The Bulletin of the Royal College of Pathologists

Number 193 January 2021

In this issue

Celebrating the pathology workforce and securing its future RCPath Foundation taster event and Foundation Fellowship scheme Higher Specialist Scientific Training: preparing healthcare scientists for consultancy roles Diversity and inclusion – time for real and permanent change International Pathology Day: COVID-19, future vision and sharing knowledge

Also in this issue: The Royal College of Pathologists Delivering exams in a pandemic Pathology: the science behind the cure National Pathology Week round-up Coronaviruses: ready for the next one? The Royal College of Pathologists CONTENTS Pathology: the science behind the cure JANUARY 2021 NUMBER 193

EDITORIALS 248 INTERNATIONAL 286 From the Editor 248 Infection through the lens of COVID-19: From the President 249 an international viewpoint 286 CELEBRATING THE PATHOLOGY WORKFORCE TRAINING 288 Esther Youd: Celebration in challenging times 252 From Summer School to The second RCPath/BDIAP Foundation taster histopathology trainee 288 event and the Foundation Fellowship Scheme 254 A matter of life and death: redeploying Higher Specialist Scientific Training to the mortuary during COVID-19 290 in pathology: an overview 256 WORKING SMARTER 292 Diversity and inclusion: a College perspective 261 A district general hospital’s robust Making diversity and inclusion matter at the response to the COVID-19 pandemic 292 National School of Healthcare Science 263 CLINICAL EFFECTIVENESS 294 COLLEGE NEWS 265 Re-auditing the use of the CURB-65 score 294 Delivering high-stakes examinations PEOPLE 297 in a pandemic 265 Appreciation: Dr Edward Ilgren 297 A Vice President reflects 268 Appreciation: Professor Ian Talbot 298 Leaving the comfort zone for the bigger picture 269 Anthony Nolan's tireless mission 299 Professionalism: the foundation Deaths reported to Council 300 that supports pathology 271 Consultants: new appointment offers 301 Improving the job description review service 273 Examination results 302 Pathology Portal: the journey so far 275 REVIEWS 308 ON THE AGENDA 276 Book reviews 308 COVID-19 and lessons from the animals: Advances in Transfusion Medicine: a true One Health approach 276 a virtual conference 310 SHARING OUR SUBJECT 279 NOTICEBOARD 312 Pathology: at the heart of healthcare – Legacies 312 a round-up of National Pathology Week 2020 279 College conferences 314 Journey of a biopsy in pictures 281 CPD-accredited events 314 The Royal College of Pathologists The social mobility path to 6 Alie Street, London E1 8QT a career in medicine 282 Showcasing pathology careers T: 020 7451 6700 E: [email protected] during the pandemic 283 www.rcpath.org Art of Pathology competition 285

President Dr Mike Osborn Vice Presidents Professor Sarah Coupland Dr Angharad Davies On the cover: Heroes by Professor Peter Johnston Johnny Ma Kwok, winner of Registrar Dr Lance Sandle the 2020 Art of Pathology Assistant Registrar Dr Esther Youd competition, 11–17 category. Treasurer Dr Andrew Boon CEO Daniel Ross Bulletin Editor Dr Shubha Allard Disclaimer: Authors’ views are personal and are not indicative of College policy, except when College Officers write in their official capacity. Errors or admissions are the responsibility of the Interim Editor Brian Burns authors alone. Advertisements are paid for by external agencies and do not indicate endorsement or otherwise by the College. Editorial & Digital Manager Stacy Baxter www.rcpath.org Number 193 January 2021 247 EDITORIALS

EDITORIALS From the President

Hello and welcome to the January 2021 Bulletin. the many members actively supporting so many From the Editor This is my first Editorial as president and it is essential College activities. a great honour to be able to speak to you directly. As a profession, we can be forgotten and Welcome to the January 2021 Bulletin. What an conferences (International Pathology Day, pages The Bulletin is a great way to highlight the diversity, ignored, eclipsed by what some perceive as more exceptionally stressful year, culminating in a 286–287, Transfusion symposium, pages 310–311). professionalism and achievements of you all, our glamorous and news-grabbing specialties. At the rather non-festive and muted seasonal break with Similarly, delivering National Pathology Week fantastic pathology workforce. College we are working hard to overcome this and many other uncertainties yet to come. within the constraints of lockdown with even more to signpost the achievements of our members. I am of course delighted with the Bulletin theme verve and creativity than before truly demonstrates Thanks In November, we announced the RCPath of ‘Celebrating the pathology workforce’, which our great reserves and resilience (pages 279–280). When celebrating our workforce, the first thing I Achievement Awards 2020. Open to teams and would like to do is thank Professor Jo Martin for individuals from all pathology backgrounds and seems a particularly apt title to start this year. You I also read with considerable interest Simon Dr Mike Osborn no doubt agree that we need to recognise efforts Priestnall’s informative article ‘COVID-19 and her excellent tenure as president. Jo’s presidency disciplines, the awards highlighted the huge range and contributions across pathology, including lessons from the animals: a true One Health was especially marked by our move to a great of fantastic achievements by our members and both medical and scientific disciplines, at various approach’, which urges closer collaboration new building and then by COVID, the pandemic their colleagues in allied professions. Dr Shubha Allard stages of seniority, from different backgrounds between veterinary and medical scientists, clini- that has affected us all. I hope that the end of the Some were individual achievements, others and across the many specialties. I hope the various cians and pathologists to help us predict and better pandemic is now in sight. were awarded to teams and groups, but all demon- articles in this edition give a flavour of this intent prepare for emerging infections (pages 276–278). Jo expertly steered the College through these strated a fantastic contribution to pathology in all and going forward we will need your help and This is surely good advice that needs to be heeded? stresses and we are in a good place thanks to its forms – be that through teaching, research or continued input to this effect. The pandemic has had a major impact on the her. I would also like to thank the previous service provision. We are certainly encouraging young talent essential work being undertaken by charities, with Vice Presidents, Rachael Liebmann, Shelley The winners are truly inspirational and an into pathology with great efforts at the founda- the considerable funding shortfall also affecting Heard and Tim Littlewood, who have helped Jo example to us all, and to those outside pathology, tion level (pages 254–256) and it is good to see the Anthony Nolan (pages 299–300). The new Chief achieve this and who have worked exhaustively of the huge contribution you make to healthcare activity by members in promoting interest and Medical and Scientific advisor outlines his vision for the College and us, its members. in this country and beyond. Well done to everyone awareness around careers bearing fruit (‘From for steering this charity towards its key goals at I would also like to recognise the contribu- who entered the competition and to all the winners. Summer School to histopathology trainee’, pages the core of the transplant community in the UK tions of our many members who have been, and 288–289). I am greatly impressed by progress of and globally serving patients of all backgrounds continue to be, involved in College activities. Your COVID the training program developing consultant clin- needing a matched donor. time and expertise support the College, members The COVID-19 pandemic continues to rule our lives ical scientists (pages 256–259), with this pathway The year 2020 will go down in history like no and healthcare as a whole. The College and the at home and at work, and it would be wrong for me now open to many more biomedical scientists. other for many of us in our lifetime so far. Our profession could not function without you. not to mention it. We should congratulate ourselves Other articles across this edition demonstrate innate optimism must urge us to look forward for all the work we have done in combating this the multitude of efforts supporting the work- and, of course, there is much on the horizon to be Condolences terrible outbreak, which has touched all parts of the force in so many different ways (‘Celebration in hopeful about. The new year has brought the sad news that our world. Every one of you has contributed in some challenging times’, pages 252–253). This ranges Innovation in testing, vaccine development, past President, Professor Sir Peter Lachmann, died way, whether directly by involvement in testing for from continuing professional development and education and learning and the sheer speed on Boxing Day. COVID-19, through redeployment into other areas supporting recruitment (pages 271–274), to the of delivery of high-quality clinical trials have all Professor Lachmann was an eminent immu- needing help or by picking up the extra workload frankly heroic efforts of the Learning department been breathtaking, with pathologists playing an nologist who made numerous significant associated with the healthcare backlog – a particular and, indeed, College members as examiners in essential role. contributions to healthcare and medicine, and legacy of the lockdowns. ensuring that examinations did go ahead during We will aim to cover various key ongoing played a major role in the College, including the pandemic (pages 265–267). advances in the Bulletin in 2021. Editions this year serving a term of office as President. We have At the forefront Some of the reflections of the outgoing Vice will focus on further advances in genomics, with sent our deepest condolences to his family, friends A special mention should, however, go to our Presidents also give due acknowledgement to the some other broad themes emerging – namely, and colleagues. virology and immunology colleagues who have wide breadth of College activities and the individ- mother and child health, and cancer diagnosis, Earlier this month we heard the sad news really been at the forefront of the outbreak – uals involved in delivering these (pages 268–270). and then returning to the central theme of people that Professor Donal O’Donoghue, registrar for developing, overseeing and running the testing I am pleased that the College is moving forward and the workforce in pathology, just as the College the Royal College of Physicians, and an eminent services, managing treatment of affected patients in considering differences in the make-up of turns 60 in 2022. renal physician who worked tirelessly to improve and, most spectacularly perhaps, helping develop our membership so that all are represented and So, that’s the plan and no doubt we all hope healthcare and renal services, had died. We have the vaccines that now provide us with some hope supported accordingly. This seems a great start to that, as 2021 progresses, the year will become a bit extended our sympathies to his family, friends and that this terrible episode will end. meaningfully turning good intentions into action calmer and more predictable. I'll happily raise a colleagues. The College fully supports the vaccination when talking about diversity and inclusion. I have virtual glass to that thought. In our April Bulletin we will carry a full apprecia- programme and has signed up to the Academy high expectations of the College’s Diversity and tion of Professor Lachmann’s life, and our registrar, of Medical Royal Colleges’ statement. From a Inclusion Advisory Group, and look forward to Dr Shubha Allard Dr Lance Sandle, will contribute a personal remi- College perspective, we have been working hard hearing about further progress (pages 261–262). Bulletin Editor niscence and tribute to Professor O’Donoghue. to champion your views and needs as they relate COVID continues, not surprisingly, as an addi- to COVID-19 and the pandemic. For example, tional theme, and we all have had to adapt in some The future following input from members, the College has way, be this in relation to smarter ways of working I am now looking forward to working with my issued a statement on Lateral Flow Testing for RETURN TO with rapid in-house testing (pages 292–293) RETURN TO fantastic new Vice Presidents, Angharad Davies, COVID-19, which has been supported by the CONTENTS or organising national or international virtual CONTENTS Sarah Coupland and Peter Johnston, together with Academy of Medical Royal Colleges.

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Furthermore, I have been representing the Diversity and Inclusion Advisory Group. For more In December, I took part in a New Statesman Transfusion Committee and NHS Blood and College every week in discussions with Public on this, see the article on pages 261–263 by the roundtable discussion on the future of genomics, Transplant in England have published Transfusion Health England, policy-makers and other stake- group’s Chair, Dr Esther Youd. during which I explained the huge potential of 2024 – A Five-year Plan for Clinical and Laboratory holders relating to COVID-19, and the associated the field to provide diagnostic and prognostic Transfusion. The plan outlines key priorities, testing and vaccination programme. Changes to College ordinances information, and to allow personalised targeted with an emphasis on a skilled and trained I have given a variety of interviews to the press, As you are aware, at the AGM in November, we care and therapy for patients. workforce, and better use of data, technology and for example the Financial Times, and was involved passed a variety of changes to our ordinances. I emphasised that this was dependent on integration while promoting a safer culture in in a roundtable discussion event held by the Health There are two very significant changes that we sufficient pathology input, support and funding. accordance with the NHS Patient Safety Strategy. Service Journal. The College has recently contrib- hope will help you feel more represented by the I have also raised these issues in press interviews, This document is just one of the many great uted to several pieces of national guidance and College whatever your specialty. for example with the Health Service Journal and examples of members of our College working advice, for example for NICE, relating to topics such The first of these is that the Presidency of Health Europe Quarterly. together to improve healthcare. as long COVID and other aspects of the pandemic. the College should rotate between candidates working in different specialties (i.e. precluding Recognising transfusion medicine End in sight COVID Advisory Group a candidate practising in the same specialty I would like to finish this first editorial by high- COVID is still with us, but the end is in sight, we To ensure the views of the College and our members as an incumbent President from standing for lighting some further great work by one group hope, thanks in no small part to our members. are heard, we have set up a COVID Advisory Group, election). This should ensure regular opportuni- of our membership. Around two million units of As we move forward, the College will continue made up largely of virologists, but including other ties for representation in the office of President blood and components are transfused in hospitals to champion your needs, lobby for support for specialties such as immunology, haematology, across the whole membership. across the country each year. I, for one, am quietly pathology and the pathology workforce with microbiology and histopathology. The group’s aim The second is that, under the current ordi- reassured to know that if I need it, there will be the governments, and represent your views. I hope you is to help the College provide accurate and timely nances, Diplomates have no voting rights. Certain right blood, in the right place, at the right time for enjoy this edition of the Bulletin. Thank you for input into the many COVID-related documents we updates have now been passed to allow Diplo- me, and I applaud the UK blood services for their supporting the College. are asked to contribute to and to highlight issues mates to participate in the election of Honorary collective efforts towards this achievement. that matter to you, to policy-makers and those Officers, General Council Members and, to the To maintain and develop their excellent work Dr Mike Osborn MRCS FRCPath overseeing the response to the pandemic. extent a Diplomate resides within England, the and vital role in healthcare, the National Blood President, The Royal College of Pathologists We await the outcome of the largest randomised English Regional Representatives on the Council. trials, to date, of convalescent plasma (REMAP- This proposal will permit the future Fellows of CAP and RECOVERY), with exceptional leadership the College to become involved in governance at and contribution from our members. Through an earlier stage in their careers, recognising their these remarkable projects we are able to show that importance to the future work of the College. large, well-conducted trials are feasible and can These two changes were passed at the AGM address important therapeutic questions during but we need to wait until the Privy Council, who a pandemic. oversee the College ordinances as we have a Royal Charter, to sign off on these changes. This is likely A special mention to ... to be in the early spring. Finally, no celebration of our workforce touching on COVID would be complete without congratu- Workforce lating our member, Professor Jonathan Van-Tam, Despite the continuing excellent work of our the Deputy Chief Medical Officer for England, pathology workforce, and our colleagues in allied and a well-known face in the news and on our professions, there are clearly significant staffing televisions, for all his hard work trying to keep issues in many areas of pathology. We are working us and the nation safe. Thank you, Jonathan, the hard to represent your views and needs in this College is very proud of you. fundamental area.

A welcoming College Getting the message across While many people are already involved in the Essentially our message is this: pathology under- College, others may be somewhat more reticent pins almost every healthcare interaction; without about becoming involved, believing the College pathology, you cannot have healthcare. It’s a is a clique and not for them, that their involve- simple message that we highlight at every oppor- ment will not be welcomed or that their views tunity to policy-makers and other stakeholders so and opinions will not be listened to. We will that we in pathology are not forgotten. be working very hard to overcome any such As President, I have contributed to a variety misconceptions. of national reviews and documents, alongside It is your College and we want to make it as attending meetings where I have highlighted inclusive as possible so that every member feels the need for adequate staffing and investment in their views are listened to, their needs taken seri- pathology going forward. These have included the ously and that they can and should contribute by January 2021 NICE impact report on diagnostic becoming more involved in College activities. pathology, and a commentary that considers the To help with this aim and to try and increase NICE report and identifies the challenges and RETURN TO diversity in all areas of the College so that we better barriers there may be to the implementation of RETURN TO CONTENTS represent our members, we have set up the College NICE guidance. CONTENTS

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ne side effect of the pandemic has been a much wider understanding of the importance of pathology. Dr Esther Youd outlines the many ways in which the O profession is strengthening and safeguarding its vital workforce for the future. It is my privilege as Assistant Registrar to oversee Foundation Fellows College matters relating to the pathology work- Angharad also introduces some of our newest force. I am supported by a great workforce team College members – Foundation Fellows. These are – Fiona Addiscott, Reshma Patel and Kitty Kean – foundation doctors whose job rotation includes a in this important though sometimes unenviable spell in a pathology discipline and who are there- Dr Esther Youd task in the context of widespread workforce short- fore eligible to apply for a Foundation Fellowship. ages across pathology. We gather data and publish This year was the first year of the scheme and reports to highlight current challenges and influ- I’m delighted to see it was so popular and 24 people ence investment in the pathology workforce. were appointed. One aspect of the future of the pathology workforce is ensuring that it embraces members from Our tasks also include providing guidance If you have foundation doctors rotating through many different backgrounds and identities. Both the College and the National School of Healthcare about job descriptions and input into appoint- your pathology department, please do encourage Science have begun work to embed inclusion and diversity as a permanent change in the culture. ment committees to help ensure high standards for them to apply for future rounds. It is a great way recruitment across the pathology workforce. to help support early career doctors into pathology. workforce, and the assumptions we make about backgrounds and identities. You can see the work You can read interesting points of view from two people. This brings me on to the importance of the College is embarking upon on pages 261–263. Celebrating you all Foundation Fellows on page 255. diversity and wider inclusion. We need your input to ensure this work is not just a Our pathology workforce is clearly vital to the topical reaction to events but instead leads to long- ability of healthcare services to provide patient Higher Specialist Scientific Training Diversity and inclusion lasting change. care and high-quality pathology services. Lisa Ayers and Professor Berne Ferry from the Both the College and the NSHCS started work in This issue of the Bulletin promotes that workforce National School of Healthcare Science (NSHCS) 2020 on improving diversity and inclusion. Our Rising to the challenge of the pandemic and highlights some of our newest members – introduce us to some relatively new members – workforce is hugely diverse, yet this isn’t repre- Finally, I want to recognise the hard work and Foundation Fellows and those undertaking Higher those undertaking HSST. sented at senior levels in the College. dedication by all of you, especially over the last year Specialist Scientific Training (HSST). The HSST programme was introduced several The NSHCS, which directly recruits into scien- with the challenges of the pandemic. At least we The pathology workforce and the College years ago and now the first few consultant tist training, is also examining their recruitment can be sure that most of the world now knows what membership is made up of a huge range of roles, clinical scientists are emerging from the completed and training processes to ensure greater diversity a virologist does and the importance of pathology including medical students, foundation doctors, programme. and inclusion. You can read more about the work testing and infection control. We will continue to specialty trainees, clinical scientist trainees, SAS Clinical scientists make up a vital part of the of the NSHCS in this area on pages 264–265. work hard to raise the profile of all our specialties. doctors, medical consultants, consultant clinical workforce in several pathology disciplines, most The College will strive to make our diver- scientists, veterinary pathologists, biomedical notably biochemistry, genetics, reproductive sity more visible, to celebrate and recognise the Dr Esther Youd scientists, medical examiners and medical exam- science microbiology, haematology and transfu- immense value of all members from many different Assistant Registrar iners officers. We celebrate you all. sion. Their training includes the achievement of FRCPath by examination and they ultimately work Pipeline for the future independently at consultant level. Dr Angharad Davies, Vice President for Learning, Lisa and Berne also describe how HSST trainees introduces us to the work the College has been doing helped with the response to COVID-19, utilising to ensure we have a pipeline of pathologists for the their capacity for innovation and adaptability. Five future. It’s never too early to get people excited about HSST trainees share their experiences on pages pathology, to raise awareness of pathology careers, 257–260. to spark enthusiasm for our varied specialties and to recruit a pathologist in the making. Opening up to biomedical scientists Angharad talks about the ever popular Lisa and Berne also report the recent change to eligi- Foundation taster event (see page 254), which was bility to allow biomedical scientists to access HSST held online this year because of the pandemic. training. This will open up the career progression Consequently, it reached a much larger audi- options for biomedical scientists to train as clinical ence. The event showcases pathology careers with scientists to consultant level, and will broaden the a group of enthusiastic volunteers who clearly resilience of the workforce through skill mix. made a big impact on the attendees: ‘It was The opening up of HSST training to non- clear that everyone participating in the event traditional routes such as biomedical scientists RETURN TO is passionate about pathology, and that made me is an example of thinking differently about the RETURN TO CONTENTS feel very excited.’ traditional assumptions we have made about our CONTENTS

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The second RCPath/BDIAP Foundation Fellowship profiles

Foundation taster event and the Movin supportive and the Fellowship has opened many Abeywrickema doors. As well as learning more about a career in Foundation Fellowship Scheme pathology, and getting up to date with the latest Fellowship in research, I have also had the chance to contribute Microbiology to medical communications at a national level. n the summer of COVID, the College’s second taster event moved online and proved The year 2020 has amply demonstrated no less a success. Meanwhile, as Dr Angharad Davies reports, 24 new Foundation that pathology is an ever-changing field. I am Fellows were appointed. thankful for the skills and insight the Fellowship I has already given me and I’m excited about the Dr Angharad Davies In July 2020, the College’s second Foundation taster Box 1: Feedback comments learning opportunities that still lie ahead of me. event, ‘Pathology through a COVID lens’, was held from participants. online. Since the usual residential undergraduate The Pathology Foundation Fellowship in Phoebe ‘Completely changed my view of pathology. summer school could not be held because of the Microbiology is an invaluable opportunity Such an insight.’ Sharp pandemic, the 2020 taster event was also opened that will support my future career aspirations Fellowship in up to medical students. ‘I felt inspired and was particularly impressed in the specialties of infectious diseases and There was a lot of interest, with more than 200 that very senior doctors would take the microbiology. Histopathology attendees. Upon registering for the event, partici- opportunity to talk to us about pathology So far, I have been drawn to areas covered by pants were asked to enter three words describing training.’ these specialties: the diversity of microorgan- their perception of pathology – these are repre- isms, systems and demographics. Infection spans ‘It was clear that everyone participating in the sented in the wordcloud below. all areas of medicine and surgery – my rotation event is passionate about pathology, and that For the new online format, consultants and in microbiology has given me insight into cases made me feel very excited. Not only was I able trainees in each major specialty prerecorded videos across a wide variety of patient backgrounds and to learn more about pathology as a career, I was showcasing their specialty, describing the specialty ages, while having discussions with specialties When my postgraduate team contacted me about also able to learn about some of the research Wordcloud training pathology and giving examples of its role ranging from haematology to neurosurgery. the Foundation Fellowship, I just knew I had to being conducted now, which was very exciting representation of in tackling COVID-19. In advance of the meeting, Achieving greater knowledge in microbiology apply as it seemed like a great way to get more and interesting to hear. Thank you very much attendees’ perception these were made available to participants on and infectious disease feels inherently human- exposure to pathology, and involved with the for a great event.’ of pathology prior to YouTube so they could select and watch those rele- itarian, as we are accountable not only to our College and their events. the taster event. vant to their specialties of interest. patients, but also to the whole planet. I have always had a special interest in histopathology and its central role in the We thank you Twofold motivation diagnosis of disease. It is at the heart of all medi- A huge ‘thank you’ is due to the following panel- My initial motivations were twofold: to secure an cine but is such an overlooked specialty due lists for representing their specialties in the videos opportunity to delve deeper into current knowl- to lack of exposure during medical school, and on the Q&A panel: edge in the field, and to gain real insight into the and even in foundation years. My rotation in • Ruth Ayling and Atul Goyale (chemical reality of a career in infectious disease. histopathology will provide me with the appro- pathology) I enjoyed attending the College’s Path to priate base on which to build my knowledge • Cath Booth and Thomas Erblich Success event, especially the discussions on before I embark on my specialty training. (haematology) the interplay of pathology specialties in clin- Since being awarded the Fellowship, I have • Ali Robb and Ian Blythe (medical microbi- ical cases. Through the Fellowship there will be seized on opportunities to attend the Newcastle ology/infectious disease) further opportunities to learn more from people Path to Success virtual event and the webinar series • Mike Osborn and Katie Allen (histopathology) who work in infectious disease on The Art and Science of Practical Management. • Shuayb Elkhalifa (immunology). Cutting-edge access Encouraging others For joining the expert Q&A panel, thanks must The Fellowship gives me access to cutting-edge In the coming year, I am looking forward to also go to: research at inspirational meetings and confer- attending College conferences but, most of all, • David Roberts (research in pathology) ences, and the opportunity to explore exciting I hope to be able to speak at the College’s Pathology • Jo Brinklow (RCPath Director of Learning). avenues for future research. Summer School and encourage more people to I have previously been involved in organ- consider pathology as their future career. Finally, thanks are due to Kristen Pontello and ising local teaching opportunities for medical the College Events team for their flawless organisa- students, so I am looking forward to becoming The career for you? During the live part of the event, I gave an intro- tion, and to the British Division of the International more involved in the College’s public engage- Whether you are passionate about pathology or duction as the College Foundation Lead. The then Academy of Pathology (BDIAP) for sponsoring ment and student events. just curious about what it entails, I’d definitely College President, Professor Jo Martin, followed up the event. recommend applying for the Foundation Fellow- with a talk asking the question: ‘Why is pathology Opportunities ahead ship. It will give you plenty of chances to explore important?’ An interactive Q&A session with the Positive feedback I would strongly urge any Foundation doctors with all the different branches of pathology and what panel of consultants and trainees followed, which The feedback was very positive (see Box 1). Before an interest in a pathology specialty to apply for the they have to offer, and you may even find that it’s was led by Dr Matthew Clarke, Chair of the Trainee the event started, 36% of those who had signed up RETURN TO RETURN TO Foundation Fellowship. The College has been very the career for you. CONTENTS Advisory Committee. continues on page 256 CONTENTS

