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Pathology

Pathology is a multidisciplinary field, comprising four main specialties: Chemical Pathology, Haematology, Histopathology, and Microbiology and Virology.

The Royal Society of Medicine offers a range of events for different specialties, including Pathology – see a full list on our Events page>>


Entry Route into Pathology

Applicants need to have completed the two-year Foundation Programme. Trainees can then apply for run-through training in Chemical Pathology and Histopathology. Training in Chemical Pathology and Metabolic Medicine is possible at ST3 if trainees have completed Core Medical Training (CMT) or the Acute Care Common Stem (ACCS).

Trainees can enter Haematology training through the CMT pathway, the ACCS pathway, or level one paediatrics training.

Entry into Medical Microbiology and Virology (MMV) is through the CMT or ACCS pathway. Trainees also need to complete two years of Combined Infection Training (CIT) before they can move onto higher speciality training.

Chemical Pathology

Chemical Pathology involves using biochemical and laboratory tests to diagnose and manage patients.

After completing the Foundation Programme, trainees can apply for five years of run-through training that starts at ST1. To progress to ST3, trainees must complete the CMT pathway or the ACCS pathway. At ST3 trainees can start training in Metabolic Medicine. Part One of the Fellowship of the Royal College of Pathologists is taken at the end of ST3, and part two at the end of ST4. Completion of the examinations allows the trainee to progress.

Metabolic Medicine is the only subspeciality within Chemical Pathology and includes clinical work in nutrition, cardiovascular risk, diabetes mellitus, metabolic bone disease, and inherited metabolic disease.

Haematology

Haematology involves the management of patients with disorders of the bone and blood marrow. Haematologists also provide clinical support for the haematology laboratory.

Applicants need to have completed the two-year Foundation Programme. Following this they will need to complete core training in one of three pathways:

Trainees will need to complete the membership of the Royal College of Physicians or the Royal College of Paediatrics and Child Health before entry to higher specialist training (ST3-7), which takes at least five years. This includes completing the part two examinations for Fellowship of the Royal College of Pathologists.

Before trainees can enter higher specialist training they must have either 24 months of experience in medical specialties – 12 months of which must include the care of acute medical in-patients – or 24 months’ experience in paediatrics. Although working hours generally follow a standard working day, there may occasionally be some on-call work.

Microbiology and Virology

MMV involves the diagnosis and management of patients with infectious diseases both in the hospital and the community. Applicants need to have completed the two-year Foundation Programme to be eligible to apply for training in Medical Microbiology and Virology.

Before trainees can apply for higher specialist training they need to have completed Core Medical Training through the Core Medical Training pathway or the ACCS pathway. They should also have full membership for the Royal College of Physicians. After core training, the next stage is Combined Infection Training (CIT), a two-year programme that integrates laboratory and clinical training. The programme covers basic skills in MMV, infection prevention and control, and tropical medicine. Trainees complete part one examinations for the FRCPath during this training programme.  After an additional two years of higher specialist training, trainees must then complete the second part of the FRCPath.

In addition to this, there are numerous subspecialities associated with MMV, including Infectious Disease and Public Health.

Histopathology

Applicants need to have completed the two-year Foundation Programme before they can apply for the five-year run-through training in Histopathology at ST1. In addition to the minimum training time of five years, which also includes time to complete both parts of the FRCPath examinations, trainees can choose to undertake two out of three optional training packages that are each three months long. There are no subspecialties within Histopathology, but there are CCT specialties such as Forensic Histopathology, Diagnostic Neuropathology and Paediatric and Perinatal Pathology.

Job Progression as a Pathologist

Trainees can apply for consultant positions six months before obtaining their CCT, and there are opportunities to work in management as a clinical lead, or a clinical or medical director. There are also formal opportunities to become involved in the education and training of junior doctors by working as

Academic Pathology Roles

Trainees interested in an academic career can apply for an academic clinical fellowship. Alternatively, trainees can continue the ST clinical training programme after ST4 level.

Competition for Pathology Posts

Chemical Pathology

In December 2017, there were

This is a very small speciality and recruitment may not occur every year. There are no statistics available on competition ratios at present.

Haematology

In 2017, the competition ratio at ST3 was 1.66, with 133 applications for 80 posts. The competition ratio at CT1 was 1.39.

In December 2017, there were

Histopathology

In 2015, the competition ratios for CT1/ST1 places in Histopathology was 1.83 – with 174 applications for 95 posts.

In December 2017, there were

Medical Microbiology and Virology

In 2017, the competition ratio at ST3 for Combined Infection Training (covering both Microbiology and Virology) was 2.06, with 109 applications for 53 posts.

In December 2017, there were

Salaries 

The salary for NHS consultants ranges from £76,000 to £102, 500, and for speciality doctors from £37,500 to £70,000. The salary for doctors in training ranges from £26,350 to £45,750.

A Day in the Life of a Pathologist

Chemical Pathology

The main role of chemical pathologists is to manage both the biochemistry lab, and patients with metabolic disturbances on wards or in outpatient clinics

Daily work involves a mixture of attending outpatient clinics, conducting ward rounds, supervising tests and colleagues in the laboratory, and attending multidisciplinary and laboratory management meetings. Many consultants also teach medical students and trainees, in addition to conducting research. There is some low-intensity on-call work that can be managed from home.

Haematology

Daily work is divided between conducting ward rounds, running outpatient clinics, and managing the laboratory.  Many patients have critical illnesses for which specialist care and laboratory services are necessary, so some on-call work is to be expected.

Histopathology

Histopathologists work in the laboratory together with scientists and other clinical specialists, and are members of the multidisciplinary team that assesses patients with cancer and plans their management. They also play a key role in cancer screening. Some histopathologists have specific clinical roles, such as taking fine-needle aspiratory cytology specimens in outpatient clinics, but the majority rarely interact with patients. However, histopathologists may see patients to explain how the diagnosis has guided their treatment, or they may see the family of a deceased patient to explain the cause of death.

Medical Microbiology and Virology

Medical microbiologists work primarily in a laboratory setting, but their role is becoming increasingly clinical. They provide advice on the likely causes of patients’ infections and the best tests to use for diagnosis. They also advise other specialists on the interpretation of laboratory results, the need for further investigations, and the suitability of antibiotic treatment.  Medical microbiology and virology specialists also supervise and run diagnostic laboratories and play a key role in controlling the spread of infectious disease. Finally, specialists in MMV contribute to public health protection by reporting on new or unusual occurrences of infections.

Medical virologists work in a variety of settings including the laboratory, inpatient wards, and in the community.  Multidisciplinary meetings with other specialists, and on-call work that may be undertaken from home, are regular part of the work.

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