analysis. Our tests tell the oncologist whether surgery was sufficient or further treatment is necessary.
What have you learned from your role as Registrar for the Royal College of Pathologists?
I've been involved with the College for a while in focused roles, such as Vice President for Communications. The beauty of the Registrar role is that it covers multiple ares – workforce, communications, profession, teaching, and learning – so you gain more knowledge of the inner workings of the College.
With that oversight, the Registrar is sometimes called upon to represent the President at events, which is very interesting. The role also involves interactions with other organizations, such as other Royal Colleges, the Institute of Biomedical Sciences, and the National Health Service – all of which opens up insights and knowledge that you don't get from sitting behind a microscope in the office.
One of my favorite aspects of the role is reading out the names of all the new pathology fellows at the award ceremony, in person, in the College building. It's always a very pleasurable event.
Do you think that pathology training in the UK is fit for purpose?
No. Exposure of medical students to pathology is virtually non-existent in the UK. It's very superficially touched upon in the various organ system modules. That approach has a knock-on effect when doctors qualify, and they are completely unequipped to understand pathology reports
Pathology can be very dry in teaching. I'd like to see it made more exciting. I know a professor of anatomy in Melbourne who uses virtual reality masks to teach the topics. The students are able to metaphorically dive into each organ, exploring its fine structures in three dimensions. I think if pathology was taught using new media, and digitized slides, we might see greater uptake.
I think the solution for training is twofold. First, we need to increase the pathology content in medical undergraduate courses. Then we should increase the number of training places available for resident doctors to specialize in pathology. If we continue to limit them, this produces an unnecessary pinch point, and we create workforce problems in the future. Going forward, the whole system needs to be overhauled, removing such bottlenecks.
How has your experience as a mother of triplets shaped your communication skills?
It has taught me to cater to the individual and be mindful of personality types when communicating. You also learn not to make assumptions about groups of young people of the same age – they don't necessarily have the same levels of knowledge or maturity, as life's experiences differ greatly.
Being a parent does help with understanding the external pressures on younger colleagues in the lab. When I'm supervising undergraduate or PhD students, I can empathize when they talk about accommodation struggles, employment worries, or social problems arising from the pandemic experience. I went through those things with my own children.
What advice would you offer to women in pathology with leadership aspirations?
It can be a hard grind, with multiple setbacks. But there are good days too, and those are what drive you on.
Firstly, be patient but persistent. When I set up my research group, I had five or six grant applications rejected before one was accepted. And, over time, I became more aware of what funders were looking for in grant applications, better at writing them, and more successful at winning funding.
And secondly, take advice. There will always be points where you come up against "T intersections", where you need to make a decision but are unsure which way to go. So it's good to have mentors to bounce ideas off. And vice versa – if someone needs you to read something they've written, or to talk through a decision, you can reciprocate. Women are usually good at helping each other!
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