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were fairly sure they wanted a career in pathology. Box 2: Foundation Fellows appointed. higher specialist scientific and clinical knowledge. Afterwards, 59% said they were either likely or Trainees also benefit from networking with other HSST trainee profiles very likely to pursue a career in pathology, with Hawa Abdulrahman Kemal Gilanli HSST trainees and have opportunities to learn another 38% considering it as a possible option. from and collaborate with experts in their field. Movin Abeywikrema Veda Kudva Most encouragingly, 95% said they would recom- The programme provides trainees with full Paula Waits mend the event to others. Rishi Agrawal Kashing Leung funding of £3,000 per annum for the academic Fellowship element, which can consist of a Professional Adam Andreani Raihan Mohammed in Molecular Foundation Fellowship Scheme Doctorate (DClinSci) in their chosen field and a In 2020, the College launched its new Foundation Owain Blackwood Sam Morfett PgDIP in Leadership and Management for scien- Pathology of Fellowship scheme. The scheme aims to support tists with or without a previous PhD. Acquired Disease Rhona Boyle Poobalan Nayanatara high-calibre Foundation doctors with an interest In addition, trainees benefit from a £13,000 Year 5 in pathology and to engage them with the work of Bethan Carter Soumya Ojha annual training budget for five years, to support the the College. Professor Berne Ferry other training costs of the programme, including Ryan Clark Sojin Park All Foundation doctors whose rotations include conference fees, professional examinations, travel a post in any pathology discipline are eligible Amarpreet Devi Rebecca Prince and accommodation, and research costs. to apply for an RCPath Foundation Fellowship The HSST programme is made up of 20% study The HSST training gave me the opportunity to Lerryn Edgehill Sidhant Seth through a competitive selection process. time and time spent attending academic workshops rotate into all areas of the oncology genomics I am grateful to Dr Mike Masding, Co-Chair of Enea Fotis Phoebe Sharp and undergoing professional assessments. team to ensure both the breadth and depth of the UK Foundation Programme Office and Lead The majority of HSST trainees are in-service training essential for this ever-evolving multidis- Leanne Gale Stefani Widya Foundation School Director, Health Education candidates and therefore have important NHS ciplinary role. This is especially important when England (HEE), for supporting and promoting service delivery roles in their departments, which sitting RCPath examinations and completing these Fellowships through the Foundation Schools (see Box 2). Congratulations to them all. We extend complement the aims of the programme, providing OneFile competencies Directors Committee. a warm welcome and hope that they enjoy and practical experience and opportunities to put into It also means I have representation on many The appointed Fellows enjoy a number of benefit from this new scheme. practice the skills learnt on the course. senior leadership team meetings within my benefits, including College membership, the If your department hosts Foundation doctor To find out more about HSST from scientists department, covering areas such as health and opportunity to attend various College events and posts, please do encourage those rotating through who have completed or are currently undertaking safety and quality assurance. I get to engage educational meetings, and opportunities to present next year to apply for a Fellowship. Applications this programme, please see the five trainee profiles with clinical teams, have greater involvement at events such as the Foundation taster event and for next year will open in summer 2021. beginning in the opposite column and continuing in multidisciplinary team meetings, attend key undergraduate summer school. to page 260. external meetings and disseminate key findings The scheme was oversubscribed and many Dr Angharad Davies with the wider team. excellent applications were received. I am delighted Joint Lead for Undergraduate and Foundation Trainees emerging after HSST completion I particularly enjoyed the PGDip in Leadership to report that 24 Foundation Fellows were selected Education (Foundation) The initial HSST cohorts are now beginning to and Management from Manchester University. complete the programme and move into consultant This was unlike any other training that I'd done scientist roles across the NHS, implementing the previously and has given me the tools to become skills that they have developed. Understanding more confident in my leadership role. and recognition of this programme continues to Higher Specialist Scientific Training grow in the healthcare science community and Expectation versus reality among colleagues in other healthcare professions, Being part of the first cohort of the HSST was including medicine and pharmacy. Gradually, too, certainly not without its challenges, as any of in pathology: an overview Trust managers and HR personnel are beginning to the first cohort will tell you. Navigating around acknowledge and understand its value. the reality of the training, versus the expecta- isa Ayers and Professor Berne Ferry summarise the key aspects of the Higher We are now seeing life science HSST candidates tions of the training, was especially challenging Specialist Scientific Training programme, which prepares healthcare scientists take on significant clinical and scientific respon- and tested negotiation skills to the maximum. sibilities, becoming clinical leads of departments However, now that this programme has been for consultant posts. L and, where appropriate, running clinics. This widely adopted, this is no longer as much of a The five-year, work-based Higher Specialist Royal College of Pathologists (RCPath). Informa- increase in scope of practice is easing the burden in challenge for subsequent trainees. Scientific Training (HSST) programme is the most tion on the wide range of HSST curricula available pathology areas where significant workforce gaps While I thoroughly enjoyed the PGDip in senior-level training provision for healthcare can be found at www.rcpath.org/trainees/training/ have been previously identified Leadership and Management, going back into Lisa Ayers scientists. It is open to the four countries of the UK, training-by-specialty.html. an academic environment and writing essays for is managed and delivered by the National School of In these subjects, HSST trainees are required to COVID-19 pandemic: stepping up to the mark a non-scientific subject was also somewhat of a Healthcare Science (NSHCS), and funded by Health gain Fellowship of the RCPath by undertaking their During the COVID-19 pandemic, HSST trainees challenge, although a good one. Education England (HEE). It is designed to prepare specialist FRCPath examinations. Gaining FRCPath have risen to the challenge and taken on additional OneFile competencies were also an enormous healthcare scientists for the challenging role of is essential, along with research, leadership and roles and responsibilities to support the response. challenge, so my advice is – do them as you go consultant scientist in the NHS, and is supported high-level clinical competence, for completing the Some have been redeployed to critical areas, others along, as it will be much easier in the long run. by an underpinning part-time, doctoral-level programme. have supported stretched clinical services, and programme. all have contributed to additional service provi- Tough but worth it An outline of training and support provided sion. The adaptability, resilience and innovative The HSST is a fantastic opportunity to enhance HSST and pathology specialties HSST offers a blend of training for essential skills thinking shown are testament to these trainees and your skills, both as a scientist and as a leader RETURN TO Training for pathology specialties and life sciences required in senior scientific roles in the NHS, RETURN TO their experiences on the programme. in the molecular pathology field. It will give CONTENTS is implemented through partnership with the including leadership, innovation, research, and CONTENTS continues on page 259 you the benefit of continued learning in a

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and networks, while remaining in the hospital Support from your department and clinical/ HSST trainee profilescontinued setting. This opportunity to work across different training supervisors is important and can make organisations throughout my training has really a huge difference in your journey throughout structured format and should, ultimately, allow and the training being such a big task, the course added depth and breadth to my knowledge and the programme. you to progress into more senior management was often adapted and added to around us. It experience – and likely wouldn’t have been roles. Never, though, underestimate how tough wasn’t always clear what stages were next, what available to me outside of HSST. Tom Bullock this five-year training programme is, but also exactly we needed to do and how we were to go So far, the postgraduate diploma in Leader- Transfusion never forget just how rewarding it can be. about doing it. Now that trainees are starting to ship and Professionalism for Healthcare Sciences Science has been the most challenging aspect. Not because complete the training, this will be much less of an Year 5 Lewis Darnell issue for future cohorts. the content of the course is particularly difficult, but because it is very different to any other form of Completed Genetics/ Transferable knowledge study I have previously completed. It is less scien- training Genomics HSST opens doors to many experiences that you tific or clinically focused and concentrates more Year 5 may otherwise not have had, from networking on social sciences. with colleagues from other sites to attending HSST has helped me in so many ways to higher-level meetings at your own Trust. This develop as a leader and apply what I’ve learned in gives you a good overview of a wide variety the workplace. But it’s not always easy to find the The HSST transfusion science curriculum is of tasks and the chance to discover what you correct headspace to appreciate fully the training broad and consists of two stages, with the subject like, what you’re good at and which areas need while juggling a full-time job, research, Royal matter in each stage of the curriculum examined improvement. Overall, you gain a wide-ranging College exams and a personal life. That said, HSST in the FRCPath Part one or Part two exams. It also As a life sciences trainee, I undertook the Leader- experience of science in the NHS that’s transfer- has benefited me greatly, providing me with a includes doctoral research and development. ship and Management A unit modules with the able to a variety of future roles. firm foundation in leadership skills. Stage one covers topics such as haematology, University of Manchester while simultaneously blood group systems, transfusion therapy, donor- studying to take the Royal College of Pathology Josephine Happy to discuss recruitment testing and processing of blood exams to obtain a fellowship. McCullagh I’d urge anyone interested in the HSST training components, among others. programme to visit the National School of Health- Stage two covers modules including clinical I work as a clinical scientist in the Molecular Transfusion Genetics department at Nottingham University care Science website, where there is a wealth of bioinformatics, genomics and personalised medi- Hospitals NHS Trust. Much of the HSST training Medicine information on the programme. cine, science communication, adverse reactions revolved around that role, including service Year 4 I would also strongly encourage them to get in to transfusion and therapeutic apheresis. management, quality assurance, service develop- touch with current trainees. There are now many ment and training others. more HSST trainees on the transfusion medicine Research relevant to the day to day My research projects led to the introduction specialty pathway than when I started. Current My doctoral research project focused on red blood of a new testing service in the department and, trainees can offer an excellent perspective and cell microvesicles in sickle cell disease and their separately, evaluation of an improved method useful advice from their own experience. I’m role in vaso-occlusive crises. It gave me the oppor- for diagnosing patients with rare recessive As a blood sciences trainee I had the option to happy to discuss HSST with any aspiring transfu- tunity to perform research into an area relevant genetic conditions. study for the full DClinSci or to complete some sion medicine candidates, especially those from a to my specialty using techniques unfamiliar to I achieved the fellowship of the Royal College but not all elements of the training. I chose hospital setting. me, such as confocal microscopy. As a red cell of Pathologists through a combination of exam- the former, which meant that I would need to Finally, anyone interested in this programme immunohaematology specialist, I often provide ination and research. Both of the research and complete: Section A: Postgraduate Diploma in really should discuss it with their department. continues on page 260 development projects I undertook as part of the Leadership and Professionalism for Healthcare HSST were successful. Sciences; Section B: FRCPath part 1; and Section Change in eligibility criteria increasing access of the RCPath by examination, to complete HSST C: Doctoral Research and FRCPath part 2. In September 2020, the National School of Health- and join the Higher Specialist Scientist register Single workflow, multiple benefits I’ve enjoyed two main elements: being care Science released a joint statement with the with the AHCS. Therefore, all healthcare scien- The first led to the introduction of a single work- involved in research and my honorary contract RCPath, Academy for Healthcare Science (AHCS), tists will exit the programme with the same flow to allow efficient testing of a variety of with NHS Blood and Transplant (NHSBT). Institute of Biomedical Science and Manchester consultant-level skills. cancer and non-cancer services. This not only Academy of Healthcare Science Education The high-level scientific expertise, research reduced the cost of testing, but also led to faster Exploring the clinical academic pathway regarding a change to eligibility for entry to HSST skills and leadership training that HSST trainees results, estimated to save over 900 hours of staff I’ve been involved in several interesting research from 2021, allowing entry for the first time to are beginning to bring to the NHS will benefit time per year. It also allowed for the introduc- projects, primarily my doctoral research project, senior biomedical scientists with appropriate expe- patients and provide the agility and scope needed tion of a testing service for autosomal dominant which involved collaboration with many rience and qualifications. to develop many different clinical teams across the polycystic kidney disease without further impact different organisations. We’ve been looking All four nations of the UK support this opening healthcare spectrum in the UK. on staffing or resources. at the feasibility of introducing a whole-blood up of eligibility criteria. It is hoped, too, that it will My final research project resulted in a genetic component in the pre-hospital setting. Working allow for wider participation in the programme and Lisa Ayers diagnosis for four families with rare genetic in research at this level made me realise how support recruitment in those specialties with the HSST Training Programme Director disorders, allowing me to complete the doctorate much I enjoy this aspect of my role. It’s helped me greatest workforce needs, including haematology, portion of the HSST. to explore becoming a clinical academic, a career National School of Healthcare Science transfusion and microbiology. As I was part of the first HSST cohort, the most pathway that I would very much like to pursue. Clinical scientists and biomedical scientists challenging part was knowing how to plan my I’ve been working collaboratively with Professor Berne Ferry will have to complete the same academic and RETURN TO workload. With so many organisations involved, NHSBT, developing valuable skills, knowledge RETURN TO Head of the National School of CONTENTS CONTENTS professional components, and achieve Fellowship Healthcare Science

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Diversity and inclusion: HSST trainee profilescontinued

transfusion advice for patients with this disease. Combining scientific and laboratory skills a College perspective So, it was invaluable in my day-to-day role to with knowledge and understanding of clin- learn more, as a part of my thesis, about the patho- ical pathways and management has given me a iversity and inclusion are essential to ensuring the College serves all its physiology of the condition and treatments for different perspective on fostering innovation and members. Dr Esther Youd outlines plans already in motion to embed a these patients. improvement in the microbiology service. HSST was primarily a work-based programme, D real and continuous change in our culture. involving a combination of experiential learning, Juggling required Over the last year there has been increased focus scientists, members from devolved nations, part-time case-based discussions, work placements and The programme also provides a structured oppor- on racism in society, in particular with the killing and full-time workers, and academics, from teaching teaching, undertaken primarily at my workplace tunity to undertake patient/service-focused of George Floyd in the USA and the Black Lives hospitals, from district general hospitals and from or on placement. research and build wider multidisciplinary Dr Esther Youd Matter movement. This came at the same time as outside the NHS. The FRCPath curriculum was both chal- and academic links. This was something that I a recognition that people from some Black, Asian The invitation to participate was shared and lenging and enjoyable, giving me the opportunity found to be very useful in preparing me for my and minority ethnic (BAME) groups were at much promoted by colleagues at the British Association of to learn about areas I had not encountered in new consultant role. higher risk from coronavirus disease (COVID-19) Physicians of Indian Origin (BAPIO), The Association my previous role. I especially enjoyed attending At times, it was overwhelming juggling the than white groups. These two things have caused a of LGBTQ+ Doctors and Dentists (GLADD) and the donor sessions and haematology clinics, meeting requirements of the Doctor of Clinical Science concentration across society as a whole on racism Disabled Doctors Network (DDN). both the donors and the patients we provide (DClinSci) programme, service provision, and, in medical arenas in particular, on its impacts The advisory group membership is formed of with the blood components necessary to their work-based learning and preparation for the on health. people representing a huge range of characteristics, treatment and recovery. FRCPath examinations. At the College Trustee Board, we have been experience and expertise (26 in total at the time of conscious for some time that the composition of writing), as highlighted in Table 1 on page 262. Shaping real leaders Work, rest and plan Trustees (all white), although largely elected by The group met first on 22 October 2020 to agree Much of the programme was challenging at times, There is a large amount of learning to cover over College Fellows, does not reflect the broad diver- terms of reference and the broad areas on which to but the PGDip leadership modules at the University the five years and demands on your time can be sity of College membership. report to the Trustees. These include: of Manchester business school were particularly significant. It is important to plan your work- Diversity in the healthcare setting can refer to tough. This part of the programme centres around load wherever possible, incorporate revision • the diversity of College committees, Council a number of characteristics, such as race, ethnicity, social sciences and is designed to ensure candidates and wider learning into everyday practice and to and Trustee Board gender, sexual orientation, religion, physical abili- develop into leaders capable of self-reflection and understand when rest is needed. • how inclusive the College is for members and ties and disabilities, to name just a few. Additional questioning their actions to improve. HSST requires a significant commitment to staff of diverse backgrounds and identities features, including socioeconomic background, It pushed me outside the comfort zone of my postgraduate learning. I would encourage those • what steps can be taken to improve equality, education, language, culture, age, seniority and scientific discipline, forcing me to reflect on my considering this training to do their research to diversity and inclusion at the College geographical location, can introduce further points weaknesses and strengths as an individual, and fully understand what is really required during • a remit to cover all functions of the College of difference but the list can of course be wider. helping me to continually develop and adapt my the programme and what the role of a consultant for members and staff Diversity brings immense value – and diver- practice as a consultant clinical scientist. clinical scientist involves. • providing advice on matters of diversity that sity of thought is important to facilitate proper I would recommend HSST to any health- There are many resources available on the impact on pathology practice scrutiny of decision-making and ensure the College care scientist looking to develop as experts in internet via the National School of Healthcare • exploring opportunities to establish rela- is serving all its members. their field of practice. The programme provides Science, the Academy for Healthcare Sciences and tionships between the College and networks Trustees and the senior management team a career framework that prepares scientists to NHS Employers. Speak with other HSST trainees or organisations that can help the College agreed that this is an important area for further provide advice at consultant level, working and consultants in the discipline to understand improve diversity and inclusion. action and improvement. We do need to understand alongside medical colleagues to offer patients the their experiences. why people want to get involved at the College and We had an open discussion about diversity and best possible care. It is worth stressing that HSST is a bespoke ask the question – how inclusive are we? inclusion, with some important themes emerging learning programme, so it is important when that will form the basis of more in-depth discus- Dr Victoria embarking on it that you understand your The Diversity and Inclusion Advisory Group sion at future meetings. These included: McCune individual learning needs and reflect on your The Trustees have now commissioned a Diversity previous training and experience. • covering the need to widen participation Microbiology and Inclusion Advisory Group to discuss these key • supporting people to better understand how Year 5 issues and to advise the Board on what steps need Exciting time for the challenge the College works and to get involved to be taken. I have volunteered to lead this group Completed The consultant clinical scientist role in micro- • reviewing how inclusive the College appears and am keen to see the College become a fair, inclu- training 2019 biology is increasingly being recognised and on the website sive, open, honest and representative organisation developed to support new ways of working in • how to empower people that welcomes you and allows you to participate and the laboratory. As pathology networks develop, • mentoring succeed, no matter what your background or identity. and medical consultant roles in our discipline • increasing the transparency of appointments The response to the call for volunteers to join this become more patient facing, there will be an even processes new group was extremely positive and I am proud One of the most enjoyable parts of HSST was greater need for senior scientists with detailed • use of technology to overcome the London- to chair such an enthusiastic group of members, the opportunity to take on a different chal- knowledge of laboratory and quality-manage- centric view who all want to help shape a better College. We have lenge and develop my clinical knowledge and ment systems to help manage and shape the • making our diversity visible College members and College staff involved, trainees skills, working in a new environment within the laboratories of the future. This is an exciting time • opening doors from foundation, specialty training and Medical RETURN TO Infection Service team. to take on the challenge of HSST. RETURN TO • challenging traditional assumptions Training Initiative, consultants, medics and clinical CONTENTS CONTENTS • having diverse role models.

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Table 1: Results of the audit. As a result, an environment has been cultured and the society we live in, and it means we automati- company CEO a woman? (with credit to Valerie where we appear to have become scared of asking cally respond in certain ways without thinking. Alexander TEDxPasadena, ‘How to outsmart your Diversity/experience/ Number of members for or holding information about anyone. At the Imagine for a moment: you’re late to catch a own unconscious bias’, via YouTube). expertise (n = 26) College we do not actually hold information about flight, you rush through the terminal and just We need to be aware of our own unconscious BAME/ethnicity 16 aspects of diversity. This means I do not know the make the gate, and as you climb into the plane, the bias so that we can stop ourselves having these proportion of members who are BAME or LGBTQ+, pilot steps out of the cockpit and says, ‘Hi’. automatic responses, which may not always be for example, and so I cannot tell you or ensure that When you get to your destination, you go to helpful and may cause unintended harm and Gender 9 our committees, Council and Trustees are repre- a local restaurant and have the most wonderful discrimination. sentative of those groups of members. meal. A couple at the next table are celebrating I would greatly welcome views and further LGBTQ+ 4 At a Royal Society of Medicine webinar on their anniversary. suggestions from members around the proposed LGBTQ+ healthcare I attended, a speaker said: The next morning you attend the world’s activities of the College Diversity and Inclusion Disability 4 ‘If you don’t count me, I don’t count.’ If we don’t biggest technology conference and the CEO of the Group. Please drop me an email at esther.youd@ understand our data on diversity, how can we be hottest new tech start-up takes to the stage. rcpath.org inclusive, provide equitable services and represent Now, think back – what did you see as you imag- Religion 2 our members? ined the above scenarios? Was the pilot black? Was Dr Esther Youd This is one of the topics that the Diversity and the couple in the restaurant two men? Was the tech Assistant Registrar Socioeconomic status 2 Inclusion Advisory Group considered and felt to be important. As a result, it is likely that the College will be asking for more information about you in Devolved nations 4 the online workforce census when you log in to the College website. Sharing such data is voluntary, but Making diversity and inclusion Less than full time (LFT) 3 I hope you can see the benefits of doing so, in order that we can better ensure we represent all of you, matter at the National School Marginalised groups 1 while providing reassurance of GDPR compliance.

