Nicole Aqui
Vice Chair for Inclusion, Diversity, and Equity; Director, Pathology Residency Program; Chief, Transfusion and Apheresis Services at the Hospital of the University of Pennsylvania, USA
Biggest challenge in pathology? The biggest challenge is making sense of the enormous amount and complexity of data generated by the scientific fields known as omics – genomics, proteomics, metabolomics, transcriptomics, and more. Obtaining the data is just the first step, it must then be interpreted and translated so it can be understood by the ordering provider. While genomics is the most mature of the omics, all may aid in decisions about disease prevention, diagnosis and treatment. There is a critical need for pathologists with expertise in bioinformatics and data management who can integrate omics data with standard clinical information.
Exciting developments and trends? I may be biased because it’s my field, but the expanding role of pathologists into therapeutics is incredibly exciting. Chimeric antigen receptor T cells (CAR-T) and gene-modified stem cells are revolutionizing the treatment of hematopoietic cancers and hemoglobinopathies. With several FDA-approved cellular products, pathologists play a major part in these innovative, personalized therapies by providing the starting material for manufacture of the product. Our expertise in cell collection, processing, and quality control uniquely positions us to shepherd these research breakthroughs into clinical use. At the University of Pennsylvania (UPenn), for example, cells are collected in our apheresis unit and, in some cases, the gene-modified product is also infused here. On a personal note, it is gratifying to participate in the entire process, vein to vein.
Controversial opinion? Pathology is not a backup specialty for students who don’t match in their desired fields, and pathologists are not second-class doctors. We are experts at what we do and deserve to be recognized as such. Many in the public, and even in healthcare, have no clue what happens to their tissue or blood samples after they’ve been collected. Pathologists need to do more to increase our visibility so people understand the role we play in healthcare. We must advocate for our specialty, but we won’t be successful if no one knows who we are.
Pathologists must be at the table when decisions are made about hospital resources. We need to make more of an effort to connect with patients. Due to the Cures Act, patients now have access to their test results, often before their ordering provider has had a chance to review them. We don’t want them turning to Dr. Google because they don’t understand what we’ve written. What curated resources can we provide for patients so they don’t think they’re about to die? (Try looking up any symptom online, they all end in death.) It’s time to get out of the lab, step from behind the microscope.
Inspiring leader? Working at a place like UPenn, I’m surrounded by people who inspire me every day, but I’d like to mention Dr. Kumarasen Cooper. Dr. Cooper is a preeminent soft tissue pathologist with hundreds of publications to his credit, who, through the Botswana-UPenn partnership, travels to Botswana two separate months of the year to assist in training the Botswana pathology residents. When he started the initiative in 2016, there were no Botswana-trained pathologists in the country. The first class graduated in 2023.
His personal commitment to advancing global pathology aside, the reason he is so inspiring is his quiet leadership style, which is vastly different from most. Dr. Cooper epitomizes a servant leader – one who is not concerned with his own recognition but is focused on the needs of his team. He is generous with his time and is truly the kindest person I’ve ever met. As a residency program director, I get input from all sides – faculty, trainees, and staff. However, I look forward to the unsolicited texts and emails from Dr. Cooper because (usually) he’s telling me I’m doing a good job – that’s it, that’s the entire message. A little encouragement can go a long way, especially on days when I’m reevaluating all my life decisions. Dr. Cooper’s example of how to nurture others is something I make a conscious effort to incorporate into my own leadership style.
Attracting talent… Show them we’re not antisocial nerds hiding in the basement because we don't like talking to people – just kidding (but not really.) If we’re excited about what we do, others will see it too. But for that to happen, we must engage! And we need to start early. At UPenn, we have a pipeline program that brings undergraduates into the department to complete mentored research projects. We also expose them to different sections in anatomic and clinical pathology, so they get a better understanding of our specialty and how their research can lead to improvements in patient care through the development of new tests and therapeutic targets.
Pathology is being squeezed out of the curriculum at many medical schools, so we have to be intentional in how we market ourselves and our specialty to inspire the next generation of pathology leaders.