Pathology practice of Healthcare Science Returning to work 1 There are aspects of the practice of pathology where culture, race, gender and other identities nspired by the national solidarity shown in the face of COVID-19, and 2020’s many Clinical scientist 2 may impact how we work. We need to be aware of specific diseases that present in certain groups reminders of the persistence of systemic racism, the National School of Healthcare Medical 20 and may have to adjust treatment regimens or diag- Science decided to lead by example. nostic ranges according to patient demographics. I We also need to be sensitive in the language we Chanelle Peters It was amazing to see last year how we came identify areas of improvement for the School and Academia 2 use. The Advisory Group will be looking at some of together in solidarity as a country, to help ease the the services we provide. In practice, this means these and specialty guidance may follow. strain on the NHS during the COVID-19 pandemic. being accountable to the School’s senior manage- College staff 6 We followed government guidelines and were ment team, in order to meet standards, promote Moving forwards mindful of those around us and their needs. inclusion and create an environment in which we So what do we need? I think we need to achieve a In the summer of 2020, we witnessed and expe- are constantly educating ourselves and others. rienced tragedies that stirred emotions for many Learning at work change in culture in the College with more open of us, reminding us of another pandemic that has Extraordinary meetings I ran a lunchtime session with Sharonne Baiden, conversations about issues such as race, gender, been affecting a lot of people for many years – In practice, this means, individuals in the School HR Manager, for College staff on diversity and sexuality, disability, socioeconomic status, oppor- systemic racism. make suggestions and come up with ideas that are inclusion during the Learning at Work week held tunity and other aspects that may cause members At the National School of Healthcare Science, then addressed in ED&I committee meetings. If a in October. This included a training video followed to feel excluded. We need to work towards more we did not want the solidarity inspired by the matter is more urgent and cannot wait until the by a frank and interactive discussion that provided appropriate representation of our diverse commu- pandemic to end there. We felt it was time to next scheduled meeting, we sometimes conduct extremely valuable ideas and perspectives on nity across College activities. lead by example, by eliminating any potential extraordinary meetings. diversity and inclusion at the College. The experi- We will share experiences and expertise from Katie Foster for racism in the School, and actively promoting Once matters have been discussed in a meeting, ence of some of the participants present, who had other professional organisations to better under- equality, diversion and inclusion. recommendations are made on how we can move either encountered discrimination themselves or stand our current position and decide on the best forward and come up with a formal process. had witnessed examples of this behaviour, clearly steps towards change. Developing our Equality, Diversity and These are also presented at our senior management underlines the need for further action. We need to accept there is a problem so we can work towards solutions and aim for an environment Inclusion Committee meetings (SMM) to be sure all teams are aware of Staff at the School were not alone in wanting these improvements. The need for demographic data where all members feel included and supported, no to tackle the problem of systemic racism being We are also in close collaboration with the BAME Understanding the data about members is vital to matter what their background or identity. Above all embedded in our processes and thinking. A number Scientist Trainee Network, which reached out to us ensure that the College can be truly representa- we need to embed the change so it becomes contin- of trainees on our programmes got in touch to and maintains close contact to make sure that their tive of its members. And here we hit a roadblock uous and not simply a topical reaction to events. express their concerns and ideas. This confirmed voices are heard throughout this process of change. (temporary, I hope). In light of the General Data for us that we needed to take further steps to bring Protection Regulations (GDPR) that came from Unconscious bias about change. Improving our recruitment processes the Data Protection Act 2018, there was, rightly, a I’ll leave you to consider this. Our first move was to create, very quickly, We are working to improve both our internal and detailed look at the personal information held by We all have biases that we bring to any situation. RETURN TO RETURN TO an Equality, Diversity and Inclusion (ED&I) national recruitment processes to the healthcare organisations, and at the need to hold such data. Unconscious bias is the product of our upbringing CONTENTS CONTENTS Committee, which would meet regularly to science training programmes we facilitate. Our

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COLLEGE NEWS Delivering high-stakes examinations in a pandemic

ith the spring examinations deferred, the College faced a major technical and organisational challenge: be fully prepared for online sessions by W autumn. Joanne Brinklow describes how we rose to the occasion. Following the deferral of the spring 2020 examina- Following approval from Trustee Board, the tion session, the Examinations team dealt with a College purchased the ‘quick start’ option, which tidal wave of work to deliver the autumn session. allowed exam papers to be set up for the autumn Joanne Brinklow Events in 2020 led the National School of Healthcare Science to create its own equality and This required major changes to the delivery of session without the need to integrate question diversity training resources for internal use and external stakeholders. most of the College examinations. The delivery of banks, since there wasn’t time. the autumn session was important for candidates We organised a number of viva/oral exam- recruitment team is currently in the early stages However, now that the School has appointed key on a personal level. For the wider pathology inations on Microsoft Teams and Zoom, with of working with the external academic research individuals to dedicate the time and effort to prior- specialties already facing shortfalls, delay could appropriate ID and security checks in place, organisation the Work Psychology Group to review itising this holistic approach, we are confident that seriously affect future recruitment. allowing College examiners to examine candidates these processes. we will see progress happen sooner rather than later. Yet, on Friday 20 November 2020, just 36 weeks virtually in their home or workplace. This work aims to identify and eliminate any We hope that our initiative encourages other after deferral, the College issued approximately Finally, some examinations involving glass bias in the various stages from initial applica- organisations, networks and individuals to invest the 1,170 examination results from the autumn session slides and microscopes (e.g. histopathology and tion right through to the placement of trainees time and resources, to listen to their service users, to for candidates sitting their examinations in the UK, haematology) did take place in person, following on the programme. We intend to be as trans- reduce injustice and bias, and find ways to promote the Republic of Ireland and the rest of the world. social distancing guidelines. . parent as possible and will make the relevant data equality, diversity and inclusion in the workplace. This huge achievement would not have been available on a dedicated Equality and Diversity possible without the hard work of the College Exam applications and approving the process Matters page (currently under construction) on Forming a partnership with STEM Examinations team and examiners, the latter On 15 May, exam applications were opened up for the School website. We have also recently formed a partnership having to juggle the competing demands of deliv- an extended period for the autumn session, and Internally, we have since late September with the charity In2Science. Founded in 2010, ering the examinations with their busy day jobs. the proceeding candidate withdrawal period was 2020 introduced more diverse interview panels, In2Science aims to provide young people from also extended. In the summer, Council approved a with wider representation from people of low-income and disadvantaged backgrounds Achieving the remarkable derogation, which meant that any examinations different genders, ages and ethnicity, and include with opportunities to gain practical insight into In May, we conducted a survey to find out candi- taken in the autumn sessions would not count interview questions directly on equality, diversity the Science, Technology, Engineering and Maths dates’ thoughts on options for delivering the towards candidates’ overall number of attempts. and inclusion. (STEM) sector. examinations. In the July Bulletin, we reported on At the beginning of August, on a very hot day, We hope that, in this way, people we recruit Each year, In2science offers nearly 500 students the results, which indicated that candidates were the College Examination team put themselves in the will understand the importance of the values a chance to take part in life-changing summer place- keen to avoid travelling and staying away from figurative and literal hot seat in a webinar, answering of equality and diversity to the School from the ments, working alongside researchers and industry home during the pandemic. numerous questions gathered from candidates moment of their interview. In turn, we hope they professionals to get hands-on STEM experience. The College then decided it should purchase about how we would run examinations in autumn. too will demonstrate and implement these values We are delighted that the School will be able to an online platform to deliver FRCPath Part 1 Dr Matthew Clarke, Chair of the Trainees’ Advisory help more schoolchildren with an interest in science examinations and some FRCPath Part 2 and certif- Committee (TAC), put the questions. A holistic approach to training to gain professional experience, especially those icate examinations. The platform would include On top of all that, once the new methods of The School is also actively creating its own equality who would like to work in healthcare and the NHS. remote proctoring to allow candidates to attempt examination delivery were agreed, we had to apply and diversity training resources for internal use This is an exciting venture and we look forward to their exam from their home or workplace, with an to the General Medical Council for approval of the and for our stakeholders, including trainees, helping young scientists of today walk through the online proctor providing invigilation. proposed changes. Applications were duly made apprentices, supervisors, training officers, asses- doors of NHS departments of the future. The Examinations team consulted with all and approval received on 13 August. sors and recruiters. Through these, we hope to Exam Panel Chairs in June to understand their create an environment of continuous learning and Chanelle Peters needs, fears and concerns, and consider the full Specialties, challenges and mistakes self-reflection on how we promote these values, Digital Services Support Officer range of requirements for the tender document. September arrived swiftly and with it the first round A full procurement process was undertaken and of examinations. An immense amount of work was and to identify any areas of improvement. Chair for NSHCS Equality, Diversity four companies were interviewed. needed to prepare for the TestReach system. Our future plans are to view equality, diversity and Inclusion Committee As part of the process, trainees who had recently It is easy, perhaps, for candidates and even and inclusion in a holistic way, embedding these National School of Healthcare Science core principles in all of our training programmes. passed their FRCPath Part 2 examination indepen- examiners to forget that the College delivers dently reviewed the tender documentation from examinations in every specialty that it oversees. We do not anticipate change happening over- Katie Foster the final two companies and expressed their pref- The official number of College specialties is 17 night, and nor do we expect immediate results. Stakeholder Engagement Manager RETURN TO We must remind ourselves that this is a marathon, RETURN TO erence. Unanimously, they chose TestReach, but, with subspecialisation, the actual number of National School of Healthcare Science CONTENTS and not a sprint. CONTENTS as did the College procurement panel. continues on page 267

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different examinations is much higher. Many they got used to Zoom or MS Teams, the virtual Spring deferral, autumn delivery specialties use different examination formats and examinations worked very efficiently and were there can even be differences between specialties very well received by examiners and candidates. Examinations deferral means trainees continue to occupy that use the same format. Judging by the feedback I received, the haema- So, it was perhaps unsurprising that TestReach tology examiners were particularly impressed. training places and recruitment is halted, exacerbating issues faced quite a challenge preparing papers for use on The larger FRCPath Part 2 examinations took already affecting the pathology workforce. The personal impact their platform and, very often, this left little time place in person from the middle to the end of on trainees is also significant. Dr Matthew Clarke reports on the for the College team or the examiners to check October. During that time, infection rates were collective effort to make the autumn sessions a reality. them as fully as they might have liked. rising around the UK and the tier system had In some specialties, this led to unintentional already been introduced in September. Dr Matthew Clarke mistakes. There were other challenges too. The The College put together guidance outlining drawing tool that TestReach had shown us in the how we were adapting to the new restrictions and procurement stage had to be withdrawn at very working to keep candidates and examiners safe. Examinations are a major facet of the trainee exam. We are also collaborating on a briefing short notice, as it routinely caused connectivity Following significant pressure from our College journey. Many put their personal lives on hold video so that candidates know exactly what to issues for candidates using it. and others, the Academy of Medical Royal Colleges to revise and work towards the exams, under- expect on the day of the exam. We communicated this immediately to exam- released a statement confirming that exami- going very real physical and mental stress. On 20 November, more than 1,170 candidates iners and candidates but, understandably, it caused nations should be ‘prioritised alongside direct COVID-19 has created significant additional received their results. Some will have been very additional anxiety for the examiners reviewing clinical care’. stresses for pathology trainees, through redeploy- happy, and others disappointed. However, they and adjusting papers, and for candidates used to We were, to an extent, fortunate that these ment to clinical frontlines or loss of training time. should all be congratulated for attempting to drawing exam diagrams with pen and paper. examinations finished before the second Both bring increased anxiety. The postponement tackle what are already very challenging exami- lockdown in England was announced, and went of the College’s spring exams presented us with nations in such unusual circumstances. Overcoming connectivity problems ahead without interruption. a major challenge: how to keep functioning and It was a harrowing experience, for myself, As the examinations rolled out, some candi- make progress in our different training trajectories. College staff and TestReach, to read some candi- dates experienced connectivity issues. Many were And finally ... dates’ negative experiences. Everyone involved resolved in real time, with candidates having lost As the examinations were completed one by one, New format, new stresses, new solutions is sorry that they faced these difficulties and will time added on at the end. the race was on to mark them and prepare results The engagement with the examination survey try to ensure that these problems do not recur. However, for some, the loss of connectivity for the Examinations Committee on Thursday was impressive (see page 265), with many trainees That said, it must be noted that these diffi- was more serious. During the FRCPath Part 1 in 19 November. From discussions in the Committee, providing valuable data to support our planning cult circumstances led to some very unpleasant histopathology, 27 candidates experienced such it was clear that each panel had mitigated appro- and strategy, allowing exams to be held online. communications. Errors and mistakes happen significant interruption that they struggled to priately for any issues candidates experienced For most candidates, the exams proceeded to all of us in clinical practice, and to those complete the examination. One candidate couldn’t during examinations and did a great deal of without issue but there were technical issues, who work in examination delivery, particu- even start. careful work to ensure that results issued were fair some more serious than others (see page 267). larly in highly pressured circumstances. The cause of the difficulties was high- and consistent. In the already pressured circumstances We surely need no reminder that we must resolution images not being uploaded prop- We have learned so much over the past eight of a new exam format, stresses like these can show professionalism to others at all times. erly. If candidates already had low connectivity, months, and while not everything went to compound matters, making concentration We need to work together to address these they experienced significant issues. Following an plan, much of it did. Both the Trustee Board and difficult. However, despite these challenges, all problems, just as we do in the clinical setting. incident report from TestReach, all affected the TAC were kept regularly informed of progress, candidates completed their examination. candidates were given an opportunity to sit their including the various challenges faced along The College Examinations team are also to be Many thanks to all involved examination (different paper) in October and all the way. commended for arranging another sitting of the I would like to offer a huge ‘thank you’ to every completed it without issue. We have already met with TestReach to identify FRCPath Part 1 histopathology exam for several member of the College team who helped to Despite these issues, and without diminishing our priorities for the spring session, and Dr Clarke candidates with serious connectivity issues. make these examination sessions happen. They them in any way, the Examinations team received relayed feedback from candidates that he collected It would have been easier to defer until the worked tirelessly for past eight months and some positive feedback from candidates about personally with the help of the TAC (see page 266). next sitting, but the team went out of its way sacrificed their annual leave to see this through. the TestReach system. This was always welcome, I am very proud of the College team’s collective to accommodate these candidates, in recogni- It is a remarkable achievement and a source of as was candidates taking time to recognise the effort – the staff, examiners and College officers tion of the effort each had made to prepare for pride for the whole College. extraordinary efforts being made on their behalf. who made it happen. I also recognise our candi- the exam, and the huge personal impact likely My thanks, also, to all the trainees who dates who made such an exceptional effort in the to result from deferral. volunteered to help in the selection of the online Positive experience with virtual vivas most extraordinary of circumstances. platform and with other aspects of the process. The examinations held on Zoom and MS Teams, Trainee feedback Thanks also to TAC for all its help in gathering and in person, all went well. The Examinations Joanne Brinklow The Trainees’ Advisory Committee (TAC) the vital feedback from candidates that has team members were in complete control and once Director of Learning sourced feedback from candidates, which I then helped to refine the process for future sittings. collated and submitted to the Examinations And finally, all the candidates who under- team for review. We later presented the feed- took these examinations should be commended back to TestReach with recommendations for for their hard work and commitment in such subsequent sittings. challenging circumstances. Be proud of your- For example, a more robust, easy-to-use selves for all you have done and continue to do. communication system is now being put in place, which will be conveyed to each candidate Dr Matthew Clarke RETURN TO should they encounter a problem during the Chair, Trainees’ Advisory Committee RETURN TO CONTENTS CONTENTS

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focusing on a key area: foundation, education and The Foundation and Training Group Leads – A Vice President reflects engagement. Dr Angharad Davies (Foundation), Dr Hasan Rivzi The aims of the strategy are to support under- (Education) and Dr Richard Byers (Engagement) – graduate and Foundation trainees in order to have contributed significantly to achieving many rior to handing over to her successor, former Vice President for Learning, Professor ensure that they: of these aims. My sincere thanks to them for their Shelley Heard, reflected on her time in the role and the main achievements of the hard work, originality and commitment. • develop a solid and comprehensive scientific past three years. Through their work we have seen, for example, understanding of the underlying pathological P the development of Foundation Fellows, a review processes of disease Three years ago, I was surprised and delighted when to support the education and training of the and update of the undergraduate curriculum, • are provided with role models and mentors to the then President-Elect of the College, Professor pathology workforce. There have been three main and increasing links with other organisations better understand the work and contribution Jo Martin, called to offer me one of the three Vice areas of work of which I am most proud: working interested in raising the profile of pathology of pathologists to patient care and outcomes President (VP) roles, following the elections. I had with trainees, the RCPath COVID-19 pandemic among undergraduates and trainees. • have the opportunity to be inspired by the no hesitation in choosing VP for Learning. It was a video-based learning programme, and the Under- I have thoroughly enjoyed my time as VP. work of pathologists Professor Shelley Heard great decision. graduate and Foundation Training Group. I would urge any College Fellow with an interest in • understand the range and choice of careers In most areas of life, it’s people and relation- furthering pathology as a specialty and supporting offered through the pathology specialties ships that make for success and enjoyment. I have Working with trainees trainees to consider standing for this or other and consider these carefully as future career thoroughly enjoyed my time as VP for Learning at My role as VP for Learning has really been all about College roles in the future. You will have great options. the College, largely because I have been working working with trainees, especially Dr Matthew colleagues, a great deal of support and lots of fun. with the most wonderful group of people. Clarke, Chair of the Trainee Advisory Committee. A further aim is to increase the number of Jo Brinklow, Director of Learning, and her Helping to support trainees to learn about doctors applying for and being appointed to Professor Shelley Heard fantastic learning team have made the role easy and pathology has been a privilege and a pleasure. pathology training programmes. Former Vice President for Learning a great deal of fun. Their ongoing work during these Increasingly, pathology posts available across challenging times has been extraordinary. They all 17 specialties are being filled. This is a great sign have updated curricula to meet the requirements that, by sharing their experiences in pathology, our of the GMC’s new Generic professional capabili- trainees are supporting and influencing under- ties framework, had tremendous success ensuring graduates and young trainees, encouraging them Leaving the comfort zone that examinations could take place in September into pathology. and October, despite the complexity of doing so We’ve seen the Paola Domizio Undergraduate during the pandemic, and updated the e-portfolio, Essay Prize and the Hugh Platt Foundation Essay for the bigger picture Learning Environment for Pathology (LEPT). Prize receive more and more excellent submis- sions, again demonstrating a growing interest in r Rachael Liebmann looks back on the challenges and achievements during her pathology as a career. time as Vice President for Communications and International, raising the profile COVID-19 pandemic: video-based learning D of our work, embracing digital and more. programme When taking on a senior College position, the Key achievements Developing and seeing through to fruition the challenge involves providing leadership on a International collaborations College’s COVID-19 pandemic video-based broader scale, perhaps coming out of the comfort It has been great to work with the Interna- learning programme has probably been the most Dr Rachael Liebmann zone of one’s own specialty or having to think tional team on key initiatives and projects. These enjoyable experience in my time as VP. about issues at a national rather than local or have included supporting overseas members Throughout April, May, June and July 2020, the regional level. by responding to enquiries and providing College ran a weekly series of online seminars on Being Registrar previously gave me a helpful guidance where needed, overseas pathology COVID-19 and its implications for, and impact on, basis, but I still had the challenge of bringing in the summer schools and College examination centre pathology. College Fellow, Professor Will Irving, a sharper focus needed for the Vice President (VP) management, trainee sponsorship schemes, virologist from Nottingham, introduced the series, role. The remit of the Registrar stretches widely Memoranda of Understanding to encapsulate the and each seminar was led by a subject expert. across the College, providing a great opportunity relationships the College has with the govern- The seminar format was a 15–20-minute talk to get involved in all sorts of interesting College ments of other countries, and other major projects followed by a 15-minute Q&A session. A recording work. By contrast, the VP for Communications such as Lab Skills Africa and the ARISE projects. of each session is available on the College website. and International has very distinct boundaries Professor Heard A proposal has just been accepted to run a second Dr Nicky Cohen and Dr Sanjiv Manek have and expectations. Raising the profile of pathology with 2018 Furness series to update College members as the pandemic been superb in their respective roles as Clinical Both the Communications and International I have enjoyed working very closely with the Prize Winners, Navin progresses. This will, of course, be up to the new VP Director of Training and Assessment and Clinical teams had undergone considerable upheaval with Communications team on activities essential to Mukundu Nagesh and for Learning to decide. I am delighted to hear that Director of Examinations. Dr Rachael Liebmann the loss of some key staff. So, the first priority was the College. Public affairs entails reaching out to Bogdan Chiva Giurca. Angharad Davies is stepping into this role. and Dr Tim Littlewood have been outstandingly to help support and enthuse the remaining team and informing and lobbying politicians and policy supportive colleagues in the other vice presiden- members and to ensure that the new recruits makers on pathology issues. This is a vital part Undergraduate and Foundation Training Group tial roles, and Jo Martin has been an inspirational quickly found their feet. I am pleased to say that of College activity and I was also able to deputise Another highlight of my time as VP has been the and fantastic College President. not only did the teams rebuild and strengthen, for the President in reporting to the All-Party establishment and development of the Under- but that this enabled some of the more senior Parliamentary Group on Coronavirus. graduate and Foundation Training Group. The Three main areas roles to be filled by internal candidates, demon- Our ‘brand’ is important in spreading the word College approved a strategy for such a group back A key feature of the last three years has been the strating a growth in capability and confidence in about our members’ work. When producing RETURN TO in November 2018 and appointed three leads, each RETURN TO CONTENTS ability to implement innovative programmes CONTENTS the staff members. College guidance, workforce reports for widespread

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dissemination, the Bulletin and Annual Report, the tone and style must reflect the College as a Professionalism: the foundation that reputable organisation with a consistent and authoritative contribution. However, publications must also provide interest to attract and keep the supports the pathology workforce readers’ attention. This requires a great deal of work and repeated input, review and feedback to rofessionalism underpins the College’s goal of supporting members, maintaining various authors. standards in recruitment, and inspiring pathology professionals to deliver excellence, ensuring the best in patient care and safety. Promoting careers in pathology P Public engagement activity brings together The Professionalism department is one of the reflected in the preparation of NICE recommenda- College members from across the country, College’s main functional areas to engage directly tions wherever relevant. We seek advice from our enhancing people’s understanding of our profes- with pathology and the profession. It comprises three members to inform the development of NICE guid- Fiona Addiscott sion and includes the now hugely popular National teams: Clinical Effectiveness, Professional Standards ance and all our members are invited to give their Pathology Week. and Workforce. Each has its own area of work, but all opinion and advice. Please do look out for emails I was delighted to support various activi- three share the common goal of providing excellent regarding these consultations. ties, but in particular to ensure a firm emphasis service and standards to our membership. on highlighting the opportunities and rewards a Key assurance indicators and key performance career in pathology can provide, and furthering Clinical effectiveness indicators knowledge to help address the workforce crisis we The Clinical Effectiveness team aims to facilitate In November 2019, we published our KAI document face. In addition to giving several careers talks in the maintenance, delivery and development of to assure service quality rather than performance schools, I produced a video guide to help pathology agreed standards across the pathology profession efficiency in pathology. We are currently working colleagues to give such talks and hopefully spread to meet the national requirements for pathology on the development of specialty-specific KPIs, the word as widely as possible. services that benefit patients and the public. which each specialty can use to demonstrate the We support members through four main areas clinical effectiveness of their services. Digital pathology of work: the clinical guidelines programme, quality CE Daniel Ross, former Treasurer Dr David Digital aspects of the College communications Maria Marrero Feo improvement and patient safety, College involve- Professional standards Cassidy and Dr Liebmann inspect the ‘new’ activity have become more and more important, ment in NICE consultations, and key assurance The Professional Standards team undertakes a building at 6 Alie Street before completion. from setting up a digital consultation platform for indicators (KAI)/key performance indicators (KPI). diverse range of work with the ultimate goal of College guidelines and best practice recommen- supporting its members in their professional dations, to using social media and creating a map Thus, it was greatly satisfying to oversee Clinical guidelines development and to improve patient safety in the showing College activities in your region. Like the establishment of a Resources Hub to allow We produce a growing number of NICE-accredited workplace. Dr Liebmann a garden, a website needs constant maintenance members ready access to guidance relevant to guidelines to inform and assist pathologists, and The largest area of our work is the Continuing deputising for to make sure it is looking its best. To help in this, their COVID-19 work. I also welcomed the oppor- other healthcare providers, on best clinical practice. Professional Development (CPD) scheme, which Professor Jo Martin at I encourage members to report any outdated infor- tunity to outline quality and governance aspects We are involved in the development and updating provides our 5,000-plus members with a robust, a College dinner. mation to the College Communications team . of Pillar Two testing at a College online seminar of 95 clinical guidelines, of which 52 are cancer data- reliable and user-friendly online CPD portfolio to as part of this hugely successful series. In my inter- sets, 17 tissue pathways, 19 autopsy guidelines and record, store, demonstrate and export their CPD for national role, I contributed to the planning of our seven cross-specialty specific guidelines. appraisal and revalidation. recent and very successful COVID-19-themed During the COVID-19 pandemic, we further International Pathology Day (see page 286). Quality improvement and patient safety supported our members by extending the CPD Shane Johns Our continuous quality improvement (CQI) and returns deadline to the end of September 2020 Final reflections… patient safety initiatives help to support our and publishing regular news posts and advice on It is important not to let the VP role overwhelm members in maintaining and improving the quality collecting CPD. you and to have the confidence to rise to the of services for patients. Going forward, we will We responded to many queries and requests for occasion, even when deputising for the President also be focusing on ways in which we can support extensions, reassuring many of our members and at the College Dinner. members to improve safety in their workplace. providing some breathing space. To provide other To deliver the achievements above, I have This is all done through our Audit Certification ways of collecting CPD, we also processed many been blessed to work with Diane Gaston and Scheme, CQI Mentoring Scheme, audit templates and applications for CPD approval of virtual meetings, Jo Brinklow, and fantastic managers and members Patient Safety Awareness Week. The last of these was webinars and online training events. of staff in both the Communications and Inter- originally launched in 2018 as CQI awareness month, national teams. I could not overestimate the but has since evolved to focus on patient safety. It is External Quality Assurance contributions of Dr Lorna Williamson and delivered every year, offering a range of resources We further support best practice and patient safety Dr Shubha Allard, as Clinical Directors of and interactive activities. We are finalising the dates by managing the College’s External Quality Assur- Publishing and Engagement, and Dr Maadh for 2021 in light of the COVID-19 pandemic. Please ance (EQA) review programme. This work is being COVID-19 resources Aldouri, as Clinical Director for International visit our website to find out more about how to get undertaken to improve system-wide governance Of course, no article drafted in 2020 would be Activities, whose support and specialist knowl- involved in this year’s event. and oversight of technical EQA. complete without a mention of COVID-19. In edge have been invaluable. A simple and effective way to help keep patients my role as VP, it was clear that COVID-19 testing, NICE consultations safe, the patient safety bulletins offer valuable autopsies for COVID-19-positive patients and Dr Rachael Liebmann The College has a vital role in contributing to insight and a chance to learn from others’ experi- RETURN TO accurate death certification were all vital to the RETURN TO RCPath Council Member for London NICE consultations, ensuring that pathology is ences and develop professionally. We engage with CONTENTS UK’s pandemic response. CONTENTS

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our members to encourage individuals to submit Royal College’s Supporting Professional Activities case studies based on past experiences in their advice and relevant RCPath recommendations. Improving the job description workplace and CPD credits are available on submis- sion. Each month, a new bulletin is published Interview panels online and they cover all specialties and services. We respond to all requests from employing bodies review service If you would like to submit your own case in the NHS to provide a College representative on studies and claim CPD credits, please complete the interview panels for medical and clinical scien- ppealing and professionally produced job descriptions help to attract and case study template. tist appointments in the UK, excluding Scotland, secure the right candidates. Here are some useful dos and don'ts from the which has its own process. We have recently College’s Workforce team. Workforce prepared College best practice recommendations A Through workforce planning, the Workforce for virtual AACs. The College provides a service where we review on the wellbeing of the workforce to improve team aims to maintain standards in pathology We have a quality assurance process for job and endorse medical, consultant clinical scientist retention. Additionally, the College recognises that by reviewing and approving consultant-level job description review and representation on inter- level and specialty and associate specialist (SAS) there is something that employers can do to make Dr Esther Youd descriptions and monitoring appointments. We view panels to ensure that standards are being met grade job descriptions. We also arrange for College unfilled posts more attractive or to present jobs enable the College to plan an efficient, high-quality and a high-quality service is delivered. assessors to attend advisory appointment commit- that actively encourage pathologists away from pathology service through direct surveys and by tees (AAC) and provide guidance on recruiting the locuming and into substantive posts. advising relevant professional groups of the results. Meeting pathology demand and advocacy right candidates. The Workforce team offers a consultant job We run direct surveys across all pathology To NHS Trusts in the UK (excluding Scotland, College suggestions description review service and provides College specialties, to obtain accurate workforce data and which has a separate system), this process contrib- These suggestions have been drafted to help representation at Advisory Appointment Commit- information on vacancies. From the data gathered, utes to the statutory framework governing the employing bodies produce job descriptions that tees (AACs) to ensure that pathologists appointed we produce Meeting pathology demand briefings appointment of consultants, and we extend this will attract the ideal candidate to their post. to consultant posts in the NHS are qualified to the that help us to advise government departments, service to other employing bodies. Foundation appropriate standard. national organisations, medical and academic Trusts are not bound by statutory regulations and, The dos This is an important opportunity for the bodies, etc. on all matters relating to pathology by extension, not bound to accept College advice, • Choose clear (web-safe) fonts, as they will College to play an independent role in an employ- workforce issues. This advice has contributed although they frequently accept that it is good display better on all browsers and devices. er’s appointments process. On a three-yearly cycle, to funding being provided to the NHS by NHS practice to do so. • Space the headers for each area for ease of we review all consultant model job descriptions. England, NHS Improvement and Health Education Reshma Patel The College is not involved in the terms and reading. This provides the NHS with a framework that England (HEE). conditions of service. The BMA provides guidance • Ensure margins are not too big on one side, employers can use to attract suitable candidates to We encourage all members to complete their on this. However, making consultant roles more and use the space on the page wisely. posts. It also gives members a clear outline of the workforce data record on the College website with appealing is important for attracting the right • Keep the job description simple, concise and expectations of any given role. up-to-date information so that we can advocate candidates and helping to retain the existing work- to the point. effectively on behalf of our membership at all times. force. The College’s job description review service • Include a suitable title, with grade, specialty Centralised review and monitoring We would like to hear your views on how we shows that practice varies in all of these areas. and employing body all clear at a glance. The Workforce team carries out research and can improve our support to members, and welcome We therefore produced this guidance for employing • Keep the content professional, yet try also to conducts surveys of the current pathology work- any suggestions for the development of new bodies, with the intention of helping to create job have a personal touch. force. The College publishes these results in initiatives that may help to improve the quality of descriptions that will attract the ideal candidates to • Use the employing body’s generic templates; influential reports and papers, helping to ensure service and care for patients. these posts. however, adapt to suit the specialty. decision-makers commission enough patholo- Send your views or suggestions to: • Keep the subject matter relevant, e.g. if candi- gists with the right skills, training and expertise to [email protected] College experience dates want to know more about the area, ensure patient safety. To provide employing bodies with some tips, then provide links for them to do their own To enable the College to endorse job descrip- Fiona Addiscott College staff have drawn from past experience research. tions and job plans, we have centralised the review Workforce Planning Manager of reviewing job descriptions. These will help • Ensure references are up to date and that links process – co-ordinating communications from employing bodies to produce job descriptions work (hyperlinks are preferable to weblinks). specialty advisors and employing bodies around Maria Marrero Feo that inform prospective candidates about the • Keep all information such as staff lists, work- the UK. This allows us to monitor the content, Clinical Effectiveness Manager role they are applying for, and about the facilities load statistics and header and footers up including the Direct Clinical Care and Supporting and benefits. to date. Professional Activities split within job descriptions Shane Johns The important areas where we encourage good • Include all the items required to meet a basic and job plans. We encourage employing bodies to Senior Professional Standards Coordinator practice in job descriptions are: standard, e.g. duties of the post, facilities for comply with the terms of the Academy of Medical the appointee, model job plan, person speci- • creating a balanced role fication, contacts for visiting in advance, etc. • demonstrating the employer has a flexible • Create a balanced role that demonstrates the attitude to work/life and less than full-time employing body has a flexible attitude to working work/life balance and to less than full-time • adequate time for supporting professional working. activities (SPAs) • Make sure that the programmed activities • a reasonable or flexible number of add up. programmed activities (PAs) • Ensure there are enough SPAs for continuing • promoting the advantages of the local area. professional development (CPD), audit and RETURN TO RETURN TO While unlikely to address the workforce deficit, quality assurance, appraisal, revalidation, CONTENTS CONTENTS these areas do support the College’s national focus teaching/training and research.

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• Use suitable images to promote the area and • Do not waste space on unnecessary content; encourage potential candidates. stick to the relevant details. Pathology Portal: the journey so far • Have clear standards on both the essential • Do not make extravagant claims about the and desirable columns of the person employing body and/or department. he Digital Now platform, Professor Jo Martin's brainchild, funded and specification. • Do not put paragraphs into boxes as this • Specify ‘experience in’, ‘evidence of’ or ‘quali- makes it more difficult to review the docu- co-developed with HEE, is now Pathology Portal. Dr Hasan Rizvi provides an fication in’, not ‘an interest in’ or ‘enthusiasm ment, especially if changes need to be made. update on the project’s progress on delivering enhanced training for pathologists. for’. • Do not forget to ensure information is as up to T date as possible. Pathology Portal: objectives and outcomes Beta • Do not make the images too large, as the docu- The key aims are: This is the building phase and will result in The don'ts ment will be impossible to email. a minimum viable product (MVP) with basic • to provide a single national platform for • Do not use more than two fonts, as this does functionality as outlined and designed in the first hosting whole-slide scans (along with videos, not read well and can look messy. two phases. Conclusion Powerpoint presentations and other common • Do not use a cursive font (e.g. Script, Mistral, Through multiple testing cycles, users will With these suggestions, we aim to support College file formats) for healthcare training, quality Pistrina), as they do not display clearly or Dr Hasan Rizvi evaluate functionality and feedback to the members to maintain high standards in education, assurance schemes and any learning activity correctly on devices. technical developers who will redesign and training and research to deliver the best patient • to develop learning sets mapped to the • Do not use double spaces between sentences, rebuild, as required. care. These tips supplement the College’s model College’s specialty curricula that will provide as this makes the document too long. job descriptions, which are reviewed on a three- a graded reporting framework for learning • When using tables, do not justify the text, and Live yearly basis. and assessment avoid the use of bullet points, if possible. During this phase, the functional product will be • to develop an adaptive learning approach that • Do not use gender-specific language, only rolled out widely with ongoing support and minor Dr Esther Youd allows trainees to demonstrate proficiency in gender-neutral words, i.e. replace he/she with tweaks as required. specialist areas of reporting and provide an they. Assistant Registrar alternative to time-bound training. • Do not use language that may be seen as Our progress so far racially discriminating, e.g. ‘foreign’ or Miss Reshma Patel The overall objective is to allow flexibility in The College, working with the Technology ‘Eastern European’. Instead, use terms like Workforce Co-ordinator training and address gaps in learning needs at Enhanced Learning (TEL) team at Health Educa- ‘international’, ‘overseas’ or ‘European’. local, regional and national level. Once fully devel- tion England (HEE), appointed an external partner oped, this will allow schools of pathology and local – BJSS, a business technology consultancy – for provider (NHS trusts) to train existing and future the discovery and alpha phase, which concluded in healthcare workers with material that can be July 2020. customised to individual needs. Over the summer, I worked closely with The platform is expected to serve a variety of colleagues in the TEL team to develop an internal Soulsby Fellowships purposes, including provision of subspecialist business case to provide ongoing support for the training material that is not widely available project within HEE. The Soulsby Foundation was established in 2016 to honour the (e.g. diagnostic cytology, paediatric and neuropa- I also worked with colleagues in the College pioneering role of Lord Soulsby of Swaffham in championing the thology), flexible training, return-to-work training, and the TEL team to draft the procurement frame- quality assurance and competence testing. This concept of ‘One Health’ internationally. He was rather unique in work, which was used for the tendering process will eventually lead to more widespread adop- and to find a technical partner for helping the having been President of both the Royal Society of Medicine (RSM) tion of online assessments – both formative and Learning Hub team within TEL in the develop- and the Royal College of Veterinary Surgeons (RCVS), bringing summative. Ultimately, it is hoped that this will ment of the platform. together these aspects of health. The Foundation, working closely help ease the burden from already overworked Softwire was shortlisted as the technical trainers, especially in areas of workforce shortages partner for the ‘Beta’ phase in early December and with the RSM, the RCVS and the Royal Society of Tropical Medicine it is hoped that development work will start in the and Hygiene, awards up to five Traveling Research Fellowships (up Work streams new year. The development, being undertaken by to £12,000) known as ‘Soulsby Fellowships’ to individuals proposing The work for the project is divided into four phases: the Learning Hub team with the external partner, a project within the international field of One Health. These are open discovery, alpha, beta and live. is expected to take six to nine months. The project will require development of content with input to applicants with a degree in either human or veterinary medicine. Discovery from and editorial oversight by College fellows This includes interviews and workshops with and members The closing date for 2021 Fellowships is 31 January 2021. users and stakeholders to outline the functional It has been a rewarding and exciting journey so For more information, go to https://rstmh.org/news-blog/news/ requirements of the platform. far but, unfortunately, for personal reasons, I am stepping down from the role of Clinical Director soulsby-foundation-calls-for-applications-for-2021-one-health- Alpha at the end of my first year. From January 2021, fellowships Working with users and stakeholders, this phase Professor Martin will continue to lead on and involves designing the platform. The end results oversee this important project. are design and technical prototypes along with a detailed document of the technological archi- Dr Hasan Rizvi tecture required for each of the functional Clinical Director, Pathology Portal Programme RETURN TO RETURN TO requirements from the discovery phase Royal College of Pathologists CONTENTS CONTENTS

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Figure 1: (A) Normal canine tracheal ON THE AGENDA epithelium. (B) Canine tracheal epithelium 48 hours after infection COVID-19 and lessons from the (ex-vivo air-interface culture) with CRCoV. Note diffuse loss animals: a One Health approach of cilia and goblet cells with multifocal ith hindsight, suggests Professor Simon Priestnall, the COVID-19 pandemic epithelial cell necrosis. should have been easy to predict, given what we already knew about animal W coronaviruses. But, he asks, are we ready for the next one? For years, the medical community considered Naturally occurring betacoronavirus in dogs Pathology of veterinary coronaviruses genetic drift through the accumulation of genetic coronaviruses to be of relatively minor impor- In late 2003, as I was finishing my veterinary Coronaviruses have long been the subject of mutations due to the natural mechanism of virus tance to human health. Two human coronaviruses studies at the University of Bristol, I was contacted research among the veterinary community, with replication that employs a low-fidelity, RNA- Professor Simon Priestnall (HCoVs), HCoV-229E and HCoV-OC43, were by Professor Joe Brownlie, who was, at the time, the focus on viruses specific to domestic and dependent RNA polymerase, are responsible for known causes of the seasonally linked common leading a small research group at the Royal Veter- farmed species. Some, like CRCoV, generally cause the many different serotypes of the virus.14 cold. The former, an alphacoronavirus, origi- inary College, London, investigating the causes of mild disease, but others such as feline coronavirus Emergence of new IBV serotypes is through nated in bats and transmitted to humans through infectious respiratory disease in a large rehoming (FCoV) have a seemingly unique ability to mutate, selection acting on these molecular changes, with alpacas, and the latter, a betacoronavirus, passed shelter for dogs in central London. The shelter within the host, and cause invariably fatal disease vaccination of commercial poultry being one of the from rodents to humans through cattle.1 Neither had repeated outbreaks of disease despite the use in cats. fundamental selection pressures. Hence, the scien- was a major target of either biomedical research or of vaccination, and the group was undertaking FCoV is responsible for the intriguing disease, tific game of ‘cat and mouse’ to keep up with the vaccine development. a more in-depth investigation into the possible feline infectious peritonitis. Current under- ever-evolving threat to commercial production. infectious causes. standing is that the spike (S) protein of the virus It is perhaps too early to say how SARS-CoV-2 A predictable scenario A year earlier in 2002, Dr Kerstin Erles (a veter- mutates spontaneously within the host, and it will evolve, in terms of antigenicity and patho- Things changed abruptly in late 2002 when severe inary virologist and now a Fellow of the RCPath, is the immune response, mounted towards the genicity. What is clear, however, is that human acute respiratory syndrome (SARS; now known to working in that group) had discovered a novel mutated form of the S-protein, that causes signifi- influences such as high-speed international travel, be caused by SARS-CoV-1) first emerged in Guang- betacoronavirus (canine respiratory coronavirus, cant clinical disease.11,12 ‘bottle-necking’ events such as the isolation of dong province in southern China and spread to CRCoV) in dogs from the shelter.4–6 Virtually Antigen–antibody complexes can block the whole populations, and vaccines themselves will Hong Kong.2 This largely, but not exclusively, nothing was known about this virus, except that microvasculature, causing effusions and trig- all contribute variously to viral evolution in a respiratory infection was both highly infectious it did seem to be associated with clinical signs of gering a vasculitis or perivasculitis. At necropsy, way not previously seen with the other human and had considerably greater levels of morbidity respiratory disease in dogs.4 classic white to cream pyogranulomas are present betacoronaviruses. and, indeed, mortality than the other human in various organs but, most notably, in the kidneys coronaviruses known up to that point. Too good an opportunity to miss and throughout the intestinal serosa (hence the Preparing for the next coronavirus SARS came and went and for a time there was Prof Brownlie knew I was keen to undertake a name, feline infectious peritonitis). What is eminently clear (I sincerely hope) from a flurry of research interest in potential pandemic PhD and the prospect of being able to work on a The ability of FCoV to mutate within the host the current pandemic is that emerging viruses of CoVs. This interest gradually ebbed and as time novel virus was too good an opportunity to turn (indeed, in some instances, even between different animal origin can no longer be ignored or consid- passed, it seems fair to say, the medical community down. Over the next three years I discovered: the lesions in the same animal) poses a rather worri- ered someone else’s problem. In our globalised became complacent. virus was present globally;7,8 it was associated with some attribute of some coronaviruses, However, society, a problem in one country or region can, The emergence of Middle East respiratory mainly mild upper respiratory tract disease (akin the immunopathology observed with mutated virtually overnight, become a problem for the syndrome (MERS) in Saudi Arabia in 20123 again to the human common cold);9,10 it caused damage FCoV (an alphacoronavirus) is worthy of investiga- whole world. highlighted the significant potential threat these to ciliated cells in the trachea and upper airways tion as a possible model of the more severe forms of We were relatively lucky with SARS-CoV-1, viruses, of essentially animal origin, pose to (predisposing to secondary infections); and it had COVID-19 observed in humans but SARS-CoV-2 has taken full advantage of weak humans. Again, perhaps because of its geograph- a curious effect on the innate immune response, surveillance mechanisms, high-speed interna- ically restricted occurrence, this virus was not initially dampening down the proinflammatory Lessons for vaccination tional travel, and poor international cooperation taken as seriously globally as perhaps it should cytokine response of the host.9 Infectious bronchitis virus (IBV) is a gammacoro- and coordination. Of all the animal species from have been. One thing that struck me very early on in navirus that affects chickens and causes significant which potential human pathogenic viruses could Now, here we are in winter 2020–2021 and it’s working with this virus was just how infectious mortality in unvaccinated flocks.13 IBV, which is emerge, bats stand head and shoulders above the easy to say, with the huge benefit of hindsight of it was: transmission is via aerosols/secretions spread through aerosols, causes conjunctivitis, rest. In particular, the Rhinolophus (horseshoe) course, that this current scenario was all too easy and fomites, and almost 100% of dogs had tracheitis and occasionally nephritis. When intro- bats, of which around 106 species widely distrib- to predict. It could be argued, in fact, that it very seroconverted with detectable antibodies to the duced to naive flocks, it can cause up to 100% uted around the globe have so far been described, much was predicted, as outlined below. virus within three weeks of entry to the shelter.4 morbidity and, in some cases, significant mortality are host to a growing number of SARS-related CoVs Needless to say, a staggering amount of research It was possible to control the virus by reducing when complicated by secondary bacterial infec- (SARS-rCoVs). has already been done and will continue globally to the stocking density of the shelter, increasing tions of either the lungs or urinary tract. The first bat CoV was described in 2005 but, meet the many challenges being posed by COVID- distance between housed dogs, strict and thor- Vaccination and strict biosecurity protocols since then, over 35% of the bat virome has been 19. I am confident (and fully agree with Professor ough disinfection and sanitisation of kennels, have for a number of years been the main means of reported to be composed of coronaviruses. Cui et RETURN TO Chris Whitty, England’s Chief Medical Officer on and quarantining new dogs entering the shelter – RETURN TO control. However, control requires constant effort. al noted in 2007 that ‘understanding their [bats] this) that we will overcome this virus, as we have measures that will currently sound very familiar Genetic shift through recombination events, and diversity, behaviour, and mechanisms of virus CONTENTS many others throughout history. to us all. CONTENTS

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veterinary scientists that deal on a daily basis with the plethora of viruses existing at the human– SHARING OUR SUBJECT animal health interface. Although scientists were well aware of this hazard, no substantial actions were taken. Various human activities are accelerating the Pathology: at the heart of healthcare chances not only of direct zoonotic transmission events occurring, but also of transmission between – a round-up of National Pathology animal species. Intermediate host species, such as the palm civet in the case of SARS-CoV-1, increase the likelihood of a successful zoonotic transmis- Week 2020 sion event occurring. Indeed, it is not a case of if, but when, the next animal-origin coronavirus eople around the UK and beyond took part in our first online National Pathology Figure 2: Opened transmission may play a key role in preventing (‘SARS-CoV-3’) will emerge. Closer collaboration Week, enjoying online origami, sixth-form careers talks, a book panel discussion, abdomen of cat with future outbreaks of both known and unknown between veterinary and medical scientists, clini- 15 feline infectious zoonotic diseases of bat origin’. cians and pathologists will be our best way to meeting pathologists, heart health activities and, of course, pub quizzes. This very same group, from the Wuhan Insti- P peritonitis (FIP). Note predict and prepare for that day. abundant straw- tute of Virology, Hubei (China), no less, stated Penny Fletcher The College has coordinated National Pathology chance to hear about Jo and Mike’s careers, and to Week (NPW) every November since 2008. The ask them questions. yellow (fibrin-rich) in a March 2019 review: ‘... given the prevalence References available on our website. effusion and multiple and great genetic diversity of bat SARS-rCoVs, challenges posed by COVID-19 and social Around 85 people attended and the feedback, distancing became opportunities both to innovate collected via an anonymous survey after the event, cream-white foci their close coexistence and the frequent recombi- Professor Simon L Priestnall and reach more audiences for NPW 2020. was extremely positive. One non-member who (pyogranulomas) on nation of CoVs, it is expected that novel variants Professor of Veterinary Anatomic Pathology, 16 As well as College-led online events, there were attended commented: ‘It was a great way for the the omentum. will emerge in the future’. This statement was Head of Pathology not surprising to coronavirologists, nor to those online and socially distanced activities in hospitals public to meet senior people within the organisa- The Royal Veterinary College, Hatfield and schools all over the UK. These included a virtual tion. My 15-year-old daughter got her first insight careers talk for sixth formers in Exeter and an online into being a pathologist and this has encouraged her exhibition about digital pathology developed by even more!’ College Fellow Dr Samar Betmouni in collaboration with the National Science and Media Museum in Welcome to Book Club Bradford (see page 280). The first ever ‘RCPath Book Club’ took place on The NPW 2020 programme kicked off on Tuesday 3 November and featured Mark Honigs- Thadcha Retneswaran Monday 2 November with live-streamed heart baum’s The Pandemic Century. The event was origami activities for school students with hosted by healthcare scientist and science commu- science-based artist Dr Lizzie Burns, who has nicator Kip Heath and featured a panel made up previously delivered a wide range of activities and of virologist Professor Will Irving, immunologist events for the College. Her new range of heart- Dr Shuayb Elkhalifa and Financial Times journalist Lab Tests Online-UK: editors needed Below: origami health activity resources for this year's NPW have Anjana Ahuja. beating heart. been extremely popular. Following a reading by the author, the panel Lab Tests Online-UK invites interested healthcare scientists, doctors and recently retired fellows to discussed the book, what we can learn from join the voluntary team of editors for www.labtestsonline.org.uk previous pandemics and the importance of pathology during pandemics. Around 70 people Lab Tests Online-UK (LTO-UK) is written by practising laboratory professionals to help the public understand the attended and there were lots of great questions for many clinical laboratory tests that are used in diagnosis, monitoring and treatment of disease. It is supported by Mark and the panel. We hope to run more RCPath the Association for Clinical Biochemistry and Laboratory Medicine (ACB), the Institute of Biomedical Science (IBMS) Book Club events in the future. and The Royal College of Pathologists, and is entirely dependent on the efforts of unpaid volunteers. It is non- commercial and is consistently rated highly by patient associations and GPs as a trusted website. A busy week On Wednesday 4 November, school students from Editing pages is interesting and plays an important role in helping patients understand the tests we perform. CPD around the UK and beyond tuned in to see three points can be claimed as self-accredited points under the RCPath CPD scheme. College members speaking about their careers and Your role as an editor would involve the review of new and existing pages on the website about specific tests and work in the first of our series of virtual ‘Meet the conditions and the contribution to the articles for news feed. All specialties are welcome to apply and we have a Pathologists’ events. particular shortage of editors with haematology, genetics and microbiology/virology expertise. Consultant haematologist Dr Guy Hannah, consultant histopathologist Dr Seth Horsu and For more information, please contact: [email protected] histopathology registrar Dr John Jackson each The official ‘launch’ event for NPW 2020 took presented a five-minute interactive presentation place on the evening of 2 November. ‘Meet the that gave students an insight into their ‘typical Presidents’ was a conversation-style event with day’ and the path they took to get to their current the then College President Professor Jo Martin positions. The students, all aged 13–18, had many and Dr Mike Osborn, who was President-Elect questions for the three presenters, and were RETURN TO RETURN TO at the time. Hosted by medical microbiologist provided with College careers materials and links CONTENTS CONTENTS Dr Nicola Hardman, the webinar offered the to careers videos after the event.

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Journey of a biopsy in pictures

r Samar Betmouni reports on a display depicting the journey of a biopsy, which she developed for National Pathology Week in collaboration with the National Science Dand Media Museum, the University of Bradford and NHS colleagues. In celebration of National Pathology Week (NPW) the online resource. The physical display will 2020, I developed a foyer display at the National remain in place for two to three months, so hope- Science and Media Museum in Bradford with Dr fully visitors will be able to see it for themselves at Sarah Rawlins, Interpretation Developer at the the museum in the near future. For those unable museum, which captured the journey of a biopsy to visit the museum, I made a short video of the Dr Samar Betmouni in a series of photographs. We also developed display in situ. an accompanying online version to accommo- I am grateful to Dr Rawlins and the National date pandemic restrictions, which incorporates a Science and Media Museum in Bradford for their video animation created by Media and Design support and enthusiasm. Technology students at the University of Bradford. The display captures a biopsy’s journey Dr Samar Betmouni Above: On Saturday 7 November, science-based artist, Dr Lizzie Burns, led the online art-science through a histopathology department. Comple- Consultant Neuropathologist, Sheffield workshop for families, with its theme of heart health. tion of the project was only possible through the Teaching Hospitals NHS Foundation Trust generosity of laboratory medicine colleagues at Director, Digital Health Enterprise Zone, Virtual quizzes Heart health Sheffield Teaching Hospitals NHS University of Bradford (until November 2020) To engage undergraduate students on relevant On Saturday 7 November, Dr Lizzie Burns was Foundation Trust who allowed me to take courses, we ran two ‘Virtual Pathology Pub Quizzes’ joined by the College’s Assistant Registrar, photographs of them at work. The College also Below: the theme of on Thursday 5 and Friday 6 November. Quiz ques- histopathologist Dr Esther Youd, for a special allowed me access to their picture library, National Pathology tions were provided by College Specialty Advisory heart-themed online event for families. Attendees providing additional quality images for the Week 2020 was Committees and by the College members who were sent some of the heart-health resources display. ‘Pathology: at the were recruited as hosts. in advance and were able to ask Dr Youd about This fantastic public engagement tool explains heart of healthcare’. The Thursday quiz involved around 50 medical the heart and how it works, while they carried out digital pathology and its potential impact in Many of our members and biomedical science students, and was hosted the activities introduced by Lizzie. Many whole clinical practice. This is further highlighted with used the design we by two chemical pathology trainees, Dr Eamon families joined the Zoom-based event and made a caption on the role of artificial intelligence developed for this McCarron and Dr Emma Murray, and RCPath their own origami ‘beating heart’. (AI) as a diagnostic tool. I am grateful to theme to promote Pathology Foundation Fellow Dr Rishi Agrawal. Dr Pahini Pandya from Panakeia Ltd for their events and to On Friday, around 40 veterinary science and Thank you providing illustrative AI images. show their support veterinary medicine students enjoyed a veteri- After a busy week, it was fantastic to share the on social media. nary pathology quiz. Hosts Professor Roberto La many photos and comments posted on social Online during lockdown media from members and supporters who had The project highlighted the teamwork at the heart run their own NPW events. Thanks to all who of delivering diagnostic services. It also empha- contributed to NPW 2020. sised the importance of working across boundaries The winner of our #HeartOfHealthcare Twitter to communicate our excitement about pathology. photo competition was Sarah Gibson for her Although lockdown restrictions meant that visually striking image, which can be seen at it has not been possible for visitors to view the www.rcpath.org/pathologyweek. display, we did, nevertheless, mark NPW with Overall, the range of images created and the creativity on display was fantastic. Thank you to everyone who took part. National Pathology Week 2021 will run from 1 to 7 November. Please save the date.

Penny Fletcher Public Engagement Manager Ragione, Dr Simon Spiro and Dr Kate English repre- sented the three main areas in veterinary pathology Thadcha Retneswaran and provided a range of thought-provoking and Communications Officer entertaining questions. RETURN TO RETURN TO CONTENTS CONTENTS

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Huntington’s: The social mobility path to Medical student Hannah Reilly presented a a career in medicine fictionalised case study about n September 2020, the College and the Social Mobility Foundation teamed up to host a Huntington’s disease. medical ethics webinar for disadvantaged students aged 16–18 interested in studying Imedicine. Penny Fletcher reports on a successful collaboration. Under normal circumstances, the College runs There was an online vote on the ethical ‘Your Body, Your Consent’, a workshop on medical dilemmas presented and a discussion about the ethics, a few times a year for students aged 16–18, Huntington’s scenario, led by fifth-year medical Penny Fletcher at schools and public venues around the UK. Its student Hannah Reilly, who has completed her learning in the context of clinical and professional Social Mobility Foundation via their e-mentoring aims are to stimulate discussion and reflection on intercalated MRes degree in pathology. practice), and the problem-based learning method volunteer programme. It offers an opportunity to consent for different uses of human tissue, such as used at medical school. support young people from diverse backgrounds to research and transplantation. Organ donation Since the webinar, the College has continued succeed in medicine, and is a chance to highlight With COVID-19 still restricting large public Dr Lorna Williamson, College Fellow and Human to promote relevant College events and activi- pathology as a career. events, the College approached the Social Mobility Tissue Authority board member, introduced a ties to SMF students and is in talks with the SMF Foundation (SMF) about running an online version discussion about organ donation and spoke about team about future collaborative events. College Penny Fletcher of the workshop with school students involved in recent changes to the laws around deemed consent members can get involved in the work of the Public Engagement Manager their programmes. A key area of the SMF’s work is (‘opting out’). This was timely, since the event supporting young people who want to study medi- was held the week before the annual NHS Blood cine, but may be prevented from doing so by their and Transplant (NHSBT) initiative ‘Organ Dona- socioeconomic circumstances. tion Week’. The polls included questions about The SMF agreed and, in September 2020, the altruistic organ donation – nearly half the students Showcasing pathology careers Ethical principles: College’s Public Engagement team worked with said they would donate a kidney to save someone’s Professor Mark two College Fellows and a team of medical under- life, whether they knew them or not. Wilkinson opened the graduates to deliver an interactive, 90-minute during the pandemic session by introducing ‘Your Body, Your Consent’ webinar. More than 160 Debating monetary reward the ethical principles SMF secondary school students took part. If they The last part of the webinar focused on debates hroughout the pandemic, the College has found new ways to let students and that underpin the do progress to studying medicine, the SMF will around monetary rewards for those who donate Foundation doctors know about the diverse and fascinating careers on offer in medical profession. support them throughout their degree. tissue for research. After another poll, and some pathology – from members’ ‘selfie videos’ to online careers talks for schools. discussion between the medical students on this T topic, the speakers had time to answer just some of Public interest in pathology has, unsurprisingly, and those who landed on a careers page directly the school students’ questions. Because there were heightened during the 2020 pandemic. We have through our website. so many questions, the College panel answered the recorded a huge increase in visits to the College’s Penny Fletcher rest in writing. careers pages. Our virologist page alone received Young Gifted and STEM over 22,000 views between March and July 2020, To support our social media efforts to reach Future collaborations on the cards compared with 1,590 views in the same period secondary school students, we also coordinated Adapting ‘Your Body, Your Consent’ to an online in 2019. and contributed to online events aimed at this format worked well, and the SMF is keen to work In May 2020, in response to increased interest age group. In October 2020, we contributed to the with the College again. One of the programme’s in the work of pathologists and clinical scientists, online launch event of an initiative called Young coordinators, Shauna Dillane, said: ‘It was a we launched a social media campaign, ‘#Career- Gifted and STEM. The free event was aimed at fantastic webinar. Thank you so much for all of the Path’, to engage school students, undergraduates young black and ethnic minority men and women, work that you put into organising it. It was so inter- and Foundation doctors. aged 11–18, and involved learning activities, esting that we wanted to make sure you were able Using our existing and extensive range of careers talks and workshops. to cover all of the content, which is why we decided careers profiles, videos and images, we posted In one session, RCPath haematology trainee to let things run and cut the Q&A slightly short.’ Owing to safeguarding requirements, school content about all 17 of the pathology specialties Funmi Oyesanya’s interactive workshop explored The pathologists and medical students involved students were not visible or able to speak directly to on the RCPath Twitter and Facebook accounts how blood disorders such as sickle cell, acute also enjoyed the experience. One student said: ‘It Thadcha Retneswaran the presenters during the workshop. However, they about three times a week. Since the start of October leukaemia and malaria are diagnosed. Funmi was really interesting to think about organ dona- could interact with the speakers via online polls and 2020, we have focused on sharing careers-related showcased her passion for haematology and tion and who I would be willing to donate an organ Zoom’s Q&A function. posts and stories on Instagram, as around 70% of pointed out the many careers options available to. I also learnt lots about pathology, an area of Professor Mark Wilkinson, now a retired Instagram users are aged 13–34. within pathology. The feedback from attendees medicine I didn’t know much about.’ histopathology Fellow and the creator of ‘Your As well as repurposing existing careers content was extremely positive, with a number of them Following the success of this event, Professor Body, Your Consent’, led the online workshop. for Instagram, we have also worked with RCPath describing Funmi’s presentation as a highlight. Wilkinson was invited to lead a session on He introduced the students to the history of members to produce ‘selfie videos’ about their study skills with new medical students. He used medical ethics before presenting a fictionalised work and career path. In total, our careers pages Online careers talks pathology example questions to teach about inte- RETURN TO example of an ethical case involving someone RETURN TO received 91,519 unique visits from May to October In November and December 2020, we ran a series gration (a teaching method that places basic science CONTENTS with Huntington’s Disease. CONTENTS 2020. This includes visitors using a search engine of five online virtual careers talks for schools. Each

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Art of Pathology Competition 2020

gainst the backdrop of COVID-19, we invited adults and children to enter this year’s Art of Pathology competition and offer interpretations of the theme A ‘Pathology: at the heart of healthcare’. Here, we celebrate the winners. This year’s Art of Pathology judges had an incred- ibly difficult task on their hands. For the first time since its launch, the competition was opened to the international community. Of the 74 fantastic Kristen Pontello entries we received, 23 were from entrants outside Thadcha Retneswaran the UK, including the USA, India, Pakistan, Bangla- desh, Sri Lanka, Saudi Arabia and Zimbabwe. The entries we received reflected how vital pathology Above: Dr Funmi Oyesanya explored blood disorders and discussed pathology careers during her has been in global efforts to combat COVID-19. interactive workshop. Thank you to everyone who took the time to submit their artwork. We are also extremely Below: Young Gifted and STEM is an initiative to improve the experiences and engagement of black grateful to the judges, then Vice President for and ethnic minority young people with STEM subjects. Communications and International, Dr Rachael Liebmann, Clinical Director of Publishing and session involved three RCPath members individ- Foundation taster event Engagement. Dr Shubha Allard, and science-based ually giving a five-minute talk about their career As well as reaching students through our online artist Dr Lizzie Burns. path and work. The members involved had all careers engagement, the College events team also The competition will open again in Spring 11–17 category winner: Heroes by Johnny attended online public engagement training with ran the now-annual Foundation taster event. This 2021. In the meantime, why not try out our Ma Kwok (UK) a team from the Science Museum in October 2020. year, it was online, with the theme ‘Pathology new heart of healthcare art activities and virus Pathologists play a critical role in the world of The training helped participants think about through a COVID lens’. origami resources? healthcare. From diagnosing patients and admin- how to appeal to a teenage audience and use online Around 180 attendees, including Founda- istering treatment to developing medicines for tools to add interactivity to a virtual event where the tion doctors and medical students, joined the disease prevention, they play a pivotal role in the audience could not be seen. Students and teachers event, which consisted of Q&A panel discussions heart of healthcare. Dive down into the micro- from around the UK and beyond tuned into the with RCPath members working across a range of scopic realm, explore the undiscovered and who sessions. The feedback was extremely positive, with specialty areas. Attendees were sent videos of pres- knows what you’ll find. More importantly, who is one attendee remarking: ‘It was a really good event. entations by each of the panellists in advance so this pathologist? Could it be you? As a side note, I learnt how interesting a career in pathology is, and they could ask each speaker questions at the event the pathologist in the digital art has no face because the paths taken to achieve the career.’ (see also pages 254–256). the identity remains unknown –it can be anyone. This year, we will continue to build on engaging relevant audiences with messages about the career opportunities on offer in pathology – and we’re keen to involve as many members as we can. If you’d like to create your own ‘careers selfie video’ for us to use on social media, please get in touch at [email protected].

Penny Fletcher Public Engagement Manager

Thadcha Retneswaran Communications Officer Under 11 category winner: Pathology to the rescue in a sea of uncertainty by Ava Pundole Tamara Obeng-Korang (Pune, India) Senior Digital Officerr Over 18 category winner: The Heart of the Matter by Max Butler (UK) The ship called Pathology helps doctors, surgeons Through diagnostic testing and the development and other healthcare professionals to navigate the Kristen Pontello of potential treatments and vaccines, pathologists rough and predatory seas of healthcare. The sharks Senior Events Officer have been central in the fight against COVID-19. represent sickness and disease. The boat also has a A pathologist’s insights can have far-reaching microscope to represents the ship’s wheel, which is consequences – from shaping national guidelines, to used to navigate the seas safely. transforming patient care. In this challenging time, RETURN TO RETURN TO it has been particularly clear: pathology is at the Thadcha Retneswaran CONTENTS CONTENTS heart of healthcare. Communications Officer

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INTERNATIONAL This year’s roundtable discussion explored the importance of international Infection through the lens of information exchange. Clockwise: Professor COVID-19: an international viewpoint Tahir Pillay, Evangelos Kotsopoulos, Dr Pikka Jokelainen, Dr Josh his year, International Pathology Day went online. Kelley Price reports on four Wright, Professor fascinating COVID-related presentations, a thought-provoking roundtable Jo Martin and Tdiscussion on international knowledge sharing and the digital poster competition. Professor Ali Hajeer. On 11 November 2020, we held our annual ‘My aim as President will be to develop these of SARS-CoV-2 antibodies and the effect this digital poster competition, judged by Dr Mike International Pathology Day (IPD) and for the first international links and collaborations even phenomenon has on herd immunity and the impli- Osborn, Professor Jo Martin and Dr Shubha Allard. time in its history IPD went virtual. Fittingly, the further,’ Dr Osborn said. ‘We can develop the tech- cations for proposed immunity passport systems. Congratulations to the following winners: Kelley Price He also explored the use of serology in coronavirus theme for 2020’s event was ‘Infection through the niques we have learned through the COVID-19 • first prize – awarded to Professor Dimitris infections. lens of COVID-19 with an international viewpoint’. pandemic and make that vital knowledge available Grammatopoulos The Pathologist and sponsor Sonic Healthcare UK online to our members around the world.' • second prize – Nithin Krishnan A South African perspective collaborated with us for another year. We were also ‘In this way, we all benefit from the expertise • joint third prize – Cangul Seran, Vuyelwa The first two talks dovetailed nicely into ‘The pleased to have a newcomer to our alliances, The and inspirational teachings of our members and Nkomo, Mohammed Islam, Lisa Choo and South African perspective on COVID-19: devel- British Society for Haematology (BSH). colleagues, no matter where they are in the world. Anisa Hussain. Professor Jo Martin, Immediate Past Presi- The technology is already available, and we already oping new diagnostic approaches’, by Professor dent, welcomed an audience that spanned nearly share the spirit of cooperation, as today and other Tahir Pillay, Professor and Chair, Department of The competition was sponsored by Sonic every continent, College members, and our event events demonstrate.’ Chemical Pathology and Head of Pathology, the Healthcare UK. collaborators and sponsor. Professor Martin University of Pretoria. acknowledged how, globally, it had been a tough Distinguished speakers Professor Pillay outlined measures taken by Roundtable discussion year, stating that she could not have been prouder The virtual floor was then passed, in turn, to highly the South African government, the challenges The time then came for mediator, Professor Tahir of the way College members around the world distinguished speakers from Germany, Saudi for pathology and laboratory medicine, and three Pillay, and panellists Professor Jo Martin, Evan- have risen to the challenges of COVID-19. Arabia, South Africa, Denmark and the UK, who prongs of COVID testing. He also touched on the gelos Kotsopoulos, Professor Ali Hajeer, Dr Pikka delivered a highly varied range of presentations. potential role for rapid antigen testing and the Jokelainen and Dr Josh Wright, Consultant Haema- The brochure for role of nanobodies. As the professor described tologist at Sheffield Teaching Hospitals and Vice the 2020 virtual Saving the Bundesliga it, ‘the evolving South African response to the President for BSH, to take to the roundtable. International Evangelos Kotsopoulos, CEO for Sonic Healthcare pandemic has been like trying to build a ship The roundtable was a multifaceted discussion Pathology Day Germany and Continental Europe, opened the while sailing in it.’ on the importance of international information conference. presentations and shared some insights about how exchange – especially in a pandemic – and how early COVID-19 testing contributed to a robust Endemic pathogens and international research screening, diagnosis, treatment selection and pandemic response in Germany. The final talk, from Dr Martha Betson, the Univer- health monitoring differ between countries. Along the way, this saved the professional sity of Surrey School of Veterinary Medicine, UK, Against the backdrop of COVID-19, it was agreed association football league, the Bundesliga, which and Dr Pikka Jokelainen, Statens Serum Institut, that it has become more important than ever not on 16 May 2020 became the first professional Denmark, delivered something a bit different – to place boundaries on our ability to learn from sports league in the western world to resume play. ‘Endemic pathogens and international research one another. Over a six-week period, a task force estab- projects during a pandemic: Toxoplasma gondii and A special musical tribute to pathology staff and lished an extremely meticulous hygiene and international research project TOXOSOURCES as healthcare workers worldwide ended a fantastic testing concept. This covered detailed testing and an example’. day on a lovely note, as singer-songwriter Rod escalation protocols, as well as personal behav- Toxoplasma gondii was described as a beautiful Gozzett performed a cover of the Stereophonics’ iour guidelines for 1,400 people – players, coaches and fascinating parasite that deserves respect as a ‘Maybe Tomorrow’. and support staff – including rules on contact successful pathogen. The presentation covered the while travelling. parasite’s life cycle, the impact of COVID-19 on its Catch up with what you missed or view again transmission, and its effects on humans and animals. All four IPD 2020 talks and the roundtable discus- Serology testing The speakers then shared details of sion are available to watch on demand. You can Professor Ali Hajeer, Laboratory Director, King ‘TOXOSOURCES – Toxoplasma gondii sources quan- also enjoy the splendid IPD digital poster competi- Abdulaziz Medical City, Saudi Arabia, took us on tified’, a joint research project of the One Health tion entries on the College website. Future vision a fascinating journey into serology testing for European Joint Programme involving 37 organisa- Huge appreciation goes out to everyone who Speaking for the first time at IPD in his role as MERS-CoV and SARS-CoV-2 infections. tions and 19 countries. supported IPD 2020. We look forward to cele- President-Elect, Dr Mike Osborn spoke of the Coronaviruses are enveloped, single-stranded brating the day with you again in November 2021. College’s strong history of collaboration with other RNA viruses, and Professor Hajeer described how Competition winners RETURN TO countries and institutions worldwide, and went on antibodies to MERS and SARS-CoV-2 decline RETURN TO Excitement stirred after lunch as Dr Rachael Kelley Price CONTENTS to outline his vision for the College. over time. He went on to explain the rapid decay CONTENTS Liebmann OBE revealed the winners of the IPD International Projects Officer

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How have your colleagues, family and friends TRAINING reacted to your decision to become a pathologist? A few colleagues have told me that they would not have considered histopathology as a career option. From Summer School to I find this disappointing but I think there is a need for pathologists to better ‘market’ their speciality histopathology trainee to trainees, who seem largely to look to medicine, surgery and general practice as careers. There is clearly a lack of understanding around r Annie Kret attended the first Pathology Summer School in 2014. Now a the roles and value of pathology, since on a number histopathology trainee in Sheffield, she tells Dr Suzy Lishman how that of occasions senior colleagues have told me that decision influenced her career choice and what she has been doing since. my talent will be wasted looking at slides. D When I told my parents I want to be a histo- How did attending the Pathology Summer How did you maintain your interest pathologist, my mum cracked an obligatory ‘over School influence your choice of specialty? in histopathology during training? my dead body’ joke. My biggest supporter is my Being an avid lover of crime novels, I was certainly There are so many opportunities during medical partner, who has never seen me happier coming Dr Annie Kret interested in forensic pathology. However, school to try something new and my advice is to home from work than during my taster week. attending the breakout sessions at the Pathology say ‘yes’ to these opportunities. The skills you learn Summer School helped me realise that my heart lies are transferrable and add to your CV. How has COVID-19 affected your training with histopathology. I was keen to get involved in histopathology this year? I enjoyed the opportunity to have a light- and one of the lecturers helped me find a project I came into histopathology straight from Founda- hearted chat during the breaks. I remember how at the local histopathology department that intro- tion Year 2. The pandemic reduced the number of Dr Nicki Cohen would tell us jokes and I thought, duced me to research. This also put me in contact workplace assessments required for the Annual ‘Wow, they are just like normal people!’ with other histopathologists who were happy to Review of Competency Progression, which The talks were very useful and demonstrated take on a mentorship role. allowed me to focus on treating patients rather the innovative side of pathology. It was helpful Professor Peter Johnston was incredibly The excitement of training comes in new than stressing about completing the forms. for speakers to share experiences around their supportive, helping me with an audit and then ‘firsts’ – the first correct specimen dissection, During my last rotation, because of the impact an application to present our poster at the Patho- diagnosis, autopsy and more. of COVID-19, we saw the transition from paper logical Society winter meeting. I did my elective Dr Kret sees a to electronic records and the introduction of self- in histopathology and was fortunate to receive clear need rostering, which were big improvements for the the Pathological Society Undergraduate Elective What interactions did you have with for pathologists local junior doctors. bursary, which helped offset the cost of fees. histopathology during your training? to better ‘market’ From an ST1 perspective, unfortunately, I enjoyed going to multidisciplinary team meet- their specialty COVID-19 has had a big impact on learning and Did you share your interest in pathology ings and seeing how valuable the contributions to trainees. training. This year, because the Bristol teaching with fellow students and trainees? of pathologists and radiologists are to patient week was virtual, we missed out on the opportu- Attending the Pathology Summer School inspired management. nity to meet other ST1s. Also, with the need for me to form an undergraduate pathology and radi- As a Foundation Doctor, I took the opportunity social distancing and more staff working from ology society called DiagnostiX with a fellow student to spend my taster week in the local histopathology home, consultants are less likely to drop by with at my medical school, as we felt these specialties department. Following previous placements as an impromptu interesting case. were under-represented in the curriculum. a medical student, this experience reinforced On a positive note, since the introduction of DiagnostiX focused on organising educa- my interest in this specialty as a career pathway. Microsoft Teams, the quality of online teaching tional events and talks for students. The local It also gave me a great opportunity to gather has greatly improved. histopathology department held an annual virtual the views of trainees and some helpful tips for autopsy event for the students, inspired by Dr Suzy the specialty (histopathology) recruitment and How do you relax? Lishman’s demonstration during the Summer selection interview. Work–life balance is very important for me. School. We used these events to encourage students Putting on my running shoes and an upbeat to attend a real autopsy – something that many How are you enjoying histopathology playlist really helps me to switch off from work. students wanted to do but did not know how to go training so far? Since I started my histopathology training, I am about organising. Coming from the Foundation Programme into conscious of how much time I spend sitting at DiagnostiX also helped to bring pathologists histopathology was a big change. There are fewer my desk, so I now aim to do yoga or stretching closer to students. We organised careers events to trainees and the interactions feel more personal. exercises every day. demonstrate that pathology is not just something I greatly value the one-to-one teaching with you learn for your finals, but is an attractive career consultants. Interview by Dr Suzy Lishman with option. We were keen to get involved in National The learning curve is steep and can, at times, Dr Annie Kret training pathways and how they were able to adapt Pathology Week (NPW), so I reached out to feel overwhelming, but the ST1 curriculum helps Histopathology Trainee Scotland’s public engagement representative, to keep things in perspective. I enjoy experiencing their jobs. Particular examples included options to Sheffield Teaching Hospitals Dr Kevin Deans, who was very supportive. Our the excitement of new ‘firsts’ – the first correct have patient contact by running fine needle aspira- NHS Foundation Trust RETURN TO tion clinics or not performing autopsies in the long yearly NPW public engagement events at the local RETURN TO specimen dissection, the first autopsy, the first CONTENTS term, if they preferred not to do so. science centre were a great success. CONTENTS correct diagnosis, and so on.

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confidently state a cause of death. While it’s direction from my previously considered route of A matter of life and death: redeploying usually easy to obtain one, it can feel incredibly paediatric dentistry). intimidating to fill in the death certificate of I honestly believe that every junior doctor a patient you didn’t even see. It is therefore should spend at least a week in the hospital to the mortuary during COVID-19 understandable that, despite the changes in regu- mortuary, and not merely shadowing or watching lations, many doctors, junior doctors in particular, the post mortems, but taking care of the patients so r India Spiers-Laborde, a trainee in maxillofacial surgery, provides a personal are reluctant to undertake this duty. as to understand the physical and emotional strain and emotional account of her time redeployed to a mortuary during the first Just as with everything else in life, commu- that comes with caring for them. nication, empathy and consideration are vital to If there is one fundamental message I wish to wave of the pandemic. D forming a cohesive working relationship between impart, it is that our duty of care doesn’t end when I qualified as a dentist in 2018 and, after a year those who tend to the living and those who tend to the patients die; it is the care and respect with which in practice, I realised I was interested in more the dead. I hope that, in some way, I have managed we treat our dead that gives us our humanity. hospital-based dentistry. So, I went into maxillofa- to bridge the gap and allow for a little more This month has humbled me. It has given me Dr India Spiers-Laborde cial surgery as a trainee and was greatly enjoying it understanding between the two. nightmares and life-long connections to people – I was learning so much and thriving on the high I would never otherwise have met. Above all, I have intensity of the role. Humility and humanity learned resilience, humanity and a deep respect Then, in May 2020, it all came to a sudden halt. I am in a rather introspective mood following for those who devotedly and unflinchingly tend Plans for redeployment in our department during my time in the mortuary, and it is no exagger- to our dead. our now non-existent elective rotation went ation when I say that this redeployment has largely unrealised, so I arranged a placement in changed my life. I once again seriously considered The author dedicates this article to the incredible staff the hospital mortuary. I hoped, given my forensic studying medicine, not for maxfax but for at the Hull Royal Infirmary mortuary and pathology training with an MSC in Forensic Anthropology, pathology. I think reason won out in the end, department, and to NHS colleagues across the country that I might be of help. although I was deeply torn. Pursuing the rather tirelessly fighting COVID-19. convenient compromise of oral pathology is A steep learning curve eminently more sensible, and I have been lucky Dr India Speirs-Laborde The mortuary management and staff were very enough to secure a DCT2 training post in oral DCT2 Oral Pathology and Oral Medicine accommodating and one of the pathologists took pathology for the coming year (entirely changing Sheffield Teaching Hospital me under his wing, with many afternoons spent helping with cut-ups and specimen selection for Dr Spiers-Laborde’s parting glimpse of Hull Royal histology. He also started letting me actively partici- Infirmary, as she finishes her last shift. pate in dissections during his post-mortem sessions. It was certainly a steep learning curve. My knowledge of general anatomy has sky-rocketed. I feel that there is a need to recognise more widely Everything from the neck down is no longer as that this poses challenges for mortuary staff who, in much of a mystery. I can now recognise myocardial turn, are undertaking physically and emotionally infarction and coronary artery disease, and find the demanding jobs and, like many other healthcare pancreas on demand. staff, placing themselves at risk not only during the In return for the excellent training oppor- pandemic, but also in their day-to-day work. tunity, I spent the mornings working for the For example, contracting tuberculosis is a mortuary. I had a range of duties. First, I helped the risk for mortuary staff. They are of course also technicians clean down the post-mortem room attempting to support grieving family members after a session. I also assisted in tending to the where delays in producing the necessary paper- patients – moving them, cleaning them, receiving work adds to further distress. them from the community and releasing them to funeral directors. Impact of COVID-19 Then, I had to disinfect areas of high traffic, During the COVID-19 pandemic, it became increas- travel to the various wards throughout the hospital ingly difficult to keep up with the changes, often to chase up death certificates and cremation forms, daily, to regulations, guidelines and policy. This and attend to administrative tasks. information dissonance can understandably result in confusion and uncertainty as to what can and Death certificates delayed can’t be done. One of my duties involved obtaining the required Previously, only a doctor who was directly paperwork from doctors. The mortuary manager responsible for the clinical care of the patient was told me that their death certificate turnover rate able to complete a death certificate. The COVID-19 had increased by approximately 40% following regulations stated that essentially anyone at my efforts. This led me to the uncomfortable all with a GMC number could complete this, realisation that in busy clinical wards there were regardless of whether or not they had seen or often delays in prioritising completion of death treated the patient. RETURN TO certificates and I was more likely to be able to obtain The caveat is that we need access to detailed RETURN TO CONTENTS the paperwork than my mortuary colleagues. information about the patient in order to CONTENTS

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cases, for the rapid genome-sequencing service and WORKING SMARTER on updating our local policies to reflect this guid- ance in a continuously evolving situation. We are in continuous contact with the national and regional coordinating testing teams for support A district general hospital’s robust in guiding us to laboratories that can accommo- date our non-urgent testing, such as for elective response to the COVID-19 pandemic procedures and most of the staff testing. We have regular virtual catch-up meetings, in compliance with social distancing requirements, to rofessor Jo Martin visited West Hertfordshire Hospitals Microbiology Laboratory update one another and provide feedback from the Service on 14 October 2020 and spoke to RCPath Excellence Award winner various meetings that we all attend during the week. Dr Prema Seetul-Singh about rising to the challenges of COVID-19. P What are the biggest challenges you have The Microbiology Laboratory providing a service to Specialist Commissioning groups, NHS Emergency, faced as a service during the pandemic? the West Hertfordshire Hospitals reacted promptly Preparedness Resilience and Response leads, and As with every department in the country, the to the need for increased rapid in-house testing for High Consequence Infectious Diseases (HCID) unit biggest challenge has been the need to respond Dr Prema Seetul-Singh SARS-CoV-2. Processing around 250 samples a day (at leads, dialling in to teleconferences and webinars. rapidly to a continuously evolving environment. Professor Jo Martin, testing for SARS-CoV-2. Samples are taken from the time of writing, in November 2020), it achieved a The primary focus from the start was on imple- The scientific evidence that underpins all our Dr Prema Seetul- patients with symptoms suggestive of COVID- less than 24-hour turnaround, becoming one of the menting a SARS-CoV-2 PCR service for our Trust to initiatives was also lacking at times, as this was a Singh, Arezou 19, as well as from asymptomatic patients as few UK district general hospitals able to ramp up provide a turnaround time in under 24 hours. new virus. Fanaie, Laboratory per the National Testing Strategy and guidance. testing capacity at this point of the pandemic. The shortage of reagents for testing made it Manager, and Hala Samples commonly taken are nose and throat or SARS-CoV-2 testing very challenging, but we worked with our national Kandil, Consultant nasopharyngeal swabs. We have designed a demon- How did you set up your COVID-19 At the start of the COVID-19 pandemic, we did and regional coordinating testing teams to try and Microbiologist. stration video on sampling to optimise sampling response group? not have in-house technology to provide routine ensure a stable allocation. When demand exceeded techniques. Professor Jo Martin, At the start of the pandemic, a Commanding team testing for SARS-CoV-2. As per the National Testing capacity, other laboratories such as PHE laborato- The swabs are booked on our system via the former RCPath framework was set up. It consisted of: a Tactical Strategy at the beginning of the pandemic, we relied ries and hub laboratories within and outside the clinical order entry and then followed through president, and Commander who was the Head of Emergency solely on forwarding our samples to our regional region or network supported us. the testing process. They are initially processed Dr Prema Seetul- Planning, Preparedness and Resilience, a Medical PHE laboratories in London and Cambridge. under a containment level 2 safety cabinet before Singh, Clinical Lead, Commander; myself as Infection Control Doctor; However, as the pandemic escalated, it became Is there anything that you think is particularly being loaded into the individual analysers. These in front of the and a Strategic Commander shared by the Chief clear that we needed to offer provision for routine unique to your microbiology service/ analysers automate and integrate sample prepa- high-throughput Nurse and Director of Infection Prevention and in-house testing with faster turnaround times to laboratory? ration, nucleic acid extraction, and amplification PCR analyser. Control, and the Chief Operating Officer. expedite clinical care of high-priority patients, We have a highly motivated team that has a ‘can do’ and detection of the target sequences using real- and to ensure good infection-control manage- attitude, is very adaptable and rises to challenges. time Reverse Transcriptase PCR (RT-PCR) assays ment. We reviewed what we could deliver in Our quality processes, which are well embedded in in disposable cartridges that hold the RT-PCR terms of in-house testing capacity, identified the practice and have been praised by UKAS assessors reagents and host the RT-PCR process. high-priority groups after discussion with our clin- during their visits, ensure a good quality manage- We had to implement new technology using ical colleagues, and designed a new microbiology ment culture. new equipment, setting up the right IT interface, request form to facilitate this process. Our team is keen to progress, and we share recruiting the staff needed, organising the required Initially, we did not have the space or facili- common goals and objectives. We are very accom- training sessions and embedding the process ties within the laboratory for molecular testing. modating to demands put upon us, and go the extra within a Quality Management System. However, we were able to identify rapidly two mile to react to those pressures and put patient care We have been able to achieve a turnaround possible options: one room that had been initially at the centre of everything that we do. time of less than 24 hours from the time the swab identified to accommodate a Viper analyser At the end of the visit and laboratory tour, is collected and received in the laboratory. for qualitative detection of chlamydia and GC Professor Jo Martin said: ‘It was a delight to meet targets (CT/GC NAAT); and two adjacent rooms the team and to see what stunning work they are How do you work with other clinical colleagues functioning as offices, refurbished and made fit doing. You seem such a happy team with great and teams to manage the pandemic? for purpose for PCR testing. We are grateful to our leadership.’ We feel we are ready to cope with the As the Clinical Lead, I am part of various COVID pathology colleagues for agreeing to grant us use of next phase of the pandemic. groups and panels, including a Clinical Advisory these facilities. Group and Decision Panel chaired by the Medical We rose to the challenge of rapidly implementing Acknowledgments Director, the daily (and then weekly) Incident local PCR tests for SARS-CoV-2, and introduced an We are grateful to our Executive team, the Division Management Team meetings, and other COVID- extended hours service, followed by a 24/7 service of Clinical Support, Pathology Colleagues and the This response group planned and coordinated related task and finish groups. after recruiting the required number of scientists. Emergency Planning and Resilience Department for the Trust’s response to COVID-19 and shared the These ensure proper engagement with Clinical, their support. latest intelligence from regional, national and Infection Control, Management and Emergency How do you test for SARS-CoV-2, what international perspectives through local daily Planning and Resilience Teams to ensure that techniques and equipment are used, and Interview by Professor Jo Martin with Incident Management Group meetings. appropriate measures are implemented to prevent how long does this take? Dr Prema Seetul-Singh, Consultant The Commanding officers also liaised with further spread of infection. We now have two molecular laboratories within Microbiologist, Clinical Lead, Infection RETURN TO national organisations such as NHS England/ RETURN TO We also liaise with PHE and the local Health our laboratory service able to perform molecular Control Doctor, Watford General Hospital CONTENTS Improvement, Public Health England (PHE), CONTENTS Protection Team to seek their input on complex

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CLINICAL EFFECTIVENESS Table 1: Results of the audit. No Standard Audit cycle results Audit cycle results Improvement (cycle 1: 2018) (cycle 2: 2019−2020)

Re-auditing the use of the 1. 100% of patients had a documented CURB-65 0/9 (0%) 2/7 (29%) Up CURB-65 score assessment when a diagnosis of CAP was made at presentation to hospital Background • 100% of patients had a documented CURB-65 Legionnaires’ disease is a severe pneumonia caused assessment when a diagnosis of CAP was 2 100% of patients with by several species of Legionella bacterium, most made at presentation to hospital CAP received any 9/9 (100%) 7/7(100%) Same commonly Legionella pneumophila, and is reported to • 100% of patients with CAP received any antibiotic within four 1 have a mortality rate of about 7% in England in 2016. antibiotic within four hours of admission to hours of admission to The British Thoracic Society (BTS) and NICE hospital hospital produced guidelines for the management of • 100% of patients with CAP received an anti- community-acquired pneumonia (CAP) in 2009 biotic active against Legionella (macrolide or a 3 100% of patients 2, 3 and 2014, respectively. The BTS provides specific quinolone) within four hours of admission to with CAP received an 4/6 (67%) 3/3 100% Up advice for the management of Legionnaires’ hospital if the CURB-65 score was ≥2. antibiotic active against disease. The recommendations relating to anti- Legionella (macrolide or microbial management are included in the Trust Method a quinolone) within four pneumonia antibiotic guidelines. The Laboratory Information System was interro- hours of admission to In 2018, an audit of use of the CURB-65 score gated using Qlikview analytics software to identify hospital if CURB-65 score in patients diagnosed with Legionella infec- all positive Legionella urine antigen test or sputum was ≥2 tion at Cambridge University Hospitals (CUH) cultures. There were seven patients with a labora- showed poor compliance with documentation tory-confirmed diagnosis of Legionnaires’ disease. of the CURB-65 score for assessment of pneu- The clinical and laboratory notes were reviewed to Further observations Mortality monia severity. All patients received an antibiotic collect the following data: Patient population Three of seven patients died. They were either within four hours of presentation, although 67% Seven patients had a confirmed diagnosis of immunocompromised or had scores of ≥2. All of patients with a score of ≥2 received a macrolide • a diagnosis of CAP confirmed by the Legionella infection. One patient had a false-posi- received appropriate therapy within four hours of within four hours of admission. admission chest X-ray tive Legionella urinary antigen result and was admission. Further information about the patients The 2018 audit was presented to relevant • data to calculate the CURB-65 score on excluded from the analysis. The average age was 66 is given below. clinical teams to highlight use of the CURB-65 admission years (65 years in 2018). Infection was acquired in • An 80-year-old who travelled to France had a score in the management of CAP to ensure that • one point for each feature present: the UK in four (57%) of seven patients. CURB-65 score of 2 and received vancomycin patients with moderate to severe infection received – Confusion Of 1,269 samples received between 1 January and ciprofloxacin owing to penicillin allergy an antibiotic against Legionella. – Urea >7 mmol/l 2019 and 17 July 2020, 14 (1.1%) samples from six within two hours of admission. Epic, the hospital information system, automat- – Respiratory rate ≥30/min patients tested positive by Legionella urine antigen. • A kidney and pancreas transplant recipient ically reminds staff to calculate the score when the – Blood pressure (systolic blood pressure Diagnosis was made by respiratory PCR of bron- returned from Germany and had a CURB-65 CAP order-set is used, but this order-set was not <90 or diastolic blood pressure ≤60 mmHg) choalveolar lavage (BAL) fluid in one patient score of 1. They received tazocin/doxycycline always used by admitting clinical staff. We also – age ≥65 (L. longbeachae). All results were confirmed in the within two hours of admission. Ciprofloxacin explored using Epic to generate the CURB-65 score • evidence from case note reviews that the reference laboratory. for users, but this was not possible. CURB-65 score was calculated within four was started the day following admission, after the result of urine Legionella antigen. The importance of the use of molecular hours of admission CURB-65 assessment • An asthmatic patient, who visited the south diagnostics for non-Serotype 1 organisms, a gap • time from admission to receipt of the first Two patients had documented CURB-65 assess- of England for the weekend, had a CURB-65 in the diagnosis with Legionella urine antigen, was antibiotic active against Legionella infection. ments on the day of admission compared with no score of 4, and received tazocin/clarithro- also highlighted in the previous audit. PCR testing patients in the previous audit. Four (57%) of seven is now available for patients admitted with severe mycin within three hours. They were initially Results patients had mild to moderate CAP with scores <2. pneumonia to our critical care units. thought to have COVID-19 infection. The results of this audit are shown in Table 1 (see page 295). Antimicrobial treatment Re-audit: aims and objectives All patients received an antibiotic active against Conclusion The 2019–2020 re-audit was undertaken to deter- Commentary Legionnaires’ disease within four hours of admis- Legionnaires’ disease is of low incidence with mine whether there was any improvement in Compliance in two of three standards was 100%. sion, which was an improvement on the previous a high mortality in our patients. Seven patients documentation of CURB-65 score for management Table 1 shows the improvement in compliance audit (clarithromycin [five patients], ciproflox- were diagnosed with Legionnaires’ disease in 18 of pneumonia among patients subsequently diag- with audit standards relating to use of the CURB-65 acin [one patient], doxycycline [one patient]). Four months and three (43%) of seven patients died nosed with Legionnaires’ disease. Bullet point style score and receiving an antibiotic against Legionella patients, six patients and all patients received this during the admission. within four hours of admission. The numbers, within two hours, three hours and four hours, Overall, there was an improvement in audit Standards and criteria however, are small. respectively. Doxycycline is not the preferred anti- findings. The poor documentation of CURB-65 RETURN TO The following criteria and standards were set: RETURN TO CONTENTS CONTENTS biotic of choice, particularly in severe disease. scores did not impact on the time to initiate

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treatment with an agent against Legionnaires’ • No further audit of the use of CURB-65 disease: among patients with Legionnaires’ disease is recommended. PEOPLE • 29% documentation in CURB-65 score compared with 0% in 2018 • 100% of patients received an antibiotic active Action plan for 2019–2020 audit against Legionnaires’ disease within four Appreciation: Dr Edward Bernard Ilgren 1. It was agreed that Dr Jumoke Sule (JS) would hours compared with 66% of eligible patients disseminate the report to microbiologists and in 2018 Dr Edward Bernard Ilgren, an American toxicolo- present at the audit group meeting, • one patient received doxycycline to cover gist and neuropathologist known internationally and Dr Clare Sander (CS) would disseminate atypical infection on admission and was for his work on the human impacts of asbestos, died the report to respiratory clinicians, by changed to ciprofloxacin the following day Monday 18 May in a cycling accident in Arica, Chile, 30 September 2020. This was a medium when the diagnosis of Legionnaires’ disease where he was living. priority recommendation and was achieved was made. Ed was the author of two books and dozens of by the set date. technical articles in scientific journals. He held Clinical judgement is important when making 2. It was agreed that JS and Dr Theo Gouliouris academic positions at Oxford University and the diagnosis of pneumonia and ordering Legionella (TG) would present results to the antimicro- several other universities in the USA and abroad, tests. Four patients had CURB-65 scores <2, where bial stewardship group, to consider the and was an expert witness in many high-profile mortality risk is determined to be low. This findings while preparing an activity on CAP litigation cases. He was a Fellow of the Royal included a patient with a renal and pancreas trans- antimicrobial stewardship for the current College of Pathology and Diplomate of the Amer- plant who died during the admission. year, by 30 September 2020. This was a ican Board of Pathology. Ed was recognised by One patient had L. longbeachae diagnosed by PCR medium priority recommendation and was scientific bodies for major original contributions on BAL similar to the audit in 2018. This continues achieved by the set date. to oncology, neurology, embryology and compara- to highlight the importance of availability of PCR 3. It was recommended that no re-audit be tive pathology. for diagnosis of Legionella non-serotype 1 infections undertaken and that TG would review the He was an avid cyclist who rode wherever that are not detected by Legionella urine antigen. CURB-65 score as part of the CAP antimicrobial he travelled in the world. Even growing up, Ed The validity of CURB-65 scores in patients with stewardship by 23 July 2020. This was a medium insisted upon taking his bike on numerous family multiple comorbidities and immunosuppres- priority recommendation and was achieved Center, and was cited by proclamation for his help holidays. While attending Penn State, there were sion is not clear, and there is controversy among by the set date. by the City of New York. He provided commen- several occasions when Ed would ride his bike clinicians at CUH about its use in patients with tary on asbestos medical criteria in a report for the home in Wynnewood to surprise his family for a underlying morbidity, as seen at our hospital. This Fairness in Asbestos Injury Resolution Act at the Re-audit date home-cooked meal. may account for the poor uptake in use of the score. request of Senator Jon Kyl in 2003. As per the 2019–2020 action plan, no re-audit date Ed was born in Philadelphia, the son of Poor compliance with use of the score did not Beyond his specific professional interests, has been set. Dr Herbert and Maxine Ilgren. He attended Lower impact on the management of pneumonia during Ed applied his humanitarian nature to many Merion High School and Penn State University the current audit. medical and environmental problems, including References available on our website. and received his MD from Hahnemann Medical aflatoxins in food, smoking, prenatal risks from College in 1974. Afterwards, he served as a forensic Recommendations for improvement lithium in Bolivia, asbestos in firefighting, and Dr Jumoke Sule pathologist in the New York City Medical Examin- agricultural development in northern Chile. Most • Heightened awareness of Legionella infection er’s Office, before moving to Oxford to do cancer Consultant Microbiologist recently, he was working on COVID-19 risks and in patients who present with CAP, including research, receiving a D.Phil. in 1980. Clinical Microbiology and Public Health immunisations. patients with mild infection, is important Ed served as a pathologist to Her Majesty’s Laboratory, Public Health England Ed was a true Renaissance spirit from an older because of high mortality and public health Coroner for Oxfordshire, and was a member and gentler era. He had an incredible and detailed consequences. of the biochemistry faculty at Oxford Univer- Dr Clare Sander approach to medicine and life in general, and a • Further management of CAP will be under- sity. For the last 20 years, he also worked as an Consultant Acute Medicine and Respiratory talent for developing friendships that encircled taken by the antimicrobial stewardship group, independent consultant and expert on matters Medicine, Cambridge University Hospitals the globe. All who knew him delighted in his rare including monitoring of the use of CURB-65. related to complex environmental and toxic tort NHS Foundation Trust combination of intellectual purposefulness and litigation. He lectured worldwide and taught impulse to celebrate. He made residences vari- cellular pathology at the Sir William Dunn ously in Chile, England, Italy and Hawaii, but his School of Pathology at Oxford and the University home was always here in the Philadelphia area. of Chile. Ed is survived by his sisters, Barbara Ilgren Ed and Dr Kevin Browne were the first Russell (Cal) of Bonners Ferry, Idaho, and Nancy to publish on mesothelioma threshold and Ilgren Schluter (William) of Wilmington, DE, and continued to make contributions to the study of many nieces, nephews and cousins. In addition to his mesothelioma, conducting investigations on five parents, Ed is predeceased by his sister, Patty Kapp. continents. In a 2002 congressional investigation Owing to the COVID-19 pandemic, a memorial at the request of Congressman Jerrold Nadler, to remember Ed will be set at a later date. Ed established the health risks from exposure to asbestos, inorganic metals and various chemicals Mrs Nancy Ilgren Schluter resulting from the collapse of the World Trade RETURN TO RETURN TO CONTENTS CONTENTS

296 January 2021 Number 193 The Bulletin of the Royal College of Pathologists www.rcpath.org Number 193 January 2021 297 PEOPLE PEOPLE

Appreciation: Professor Ian Charles Talbot Anthony Nolan’s tireless mission

pathologist to the Leicestershire Health Authority, rofessor Antonio Pagliuca had long been an advocate of the work of the charity where he remained until 1988. In 1987, he was Anthony Nolan. When the role of Chief Medical and Scientific Advisor became promoted to Reader and was awarded the Fellow- vacant, he saw an opportunity to pursue a shared vision. ship of the Royal College of Pathologists (FRCPath) P in 1983. His work in Leicester included a large In 1971, when Anthony Nolan was born with a colleague, Professor Alejandro Madrigal, who had contribution to setting up the curriculum in rare blood disorder, Wiskott-Aldrich syndrome, his occupied the position for more than 25 years. With pathology for the new medical school. mother Shirley was told his only chance of survival my time split between Anthony Nolan and King’s, In 1988, he returned as a consultant histopathol- was through a stem cell transplant from a matching I’m rapidly learning new skills. ogist to St Mark’s Hospital, where he remained until unrelated donor. At the time, there was no system for Since the start of my career in transplantation his retirement from the NHS in 2004. He was part of Professor Antonio recording potential donors and no worldwide regis- in the 1980s, Anthony Nolan has been centre stage the recently established extramural Imperial Cancer Pagliuca ters to search. Nor had there yet been a successful in helping to find transplant matches (see Figure 1). Research Fund Cancer Unit at St Mark’s, where he stem cell transplant anywhere in the world. It has also been a leading light in stem cell trans- continued his research in collaboration with his That changed in 1973, when a young boy in the plantation research through the Anthony Nolan clinical colleagues into large bowel cancer, polyps UK named Simon Bostic received the world’s first Research Institute (ANRI). I have worked with the and polyposis syndromes, inflammatory bowel successful stem cell transplant from an unrelated charity on many levels and have been a regular disease and other aspects of colorectal disease. donor. This fired Shirley’s drive to try to save her proponent of its tireless work in the field. In 2018, Ian was author or co-author of over 230 peer- son. In 1974, she set up the world’s first register to I became an Anthony Nolan trustee. reviewed publications during his career. He was match stem cell donors with patients in desperate So, when the role of Chief Medical and Scien- co-editor of the 7th edition of the highly regarded need, and the name Anthony Nolan came tific Advisor at the charity opened up, I was text book, Walter and Israel’s General Pathology, to prominence. inspired to apply and pursue our shared vision published in 1996. With several other famous of improving outcomes for all patients needing a names in his specialist field, he co-authored the stem cell transplant. Professor Ian Talbot, who was born in Blackpool 4th edition of Morson and Dawson’s Gastrointes- in December 1939, died on 15 December 2019. tinal Pathology, published in 2003. The book Biopsy Navigating the differences The eldest of three siblings, Ian began his medical Pathology in Colorectal Disease, published in 1998 The immediate difference is one of size. King’s is a studies at Kings College, London, in 1959 and qual- in co-authorship with Professor Ashley Price and very large trust with more than 12,500 staff and a ified as a doctor in 1964. He decided on pathology Dr Manuel Salto-Tellez, was greatly influential. turnover of over a billion pounds. Anthony Nolan is as his specialty early in his career and became Ian served as adviser to various national bodies, clearly much smaller, but it has all the same func- Demonstrator in Pathology in the Medical School including the Medical Research Council, British tions and processes that I have managed as both a of King’s College Hospital from 1966 to 1968 and Medical Association, the Department of Health, Clinical and Medical Director. It also has a strong subsequently obtained a post as Registrar in the the Scottish Home and Health Department and research arm to support its service delivery arm. Department of Morbid Pathology at the Hammer- the University of Bristol. He was appointed to a Anthony Nolan provides stem cell products smith Hospital from 1968 to 1970. personal chair in pathology at Imperial College globally and, over a decade ago, created a cord blood He returned to King’s College Hospital in 1970 London in 1997. Greatly respected by gastrointes- bank that is now starting to develop in the field of as Senior Registrar and Lecturer in the Department tinal pathologists throughout the country, he was cell and gene therapy. The Anthony Nolan Cell of Morbid Anatomy. He became a Member of the often asked for his expert opinion and had a repu- and Gene Therapy Service aims to facilitate ethical Royal College of Pathologists (MRCPath) in 1971. tation for being right. research and development in the cell and gene ther- In 1974, Ian Talbot became a Research Fellow under Some years after he retired he developed a progres- apies sector to improve the quality of patients’ lives. Dr Basil Morson at St Mark’s Hospital, obtaining sive form of Parkinson’s disease, which gradually the degree of Doctor of Medicine in 1979. Figure 1: The Anthony Nolan Bone Marrow Register was rendered him unable to perform the simplest phys- A greater IMPACT Ian greatly added to knowledge around the Anthony Nolan’s established in Westminster Children’s Hospital, ical functions while his cognitive ability remained IMPACT is the major trials network advocating for significance of the spread of cancer to the venous strategy for increasing where Anthony was a patient. His story captured normal. He showed the greatest bravery throughout stem cell transplant patients and teams working system through the study of surgical resec- transplant success the imagination, inspiring many thousands to join this terrible ordeal. Ian had many interests outside here in the UK and abroad (see Figure 2). By tion specimens to demonstrate the prognostic includes research, the register. Sadly, Anthony died in 1979, aged just medicine, including art, music and classic cars. His providing the vital infrastructure that transplant importance of venous invasion in rectal cancer. funding trials and seven, while waiting for a donor to match. Today, kindness, combined with a delicate sense of humour centres need to work together, IMPACT will make Extramural venous invasion was associated with informing clinicians. the Anthony Nolan charity carries on, working and an ability to collaborate with others, made him a it easier and quicker to deliver clinical trials that reduced cancer-specific survival and to the pres- tirelessly to fulfil Shirley’s mission: to make sure tremendous colleague. He is survived by his wife Sue focus on improving stem cell transplant outcomes. ence of liver metastases. The recording of the that everyone who needs a stem cell transplant can and their son Andrew and his family. As a result of this UK-wide partnership, these presence or absence of ‘venous invasion’ entered find their best possible match. trials will reach a much larger patient population routine histopathological cancer reporting. R John Nicholls than would be possible at an individual trans- In 1975, Ian left St Mark’s to take up a Senior From trust to charity Emeritus Consultant Surgeon, plant centre. There are dedicated IMPACT research Lectureship in Pathology at the University of I started my new role with Anthony Nolan, as St Mark’s Hospital, Harrow nurses in nine centres, plus a further 13 affiliated Leicester and become an honorary consultant Chief Medical and Scientific Advisor, in October Professor of Colorectal Surgery, Imperial College 2020, after 26 years as a consultant haematolo- centres that also participate in clinical trials. gist and Professor of Stem Cell Transplantation at Anthony Nolan funds a proportion of IMPACT’s RETURN TO RETURN TO King’s College Hospital NHS Foundation Trust, work to deliver several clinical trials in the London. I follow in the footsteps of my esteemed stem cell transplant field (www.impactpartner- CONTENTS CONTENTS ship.org.uk).

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has been COVID-19, which has had a major impact on Anthony Nolan. The incredible complexity now Consultants: new appointment offers involved when shipping products internation- ally, and the resulting reduction in provisions, has The following appointments have been offered and are subject to acceptance by the applicants. The lists completely changed our bone marrow transplant are prepared by the College’s Workforce department, on the basis of returns completed by College asses- and cellular therapy practice. Transplant activity sors on consultant advisory appointment committees submitted by 23 October 2020. was dramatically reduced in the first half of 2020 . Please note, we receive no return following 20% of AACs. Any forms received after 23 October 2020 will The biggest impact, though, for the charity has be published in the next issue. If you do not take up your post, or have additional information, please inform been on fundraising for our core services. All the the Workforce department. Whenever you move home or job, please inform the Membership department. teams have put in a truly been truly heroic effort and we hope that funding will, in time, return to Haematology appointments fill the financial gap. Once we are better able to manage COVID-19, Region Employing body Base hospital Appointee I will focus on developing the clinical and research North West Clatterbridge Clatterbridge Dr Muhammad A Saif strategy that will ensure we continue to find the North West London London North West Across sites Dr Arunodaya Mohan best match for patients in need. Guy’s and St Thomas’ Guy’s Dr Sajitha We know that we need to do more to find a South London Figure 2: The aligned stem cell registry Sachchithanantham suitable donor for everyone, especially patients Anthony Nolan Anthony Nolan forms part of the UK’s aligned University Hospitals Derriford Dr Claire Lentaigne from minority ethnic backgrounds. We are South West Research Institute’s stem cell registry, with around 2 million donors Plymouth three aims include providing stem cells for more than 1,500 patients currently looking at HLA diversity on the Anthony Yorkshire and The Leeds St James’s Dr Chun H Teh researching what per annum. In the UK, 1,726 allogeneic procedures Nolan Register to influence donor recruitment Humberside makes the best match, were undertaken in 2019 and 18,500 across Europe. and enrichment strategies. One example of how we could do this is by locating our cord blood increasing survival Globally, more than a million patients have Histopathology and cytology appointments rates and reducing received this life-saving treatment, and Anthony collection sites at hospitals serving the most complications. Nolan has been key to this provision. Human diverse communities. Region Employing body Base hospital Appointee Another key priority is our Cell and Gene leukocyte antigen (HLA) and histocompatibility North Central and Royal Free Royal Free Dr Anuja P Pradhan Therapy Service. It will help to generate new treat- are a core service and research component. East London University College London University College London Dr Tanya S Alan There has been a 4–7% increase in activity ment options for patients, along with income for Imperial Imperial Dr Rana K H Asakra annually, with stem cell transplantation now the organisation in the difficult post-COVID-19 era. North West London being used in several non-malignant disorders, My aim is to ensure that Anthony Nolan, on its Imperial Imperial Dr Mufaddal T Moonim such as sickle cell disease.1 50th birthday, remains at the core of the stem cell Imperial Imperial Dr Anna M Silvanto Our vision is for all stem cell transplant recip- transplant community in the UK and globally, still Northern Ireland Belfast Royal Hospitals Dr Jennifer L Taylor serving today, as Shirley Nolan intended in 1974, ients not just to survive, but also to be free of South West North Bristol Southmead Dr Cornelia M Szecsei all patients in desperate need of a match. transplant-related complications. Currently, only Northern Devon North Devon Dr Adetope O Adegbayibi 2 half of our patients will still be alive five years West Midlands Worcestershire Across sites Dr Sherin Jos-Payyappilly after their transplant.3 Those who are often need References available on our website. to make dramatic lifestyle changes and adapt to a Medical microbiology, communicable disease control, virology and epidemiology appointments ‘new normal’ for many years into their recovery. Professor Antonio Pagliuca With the help of our supporters, we are creating Chief Medical and Scientific Advisor, Region Employing body Base hospital Appointee Anthony Nolan new treatments and have a better understanding East Midlands Nottingham Across sites Dr Katherine G Prescott of how to prevent these complications from Professor of Stem Cell Transplantation, University College London University College London Dr Sophia De Saram happening. This drives our ability to make sure King’s College Hospital NHS Foundation Trust North, Central and East University College London University College London Dr Trupti Patel everyone receives a successful stem cell transplant. London University College London University College London Dr Giovanni Satta University College London University College London Dr Neil R H Stone The first year’s greatest challenge North West Liverpool Royal Liverpool Dr Anna A Smielewska In my first year in this role, the greatest challenge, unsurprisingly, at both King’s and Anthony Nolan Wales Cwm Taf Morgannwg Across sites Dr Soma Gaur Public Health, Swansea Dr Ian A D Blyth Swansea Bay Bay Yorkshire and the Sheffield Teaching and Across trusts Dr Emma Boldock Humberside Sheffield Children’s

Deaths reported to Council Consultant clinical scientist appointments – clinical biochemistry Region Employing body Base hospital Appointee The deaths of the following Fellows were announced at the November 2020 Council meeting. We extend our condolences to those who grieve for them. North West Manchester Manchester Mrs Beverly Hird John Mackenzie Anderson, Dundee, UK Anand Edmund Prabhaka, Uxbridge, UK South London St George’s St George’s Miss Felicity J Stokes West Midlands University of the North University of the North Dr Christopher J Duff RETURN TO RETURN TO Midlands Midlands CONTENTS CONTENTS

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Margarita Constantina Kanwal Babar Niteeka Gurung Examination results Triantafillou Raluca Daniela Badea Sakar Hayder Marios Tsoutsoukis Saeed Bahabri Naoimh Herlihy Micky Tsui Gavin Baker Cassandra Hill Sobia Umar Niyatha Balakrishnan Siu Lun Ho Successful candidates for the Part 1 Examination Sona Vora Shailaja Balakumar Edward Samuel Hookway The following candidates have passed all components of the relevant Part 1 examination: Mairi Walker Madhurjya Barman Katie Hoyles Edmund Watson Michelle Basquill Ahmed Abdelalim Abdelrahman Clinical Biochemistry Haematology Shweta Gupta Philip Weir Archana Bommana Hussein Alana Burns Ahmed Abdulgawad Steven Hanson Charlotte Wilding Aaron Borbora Afaf Ibrahiem Rabia Chaudhry Manoja Dhammini Sophie Hazell Manujasri Wimalachandra Lucas Adam Brammar Adeyemi Idowu Hoi Ning Cheung Abhayawickrama Dinusha Chathurani Herath Julia Wolf Maria Brereton Shreeya Indulkar Rachel Claire Dale Maria Zahid Ahmed Mudiyanselage Yee Yee Yap Tiffany Buhagiar Javed Iqbal Samir Elgerray Ahmed Al-Hassani Richard Hinton Vivian Ka Pik Yeung Alexandra Cavanagh Jhansi J Danni Fan Rebecca Allam Kameta Imaeva Rashmi Chandrashekara Reddy John Jackson Roxanne Farnon Ahmed Youssef Mohamed Md Tawheedul Islam Haematology Clinical Science Debajyoti Chatterjee Pragya Jain Hannah Fearon Badawi Amer Megan Kell Nathan Kerr Dimple Chaudhary Supriya Jain Lakmini Ginige Daniel Angelov Naveeda Khaliq Lauren Jamieson Venkata Lakshmi Chavali Unaiza Jamil Moises Hernandez Hernandez Aisling Barrett Chloe Knott Daphne Shao Yi Chen-Maxwell Adil Jaulim Michelle Hookham Martin Best Ho Pui Jeff Lam Histocompatibility and Kevin Ka-Chun Cheung Nimmy John Lauren Hughes Sarah Bird Tze Shin Leong Immunogenetics Stephen Chew Nita Mary John Daniel Isemede Jessica Boot Christopher Chin Keong Liam Amy Sarah De'Ath Noel Yida Chia Lisa Johnston Anthony Jackson-Crawford Richard Buka Oliver Lomas Daniel Eggleston Natasha Cutmore Emily Joslin Lucille Kavanagh-Wright Wei Yee Chan Arunthethy Mahendrayogam Emily Halford Claire Deakin Lakshmi K Kia Langford-Smith Jillian Coll Wai Man Vivien Mak Kim McShane Daniele Mario Di Capua BIJI K A Chun Yiu LAW Emma Conway O'Brien Nasir Mir Emma Rowe Vanessa Djabatey Kalaranjini K.V Nicholas McArdle Catherine Cox Jayna Mistry Adam Palmer Douglas Nourdin Kadi Laura McNeil Brian Craven Smeera Nair Histopathology Lauren D'Sa Karasinghe Kankanamage Gavin Mercer-Smith Christina Crossette-Thambiah Andrew Nicholds Anubhav . Laura Dunbar Malinda Amesh Karasinghe Ewen Millar Naveenvairamoorthy Faiza Noor Zainab Abbas Rimlee Dutta Ansam kareem Thomas Glyn Morris Dakshinamoorthy Stella Jumoke Okikiolu Marwa Abdelhakim Thomas Benjamin Dytor Yash Karia Sabrina Mosaheb Dassanayake Mudiyanselag Omer Pervaiz Nazneen Abdul Kader Godwins Echejoh Jyothi Karikkanthra Lucy Murfitt Hansini Menaka Dassanayake Keir Pickard Rafat Abu Shakra Weam Eltoum Zahra Kasaei koopaei Jennifer Nobes David Davies Paul Player Charles Adetayo Adewole Felicity Sarah Elwin Roshen Preet Kaur Zain Odho Nicholas Denny Sahar Rabbani Noha Samy Ahmad Said Ola El-Zammar Manpreet Kaur Louise O'Donnell Jaymathi Dhanapal Zunaira Rafiq Azad Ahmed Uchenna Ezenkwa Gurwinder Kaur Oliver Rayner Dissanayake M U P Dissanayake Monica Ragheb Imran Ahmed Benjamin Livingston Farah Anna Keogh Eleanor Ringland Karunathilake Syed Ashar Rais Shakeel Akhtar Farah farah Graeme Kerr Leanne Sheppard Dearbhla Doherty Maya Raj Intisar Al Malki Sana Firdous Majd Bassam Khader Helen Valentine Ayesha Ejaz Nitha Ramachandran Iman Al yabary Louis Flood rizwan ullah khan Agatha van der Klaauw Anietie Ekong Kavita Ramlochan Sally Alabdulmohsen Tsun Fong Yusra Nayab Khan Dinesha Maduri Huda Elfakharany Alexandros Rampotas Fatima Al-Amri Al-walid Freih Fraih Nausheen Khan Vidanapathirana Sara Elhag Hanna Renshaw Violet Albert Natasha Frewer Manika Khare Katharine Whitehurst Michelle Escobedo-Cousin Caitlin Rice Ayman Abdulmajeed Aldeheshi Mogolodi Gabolwelwe Kgalalelo Koronale Ralph Wigley Astrid Etherington Srdan Rogosic Umnia Nafea Aldulaimy Gréta Galambosi Eman Kreishan Daniel Farrugia Eileen Ryan Rawa Muhsin Ali Katherine Gardner Brijesh Kumar Genetics Graeme Ferguson Malik Shahzad Saeed Duaa Aljarrah Jennifer Garry Shui Wun Lai Rachel Challis Amelia Fisher Jeremy Schofield Aysha Anwar Abdulla Aljawder Stella Garvie Hiu Yeung Lau James Eden Helen Fogarty T Seddon Luha Allawi Jyotsana Harit Gaur Ross Leaver Nicole Gossan David Foldes Srividhya Senthil Daniel Alan Allsop Divya George Hoi Ki Leung Lorraine Hartles-Spencer Katrina Fordwor Kartthik Shanmugam Zainab Almukhtar Sophia Merilyn George Yasmin Levene Catherine Emma Husher Tanya Freeman Sobia Sharif Dr.Sulaiman Al-Rushaidan Samirah Essam I. Ghandurah Adam Paul Levine Claire Kyle Ee Leng Gan Amir Shenouda Fatimah Alturkistani Sana Ghulam Nabi Cheuk Nam Ling Kathleen Murphy Elena Ganendra Caroline Shrubsole Sameer Abdul Hameed Ansari Apoorv Giri Appuhamy Mudiyanselage Savita Nutan Louise Garth Dean Smyth Sidra Arshad Imran Gorur (G M ,Gorur Shakthi Ama Liyadipita Evgenia Petrides Thamudika Pushpakumari Nelson Soong Boma Precious Athanasius Mohammed) Anandi Lobo Gavin Ryan Gonagala Vithanage Amrutha Sridhar Aribah Atiq Patricia Gou Jonathan Lye Angharad Williams Harshita Goradia Asma Tameez Ud Din Zeena Ayad Thomas Green Logaswari M Nicola Gray Yishi Tan Ebru Sebnem Ayva Raluca Grigorescu Kaushik Majumdar RETURN TO Amy Gudger Thomas Taylor RETURN TO Faiza Azam Garima Gupta Wardah Malik CONTENTS Benjamin John Gray CONTENTS

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Poonkodi Manohar Mariyam Shafi Oliver Bannister Lynne Ferguson Oral Pathology Joyce Mary Mathew Bhoomiben Abhishek Shah Li-An Brown Julie-Anne Houlihan Oluyori Kutulola Adegun James Matossian Kashmi Sharma Prasun Chakravorty Stephen Peter Kidd Stephen James Brown Mark McCabe Ritika Sharma Alan Cordey Chung Ho Lee Shashank Mishra Abigail Sharp Kate David Ramya Madhavan Reproductive Science Samiah Moalwi Stuart Sherlock Rhys John Davies Clare Moore Dima Abdo Hasrath Mohamadi Vrunda Sheth Kate El Bouzidi Niamh Mullane Sophie Bird Mujeeb Siddiqui Mohammed Morvarid Shirmohammadi Terry John Evans Subha Narasimhan Zoe Brame Abdul Kieran Shotton Hamzah Farooq Chukwuemeka Obiagwu Millie Kanani Bhavya P Mohan Rania Showeil Malick Gibani Chidi Onwukwe Onwukwe Anne Quinn Limi Mohandas Sabeehuddin Siddique Jennifer Goldblatt Sajeevan Rasanantham Lydia Ruddick Aml Mousa Ritika Singh Stephanie Harris Felicity Ryan Emma Tomes nee Whitney Tanushri Mukherjee Kritika Singh Yadav George Hills Yan Ling Shireen Tan Lucy Wood Sadaf Muzaffar Seema Singhal Sarah Jawad Kaniyappan Nambiyaw Ankita Singhania Catherine Jane Eleri Jones Molecular Pathology Veterinary Pathology Sarah Maire Ni Mhaolcatha Mukinkumar Sonai Gwennan Jones Baljinder Matharu Jelena Mraovic Mary Niven Supriya Srivastava Sarah Kennedy Claire McKeeve Roy Brett Wakefield Isma Noaman Parveen Tabassum Nuzhath Khan Paula Scott Ayesha Nusrat Balsam Tameemi Francesca Knapper Iryna Stasevich Veterinary Clinical Pathology Segun Samson Odetola Denise Tao Anastasia Kolyva Moushumi Suryavanshi Anne Aworinde Mosebolatan Olatokunboh Muhammad Usman Tariq Alexander May Guy Davies Odubanjo Dilek Taze Jamie McAllister Daniel Ong Ramesh Babu Telugu Rebecca McHugh Successful candidates for the Part 2 Examination Zun Pwint Oo Ben Templer Mark David McNicol The following candidates have passed all components of the relevant Part 2 examination: Manogna Das Oravakandy Ayeesha Sithika Thajudeen Charlotte Milne Nahla Osman Kate Tilley Thomas Morris Clinical Biochemistry Jahanzaib Khwaja Histopathology Sarah Page Shun Hin Ting Edward Moseley Alaa Abdelrazik Thinzar Ko Ko Engy Abdellatif Christos Panayi Zoe Tomaszewski Callum Peter Mutch Ashley Eve Garner Nicholas Lafferty Shraddha Arun Adamane Devasis Panda Sarah Toomey Nicholas Norton Laura Elaine Bernstone Prabal Mittal Gbadebo Aderinola Adeleke Vinita Pandey Chui San Zara Tsang Leah Schofield Owen Stephen Michael Gibbons Hana Mohamed Zahabia Ali Mayur Parkhi Daniel Turek Vinesh Patel Brian Tennant Kathryn Moss Iteeka Arora Julia Patterson Madhumitha Udayakumar Lara Payne Chin Loon Neoh Nathan Alex Asher Jocelyn Sara Paul Viren Laljibhai Vaghasiya Matthew Powell Genetics Phillip Lindsay Ross Nicolson Mohammed Basem Awadh Nikhila Paulose Sumedha Vats Vivien Price Kirsten McKay Bounford Musab Eltayeb Osman Omer Sheena Bajaj Asha Peedikayil Punnoose Sereen Wahballa Fauzia Rizwan Kate Orf Ali Ben-Mussa Nataliya Piletska Craig Wakefield Matthew Routledge Haematology Matthew Paul Player Daniel Anthony Brett Parvathi Pillai Tamsin Walford Penelope Sellers Sembukutti A S P Abeyrathna Paolo Polzella Rebecca Mary Brown Dane Pointing Elizabeth Walsh Avneet Shahi Samah Babiker Edward Poynton Elizabeth Beatrice Brown GAURI PRABHUSALGAONKAR Elizabeth Walsh Luke Snell Aadil Jalal Bachh Sinthiya Punnialingam Maria Lorena Stefania Buttice Priyanka Prakash Rachael Winstanley Shuchita Soni Muhammad Mansoor Baig Moosa Rashid Qureshi Catherine Connolly Ananda Julian Pulle Igor Starinskij Neil Barrett Iman Qureshi Kevin Culligan Ali Qibi Immunology Simon Stoneham Edward Blacker Prabina Rai Adam Dallmann Niranjani R William Bermingham Sathyavani Subbarao Adam Bond Amita Ranger Olusola Jumoke Daramola Preethi Rai Samuel Chee Clare Thakker Karen Boyd Haifaa Saadi Matthew Robert Di Capite Prajna Brijesh Rai Elizabeth Frances Cleave Benjamin Tomlinson Duncan L Brian Iram Saeed Victoria Jane Doyle Suman Rai Fionnuala Cox Oliver Toovey Stephanie Anne Bruce Vallari Shah Neelaveni V V K N Duhli Prabha Raj Sarah Denness Helen Umpleby Simon John Bulley Suthesh Sivapalaratnam Mary Ferrier Athulya Raj Anthony David Peter Dorr Rachel Wake Sarah Elizabeth Clarke Ahalyaa Sivashangar Kezia Lyndall Gaitskell Archana Rajan Hari Chandana Ghanta Joanna Walker James Croft Elizabeth Smyth Jonathan Gareze Madhu Rajeshwari S Jesmeen Maimaris Thomas Cummin Amit Sud Nichola Gaunt Alka Rana Hadeil Morsi Medical Microbiology & Kanchana De Abrew Rachel Trickey Richard David Griffiths B. Vishal Rao Karen Smith Virology Josh Dmochowski Stella Williams Robert Ivor William Harkness Claire Roberts Kavitha Sooriyakumar Aaisha AlBalushi Lauren Ellis Fionnuala Mary Hinds Tamara Said Sarah Spencer Patricia Alice Alcock Alison Gibson Histocompatibility and Daniel Hopkins Nancy Mohey Sadek Salama Thomas Wilding Mashahed Alkreebani Graeme Greenfield Immunogenetics Aneeta Jassar Abdulhadi Samman Rachel Barry Sudarshan Gurung Sandra Helen Lloyd Hadeel Jawad Premila Samuel Infection Nicola Boran Mohamed Habib Katherine Lillian Mounsey Dilbar Singh Johal Azmat Kaur Sandhu Esson Adobah Phillipa Burns Michelle Harrison Sana Khalid Sarah Sarah Sokolayam Atanze Priyanka Chaskar RETURN TO RETURN TO Samuel Harrison Rubia Farheen Khan Mohamed Sulaiman Seyed Omer Robert James Ball James Donnelly CONTENTS CONTENTS Claire Patricia Horgan Eimear Lee

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Mariam Masood Janine Warnick Hamed Mohamed Ashraf Hamed Successful candidates for the Certificate Examinations Lisa Mellerick Holly Rose White Ahmed Sharaf The following candidates have passed the Certificate in Higher Autopsy Training: Peter Molony Tadhg Michael Sullivan David John Mooney Immunology Jon Jurriaan van Aartsen Colin Samuel Alderson Suzanne Foster Megan Ramsey Ceri Morgan Sameer Bahal James Veater Shane Daniel Brennan Kathryn Griffin James Stevenson Veronica Patricia Moyo Evon Boules Jennifer Walsh Guy Alexander Conlon Hannah Hawrot Lisa Thompson Arunima Mukhopadhyay John Guly Karmel Webb Catherine Connolly Harry Haynes Deirdre Timlin Rebecca Elizabeth Mulholland Natasha Weston Aoife Margaret Doyle Katherine Humphris Rhona Thuillier Dorinda Mullen Medical Microbiology Neil Fennelly Darrell Martin Sarah Elizabeth Joan Mullins Zoie Alexandra Aiken Neuropathology Steven Nottley Noora Al Balushi Miren Aizpurua Gomez The following candidates have passed the Combined Infection Certificate Examination: Roisin O'Connor Omaima Mohamed Hamdan Al Kevin Kinch Andrew O'Keeffe Ismaili Annelies Quaegebeur Aleem Ahmed Christopher Mansbridge Marcello Scopazzini John Patrick O'Neill Maya Al-Salti Ed Birkhamshaw Jame McCrae Anika Singanayagam Sweta Patil Anjaneya Bapat Paediatric Pathology Farnaz Dave William Nevin Keira Skolimowska Richard Thomas Pilkington Melissa Baxter Delyth Angharad Badder Sarah Denny William Osborne Vino Srirathan Juliet Isobel Raine Ranajoy Sankar Bhattacharya Barbara Ciolka Nathan Jacobs Hannah Rickman Thomas Alexander Yates Simon Rajendran Mark Campbell Heather Louise Keir Drosos Karageorgopoulos Charlotte Richardson Prashant Ramteke Kal Cave William Simmons Oliver Lloyd Sakib Rokadiya Nadeeka Gerly Ranawaka Margaret Creedon Alice Elizabeth Richards Abhishek Das Reproductive Science The following candidates have passed the Certificate in Medical Genetics: Neil Alfred Robinson Ankush Dhariwal Helen Priddle Edward George Rogers Aaron Doherty Andrew Gordon Thomson Claire Forde Karen Mackenzie Joanna Keziah Round Louise Downs Elizabeth Harris Lara Menzies Caroline Imogen Russell Jenna Victoria Gillies Toxicology Eleanor Hay Oliver Murch Amany Said Ashley Horsley Adelaide Fimpong Farah Kanani Sarah Wedderburn Niall Scully Gareth Hughes Rashmi Shetty Anna Amrit Jarchow-MacDonald Virology Successful candidates for the Diploma Examinations Emma Louise Short Alex Kew Richard James Capstick The following candidates have passed the Diploma in Dermatopathology: Emma Spoor Nicholas Laundy Jennifer Hart John Alphonse Tadross Laura Veronica Lloyd Louise McCorry Eglantine Lebas Steven Tan Judi Lynch Anne Margaret Melhuish Priya Thomas Samira Mohd Afzal Thomas Rampling Silke Toy Peter Thomas Nelson Anna Alexandra Smielewska Sumiti Vanjani Anand Odedra

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306 January 2021 Number 193 The Bulletin of the Royal College of Pathologists www.rcpath.org Number 193 January 2021 307 REVIEWS

in liver pathology. The discussion of the genetic describes how much of his original text remains changes associated with liver tumours (chapter today. It strikes me that this philosophy, of keeping REVIEWS 11) is comprehensive without being overly what works and updating that which has changed, complicated. Indeed, where this book succeeds is is key to this book’s success. in the presentation of information in easy-to-use It will indeed be useful to all those who ‘inter- BOOK REVIEW Cytology: Diagnostic tables and algorithms, which will be appreci- pret liver biopsies’, whether trainees or specialists. Principles and Clinical Correlates ated by those revising for exams. However, those Uniquely for a histopathology textbook, those looking only for bullet points and lists will be clinicians who care for patients with liver disease By Edmund Cibas and Barabara Ducatman £149.99, 688 pp, hardback disappointed; this book is more similar to the will also find it to be an accessible and user-friendly Elsevier, 2020 ISBN: 978-0323-63636-0 lectures of a knowledgeable, yet kindly, scholar resource to be consulted as required. I will certainly This is the fifth of edition of the already popular allowing an excellent representation of nuclear and whose narrative style will appeal to some, and be recommending this book as a ‘must-buy’ for our cytology textbook by Edmund Cibas and Barbara cytoplasmic detail. The majority of the cytological likely frustrate others. trainee library. Ducatman. Cytology is an integral part of the images are of Papanicolaou- and Romanowsky- In the preface to this book, the author pays histopathology training curriculum and a topic that stained slides, both of which are often featured side homage to Professor Peter Scheuer, Professor of Dr Kathryn Griffin many trainees, like myself, struggle with. by side for a useful comparison. Pathology at the Royal Free Hospital and author Specialty Registrar/NIHR Clinical Lecturer To assist with understanding the complexities Another good feature of this book is the use of of the first edition of Liver Biopsy Interpretation, and Leeds Teaching Hospitals Trust of cytopathology, this book offers a logical and easy-to-read and bullet-point boxes throughout, comprehensive approach to the topic, dividing the which break up the text and allow a quick look-up text into chapters for each specimen site. It includes of the cytomorphology and differential diagnoses all the routine cytology specimens, such as thyroid, for each condition. BOOK REVIEW Artificial Intelligence cervical and respiratory tract fluids, and also covers Perhaps the only potential pitfall for UK-based and Deep Learning in Pathology some of the less commonly encountered speci- pathologists using this text is that this book is mens that you might not see in everyday practice, written by authors practising in the USA, so the By Stanley Cohen £74.99, 288 pp, paperback such as aspirates from bone and soft tissue. reporting terminology used may not always line Elsevier, 2020 ISBN: ISBN: 978-0323-67538-3 In each chapter, the common inflammatory, up with the reporting terminology recommended Artificial intelligence (AI) is being used in radi- The later chapters relate these techniques benign and malignant conditions are addressed in by the Royal College of Pathologists. ology in many ways. Now, with increasing use of to histopathology and go through some of the a systematic and structured manner. Many chap- Regardless of this caveat, I would highly digital pathology, histopathology is ripe for further issues specific to this. Problems with staining ters include an overview of the different sample recommend this book to all pathologists, espe- innovation. There are workforce shortages within and artefact, which the human mind has learnt types you might receive, give details of current cially those working towards the Part 2 exam. pathology, so AI-led pathology services could to ignore, would need complicated and ingenious molecular techniques and provide a thorough I believe it could be of educational value, whether potentially have tangible benefits to the patient. techniques to overcome. I found the chapter on description of what samples from normal tissue you choose to read the text cover to cover, or use In this book, Professor Cohen has collected whole slide imaging and deep learning particu- should look like. An additional chapter detailing it to flick through and look at some of the beauti- contributions from some of the foremost indi- larly useful, given the current transition to digital the practicalities of fine needle aspiration tech- fully presented images. viduals working with AI and pathology in the pathology. nique and specimen handling has also been added USA. They have identified an existing gap in the The ideas explored in the book are necessarily since the last edition. Dr Hannah Hawrot literature between overly basic explanations of complex and unfamiliar to many pathologists. In my opinion, the best feature of this textbook Histopathology Registrar AI for the layperson, and highly technical The contributors have made these accessible and is the number, size and quality of the images used, St James’s University Hospital, Leeds manuals. This book fills that gap and introduces AI reduced them to more understandable concepts, to pathologists. for example using the biological neuronal path- I began with minimal knowledge of software ways as analogies. and fading recollections of school mathematics. AI will influence and change innumerable BOOK REVIEW Scheuer’s Liver Biopsy Interpretation I therefore appreciated that the contributors professions and aspects of society, from self-driving By Jay H Lefkowitch £134.99, 464 pp, hardback assumed no such knowledge and kept tricky equa- cars to construction. Prof Cohen asserts that AI will Elsevier, 2020 ISBN: 978-0702-07584-1 tions to a minimum. be an assistant and will not replace pathologists – The book is easy on the eye. The chapters are and I leave you to consider your own views on this. It is no secret that liver pathology is one area that the major areas of liver pathology, including trans- broken into digestible chunks with plenty of images We do, however, need to understand AI and trainee histopathologists often find challenging. plant-related changes and those diseases seen in and graphics. The opening few chapters provide a adapt to it. This book is a great introduction, Limited exposure to this tertiary specialism means children and in pregnancy. background of AI and deep learning in general. This as well as a stimulating read. It is recommended that it can often seem overwhelming or at least The introductory chapters, covering principles would be of interest to non-pathologists as well. for those interested in AI, software or the future unfamiliar, so can the right choice of textbook help? of biopsy assessment, the normal liver and patterns Interesting nuggets of information are scattered of pathology. Well yes it can, at least in part ... and based on of liver injury, are particularly well written and throughout. For example, I was intrigued to learn its stated purpose, Scheuer’s Liver Biopsy Interpreta- throughout the book there are numerous, large, how ‘hidden layers’ meant that neither the human Dr Niall O’Neill tion (now in its tenth edition) should be that choice. high-quality photomicrographs that illustrate key operator nor the machine could really tell how a ST2 Histopathology Trainee Aiming ‘to help those who need to interpret liver points. The ‘differential diagnosis of individual deep learning program had arrived at a decision. Royal Victoria Hospital, Belfast biopsies’, for the last 50 years this reference has set findings’ section will prove particularly useful out to provide ‘technical tips, diagnostic clues and for those at the early stages of training, enabling pearls’ on all aspects of liver biopsy pathology. So, trainees to assess the findings they have identified how does it perform? and begin to triage potential aetiologies. The book itself is well organised and easy to This latest edition has been updated to reflect RETURN TO navigate with chapters, as expected, comprising all the increasing importance of molecular medicine RETURN TO CONTENTS CONTENTS

308 January 2021 Number 193 The Bulletin of the Royal College of Pathologists www.rcpath.org Number 193 January 2021 309 REVIEWS REVIEWS

Young investigators Advances in Transfusion We heard presentations from two young investi- gators. Dr Strachan Mackenzie shared his insights into the increase in ‘wrong blood in tube’ samples Medicine: a virtual conference during the COVID-19 pandemic, which, judging by comments in the ‘chat’ box, was something many he College’s 2020 Advances in Transfusion Medicine conference highlighted the in the audience had also experienced. depth and range of support transfusion services provide to the wider NHS. Cath Tom Scorer described his laboratory work on the functional properties of cold-stored platelets Booth and Jo McCullagh give an overview of this fascinating one-day virtual event. T transfused to patients undergoing cardiac surgery. Trials are under way in clinical practice, with Adapting to a virtual conference potential implications for hospital blood banks. The Royal College of Pathologists’ biannual ‘Advances in Transfusion Medicine’ conference Dr Cath Booth Celebrating the UK Serious Hazards of scheduled for November 2020 had been two years Transfusion Haemovigilance Scheme in the planning since 2018’s event. Organisers and Dr Shruthi Narayan summarised the achievements delegates alike had been eagerly anticipating two Attendees taking part challenges of implementing patient blood manage- of the Serious Hazards of Transfusion (SHOT) days of listening in a packed lecture hall to the in one of the many ment (PBM) recommendations. She spoke of being haemovigilance scheme over the last 24 years. We latest transfusion research and topical debates discussions during overwhelmed as recommendations come thick take SHOT for granted but should remember that from leaders in the field, while enjoying opportuni- the conference. and fast, with no advice on how to prioritise. She this is a pioneering scheme that has been the model ties for networking, perusing posters and partaking also explained the significant burden national for many others across the world. It has yielded of the College’s first-rate refreshments. comparative audits placed on TPs – an estimated significant improvements in patient safety and In the event, the lecture theatre sat empty and 9,700 hours (five years) of person-hours to collect we can all continue to contribute by submitting the only coffee came from our own kitchens, but data for the six studies in the last two years. reports and taking on board the learning messages the 250 registered delegates were not to be disap- Her words should make all of us involved in pointed. The wonder of Zoom brought those same Dr Lise Escourt discusses convalescent plasma creating guidelines or designing surveys pause Percy Oliver award: another worthy recipient high-calibre speakers directly to us, in a rich one-day and the trials in progress. to reflect and put ourselves, for a moment, in the This award was set up in the memory of Percy Lane Jo McCullagh virtual programme. Even the posters showcasing shoes of the end user. Oliver, who developed the world’s first voluntary the work of promising young investigators could be collaboration and multidisciplinary teamwork Recommendations should be realistic, with blood donor service, to recognise medical, scien- viewed electronically on the College website. required to support national research programmes clear outcome measures. Surveys should focus on tific and lay achievements in transfusion medicine. to improve outcomes for these patients. areas where we can change practice, with reports This year’s recipient was Dr Heidi Doughty for her Molecular advances Further talks showcased the developments in that give something back to our frontline teams. outstanding contribution to the fields of military The day began with talks on the use of molecular treatment and management of haematological Transfusion 2024, a five-year plan for clinical and and indeed civilian transfusion genetics in the field of transfusion medicine, high- conditions. Dr Banu Kaya discussed some of the laboratory transfusion practice, includes a call for lighting that molecular genetics is not the science trials and developments in the treatment of sickle a national TP competency framework as well as An enjoyable and informative day of tomorrow: it is here today. cell disease – an area that has recently received a benchmarking of TP staffing numbers, which is This was an interesting and varied day with some Professor Martin Olsson, introduced by the much-needed surge in research interest. welcomed across the transfusion community. great discussions among the speakers and audi- College President Mike Osborn, delivered the Foun- In his fascinating Star Wars-themed talk – ence. Talks ranged from cutting-edge research with dation lecture, taking us on a tour of the past, present ‘Tumour Wars, the lymphocyte awakens’ – Dr James Patient blood management: one size the potential to lead to wide changes in patient and future of blood grouping. The genetic revolu- Griffin discussed the research and success stories of doesn’t fit all care to those that concentrated on the day-to-day tion and international collaborations have led to CAR T-cell therapy. Dr Quentin Hill summarised Dr Simon Stanworth spoke about evidence-based issues experienced by many in the hospital trans- great advances in the discovery of new blood groups. new directions in the management of autoimmune PBM, especially highlighting areas of uncertainty fusion community. Professor Willem Ouwehand continued with haemolytic anaemia, a challenging condition for where further research is needed. Transfusion research Finally, the poster session and talks delivered the theme of genomics in his talk on the 100,000 which, thankfully, many agents are now under trial. has blossomed in the last 20 years, with increasing by the young investigators showcased the up and genomes project and also touched upon the future numbers of good-quality randomised trials. coming talent in transfusion medicine. We had a potential of introducing molecular techniques into COVID-19: convalescent plasma trials One thing these trials clearly illustrate is that tantalising view of how transfusion might look in routine hospital transfusion testing in the UK In 2020, it was essential to discuss COVID-19. one size does not fit all, so the more groups we the future, and we look forward to meeting again Dr Lise Escourt delivered a session on convales- study, the more evidence we will have to tailor in 2022 (perhaps face to face) to see what further Evidence-based clinical practice: cent plasma and highlighted how well hospitals transfusion to the individual. For example, do strides have been taken. the future beckons and the transfusion services in the UK are set up to our widely cited restrictive thresholds apply to The management of major haemorrhage in trauma support national trials and research. As a result of all patient cohorts? Should we have different major Dr Cath Booth and obstetrics was explored in two talks. Dr Laura this we heard that the RECOVERY and REMAP-CAP haemorrhage protocols depending on the cause Consultant Haematologist Green gave an overview of the UK’s progress in trials are two of the biggest in the world looking at of bleeding? introducing a whole blood component for the the efficacy of convalescent plasma. We wait with This emphasises that guidelines are not rules, NHS Blood and Transplant and Barts Health management of traumatic major haemorrhage and baited breath for the results. and every transfusion decision needs to consider NHS Trust, London, UK explored the practical implications. Professor Peter that particular patient’s circumstances and symp- Collins talked about the management of obstetric Hearing from the coalface: the transfusion toms. We were also reminded of the important role Jo McCullagh major haemorrhage and work to identify the most practitioner perspective of trust transfusion teams in disseminating find- Principal Clinical Scientist – Blood Transfusion appropriate components to support the manage- One of the most affecting talks of the afternoon ings from major clinical trials, and particularly the Clinical Lead RETURN TO ment of bleeding in this setting. Both sessions came from experienced transfusion practitioner RETURN TO psychology involved in encouraging other clinical Bolton NHS Foundation Trust, Greater CONTENTS brought home the level of inter-organisational (TP) Wendy McSporran, who described the practical CONTENTS teams to make changes. Manchester UK

310 January 2021 Number 193 The Bulletin of the Royal College of Pathologists www.rcpath.org Number 193 January 2021 311 NOTICEBOARD

NOTICEBOARD Form of codicil

(Please photocopy and complete in block capitals)

I ...... (name) of ……………………………………………………..…..... ……………………………………………………..…...... (address) declare this to be a Codicil, which I make this ……….. day of ……………..… 20…….. to my Will, which bears the date ………………. day of ……………(month) …………(year).

I give to the Royal College of Pathologists (‘the College’), registered charity number 261035, the sum of £…………………. (amount in words) ………...... …………………………………… ……………………… free of all taxes whether payable in the United Kingdom or in coun- tries overseas for the general purposes of the College and I declare that the receipt of the Honorary Treasurer for the time being of the College shall be sufficient Legacies discharge to my executors.

The objectives of the College are to develop and this country through schools, colleges, hospitals maintain high standards of pathology education, and many other sites where the general public can training and research; promote excellence and have access to important healthcare information. In all other respects I confirm my said Will. In Witness thereof I have hereunto set advance knowledge in pathology practice; increase If we are to safeguard the future of our profession my hand the day and year first written above. the College’s influence through a clear, coherent, in the face of increasing competition from other professional voice; and resource the future of the medical and science career opportunities, it is vital College. Financially, the College aims to match that we commit ourselves to the promotion and activities to projected income. The College is funded awareness of pathology, and continue to train our Signed by the Testator/rix: …………………………………………………..……...... (signature) from subscriptions, examinations and related fees, young professionals to the very highest standards. Daniel Ross investment income, grants from outside bodies and This public engagement programme will as a Codicil to his/her last Will in our joint presence and by us in his/hers. charitable donations. require financial support from the College for years Bequests or legacies are always gratefully to come and we hope very much that we can build received. Leaving a gift to charity in your will is a on the tremendous support you have already given very special way of helping to secure the future for and ask if you would consider leaving a legacy. FIRST WITNESS: ...... …………………………… ………...... …... (signature organisations such as the Royal College of Patholo- Additions to your existing will can be made using of first witness) gists. Legacies to the College have the added benefit a ‘Form of codicil’, available on our website. Alter- of being exempt from inheritance tax. natively, please write to us and we will be happy to Name and address: …………………………………………………...... An open legacy may be made toward the post you a copy. general purposes of the College. This is preferred Please note that witnesses should be present ...... …………...... ………...... ………………………………………………………………………………………………... because it allows the College to apply the funds when you sign the form, but it should not be ....………...... ……………………………………………………………… donated where the need is greatest at the time witnessed by a College member or the spouse of the legacy eventually becomes available. This can a College member. We recommend consulting a ………………………………...... ………...... be quite different from the perceived need when a solicitor or qualified will-writer before making will is made. However, you may legally oblige the a will; they should give you all the legal and tax College to spend the money in a particular area of advice that you require. College work or for a specific purpose by making a If you are considering including a legacy to the SECOND WITNESS: ...... …………………...... (signature restricted legacy. College in your will, we would very much appre- of second witness) The College undertakes many educational initi- ciate being informed of your generous act. To atives. We are actively undertaking an outreach inform us of your bequest or for specific advice on Name and address: …………………………………………………...... …...... ………………...... programme that spreads the awareness of pathology legacies to the College, please contact me. throughout the UK and abroad. No other UK ...... ………………...... ………………………………………………………………………...... college has committed so much time and resources Daniel Ross …………………………...... ………………………………………………………………… to the future of our profession. This will promote Chief Executive RETURN TO RETURN TO ……………………………...... ………...... CONTENTS the importance of pathology to the grass roots of ([email protected]) CONTENTS

312 January 2021 Number 193 The Bulletin of the Royal College of Pathologists www.rcpath.org Number 193 January 2021 313 NOTICEBOARD Pathological Society of College conferences Great Britain and Ireland The Pathological Society of Great Britain and Ireland offers a wide range of grant schemes. EDUCATION GRANTS/COMPETITION Bursaries for undergraduate elective or vacation studies 27 February & 28 April (available to Associate Undergraduate Members of the Society) Education Grant 1 April & 1 October Intercalated Degree NEW date: 1 October (available to Associate Undergraduate Members of the Society) Student Society Bursary Scheme Open (available to Associate Undergraduate Members of the Society) Undergraduate Essay Competition 31 August (available to Associate Undergraduate Members of the Society) New for 2020 Jean Shanks/Pathological Society Summer Studentships 1 March, 1 July & 1 October

RESEARCH GRANTS Best Trainee Research Impact Award 1 October Best Trainee Research Paper Award 1 October Consultant’s Pump-Priming Small Grants Scheme 1 April & 1 October CRUK/Pathological Society Predoctoral Research Bursary 26 March & 17 September Cuthbert Dukes Grant 1 April Early Career Pathology Research Grant – Hodgkin & Leishmann 1 April & 1 October Equipment Scheme 1 April & 1 October International Collaborative Award 1 October PhD Studentship 1 October Post-Doctoral Collaborative Small Grant 1 April & 1 October Trainees Collaborative Small Grant 1 April & 1 October Trainees-Clinical Scientist Partnership Grant Funding Scheme in Morpho-Molecular Pathology 1 October Trainees’ Small Grants Scheme 1 April & 1 October CPD-accredited events Visiting Fellowships 1 April & 1 October

TRAVEL GRANTS Pathological Society Meeting Bursaries 31 May & 31 December Pathological Society Meeting Bursaries for undergraduate 31 May & 31 December JANUARY 2021 Travel & Conference Bursaries Open

JEAN SHANKS/PATHOLOGICAL SOCIETY (JSPS) RESEARCH GRANTS Pre-Doctoral Research Bursary 1 April & 1 October Clinical PhD Fellowship 1 April & 1 October FEBRUARY Clinical Lecturer Support Grant 1 April & 1 October 2021 Intermediate Research Fellowship 1 April & 1 October New for 2020 Clinical Lecturer Grant 1 April & 1 October Clinical Academic Research Partnership (CARP) 1 April & 1 October APRIL

2021 OTHER GRANTS Open Scheme 1 March, 1 June, 1 September & 1 December RCPath CPD accredited online resources can be found here Pathological Society Meetings Bursaries 31 May & 31 December Public Engagement 1 March, 1 June, 1 September & 1 December

Full details are available on our website: www.pathsoc.org or from: To see all 2021 conferences visit our website. Julie Johnstone, Deputy Administrator, Pathological Society of Great Britain and Ireland. E: [email protected] RETURN TO Manchester Pathology 2021 – fully virtual meeting, 6–8 July CONTENTS Due to the COVID-19 crisis, grant deadlines may be changed and/or rescheduled. Please refer to our website for updates.

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